Social networks of patients with multimorbidity: a qualitative study of patients' and supporters' views

Multimorbidity and loneliness. Longitudinal analysis based on the GSOEP

BACKGROUND

Our aim was to examine the longitudinal association between multimorbidity and loneliness in the general adult population (and in different age groups) in Germany.

METHODS

Longitudinal data were used from the German Socio-Economic Panel (n= 44,385 observations in the years 2013 and 2017) - a nationally representative sample including adults aged 18 years and above. Respondents are re-surveyed annually. Loneliness was quantified using the established UCLA-3. Multimorbidity was defined as the coexistence of two or more conditions and was indicated by a list containing 13 somatic and mental diseases. Asymmetric linear fixed effects regressions (also stratified by three age groups: 18 to 44 years; 45 to 64 years, 65 years and older) were used to examine the association between the onset and end of multimorbidity as well as loneliness.

RESULTS

After adjusting for possible confounders, regression analysis revealed that the onset of multimorbidity is associated with an increase in loneliness in the total sample (β = 0.07, p < 0.001) and among individuals aged 65 years and older (β = 0.13, p < 0.001), whereas no significant association was found in the other age groups. The end of multimorbidity was not associated with loneliness neither in the total group nor in the individual age groups.

CONCLUSION

This study revealed an association between the onset of multimorbidity and higher loneliness particularly among individuals in late life. Thus, preventing or delaying multimorbidity may be beneficial to avoid loneliness among older adults.

Frequency and Correlates of Multimorbidity Among the Oldest Old: Study Findings from the Representative "Survey on Quality of Life and Subjective Well-Being of the Very Old in North Rhine-Westphalia (NRW80+)"

Purpose

Our aim was to clarify the frequency and correlates of multimorbidity among the oldest old.

Patients and Methods

We used data from the representative "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)" covering participants ≥80 years living in private households and in institutionalized settings in North Rhine-Westphalia (n = 1484, mean age was 86.3 years). Multimorbidity is defined as the co-occurrence of at least two chronic conditions. Sociodemographic, lifestyle-related, and health-related (including health literacy) correlates were included in regression analysis.

Results

About 79% of the participants were multimorbid. Logistic regressions showed that the likelihood of multimorbidity significantly increased with living in a private household, having a larger network size, worse self-rated health, higher functional impairment, and more depressive symptoms, whereas the remaining sociodemographic and lifestyle-related factors as well as health literacy were not significantly associated with multimorbidity.

Conclusion

A large proportion of participants in very late life is multimorbid. Apart from health-related factors, also two sociodemographic factors (ie, living situation and network size) were associated with multimorbidity among the oldest old. This knowledge may help to identify individuals at risk for multimorbidity in very late life.

Relationships between non-communicable disease, social isolation and frailty in community dwelling adults in later life: findings from the Hertfordshire Cohort Study

BACKGROUND

Social relationships play a fundamental role in individuals' lives and health, and social isolation is prevalent among older people. Chronic non-communicable diseases (NCDs) and frailty are also common in older adults.

AIMS

To examine the association between number of NCDs and social isolation in a cohort of community-dwelling older adults in the UK, and to consider whether any potential association is mediated by frailty.

METHODS

NCDs were self-reported by 176 older community-dwelling UK adults via questionnaire. Social isolation was assessed using the six-item Lubben Social Network Scale. Frailty was assessed by the Fried phenotype of physical frailty.

RESULTS

The median (IQR) age of participants in this study was 83.1 (81.5-85.5) years for men and 83.8 (81.5-85.9) years for women. The proportion of socially isolated individuals was 19% in men and 20% in women. More women (18%) than men (13%) were identified as frail. The number of NCDs was associated with higher odds of being isolated in women (unadjusted odds ratio per additional NCD: 1.65, 95% CI 1.08, 2.52, p = 0.021), but not in men, and the association remained robust to adjustment, even when accounting for frailty (OR 1.85, 95% CI 1.06, 3.22, p = 0.031).

DISCUSSION

Number of self-reported NCDs was associated with higher odds of social isolation in women but not in men, and the association remained after considering frailty status.

CONCLUSIONS

Our observations may be considered by healthcare professionals caring for community-dwelling older adults with multiple NCDs, where enquiring about social isolation as part of a comprehensive assessment may be important.

