英国老年人孤独感、社会孤立与衰弱之间的纵向关系：一项前瞻性分析。

The longitudinal relationship between loneliness, social isolation, and frailty in older adults in England: a prospective analysis.

作者信息

Davies Katie, Maharani Asri, Chandola Tarani, Todd Chris, Pendleton Neil

机构信息

Manchester University National Health Service Foundation Trust, Manchester, UK.

School of Health Sciences, The University of Manchester, Manchester, UK.

出版信息

Lancet Healthy Longev. 2021 Feb;2(2):e70-e77. doi: 10.1016/S2666-7568(20)30038-6. Epub 2021 Jan 14.

DOI:10.1016/S2666-7568(20)30038-6

PMID:36098160

Abstract

BACKGROUND

It is estimated that about 10% of people aged 65 and older are frail. Loneliness and social isolation are linked to increased mortality and poorer functional capacity. We assessed trends in frailty status associated with loneliness and social isolation over 14 years in a representative sample of English older adults.

METHODS

In this longitudinal study, we used data from the English Longitudinal Study of Ageing (ELSA), which was designed to recruit a representative sample of adults aged 50 years and older living in private households in England. We analysed Waves 2-8 (covering June, 2004, to June, 2017). Frailty was defined using the frailty index, analysed continuously and as pre-specified categories, to categorise individuals as being non-frail (≤0·08), pre-frail (>0·08 to <0·25), or frail (≥0·25 to 1·00). Loneliness was measured using the UCLA 3-item Loneliness Scale and social isolation was measured following a previous ELSA approach, and both sets of scores were categorised into low, medium, or high. Linear mixed methods and Cox proportional hazard modelling were used, adjusted for confounders.

FINDINGS

The study sample consisted of 9171 participants at the baseline of Wave 2 (4083 male and 5088 female), with similar numbers in subsequent waves. In the fixed effect model, adjusted for marital status, age, gender, wealth, and smoking status, respondents with higher levels of loneliness had a higher frailty index score (β coefficient 0·006, 95% CI 0·006 to 0·007; p<0·0001), as did those with a higher level of social isolation (β 0·002, <0·001 to 0·002; p<0·0001). Increasing age was associated with an increased frailty index, adjusted for loneliness and social isolation independently. Compared with a low level of loneliness, there was a higher risk of developing frailty with medium loneliness (hazard ratio [HR] 1·57, 95% CI 1·49 to 1·65; p<0·0001) and high loneliness (HR 2·62, 2·49 to 2·76; p<0·0001). Compared with a low level of social isolation, there was a higher risk of developing frailty with medium social isolation (HR 1·12, 1·05 to 1·20; p<0·0001) and high social isolation (HR 1·32, 1·22 to 1·43; p<0·0001).

INTERPRETATION

Both loneliness and social isolation increase the risk of developing frailty. Understanding these mechanisms might offer opportunities to attenuate this risk.

FUNDING

None.

摘要

背景

据估计，65岁及以上的人群中约有10%身体虚弱。孤独和社会孤立与死亡率增加及功能能力下降有关。我们在英国老年成年人的代表性样本中评估了14年间与孤独和社会孤立相关的虚弱状态趋势。

方法

在这项纵向研究中，我们使用了英国老龄化纵向研究（ELSA）的数据，该研究旨在招募居住在英国私人家庭中的50岁及以上成年人的代表性样本。我们分析了第2 - 8轮数据（涵盖2004年6月至2017年6月）。使用虚弱指数定义虚弱，对其进行连续分析并按照预先设定的类别进行分类，将个体分为非虚弱（≤0·08）、pre - 虚弱（>0·08至<0·25）或虚弱（≥0·25至1·00）。使用加州大学洛杉矶分校3项孤独量表测量孤独感，并按照之前ELSA的方法测量社会孤立，两组分数均分为低、中、高。使用线性混合方法和Cox比例风险模型，并对混杂因素进行了调整。

结果

研究样本在第2轮基线时有9171名参与者（4083名男性和5088名女性），后续轮次的人数相似。在固定效应模型中，调整婚姻状况、年龄、性别、财富和吸烟状况后，孤独感较高的受访者虚弱指数得分较高（β系数0·006，95%置信区间0·006至0·007；p<0·0001），社会孤立程度较高的受访者也是如此（β 0·002，<0·001至0·002；p<0·0001）。在分别调整孤独感和社会孤立后，年龄增长与虚弱指数增加相关。与低孤独水平相比，中度孤独（风险比[HR] 1·57，95%置信区间1·49至1·65；p<0·0001）和高度孤独（HR 2·62，2·49至2·76；p<0·0001）时发生虚弱的风险更高。与低社会孤立水平相比，中度社会孤立（HR 1·12，1·05至1·20；p<0·0001）和高度社会孤立（HR 1·32，1·22至1·43；p<0·0001）时发生虚弱的风险更高。