Socially isolated long-term care facilities increase residents' all-cause mortality risk

Long-term care facilities’ frequent location in socially isolated neighborhoods increased risk for 30-day all-cause mortality among residents, according to results of a cross-sectional study published in JAMA Network Open.

“To our knowledge, there is no information on the extent that [long-term care] facilities are located in socially isolated neighborhoods,” Chanhyun Park, PhD, of the department of pharmacy and health systems sciences at Northeastern University’s Bouvé College of Health Sciences in Massachusetts, and colleagues wrote. “The objectives of this study were to characterize the social isolation of [long-term care] facilities in the U.S. and to assess short-term (30-day) all-cause mortality risk in residents within the [long-term care] facilities that experience the social isolation. We posit that the social isolation of [long-term care] facilities may be important if it is associated with barriers to connections with friends and family and negative health risks to their residents that have been documented in the community setting.”

The researchers included 730,524 long-term care residents (62.71% women; 83.61% non-Hispanic white; 57.45% aged 80 years or older) from 14,224 long-term care facilities across the U.S. in 2011 and linked a nationwide long-term care database with ZIP code tabulation areas to population-level geographic data from the U.S. Census Bureau. Social isolation of long-term care neighborhoods, defined as the percentage of households in the ZIP code tabulation areas with individuals aged 65 years or older who lived alone and categorized into quartiles of social isolation, served as the main variable of interest.

The researchers created maps to demonstrate geographic variation of long-term care facilities at the ZIP code tabulation area level by the quartile of socially isolated neighborhoods, and they estimated the adjusted likelihood that long-term facilities were located in areas of highest social isolation using generalized estimating equations. Further, they evaluated the association between the social isolation of neighborhoods of long-term care facilities and 30-day all-cause mortality following admission to long-term care using multilevel logistic regression. They conducted subgroup analyses according to race and ethnicity.

Results showed 8,652 (26.1%) of ZIP code tabulation areas in the U.S. had one or more long-term care facilities. Increasing levels of social isolation correlated with location of long-term care facilities. Multivariate models showed long-term care facilities were eight times more likely to be located in ZIP code tabulation areas with the highest percentages of older adults who resided in single-occupancy households (OR = 8.46; 95% CI, 7.44-9.65) compared with ZIP code tabulation areas that had the lowest percentages. Park and colleagues noted that the association remained across ZIP code tabulation areas with most African American and Hispanic individuals; however, it was strongest in ZIP code tabulation areas with a majority population of white individuals. The researchers observed a 17% increased risk for 30-day mortality (OR = 1.17; 95% CI, 1.1-1.25) among long-term care residents who entered facilities in neighborhoods with the highest levels of social isolation among older adults vs. those in neighborhoods with the lowest levels of social isolation among older adults.

“There may be a need for special attention and strategies to keep [long-term care] residents connected to their family and friends,” Park and colleagues wrote. “Such measures could eventually contribute to improved health trajectories in the U.S. population that is increasingly aging and at growing risk [for] entering [long-term care] facilities.”