Combined association of multiple chronic diseases and social isolation with the functional disability after stroke in elderly patients: a multicenter cross-sectional study in China

Abstract

Background Multiple chronic diseases (MCDs) and social isolation are independent risk factors related to stroke and disability, but it is unknown whether the combination of these two conditions resulted from aging-related to functional disability in stroke patients. This study aimed to probe the relationship between the combination of MCDs, social isolation, and functional disability after stroke in elderly patients. Methods A multicenter and cross-sectional study was conducted in the Departments of Rehabilitation of 103 hospitals located in 23 cities across China. Stroke patients aged 60–90 years were selected for analysis. Demographic characteristics, lifestyles, and clinical information were investigated by questionnaires and medical records. MCDs (hypertension/ diabetes/ hyperlipidemia/heart disease/kidney disease) were categorized into three levels: 0, 1, and ≥ 2. Functional disability was assessed by the Barthel Index and categorized into four groups: no, mild, moderate, and severe disability. The multi-nominal logistic regression model was used to explore the independent and combined association of MCDs and social isolation with functional disability. Results A total of 4046 elderly stroke patients (55 % males) were included in the final analysis. The prevalence of social isolation, MCDs ≥ 2, and severe disability increased with aging. In the fully adjusted model, patients with social isolation or MCDs had a higher risk of functional disability significantly than those without. Patients with social isolation combined MCDs ≥ 2 were 35 times (95 % CI: 18.89–64.69) more likely to suffer severe disability after stroke, and 8 times (95 % CI: 18.89–64.69) for moderate disability than those without social isolation and MCDs. Conclusions MCDs, social isolation, and their combination were associated with a higher risk of functional disability after stroke in Chinese elderly patients. The elderly population should be encouraged to participate in more social activities, particularly in those with MCDs. Future secondary prevention and rehabilitation treatments to the functional ability of elderly stroke patients should underscore both social activity and the combined treatments of MCDs. Trial registration NO: ChiCTR2000034067.

Gender specific cut-off points of age for disability among rural elderly in Anhui Province, China

“…On the one hand, older adults with mobility limitations might feel more unsafe in their neighborhood, and were less likely to walk around, potentially affecting social participation ( 25 ). On the other hand, social isolation may decrease musculoskeletal function, accelerating the mobility limitation relevant to aging ( 26 ). One disability does not worsen independently, but also causes another disability.…”

Post-Stroke Brain Health Monitoring and Optimization: A Narrative Review

“…Consider screening for social isolation, particularly in elderly stroke survivors or those with other mood disorders [146,175,176].…”

Reversal of the detrimental effects of social isolation on ischemic cerebral injury and stroke-associated pneumonia by inhibiting small intestinal γδ T-cell migration into the brain and lung

“…8 Emerging evidence has indicated a compelling association between ISO and an increased risk of stroke. 9,10 Social deprivation contributes to accelerated disease progression and impaired recovery from stroke, 11–13 which has been recapitulated by experimental models. 14,15 In contrast, social support potentially decreases the detrimental impacts of maladaptive psychological responses to stress and has been linked epidemiologically with improved functional recovery from stroke.…”