Health and Mental Health Predictors of Social Isolation Among Older Adults Living in Mexico

Background and Purpose:

Social Isolation (SI) is a global hazard affecting older adults and has been identified as a “silent killer” (SW Grand
Challenges 2015). Loneliness and isolation among elders are associated with increased rates of heart disease, mortality, cancer and a range of negative health behaviors.  To date, most research has focused in high-income countries using SI as a predictor of outcome.  However little is known regarding the predictors of SI and how SI varies by culture. In Mexico increasing attention has been paid to the challenges facing elders; however no studies have explored the predictors of SI among this population. To address this gap we aimed to estimate prevalence of SI and identify physical and mental health predictors by using a national probability sample of older adults in Mexico as guided by Nicholson’s (2009; 2012) conceptual analysis.

Methods:

Data are from the Mexico component of the WHO Study on Global AGEing and Adult Health (SAGE). The survey used a multi­stage, stratified clustered sample design, with household clusters sampled to reflect age, sex, level of wealth/local economic development, and urban/rural status in the Mexico Census. Interviews included 1,881 adults aged ≥ 60 years in Wave 1 (2007­ 2010). Measures are standardized, well­validated and widely used in world health surveys. As proxy for SI it was defined as moderate to extreme difficulty with interpersonal activities (WHO “Interpersonal Activities”; α=.87).  Independent variables included 1) sociodemographic (i.e. age, gender, education, income, marital status; 2) physical health (i.e. chronic health conditions, vision/hearing impairment, fatigue, alcohol/tobacco use, functional impairment); and 3) psychosocial (i.e. depression, social cohesion, quality of life, memory impairment). We examined zero-order correlations across variables and used logistic regression for analysis while controlling for sociodemographics.

Results: 

Per our definition, approximately 6% of older adults in Mexico are socially isolated.  Results indicate that among elders in Mexico: those who are ≥75 years have 2.5x the odds of SI compared to those who  60 to 75 years; those who report  moderate to extreme fatigue have 3.5x the odds of SI compared to those with little or no fatigue; those dissatisfied with their quality of life have 2x the odds of SI compared to those not dissatisfied; and those reporting moderate to severe functional impairment have 6.5x the odds of SI compared to those reporting less than moderate  impairment.

Conclusions and Implications:

SI is an under-recognized yet critical social concern among older adults in Mexico.  Based on our results 1) Mexico’s geriatric professionals should address SI through their developing geriatric care infrastructure and 2)  practitioners (primary care physicians, psychologists, social workers, “gerontologos”) should screen for SI among all older adults, especially the oldest old and those who with identified risk factors.

Future research should both identify protective factors and explore the role of critical socio-political (e.g. violence, city planning) and cultural factors (e.g. familism, perceptions of aging, ageism) for SI in Mexican context and how these elements may be incorporated into effective strategies for prevention and intervention for this vulnerable population.