Social isolation entering ICU can be deadly for older adults

Socially isolated older adults who enter intensive care units (ICUs) are more likely to die and are at increased risk of disability after discharge compared with those who are more connected to family and friends, a new Yale University study shows.

 

The study, published Sept. 7 in the journal JAMA Internal Medicine, “illustrates the need for hospitals to identify older patients who lack social networks and connect them with programs designed to provide isolated individuals support,” said Dr. Lauren E. Ferrante, a pulmonary and critical care physician in the Pulmonary, Critical Care & Sleep Medicine Section (Yale-PCCSM) at Yale School of Medicine and senior author of the paper.

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Patients over 65 are more likely to have functional problems such as problems dressing or walking after discharge from a hospitalisation that included an ICU stay. More than one in three of those who experience few social connections die within three years of discharge, a rate three to five times higher than the general older adult population, the researchers found.

 

“Our work is focused on understanding and improving the functional recovery of older adults who survive the ICU,” said Ferrante, a critical care doctor at Yale New Haven Hospital. “We know from prior studies that older adults value functional independence even more than staying alive.”

 

In collaboration with former colleague Jason Falvey, now a professor at the University of Maryland School of Medicine, Ferrante and the Yale team looked at data from patients participating in the National Health and Aging Trends study who were admitted to intensive care units between 2011 and 2018. Participants were asked questions about their social interactions, such as whether they talk with family or friends about important matters, visit with family members or friends, and participate in social events or church. Levels of social isolation were ranked from 0 to 6.

 

Each increase in social isolation scores corresponded to an increased risk of functional disability and death, the researchers found. The most socially isolated older adults had a 50% higher burden of functional disability in the year after an ICU admission and a 119% greater risk of death.

 

After older patients are discharged, she suggested, hospital staff could make sure they receive weekly phone calls from volunteers or arrange transportation to appointments. Also, social workers can help enroll the elderly in programs that facilitate social engagement.

 

“Hospitalisation may be our only chance of identifying people who are socially isolated,” Ferrante said. “In the hospital, we are all aware of the patient’s medical details, but we need to be more aware of the patient’s social situation as well.”

 

14 September 2021.