Summary: Socially isolated older adults are more likely to die when admitted to ICU or face an increased risk of disability once discharged than those who have social support.
Socially isolated older adults who enter intensive care units (ICUs) are more likely to die and are at increased risk of disability after discharge compared with those who are more connected to family and friends, a new Yale University study shows.
The study, published Sept. 7 in the journal JAMA Internal Medicine, “illustrates the need for hospitals to identify older patients who lack social networks and connect them with programs designed to provide isolated individuals support,” said Dr. Lauren E. Ferrante, a pulmonary and critical care physician at Yale School of Medicine and senior author of the paper.
Patients over 65 are more likely to have functional problems such as problems dressing or walking after discharge from a hospitalization that included an ICU stay. More than one in three of those who experience few social connections die within three years of discharge, a rate three to five times higher than the general older adult population, the researchers found.
“Our work is focused on understanding and improving the functional recovery of older adults who survive the ICU,” said Ferrante, a critical care doctor at Yale New Haven Hospital. “We know from prior studies that older adults value functional independence even more than staying alive.”
In collaboration with former colleague Jason Falvey, now a professor at the University of Maryland School of Medicine, Ferrante and the Yale team looked at data from patients participating in the National Health and Aging Trends study who were admitted to intensive care units between 2011 and 2018.
Participants were asked questions about their social interactions, such as whether they talk with family or friends about important matters, visit with family members or friends, and participate in social events or church. Levels of social isolation were ranked from 0 to 6.
Each increase in social isolation scores corresponded to an increased risk of functional disability and death, the researchers found. The most socially isolated older adults had a 50% higher burden of functional disability in the year after an ICU admission and a 119% greater risk of death.
After older patients are discharged, she suggested, hospital staff could make sure they receive weekly phone calls from volunteers or arrange transportation to appointments. Also, social workers can help enroll the elderly in programs that facilitate social engagement.
“Hospitalization may be our only chance of identifying people who are socially isolated,” Ferrante said. “In the hospital, we are all aware of the patient’s medical details, but we need to be more aware of the patient’s social situation as well.”
Association of Social Isolation With Disability Burden and 1-Year Mortality Among Older Adults With Critical Illness
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).
Main Outcomes and Measures
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).
Conclusions and Relevance
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.
Original Research: Closed access.
“Association of Social Isolation With Disability Burden and 1-Year Mortality Among Older Adults With Critical Illness” by Lauren E. Ferrante et al. JAMA Internal Medicine