Loneliness as a risk factor for care home admission in the English Longitudinal Study of Ageing

Hanratty, Barbara; Stow, Daniel; Moore, Danni Collingridge; Valtorta, Nicole; Matthews, Fiona E.

doi:10.1093/ageing/afy095

Cited by 62 publications

(52 citation statements)

References 21 publications

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“…[3][4][5][6] This failure to address the full spectrum of patient needs is problematic given that factors such as financial concerns, stress, and anxiety have been shown to negatively impact health outcomes, leading to lower functional status, earlier mortality, increased rates of medical complications, and higher incidence of acute hospitalization. [7][8][9][10][11][12] Primary care providers (PCPs) must balance management of acute and chronic medical conditions while also addressing an increasing number of quality and guideline-based metrics. [13][14][15] Multiple competing demands and limited time during primary care visits represent significant barriers to successful patient-provider communication and collaboration.…”

mentioning

confidence: 99%

Patient-Defined Visit Priorities in Primary Care: Psychosocial Versus Medically-Related Concerns

Santo

Uratsu

et al. 2019

J Am Board Fam Med

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Background: Primary care providers (PCPs) are often challenged to address multiple patient concerns during time-limited visits. The need for PCPs to limit the number of issues addressed may have a negative impact on discussion of patient-defined visit priorities. Methods: Using data from a recent clinical trial (Aligning Patients and Providers, ClinicalTrials.gov: NCT02707146), we examined the association between patient-defined visit priorities and subsequent provider actions taken during and after the visit. We tested the hypothesis that psychosocial concerns (eg, stress, anxiety, caregiving demands) are less likely to be addressed than traditional medical concerns. Results: We analyzed 147 patient-defined visit priorities submitted just before the visit by 109 patients (mean age, 59.0 ؎ 12.7 years; including 73.4% women, 47.7% non-White race/ethnicity). Nearly one quarter of patient-defined visit priorities were related to psychosocial concerns (35/147; 23.8%). In models adjusting for age, gender, race/ethnicity, and familiarity with PCP, patients' psychosocial priorities were significantly less likely than medical priorities to be addressed during the visit (63% vs. 88%; adjusted odds ratio [aOR], 0.16; 95% CI, 0.06 to 0.41; P < .001), to receive clinical action (51% vs. 82%; aOR, 0.15; 95% CI, 0.06 to 0.38; P < .001), or to receive post visit information from the primary care doctor (17% vs. 32%; aOR, 0.39; 95% CI, 0.14 to 1.08; P ‫؍‬ .07). Conclusions: Patient-defined psychosocial priorities are less likely to be addressed during (or immediately after) primary care visits compared with patient-defined medical priorities.

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confidence: 99%

Patient-Defined Visit Priorities in Primary Care: Psychosocial Versus Medically-Related Concerns

Santo

Uratsu

et al. 2019

J Am Board Fam Med

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“…Similarly, for people residing in a nursing home at the end of life, an increased awareness of the prevalence and effects of loneliness may help staff to better support patients at the end of life . The data on loneliness on nursing homes placement risk are mixed, but some studies do suggest that loneliness may be a modifiable risk factor that can be used to reduce nursing home admission …”

Section: Epidemiologymentioning

confidence: 99%

“…44 The data on loneliness on nursing homes placement risk are mixed, but some studies do suggest that loneliness may be a modifiable risk factor that can be used to reduce nursing home admission. 45 Healthcare systems focusing entirely on traditional risk factors, such as hyperlipidemia and hypertension, may miss opportunities to impact factors that have as great an impact on health. Vast resources, such as new pay-for-performance measures, are expanded on these traditional risk factors, but equal resources are not extended to what are often labeled "social risk factors or social determinants of health."…”

Section: Health Effects Of Loneliness and Social Isolationmentioning

confidence: 99%

A Practical Approach to Assessing and Mitigating Loneliness and Isolation in Older Adults

Perissinotto

Holt‐Lunstad

Periyakoil

et al. 2019

J American Geriatrics Society

134

144

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Loneliness and social isolation are strongly associated with several adverse health outcomes in older persons including death and functional impairments. The strength of these associations has been compared with smoking. Accordingly, loneliness and isolation have significant public health implications. Despite the adverse impacts of loneliness and social isolation on quality of life, and their strong association with health outcomes, the evaluation of loneliness and isolation have not been integrated into medical care. The risks for loneliness may be of particular concern to persons with serious illness as patients and caregivers cope with the experience of loss, loss of independence, and increasing care needs. To date, there has been no uniform way of evaluating and documenting loneliness and social isolation as a part of a review of a patient's social determinants of health. This article provides a framework for healthcare systems, providers, and community members working with older adults to (1) understand loneliness, isolation, and its counterpart social connection; (2) describe the different ways loneliness affects health; and (3) create a framework for asking about and documenting these experiences. Finally, because the lack of studies assessing whether targeting loneliness can improve health outcomes is a major gap, we provide guidance on the future of interventions. J Am Geriatr Soc 67:657–662, 2019.

