An 80-year-old man comes to the office for routine follow-up. He lives alone and is independent in his activities of daily living. He still drives infrequently but has his groceries delivered. His spouse of 50 years died 2 years ago. The patient denies feeling down and is still interested in music and playing golf but remarks that he is not going out as much as he once did. He admits to lacking companionship and feeling lonely. He has hypertension, hyperlipidemia, benign prostatic hyperplasia, and osteoarthritis of the knees. The patient takes 5 medications daily and is adherent with his medical regimen. He drinks 1 or 2 glasses of wine a day.
On physical examination, the patient is well dressed and groomed. Blood pressure is 130/84 mm Hg and pulse is 80/min. BMI is 25 kg/m². Mini-Mental Status Examination score is 27/30. He has slight tenderness to palpation of the joint line of his left knee but has full range of motion. The rest of the examination is within normal limits.
Which of the following is the strongest risk factor for functional decline and increased mortality in this patient?

Question

Quizplus · Accepted Answer

The elderly often suffer from loneliness due to the loss of friends and relatives, resulting in a smaller social network. Loneliness is a modifiable risk factor that has been found to be an independent predictor of functional decline and death when adjusting for depression and medical illness severity. If not addressed, social isolation can lead to increased rates of anxiety, depression, disability, and suicide. For patients who admit to feeling lonely, physicians can help to improve quality of life with interventions that decrease social isolation, such as referral to social services agencies, senior center activities, and volunteer work. Providers should routinely ask elderly patients about loneliness in primary care visits as a method of primary prevention regarding subsequent disability. (Choice A) This patient's alcohol use is in the moderate range (men <3, women <2 drinks/day) with no indication of misuse. Some studies have shown a decreased mortality associated with moderate alcohol consumption. (Choice B) Hypertension has been associated with increased morbidity and mortality due to cardiovascular events (eg, myocardial infarction, cerebrovascular accident); however, this patient's blood pressure appears to be well controlled on medications. (Choice D) Many patients who report loneliness do not have associated depression. This patient denies feeling down and still has interest in doing things. Intervention to counter his social isolation rather than treatment for depression is indicated. (Choice E) Although osteoarthritis can create physical limitations, this patient has good range of motion; it is his loneliness rather than his osteoarthritis that is a source of distress. Educational objective: Loneliness is an independent risk factor for functional disability and increased mortality in the elderly that is modifiable with social interventions. Physicians should routinely inquire about loneliness at health care visits and recommend interventions that decrease social isolation. __________ References: Loneliness in older persons: a predictor of functional decline and death. (http://www.ncbi.nlm.nih.gov/pubmed/22710744) Loneliness is adversely associated with physical and mental health and lifestyle factors: results from a Swiss national survey. (http://www.ncbi.nlm.nih.gov/pubmed/28715478)

An 80-Year-Old Man Comes to the Office for Routine Follow-Up