Association of Social Support With Functional Outcomes in Older Adults Who Live Alone

Question  What is the association between social support and functional outcomes (ie, activities of daily living dependence, prolonged nursing home stay, death) in older adults who live alone?

Findings  In this cohort study of 4772 older adults who live alone, identifiable social support was associated with a lower likelihood of prolonged nursing home stays but only in the setting of a sudden change in health (eg, hospitalization, new cancer diagnosis). Support was not associated with new activities of daily living dependence or death.

Meaning  Identifiable support may buffer the risk of prolonged nursing home stays when facing a new health stressor while living alone.

Importance  Older adults who live alone are at risk for poor health outcomes. Whether social support mitigates the risk of living alone, particularly when facing a sudden change in health, has not been adequately reported.

Objective  To assess if identifiable support buffers the vulnerability of a health shock while living alone.

Design, Setting, and Participants  In this longitudinal, prospective, nationally representative cohort study from the Health and Retirement Study (enrollment March 2006 to April 2015), 4772 community-dwelling older adults 65 years or older who lived alone in the community and could complete activities of daily living (ADLs) and instrumental ADLs independently were followed up biennially through April 2018. Statistical analysis was completed from May 2020 to March 2021.

Exposures  Identifiable support (ie, can the participant identify a relative/friend who could help with personal care if needed), health shock (ie, hospitalization, new diagnosis of cancer, stroke, heart attack), and interaction (multiplicative and additive) between the 2 exposures.

Main Outcomes and Measures  The primary outcomes were incident ADL dependency, prolonged nursing home stay (≥30 days), and death.

Results  Of 4772 older adults (median [IQR] age, 73 [68-81] years; 3398 [71%] women) who lived alone, at baseline, 1813 (38%) could not identify support, and 3013 (63%) experienced a health shock during the study. Support was associated with a lower risk of a prolonged nursing home stay at 2 years (predicted probability, 6.7% vs 5.2%; P = .002). Absent a health shock, support was not associated with a prolonged nursing home stay (predicted probability over 2 years, 1.9% vs 1.4%; P = .21). However, in the presence of a health shock, support was associated with a lower risk of a prolonged nursing home stay (predicted probability over 2 years, 14.2% vs 10.9%; P = .002). Support was not associated with incident ADL dependence or death.

Conclusions and Relevance  In this longitudinal cohort study among older adults who live alone, identifiable support was associated with a lower risk of a prolonged nursing home stay in the setting of a health shock.