Are Loneliness and Social Isolation Equal Threats to Health and Well-being? An Outcome Wide Longitudinal Approach

Abstract The detrimental effects of loneliness and social isolation on health and well-being outcomes are well documented. In response, governments, corporations, and community-based organizations have begun leveraging emerging tools to create interventions and policies aimed at reducing loneliness and social isolation at-scale. However, these efforts are frequently hampered by a key knowledge gap: when attempting to alleviate specific health and well-being outcomes, decision-makers are unsure whether to target loneliness, social isolation, or both. Participants (N=13,752) were from the Health and Retirement Study- a diverse nationally representative, and longitudinal sample of U.S. adults aged > 50 years. We examined how changes in loneliness and social isolation over a 4-year follow-up period (from t0:2008/2010 to t1:2012/2014) were associated with 32 indicators of physical-, behavioral-, and psychosocial-health outcomes 4-years later (t2:2016/2018). We used, multiple logistic-, linear-, and generalized-linear regression models, and adjusted for sociodemographics, personality traits, pre-baseline levels of both exposures (loneliness and social isolation), and all outcomes (t0:2008/2010). After adjusting for a wide range of covariates, we observed that both loneliness and social isolation have similar effects on physical health outcomes and health behaviors, whereas loneliness is a stronger predictor of psychological outcomes. In particular, behavioral dimensions of the social isolation measure (i.e., participation in social/religious activities, social interaction frequency) were most strongly associated with the largest number of health and well-being outcomes, including all-cause mortality. Loneliness and social isolation have independent effects on various health and well-being outcomes, thus, should be distinct targets for interventions aimed at improving the health and well-being.

adults.Given these disparities, it is important to identify methods that reduce social isolation and loneliness among this population.Social technology, such as Facebook and Skype, is one possible way to connect with others.This study uses the Health and Retirement Study (HRS) dataset to examine racial and rural disparities in the relationship between social technology use and social isolation, loneliness, and social support among individuals age 50 and older.The overarching hypotheses are that (1) rural-dwelling older adults and older Blacks will report less social technology use compared to urban-dwelling and older White adults, and (2) there will be a negative relationship between loneliness and social technology use, and (3) a positive relationship between perceived positive social support and social technology use.Racial or rural disparities in these latter potential relationships are exploratory.Multiple linear regression analysis will be performed to assess these relationships.Preliminary correlational results indicate that, consistent with prior work, greater use of social technology was associated with higher social support (N=6,029; r=.29, p<.001).However, contrary to our hypothesis, greater self-reported loneliness was associated with greater social technology (r=.09, p<.001).Examination of potential racial and rural disparities in these relationships are currently underway.

A DIGITAL INTERVENTION TO ALLEVIATE LONELINESS AND DEPRESSION AMONG OLDER PERSONS DURING THE COVID-19 OUTBREAK
Ella Cohn-Schwartz, 1 Stav Shapira, 2 Daphna Yeshua-Katz, 3 Limor Aharonson-Daniel, 4 A. Mark Clarfield, 3 and Orly Sarid, 3 1.Ben-Gurion University, Beer-Sheva, HaDarom, Israel, 2. Ben-Gurion University of the Negev, Ben-Gurion University of the Negev,HaDarom,Israel,Beer Sheva,HaDarom,Israel,Beer Shave,HaDarom,Israel Social distancing has been proven to be effective in reducing infections but may cause ill effects on the mental health of older adults.We evaluated the effects of a short-term virtual group intervention that provided tools to promote better coping, and mitigate adverse mental health effects during the outbreak of the covid-19 pandemic.A Randomized controlled trial tested the effects of a guided intervention comprised of seven online group sessions in which cognitivebehavioral techniques targeting maladaptive beliefs and appraisals were learned and practiced via ZOOM.A total of 82 community-dwelling adults from Israel, aged between 65 -90 were randomized to either an intervention group (n=64) or a wait-list control group (n=18).Loneliness (UCLA loneliness scale) and depressive symptoms (PHQ-9) were measured pre-intervention, post-intervention, and at 1-month follow-up.The findings showed a significant decrease in loneliness and depression scores in the intervention group with results maintained at 1-month follow-up.There were no significant changes in the wait-list control group.In addition, ten participants (16%) from the intervention group demonstrated a clinically meaningful decrease in depression between baseline and post-intervention, and this was maintained among 7 participants (10%) at 1-month follow-up, compared to only 1 participant (5%) in the control group.Our intervention presents a simple and easy-to-implement tool.Its relevance extends beyond the current pandemic as the skills acquired can be applied in other forms of social crises and during routine life, in order to promote the mental health of older adults who live alone and/or reside in remote areas.

