Aging
Unraveling the Nexus: Social Isolation, Loneliness, and Pain Outcomes in Older Adults Yulin Yang* Yulin Yang Jacqueline Torres Ashwin Kotwal
Social isolation and loneliness pose a pressing public health challenge and are linked to many health conditions in older adults; however, little is known about the role of social isolation and loneliness in shaping pain outcomes and management. This study aims to understand how social isolation and loneliness are associated with pain and the use of non-opioids or opioids pain medications. We analyzed data from 14,118 Americans aged 50 and above from the Health and Retirement Study (HRS 2016-2020; 31,130 person-wave observations). We fitted generalized estimating equation (GEE) log-binomial models to evaluate how social isolation (household and core contacts, social Network Interactions, and community Engagement) and loneliness (3-item UCLA Loneliness Scale) are associated with the prevalence of high-impact pain (moderate-to-severe pain, or pain limiting usual activities), taking over-the-counter pain medications (e.g., Advil, Aleve, Tylenol) in the past three months, and taking opioids pain medications (e.g., Vicodin, OxyContin, codeine) in the past three months. We stratified our analyses by sex and race/ethnicity. All models applied survey weights and controlled for age, sex, race/ethnicity, education, household wealth, nursing home status, and Medicaid enrollment. Overall, both social isolation and loneliness were associated with higher risks of high-impact pain (Social isolation Prevalence Ratio [PR]: 1.12, 95% confidence interval [CI]: 1.02, 1.23; loneliness PR: 1.45, 95% CI: 1.35-1.56). Social isolation was associated with a lower risk of using OTC pain medications (PR: 0.87, 95% CI: 0.78, 0.96), while loneliness was associated with greater risk of using OTC pain medications (PR: 1.09, 95% CI: 1.02, 1.18). We found limited evidence that social isolation was associated with self-reported opioids use, but loneliness was associated with greater risk of opioids use (PR: 1.25, 95% CI: 1.12, 1.39). In stratified models, there was some variation by gender, race, and ethnicity. Our findings demonstrate important associations between social isolation, loneliness, and high-impact pain among older adults, revealing nuanced patterns in the use of non-opioids or opioids medications. Addressing social connectedness may be relevant to comprehensive pain management strategies for older adults.