Department of Physical Therapy and Rehabilitation Science and Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore.
Section of Geriatrics, Yale School of Medicine, New Haven, Connecticut.
JAMA Intern Med. 2021 Nov 1;181(11):1433-1439. doi: 10.1001/jamainternmed.2021.5022.
Disability and mortality are common among older adults with critical illness. Older adults who are socially isolated may be more vulnerable to adverse outcomes for various reasons, including fewer supports to access services needed for optimal recovery; however, whether social isolation is associated with post-intensive care unit (ICU) disability and mortality is not known.
To evaluate whether social isolation is associated with disability and with 1-year mortality after critical illness.
DESIGN, SETTING, AND PARTICIPANTS: This observational cohort study included community-dwelling older adults who participated in the National Health and Aging Trends Study (NHATS) from May 2011 through November 2018. Hospitalization data were collected through 2017 and interview data through 2018. Data analysis was conducted from February 2020 through February 2021. The mortality sample included 997 ICU admissions of 1 day or longer, which represented 5 705 675 survey-weighted ICU hospitalizations. Of these, 648 ICU stays, representing 3 821 611 ICU hospitalizations, were eligible for the primary outcome of post-ICU disability.
Social isolation from the NHATS survey response in the year most closely preceding ICU admission, which was assessed using a validated measure of social connectedness with partners, families, and friends as well as participation in valued life activities (range 0-6; higher scores indicate more isolation).
The primary outcome was the count of disability assessed during the first interview following hospital discharge. The secondary outcome was time to death within 1 year of hospital admission.
A total of 997 participants were in the mortality cohort (511 women [51%]; 45 Hispanic [5%], 682 non-Hispanic White [69%], and 228 non-Hispanic Black individuals [23%]) and 648 in the disability cohort (331 women [51%]; 29 Hispanic [5%], 457 non-Hispanic White [71%], and 134 non-Hispanic Black individuals [21%]). The median (interquartile range [IQR]) age was 81 (75.5-86.0) years (range, 66-102 years), the median (IQR) preadmission disability count was 0 (0-1), and the median (IQR) social isolation score was 3 (2-4). After adjustment for demographic characteristics and illness severity, each 1-point increase in the social isolation score (from 0-6) was associated with a 7% greater disability count (adjusted rate ratio, 1.07; 95% CI, 1.01-1.15) and a 14% increase in 1-year mortality risk (adjusted hazard ratio, 1.14; 95% CI, 1.03-1.25).
In this cohort study, social isolation before an ICU hospitalization was associated with greater disability burden and higher mortality in the year following critical illness. The study findings suggest a need to develop social isolation screening and intervention frameworks for older adults with critical illness.
在患有危重病的老年人中，残疾和死亡是常见的。由于各种原因，社会孤立的老年人可能更容易出现不良后果，包括获得最佳康复所需服务的支持较少；然而，社会孤立是否与 ICU 后残疾和死亡率有关尚不清楚。
评估社会隔离是否与危重病后残疾和 1 年死亡率有关。
设计、地点和参与者：这项观察性队列研究纳入了参加 2011 年 5 月至 2018 年 11 月全国健康与老龄化趋势研究（NHATS）的居住在社区的老年人。住院数据通过 2017 年收集，访谈数据通过 2018 年收集。数据分析于 2020 年 2 月至 2021 年 2 月进行。死亡率样本包括 1 天或更长时间的 997 例 ICU 入院，代表了 5705675 例经过调查加权的 ICU 住院治疗。其中，648 例 ICU 入住，代表 3821611 例 ICU 住院治疗，符合 ICU 后残疾的主要结局。
在 ICU 入院前最接近的一年的 NHATS 调查回复中，通过评估与伴侣、家人和朋友的社会联系以及参与有价值的生活活动的有效性来衡量社会隔离情况（范围 0-6；分数越高表示隔离程度越高）。
主要结局是出院后首次访谈时残疾的数量。次要结局是入院后 1 年内死亡的时间。
共有 997 名参与者进入了死亡率队列（511 名女性[51%]；45 名西班牙裔[5%]，682 名非西班牙裔白人[69%]，228 名非西班牙裔黑人[23%]）和 648 名残疾队列（331 名女性[51%]；29 名西班牙裔[5%]，457 名非西班牙裔白人[71%]，134 名非西班牙裔黑人[21%]）。中位（四分位距[IQR]）年龄为 81（75.5-86.0）岁（范围，66-102 岁），中位（IQR）入院前残疾计数为 0（0-1），中位（IQR）社会隔离评分 3（2-4）。在调整人口统计学特征和疾病严重程度后，社会隔离评分每增加 1 分（0-6），残疾计数增加 7%（调整后的比率，1.07；95%CI，1.01-1.15），1 年死亡率风险增加 14%（调整后的危险比，1.14；95%CI，1.03-1.25）。
在这项队列研究中，ICU 入院前的社会隔离与危重病后残疾负担增加和死亡率升高有关。研究结果表明，需要为患有危重病的老年人制定社会隔离筛查和干预框架。
