Roger C. Lipitz Center for Integrated Health Care, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Center for Equity in Aging, School of Nursing, Johns Hopkins University, Baltimore, Maryland.
JAMA Intern Med. 2023 Sep 1;183(9):955-962. doi: 10.1001/jamainternmed.2023.3064.
Social isolation is associated with adverse health outcomes, yet its implications for hospitalization and nursing home entry are not well understood.
To evaluate whether higher levels of social isolation are associated with overnight hospitalization, skilled nursing facility stays, and nursing home placement among a nationally representative sample of community-dwelling older adults after adjusting for key health and social characteristics, including loneliness and depressive symptoms.
DESIGN, SETTING, AND PARTICIPANTS: This observational cohort study included 7 waves of longitudinal panel data from the Health and Retirement Study, with community-dwelling adults aged 65 years or older interviewed between March 1, 2006, and June 30, 2018 (11 517 respondents; 21 294 person-years). Data were analyzed from May 25, 2022, to May 4, 2023.
Social isolation was measured with a multidomain 6-item scale (range, 0-6, in which a higher score indicates greater isolation). Multivariate logistic regressions were performed on survey-weighted data to produce national estimates for the odds of self-reported hospitalization, skilled nursing facility stays, and nursing home placement over time.
A total of 57% of this study's 11 517 participants were female, 43% were male, 8.4% were Black, 6.7% were Hispanic or Latino, 88.1% were White, 3.5% were other ("other" includes American Indian or Alaska Native, Asian or Pacific Islander, and other race, which has no further breakdown available because this variable was obtained directly from the Health and Retirement Study), and 58.2% were aged 65 to 74 years. Approximately 15% of community-dwelling older adults in the US experienced social isolation. Higher social isolation scores were significantly associated with increased odds of nursing home placement (odds ratio, 2.01; 95% CI, 1.21-3.32) and skilled nursing facility stays (odds ratio, 1.16; 95% CI, 1.06-1.28) during 2 years. With each point increase in an individual's social isolation score, the estimated probability of nursing home placement or a skilled nursing facility stay increased by 0.5 and 0.4 percentage points, respectively, during 2 years. Higher levels of social isolation were not associated with 2-year hospitalization rates.
This cohort study found that social isolation was a significant risk factor for nursing home use among older adults. Efforts to deter or delay nursing home entry should seek to enhance social contact at home or in community settings. The design and assessment of interventions that optimize the social connections of older adults have the potential to improve their health trajectories and outcomes.
社会隔离与不良健康结果相关，但它对住院和疗养院入院的影响尚不清楚。
评估在调整了关键健康和社会特征（包括孤独和抑郁症状）后，在一个具有全国代表性的社区居住的老年人样本中，较高水平的社会隔离是否与夜间住院、熟练护理设施入住和疗养院安置有关。
设计、地点和参与者：这项观察性队列研究包括健康与退休研究的 7 个纵向面板数据波次，年龄在 65 岁或以上的社区居住成年人于 2006 年 3 月 1 日至 2018 年 6 月 30 日之间接受采访（11517 名受访者；21294 人年）。数据于 2023 年 5 月 4 日从 2022 年 5 月 25 日开始进行分析。
社会隔离采用多领域 6 项量表进行测量（范围为 0-6，得分越高表示隔离程度越高）。对调查加权数据进行多变量逻辑回归，以产生随时间变化的自我报告住院、熟练护理设施入住和疗养院安置的全国估计。
本研究的 11517 名参与者中，共有 57%为女性，43%为男性，8.4%为黑人，6.7%为西班牙裔或拉丁裔，88.1%为白人，3.5%为其他（“其他”包括美洲印第安人或阿拉斯加原住民、亚洲或太平洋岛民以及其他种族，由于该变量直接来自健康与退休研究，因此无法进一步细分），58.2%年龄在 65 至 74 岁之间。大约 15%的美国社区居住老年人存在社会隔离问题。较高的社会隔离评分与疗养院安置（比值比，2.01；95%置信区间，1.21-3.32）和熟练护理设施入住（比值比，1.16；95%置信区间，1.06-1.28）的几率增加显著相关。在两年内，个人社会隔离评分每增加 1 分，疗养院安置或熟练护理设施入住的估计概率分别增加 0.5 和 0.4 个百分点。较高的社会隔离程度与两年内的住院率无关。
这项队列研究发现，社会隔离是老年人入住疗养院的一个重要危险因素。为了阻止或延缓疗养院的入住，应该努力加强老年人在家中和社区环境中的社交联系。设计和评估能够优化老年人社交联系的干预措施有可能改善他们的健康轨迹和结果。
