Medicare Spends More on Socially Isolated Older Adults

Flowers, Lynda; Houser, Ari; Noël-Miller, Claire; Shaw, Jonathan E.; Bhattacharya, Jay; Schoemaker, Lena; Farid, Monica

doi:10.26419/ppi.00016.001

Cited by 48 publications

(37 citation statements)

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“…To combat social isolation, a recent report 21 recommends screenings, targeted interventions, and interdisciplinary team engagement. Screenings can occur at the Welcome to Medicare and annual wellness visits, utilize the predictors we found, and use short and validated measures such as the Berkman‐Syme Social Network Index . Targeted interventions (eg, online resources and community programs) focus on mechanisms to enhance social support and increase social connectedness, and incidentally could offer social support .…”

Section: Discussionmentioning

confidence: 99%

“…Transition to RCFEs are appropriate when community‐dwelling older adults require more intensive care needs and may provide the older adult with an additional source of social support . For continued care in the home, we recommend a continued push to cover home visits under Medicare with particular eligibility criteria, such as the presence of Alzheimerʼs or multiple functional impairments . Community programs mentioned earlier would benefit from continued support, for example, through shifting of Medicaid funds to successful programs or expanded support for Medicaid waivers that financially cover HCBS .…”

Section: Discussionmentioning

confidence: 99%

“…15,16 Social isolation and loneliness is a growing public health problem due to its 5-fold increase over the past 3 decades and associations with poor health status, mortality, and higher Medicare expenditures. [17][18][19][20] To combat social isolation, a recent report 21 and annual wellness visits, utilize the predictors we found, and use short and validated measures such as the Berkman-Syme Social Network Index. 18 Targeted interventions (eg, online resources and community programs) focus on mechanisms to enhance social support and increase social connectedness, and incidentally could offer social support.…”

Section: Discussionmentioning

confidence: 99%

“…[17][18][19][20] To combat social isolation, a recent report 21 and annual wellness visits, utilize the predictors we found, and use short and validated measures such as the Berkman-Syme Social Network Index. 18 Targeted interventions (eg, online resources and community programs) focus on mechanisms to enhance social support and increase social connectedness, and incidentally could offer social support. 21 Connect2Affect is an initiative spearheaded by the American Association of Retired Persons that has assembled an online directory of programs and services to help build social connections.…”

Section: Discussionmentioning

confidence: 99%

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Social Support and Patterns of Institutionalization Among Older Adults: A Longitudinal Study

Patel

Boscardin

et al. 2019

J American Geriatrics Society

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OBJECTIVES To identify participants living at home and to estimate the risk of their transition into an institutional setting. DESIGN Prospective cohort study from the National Health and Aging Trends Study (NHATS), a nationally representative survey of US adults aged 65 and older. SETTING US national sample. PARTICIPANTS A total of 4712 NHATS participants were living at home in 2011. Residential transitions were described every year through 2017. MEASUREMENTS The primary outcome was transition time into an institutional setting. Primary predictors were social support factors (living spouse, lives with others, presence of social network, and participation in social activities). Covariates included age, sex, race, cognitive status, functional disability, multimorbidity, and Medicaid enrollment. A Fine and Gray hazards model estimated the risk of transition into an institutional setting, with death before institutionalization considered a competing risk. RESULTS In 2011, 4712 NHATS participants were living at home (78 ± 8 y; 57% female; 80% white; 10% probable dementia; 7% with three or more activities of daily living disabilities). By 2017, 58% remained at home, 17% had either transitioned to an institution or died in an institution, and 25% died before institutionalization. In multivariable analyses that adjusted for age, sex, race, cognitive status, functional disability, multimorbidity, and Medicaid enrollment, participants were more likely to move out of the home into an institution if they had no social network (0 vs three or more people; subhazard ratio [sHR] = 1.8; 95% confidence interval [CI] = 1.2–2.5; P = .003) or lived alone (sHR = 1.9; 95% CI = 1.6–2.2; P < .0001). Older adults who enjoyed going to the movies, dinner, or the casino and visiting family or friends had a lower probability of institutionalization compared with participants who did not enjoy these activities or did not visit family or friends (adjusted sHR = .7; 95% CI = .6–.9; adjusted sHR = .7; 95% CI = .6–.9, respectively). CONCLUSION Policy initiatives should target older adults with limited social support to reduce the risk of moving from home into an institution. J Am Geriatr Soc 67:2622–2627, 2019

