Loneliness and social isolation in older people are increasingly recognized as a serious public health problem (1). The latest reports suggest that 1 in 4 largest lack narrow social ties (family and/or friends). That is, they feel alone (2). But, unfortunately, it is an unwanted loneliness in which, unlike the desired one, the individual feels that his social needs are not covered. And more right now, where they have been one of the groups most affected by the Covid-19 pandemic. In addition, these people are usually more vulnerable to diseases such as depression, fragility or dementia (3–5).
Given this sad scenario, a study recently published in the prestigious Jama Internal Medicine has answered the question of whether the elders who are socially isolated have, in addition, a greater risk of suffering a serious and even dying disability (6). In this new study, the researchers analyzed the data of a cohort of almost a thousand people (> 65 years) that had required admission to an intensive care unit (ICU). The social isolation was evaluated through a scale of between 0-6 points, reflecting 0 be well socially integrated and 6 the opposite, a null social integration.
Upon receiving the UCI discharge, those most socially isolated people had an increased risk of complications when carrying out basic activities of daily life. Those who were most socially integrated had a problem on average while the most isolated more than 3 ( Figure 1 ). In addition, compared to the most socially integrated older ones, moderate social isolation was associated with 23% higher risk of having functional disabilities (eg, problems to dress, walk or clean), while this risk amounted to 50 % in the case of the most serious social isolation.
However, bad news does not end here. Not surprisingly, social isolation was associated with a greater probability of death in the year following the entrance in ICU . Specifically, moderate social isolation was associated with a risk of death by 48% higher, while the most serious isolation triggered the risk of death up to 119% more. It should also be noted that each increase of a point on the scale of 0 to 6 isolation meant a 14% increase in the risk of death in the year after admission.
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Conclusions
To the already known problems derived from social isolation in the elderly, aggravated during the pandemic - such as anxiety, depression, worse quality of sleep and physical inactivity (7) -, there is an increased risk of suffering a worsening of their disability or die when they return home after hospitalization in an ICU. Very much to take into account is also the fact that, despite the common thing that this situation is, no more interventions are implemented that reduce social isolation among the elderly. Paradoxically, hospitalization could be the best opportunity to detect people who are socially isolated. This would allow to have a database where these people were identified and through volunteer programs could be made telephone calls or visits that made them feel accompanied, or even promote group activities among them that favor social interactions. What is clear is that we cannot abandon our elders and allow them to feel alone in this last stage of their lives.
References:
1. National Academies of Sciences. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Social Isolation and Loneliness in Older Adults. National Academies Press; 2020.
2. Cudjoe TKM, Roth DL, Szanton SL, Wolff JL, Boyd Cm, Thorpe RJ. The Epidemiology of Social Isolation: National Health and Aging Trends Study. Journals Gerontol Be B. 2020; 75 (1): 107–13.
3. Noguchi T, Saito M, Aida J, Cable N, Tsuji T, Koyama S, et al. Association Between Social Isolation and Depression onset Among Older Adults: A Longitudinal Cross-Longitudinal Study in England and Japan. BMJ Open. 2021; 11 (3): E045834.
4. Davies K, Maharani A, Chandola T, Todd C, Pendleton N. The Longitudinal Relationship Between Loneliness, Social Isolation, and Frailty in Older Adults in England: A Prospective Analysis. Lancet Heal Longev. 2021; 2 (2): E70–7.
5th Fratiglioni L, Wang HX, Ericsson K, Maytan M, Winblad B. Influence of Social Network on Occurrence of Dementia: A Community-Based longitudinal Study. Lancet 2000; 355 (9212): 1315–9.
6. Falvey Jr, Cohen Ab, O'Leary Jr, Leo-Summers L, Murphy Te, Ferrante Le. Association of Social Isolation with Disability Burden and 1-YEAR Mortality Among Older Adults with Critical Illness. JAMA INTER MED. 2021
7. Sepúlveda-Loyola W, Rodríguez-Sánchez I, Pérez-Rodríguez P, Ganz F, Torralba R, Oliveira D V., et al. IMPACT OF SOCIAL ISOLATION DUE TO COVID-19 ON HEALTH IN OLDER PEOPLE: Mental and Physical Effects and Recommendations. J Nut Heal Aging. 2020; 24 (9): 938–47.