Association of Social Isolation With Disability Burden and 1-Year Mortality Among Older Adults With Critical Illness

Abstract

IMPORTANCE 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.OBJECTIVES 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.EXPOSURES 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 MEASURESThe 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.RESULTS 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 RELEVANCEIn 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.

Surviving COVID-19: a familiar road to recovery?

“…In another large cohort study published in 2021, social isolation before ICU hospitalisation was associated with a greater disability burden in the year after critical illness, suggesting the need for social isolation screening and intervention frameworks. 4 Additionally, socioeconomic position might affect health outcomes, particularly mental health, after critical illness. 5 These previously published data illustrate the important impacts of the social determinants of health.…”

A Performance-Based Teleintervention for Adults in the Chronic Stage after Acquired Brain Injury: An Exploratory Pilot Randomized Controlled Crossover Study

“…Another interesting finding of our study was that the frequency of leaving the house increased significantly after the tele-CO-OP intervention. Frequency of leaving the house is a simple pragmatic measure whose improvement may be significant because of its association with function, health status, and mortality among community-residing older adults [ 64 , 65 , 85 ]. Leaving one’s home is important and provides opportunities to engage in a variety of activities that involve social, cognitive, productive, emotional, and other aspects [ 64 ].…”

“…During the COVID era, social isolation has become the preferred default option, particularly for people with recent morbidity, such as the subjects included in our study. Moreover, due to social distancing and the reduced availability of community-based services, telehealth innovations are crucial for closing this gap for this vulnerable population [ 85 ].…”

Social isolation: an attributing factor of increased frailty risk and mortality amongst advanced-age intensive care unit survivors

“…The research3 was an observational cohort study on adults aged between 66 and 102 years. Participants were drawn from the National Health and Aging Trends Study, community based and had ICU admission(s).…”

“…More so among the older and homebound population. This study3 investigated the association between social isolation and disability burden and mortality rate of the older intensive care unit (ICU) survivors. The findings revealed that a one-point increase in the isolation score was responsible for a 7% greater disability count and a 14% increase in 1-year mortality risk.…”