Lenford Kasungu
Lecturer
Association of loneliness and social isolation with all-cause mortality among older Mexican adults in the Mexican health and aging study: a retrospective observational study
Published on: March 24, 2025
The global aging population is increasing rapidly, with WHO predicting that by 2050, one in five people will be 60 or older, with 80% residing in low- to middle-income countries. This demographic shift presents challenges for individuals, families, and public health systems, particularly in Mexico, where 7.8% of the population is over 65. Loneliness, a subjective feeling of isolation despite social connections, differs from social isolation, which is an objective lack of social contact. While the two are related, their correlation varies. Aging is a risk factor for both, with loneliness affecting 10–50% of older adults and social isolation ranging from 6–43%. In Mexico, loneliness prevalence is between 13.2% and 34.9%, while social isolation affects 34–43%. Both conditions are associated with increased risks of cardiovascular diseases, infections, sleep disturbances, cognitive decline, and depression. However, their impact on mortality remains debated, with some studies indicating an increased risk while others do not find them to be decisive factors. The combined effect of loneliness and social isolation on health is still unclear, especially in collectivist, middle- and low-income societies like Mexico, where cultural and socioeconomic factors influence health outcomes. Methods This study is an observational retrospective cohort study that included Mexican adults over 50 years old. Participants with incomplete data on loneliness and social isolation were excluded. The study utilized data from the Mexican Health and Aging Study (MHAS), a longitudinal cohort study initiated in 2001 to examine aging, disease, and disability. The 2015 wave of MHAS data was used to assess loneliness, social isolation, and other socio-demographic, clinical, psychological, and lifestyle factors. Mortality data was obtained from the 2018 follow-up. Results The study analyzed data from 11,713 participants, with a mean age of 66.6 years, of whom 58.2% were women. Most had no prior hospitalizations (86.7%), while 9.5% had experienced up to five, and 3.9% had more than five. Over a three-year follow-up, the all-cause mortality rate was 6.0% (n = 707). Loneliness and social isolation were prevalent, with 42.05% of participants experiencing loneliness and 53.34% classified as socially isolated. Higher loneliness levels were linked to financial difficulties, depressive symptoms, lower life satisfaction, and increased falls. Social isolation was also associated with financial struggles and depression, though life satisfaction was similar among isolated and non-isolated individuals. While multimorbidity increased with loneliness, it was not significantly higher among the socially isolated. The study found a strong relationship between loneliness, social isolation, and mortality. Mortality was highest (10.5%) among individuals facing both severe loneliness and social isolation, while those with no loneliness and strong social integration had the lowest mortality rate (4.1%). In the unadjusted analysis, severe loneliness (OR = 1.73) and social isolation (OR = 1.50) were linked to higher mortality risk. However, after adjusting for socio-demographic, clinical, psychological, and lifestyle factors, only social isolation (OR = 1.30) remained a significant predictor of mortality, while loneliness alone did not significantly impact death rates. Correlation analysis showed a weak but significant link between loneliness and social isolation, indicating that social isolation contributes to feelings of loneliness. Living alone was moderately associated with both conditions. However, the interaction between loneliness and social isolation did not significantly increase mortality risk beyond the individual effect of social isolation. Conclusion The study found that social isolation is a significant predictor of all-cause mortality in older Mexican adults, while loneliness alone is not. This challenges the assumption that loneliness is equally harmful across all cultures, particularly in collectivist societies. The findings emphasize the importance of community integration and support systems in promoting better health outcomes. Public health interventions should prioritize reducing social isolation through community involvement, family engagement, and social programs that strengthen social networks. Addressing social isolation can enhance the well-being and longevity of older adults, especially in societies where family and community support are central. Impact of the research The research has significant public health implications, particularly for collectivist societies like Mexico. Combating social isolation through community-based programs, such as neighborhood support groups, social clubs, and intergenerational initiatives, could enhance social participation and improve health outcomes. Policies promoting active aging, including volunteer opportunities and social spaces for older adults, may further support mental and physical well-being. Given the cultural emphasis on family bonds, family-centered interventions are also essential. Encouraging family involvement in caregiving and social activities, while providing resources to caregivers, can help mitigate the negative effects of social isolation on older adults. Keywords: Loneliness, Social isolation, Mortality, Older adults, Mental health.
