Social support after illness associated with better outcomes in older adults who live alone

U.S. researchers used data from the Health and Retirement Study to determine whether older adults who had a relative or friend to help with personal care if needed experienced better outcomes after new onset of a major illness or hospitalization.

Older adults who live alone may be more likely to avoid a prolonged nursing home stay after a health event if they have an identifiable source of social support, according to a new study.

U.S. researchers performed a longitudinal, prospective cohort study using data from the Health and Retirement Study to examine whether having identifiable support helps mitigate the effects of a health shock in older adults. They defined identifiable support as being able to identify a relative or friend who could help with personal care if needed and defined a health shock as hospitalization or a new diagnosis of cancer, stroke, or heart attack. The study's primary outcomes were incident dependency in activities of daily living (ADLs), prolonged nursing home stay (defined as ≥30 days), and death. The study results were published Nov. 15 by JAMA Internal Medicine.

From March 2006 to April 2015, the Health and Retirement Study enrolled 4,772 community-dwelling adults who were ages 65 years and older, lived alone, and could complete ADLs and instrumental ADLs independently. Participants were interviewed at baseline and every two years through April 2018. The median age was 73 years, and 71% were women. Mean follow-up was 4.9 years. At baseline, 1,813 participants (38%) could not identify a source of support, and 3,013 (63%) experienced a health shock during the study. Overall, participants who had support had a lower risk for a prolonged nursing home stay at two years than those who did not (predicted probability, 6.7% vs. 5.2%; P=0.002). When the researchers compared participants with support versus no support according to health shock, the predicted probability of a prolonged nursing home stay over two years was 1.9% versus 1.4% when no health shock occurred (P=0.21) and 14.2% versus 10.9% when it did (P=0.002). No association was seen between support and incident ADL dependence or death.

The researchers could not account for any changes to household status or social support after the baseline study interview and noted that their results may not be generalizable to different populations, among other limitations. They concluded that identifiable support among older adults was associated with lower risk for a prolonged nursing home stay after a health shock. “Supporting informal caregivers may meet the desires of many older adults to remain in the community and reduce nursing home costs borne by patients and insurers,” the authors wrote. “For the nearly 40% of older adults who live alone without identifiable support, we need to identify what type of support may be beneficial, especially following a health shock.”