Social isolation, homebound status, and race among older adults: Findings from the National Health and Aging Trends Study (2011–2019)

Abstract

Background Multiple factors may influence the risk of being homebound, including social isolation and race. This study examines the relationship between social isolation and homebound status by race over 9 years in a sample of adults. Methods Utilizing a representative sample of 7788 Medicare beneficiaries aged 65+ from 2011–2019, we assessed the odds of becoming homebound by social isolation. We defined social isolation as the objective lack of contact with others. We defined severe social isolation as scoring a 0 or 1 on a social connection scale from 0 to 4. Homebound status was defined as never leaving home or only leaving home with difficulty. Utilizing a multivariate Cox proportional hazards model adjusting for age, gender, marital status, income, and education, we examined the association between social isolation at baseline and becoming homebound during the study in those who were not initially homebound. Results Older adults in this study were on average 78 years old. Overall, most were white (69%), female (56.3%), and married (57.8%) and reported that they had a college education or higher (43.9%). Also, at baseline, approximately 25% of study participants were socially isolated, 21% were homebound, and 6.3% were homebound and socially isolated or severely socially isolated. Homebound status at baseline varied by race: Black, 23.9% and white, 16.6% (p < 0.0001). After 9 years, socially isolated black (hazard risk ratio, HRR 1.35, 95% confidence interval CI [1.05,1.73], p < 0.05) and white (HRR 1.25, 95% CI [1.09,1.42], p < 0.01) older adults were at higher risk of becoming homebound. Conclusion Socially isolated black and white adults are more likely to be homebound at baseline and become homebound over time. Further research is needed to determine whether community‐based strategies and policies that identify and address social isolation reduce homebound status among community‐dwelling older adults.

Impact of technology on social isolation: Longitudinal analysis from the National Health Aging Trends Study

“…4 Furthermore, social isolation is associated with mortality and functional decline in older adults. [5][6][7] Risk factors for social isolation among older people include family dispersal, decreased mobility and income, and loss of loved ones. 1 Additionally, being unmarried, male, having lower education attainment, having a low income, living alone, lacking participation in social groups, having fewer friends, and strained relationships are each independently associated with social isolation.…”

Social isolation and 9‐year dementia risk in community‐dwelling Medicare beneficiaries in the United States

“…30 While modest progress has been made to increase recruitment and retention of older adults from underrepresented groups in dementia research, 30 this work continues to advocate for greater representation of diverse racial and ethnic subgroups in longitudinal studies of aging in order to understand the critical implications of potential group differences in the social isolation-incident dementia association. 31,32 The primary analyses estimated the cause-specific hazard of dementia before death by social isolation status. These estimates cannot be interpreted as the absolute risk of dementia over time associated with social isolation because dementia incidence depends on dementia risk as well as survival.…”

Evidence-informed and community-based strategies are essential to developing affordable and accessible technology-based interventions to prevent social isolation among older adults and promote their well-being and quality of life

“…Social isolation is a fundamental public health problem, and it has significant negative effect on the healthcare system along with surge in ageing population 1–3. Furthermore, social isolation is linked with increased mortality rate, cognitive and functional decline among older adults 1 2 4. While the impact of technology on seniors’ social isolation has been somewhat explored, research on the access and use of basic technology and social engagement among seniors are little 1 2.…”