Health-Related Quality of Life of COVID-19 Survivors Treated in Intensive Care Unit-Prospective Observational Study
Published on: March 03, 2025
In December 2019, SARS-CoV-2, a new coronavirus, was discovered in China, causing widespread pneumonia in Wuhan. Due to its rapid spread, the WHO declared it a public health emergency in January 2020 and a pandemic in March 2020. By August 2022, 580 million infections and 6.4 million deaths were confirmed. COVID-19 symptoms range from mild to severe, with some patients experiencing persistent health issues affecting physical, mental, and cognitive well-being. These long-term effects can significantly impact health-related quality of life (HRQoL), assessed through patient-reported measures. Identifying the most affected symptoms and HRQoL areas can help target early rehabilitation for at-risk patients. While studies on severe COVID-19 survivors exist, findings on affected domains and associated factors vary. This study aims to examine HRQoL in ICU-treated COVID-19 patients and identify factors linked to worse QoL outcomes. Methods This prospective single-center cohort study examined patients hospitalized in a tertiary hospital ICU for severe COVID-19 between November 2021 and February 2022. All patients required respiratory support, either invasive (intubation and mechanical ventilation) or non-invasive (CPAP masks or HFNC). COVID-19 diagnosis was confirmed via PCR before ICU admission. The primary objective was to assess health-related quality of life (HRQoL) among severe COVID-19 survivors, while the secondary objective was to identify factors associated with worse HRQoL scores. Results The median follow-up time was 4.75 months. Of the 285 patients, 126 (44%) had died, and contact could not be established for 33 patients (11.5%), leaving 113 participants in the study. The median age was 61.2 years, with 74% being male. Patients spent a median of 7 days on invasive respiratory support, 11 days in the ICU, and 18 days in the hospital. Severe acute respiratory distress syndrome (ARDS) was common, with 71% of patients affected. The EQ-5D-5L questionnaire results showed that most patients reported minimal mobility, self-care, and pain issues, but 29% had moderate to severe mobility problems, and 36% experienced moderate to severe anxiety or depression. The median VAS score was 70. At follow-up, 34% reported no symptoms, while 14% still required supplemental oxygen, and 11% had neurological symptoms. Other complications included Clostridium difficile infections (8%), cardiovascular issues (5%), and 5% of patients were bedridden. Analysis revealed that older patients (65+) had worse mobility, self-care, and usual activity scores. Women scored higher in all categories except self-care, while men had significantly better self-care scores. Shorter respiratory support and hospital stays were associated with better HRQoL. Patients with three or more comorbidities had worse mobility and usual activity scores, and VAS scores were higher in younger patients and those with fewer comorbidities. Conclusion In conclusion, many survivors of severe COVID-19 who required ventilatory support experienced significantly reduced health-related quality of life (HRQoL) four months after ICU admission. Nearly half reported moderate to severe anxiety or depression, while about one-third had difficulties with mobility and usual activities. Older patients (65+) and female patients had lower QoL in the usual care domain, while male patients had lower self-care scores. No age or sex differences were observed in pain/discomfort or anxiety/depression. Longer durations of mechanical ventilation, ICU stays, and hospitalizations were associated with worse QoL in all domains. Despite improved survival rates, many patients continue to experience prolonged symptoms and reduced QoL post-ICU. Impact of the research This study highlights the prolonged impact of severe COVID-19 on health-related quality of life (HRQoL), particularly among patients treated in intensive care units (ICUs) with ventilatory support. Nearly half of the patients reported moderate to severe anxiety and depression, while a third faced significant difficulties with mobility and usual activities. The study identifies key factors contributing to reduced QoL, including older age, prolonged ICU and hospital stays, extended ventilatory support, and multiple comorbidities. These findings align with previous research, confirming that while physical recovery tends to improve over time, psychological distress often persists, emphasizing the need for long-term mental health support. Additionally, the study explores gender differences, revealing that male patients scored higher in self-care, while female patients experienced more challenges in performing usual activities. These insights highlight the necessity for gender-specific rehabilitation approaches. The research also reinforces the importance of post-ICU rehabilitation programs, mental health interventions, and tailored patient management plans to enhance long-term recovery. However, limitations such as the study’s single-center design, lack of a control group, and telephone-based follow-up indicate the need for larger, multi-center studies to provide more generalizable findings. Overall, this study contributes to a deeper understanding of COVID-19’s long-term effects and supports the development of targeted rehabilitation strategies for improved patient outcomes. Keywords: COVID-19, Health-Related Quality of Life, Intensive Care Unit, Ventilatory Support.
