Center for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Front Public Health. 2023 Jun 2;11:1099734. doi: 10.3389/fpubh.2023.1099734. eCollection 2023.
Defined as having few social relationships or infrequent social contact with family, friends, and the community, social isolation is a public health crisis. We aimed to evaluate the prevalence of social isolation and explore the association between social isolation and health status among community-dwelling Chinese Older Adults living with homecare services.
This is a cross-sectional survey with a structured questionnaire conducted among older adults aged ≥60 in the Central Kowloon District of Hong Kong during 2017-2018. Social isolation was assessed by the Lubben Social Network Scale-6 and a score less than 12 was defined as socially isolated. Six aspects of health status including fall risk, cognitive function, depression, activities of daily living (ADL), instrumental activities of daily living (IADL), and functional mobility were measured by standardized instruments. Multi-criteria decision analysis (MCDA) was applied to estimate an index to represent the overall health status of the respondents. Multivariate logistic/linear regression models were applied to examine the associations between social isolation and health status after adjusting the sociodemographic characteristics.
Among the 1,616 participants included in this analysis, the mean age was 80.9 years, 66.3% were female and 41.4% were identified as socially isolated. Compared with the non-isolated group, the socially isolated group had higher proportions of males, divorced or unmarried, ever smoking and drinking, living alone, and living in public housing without religion. After adjusting for confounders, the odds ratios (OR) comparing the socially isolated vs. non-isolated groups were 2.52 (95%CI: 1.79, 3.56) for high fall risk, 1.51 (1.17, 1.94) for cognitive impairment, and 1.78 (1.31, 2.43) for depression. The socially isolated group increased the odds of abnormal ADL, IADL, and functional mobility by 105-150%, and decreased the overall health score by 5.30 (3.42, 7.18).
We demonstrated the association of social isolation with poorer physical function and mental health and overall health status among the community-dwelling Chinese older adults living with homecare services. These findings provided new knowledge about the association of social isolation with both physical and mental function for daily living even for those receiving an integrated homecare service in the community. It implies that an unmet healthcare need existed when comparing the service scope of the current homecare services in the community. It also highlighted the need for targeted prevention and intervention initiatives among community-dwelling old adults to alleviate social isolation for better health and good functioning in the community.
社会隔离是指与家人、朋友和社区的社交关系很少或很少有社交接触，这是一个公共卫生危机。我们旨在评估社会隔离的流行程度，并探讨社会隔离与居住在有家庭护理服务的中国社区老年人健康状况之间的关系。
这是一项 2017-2018 年在香港九龙中部地区进行的、针对 60 岁及以上老年人的横断面调查，采用结构化问卷进行。社会隔离程度采用 Lubben 社会网络量表-6 进行评估，评分低于 12 分定义为社会隔离。健康状况的六个方面包括跌倒风险、认知功能、抑郁、日常生活活动（ADL）、工具性日常生活活动（IADL）和功能性移动性，通过标准化工具进行测量。应用多标准决策分析（MCDA）来估计代表受访者整体健康状况的指数。应用多变量逻辑/线性回归模型，在调整社会人口特征后，研究社会隔离与健康状况之间的关联。
在本分析中纳入的 1616 名参与者中，平均年龄为 80.9 岁，66.3%为女性，41.4%被确定为社会隔离。与非隔离组相比，社会隔离组中男性、离异或未婚、有吸烟和饮酒史、独居和居住在没有宗教信仰的公共住房的比例较高。在调整混杂因素后，与非隔离组相比，社会隔离组发生高跌倒风险的比值比（OR）为 2.52（95%CI：1.79，3.56），认知障碍的 OR 为 1.51（1.17，1.94），抑郁的 OR 为 1.78（1.31，2.43）。社会隔离组发生异常 ADL、IADL 和功能性移动的可能性增加了 105-150%，整体健康评分降低了 5.30（3.42，7.18）。
我们证明了社会隔离与居住在有家庭护理服务的中国社区老年人的身体功能和心理健康以及整体健康状况之间存在关联。这些发现为社会隔离与身体和精神功能之间的关联提供了新的知识，即使对于那些在社区中接受综合家庭护理服务的人也是如此。这意味着与社区中当前家庭护理服务的服务范围相比，存在未满足的医疗保健需求。这也强调了需要针对社区中居住的老年人群体制定有针对性的预防和干预措施，以缓解社会隔离，促进社区中的健康和良好功能。
