Advance Care Planning: Social Isolation Matters

Area of Science:

• Gerontology
• Public Health
• Sociology

Background:

• Social isolation is a significant risk factor impacting the health and well-being of older adults.
• Understanding the relationship between social isolation and healthcare decisions is crucial for geriatric care.

Purpose of the Study:

• To compare advance care planning (ACP) engagement among older adults with varying degrees of social isolation: severely isolated, socially isolated, and not socially isolated.
• To examine the association between social isolation and engagement in key components of ACP.

Main Methods:

• Cross-sectional analysis of the 2012 National Health and Aging Trends Study (NHATS) involving 2015 community-dwelling Medicare beneficiaries aged 65 and older.
• Participants were categorized by social isolation levels. ACP engagement was measured by end-of-life (EOL) discussion, durable power of attorney (DPOA), and advance directive (AD).
• Logistic regression analyses were performed to assess the association between social isolation and ACP.

Main Results:

• Approximately 23% of older adults reported severe or social isolation.
• Older adults experiencing social isolation were significantly less likely to engage in ACP compared to their non-isolated peers.
• Adjusted analyses revealed lower odds of EOL discussions (AOR=0.65) and DPOA (AOR=0.71) among socially isolated individuals.

Conclusions:

• Social isolation is demonstrably associated with lower rates of engagement in advance care planning among older adults.
• Healthcare providers should proactively identify older adults at risk for or experiencing social isolation.
• Targeted ACP interventions for socially isolated older adults may improve their end-of-life care planning and outcomes.