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      Older Adults’ Social Relationships and Health Care Utilization: A Systematic Review

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          Abstract

          <p class="first" id="d13233805e150"> <b>Background.</b> Deficiencies in older people’s social relationships (including loneliness, social isolation, and low social support) have been implicated as a cause of premature mortality and increased morbidity. Whether they affect service use is unclear. </p><p id="d13233805e155"> <b>Objectives.</b> To determine whether social relationships are associated with older adults’ use of health services, independently of health-related needs. </p><p id="d13233805e160"> <b>Search Methods.</b> We searched 8 electronic databases (MEDLINE, Embase, CINAHL, Web of Science, PsycINFO, Scopus, the Cochrane Library, and the Centre for Reviews and Dissemination) for data published between 1983 and 2016. We also identified relevant sources from scanning the reference lists of included studies and review articles, contacting authors to identify additional studies, and searching the tables of contents of key journals. </p><p id="d13233805e165"> <b>Selection Criteria.</b> Studies met inclusion criteria if more than 50% of participants were older than 60 years or mean age was older than 60 years; they included a measure of social networks, received social support, or perceived support; and they reported quantitative data on the association between social relationships and older adults’ health service utilization. </p><p id="d13233805e170"> <b>Data Collection and Analysis.</b> Two researchers independently screened studies for inclusion. They extracted data and appraised study quality by using standardized forms. In a narrative synthesis, we grouped the studies according to the outcome of interest (physician visits, hospital admissions, hospital readmissions, emergency department use, hospital length of stay, utilization of home- and community-based services, contact with general health services, and mental health service use) and the domain of social relationships covered (social networks, received social support, or perceived support). For each service type and social relationship domain, we assessed the strength of the evidence across studies according to the quantity and quality of studies and consistency of findings. </p><p id="d13233805e175"> <b>Main Results.</b> The literature search retrieved 26 077 citations, 126 of which met inclusion criteria. Data were reported across 226 678 participants from 19 countries. We identified strong evidence of an association between weaker social relationships and increased rates of readmission to hospital (75% of high-quality studies reported evidence of an association in the same direction). In evidence of moderate strength, according to 2 high-quality and 3 medium-quality studies, smaller social networks were associated with longer hospital stays. When we considered received and perceived social support separately, they were not linked to health care use. Overall, the evidence did not indicate that older patients with weaker social relationships place greater demands on ambulatory care (including physician visits and community- or home-based services) than warranted by their needs. </p><p id="d13233805e180"> <b>Authors’ Conclusions.</b> Current evidence does not support the view that, independently of health status, older patients with lower levels of social support place greater demands on ambulatory care. Future research on social relationships would benefit from a consensus on clinically relevant concepts to measure. </p><p id="d13233805e185"> <b>Public Health Implications.</b> Our findings are important for public health because they challenge the notion that lonely older adults are a burden on all health and social care services. In high-income countries, interventions aimed at reducing social isolation and loneliness are promoted as a means of preventing inappropriate service use. Our review cautions against assuming that reductions in care utilization can be achieved by intervening to strengthen social relationships. </p>

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          Most cited references 112

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          Social support and patient adherence to medical treatment: a meta-analysis.

          In a review of the literature from 1948 to 2001, 122 studies were found that correlated structural or functional social support with patient adherence to medical regimens. Meta-analyses establish significant average r-effect sizes between adherence and practical, emotional, and unidimensional social support; family cohesiveness and conflict; marital status; and living arrangement of adults. Substantive and methodological variables moderate these effects. Practical support bears the highest correlation with adherence. Adherence is 1.74 times higher in patients from cohesive families and 1.53 times lower in patients from families in conflict. Marital status and living with another person (for adults) increase adherence modestly. A research agenda is recommended to further examine mediators of the relationship between social support and health.
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            Social relationships and risk of dementia: A systematic review and meta-analysis of longitudinal cohort studies.

            It is unclear to what extent poor social relationships are related to the development of dementia. A comprehensive systematic literature search identified 19 longitudinal cohort studies investigating the association between various social relationship factors and incident dementia in the general population. Relative risks (RRs) with 95% confidence intervals (CIs) were pooled using random-effects meta-analysis. Low social participation (RR: 1.41 (95% CI: 1.13-1.75)), less frequent social contact (RR: 1.57 (95% CI: 1.32-1.85)), and more loneliness (RR: 1.58 (95% CI: 1.19-2.09)) were statistically significant associated with incident dementia. The results of the association between social network size and dementia were inconsistent. No statistically significant association was found for low satisfaction with social network and the onset of dementia (RR: 1.25 (95% CI: 0.96-1.62). We conclude that social relationship factors that represent a lack of social interaction are associated with incident dementia. The strength of the associations between poor social interaction and incident dementia is comparable with other well-established risk factors for dementia, including low education attainment, physical inactivity, and late-life depression.
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              Social Relationships and Health

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                Author and article information

                Journal
                American Journal of Public Health
                Am J Public Health
                American Public Health Association
                0090-0036
                1541-0048
                April 2018
                April 2018
                : 108
                : 4
                : e1-e10
                Affiliations
                [1 ]Nicole K. Valtorta, Lynn Barron, Daniel Stow, and Barbara Hanratty are with the Institute of Health and Society/Newcastle University Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom. Danielle Collingridge Moore is with the International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom.
                Article
                10.2105/AJPH.2017.304256
                5844393
                29470115
                © 2018

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