Social engagement within the facility increased life expectancy in nursing home residents: a follow-up study

Abstract

Background Social engagement (SE) has been consistently shown to improve survival among community-dwelling older people, but the evidence in nursing home residents is inconclusive and prone to short-term reverse causation and confounding by major health determinants. Our main objective was to study the potential causal effect of within-the-facility social engagement (SE) on long-term all-cause mortality in care home residents. Methods A representative cohort of 382 nursing home residents in Madrid without severe physical and cognitive impairments at baseline was followed up for 10-year all-cause mortality. Standardized mortality curves for residents with low/null, moderate, and high levels of SE at baseline were estimated using Kaplan-Meier methods and spline-based survival models with inverse probability of exposure weights conditional on baseline sociodemographic characteristics, facility features, comorbidity, and disability. Standardized 5-year mortality risks and median survival times were compared across levels of SE. Results The baseline prevalences of low/null, moderate, and high SE were 36, 44, and 20%, respectively. Compared with residents with low/null SE at baseline, the standardized differences (95% confidence intervals) in 5-year mortality risk were − 2.3% (− 14.6 to 10.0%) for moderately engaged residents and − 18.4% (− 33.8 to − 2.9%) for highly engaged residents. The median survival time increased by 0.4 (− 1.4 to 2.2) and 3.0 (0.8 to 5.2) years, respectively. Conclusion Residents with high SE within the nursing home had an 18% lower 5-year mortality risk and a 3-year increase in their median survival, as compared with residents with similar health determinants but low/null SE. The development of adequate tailored intervention programs, addressed to increase SE in nursing home residents, could improve their long-term survival, in addition to expected gains in quality of life.

Health effects of social connectedness in older adults living in congregate long‐term care settings: A systematic review of quantitative and qualitative evidence

“…Findings from included cohort studies are also summarized in Table 5. Although the outcomes under study differed, as did the operational definitions of social connectedness, studies reported that social connectedness was associated with favourable outcomes including psychological well‐being (Mao & Han, 2018), delayed cognitive decline (Freeman et al, 2016; Yamada et al, 2016), positive behaviours (Inventor et al, 2018), self‐feeding independence (Palese et al, 2019), positive affect (Kroemeke & Gruszczynska, 2016), decreased depression or depressive symptoms (Chau et al, 2021; Kloos et al, 2019; Lou et al, 2012; Neufeld et al, 2019) and delayed time to death (Fehnel et al, 2015; Hjaltadottir et al, 2011; Kiely et al, 2000; Kiely & Flacker, 2003; Maxwell et al, 2015; Pastor‐Barriuso et al, 2020). Three studies suggested that social connectedness measures may have opposite effects.…”

“…Table 4 shows that in the eligible cohort studies, there was heterogeneity in the proportion of participants with no or low social engagement (range of % of no social engagement: 6.6% [Kiely & Flacker, 2003] to 33% [Vetrano et al, 2018], range of % of no or low social engagement: 18.2% [Freeman et al, 2016] to 36.0% [Pastor‐Barriuso et al, 2020], 61.2% with reduced social engagement [Foebel et al, 2015]). Findings from included cohort studies are also summarized in Table 5.…”

Social connection and physical health outcomes among long-term care home residents: a scoping review

“…Eight studies assessed the association between social connection and mortality. Seven studies reported higher social connection (social engagement or support) were associated with reduced risk of mortality [ 40 – 46 ]. The eighth study reported an unadjusted association between social network quality, but not size, with results suggesting this relationship may depend on sex and cognitive impairment, but the associations were not statistically significant in multivariable models [ 47 ].…”

The association of care satisfaction and COVID-19 contact restrictions with quality of life in long-term care homes residents in Germany: a cross-sectional study

“…However, contact restrictions were not limited to relatives visiting, but also had an impact on resident’s social engagement, such as having contact with each other and activities within the long-term home set up by nursing staff and volunteers. Social engagement was not only to be shown to predict QoL in residents of long-term homes [ 39 ], but residents having a high engagement showed lower mortality [ 40 ]. In addition, having the possibility to go outside, was shown to be an important predictor of QoL [ 39 ].…”