Health Outcomes Associated with Loneliness and Social Isolation in Older Adults Living with HIV: A Systematic Review.

Self-management of HIV is crucial to reduce disease-related negative health outcomes. Loneliness and social isolation are associated with poor disease self-management (e.g., medication non-adherence and care disengagement) in younger people with HIV and negative health outcomes in the general older adult population. Older adults with HIV (OWH) are at increased risk for loneliness and social isolation, but the associated health outcomes remain unclear. A comprehensive review of Pubmed, Embase, PsycINFO, and Web of Science databases was conducted. Criteria for inclusion were original quantitative research, published in the English language, included adults with a mean age ≥ 50 years, and included a measure for loneliness or social isolation, and a health outcome measure. A total of 41 studies were analyzed and 19,282 participants contributed to this review. The main findings were that loneliness and social isolation were associated with negative health behavior, disease self-management, physiological, and psychological outcomes. Pooled prevalence of loneliness was 33.9% across 8 studies. Loneliness and social isolation are highly prevalent in OWH and are associated with negative outcomes in OWH, similarly to older adults in the general population. Older adults with HIV, however, are challenged by unique psychosocial circumstances that place them at greater risk for loneliness and social isolation and associated negative health outcomes. These findings should be verified in larger, diverse, and longitudinal samples to better understand interrelationships of psychosocial factors and clinical outcomes in OWH.

A Protocol-Driven, Bedside Digital Conversational Agent to Support Nurse Teams and Mitigate Risks of Hospitalization in Older Adults: Case Control Pre-Post Study.

BACKGROUND: Hospitalized older adults often experience isolation and disorientation while receiving care, placing them at risk for many inpatient complications, including loneliness, depression, delirium, and falls. Embodied conversational agents (ECAs) are technological entities that can interact with people through spoken conversation. Some ECAs are also relational agents, which build and maintain socioemotional relationships with people across multiple interactions. This study utilized a novel form of relational ECA, provided by Care Coach (care.coach, inc): an animated animal avatar on a tablet device, monitored and controlled by live health advocates. The ECA implemented algorithm-based clinical protocols for hospitalized older adults, such as reorienting patients to mitigate delirium risk, eliciting toileting needs to prevent falls, and engaging patients in social interaction to facilitate social engagement. Previous pilot studies of the Care Coach avatar have demonstrated the ECA's usability and efficacy in home-dwelling older adults. Further study among hospitalized older adults in a larger experimental trial is needed to demonstrate its effectiveness. OBJECTIVE: The aim of the study was to examine the effect of a human-in-the-loop, protocol-driven relational ECA on loneliness, depression, delirium, and falls among diverse hospitalized older adults. METHODS: This was a clinical trial of 95 adults over the age of 65 years, hospitalized at an inner-city community hospital. Intervention participants received an avatar for the duration of their hospital stay; participants on a control unit received a daily 15-min visit from a nursing student. Measures of loneliness (3-item University of California, Los Angeles Loneliness Scale), depression (15-item Geriatric Depression Scale), and delirium (confusion assessment method) were administered upon study enrollment and before discharge. RESULTS: Participants who received the avatar during hospitalization had lower frequency of delirium at discharge (P<.001), reported fewer symptoms of loneliness (P=.01), and experienced fewer falls than control participants. There were no significant differences in self-reported depressive symptoms. CONCLUSIONS: The study findings validate the use of human-in-the-loop, relational ECAs among diverse hospitalized older adults.

Longitudinal Associations of Social Support and Gait Speed Decline in Aging.

BACKGROUND: Social support predicts functional and cognitive decline in aging. Yet, the associations between social support and gait speed decline-a functional vital sign-are not well understood. This study examined associations between social support and gait speed decline in aging. METHODS: Social support and gait data from 542 older adults without dementia were examined (mean age 76.1 ±â€…6.5 years). Baseline emotional support, tangible support, affectionate support, positive social interactions, and overall support from the Medical Outcomes Study Social Support Survey were the predictors of interest. Annual change in simple (normal pace walking) and complex (walking while reciting alternate letters of the alphabet) gait speed (cm/s) were the outcomes of interest. Linear mixed effects models examined associations between social support and gait speed decline, after adjusting for gender, race, depressive symptoms, overall cognition, and comorbidities. RESULTS: The mean annual change in gait speed was 1.8 cm/s during simple walking and 1.13 cm/s during complex walking. Tangible support was the only category of social support that predicted decline in simple and complex gait speed over a median follow-up of 3 years. The annual decline in gait speed was 0.51 cm/s (p = .008, 95% confidence intervals [CI] 0.13, 0.89) and 0.58 cm/s (p = .007, CI 0.16, 1.0) greater among those with low tangible support than in those with high tangible support during simple and complex walking, respectively. CONCLUSIONS: Tangible support is a potentially modifiable risk factor for gait speed decline. Further study is needed to examine mechanisms behind the observed associations and the potential for intervention.