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Social Support and Patterns of Institutionalization Among Older Adults: A Longitudinal Study

Patel

Boscardin

et al. 2019

J American Geriatrics Society

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“…Social isolation is prevalent among US adults age 65 and older. As many as 43% of all community‐dwelling older adults report being socially isolated, and a recent report estimated that the cost of social isolation to the Medicare program alone is nearly $7 billion annually . Social isolation is related to, and often inclusive of, the concepts of loneliness, social relationships, social support, and social capital .…”

mentioning

confidence: 99%

Differences in Social Isolation and Its Relationship to Health by Rurality

Henning‐Smith

Moscovice

Kozhimannil

2019

The Journal of Rural Health

125

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Purpose Social isolation is an urgent threat to public health. Meanwhile, health outcomes across multiple measures are worse in rural areas, where distance to neighbors is often greater and opportunities for social interaction may be scarcer. Still, very little research examines rural‐urban differences in social isolation. This study addresses that gap by examining differences in social isolation by rurality among US older adults. Methods Using Wave 2 of the National Social Life, Health, and Aging Project data (n = 2,439), we measured differences between urban and rural (micropolitan or noncore) residents across multiple dimensions of social isolation. We also conducted multivariable analysis to assess the associations between rurality, sociodemographic characteristics, and loneliness, overall and by rurality. Finally, we conducted multivariable analysis to assess the association between social isolation and self‐rated health, adjusting for rurality. Findings Compared to urban residents, rural residents had more social relationships and micropolitan rural residents were more likely to be able to rely on family members (95.8% vs 91.3%, P < .05). Micropolitan rural residents reported lower rates of loneliness than urban residents after adjusting for sociodemographic and health characteristics (b = –0.32, P < .05), whereas noncore rural, non‐Hispanic black residents had a greater likelihood of reporting loneliness (b = 4.33, P < .001). Conclusions Overall, noncore and micropolitan rural residents reported less social isolation and more social relationships than urban residents. However, there were differences by race and ethnicity among rural residents in perceived loneliness. Policies and programs to address social isolation should be tailored by geography and should account for within‐rural differences in risk factors.

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Factors associated with loneliness, depression, and anxiety during the early stages of the COVID‐19 pandemic

Raio,

Szuhany,

Secmen

et al. 2024

Stress and Health

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The COVID‐19 pandemic was an unparalleled stressor that enhanced isolation. Loneliness has been identified as an epidemic by the US Surgeon General. This study aimed to: (1) characterize longitudinal trajectories of loneliness during the acute phase of the COVID‐19 pandemic; (2) identify longitudinal mediators of the relationship of loneliness with anxiety and depression; and (3) examine how loneliness naturally clusters and identify factors associated with high loneliness. Two hundred and twenty‐nine adults (78% female; mean age = 39.5 ± 13.8) completed an abbreviated version of the UCLA Loneliness Scale, Perceived Stress Scale, Emotion Regulation Questionnaire, State Anxiety Inventory, and Patient Health Questionnaire‐8 longitudinally between April 2020 and 2021. Trajectory analyses demonstrated relatively stable loneliness over time, while anxiety and depression symptoms declined. Longitudinal analyses indicated that loneliness effects on anxiety and depression were both partially mediated by perceived stress, while emotion regulation capacity only mediated effects on anxiety. Three stable clusters of loneliness trajectories emerged (high, moderate, and low). The odds of moderate or high loneliness cluster membership were positively associated with higher perceived stress and negatively associated with greater cognitive reappraisal use. Our results demonstrate the important interconnections between loneliness and facets of mental health throughout the early phases of the pandemic and may inform targeted future interventions for loneliness work.

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Medicare Spends More on Socially Isolated Older Adults

Cited by 48 publications

References 0 publications

Social Support and Patterns of Institutionalization Among Older Adults: A Longitudinal Study

Social Support and Patterns of Institutionalization Among Older Adults: A Longitudinal Study

Differences in Social Isolation and Its Relationship to Health by Rurality

Factors associated with loneliness, depression, and anxiety during the early stages of the COVID‐19 pandemic

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