The researchers used a multifactorial conceptualization of social connection in their analysis, which distinguishes among structural, functional and qualitative aspects of social relationships (Holt–Lundstad conceptualization). By analyzing records from SHARE (which include interviews with both living participants and proxy respondents for those deceased), the researchers derived data on network structure (partnership status, social network size, geographical proximity and contact frequency), functional aspects (social support received and loneliness) and quality aspects of social connection (satisfaction with social networks and emotional closeness). The team compared data across different waves of the SHARE study and focused on participants who had passed away and for whom end-of-life interviews were available. This enabled a detailed examination of the changes in social connections that occurred and how those changes correlated with end-of-life outcomes, such as symptom burden, healthcare use and place of death.
The results of the study show that, contrary to the common belief that social connections deteriorate towards the end of life, certain aspects of social connection (such as the size of social networks and satisfaction with these networks) remain relatively stable. Interestingly, although loneliness did increase, the change was considered small. The study also found that being married or in a partnership was associated with a higher likelihood of dying in a hospital as opposed to other locations, similar to that when receiving personal care or help from network members or others. This finding counters previous research that has suggested that partnered individuals or those who receive social support are more likely to die at home. Furthermore, the study highlights loneliness as a significant predictor of experiencing symptoms such as anxiety, sadness, trouble breathing or pain at the end of life. The researchers highlight that future research is needed to substantiate causal relationships and determine the mechanisms that link social connection to outcomes at the end of life.
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