Evidence map›Paper›PMID 34247388›Full record

ArticleJournal of the American Geriatrics Society2021

The epidemiology of social isolation and loneliness among older adults during the last years of life.

Ashwin A Kotwal, Irena S Cenzer, Linda J Waite, Kenneth E Covinsky, Carla M Perissinotto, W John Boscardin, Louise C Hawkley, William Dale, Alexander K Smith

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American Geriatrics Society, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 68 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
68citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

68 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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  10. Loneliness Subtypes and Their Association With Prevalent and Incident Dementia.Journal of applied gerontology : the official journal of the Southern Gerontological Society · 2026
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8 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

Ashwin A KotwalDivision of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.ORCID 0000-0002-6137-8512
Irena S CenzerDivision of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.
Linda J WaiteDepartment of Sociology, University of Chicago, Chicago, Illinois, USA.
Kenneth E CovinskyDivision of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.
Carla M PerissinottoDivision of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.
W John BoscardinDivision of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.
Louise C HawkleyNational Opinion Research Center, University of Chicago, Chicago, Illinois, USA.
William DaleDepartment of Supportive Care Medicine, City of Hope National Medical Center, Duarte, California, USA.
Alexander K SmithDivision of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.

Funding

Residing in the Community with Dementia at the End of Life: Understanding Hospice Use and Residential SettingP30AG028741 · NIA · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · PI ALBERT L SIU · 2010 to 2026
$21.9M
VARC CoreP30AG044281 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Louise C. Walter · 2013 to 2026
$19.9M
Unnecessary and Harmful Medication Use in Older Adults with DementiaP01AG066605 · NIA · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · PI MELISSA Diane ALDRIDGE · 2020 to 2026
$17.7M
Mentoring the Next Generation of Geriatric Oncology Researchers in Patient-Oriented Research to Improve the Care of Older Adults with CancerK24AG055693 · NIA · BECKMAN RESEARCH INSTITUTE/CITY OF HOPE · PI WILLIAM DALE · 2018 to 2026
$1.4M
Loneliness and Social Isolation Among Older Adults with and without Alzheimer's Disease and Related Dementia in the Last Years of LifeK23AG065438 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI KOTWAL, ASHWIN AJIT · 2020 to 2024
$809k
Loneliness and Social Isolation among Older Adults in the Last Years of LIfeR03AG064323 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI KOTWAL, ASHWIN AJIT · 2019 to 2020
$242k
NIA NIH HHS K23 AG065438NIA NIH HHS K23AG065438NIA NIH HHS K24 AG055693NIA NIH HHS P01 AG066605NIA NIH HHS P30 AG028741NIA NIH HHS P30 AG044281NIA NIH HHS P30AG044281NIA NIH HHS R03 AG064323NIA NIH HHS R03AG064323
6 · The paper itself

Abstract

backgroundSocial isolation and loneliness are critical to the health of older adults, but they have not been well-described at the end of life.

objectivesTo determine the prevalence and correlates of social isolation and loneliness among older adults in the last years of life.

designNationally representative, cross-sectional survey.

settingHealth and Retirement Study, 2006-2016 data.

participantsAdults age > 50 interviewed once in the last 4 years of life (n = 3613). MEASUREMENTS: We defined social isolation using a 15-item scale measuring household contacts, social network interaction, and community engagement, and frequent loneliness using the 3-item UCLA Loneliness Scale. We used multivariable logistic regression to determine their adjusted prevalence by time prior-to-death and by subgroups of interest.

resultsApproximately 19% experienced social isolation, 18% loneliness, and 5% both in the last 4 years of life (correlation = 0.11). The adjusted prevalence of social isolation was higher for individuals nearer to death (4 years: 18% vs 0-3 months: 27%, p = 0.05) and there was no significant change in loneliness (4 years: 19% vs 0-3 months: 23%, p = 0.13). Risk factors for both isolation and loneliness included (p < 0.01): low net-worth (Isolation: 34% vs 14%; Loneliness: 29% vs 13%), hearing impairment (Isolation: 26% vs 20%; Loneliness: 26% vs 17%), and difficulty preparing meals (Isolation: 27% vs 19%; Loneliness: 29% vs 15%). Factors associated with loneliness, but not social isolation, included being female, pain, incontinence, and cognitive impairment.

conclusionsSocial isolation and loneliness are common at the end of life, affecting 1 in 4 older adults, but few experience both. Rates were higher for older adults who were poor and experienced functional or sensory impairments. Results can inform clinical efforts to identify and address end-of-life psychosocial suffering and health policies which prioritize social needs at the end of life.

Indexed as

DeathAgedAged, 80 and overCross-Sectional StudiesEpidemiologyFemaleHearing LossHumansLonelinessMaleMiddle AgedRisk FactorsSex FactorsSocial IsolationSurveys and Questionnairescognitionend of lifelonelinesspalliative caresocial isolation

Identifiers

PMID34247388
PMCPMC8595510

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.