A FAT-PROMOTING PLANT EXTRACT FROM ARTEMISIA SCOPARIA EXERTS GEROPROTECTIVE EFFECTS ON C. ELEGANS HEALTH & LIFESPAN Bhaswati Ghosh, Hayden Guidry, Maxwell Johnston, and Adam Bohnert, Louisiana State University, BATON ROUGE, Louisiana, United States
Like other biological processes, aging is not random, but subject to molecular control.Natural products that act on conserved metabolic pathways may provide entry points to extend animal lifespan and promote healthy aging.Here, we show that a botanical extract from Artemisia scoparia (SCO), which promotes fat storage and metabolic resiliency in mice, exerts pro-longevity effects on the nematode Caenorhabditis elegans, even when administered in mid-adulthood.SCOtreated worms exhibit significantly higher levels of fat compared to controls but live up to 40% longer, with signs of improved stress resistance in late age.Molecularly, SCO links elevated fat to enhanced longevity and stress resistance via activation of the transcription factor DAF-16/FOXO and upregulation of DAF-16-targeted Δ9 desaturases, lifespanextending metabolic enzymes that oversee the biosynthesis of monounsaturated fatty acids.These findings identify SCO as a natural product that can modify fat regulation for longevity benefit and add to growing evidence indicating that elevated fat can be pro-longevity in some circumstances.

A META-ANALYSIS OF THE EFFECTS OF TAILOR ACTIVITY PROGRAM (TAP) FOR PEOPLE WITH DEMENTIA
Jiin Jeong, 1 Eun-Young Yoo, 2 Byoung-Ho Kang, 1 and Yae-Na Ha, 1 1.Graduate school, Yonsei University, Republic of Korea, Kangwon-do, Republic of Korea, 2. College of Software and Digital Healthcare Convergence, Yonsei University, Republic of Korea, Kangwon-do, Republic of Korea Ninety eight percent of people with dementia are accompanied by neuropsychiatric symptoms (NPS).NPS is an important predictor of the negative prognosis of dementia.It also increases the burden on caregivers and lowers the quality of life.The tailored activity program (TAP), which is occupation-based intervention, have a positive effect on reducing NPS through meaningful activities.The aim of this study was to provide an integrated effectiveness of the TAP on NPS in people with dementia and caregiver burden through meta-analysis.We searched for studies that indicated the effectiveness of TAP through Embase, ProQuest, Pubmed, and RISS.We included a total of seven TAP studies written in Korean and English.Of these seven study designs, five were randomized control trials (RCTs) and two were one group non-RCTs.The result of meta-analysis shows that the effect size of the NPS was 0.62 (95% confidence interval [CI]=0.40-0.83,p<0.001), the caregiver burden was 0.68 (95% CI=0.29-1.07,p=0.001).Both variables indicated moderate effect.These results indicate that the TAP is an effective intervention for reducing NPS of people with dementia and the burden of caregivers.Therefore, TAP is clinically useful approach, we expect TAP to be actively applied to people with dementia in the community.

ACTION PLANNING CHECKLIST FOR SOCIAL DETERMINANTS OF HEALTH: OLDER ADULTS WITH CHRONIC CONDITIONS Joan Ilardo, and Angela Zell, Michigan State University College of Human Medicine, East Lansing, Michigan, United States
Medical residents need training to assess social determinants of health (SDOH) related to chronic conditions.We created a checklist to identify SDOH affecting residency clinic patients' ability to manage chronic conditions.The tool: 1) involves resident training; 2) provides decision support checklist; 3) influences patient activation; and 4) increases provider and patient communication through shared decision making.Action Planning Guide checklist (APG) includes questions pertaining to SDOH preventing patients from managing their chronic conditions and actions patients will take.Areas identified are discussed between patient and resident, increasing patient activation.The clinic's nurse care facilitator guides referrals to community-based resources.Fifty-two patients were enrolled, with 75% of patients responding they would like to be better managers of their chronic conditions.This information is used to develop patient's goals of care.Over 90% of patients said their conditions affect their lives and discussed ways better to care for themselves.Over 80% discussed medication management, health goals to improve their quality of life, and made a plan that maps out ways to reach their goals.All of these are essential for achieving positive health outcomes for older patients with chronic conditions.These attributes promote effective patient/provider partnerships.Seventy referrals were made; food through 2-1-1 (47%); monthly commodity food program (30%); utility payments (11%), and transportation (9%).Twenty-seven referrals were made to agencies serving older adults; 25 to the local AAA information and assistance services, and 2 to Senior Project Fresh Voucher Program.