Keeping it going: the importance of delivering interprofessional education during the COVID-19 pandemic

BACKGROUND AND CONTEXT Globally, the coronavirus disease 2019 (COVID-19) pandemic has highlighted the need for better interprofessional collaboration and teamwork. When disciplines have worked together to undertake testing, deliver care and administer vaccines, progress against COVID-19 has been made. Yet, teamwork has often not happened, wasting precious resources and stretching health-care workforces. Continuing to train health professionals during the pandemic is challenging, particularly delivering interprofessional education that often uses face-to-face delivery methods to optimise interactional learning. Yet, continuing to offer interprofessional education throughout the pandemic is critical to ensure a collaboration-ready health workforce. One example is continuing the established INVOLVE (Interprofessional Visits to Learn Interprofessional Values through Patient Experience) interprofessional education initiative. ASSESSMENT OF PROBLEM Educators have not always prioritised interprofessional education during the pandemic, despite its immediate and long-term benefits. The INVOLVE interprofessional education initiative, usually delivered face-to-face, was at risk of cancellation. RESULTS A quality improvement analysis of the strategies used to continue INVOLVE demonstrated that it is possible to deliver interprofessional education within the constraints of a pandemic by using innovative online and hybrid educational strategies. Educators and students demonstrated flexibility in responding to the sudden changes in teaching and learning modalities. STRATEGIES When pandemic alert levels change, interprofessional educators and administrators can now choose from a repertoire of teaching approaches. LESSONS Four key lessons have improved the performance and resilience of INVOLVE: hold the vision to continue interprofessional education; be nimble; use technology appropriately; and there will be silver linings and unexpected benefits to the changes.

A Study of Social Isolation, Multimorbidity and Multiple Role Demands Among Middle-Age Adults Based on the Canadian Longitudinal Study on Aging

Given the increasing complexity and fluidity of parenting, caregiving, and paid work patterns, in tandem with an increased risk of multimorbidity in mid-life, this study examines the relationship between these three concurrent roles and social isolation among middle-aged persons across multimorbidity statuses. Drawing upon life course theory, we applied linear mixed models to analyze 29,847 middle-aged participants from two waves of the Canadian Longitudinal Study on Aging. Findings reveal that participants experience greater social isolation over time, albeit the difference is extremely small. Among participants without multimorbidity, holding multiple roles is associated with lower social isolation. For those with multimorbidity, being employed full-time and providing intensive care are associated with social isolation. The occurrence of multiple roles demonstrates unique associations with social isolation among those with and without multimorbidity over time. Future research should study multimorbidity as a salient contextual variable. Moreover, enhanced support is needed for multimorbid middle-aged individuals with different role demands.

Exploring the value of social network 'care maps' in the provision of long-term conditions care

OBJECTIVES

There is renewed attention to the role of social networks as part of person-centred long-term conditions care. We sought to explore the benefits of 'care maps' - a patient-identified social network map of their care community - for health professionals in providing person-centred care.

METHODS

We piloted care maps with 39 patients with long-term conditions in three urban and one rural general practice and two hospital wards. We interviewed the health professionals (n = 39) of these patients about what value, if any, care maps added to patient care. We analysed health professional interview data using thematic analysis to identify common themes.

RESULTS

Health professionals all said they learned about their patients as a person-in-context. There was an increased understanding of patients' support networks, synthesising what is known and unknown. Health professionals understood patients' perceptions of health professionals and what really mattered to patients. There was discussion about the therapeutic value of care maps. The maps prompted reflection on practice.

DISCUSSION

Care maps facilitated a broader focus than the clinical presentation. Using care maps may enable health professionals to support self-management rather than feeling responsible for many aspects of care. Care maps had 'social function' for health professionals. They may be a valuable tool for patients and clinicians to bridge the gap between medical treatment and patients' lifeworlds.

Multimorbidity, Loneliness, and Social Isolation. A Systematic Review

No systematic review has appeared so far synthesizing the evidence regarding multimorbidity and loneliness, social isolation, or social frailty. Consequently, our aim was to fill this gap. Three electronic databases (PubMed, PsycINFO, and CINAHL) were searched in our study. Observational studies examining the link between multimorbidity and loneliness, social isolation, and social frailty were included, whereas disease-specific samples were excluded. Data extraction included methods, characteristics of the sample, and the main results. A quality assessment was conducted. Two reviewers performed the study selection, data extraction, and quality assessment. In sum, eight studies were included in the final synthesis. Some cross-sectional and longitudinal studies point to an association between multimorbidity and increased levels of loneliness. However, the associations between multimorbidity and social isolation as well as social frailty remain largely underexplored. The quality of the studies included was rather high. In conclusion, most of the included studies showed a link between multimorbidity and increased loneliness. However, there is a lack of studies examining the association between multimorbidity and social isolation as well as social frailty. Future studies are required to shed light on these important associations. This is particularly important in times of the COVID-19 pandemic.

The association of multimorbidity, loneliness, social exclusion and network size: findings from the population-based German Ageing Survey

BACKGROUND

The aim of this study was to examine the association between multimorbidity and (i) loneliness, (ii) social exclusion and (iii) network size, respectively.

