Social isolation, socioeconomic status, and development of functional impairments in Chinese older adults aged 70 years and over: a cohort study

Abstract

Background Social isolation in older people has been increasingly regarded as a public health issue in the face of rapid population ageing. It is not clear whether social isolation mediates the relationship between socioeconomic status and functional impairment. Methods We used data from a cohort of Chinese older people aged 70 or older living in community ( n = 1590). Socioeconomic status (SES) was operationalised as highest education attainment, monthly income at baseline and longest held occupation in lifetime. Functional abilities were measured using Barthel’s Index for activities of daily living (ADL) measured at 18 and 36 months of follow-up, from which impairment was defined as score ≤ 19. Social isolation was measured by six attributes, such as marital status, living alone, and social contact with others. A score of ≥ 3 was defined as being in social isolation. Causal mediation analysis using natural effect models was used to assess mediation by social isolation. Results We found that lower monthly income at baseline was related to higher risk of social isolation [relative risk comparing lowest to highest income (RR) = 1.52, 95% confidence interval (95% CI) 1.01–2.28]. Social gradient of ADL impairment was not clearly present. The evidence for the mediating role of social isolation was not clear. Conclusions Older people with low SES, particularly those with lower income, were at greater risk of social isolation. Policymakers should strive to improve the current community services and pension scheme to mitigate the situation of social isolation in older people in Hong Kong. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-022-02259-w.

Differences in Loneliness and Social Isolation among Community-Dwelling Older Adults by Household Type: A Nationwide Survey in Japan

“…In addressing social isolation among older adults, it is therefore important to consider both gender and household type. In contrast, in the present study, subjective economic status, which was significantly associated with social isolation for MT participants, was not significantly associated with social isolation for ST participants, which is different from the results of previous studies [31,36]. However, because some studies have reported that low income is not associated with the risk of social isolation [33], the association between economic status and social isolation is not consistent.…”

“…In addition, for both ST and MT participants, social isolation had the strongest association with GSES. Studies conducted before the coronavirus pandemic showed that having a low monthly income [31,36] and being male [31] were risk factors for social isolation. In addition, a trend toward higher mean LSNS-6 scores was observed in a group of participants with good subjective health [37], which is consistent with the results of this study.…”

“…Previous studies have reported demographic factors such as older age [32,33], male gender [31,33,34], low income [31,35,36], being unmarried [31,35], and having a low level of education [31] as factors associated with loneliness and social isolation among older adults. Physical factors such as low subjective health status [35,37] and the presence of chronic diseases [38] have also been reported.…”

Understanding the life experiences of elderly in social isolation from the social systems perspective: using Hong Kong as an illustrating example

“…Our results supported the previous research that the elderly participants in social isolation had a low level of social support and social participation ( 27 , 34 , 35 , 54 ). Their life experiences and conditions were affected by a range of interwoven factors of multiple levels (microsystem, mesosystem, exosystem, macrosystem, and chronosystem) ( 75 , 76 , 80 ), which support the application of the social systems perspective in analyzing social isolation of the elderly.…”

“…These affect their financial condition and physical ability to participate in social interactions and social activities, respectively ( 32 ). Lack of financial resources is viewed as a reason for being socially isolated ( 33 ) because low affordability restricts their engagement in activities involving higher-value consumption, and, in turn, restricts opportunities to meet friends through these activities ( 34 , 35 ). Due to deteriorated health and physical disabilities, their mobility to step outside, participate in activities (e.g., watching movies) ( 36 , 37 ), and engage with other people ( 38 ) is restricted.…”