Living Alone, Social Disengagement Increases Risk for Hospitalization for Respiratory Issues

Respiratory disease hospitalizations among adults were increased for those who were living alone or socially disengaged, but social contact or loneliness were not factors for increased risk, according to a paper published in the journal Thorax.

Investigators from London examined social risk factors for respiratory disease hospitalization in 4478 older adults using the English Longitudinal Study of Ageing. The study is a nationally representative biennial panel study, the authors explained. Data regarding admitted patient care was available through January 2018 with a maximum follow-up period of nearly 10 years.

Other studies about respiratory disease admissions don’t focus on social isolation or loneliness, the authors explained. However, both factors have been linked to an increased incidence of morbidity and mortality as well as decreased medication adherence and health-seeking behaviors. Those who are socially isolated or lonely may even see poorer outcomes for biological responses, such as systemic inflammation, according to the study authors.

The study authors defined social isolation as contact with children, relatives, and friends (also social contact), and frequency of engagement with community groups, volunteering, or cultural activities (also social engagement). The authors used the ULCA 3-item loneliness scale to measure that. Socio-demographic factors, health-related factors, and behavioral factors such as smoking, heavy drinking, diet, and physical activity, were all included in the analysis.

Of the 4478 patients, 11% had a respiratory disease admission within the follow-up period. The researchers found that living alone was associated with a greater hazard of respiratory disease admission even after adjusting for various confounding factors. After further adjustments, people living alone had a 32% higher risk compared to those living with others, the study authors said.

Social disengagement was also a predictor for respiratory disease hospitalizations, the investigators learned. They wrote that social disengagement corresponded to a 24% increase in the hazard of respiratory disease hospitalization.

Neither low social contact nor loneliness was associated with respiratory disease hospitalizations, the authors added.

The investigators further said that 15 patients were categorized as deaths from respiratory disease without a hospitalization, but that did not materially affect their results. The team’s results were also unaffected by excluding people who had respiratory disease admissions in the previous 5 years, nor were they affected by isolating the sample to only individuals with acute respiratory disease admissions. And finally, the study authors wrote that they found no evidence that the findings were varied based on gender or pre-existing respiratory disease conditions.

Some of the potential mechanisms that link social isolation and respiratory disease admission include a higher risk of being physically inactive or smoking, less social pressure to seek medical attention early in the development of a respiratory disorder, and biological factors including isolation-related inflammation, the study authors theorized.

“Older adults living alone with existing lung conditions may benefit from additional targeted community support to try and reduce the risk of hospital admissions,” the study authors wrote. “The roll out of social prescribing schemes may present opportunities for referring these individuals to social engagement community activities.”

Reference

Bu F, Philip K, Fancourt D. Social isolation and loneliness as risk factors for hospital admissions for respiratory disease among older adults [published online April 21, 2020]. Thorax. doi: 10.1136/thoraxjnl-2019-214445.