Barriers to healthcare access among female youths in Mozambique: a mixed-effects and spatial analysis using DHS 2022/23 data
Published on: February 17, 2025
Access to healthcare is a critical determinant of health and well-being, recognized globally as a fundamental human right. It encompasses timely, affordable, and appropriate services, which are essential for ensuring overall health. However, disparities persist, particularly in low- and middle-income countries (LMICs), despite efforts towards universal healthcare coverage (UHC) by organizations like the World Health Organization (WHO). This study examined healthcare access in Mozambique, a low-income country in southeastern Africa with a population of over 30 million. The country is divided into ten provinces and Maputo City, each with distinct geographic and economic characteristics. Northern provinces like Cabo Delgado and Niassa are predominantly rural and reliant on agriculture, whereas the southern region, especially Maputo City, is more urbanized and industrialized. Methods The study utilized secondary data from the 2022/23 Mozambique Demographic and Health Survey (MZDHS), conducted every five years to assess key health indicators, including maternal and child health, family planning, and healthcare utilization. The survey was implemented by the Instituto Nacional de Estatística (INE) and Instituto Nacional de Saúde (INS), with support from USAID’s DHS Program. Results The study analyzed sociodemographic characteristics and healthcare access barriers among 5,743 female youths in Mozambique. Most participants (53.10%) were aged 15–19, and 76.15% were unemployed. A significant portion (63.84%) belonged to middle- or high-income households, but 99.30% lacked health insurance. About 60.39% lived in rural areas, with the highest representation from Nampula (23.53%). Nearly half (49.10%) of participants faced at least one barrier, primarily financial constraints (40.69%) and distance to healthcare facilities (38.16%). Other challenges included the need for permission (13.98%) and reluctance to seek care alone (7.17%). Multilevel logistic regression showed that education level, wealth index, marital status, and place of residence significantly influenced healthcare access. Youths aged 20–24 were less likely to face barriers (AOR = 0.85), while those with no or lower education, from poorer households, or married had higher odds of encountering challenges. Rural residents had three times higher odds of facing barriers than urban dwellers. Barriers varied across regions, with significant clustering (Moran’s index = 0.442695, p
Comparison of long-term effects of metformin on longevity between people with type 2 diabetes and matched non-diabetic controls
Published on: February 06, 2025
Metformin therapy or treatment is recognized as the primary treatment for Type II diabetics (T2D). Metformin is associated with improved health span and extended life span. Several studies have indicated benefits of metformin, including reduced cognitive decline, cardiovascular disease risk factors, and low incidences of cancer. The use of metformin treatment has shown longevity benefits when compared to other treatments like sulfonylurea therapy and Thiazolidinediones. Rather, with these benefits, Metformin treatment remains narrow in most observational studies covering only a few years. Methods Joshua et al. used the Secure Anonymized Information Linkage (SAIL) database. This database consists of medical records of the Welsh population in the UK. The extracted information comprised patients diagnosed with T2D from a period between 1999 and 2018, and this information was compared to survival times among patients treated with Metformin and Sulfonylurea. In achieving this, the study utilized the accelerated failure time (AFT) model together with a log-logistic distribution in analyzing survival time whilst accounting for covariates including smoking status, cancer history, cardiovascular disease, hypertension, and social economic status. Results The study findings involved 129,140 patients treated with metformin and 68,108 treated with sulfonylurea. However, patients treated with sulfonylurea were older in age at the beginning of the treatment and presented a higher prevalence of cancer and cardiovascular disease. The investigation indicated that those that used metformin had longer survival time compared to those that used sulfonylurea. However, both groups showed shorter survival time than non-diabetic controls. Metformin patients presented a survival time ratio (STR) of 0.819 when compared to non-diabetic controls; additionally, patients using sulfonylurea presented an even lower STR of 0.778. The survival time for sulfonylurea patients who were excluded and took metformin, their survival time decreased further to a survival time ratio (STR) of 0.693. The results from a Cox regression analysis supported the results, indicating that the use of metformin was linked with better longevity outcomes when compared to sulfonylurea. Diabetes reduces the overall life span of individuals; however, the findings suggest that metformin treatment alleviates the effect more than other alternative therapies. Conclusion Metformin has demonstrated positive benefits beyond diabetes management, specifically in enhancing longevity. This research study’s long-term