ImportanceSocial isolation is associated with adverse health outcomes, yet its implications for hospitalization and nursing home entry are not well understood.ObjectiveTo evaluate whether higher levels of social isolation are associated with overnight hospitalization, skilled nursing facility stays, and nursing home placement among a nationally representative sample of community-dwelling older adults after adjusting for key health and social characteristics, including loneliness and depressive symptoms.Design, Setting, and ParticipantsThis observational cohort study included 7 waves of longitudinal panel data from the Health and Retirement Study, with community-dwelling adults aged 65 years or older interviewed between March 1, 2006, and June 30, 2018 (11 517 respondents; 21 294 person-years). Data were analyzed from May 25, 2022, to May 4, 2023.Main Outcomes and MeasuresSocial isolation was measured with a multidomain 6-item scale (range, 0-6, in which a higher score indicates greater isolation). Multivariate logistic regressions were performed on survey-weighted data to produce national estimates for the odds of self-reported hospitalization, skilled nursing facility stays, and nursing home placement over time.ResultsA total of 57% of this study’s 11 517 participants were female, 43% were male, 8.4% were Black, 6.7% were Hispanic or Latino, 88.1% were White, 3.5% were other (“other” includes American Indian or Alaska Native, Asian or Pacific Islander, and other race, which has no further breakdown available because this variable was obtained directly from the Health and Retirement Study), and 58.2% were aged 65 to 74 years. Approximately 15% of community-dwelling older adults in the US experienced social isolation. Higher social isolation scores were significantly associated with increased odds of nursing home placement (odds ratio, 2.01; 95% CI, 1.21-3.32) and skilled nursing facility stays (odds ratio, 1.16; 95% CI, 1.06-1.28) during 2 years. With each point increase in an individual’s social isolation score, the estimated probability of nursing home placement or a skilled nursing facility stay increased by 0.5 and 0.4 percentage points, respectively, during 2 years. Higher levels of social isolation were not associated with 2-year hospitalization rates.Conclusions and RelevanceThis cohort study found that social isolation was a significant risk factor for nursing home use among older adults. Efforts to deter or delay nursing home entry should seek to enhance social contact at home or in community settings. The design and assessment of interventions that optimize the social connections of older adults have the potential to improve their health trajectories and outcomes.

This study examined social isolation as a risk factor for hospitalization, nursing home stays, and mortality among a longitudinal sample of 12,860 community-dwelling older adults ages 65+ between 2006-2018. Using seven waves of Health and Retirement Study (HRS) data, we examined associations between social isolation and hospitalization, nursing home stays, and mortality. Social isolation scores ranged from 0-6 using an established typology with six objective measures of social interactions: 1) marital status; 2) living arrangement; 3) monthly communication with children; 4) family; 5) and friends; and, 6) monthly participation in groups, clubs, organizations, or religious services. Covariates included fixed demographics and time-variant characteristics including loneliness, depression, Medicaid enrollment, lifestyle behaviors, activities of daily living, number of chronic conditions, and Alzheimer’s disease or related dementias. Logistic regression analyses were conducted with panel data and random effects to examine associations between social isolation and each outcome over time. About 15% of the sample was socially isolated, with an average isolation score of 1.29. Social isolation significantly increased the odds of having a nursing home stay (OR = 1.22, p < 0.001) and mortality (OR = 1.14, p < 0.001). However, it was not significantly associated with overnight hospitalizations (OR = 0.97, p = 0.09). Social isolation may put older adults at greater risk for nursing home stays and mortality over time, as compared to social integration. Policies and practices to reduce social isolation can support aging at home or the community, delay nursing home entry, and reduce the risk of mortality.

Objective The main objective of this study was to examine peer reviewed literature on employee health management programs offered by health care organizations to address cardiovascular and metabolic conditions. Our objectives included understanding the types of interventions, measures reported, clinical and work-related outcomes, and quality of research. Study Design and Analysis Systematic review adhering to the PRISMA guidelines. Our research team included experts in health promotion, primary care, medical psychology, and library sciences. Analysis was based on evaluation guidelines for employee health management programs established by the Health Enhancement Research Organization and Population Health Alliance. We examined measures of physical health impact and work-related outcomes. Our review included a quality assessment based on National Heart, Blood, and Lung Institute criteria for case-control and before-after studies. Dataset We performed searches on PubMed, CINAHL, ABI/Inform, and PsycINFO and used backward citation tracking. Population English-language peerreviewed articles published in the US between 2000 to 2021 that reported outcomes of interventions aimed at improving employee cardiovascular and/or metabolic conditions. Interventions were randomized or non-randomized controlled trial or before-after design. A total of 2268 non-duplicate journal articles were retrieved. Two rounds of abstract screening excluded 2162 articles. A detailed evaluation of 106 full-text articles eliminated 21. Citation tracking resulted in 55 additional articles. Of the 140 articles, 22 were conducted within health care delivery organizations and included in this analysis. Results A variety of interventions were reported, most were 6 months or longer and included monetary incentives. All studies reported cardiometabolic outcomes: 20 measured blood pressure, 19 measured weight, 17 measured cholesterol, and 16 measured blood glucose. Few studies reported work-related outcomes. The majority of studies reported positive physical health outcomes. Of those reporting financial outcomes, most reported cost savings. Quality of research design varied. Major issues include high participant dropout rate, lack of sample size estimation, and lack of consistent intervention exposure. Conclusions Employer-sponsored interventions focused on improving cardiovascular and metabolic conditions may be one method to support the overall health and well-being of health professionals.