In a recent study published in The Lancet Healthy Longevity, a group of researchers investigated the changes in and impact of social connections on end-of-life outcomes, including symptoms, healthcare utilization, and place of death in older adults across 19 countries using longitudinal data.
Study: Social connection and end-of-life outcomes among older people in 19 countries: a population-based longitudinal study. Image Credit: belushi / Shutterstock
Background
The significance of social connections on health, particularly in the final stages of life, remains underexplored despite evidence suggesting its comparable impact on mortality to well-established risk factors. With aging populations facing increasing chronic illness, understanding the dynamic nature of social ties and their influence on end-of-life experiences, including symptoms, healthcare usage, and death's location, becomes crucial. Further research is needed to establish causal relationships and identify mechanisms by which social connections influence end-of-life outcomes, potentially guiding targeted interventions and policy development.
About the study
In the present study utilizing data from the Survey of Health, Ageing, and Retirement in Europe (SHARE), researchers comprehensively analyzed social connections in the latter stages of older people's lives. SHARE, an extensive longitudinal study initiated in 2004, focuses on the health, social, and family networks of individuals aged 50 and above across the European Union and has been collecting data biennially through structured interviews. Upon the death of a participant, SHARE conducts an end-of-life interview with a proxy to gather detailed insights into the deceased's final year, including health and social connectivity. This study specifically leveraged data from the seventh wave of SHARE interviews, conducted between 2017 and 2018, which included pertinent questions on symptoms and palliative care usage not covered in earlier waves.
The research aimed to track changes in social connections from the fourth to the sixth wave and explore how these connections at the sixth wave could predict end-of-life outcomes recorded in the seventh wave. By adhering to an exploratory analysis approach, the study sought to shed light on the nuanced changes in social ties and their potential impact on end-of-life experiences, such as symptom management, healthcare utilization, and death location.
Participants in this study included deceased individuals from SHARE, focusing on those whose proxies could provide comprehensive end-of-life details, thereby ensuring data integrity. The methodology hinged on rigorous data collection and analysis protocols, including face-to-face and telephone interviews, to ensure high-quality and reliable findings. Researchers utilized a variety of social connection measures and end-of-life outcomes to conduct their analyses, aiming to provide a holistic understanding of the role of social connections in the health and well-being of older adults nearing the end of life.
Study results
In the study, researchers focused on the end-of-life experiences of 3,662 individuals from 19 countries, as captured in the seventh wave of SHARE interviews conducted between 2017 and 2018. This cohort represented 87.5% of the participants identified as deceased at that time, offering a rich dataset for analysis of how social connections evolve and impact end-of-life outcomes. The researchers sought to understand the changes in the structure, function, and quality of social connections as individuals approached their final years, drawing from data across two critical waves (waves 4 and 6) before analyzing their influence on end-of-life experiences.
The participants, whose mean age at death was 79.7 years, showcased a diversity of social and health profiles. Cardiovascular diseases emerged as the most common cause of death, underscoring the prevalence of chronic conditions in this demographic. Proxy respondents, primarily female and often the deceased's partner or child, provided crucial insights into the participants' final year, revealing a pattern of close and frequent interactions.
The study uncovered significant shifts in social connections over time. Notably, by wave 6, the number of participants who were married or in a partnership decreased, highlighting changes in social structures as individuals aged. Additionally, an increase in the provision of personal care and practical help pointed to evolving functional needs within social networks. A slight uptick in loneliness scores between the two waves suggested a growing challenge of emotional isolation among older individuals despite stable sizes and contact frequencies within their social networks.
Analyzing the quality of these social connections, the researchers observed a marginal decline in overall satisfaction with social networks yet found an increase in emotional closeness, indicating a possible deepening of relationships despite broader network changes.
The analysis revealed that higher levels of loneliness were significantly associated with increased odds of experiencing anxiety, sadness, and pain in the last month of life, suggesting a pivotal link between social isolation and end-of-life symptomatology. Furthermore, marital status and the receipt of personal care were predictors of dying in a hospital, pointing to the influence of social support structures on the location of death. Interestingly, a larger social network was correlated with a higher likelihood of receiving hospice or palliative care, highlighting the potential benefits of broader social connections.
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