Loneliness is Associated With Long-Term Physical Disability in Intensive Care Unit Survivors

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Abstract RATIONALE:Functional disability, cognitive dysfunction, and mental health impairments are common sequela of critical illness. Socially isolated older Americans have increased mortality compared to their peers and experience more functional disability after discharge from an ICU stay. Loneliness, a related but distinct concept from social isolation, is associated with cognitive impairment and functional decline in older patients, but whether loneliness predicts functional disability in ICU survivors remains unknown. METHODS:We retrospectively analyzed data from the Health and Retirement Study (HRS), a longitudinal prospective cohort of more than 20,000 community-dwelling older Americans. Data were modeled for the 5 years preceding and 5 years following an ICU stay. We included adults Age>65 that survived an ICU stay and had completed a psychosocial questionnaire (“Leave Behind Questionnaire”) prior to the ICU. Loneliness was measured using a 3-item loneliness scale, and respondents were separated into three categories: Not Lonely (Score 0-3), Occasionally Lonely (4-6), and Often Lonely (7-9). The primary outcome was probability of functional independence, which was modeled via logistic regression for the 5 years preceding and following the ICU stay. We used a cox regression inverse probability weight for survival, as well as survey weighting. RESULTS: A total of 2,839 ICU survivors met our inclusion criteria and were included for analysis. Respondents in the “Often Lonely” category were more likely to be Male (61%), Nonwhite (28%), or identify as Hispanic or Latino (10.6%). Median wealth also decreased across loneliness categories, with “Not Lonely” respondents having the highest median wealth. “Often Lonely” respondents had high rates of comorbid illnesses (21.6%) and were more likely to have a prescription for Anxiety or Depression (32.2%). In our main unadjusted model, probability of independence (Pi) declined for all respondents over 10 years. “Often Lonely” respondents had lower baseline Pi, lower Pi immediately preceding ICU admission, the lowest post-ICU Pi and lowest Pi at 5 years following their ICU stay. For patients in the “Often Lonely” group, Pi decreased from >85% pre-ICU to <25% 5 years post-ICU. CONCLUSIONS Loneliness is associated with significant post-ICU functional decline. Determination of whether this finding is confounded by sociodemographic and clinical characteristics requires further modeling, which is ongoing. Loneliness may be an independent predictor of functional decline in older ICU survivors.

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