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Co-existence of social isolation and homebound status increase the risk of all-cause mortality

Published online by Cambridge University Press:  19 July 2018

Ryota Sakurai Open the ORCID record for Ryota Sakurai [Opens in a new window] ,
Masashi Yasunaga ,
Mariko Nishi ,
Taro Fukaya ,
Masami Hasebe ,
Yoh Murayama ,
Takashi Koike ,
Hiroko Matsunaga ,
Kumiko Nonaka  and
Hiroyuki Suzuki
...Show all authors
Ryota Sakurai
Affiliation:
Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
Masashi Yasunaga
Affiliation:
Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
Mariko Nishi
Affiliation:
Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
Taro Fukaya
Affiliation:
Department of Translational Research Promotion, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
Masami Hasebe
Affiliation:
Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan Faculty of Psychology and Social Welfare, Seigakuin University, Saitama, Japan
Yoh Murayama
Affiliation:
Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
Takashi Koike
Affiliation:
Department of Regional Development, Kyushu Sangyo University, Fukuoka, Japan
Hiroko Matsunaga
Affiliation:
Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
Kumiko Nonaka
Affiliation:
Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
Hiroyuki Suzuki
Affiliation:
Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
Masashige Saito
Affiliation:
Faculty of Social Welfare, Nihon Fukushi University, Mihama-cho, Japan
Erika Kobayashi
Affiliation:
Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
Yoshinori Fujiwara*
Affiliation:
Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
*
Correspondence should be addressed to: Yoshinori Fujiwara, Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan. Email: [email protected] (YF).
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Abstract

Background:

Social isolation and homebound statuses are possible risk factors for increased mortality among older adults. However, no study has addressed the impact of accumulation of these two factors on mortality. The aim of this study was to examine whether such accumulation increased the risk of all-cause mortality.

Methods:

The analyzed sample was drawn from a mail survey of 1,023 older adults without instrumental activities of daily living disability. Participants were classified into four groups according to the frequency of both face-to-face and non-face-to-face interactions with others (social isolation and non-social isolation) and the frequency of going outdoors (homebound and non-homebound). Social isolation and homebound statuses were defined as having a social interaction less than once a week and going outdoors either every few days or less, respectively. All-cause mortality information during a six-year follow-up was obtained.

Results:

In total, 78 (7.6%) participants were both socially isolated and homebound. During the follow-up period, 65 participants died, with an overall mortality rate of 10.6 per 1000 person-years. Cox proportional hazards regression analyses demonstrated that older adults who were socially isolated and homebound showed a significantly higher risk of subsequent all-cause mortality compared with healthy adults who were neither socially isolated nor homebound, independent of potential covariates (aHR, 2.19; 95% CI: 1.04–4.63).

Conclusion:

Our results suggest that the co-existence of social isolation and homebound statuses may synergistically increase risk of mortality. Both active and socially integrated lifestyle in later life might play a major role in maintaining a healthy status.

Keywords

social isolationhomeboundmortalitysocial frailtyolder adults
Type
Original Research Article
Information
International Psychogeriatrics , Volume 31 , Issue 5: Issue Theme: Well-Being in Dementia , May 2019 , pp. 703 - 711
Copyright
© International Psychogeriatric Association 2018 

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Footnotes

*

These authors contributed equally to this work.