METHODS

Cross-sectional data from a German representative sample of community-dwelling adults aged 40 and over was used (N = 7604). Multimorbidity was indicated with the presence of two or more diseases. Self-rated loneliness was assessed with a short form of the validated De Jong Gierveld Loneliness Scale and social exclusion was measured with a validated scale developed by Bude and Lantermann. Counts of important people in regular contact represented the network size of respondents.

RESULTS

Multimorbidity was present in 68% of the sample. While controlling for potential confounders, multiple linear regression analysis yielded that multimorbidity was associated with increased loneliness (b = 0.08; p < 0.001) and increased social exclusion (b = 0.10; p < 0.01). Multimorbidity was also associated with an increased network size (b = 0.27; p < 0.001).

CONCLUSION

While there was an association between multimorbidity and increased social exclusion as well as increased loneliness, regressions also revealed an association between multimorbidity and an increased network size. Although the association between multimorbidity and our outcome measures is weak, its complex nature should be investigated further using a longitudinal approach.

The longitudinal association of multimorbidity on loneliness and network size: Findings from a population-based study

OBJECTIVE

The aim of this study was to investigate the association between the onset of multimorbidity with loneliness and social network size longitudinally.

METHODS

Longitudinal data was used from the German Ageing Survey, a representative sample of adults aged 40 and over, residing in private households. The presence of two or more illnesses indicated multimorbidity. A 6-item version of the validated De Jong Gierveld Loneliness scale was used to assess perceived loneliness. The network size of respondents was represented by counts of important people in regular contact. Fixed-effects regressions adjusted for time-varying socio-demographic, life style, and health-related variables were used.

RESULTS

The regression analysis yielded, when controlling for possible confounders, that the onset of multimorbidity led to increased loneliness (β = .06, p < .001). However, the results revealed as well that the onset of multimorbidity was associated with an increased network size (β = .29, p < .001).

CONCLUSION

Results demonstrate a complex relationship of the variables examined. Efforts to target multimorbidity, eg, to postpone or prevent it, could be helpful to decrease loneliness.

The social networks of New Zealand patients with multimorbidity and the work of those nominated as their 'significant supporters': An exploratory study

Social networks are informal relationships often with social ties and voluntary or mandatory obligations that can positively support a patient with multimorbidity. This exploratory study sought insights into the social networks of New Zealand people with multimorbidity and also the work of those nominated as providing significant support. Ten participants were recruited from general practice as part of an education programme in which health professional students discussed living with multimorbidity and completed a social network template together with patients. Each patient nominated an individual from their social network whom they considered provided significant support. A researcher interviewed each supporter about their experience of providing support, and their view of the patient's social network. Significant supporters included three classified as 'lay' supporters (sister, wife and daughter) and seven classified as 'professional' supporters (exercise physiologist, general practitioners, nurse, medical specialists). The activities described by supporters was classified according to Vassilev et al.'s expansion of Corbin and Strauss's 1985 classification of work in chronic illness, including the categories of "illness," "everyday" and "emotional" work. Irrespective of whether supporters were lay or professional, they gave examples of each category. While this is expected of lay supporters, it is not expected of professional supporters who are typically viewed as undertaking illness work. Lay supporters described a complex array of activities sometimes impacting on their own personal well-being, making them more akin to meeting the formal definition of being a carer, while professional supports gave objective yet professionally invested descriptions. The work of lay and professional supporters is complementary in the provision of support for those with multimorbidity. Consideration should be given to the role of lay supporters and to their own needs if they are to be able to sustain their support work with patients.

General practice and patients’ views of the social networks of patients with multimorbidity

ABSTRACT INTRODUCTION For patients with multimorbidity to live well, they need the support of not only health professionals but family, friends and organisations. These social networks provide support, potentially enabling the formation of a Community of Clinical Practice approach to multimorbidity care. AIM This study aimed to explore general practice knowledge of the social networks of patients with multimorbidity. METHODS Social network maps were completed by both patients and general practice. The social network maps of 22 patients with multimorbidity were compared with corresponding social network maps completed by general practice staff. RESULTS In 60% (13/22) of the patients, general practice staff held a high or moderate knowledge of individual patients’ social networks. Information on social networks was recalled from staff memory and not systematically recorded in patients’ electronic health records. DISCUSSION Social network information is not routinely collected, recorded or used by general practice to understand the support available to patients with multimorbidity. General practice could take an active role in coordinating social network supporters for certain patient groups with complex multimorbidity. For these groups, there is value in systematically recording and regularly updating their social network information for general practice to use as part of a coordinated Community of Clinical Practice.