Association of Social Support With Functional Outcomes in Older Adults Who Live Alone

Abstract

Importance: Older adults who live alone are at risk for poor health outcomes. Whether social support mitigates the risk of living alone, particularly when facing a sudden change in health, has not been adequately reported.

Objective: To assess if identifiable support buffers the vulnerability of a health shock while living alone.

Design, setting, and participants: In this longitudinal, prospective, nationally representative cohort study from the Health and Retirement Study (enrollment March 2006 to April 2015), 4772 community-dwelling older adults 65 years or older who lived alone in the community and could complete activities of daily living (ADLs) and instrumental ADLs independently were followed up biennially through April 2018. Statistical analysis was completed from May 2020 to March 2021.

Exposures: Identifiable support (ie, can the participant identify a relative/friend who could help with personal care if needed), health shock (ie, hospitalization, new diagnosis of cancer, stroke, heart attack), and interaction (multiplicative and additive) between the 2 exposures.

Main outcomes and measures: The primary outcomes were incident ADL dependency, prolonged nursing home stay (≥30 days), and death.

Results: Of 4772 older adults (median [IQR] age, 73 [68-81] years; 3398 [71%] women) who lived alone, at baseline, 1813 (38%) could not identify support, and 3013 (63%) experienced a health shock during the study. Support was associated with a lower risk of a prolonged nursing home stay at 2 years (predicted probability, 6.7% vs 5.2%; P = .002). Absent a health shock, support was not associated with a prolonged nursing home stay (predicted probability over 2 years, 1.9% vs 1.4%; P = .21). However, in the presence of a health shock, support was associated with a lower risk of a prolonged nursing home stay (predicted probability over 2 years, 14.2% vs 10.9%; P = .002). Support was not associated with incident ADL dependence or death.

Conclusions and relevance: In this longitudinal cohort study among older adults who live alone, identifiable support was associated with a lower risk of a prolonged nursing home stay in the setting of a health shock.

Figure.. Association of Identifiable Support and Functional Outcomes in Older Adults Who Live Alone Stratified by Health Shock, Adjusted

When examining death and disability, there was no significant interaction between support and health shock. When examining nursing home stay, there was an additive interaction between support and health shock. Those without identifiable support had an excess risk of nursing home stay. Support was defined as answering “yes” to the question, “Suppose in the future, you needed help with basic personal care activities like eating or dressing. Do you have relatives or friends besides your spouse/partner who would be willing and able to help you over a long period of time?” Health shock was defined as hospital stay of 2 or more days, new cancer diagnosis, new stroke, or new heart attack. The predicted likelihood is a population estimate adjusted for age, sex, race and ethnicity, education, income, pain, visual impairment, hearing impairment, hypertension, cancer diagnosis, lung disease, heart disease, stroke, arthritis, cognitive impairment, and activities of daily living (ADL) difficulty. Full regression results can be found in eTables 6-8 of the Supplement.