investigation offers compelling evidence that metformin therapy is linked with a survival benefit when compared to sulfonylurea therapy. Despite the fact diabetes remains a major risk factor for reduced lifespan, metformin appears to offer a moderating effect, reinforcing its role as the preferred treatment option for T2D patients. Impact of the research Metformin’s potential benefits on longevity are strengthened by previous study evidence. Metformin’s survival advantage by the patients aligns with previous research indicating metformin’s protective effects against various comorbidities over the patients using sulfonylurea. It is observed that sulfonylurea therapy could be linked with poorer health outcomes due to its different pharmacological effects. In addition, the differences in patient characteristics, observance to treatment, and the lifestyle factors may influence the observed survival outcomes. Therefore, future studies should incorporate randomized controlled trials to further validate the causal relationship between metformin use and longevity. Keywords: Metformin, Sulfonylurea, Thiazolidinediones, Type II diabetes, Longevity, Survival time ratio
Family Ties and Older Adult Well-Being: Incorporating Social Networks and Proximity
Published on: January 23, 2025
Original author: Sarah E. Patterson, et al. 2023 (doi: 10.1093/geronb/gbad139)
Family members are frontline supporters for older adults, including those institutionalized, because they affect older adults’ health and mortality. The demographic changes in family structures have led to fewer children, lower rates of marriages, and a higher rate of divorce cases in later life, leaving behind older adults kinless or without a partner and children. It has been argued that the possibility of poor physical and mental health, isolation, and community participation for kinless older adults is high. Kinless has been defined using various terms, including aging alone, solo agers, or elder orphans, to imply aging alone with little support. It has also been highlighted that the proximity and the extent of interactions with kin are essential aspects of family relationships and caregiving, as they determine whether older adults have their kin close and are a part of one’s life. Patterson and Margolis examined how family relationships are linked to mental health, social activity, and whether being without a family and unmet needs affect older adults’ well-being. The authors analyzed this study by comparing four types of family ties, including close, kinless, distanced, and disconnected. Methodology The study utilized pooled data from the National Health and Aging Trends Study (NHATS) 2015–2019, involving participants who were 65 years and older. The analyzed data of interest included mental health, social activity, family relationships, and unmet needs. The analyzed sample consisted of communal older adults, those in residential care and nursing homes, with a total of 24,818 person-years. The study analyzed data using multivariate OLS regressions to assess the relationship between family ties and mental health and social activity, adjusting for control variables. Results The study results established that family relationships affect older people’s well-being in the United States. The findings suggest that kinless older adults experience poor mental health and a lower social activity than those who are closer to their families. It was also observed that unmet needs for self-care, mobility, and household tasks were reported to be higher. Furthermore, the findings in the study on the disconnected older adults reported having experienced poor mental health and lower social activity, this accounted for those who lacked social network ties or location data for kin, while distanced older adults that resided far from their close families presented important disadvantages in mental health or social activity than those close to their kin. The study emphasizes the need for quality and strength in family ties as analyzed by proximity and social network inclusion for the benefit of the older adult’s well-being in terms of mental health and social activity. The findings also observed that unmet needs are connected to poor consequences; however, they do not indicate the link between family relationships and well-being. Conclusion The study analyzed family ties and observed various family relationships, or ties, of older adults in the United States and their impact on older adults’ well-being. It has been highlighted that as families continue to advance, scholars should endeavor to seize the scope of the family complexes, including the level of association that the older adults share with their close families, the care given, and where it is sourced, which is essential for the older adult’s well-being and how that impacts them. Impact of the research The study highlights the role of family ties in promoting mental and emotional health in older adults. It also demonstrates how social networks through friends may be especially important in later life, contributing to the reduction of loneliness and depression among older adults. Furthermore, it outlines how policies and community initiatives can be developed that seek to enhance the quality of life for the aging population. Keywords: Family structure, Kinless, Mental health, Social activity, unmet needs
