Project Description
Social Health among Older Adults in the Last Years of Life
Loneliness
and social isolation are related, but distinct, social risk factors critical to
the health of older adults in their last years of life. Loneliness is a
subjective feeling of being alone and occurs in nearly 20 million adults over
60 years old, whereas social isolation is an objective loss in the number of
relationships with family, friends, or the community, and occurs in nearly 9
million adults over 60 years old. Both social risk factors are independently
associated with poor health outcomes relevant to late life such as depression,
functional impairment, and mortality. However, loneliness and social isolation
have been largely unexplored in palliative care literature. Our objective is
therefore to establish the epidemiology of loneliness and social isolation in
the last years of life among older adults and determine their association with
intensive health care use at the end of life. Using a U.S.
nationally-representative cohort of 2,282 older adults who died within two
years of responding to questions about loneliness and social isolation we
investigate two specific aims: 1) to determine the prevalence and predictors of
loneliness and social isolation during the last two years of life, and 2) to
determine the relationship between loneliness and social isolation with health
service use, including hospice use, ICU use, and ED visits, at the end of life
using Medicare claims data. This proposal will provide valuable real-world
clinical data on the prevalence of two frequently unrecognized social risk
factors and whether they are associated with barriers to high quality of
end-of-life care. Future directions of this work include developing and
piloting interventions to prevent loneliness and social isolation, recognize
and treat them when detrimental to quality of life, and address barriers to high
quality end-of-life care in the socially vulnerable.
Bio
Ashwin Kotwal, MD, MS is an Assistant Professor of Medicine in the
Division of Geriatrics at the University of California, San Francisco (UCSF)
School of Medicine. He received his B.A. in Anthropology at Northwestern
University, and his M.S. in Biostatistics and M.D. at the University of
Chicago. He went on to complete his Internal Medicine residency at Harvard
University’s Brigham and Women’s Hospital. He then became the first to complete
UCSF’s two-year integrated clinical fellowship in Geriatrics and Palliative
Care. In addition, he is currently a research scholar in the UCSF Claude D.
Pepper Older Americans Independence Center. Dr. Kotwal’s research focuses on
the intersection of geriatrics and palliative care and efforts to understand
and improve social connections of older adults at the end of life through
clinical practice, health systems, and policy.
Email: Ashwin.Kotwal@ucsf.edu