The predictive role of feeling lonely in nursing home placement in older adults hospitalized in an emergency setting.

introductionFeeling lonely defined as a subjective dissatisfaction with social relationships, is associated with an increased risk of functional and cognitive decline well-known factors for institutionalization. The objective was to evaluate the predictive role of feeling lonely on admission to nursing homes among elderly people hospitalized via emergency departments.

methodsThis was an observational, longitudinal, prospective, multicenter study. Participants were recruited over a period of ten months. Patients were eligible if they were aged 75 years or older and hospitalized in a medical ward of the same hospital as the emergency department (ED) where they were initially admitted. The assessment included the collection of sociodemographic data-age, sex, level of education, available support (particularly the presence of a primary caregiver), number of children, and living arrangements (home or institutional setting)-as well as clinical variables, including presence of dementia or delirium, mood disorders, comorbidities, nutritional status, dependence in activities of daily living (ADL), mobility, risk of falls, and risk of pressure ulcers. The assessment included the collection of sociodemographic (age, sex, level of education, available support (in particular the presence of a primary caregiver), number of children, living conditions (e.g., at home or in an institution) Loneliness was assessed using item 14 of the CES-D (Center for Epidemiologic Studies Depression) scale. Univariate and multivariate analyses were performed using a Cox model that took death into account as a competing risk, using a Fine & Gray model.

resultsThe mean age was 84.4 ± 5.9 years, and 55% were women. In this population, 40% reported feeling lonely, 41% were at risk of depression, 78% had at least one child, 67% had at least one family caregiver, and 79% (n = 833) lived alone. Over the 36-month follow-up period, 31.46% of patients entered nursing homes. Independent risk factors for institutionalization included social determinants specifically feeling lonely, which was independently associated with an increased risk of placement at 12, 24, and 36 months. Individuals reporting loneliness showed an increased risk of functional and cognitive decline.

conclusionThis study regarding hospitalized elderly after admission to an Emergency Department shows that feeling lonely is not merely a marker of social vulnerability but is independently associated with of nursing home admission.