Loneliness and Social Isolation Among Older Adults with and without Alzheimer's Disease and Related Dementia in the Last Years of Life

项目总结/摘要 孤独和社会孤立是相关的，但不同的，社会风险因素的健康和生活质量的关键 老年人在他们生命的最后几年。孤独是一种孤独的主观感觉，而社交 孤立是一种客观的与家人、朋友或社区的关系数量的损失。无论是社会 风险因素是常见的，并与晚年相关的不良健康结果独立相关，如 抑郁症、功能障碍和死亡率。然而，人们对孤独和社会关系知之甚少。 老年人在生命的最后几年，特别是那些有认知障碍的老年人， 阿尔茨海默病和相关痴呆症。不幸的是，老年人有和没有 阿尔茨海默氏病和相关痴呆症可能特别容易受到孤独和社会孤立的影响。 以及它们在生命最后几年的影响。虽然生命的最后几年集中在医疗保健上， 公认的社会因素，如孤独，可能对患者更重要，特别是对那些 认知障碍或阿尔茨海默病及相关痴呆症。本研究的目的是建立 老年人在生命的最后几年中孤独和社会孤立的流行病学， 认知障碍或阿尔茨海默病和相关痴呆症，并确定其与 在生命的最后阶段使用密集的医疗保健。我们假设孤独和社会孤立是一种常见的 老年人在最后几年的痛苦来源，并与质量较差的临终健康有关 护理，特别是对那些有认知障碍或阿尔茨海默病和相关痴呆症。为了验证这一 假设，提出了以下目标：目标1）确定孤独的患病率和预测因素， 有或没有认知障碍的老年人在生命的最后四年中的社会隔离， 使用全国代表性队列研究阿尔茨海默病和相关痴呆;目的2）确定 孤独和社会隔离之间的关系，以及在生命结束时潜在的繁重医疗保健， 患有或不患有认知障碍或阿尔茨海默病及相关痴呆症的人;以及目标3） 深入了解孤独、社会孤立的经历， 认知障碍或阿尔茨海默病及相关疾病的老年人的繁重医疗保健 使用定性访谈的痴呆症。这一建议将对描述一个 有和没有阿尔茨海默病和相关痴呆症的老年人的痛苦的实质性来源 关键的生命末期和潜在的干预策略。我将接受高级培训， 观察和卫生服务研究，定性分析，实施科学和临床写作， 沿着的是该领域国家领导人的指导。这项研究和培训将为以下方面奠定基础： 我的长期目标是开发干预措施，以解决孤独和社会孤立及其健康问题， 老年痴呆症和相关痴呆症患者在生命结束时的后果。

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 relationships with family, friends, or the community. Both social risk factors are common and independently associated with poor health outcomes relevant to late life such as depression, functional impairment, and mortality. Very little is known, however, about loneliness and social isolation among the general population of older adults in the last years of life, particularly those with cognitive impairment or Alzheimer’s Disease and Related Dementia. Unfortunately, older adults with and without Alzheimer’s Disease and Related Dementia may be particularly vulnerable to loneliness and social isolation and their effects in the last years of life. While the last years of life have an intense focus on medical care, less recognized social factors like loneliness may be more important to patients, especially for persons with cognitive impairment or Alzheimer’s Disease and Related Dementia. The objective of this study is to establish the epidemiology of loneliness and social isolation in the last years of life among older adults with and without cognitive impairment or Alzheimer’s Disease and Related Dementia and determine their association with intensive health care use at the end of life. We hypothesize that loneliness and social isolation are a common source of suffering among older adults in their last years and associated with worse quality end-of-life health care, especially for those with cognitive impairment or Alzheimer’s Disease and Related Dementia. To test this hypothesis, the following aims are proposed: Aim 1) Determine the prevalence and predictors of loneliness and social isolation during the last four years of life among older adults with and without cognitive impairment or Alzheimer’s Disease and Related Dementia using a nationally-representative cohort; Aim 2) Determine the relationship between loneliness and social isolation with potentially burdensome healthcare at the end of life for those with and without cognitive impairment or Alzheimer’s Disease and Related Dementia; and Aim 3) Develop an in-depth understanding of the experience of loneliness, social isolation, and potentially burdensome healthcare among older adults with cognitive impairment or Alzheimer’s Disease and Related Dementia using qualitative interviews. This proposal will have a significant impact in characterizing a substantial source of suffering among older adults with and without Alzheimer’s Disease and Related Dementia in the crucial end of life period and potential intervention strategies. I will obtain advanced training in observational and health services research, qualitative analysis, implementation sciences, and clinical writing, along with mentorship from national leaders in the field. This research and training will provide a foundation for my long-term goal of developing interventions to address loneliness and social isolation and their health consequences at the end of life for older adults with Alzheimer’s disease and related dementias.