Loneliness and Social Isolation among Older Adults 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 孤立是一种客观的丧失与家人、朋友或社区的关系。通过 不同的途径，每个社会风险因素与生活质量差，不同的医疗保健使用， 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。 隔离及其在生命的最后几年的影响，由于晚年残疾，认知障碍， 疼痛等症状。这些社会风险因素可能会对获得高质量的生命结束造成障碍 包括临终关怀使用在内的健康护理，并导致难以避免诸如住院或 急诊科就诊。此外，孤独是一种经常被忽视的痛苦症状， 在生命的最后几年，避免孤独和社会孤立是老年人的一个高度优先事项。 本研究的目的是建立在过去几年的孤独和社会隔离的流行病学， 老年人的生活，并确定其与医疗保健利用的关联。使用美国国家- 2，282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 孤独和社会隔离，我们调查了两个具体目标：1）确定患病率和预测因素 a）孤独和B）在生命的最后两年社会隔离，和2）确定关系 孤独和社会隔离之间的关系，以及使用医疗保险索赔数据在生命结束时使用医疗服务。 这项建议将产生重大影响，鼓励临床医生照顾老年人在生命的尽头， 识别和治疗社会孤立和孤独，就像他们优先治疗疼痛等症状一样， 或呼吸困难。这项工作的未来方向包括设计有针对性的干预措施，孤独和社会 在生命的最后几年里与世隔绝，并解决在社会上获得适当的临终关怀的障碍， 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.