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Loneliness is a common public health concern, particularly among mid- to later-life adults. However, its impact on early mortality (deaths occurring before reaching the oldest old age of 85 years) remains underexplored. This study examined the predictive role of loneliness on early mortality across different age groups using data from the Health and Retirement Study (HRS).
Methods
A retrospective cohort study was conducted using data from the 2010–2020 waves of the HRS, restricted to participants aged 50–84 years at baseline. Loneliness was measured using the 11-item UCLA Loneliness Scale, categorized into four levels: low/no loneliness (scores 11–13), mild loneliness (14–16), moderate loneliness (17–20) and severe loneliness (21–33). Cox proportional hazards models and time-varying Cox regression models with age as the time scale were created to evaluate the relationship between loneliness and early mortality, adjusting for sociodemographic, lifestyle, and physical and mental health factors.
Results
Among 6,392 participants, the overall mortality rate before the age of 85 years was 19.1 per 1,000 person-years. A dose–response relationship was observed, with moderate and severe loneliness associated with 23% (adjusted hazard ratio [aHR]: 1.23, 95% confidence interval [CI] = 1.02–1.48) and 36% (aHR: 1.36, 95% CI = 1.13–1.65) higher mortality risk, respectively. Significant associations existed for the 65–74-year-old (aHR = 1.37, 95% CI = 1.03–1.83) and 75–84-year-old (aHR = 1.77, 95% CI = 1.23–2.56) age groups in the fully-adjusted models, but not for the 50–64-year-old age group. Time-varying Cox models showed a stronger association for severe loneliness (aHR = 1.65, 95% CI = 1.37–1.99).
Conclusions
Loneliness is a significant predictor of mortality among older adults. Preventive and interventional programs targeting loneliness may promote healthy ageing.
In cases of mass-casualty incidents (MCIs), triage represents a fundamental tool for the management of and assistance to the wounded, which helps discriminate not only the priority of attention, but also the priority of referral to the most suitable center.
Hypothesis/Problem:
The objective of this study was to evaluate the capacity of different prehospital triage systems based on physiological parameters (Shock Index [SI], Glasgow-Age-Pressure Score [GAP], Revised Trauma Score [RTS], and National Early Warning Score 2 [NEWS2]) to predict early mortality (within 48 hours) from the index event for use in MCIs.
Methods:
This was a longitudinal prospective observational multi-center study on patients who were attended by Advanced Life Support (ALS) units and transferred to the emergency department (ED) of their reference hospital. Collected were: demographic, physiological, and clinical variables; main diagnosis; and data on early mortality. The main outcome variable was mortality from any cause within 48 hours.
Results:
From April 1, 2018 through February 28, 2019, a total of 1,288 patients were included in this study. Of these, 262 (20.3%) participants required assistance for trauma and injuries by external agents. Early mortality within the first 48 hours due to any cause affected 69 patients (5.4%). The system with the best predictive capacity was the NEWS2 with an area under the curve (AUC) of 0.891 (95% CI, 0.84-0.94); a sensitivity of 79.7% (95% CI, 68.8-87.5); and a specificity of 84.5% (95% CI, 82.4-86.4) for a cut-off point of nine points, with a positive likelihood ratio of 5.14 (95% CI, 4.31-6.14) and a negative predictive value of 98.7% (95% CI, 97.8-99.2).
Conclusion:
Prehospital scores of the NEWS2 are easy to obtain and represent a reliable test, which make it an ideal system to help in the initial assessment of high-risk patients, and to determine their level of triage effectively and efficiently. The Prehospital Emergency Medical System (PhEMS) should evaluate the inclusion of the NEWS2 as a triage system, which is especially useful for the second triage (evacuation priority).
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