ArticleJournal of the American Geriatrics Society2023
End-of-life health care use among socially isolated and cognitively impaired older adults.
Article in Journal of the American Geriatrics Society, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 12 citations in OpenAlex.
- Trajectories of Social Activity Engagement and Physical and Cognitive Function During the Last Years of Life.Journal of the American Geriatrics Society · 2026Article
- Associations of social isolation and loneliness with healthcare utilization among older adults: a systematic review and meta-analysis.Innovation in aging · 2026Review
- Development and Evaluation of a Brief Social Isolation Measure in the Nationally-Representative Health and Retirement Study.Journal of the American Geriatrics Society · 2025Article
- Loneliness and Social Isolation in the Care of the Seriously Ill Older Adult.Clinics in geriatric medicine · 2025Review
- Social connection and end-of-life outcomes among older people in 19 countries: a population-based longitudinal study.The lancet. Healthy longevity · 2024Article
- Loneliness and Social Isolation in Palliative Care: A Call to Action.Journal of palliative medicine · 2023Article
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
Abstract
backgroundSocial isolation is common in the last years of life, especially among individuals with cognitive impairment (CI), but it is unknown if social isolation is related to end-of-life health care use.
methodsWe used nationally-representative 2006-2018 Health and Retirement Study (HRS) data linked to Medicare claims, including adults age ≥65 interviewed in the last 4 years of life (N = 2380). We used a validated social isolation scale and three social isolation subscales: (1) household contacts (marital status, household size, nearby children), (2) social network interaction (with children, family, and friends), and (3) community engagement. End-of-life health outcomes included 2+ emergency department (ED) visits in the last month of life, hospitalizations or ICU stays in the last 6 months of life, and any hospice use. CI was defined using the validated Langa-Weir methodology. We used logistic regression to test the association of each social isolation measure with each end-of-life outcome, adjusted for sociodemographic covariates, and tested for interaction terms with CI (p < 0.2).
resultsThe mean age of our sample of decedents was 81.2 (SD = 9.9), 53% were female, 8% Black, and 4% Hispanic. Overall, social isolation and the community engagement subscale were not associated with end-of-life health care use. Fewer household contacts were associated with lower hospice use (aOR = 0.74, p = 0.005). There were significant interaction terms between the social network interaction subscale and CI for ED use (p = 0.009) and hospitalizations (p = 0.04), and a trend for ICU stays (p = 0.15); individuals with both low social network interaction and CI had lower health care use across all three outcomes compared to other groups.
conclusionsIndividuals with fewer household contacts had lower hospice use, and cognitively impaired individuals with low social network interaction had fewer end-of-life ED visits, hospitalizations, and ICU stays. Clinicians should consider mobilizing external support services to ensure access to goal-concordant care for older adults with limited end-of-life social contact when needed.
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