Social functions and adverse outcome onset in older adults with mild long-term care needs: A two-year longitudinal study

Objective: For older adults receiving long-term care (LTC) at home, little is known about the role of social function in the onset of adverse outcomes, such as death, institutionalization, and functional decline. We examined the association between social function and adverse outcome onset among community-dwelling older adults with mild care needs.

Methods: This two-year longitudinal study recruited non-institutionalized older adults, with mild care need levels, in 2003. Participants were followed regarding the onset of death, institutionalization, and functional decline, after two years. Social function was assessed using four items (friendships, emotional support, instrumental support, and intergenerational interactions) and scored from zero (low) to four (high). Multivariable logistic regression analysis estimated the odds ratios (ORs) and 95% confidence intervals (CIs) for the onset of adverse outcomes, composite of death, institutionalization, and functional decline.

Results: Ultimately, 281 older adults were analyzed. During the observation period, the onset of adverse outcomes was observed in 41.4% of the participants (death, 13.9%; institutionalization, 7.9%; functional decline, 19.5%). Higher social function was inversely associated with adverse outcome onset, even after adjusting for covariates including cognitive function (compared to zero point, ORs [95% CIs] were 0.85 [0.42-1.70] for one, 0.42 [0.19-0.94] for two, and 0.44 [0.20-0.99] for three or more; p = 0.018). Among the sub-items, friendships were associated with lower adverse outcome onset.

Conclusions: Higher social functioning was associated with the low onset of adverse outcomes among older adults under LTC. Enhancing social functions, including friendships, may be crucial for prognosis in LTC.