ADDRESSING PHYSICAL, FUNCTIONAL, AND PHYSIOLOGICAL OUTCOMES IN OLDER ADULTS VIA INTEGRATED MHEALTH INTERVENTION
Melba Hernandez-Tejada, 1 Sundaravadivel Balasubramanian, 2 John Bian, 2 Mohan Madisetti, 2 Alexis Nagel, 2 Samantha Bernstein, 2 and Teresa Kelechi, 2 1.University of Texas HSC at Houston,Houston,Texas,United States,2. Medical University of South Carolina,Charleston,South Carolina,United States Objective: We evaluated components of an integrated mobile (m)Health-based intervention "Activate for Life" (AFL) on health outcomes in lower-income older adults (65 years and older).Method: AFL incorporates balance (Otago; OG), physical strength (Gentle Yoga and Yogic Breathing; GYYB), and mental engagement (Behavioral Activation; BA) components.Thirty participants were randomly allocated to one of three Arms (n=10 per each arm): OG (Arm 1), (OG+GYYB (Arm2), or OG+GYYB+BA (Arm 3, or full AFL).Groups were evaluated for physical, functional and physiological endpoints at baseline, and posttreatment (12weeks and/or 3-month follow up).Results: Improvements over time in pain interference and 1,5 Ag biomarker were noted for all groups.No significant changes were observed in other physical, functional and physiological measures.DiscussionThis study illustrated potential benefits of the AFL intervention on the health of lower-income older adults and lessons learned from this pilot will be used to make improvements for a large-scale randomized controlled trial.

ADVANCE CARE PLANNING AND HOSPICE USE AMONG PEOPLE WITH DEMENTIA: A REPORT FROM THE HEALTH AND RETIREMENT SURVEY Kathryn Coccia, Saint Louis University, St. Louis, Missouri, United States
People with Alzheimer's disease and related dementias (ADRD) frequently receive sub-optimal end-of-life care (EOLC), often enduring invasive procedures such as tube feeding, resuscitation, and surgery within days of their death.While advance care planning (ACP) has shown effectiveness in improving EOLC for those with ADRD, there are many barriers to ACP specific to the ADRD population.Research suggests that hospice care is optimal in reducing end of life suffering for ADRD patients.This study aimed to empirically assess hospice utilization and ACP for individuals with ADRD compared to individuals without ADRD, and to assess the impact of ACP on hospice utilization for individuals with ADRD.Data came from the 2016-2018 wave of the Health and Retirement Study (HRS), a national longitudinal study collecting health and demographic data on older Americans.This analysis evaluated survey responses from 1,224 proxy respondents for individuals who died during this period.In this sample, people with ADRD were both significantly more likely to have utilized hospice care (OR=1.37)and to have written EOLC instructions in place (OR=1.19).Those with ADRD were 22% less likely to have discussed their EOLC wishes with their proxy than those without ADRD.Having a written EOLC plan in place significantly increased the odds of hospice utilization (OR=1.37)but discussion around EOLC preferences increased odds of hospice utilization at a higher rate (OR=1.59).These results support policy to advance earlier ACP conversations around EOLC preferences and the implementation of written EOLC instructions to reduce suffering for individuals with ADRD diagnoses .

AN ENVIRONMENTAL CONTRIBUTOR TO PARKINSON'S DISEASE CAUSES A HORMETIC LIFESPAN EFFECT IN C. ELEGANS
Jennifer Thies, Hanna Kim, Guy A. Caldwell, and Kim A. Caldwell, The University of Alabama, Tuscaloosa, Alabama, United States Only 5-10% of Parkinson's Disease (PD) cases have a direct genetic origin; however, exposure to herbicides, pesticides, and interactions with soil are potential risk factors.PD is characterized by the loss of dopaminergic (DA) neurons and the formation of protein inclusions that contain α-synuclein (α-syn).Conversely, a soil bacterium,