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      A Study of Social Isolation, Multimorbidity and Multiple Role Demands Among Middle-Age Adults Based on the Canadian Longitudinal Study on Aging

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          Abstract

          Given the increasing complexity and fluidity of parenting, caregiving, and paid work patterns, in tandem with an increased risk of multimorbidity in mid-life, this study examines the relationship between these three concurrent roles and social isolation among middle-aged persons across multimorbidity statuses. Drawing upon life course theory, we applied linear mixed models to analyze 29,847 middle-aged participants from two waves of the Canadian Longitudinal Study on Aging. Findings reveal that participants experience greater social isolation over time, albeit the difference is extremely small. Among participants without multimorbidity, holding multiple roles is associated with lower social isolation. For those with multimorbidity, being employed full-time and providing intensive care are associated with social isolation. The occurrence of multiple roles demonstrates unique associations with social isolation among those with and without multimorbidity over time. Future research should study multimorbidity as a salient contextual variable. Moreover, enhanced support is needed for multimorbid middle-aged individuals with different role demands.

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          Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study.

          Karen Barnett, Stewart Mercer, Michael Norbury … (2012)
          Long-term disorders are the main challenge facing health-care systems worldwide, but health systems are largely configured for individual diseases rather than multimorbidity. We examined the distribution of multimorbidity, and of comorbidity of physical and mental health disorders, in relation to age and socioeconomic deprivation. In a cross-sectional study we extracted data on 40 morbidities from a database of 1,751,841 people registered with 314 medical practices in Scotland as of March, 2007. We analysed the data according to the number of morbidities, disorder type (physical or mental), sex, age, and socioeconomic status. We defined multimorbidity as the presence of two or more disorders. 42·2% (95% CI 42·1-42·3) of all patients had one or more morbidities, and 23·2% (23·08-23·21) were multimorbid. Although the prevalence of multimorbidity increased substantially with age and was present in most people aged 65 years and older, the absolute number of people with multimorbidity was higher in those younger than 65 years (210,500 vs 194,996). Onset of multimorbidity occurred 10-15 years earlier in people living in the most deprived areas compared with the most affluent, with socioeconomic deprivation particularly associated with multimorbidity that included mental health disorders (prevalence of both physical and mental health disorder 11·0%, 95% CI 10·9-11·2% in most deprived area vs 5·9%, 5·8%-6·0% in least deprived). The presence of a mental health disorder increased as the number of physical morbidities increased (adjusted odds ratio 6·74, 95% CI 6·59-6·90 for five or more disorders vs 1·95, 1·93-1·98 for one disorder), and was much greater in more deprived than in less deprived people (2·28, 2·21-2·32 vs 1·08, 1·05-1·11). Our findings challenge the single-disease framework by which most health care, medical research, and medical education is configured. A complementary strategy is needed, supporting generalist clinicians to provide personalised, comprehensive continuity of care, especially in socioeconomically deprived areas. Scottish Government Chief Scientist Office. Copyright © 2012 Elsevier Ltd. All rights reserved.
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            Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies

            Nicole K Valtorta, Mona Kanaan, Simon Gilbody … (2016)
            Background The influence of social relationships on morbidity is widely accepted, but the size of the risk to cardiovascular health is unclear. Objective We undertook a systematic review and meta-analysis to investigate the association between loneliness or social isolation and incident coronary heart disease (CHD) and stroke. Methods Sixteen electronic databases were systematically searched for longitudinal studies set in high-income countries and published up until May 2015. Two independent reviewers screened studies for inclusion and extracted data. We assessed quality using a component approach and pooled data for analysis using random effects models. Results Of the 35 925 records retrieved, 23 papers met inclusion criteria for the narrative review. They reported data from 16 longitudinal datasets, for a total of 4628 CHD and 3002 stroke events recorded over follow-up periods ranging from 3 to 21 years. Reports of 11 CHD studies and 8 stroke studies provided data suitable for meta-analysis. Poor social relationships were associated with a 29% increase in risk of incident CHD (pooled relative risk: 1.29, 95% CI 1.04 to 1.59) and a 32% increase in risk of stroke (pooled relative risk: 1.32, 95% CI 1.04 to 1.68). Subgroup analyses did not identify any differences by gender. Conclusions Our findings suggest that deficiencies in social relationships are associated with an increased risk of developing CHD and stroke. Future studies are needed to investigate whether interventions targeting loneliness and social isolation can help to prevent two of the leading causes of death and disability in high-income countries. Study registration number CRD42014010225.
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              The life course as developmental theory.

              William G. Elder (1998)
              The pioneering longitudinal studies of child development (all launched in the 1920s and 1930s) were extended well beyond childhood. Indeed, they eventually followed their young study members up to the middle years and later life. In doing so, they generated issues that could not be addressed satisfactorily by available theories. These include the recognition that individual lives are influenced by their ever-changing historical context, that the study of human lives calls for new ways of thinking about their pattern and dynamic, and that concepts of human development should apply to processes across the life span. Life course theory has evolved since the 1960s through programmatic efforts to address such issues.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Aging Hum Dev
                Journal ID (iso-abbrev): Int J Aging Hum Dev
                Journal ID (publisher-id): AHD
                Journal ID (hwp): spahd
                Title: International Journal of Aging & Human Development
                Publisher: SAGE Publications (Sage CA: Los Angeles, CA )
                ISSN (Print): 0091-4150
                ISSN (Electronic): 1541-3535
                Publication date (Electronic): 12 October 2021
                Publication date (Print): April 2022
                Volume: 94
                Issue: 3
                Pages: 312-343
                Affiliations
                [1 ]Department of Gerontology, Gerontology Research Centre, Simon Fraser University, Vancouver, Canada
                [2 ]Gerontology Research Centre, Ringgold 33507, universitySimon Fraser University; , Vancouver, BC, Canada
                [3 ]Department of Gerontology & Department of Sociology/Anthropology, Ringgold 33507, universitySimon Fraser University; , Burnaby, BC, Canada
                Author notes
                [*]Andrew V. Wister, Gerontology Research Centre, Simon Fraser University, 2800-515 Hastings Street, Vancouver, BC, V6B 5K3, Canada. Email: wister@ 123456sfu.ca
                Author information
                https://orcid.org/0000-0002-0050-1193
                https://orcid.org/0000-0002-6311-9901
                Article
                Publisher ID: 10.1177_00914150211040451
                DOI: 10.1177/00914150211040451
                PMC ID: 8866749
                PubMed ID: 34636660
                SO-VID: fdbf765a-baf7-4953-8f5f-c2f43708fdf9
                Copyright © © The Author(s) 2021
                License:

                This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

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                Keywords: social isolation,multimorbidity,middle-life,multiple roles,caregiving,clsa
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                Keywords: social isolation, multimorbidity, middle-life, multiple roles, caregiving, clsa

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