In a recent study published in The Lancet Healthy Longevity, a gaggle 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 amongst older people in 19 countries: a population-based longitudinal study. Image Credit: belushi / Shutterstock

Background 

The importance of social connections on health, particularly in the ultimate stages of life, stays underexplored despite evidence suggesting its comparable impact on mortality to well-established risk aspects. 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 required to ascertain causal relationships and discover mechanisms by which social connections influence end-of-life outcomes, potentially guiding targeted interventions and policy development.

In regards to the study 

In the current study utilizing data from the Survey of Health, Ageing, and Retirement in Europe (SHARE), researchers comprehensively analyzed social connections within the latter stages of older people’s lives. SHARE, an intensive longitudinal study initiated in 2004, focuses on the health, social, and family networks of people 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 collect detailed insights into the deceased’s final yr, 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 trace changes in social connections from the fourth to the sixth wave and explore how these connections on the sixth wave could predict end-of-life outcomes recorded within the seventh wave. By adhering to an exploratory evaluation approach, the study sought to make clear the nuanced changes in social ties and their potential impact on end-of-life experiences, reminiscent of symptom management, healthcare utilization, and death location.

Participants on this study included deceased individuals from SHARE, specializing in those whose proxies could provide comprehensive end-of-life details, thereby ensuring data integrity. The methodology hinged on rigorous data collection and evaluation protocols, including face-to-face and telephone interviews, to make sure high-quality and reliable findings. Researchers utilized quite a lot of social connection measures and end-of-life outcomes to conduct their analyses, aiming to supply a holistic understanding of the role of social connections within the health and well-being of older adults nearing the top of life. 

Study results 

Within the study, researchers focused on the end-of-life experiences of three,662 individuals from 19 countries, as captured within the seventh wave of SHARE interviews conducted between 2017 and 2018. This cohort represented 87.5% of the participants identified as deceased at the moment, offering a wealthy dataset for evaluation of how social connections evolve and impact end-of-life outcomes. The researchers sought to know the changes within 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 probably the most common reason behind death, underscoring the prevalence of chronic conditions on this demographic. Proxy respondents, primarily female and infrequently the deceased’s partner or child, provided crucial insights into the participants’ final yr, revealing a pattern of close and frequent interactions.

The study uncovered significant shifts in social connections over time. Notably, by wave 6, the variety of participants who were married or in a partnership decreased, highlighting changes in social structures as individuals aged. Moreover, a rise in the supply of private care and practical help pointed to evolving functional needs inside social networks. A slight uptick in loneliness scores between the 2 waves suggested a growing challenge of emotional isolation amongst older individuals despite stable sizes and make contact with frequencies inside their social networks.

Analyzing the standard of those social connections, the researchers observed a marginal decline in overall satisfaction with social networks yet found a rise in emotional closeness, indicating a possible deepening of relationships despite broader network changes. 

The evaluation revealed that higher levels of loneliness were significantly related to increased odds of experiencing anxiety, sadness, and pain within the last month of life, suggesting a pivotal link between social isolation and end-of-life symptomatology. Moreover, marital status and the receipt of private care were predictors of dying in a hospital, pointing to the influence of social support structures on the placement of death. Interestingly, a bigger social network was correlated with a better likelihood of receiving hospice or palliative care, highlighting the potential advantages of broader social connections.