In a recent study published in , a team of researchers explored the transformations in and effects of social relationships on end-of-life results, encompassing symptoms, healthcare utilization, and the place of death in elderly individuals across 19 nations using longitudinal data.
Background
The importance of social bonds on health, particularly during the final phases of life, remains relatively uncharted despite indications of its comparable impact on mortality to established risk factors. As aging populations grapple with escalating chronic ailments, grasping the dynamic essence of social connections and their sway on end-of-life encounters, including symptoms, healthcare utilization, and the location of death, emerges as paramount. There is a call for further investigation to ascertain causal links and unveil the mechanisms through which social relationships shape end-of-life outcomes, potentially guiding tailored interventions and policy formulation.
About the study
In this study drawing on data from the Survey of Health, Ageing, and Retirement in Europe (SHARE), researchers extensively scrutinized social ties in the later stages of elderly individuals’ lives. SHARE, a comprehensive longitudinal study inaugurated in 2004, concentrates on the health, social, and familial networks of individuals aged 50 and above across the European Union, conducting biennial data collection through structured interviews. In the event of a participant’s demise, SHARE conducts an end-of-life interview with a proxy to glean detailed insights into the deceased individual’s final year, encompassing health status and social connectedness. This particular study made use of data from the seventh wave of SHARE interviews, carried out between 2017 and 2018, which featured pertinent inquiries on symptoms and palliative care utilization not addressed in prior waves.
The primary objective of the research was to monitor shifts in social connections from the fourth to the sixth wave and investigate how these connections in the sixth wave could forecast end-of-life outcomes documented in the seventh wave. Embracing an exploratory analytical approach, the study aimed to illuminate the nuanced alterations in social bonds and their potential repercussions on end-of-life encounters such as symptom management, healthcare usage, and the place of death.
The study cohort encompassed deceased individuals from SHARE, with a focus on those whose proxies could furnish comprehensive end-of-life particulars, thus ensuring data fidelity. The methodology pivoted on stringent data collection and analysis protocols, involving face-to-face and telephonic interviews to uphold the quality and reliability of the findings. Researchers employed diverse measures of social connections and end-of-life outcomes to conduct their analyses, striving to offer a comprehensive comprehension of the role of social relationships in the health and well-being of elderly individuals nearing the end of life .
Study results
The study delved into the end-of-life encounters of 3,662 individuals from 19 countries, as documented in the seventh wave of SHARE interviews conducted between 2017 and 2018. This cohort represented 87.5% of the participants identified as deceased at that juncture, furnishing a robust dataset for scrutinizing how social connections transform and impact end-of-life outcomes. The researchers aimed to grasp the alterations in the structure, function, and quality of social connections as individuals approached their final years, drawing insights from data spanning two pivotal waves (waves 4 and 6) before dissecting their influence on end-of-life experiences.
The participants, with an average age at death of 79.7 years, exhibited a spectrum of social and health profiles. Cardiovascular diseases emerged as the predominant cause of death, underscoring the prevalence of chronic conditions in this demographic. Proxy respondents, predominantly female and frequently the deceased individual’s partner or child, offered vital revelations about the participants’ final year, unveiling a pattern of close and frequent interactions.
The study unveiled notable shifts in social connections over time. Particularly, by wave 6, there was a decline in the number of participants who were married or in a partnership, signaling alterations in social frameworks as individuals advanced in age. Moreover, a rise in the provision of personal care and practical assistance hinted at evolving functional requirements within social circles. A slight escalation in loneliness scores between the two waves hinted at a mounting challenge of emotional seclusion among elderly individuals despite the stability in the sizes and frequencies of contact within their social circles.
Upon scrutinizing the quality of these social connections, the researchers noted a marginal dip in overall satisfaction with social networks but identified an upsurge in emotional intimacy, suggesting a potential deepening of relationships despite broader network transformations.
The analysis brought to light that heightened levels of loneliness were markedly linked to increased odds of encountering anxiety, sadness, and pain in the final month of life, indicating a pivotal correlation between social isolation and end-of-life symptomatology. Furthermore, marital status and the reception of personal care emerged as predictors of expiring in a hospital, underscoring the impact of social support structures on the place of death. Intriguingly, a larger social network correlated with a greater likelihood of receiving hospice or palliative care, underscoring the potential advantages of expansive social connections.