The epidemiology of social isolation and loneliness among older adults during the last years of life.
The epidemiology of social isolation and loneliness among older adults during the last years of life.
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DOI：
10.1111/jgs.17366
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发表时间：
2021-11
影响因子：
6.3
通讯作者：
Smith AK
中科院分区：
文献类型：
--
作者：
Kotwal AA;Cenzer IS;Waite LJ;Covinsky KE;Perissinotto CM;Boscardin WJ;Hawkley LC;Dale W;Smith AK
社会孤立和孤独对老年人的健康至关重要，但在生命的尽头，它们还没有得到很好的描述。确定老年人在生命的最后几年中社会孤立和孤独的患病率及其相关性。具有全国代表性的横断面调查。健康和退休研究，2006 - 2016年数据。年龄> 50岁的成年人在生命的最后四年接受过一次采访（n = 3，613）。我们使用15项量表测量家庭联系，社交网络互动和社区参与，并使用3项UCLA孤独量表定义频繁孤独。我们使用多变量逻辑回归来确定他们的死亡前的时间和感兴趣的亚组的调整后的患病率。大约19%的人经历过社会孤立，18%的人感到孤独，5%的人在生命的最后四年里都经历过（相关系数= 0.11）。接近死亡的个体的社会隔离的调整患病率较高（4年：18% vs 0 - 3个月：27%，p = 0.05），孤独感没有显著变化（4年：19% vs 0 - 3个月：23%，p = 0.13）。孤独和孤独的风险因素包括（p <0.01）：低净值（隔离：34%对14%;孤独：29%对13%），听力障碍（隔离：26%对20%;孤独：26%对17%）和做饭困难（隔离：27%对19%;孤独：29%对15%）。与孤独有关的因素，而不是社会孤立，包括女性，疼痛，失禁和认知障碍。社交孤立和孤独在生命的尽头很常见，影响四分之一的老年人，但很少有人同时经历这两种情况。贫穷和经历功能或感觉障碍的老年人的发病率更高。研究结果可以为临床工作提供信息，以确定和解决临终时的心理社会痛苦和优先考虑临终时社会需求的卫生政策。
Social isolation and loneliness are critical to the health of older adults, but they have not been well-described at the end of life. To determine the prevalence and correlates of social isolation and loneliness among older adults in the last years of life. Nationally-representative, cross-sectional survey. Health and Retirement Study, 2006–2016 data. Adults age >50 interviewed once in the last four years of life (n=3,613). We defined social isolation using a 15-item scale measuring household contacts, social network interaction, and community engagement, and frequent loneliness using the 3-item UCLA Loneliness Scale. We used multivariable logistic regression to determine their adjusted prevalence by time prior-to-death and by subgroups of interest. Approximately 19% experienced social isolation, 18% loneliness, and 5% both in the last four years of life (correlation=0.11). The adjusted prevalence of social isolation was higher for individuals nearer to death (4 years: 18% vs 0–3 months: 27%, p=0.05) and there was no significant change in loneliness (4 years: 19% vs 0–3 months: 23%, p=0.13). Risk factors for both isolation and loneliness included (p<0.01): low net-worth (Isolation: 34% vs 14%; Loneliness: 29% vs 13%), hearing impairment (Isolation: 26% vs 20%; Loneliness: 26% vs 17%), and difficulty preparing meals (Isolation: 27% vs 19%; Loneliness: 29% vs 15%). Factors associated with loneliness, but not social isolation, included being female, pain, incontinence, and cognitive impairment. Social isolation and loneliness are common at the end of life, affecting 1 in 4 older adults, but few experience both. Rates were higher for older adults who were poor and experienced functional or sensory impairments. Results can inform clinical efforts to identify and address end-of-life psychosocial suffering and health policies which prioritize social needs at the end of life.
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