Longitudinal associations of loneliness and social isolation with care dependence among older adults in Latin America and China: A 10/66 dementia research group population-based cohort study.

OBJECTIVES: With increasing life expectancy and rapid ageing, there is an expanding number of older people who have functional declines, greater needs for care and support and who are at increased risk of insufficient social interaction. Longitudinal investigations on the interplay between loneliness, social isolation and care dependence remain limited. This study thus aimed to investigate the longitudinal reciprocal association between social isolation/loneliness and care dependence among older adults in Latin America and China. METHODS: We analysed data from the population-based cohorts from the 10/66 Dementia Research Group (DRG) project (baseline 2003-07 and follow-up 2007-2010). The 10/66 DRG study recruited and followed up older adults aged 65 years or above in 11 catchment areas in Latin America and China. A total of 15,027 older adults from Latin America and China (mean age = 73.5, standard deviation = 6.5) were included in our analyses. Cross-lagged panel models were used to investigate potential reciprocal associations. RESULTS: Loneliness was positively associated with care dependence at baseline (ß = 0.11, p < 0.001 in Latin America; ß = 0.16, p < 0.05 in China]. Social isolation consistently had a stronger positive association with care dependence across all study sites in both waves. Longitudinally, care dependence positively predicted loneliness (ß = 0.10, p < 0.001) and social isolation (ß = 0.05, p < 0.001) in Latin American study sites but not in China. Yet there was no statistical evidence of lagged effects of loneliness and social isolation on care dependence in all study countries. CONCLUSIONS: Older people with care dependence are at risk of developing loneliness and social isolation. It is crucial to develop complex care models using a societal approach to address social and care needs holistically, especially for the older group with declining functional capacity. Future longitudinal research is required to explore the causal mechanisms of relationships and cultural differences, in order to inform the development of culturally appropriate care models.

Study protocol for a cross-sectional online survey investigating patient preferences and experiences of waiting for elective cardiac surgery.

INTRODUCTION: Being on a waiting list for elective (planned) cardiac surgery can be physically and psychologically challenging for patients. Research suggests that stress associated with waiting for surgery is dependent on different individual and contextual factors. However, most data on patients' experiences of waiting for surgery and preferences for waiting list management derives from non-cardiac clinical populations. The aim of the current study is to explore patients' experiences of being on a waiting list for elective cardiac surgery, and their views on how the waiting experience could be improved in the future. This work will inform the patient management strategy during the waiting period for surgery across the four major hospitals in London directly involved in this study, and potentially beyond by transferring learning to other services. METHODS AND ANALYSIS: This is a mixed-methods study that will collect quantitative and qualitative data using a cross-sectional online survey. Patients who are on waiting lists for elective surgery across four major cardiac surgery departments in London hospitals, and are at least 18 years old, will be invited by their healthcare team via text message or letter to complete the survey. The target sample size of non-randomly selected participants will be 268. Bivariable and multivariable regression models will be used to assess associations between survey items measuring the impact of the cardiac condition on specific life domains (eg, daily activities, social and family relationships, hobbies, sexual life), anxiety and depression symptoms as measured by the Patient Health Questionnaire-4 and survey items evaluating experiences of health services. Data on experience and preferences for improvements to the waiting experience will be analysed with qualitative content analysis using an inductive approach. ETHICS AND DISSEMINATION: This study was reviewed and granted ethical approval by the East of England-East Cambridge Research Ethics Committee. Findings from this study will be disseminated through peer-reviewed journals, a research website and social media and with an online event engaging patients, members of the public, healthcare professionals and other relevant stakeholders. TRIAL REGISTRATION NUMB: NCT05996640.