Living alone vs. living with someone as a predictor of mortality after a bone fracture in older age
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ORIGINAL ARTICLE
Living alone vs. living with someone as a predictor of mortality after a bone fracture in older age Kaisa Koivunen1 · Elina Sillanpää1 · Mikaela von Bonsdorff1,2 · Ritva Sakari1 · Katja Pynnönen1 · Taina Rantanen1 Received: 23 July 2019 / Accepted: 14 February 2020 © The Author(s) 2020
Abstract Background Living alone is a risk factor for health decline in old age, especially when facing adverse events increasing vulnerability. Aim We examined whether living alone is associated with higher post-fracture mortality risk. Methods Participants were 190 men and 409 women aged 75 or 80 years at baseline. Subsequent fracture incidence and mortality were followed up for 15 years. Extended Cox regression analysis was used to compare the associations between living arrangements and mortality risk during the first post-fracture year and during the non-fracture time. All participants contributed to the non-fracture state until a fracture occurred or until death/end of follow-up if they did not sustain a fracture. Participants who sustained a fracture during the follow-up returned to the non-fracture state 1 year after the fracture unless they died or were censored due to end of follow-up. Results Altogether, 22% of men and 40% of women sustained a fracture. During the first post-fracture year, mortality risk was over threefold compared to non-fracture time but did not differ by living arrangement. In women, living alone was associated with lower mortality risk during non-fracture time, but the association attenuated after adjustment for self-rated health. In men, living alone was associated with increased mortality risk during non-fracture time, although not significantly. Conclusion The results suggest that living alone is not associated with pronounced mortality risk after a fracture compared to living with someone. Keywords Social networks · Social support · Resilience · Health stressors · Living arrangement
Introduction Humans are by nature social creatures and it is widely recognized that social networks are associated with health outcomes. According to the conceptual model of Berkman et al. [1], social networks operate through different psychosocial mechanisms, such as social support and social engagement, which influence health. Further, these mechanisms influence more proximate pathways to health status, such Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40520-020-01511-5) contains supplementary material, which is available to authorized users. * Kaisa Koivunen [email protected] 1
Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
Folkhälsan Research Center, Helsinki, Finland
2
as health behavioral, psychological and physiological pathways. Living arrangements may have a substantial impact on the psychosocial mechanisms affecting health, such as the availability of social support. The number of older people living alone is rising in most countries, primarily owi
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