Difference-Making Pathways to Frailty Through Social Factors: A Configurational Analysis.

BACKGROUND AND OBJECTIVES: Social disconnection is highly prevalent in older adults and is associated with frailty. It is unclear which aspects of social disconnection are most associated with frailty, which ones are difference-making, and which combination of social factors are directly linked to frailty. RESEARCH DESIGN AND METHODS: We conducted a secondary coincidence analysis (CNA) of 1,071 older adults from the Rush Memory and Aging Project (mean age 79.3 ± 7.1; 75.8% female) to identify combinations of social factors that are difference-making for frailty. We included 7 demographic (e.g., age, sex, socioeconomic status) and structural (e.g., social network), functional (e.g., social support, social activity), and quality (e.g., loneliness) aspects of social connection. An established cut score of 0.2 on a frailty index was used to define frailty as the outcome. RESULTS: CNA produced 46 solution models for the presence of frailty in the data set. The top-scoring model was underfit, leaving a final complex solution path for frailty with the highest fit-robustness score that met the fit parameter cutoffs. We found that the combination of loneliness, low social activity, and older age was present 82% of the time when frailty was present. DISCUSSION AND IMPLICATIONS: The combination of loneliness, social activity, and old age is difference-making for frailty, and supports the inclusion of social factors in frailty prevention and intervention. Further research is needed in diverse data sets to better understand the interrelationships between the 3 aspects of social connection and frailty.

Loneliness predicts decreased physical activity in widowed but not married or unmarried individuals.

Background: Physical activity is associated with improved health and function in older adults, yet most older adults are sedentary. Loneliness is associated with decreased physical activity at the cross-section, but longitudinal studies are scarce. We examined longitudinal associations between loneliness and physical activity-and whether they were modified by marital status and network size (the number of children, relatives, and friends a person interacts with at least once a month). Methods: We analyzed data from 1,931 older adults without dementia at baseline from the Rush Memory and Aging Project with a mean follow-up of 4.8 years (mean age 79.6 ± 7.7, 74.9% women). Loneliness was assessed using the de Jong Gierveld Loneliness Scale. Physical activity was assessed as the frequency with which participants engaged in five categories of activities (e.g., walking, gardening, calisthenics, bicycling, and swimming). Linear mixed effects models examined associations between baseline loneliness and change in physical activity over time after adjusting for demographics, depressive symptoms, global cognition, disability, network size, marital status, social support, and social and cognitive activities. We assessed for effect modification by marital status and network size. Results: Associations between loneliness and physical activity differed by marital status. In widowed individuals, baseline loneliness was associated with a 0.06 h/week greater decrease in physical activity per year compared to those who were not lonely (p = 0.005, CI -0.1, 0.02)-which equaled a 150% decrease in physical activity per year. Loneliness did not predict a statistically significant decrease in physical activity in married or unmarried individuals. Discussion: Loneliness is associated with decreased physical activity in widowed older adults and should be considered in the design of interventions to prevent or slow the decline in physical activity and promote healthy aging.

Loneliness and Functional Decline in Aging: A Systematic Review.

Loneliness is prevalent in adults aged ≥65 years in the United States and is associated with functional decline. The purpose of the current review was to synthesize evidence on the relationship between loneliness and functional decline using Roy's Adaptation Model as a theoretical framework. A comprehensive review of PubMed, Medline, and Embase databases was performed. Inclusion criteria were samples including adults primarily aged >60 years, peer-reviewed, published in the English language, and included a measure for loneliness and function. A total of 47 studies were analyzed. Most studies examined correlates, risk factors, and predictors of loneliness, rather than the relationship between loneliness and function. Evidence suggests there is bidirectionality in the relationship between loneliness and functional decline. Loneliness is associated with functional decline in aging via multiple possible pathways. Further studies are needed to determine causality and biological mechanisms underlying the relationship. [Research in Gerontological Nursing, 16(4), 202-212.].

Effect of a Robotic Pet on Social and Physical Frailty in Community-Dwelling Older Adults: A Randomized Controlled Trial.

The current randomized controlled trial investigated the effect of a robotic pet on social and physical frailty in community-dwelling older adults. The intervention group (n = 107) received a robotic pet and the control group (n = 113) received usual care following hospital discharge. Social and physical frailty were measured using the Questionnaire to Define Social Frailty Status and the FRAIL questionnaire. Cognitive function and depression were assessed using the Short Portable Mental Status Questionnaire and Geriatric Depression Scale, respectively. Continuous outcomes were compared between groups using t tests or Wilcoxon rank sum tests, as appropriate. Categorical outcomes were compared between groups using chi-square tests or Fisher's exact tests, as appropriate. Main findings showed the robotic pet positively impacted cognitive status in participants who reported they enjoyed engaging with their pet. This finding supported the theoretical premise of the current study that greater engagement with the robotic pet would yield greater improvement in study outcomes. [Research in Gerontological Nursing, 15(5), 229-237.].