Social Connectedness Among Medicare Beneficiaries Following the Onset of the COVID-19 Pandemic | Geriatrics | JAMA Internal Medicine | JAMA Network
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Table 1.  Weighted Rates of Decreased Social Connectedness Since the Start of the COVID-19 Pandemic Among Selected Subpopulations
Weighted Rates of Decreased Social Connectedness Since the Start of the COVID-19 Pandemic Among Selected Subpopulations
Table 2.  Selected Characteristics and Behaviors Statistically Significantly Associated With Reporting Decreased Social Connectedness on Multivariable Analysis
Selected Characteristics and Behaviors Statistically Significantly Associated With Reporting Decreased Social Connectedness on Multivariable Analysis
1.
Tiikkainen  P, Heikkinen  RL.  Associations between loneliness, depressive symptoms and perceived togetherness in older people.   Aging Ment Health. 2005;9(6):526-534. doi:10.1080/13607860500193138PubMedGoogle ScholarCrossref
2.
Ashida  S, Heaney  CA.  Differential associations of social support and social connectedness with structural features of social networks and the health status of older adults.   J Aging Health. 2008;20(7):872-893. doi:10.1177/0898264308324626PubMedGoogle ScholarCrossref
3.
Cacioppo  JT, Cacioppo  S.  Social relationships and health: the toxic effects of perceived social isolation.   Soc Personal Psychol Compass. 2014;8(2):58-72. doi:10.1111/spc3.12087PubMedGoogle ScholarCrossref
4.
Santini  ZI, Jose  PE, York Cornwell  E,  et al.  Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis.   Lancet Public Health. 2020;5(1):e62-e70. doi:10.1016/S2468-2667(19)30230-0PubMedGoogle ScholarCrossref
5.
Smith  ML, Steinman  LE, Casey  EA.  Combatting social isolation among older adults in a time of physical distancing: the COVID-19 social connectivity paradox.   Front Public Health. 2020;8:403. doi:10.3389/fpubh.2020.00403PubMedGoogle ScholarCrossref
6.
AARP. Loneliness among older adults: a national survey of adults 45+. Accessed February 14, 2021. https://assets.aarp.org/rgcenter/general/loneliness_2010.pdf
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    Research Letter
    May 28, 2021

    Social Connectedness Among Medicare Beneficiaries Following the Onset of the COVID-19 Pandemic

    Author Affiliations
    • 1Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
    • 2Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut
    • 3Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
    JAMA Intern Med. 2021;181(9):1245-1248. doi:10.1001/jamainternmed.2021.2348

    Social distancing is an effective strategy to limit contagion and mortality from the COVID-19 pandemic. However, these measures may also decrease perceived social connectedness and conversely increase social isolation, states which are associated with psychologic and physiologic morbidity.1-5 Patients who are elderly or have disabilities are particularly encouraged to practice social distancing given their higher risk of severe COVID-19 infection, but they also have a higher baseline risk for reporting social isolation.5,6 We hypothesized that the pandemic and social distancing measures have negatively affected perceptions of social connectedness among these high-risk patients.

    Methods

    The Medicare Current Beneficiary Survey is an in-person, nationally representative survey of Medicare beneficiaries that is sponsored by the Centers for Medicare & Medicaid Services. We used the COVID-19 Summer 2020 Supplement data collected from June 10, 2020, to July 15, 2020. The institutional review board of Yale University approved the study and granted a waiver of informed consent because of the use of publicly available, deidentified data. The study cohort consisted of 9634 respondents who represented a weighted 50 851 437 community-dwelling beneficiaries who reported on changes in social connectivity during the pandemic (eMethods in the Supplement). The outcome variable, reporting decreased social connectedness, was defined as a beneficiary stating that that they felt “less socially connected to family and friends” since the onset of the pandemic.

    We selected variables that we hypothesized were potentially associated with decreased social connectedness (eMethods in the Supplement). These variables included demographic and socioeconomic characteristics, adherence to 6 specific COVID-related social distancing precautions, ownership and use of technologies that allow for remote social engagement, and medical comorbidities and care receipt that may make beneficiaries more dependent on social contacts for health reasons. We used univariable and multivariable logistic regression to identify factors associated with reported decreased social connectedness since the start of the pandemic. Predicted probabilities (PPs) were estimated using population-averaged estimates, with 95% CIs calculated using the δ method. Statistical analyses were conducted using Stata, version 13.1 (StataCorp), and statistical significance was determined from contrast estimates using the χ2 statistic. The multivariable model included variables reaching a significance level of P < .10 on univariable analysis.

