Preventing social isolation IS COMPLETELY YOUR DOCTOR'S RESPONSIBILITY! By delivering EXACT 100% RECOVERY PROTOCOLS! No excuses are allowed! You can't blame the patient for not recovering!
Potential profiles of social isolation in elderly stroke patients: A cross-sectional study
Introduction
Globally, stroke poses a significant threat to human health, characterized by high mortality and disability rates, especially in economically underdeveloped regions.1 In 2021, China recorded approximately 4.09 million new stroke cases and around 2.59 million deaths, closely linked to the rapid increase in the elderly population.1,2 The motor, emotional, and cognitive impairments caused by stroke often hinder patients from independently performing daily tasks and resuming cherished social interactions from before their stroke.3,4 Elderly patients face particularly daunting challenges due to more severe initial damage and a more complex rehabilitation process.4
The term "social isolation," as introduced by Berkman and Syme, refers to the state of an individual lacking social connections.5 Nicholas R. and colleagues further define social isolation as a condition where an individual experiences a lack of belonging in a social environment, has severely limited opportunities for interaction, infrequent social contact, and a deficiency in fulfilling and high-quality relationships.6 From an individual perspective, those experiencing social isolation often feel loneliness and helplessness brought about by separation from social groups. This experience conflicts with the intrinsic human need for belonging and social connection, potentially leading to various psychological and social issues.7 Li Q et al., using data from the China Health and Retirement Longitudinal Study (CHARLS), analyzed the social isolation status of elderly Chinese. They found that approximately 34.8 % of the 4747 surveyed elderly individuals reported feelings of social isolation.8 In another cross-sectional study focusing on elderly stroke patients, 40.4 % were suffering from social isolation.9 The cost of social isolation is substantial, with estimates suggesting it increases annual healthcare spending among the elderly by over $6.7 billion.10 Thus, reducing social isolation is crucial for enhancing the mental health of elderly stroke patients and lowering healthcare costs. Despite China's facing the severe challenge of an aging population, research on social isolation among the elderly remains insufficient.8
Previous research has partially explored the sense of social isolation among elderly stroke patients, yielding several insights. Firstly, some studies suggest that social isolation may accelerate the decline of physical and mental functions in the elderly and increase the risk of stroke.11,12 Secondly, recent animal experiments indicate that social isolation can trigger a pronounced oxidative stress response, a physiological change that may affect brain function recovery. The combination of social isolation and severe brain injuries such as stroke may impede the brain's repair process.3 Thirdly, compared to younger patients, elderly stroke patients typically exhibit a lower level of community integration, primarily due to the strong correlation between advanced age and physical limitations.13 Indeed, the complex relationship between social isolation and stroke patients underscores the need for in-depth research into whether specific individual characteristics influence the degree of social isolation experienced.
According to the Common-Sense Model of Self-Regulation (CSM), patients’ cognitive and emotional responses to their illness profoundly influence their psychological well-being and social functioning. When individuals adopt avoidant coping strategies, they may exhibit social withdrawal.14 The CSM has been widely applied to various chronic conditions, including stroke, providing a robust theoretical framework for understanding the mechanisms underlying psychological and social adaptation.14,15 Previous studies on dialysis patients have identified fear of progression (FoP) and illness-related stigma as well-documented risk factors for social isolation.14,16 FoP is a common psychological stress response, arising from the perceived ongoing threat posed by chronic illnesses such as stroke.17 While moderate levels of FoP may serve as a motivational force, encouraging individuals to pursue healthier lifestyles, excessive FoP can become a substantial barrier to recovery, hindering social engagement, occupational functioning, and everyday activities.14 Stigma, likewise, can exacerbate feelings of social disconnection. Misconceptions and societal biases surrounding stroke may lead patients to experience diminished self-worth and internalized shame. Those who experience heightened stigma are more likely to conceal their condition, deliberately avoid social interaction, and adopt a passive stance toward rehabilitation efforts.18 Conversely, a high level of self-disclosure may serve as an effective buffer against social isolation. Within the theoretical framework of the Social-Cognitive Processing Model (SCPM), the act of expressing one’s emotions and concerns to others functions as a powerful tool for emotional regulation. Among cancer patients, for instance, emotional disclosure has been shown to facilitate the reappraisal and adjustment of emotional responses in social contexts, playing a critical role in the adaptation process.19
The individual differences in social isolation among elderly stroke patients have not yet been thoroughly investigated. Given the marked variability between individuals, accounting for patient heterogeneity is crucial. However, existing research often relies on aggregate scores from specific scales to assess social isolation, a method that may fail to capture the unique patterns of isolation behavior among individuals. Latent Profile Analysis (LPA), a person-centered statistical approach, effectively identifies heterogeneous subgroups within a target population. By analyzing these subgroups, researchers can gain a more precise understanding of the key factors affecting different patient groups. This insight is invaluable for healthcare professionals, as it enables the design and implementation of more targeted interventions to reduce social isolation in elderly stroke patients.
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