Does Social Isolation Predict Hospitalization and Mortality Among HIV+ and Uninfected Older Veterans?

S. Ryan Greysen; Leora I Horwitz; Kenneth E Covinsky; Kirsha Gordon; Michael E Ohl; Amy C Justice

doi:10.1111/jgs.12410

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Journal article

Does Social Isolation Predict Hospitalization and Mortality Among HIV+ and Uninfected Older Veterans?

S. Ryan Greysen, Leora I Horwitz, Kenneth E Covinsky, Kirsha Gordon, Michael E Ohl and Amy C Justice

Journal of the American Geriatrics Society (JAGS), Vol.61(9), pp.1456-1463

09/2013

DOI: 10.1111/jgs.12410

PMCID: PMC3773301

PMID: 23927911

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Abstract

Objectives To compare levels of social isolation in aging veterans with and without the human immunodeficiency virus (HIV) and determine associations with hospital admission and mortality. Design Longitudinal data analysis. Setting The Veterans Aging Cohort Study (VACS), at eight VA Medical Centers nationally. Participants Veterans aged 55 and older enrolled in VACS from 2002 to 2008 (N = 1,836). Measurements A Social Isolation Score (SIS) was created using baseline survey responses about relationship status; number of friends and family and frequency of visits; and involvement in volunteer work, religious or self‐help groups, and other community activities. Scores were compared according to age and HIV status, and multivariable regression was used to assess effects of SIS on hospital admission and all‐cause mortality. Results Mean SIS was higher for HIV‐positive (HIV+) individuals, with increasing difference according to age (P = .01 for trend). Social isolation was also more prevalent for HIV+ (59%) than uninfected participants (51%, P < .001). In multivariable regression analysis of HIV+ and uninfected groups combined, adjusted for demographic and clinical features, isolation was independently associated with greater risk of incident hospitalization (hazard rate (HR) = 1.25, 95% confidence interval (CI) = 1.09–1.42) and risk of all‐cause mortality (HR=1.28, 95% CI = 1.06–1.54). Risk estimates calculated for HIV+ and uninfected groups separately were not significantly different. Conclusion Social isolation is associated with greater risk of hospitalization and death in HIV+ and uninfected older veterans. Despite similar effects in both groups, the population‐level effect of social isolation may be greater in those who are HIV+ because of the higher prevalence of social isolation, particularly in the oldest individuals.

HIV/AIDS

mortality

social isolation

outcomes of care

aging

hospitalization

Details

Title: Subtitle: Does Social Isolation Predict Hospitalization and Mortality Among HIV+ and Uninfected Older Veterans?
Creators: S. Ryan Greysen - University of California at San Francisco
Leora I Horwitz - Yale University
Kenneth E Covinsky - San Francisco Veterans Affairs Medical Center
Kirsha Gordon - West Haven Veterans Affairs Medical Center
Michael E Ohl - University of Iowa
Amy C Justice - West Haven Veterans Affairs Medical Center
Resource Type: Journal article
Publication Details: Journal of the American Geriatrics Society (JAGS), Vol.61(9), pp.1456-1463
DOI: 10.1111/jgs.12410
PMID: 23927911
PMCID: PMC3773301
NLM abbreviation: J Am Geriatr Soc
ISSN: 0002-8614
eISSN: 1532-5415
Number of pages: 8
Grant note: U.S. Department of Veterans Affairs American Federation Robert Wood Johnson Foundation Clinical Scholars program National Institute on Aging (K08 AG038336)
Language: English
Date published: 09/2013
Academic Unit: Psychiatry; Internal Medicine
Record Identifier: 9984094395702771

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