    Results

    Since the start of the COVID-19 outbreak, a weighted 36.7% of enrollees reported feeling less socially connected with friends and family. Decreased social connection was reported by 41.2% of female, 31.2% of male, 24.6% of Black non-Hispanic, and 38.9% of White non-Hispanic beneficiaries (Table 1). On multivariable analysis (Table 2), demographic characteristics that were independently associated with feeling less socially connected included female (PP, 40.4%; 95% CI, 38.6%-42.2%) vs male sex (PP, 33.2%; 95% CI, 31.2%-35.1%; P < .001), White non-Hispanic (PP, 38.1%; 95% CI, 36.6%-39.7%) vs Black non-Hispanic race/ethnicity (PP, 30.4%; 95% CI, 25.9%-34.9%; P < .001), income of $25 000 or greater (PP, 38.5%; 95% CI, 36.8%-40.1%) vs less than $25 000 (PP, 34.2%; 95% CI, 31.4%-37.1%; P = .02), no Medicaid eligibility (PP, 38.1%; 95% CI, 36.5%-39.6%) vs full Medicaid dual eligibility (PP, 28.6%; 95% CI, 23.5%-33.7%; P = .002), history of non–skin cancer (PP, 40.8%; 95% CI, 38.0%-43.6%) vs none (PP, 36.3%; 95% CI, 34.9%-37.7%; P = .005), and depression (PP, 41.6%; 95% CI, 39.0%-44.3%) vs none (PP, 35.5%; 95% CI, 33.9%-37.1%; P < .001). Behaviors that were associated with feeling less socially connected included performing all 6 assessed anti–COVID-19 social distancing measures (PP, 38.8%; 95% CI, 37.4%-40.2%) vs 4 or fewer (PP, 30.5%; 95% CI, 26.2%-34.8%; P < .001), computer ownership (PP, 38.4%; 95% CI, 36.6%-40.2%) vs not (PP, 34.4%; 95% CI, 32.2%-36.6%; P = .01), and use of internet teleconferencing software (PP, 40.2%; 95% CI, 38.5%-42.0%) vs not (PP, 33.3%; 95% CI, 31.1%-35.5%; P < .001). Among other variables, metropolitan (PP, 37.6%; 95% CI, 36.1%-39.1%) vs nonmetropolitan residence (PP, 35.9%; 95% CI, 33.3%-38.5%; P = .23) and geographic region were not independently associated with reported social connectivity.

    Discussion

    More than one-third of Medicare beneficiaries reported feeling less socially connected to friends and family since the start of the COVID-19 pandemic. Medicare beneficiaries who were women, had higher incomes, were not of Black non-Hispanic race/ethnicity, and had a history of cancer or depression were more likely to report a negative association of the pandemic with perceptions of social connectedness. The likelihood of reporting decreased social connection was widespread nationally and was associated with practicing more social distancing measures. The limitations of this study include an inability to assess the magnitude of the decreased connection reported and survey exclusion of the subset of Medicare-beneficiaries who are not community dwelling. The public health benefits and psychosocial costs of prolonged social distancing measures should be balanced carefully in this doubly vulnerable population.

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    Article Information

    Accepted for Publication: April 10, 2021.

    Published Online: May 28, 2021. doi:10.1001/jamainternmed.2021.2348

    Corresponding Author: Wesley John Talcott, MD, MBA, Smilow Cancer Hospital, PO Box 208040, New Haven, CT 06520-8040 (wesley.talcott@yale.edu).

    Author Contributions: Dr Talcott had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Talcott, Gross, Park.

    Acquisition, analysis, or interpretation of data: Talcott, Yu.

    Drafting of the manuscript: Talcott.

    Critical revision of the manuscript for important intellectual content: Yu, Gross, Park.

    Statistical analysis: Talcott.

    Supervision: Park.

    Conflict of Interest Disclosures: Dr Yu reported personal fees from Boston Scientific and Galera Pharmaceuticals outside the submitted work. Dr Gross reported grants from the National Comprehensive Cancer Network (Pfizer/AstraZeneca), Johnson & Johnson, and Genentech, and travel/speaking fees from Flatiron outside the submitted work. No other disclosures were reported.

    References
    1.
    Tiikkainen  P, Heikkinen  RL.  Associations between loneliness, depressive symptoms and perceived togetherness in older people.   Aging Ment Health. 2005;9(6):526-534. doi:10.1080/13607860500193138PubMedGoogle ScholarCrossref
    2.
    Ashida  S, Heaney  CA.  Differential associations of social support and social connectedness with structural features of social networks and the health status of older adults.   J Aging Health. 2008;20(7):872-893. doi:10.1177/0898264308324626PubMedGoogle ScholarCrossref
    3.
    Cacioppo  JT, Cacioppo  S.  Social relationships and health: the toxic effects of perceived social isolation.   Soc Personal Psychol Compass. 2014;8(2):58-72. doi:10.1111/spc3.12087PubMedGoogle ScholarCrossref
    4.
    Santini  ZI, Jose  PE, York Cornwell  E,  et al.  Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis.   Lancet Public Health. 2020;5(1):e62-e70. doi:10.1016/S2468-2667(19)30230-0PubMedGoogle ScholarCrossref
    5.
    Smith  ML, Steinman  LE, Casey  EA.  Combatting social isolation among older adults in a time of physical distancing: the COVID-19 social connectivity paradox.   Front Public Health. 2020;8:403. doi:10.3389/fpubh.2020.00403PubMedGoogle ScholarCrossref
    6.
    AARP. Loneliness among older adults: a national survey of adults 45+. Accessed February 14, 2021. https://assets.aarp.org/rgcenter/general/loneliness_2010.pdf
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