Loneliness and Social Isolation among Older Adults in the Last Years of LIfe

项目摘要/摘要 孤独和社会孤立是相关但不同的社会风险因素，对健康和生活质量至关重要 老年人在生命的最后几年。孤独是一种独处的主观感觉，而社交 孤立是指与家人、朋友或社区失去联系的客观原因。穿过 不同的途径，每个社会风险因素都与较差的生活质量、不同的医疗保健用途、 功能障碍和死亡率。老年人可能特别容易受到孤独和社交的影响 因晚年残疾、认知障碍和身体缺陷而导致的孤独及其在晚年的影响 疼痛等症状。这些社会风险因素可能会对获得高质量的临终关怀造成障碍 医疗保健，包括临终关怀的使用，导致难以避免负担沉重的护理，如住院或 急诊科就诊。此外，孤独通常是一种未被认识到的令人痛苦的症状 在生命的最后几年，避免孤独和社会孤立是老年人的高度优先事项。 这项研究的目的是建立孤独和社会隔离在过去几年的流行病学。 老年人的生活，并确定他们与卫生保健利用的关联。在全国范围内使用美国- 2282名老年人的代表性队列，他们在回答有关以下问题的两年内死亡 我们调查孤独感和社会孤立感有两个具体目的：1)确定患病率和预测因素 A)孤独和b)生命最后两年的社会孤立，以及2)确定关系 在孤独和社会孤立之间，使用医疗保险声称的数据，在生命结束时使用医疗服务。 这项建议将对鼓励护理临终老年人的临床医生产生重大影响 认识和对待社交孤立和孤独，就像他们优先治疗疼痛等症状一样 或者是呼吸困难。这项工作的未来方向包括设计针对孤独和社交的有针对性的干预 在生命的最后几年进行隔离，消除在社会上获得适当的临终关怀的障碍 很脆弱。

PROJECT SUMMARY/ABSTRACT Loneliness and social isolation are related, but distinct, social risk factors critical to the health and quality of life of older adults in their last years of life. Loneliness is a subjective feeling of being alone, whereas social isolation is an objective loss in the number of relationship with family, friends, or the community. Through separate pathways, each social risk factor is associated with poor quality of life, different health care use, functional impairment, and mortality. Older adults may be particularly vulnerable to loneliness and social isolation and their effects in the last years of life due to late life disability, cognitive impairment, and physical symptoms such as pain. These social risk factors may create barriers to accessing high quality end of life health care including hospice use and lead to difficulty in avoiding burdensome care such as hospitalizations or emergency department visits. In addition, loneliness is an often unrecognized distressing symptom in the last years of life and avoiding loneliness and social isolation in the last years of life is a high priority for older adults. The objective of this study is to establish the epidemiology of loneliness and social isolation in the last years of life of older adults and determine their association with health care utilization. Using a U.S. nationally- representative cohort of 2,282 older adults who died within two years of responding to questions about loneliness and social isolation we investigate two specific aims: 1) to determine the prevalence and predictors of a) loneliness and b) social isolation during the last two years of life, and 2) to determine the relationship between loneliness and social isolation with health service use at the end of life using Medicare claims data. This proposal will have a significant impact in encouraging clinicians caring for older adults at the end of life to recognize and treat social isolation and loneliness in the same way they prioritize treating symptoms like pain or dyspnea. Future directions of this work include designing targeted interventions to loneliness and social isolations in the last years of life, and addressing barriers to accessing adequate end-of-life care in the socially vulnerable.