References

Andrew, M. K., Mitnitski, A., Kirkland, S. A. and Rockwood, K. (2012). The impact of social vulnerability on the survival of the fittest older adults. Age and Ageing, 41, 161–165.Google Scholar
Cohen, S., Doyle, W. J., Skoner, D. P., Rabin, B. S. and Gwaltney, J. M. Jr. (1997). Social ties and susceptibility to the common cold. JAMA, 277, 1940–1944.Google Scholar
Cohen-Mansfield, J., Shmotkin, D. and Hazan, H. (2010). The effect of homebound status on older persons. Journal American Geriatrics Society, 58, 2358–2362.Google Scholar
Dickens, A. P., Richards, S. H., Greaves, C. J. and Campbell, J. L. (2011). Interventions targeting social isolation in older people: a systematic review. BMC Public Health, 11, 647.Google Scholar
Fried, L. P. et al. (2004). A social model for health promotion for an aging population: initial evidence on the experience corps model. Journal of Urban Health, 81, 64–78.Google Scholar
Fujita, K., Fujiwara, Y., Chaves, P. H., Motohashi, Y. and Shinkai, S. (2006). Frequency of going outdoors as a good predictors for incident disability of physical function as well as disability recovery in community-dwelling older adults in rural Japan. Journal of Epidemiology, 16, 261–270.Google Scholar
Fujiwara, Y. et al. (2017). Synergistic or independent impacts of low frequency of going outside the home and social isolation on functional decline: a 4-year prospective study of urban Japanese older adults. Geriatrics & Gerontology International, 17, 500–508.Google Scholar
Fujiwara, Y. (2017). Definition and implications of social frailty. Geriatric Medicine, 55, 23–25.Google Scholar
Ganguli, M., Fox, A., Gilby, J. and Belle, S. (1996). Characteristics of rural homebound older adults: a community-based study. Journal American Geriatrics Society, 44, 363–370.Google Scholar
Garre-Olmo, J., Calvo-Perxas, L., Lopez-Pousa, S., de Gracia Blanco, M. and Vilalta-Franch, J. (2013). Prevalence of frailty phenotypes and risk of mortality in a community-dwelling elderly cohort. Age and Ageing, 42, 46–51.Google Scholar
Gobbens, R. J., van Assen, M. A., Luijkx, K. G., Wijnen-Sponselee, M. T. and Schols, J. M. (2010). Determinants of frailty. Journal of the American Medical Directors Association, 11, 356–364.Google Scholar
Hawthorne, G. (2008). Perceived social isolation in a community sample: its prevalence and correlates with aspects of peoples' lives. Social Psychiatry and Psychiatric Epidemiology, 43, 140–150.Google Scholar
Herr, M., Latouche, A. and Ankri, J. (2013). Homebound status increases death risk within two years in the elderly: results from a national longitudinal survey. Archives of Gerontology and Geriatrics, 56, 258–264.Google Scholar
Holt-Lunstad, J., Smith, T. B. and Layton, J. B. (2010). Social relationships and mortality risk: a meta-analytic review. PLoS Medicine, 7, 1–20.Google Scholar
Iliffe, S., Kharicha, K., Harari, D., Swift, C., Gillmann, G. and Stuck, A. E. (2007). Health risk appraisal in older people 2: the implications for clinicians and commissioners of social isolation risk in older people. British Journal of General Practice, 57, 277–282.Google Scholar
Jacobs, J. M., Cohen, A., Hammerman-Rozenberg, R., Azoulay, D., Maaravi, Y. and Stessman, J. (2008). Going outdoors daily predicts long-term functional and health benefits among ambulatory older people. Journal of Aging and Health, 20, 259–272.Google Scholar
Kawai, K. (2002). The social isolation of the elderly and social welfare services in Japan. The Journal of Social Policy and Labor Studies, 7, 118–131.Google Scholar
Kobayashi, E., Fujiwara, Y., Fukaya, T., Nishi, M., Saito, M. and Shinkai, S. (2011). Social support availability and psychological well-being among the socially isolated elderly. Differences by living arrangement and gender. Nihon Koshu Eisei Zasshi, 58, 446–456.Google Scholar
Kono, A., Kai, I., Sakato, C. and Rubenstein, L. Z. (2004). Frequency of going outdoors: a predictor of functional and psychosocial change among ambulatory frail elders living at home. The journals of gerontology. Series A, Biological sciences and medical sciences, 59, 275–280.Google Scholar
Koyano, W., Shibata, H., Nakazato, K., Haga, H. and Suyama, Y. (1991). Measurement of competence: reliability and validity of the TMIG index of competence. Archives of Gerontology and Geriatrics, 13, 103–116.Google Scholar
Lindesay, J. and Thompson, C. (1993). Housebound elderly people: definition, prevalence and characteristics. International Journal of Geriatric Psychiatry, 8, 231–237.Google Scholar
Locher, J. L., Ritchie, C. S., Roth, D. L., Baker, P. S., Bodner, E. V. and Allman, R. M. (2005). Social isolation, support, and capital and nutritional risk in an older sample: ethnic and gender differences. Social Science & Medicine, 60, 747–761.Google Scholar
Makizako, H. et al. (2015). Social frailty in community-dwelling older adults as a risk factor for disability. Journal of the American Medical Directors Association, 16, 1003.e1007–1003.e1011.Google Scholar
Rubinstein, R. L., Lubben, J. E. and Mintzer, J. E. (1994). Social isolation and social support: an applied perspective. Journal of Applied Gerontology, 13, 58–72.Google Scholar
Saito, M., Fujiwara, Y., Kobayashi, E., Fukaya, T., Nishi, M. and Shinkai, S. (2010). Prevalence and characteristics of social isolation in the elderly in a dormitory suburb according to household composition. Nihon Koshu Eisei Zasshi, 57, 785–795.Google Scholar
Saito, M., Kondo, K., Ojima, T. and Hirai, H. (2015). Criteria for social isolation based on associations with health indicators among older people. A 10-year follow-up of the Aichi gerontological evaluation study. Nihon Koshu Eisei Zasshi, 62, 95–105.Google Scholar
Sakurai, R. et al. (2014). Influential factors affecting age-related self-overestimation of step-over ability: focusing on frequency of going outdoors and executive function. Archives of Gerontology and Geriatrics, 59, 577–583.Google Scholar
Sakurai, R. et al. (2016). Long-term effects of an intergenerational program on functional capacity in older adults: results from a seven-year follow-up of the REPRINTS study. Archives of Gerontology and Geriatrics, 64, 13–20.Google Scholar
Sakurai, R. et al. (2017). Neural basis for the relationship between frequency of going outdoors and depressive mood in older adults. International Journal of Geriatric Psychiatry, 32, 589–595.Google Scholar
Sakurai, R. et al. (2018). Preventive effects of an intergenerational program on age-related hippocampal atrophy in older adults: the REPRINTS study. International Journal of Geriatric Psychiatry, 33, e264–e272.Google Scholar
Shankar, A., McMunn, A., Banks, J. and Steptoe, A. (2011). Loneliness, social isolation, and behavioral and biological health indicators in older adults. Health Psychology, 30, 377–385.Google Scholar
Soones, T., Federman, A., Leff, B., Siu, A. L. and Ornstein, K. (2017). Two-Year mortality in homebound older adults: an analysis of the national health and aging trends study. Journal of the American Geriatrics Society, 65, 123–129.Google Scholar
Steptoe, A., Shankar, A., Demakakos, P. and Wardle, J. (2013). Social isolation, loneliness, and all-cause mortality in older men and women. Proceedings of the National Academy of Sciences of the United States of America, 110, 5797–5801.Google Scholar
Valtorta, N. K., Kanaan, M., Gilbody, S., Ronzi, S. and Hanratty, B. (2016). Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart, 102, 1009–1016.Google Scholar