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“…401 Residents are often excluded from a majority of population surveys. 402 This places an emphasis on data collection, which is both costly and a potential burden on busy care homes.…”

Section: Section 3: Approaches To Evaluation In Care Homes Backgroundmentioning

confidence: 99%

Innovation to enhance health in care homes and evaluation of tools for measuring outcomes of care: rapid evidence synthesis

Hanratty

Craig

Spilsbury

et al. 2019

Health Serv Deliv Res

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BackgroundFlexible, integrated models of service delivery are being developed to meet the changing demands of an ageing population. To underpin the spread of innovative models of care across the NHS, summaries of the current research evidence are needed. This report focuses exclusively on care homes and reviews work in four specific areas, identified as key enablers for the NHS England vanguard programme.AimTo conduct a rapid synthesis of evidence relating to enhancing health in care homes across four key areas: technology, communication and engagement, workforce and evaluation.Objectives(1) To map the published literature on the uses, benefits and challenges of technology in care homes; flexible and innovative uses of the nursing and support workforce to benefit resident care; communication and engagement between care homes, communities and health-related organisations; and approaches to the evaluation of new models of care in care homes. (2) To conduct rapid, systematic syntheses of evidence to answer the following questions. Which technologies have a positive impact on resident health and well-being? How should care homes and the NHS communicate to enhance resident, family and staff outcomes and experiences? Which measurement tools have been validated for use in UK care homes? What is the evidence that staffing levels (i.e. ratio of registered nurses and support staff to residents or different levels of support staff) influence resident outcomes?Data sourcesSearches of MEDLINE, CINAHL, Science Citation Index, Cochrane Database of Systematic Reviews, DARE (Database of Abstracts of Reviews of Effects) and Index to Theses. Grey literature was sought via Google™ (Mountain View, CA, USA) and websites relevant to each individual search.DesignMapping review and rapid, systematic evidence syntheses.SettingCare homes with and without nursing in high-income countries.Review methodsPublished literature was mapped to a bespoke framework, and four linked rapid critical reviews of the available evidence were undertaken using systematic methods. Data were not suitable for meta-analysis, and are presented in narrative syntheses.ResultsSeven hundred and sixty-one studies were mapped across the four topic areas, and 65 studies were included in systematic rapid reviews. This work identified a paucity of large, high-quality research studies, particularly from the UK. The key findings include the following. (1) Technology: some of the most promising interventions appear to be games that promote physical activity and enhance mental health and well-being. (2) Communication and engagement: structured communication tools have been shown to enhance communication with health services and resident outcomes in US studies. No robust evidence was identified on care home engagement with communities. (3) Evaluation: 6 of the 65 measurement tools identified had been validated for use in UK care homes, two of which provide general assessments of care. The methodological quality of all six tools was assessed as poor. (4) Workforce: joint working within and beyond the care home and initiatives that focus on staff taking on new but specific care tasks appear to be associated with enhanced outcomes. Evidence for staff taking on traditional nursing tasks without qualification is limited, but promising.LimitationsThis review was restricted to English-language publications after the year 2000. The rapid methodology has facilitated a broad review in a short time period, but the possibility of omissions and errors cannot be excluded.ConclusionsThis review provides limited evidential support for some of the innovations in the NHS vanguard programme, and identifies key issues and gaps for future research and evaluation.Future workFuture work should provide high-quality evidence, in particular experimental studies, economic evaluations and research sensitive to the UK context.Study registrationThis study is registered as PROSPERO CRD42016052933, CRD42016052933, CRD42016052937 and CRD42016052938.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Loneliness as a risk factor for care home admission in the English Longitudinal Study of Ageing

Abstract: loneliness conveys an independent risk of care home admission that, unlike other risk factors, may be amenable to modification. Tackling loneliness amongst older adults may be a way of enhancing wellbeing and delaying or reducing the demand for institutional care.

Cited by 62 publications

References 21 publications

Patient-Defined Visit Priorities in Primary Care: Psychosocial Versus Medically-Related Concerns

Patient-Defined Visit Priorities in Primary Care: Psychosocial Versus Medically-Related Concerns

A Practical Approach to Assessing and Mitigating Loneliness and Isolation in Older Adults

Innovation to enhance health in care homes and evaluation of tools for measuring outcomes of care: rapid evidence synthesis

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