Social Connectedness Matters: Its Relationship with Emergency Department Visits and Nursing Home Entry Among Older Adults Seeking Government-Subsidized Long-Term Care

Background: Older adults seeking government-subsidized long-term care have heightened vulnerabilities and often face barriers to accessing necessary support services, increasing the risk of emergency department (ED) visits and nursing home admissions. Social connections play an important role in supporting older adults to age in place, navigate health and social care services, and manage health crises, thereby potentially preventing avoidable ED visits and reduce nursing home entries.

Understanding the relationship between social connectedness and these outcomes could help develop integrated care models that address social factors impacting older adults’ overall well-being and support their ability in ageing in place. This study aims to examine the association of social connectedness with ED visits and nursing home admissions for this vulnerable older population.

 

Approach: We analyzed retrospective cross-sectional data from 25,172 Hong Kong residents aged 60 and older interviewed in 2019, using the International Residential Assessment Minimal Data Set – Home Care Assessment (MDS-HC). Social connectedness was measured by two indicators: presence of lonely feelings and reduced social interaction (less participation in activities than 90 days before). Multivariate logistic regressions were conducted to estimate for the odds of emergency department visit and moving to nursing home within 2 years, adjusting for covariates.

 

Result: A total of 60% of the participants were female, with 35% aged 75 to 84 years and 41% aged 85 to 94 years. 41% were married and 72.2% lived at home. Approximately 23% reported feeling lonely, while 28% indicated reduced social interaction. Multivariate regression models identified cognitive function, dementia, and depression as health factors increased risk of ED visit, while ADL function, cognitive function, depression, and hypertension were linked to nursing home placement. Social factors including outdoor activity frequency and being alone duration everyday significantly influenced both outcomes.

Both loneliness (odds ratio, 1.16; 95% CI, 1.05-1.29; p<0.05) and reduced social interaction (odds ratio, 1.48; 95% CI, 1.35-1.63; p<0.001) independently associated with higher risk of emergency department (ED) visit after adjusting for each other and all covariates. Also, feeling lonely was associated with a greater risk of nursing home placement (odds ratio, 1.45; 95% CI, 1.31-1.59; p<0.001), independent of social interaction and other factors.

 

However, no significant effect was found for the association between reduced social interaction and nursing home placement after adjusting for the effect of feeling lonely. This study found that feeling lonely and reduced social interaction independently associated with emergency department visit, while feeling lonely was an independent risk factor for nursing home placement.

 

Implications: Study findings underscore the importance of social connectedness in reducing emergency department visits and nursing home placement for older adults who are seeking government-subsidized long-term care. The design and assessment of integrated care models that valuing social connectedness, such as social prescribing strategies, have the potential to improve their health trajectories and prevent avoidable emergency visits.

Additionally, by recognizing the relationship between loneliness and nursing home placement, this study emphasizes the necessity of co-producing solutions with older adults to address loneliness, thereby supporting their preference to age in place rather than in institutions.