key: cord-0890396-3v10oxqq authors: Maharani, Asri; Zaidi, Syeda Nosheen Zehra; Jury, Francine; Vatter, Sabina; Hill, Derek; Leroi, Iracema title: The long‐term impact of loneliness and social isolation on depression and anxiety in memory clinic attendees and their care partners: A longitudinal actor–partner interdependence model date: 2022-04-29 journal: Alzheimers Dement (N Y) DOI: 10.1002/trc2.12235 sha: 5846cbbcc0a438fa1131c7d484cf2e29ab59578a doc_id: 890396 cord_uid: 3v10oxqq INTRODUCTION: This study examined the long‐term influence of loneliness and social isolation on mental health outcomes in memory assessment service (MAS) attendees and their care partners, with a focus on interdependence and bidirectionality. METHODS: Longitudinal data from 95 clinic attendees with cognitive impairment, and their care partners (dyads), from four MAS in the North of England were analyzed. We applied the actor–partner interdependence model, seeking associations within the dyad. At baseline and 12‐month follow‐up, clinic attendees and care partners completed measures of loneliness and social isolation, depression, and anxiety. RESULTS: Social isolation at baseline was more prevalent in care partners compared to MAS attendees. Social isolation in MAS attendees was associated with higher anxiety symptoms (β = 0.28, 95% confidence intervals [CIs] = 0.11 to 0.45) in themselves at 12 months. We found significant positive actor and partner effects of loneliness on depression (actor effect: β = 0.36, 95% CIs = 0.19 to 0.53; partner effect: β = 0.23, 95% CIs = 0.06 to 0.40) and anxiety (actor effect: β = 0.39, 95% CIs = 0.23 to 0.55; partner effect: β = 0.22, 95% CIs = 0.05 to 0.39) among MAS attendees 1 year later. Loneliness scores of the care partners have a significant and positive association with depressive (β = 0.36, 95% CIs = 0.19 to 0.53) and anxiety symptoms (β = 0.32, 95% CIs = 0.22 to 0.55) in themselves at 12 months. DISCUSSION: Loneliness and social isolation in MAS clinic attendees had a downstream effect on their own and their care partners’ mental health. This highlights the importance of including care partners in assessments of mental health and social connectedness and expanding the remit of social prescribing in the MAS context. Loneliness and social isolation are important risk factors for a range of negative outcomes in older people, including cognitive decline, 1, 2 dementia, 3 greater physical morbidity, 4 and higher mortality rates. 5 Loneliness is a subjective sense of inadequate quantity or quality of social contact and longing for close and emotional relationships with others. 6, 7 Social isolation is an objective and quantifiable lack of, or reduction of, social network size and social contact. 5, 8 Older adults may be at increased risk of being socially isolated and lonely due to bereavement, relocation, living alone, or loss of friends and social networks, all of which have been exaggerated by the COVID-19 pandemic. 9, 10 Loneliness may also arise in the context of marital or cohabiting relationships, particularly related to aging, due to changes in intimacy, functional decline or the emergence of illness, including neurodegenerative disorders leading to dementia. 11, 12 The relationship between the caregiving role and loneliness and social isolation in care partners of people with cognitive disorders and other neurodegenerative conditions is gaining attention, especially due to the disruptions in care and support services brought on by the pandemic. 9, 11 Thus, there have been calls for further quantitative studies to understand these issues better in people with cognitive disorders and their care partners, for whom loneliness is now an important public health concern. 13 In many high-income countries, memory assessment services (MAS) are often the first point of contact with care services for older people with cognitive impairment or dementia, and their families or care partners. In view of the limited effectiveness of anti-dementia medication, 14 the focus of dementia care is often on well-being or "living well with dementia." 15 Well-being includes the concept of social connectedness. 16 Data for this study came from Project CYGNUS, a non-interventional prospective observational study exploring ways of gathering meaningful data from people with memory problems in the real world. 19 To achieve the aims of Project CYGNUS, the baseline and quarterly data from consecutive MAS attendees (n = 224) and their care partner We used the 3-item short form of the revised UCLA Loneliness Scale, 23 which is the most commonly used quantitative self-report measure of loneliness and has been validated in different populations. 24 Questions were: 1. "How often do you feel you lack companionship?"; 2. "I felt left out"; 3. "I felt isolated." Response options are: "hardly ever or never," "some of the time," and "often." Scores were summed to provide a loneliness score ranging from 3 to 9, higher scores indicating greater loneliness. We used a three-item questionnaire to record social isolation. The items were: (1) In the past month, how often did you see your friends and family? (2) In the past month, how often did you call/receive a phone call from your friends and family? (3) In the past month, how often have you used the computer/table to e-mail or contact your friends or family? The items were scored by responding as "1 = three or more times a week; 2 = once a week; 3 = less than once a week; or 4 = not during last month." The social isolation index was calculated by adding the score given to each item by respondents. Scores ranged from 3 to 12, with higher scores indicating greater isolation. We used the 14-item Hospital Anxiety and Depression Scale (HADS) in which seven items measured anxiety and seven items measured depression. 25 Items are rated on a 4-point Likert scale (scored from 0 to 3) and refer to how the person felt over the past week. Total scores for each subcategory are divided into categories of normal (0-7), mild (8) (9) (10) , moderate (11) (12) (13) (14) , and severe (15-21). Baseline characteristics of the participants with dementia and their care partners are outlined in Table 1 Abbreviation: MAS, memory assessment service. MAS attendees (35.79), and that difference was significant (P < .001). There was no significant difference in proportion of education attainment (P = .164) and ethnic minorities (P = .561) between MAS attendees and the care partners. Lower proportion of MAS attendees living with partner (P = .009) and working full time or part time than the care partners (P < .001). The descriptive statistics revealed that on average, the care part- The primary aim of this study was to test for actor and partner effects in the association among loneliness, social isolation, and depression and anxiety among MAS attendees and their care partners. Although these data were collected pre-COVID-19, this question has particular resonance during the pandemic due to the social restriction measures that have been put in place worldwide. Even before the pandemic, people with dementia and their care partners were often socially isolated; pandemic-related social restrictions have exaggerated this, leading to significantly higher levels of loneliness and social isolation in care partners of people with enduring brain health conditions. 9 Here, our results revealed that loneliness in MAS attendees was To the best of our knowledge, this study is one of the first to use a longitudinal dyadic design with individuals attending memory clinics, so that the actor and partner effects of loneliness, social isolation, and mental health status can be explored. The study used accepted measures to assess relevant constructs and applied multivariable statistical methods. The findings from this investigation have several implications, particularly in the context of pandemic-related disruption of normal social relationships. It is crucial to screen for loneliness and social isolation in people with cognitive disorders, even if assessments are being conducted remotely. Loneliness and social isolation predicted depression and anxiety among individuals with cognitive disorders and their care partners in the current investigation. There are many useful tools for rapidly and accurately assessing loneliness and social isolation that could become part of clinical intake data. 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This work was funded by Innovate UK [Grant number 102159].