This new data highlights the importance of enhancing social connection for older adults and identifying those at greater risk of nursing home entry.
Mary Louise Pomeroy, PhD, MPH
Social isolation among older adults is a significant risk factor for use of nursing homes, according to recent findings, and efforts made to deter or delay entry to nursing homes should work to enhance social contact among older adults in community settings or at home.1
These findings resulted from a study seeking to expand upon the current literature on social isolation and its associations with health care costs, given that its connection to functional limitations, mental and cognitive declines, disease, and mortality risk are fairly well-known.
Prior evidence on social isolation as a potential risk factor for older adult hospitalization is known to be inconclusive, so the investigators sought to expand upon this data and make social isolation and loneliness distinct from one another.2 The research was authored by Mary Louise Pomeroy, PhD, MPH, from Johns Hopkins University’s School of Nursing in Baltimore, Maryland.
“By accounting for loneliness and depressive symptoms in analyses, this study further facilitates a comprehensive assessment of how various aspects of social connection and psychosocial health affect hospital and nursing home use,” Pomeroy and colleagues wrote.
Background and Findings
The investigators utilized data in their cohort study which was drawn from the Health and Retirement Study (HRS) spanning from March of 2006, to June of 2018. HRS is known to be a nationally representative, biennial survey focusing on employment, health, and assets among 20,000 older US residents.
The research team’s data was examined between May of 2022, and May of 2023, with response rates having been consistently above 87% from 2006 onwards. The team’s study merged core HRS files with the RAND Corporation’s longitudinal file and Psychosocial and Lifestyle Questionnaire (SAQ) responses. The SAQ was alternately given to 2 samples of the investigators’ cohort in different years, and the participants were then followed up every 2 years to track participants’ hospitalization, nursing home stays, and home placement.
The investigators’ primary element of interest in their research was social isolation, defined as a lack of social contact felt both at home and in one’s community for older individuals who are living in the community. In order to quantify social isolation, the investigators used a 6-item scale which captured various aspects of network interactions, social contact, and community engagement.
Scores were made to range from 0 to 6, and higher values would show greater isolation among participants. The study used a threshold (scores ≥3) to distinguish the different subgroups with low and high social isolation, but continuous scores were also assessed to capture the gradient nature of social connection.
The study’s participants were asked about hospitalization and nursing home stays in the past couple of years during each wave of the team’s study. The investigators categorized hospitalization as yes or no, while nursing home stays were differentiated between those who were not living in nursing facilities at follow-up (nursing home stay) and those already living in nursing homes (long-term nursing home residents). Respondents residing in nursing homes at the initial SAQ interview were excluded from the analyses.
By investigating social isolation as a key factor, this study sought to understand its relationship with home stays, hospitalization, and nursing home placement among older individuals aged 65 years and above, living in the community, and with diverse insurance types.
In this study, a total of 11,517 participants were included, with 57% of them being female and 43% male. The racial composition included 8.4% Black, 6.7% Hispanic or Latino, and 88.1% White individuals and a majority of them, at 58.2%, being within the age range of 65 - 74 years. Notably, approximately 15% of older adults residing in the US experienced social isolation.
The study findings showed that higher social isolation scores were found to be substantially linked to higher odds of placement in nursing homes (odds ratio, 2.01; 95% CI, 1.21 - 3.32) and stays in nursing facilities (odds ratio, 1.16; 95% CI, 1.06 - 1.28) over a 2-year span.
With each incremental point in a participant’s social isolation score, the investigators noted that the estimated probability of placement in a nursing home or a nursing home stay rose by 0.5 and 0.4 percentage points, respectively, within the same time frame.
Despite this fact, no major link was identified between higher levels of social isolation and 2-year hospitalization rates in these participants.
“This study contributes new data to inform planning by public health officials and health systems as they develop interventions to reduce social isolation,” they wrote. “Future research to improve aging in place through enhanced social connection can use objective social isolation measures to identify older adults who are at greater risk of nursing home entry.”
Pomeroy ML, Cudjoe TKM, Cuellar AE, et al. Association of Social Isolation With Hospitalization and Nursing Home Entry Among Community-Dwelling Older Adults. JAMA Intern Med. Published online July 24, 2023. doi:10.1001/jamainternmed.2023.3064.
National Academies of Sciences, Engineering, and Medicine. Social isolation and loneliness in older adults: opportunities for the health care system. National Academies Press; 2020. Accessed May 1, 2020. https://www.nap.edu/catalog/25663.