Nov. 16 (UPI) — Older adults who report being lonely face a higher risk of death within 30 days after non-elective surgery, highlighting the need for better recovery and support strategies, a large study of Medicare patients suggests.
In a research letter published Wednesday in JAMA Surgery, a team of investigators from the University of Michigan noted that more than 40% of older adults regularly experience loneliness — and loneliness has been associated with an increased risk of medical conditions including stroke, cardiovascular disease and dementia — and early death.
And yet, it has remained unclear whether loneliness influences post-operative outcomes, and if so, how to optimize support for seniors following surgery.
The study involved a retrospective analysis of data from the Health and Retirement Study, linked with Medicare claims from 2004 to 2016. It included roughly 4,400 Medicare patients, averaging 75 years old, who underwent general, plastic, vascular or gynecological surgery.
Loneliness was calculated based on participants’ self-reporting on a standardized survey asking about lack of companionship, feeling left out, and feeling isolated from others; and researchers looked at 30-day mortality following surgery.
Overall, 36 of 3,830 patients, or 0.9%, of people in the group who underwent elective surgery, and 46 of 623, or 7.4%, in the non-elective surgery group, died.
According to the researchers, loneliness was not associated with 30-day mortality among patients undergoing elective surgery.
But among those patients undergoing non-elective surgery, loneliness was associated with greater risk of death at 30 days: the odds of death increased by 76% for every incremental point increase in the standardized survey’s self-reported loneliness score.
The major takeaway is that “emotional health plays an important role in a patient’s overall well-being and that we may be overlooking its significance in health outcomes,” Dr. Pasithorn A. Suwanabol, a study co-author, told UPI in an email.
The study’s findings are not surprising since “many studies support the notion that psychosocial support improves medical and surgical outcomes and the absence of it is negatively associated with them,” said Suwanabol, an assistant professor in surgery at the University of Michigan who has a clinical practice at the Ann Arbor Veterans Affairs Healthcare System.
According to the study, most participants didn’t have other mental health disorders or symptoms of depression, most were married and lived with or near their children, and most were middle-class and not living in poverty.
Yet, Suwanabol said, “we have to be mindful that loneliness is the perception of isolation or a gap in social connection rather than actual experience. So, even in those with spouses or children, loneliness may still be experienced.”
The investigators said the research highlights the need for better intervention. Potential strategies might include closer postoperative follow-up, either in-person or remotely.
They added that so-called “care navigators,” who help patients navigate the complexities of the healthcare system, or community networks such as Meals on Wheels, could be used early on in post-operative period to provide better support.
The researchers noted that self-reporting of loneliness is considered to be highly accurate.
One of the study’s limitations is that loneliness was assessed when the survey was given, not at the time of surgery, the investigators said. Such timing “may impact our findings and may not reflect the transient nature or context of one experiencing or feeling lonely,” Suwanabol said.
“Loneliness may also be a proxy for social frailty or vulnerability, which is defined as insufficient resources to fulfill basic social needs,” she added, citing her earlier research exploring how social deprivation led to poorer surgical outcomes among older cancer patients.
