Changes in Social Wellbeing Among Older Adults With Limited Prognosis: Results From a Nationally Representative Cohort

BACKGROUND: Physicians use clinical prognostic estimates to identify medical tests and treatments likely to benefit patients within their lifetime. Poor social wellbeing is associated with mortality, but it is unclear if prognostic indices can identify older adults at risk for worsening social well-being. We examined associations between a mortality prognostic index and social wellbeing at baseline and over 2 years to inform care priorities in the context of a limited prognosis. METHODS: Data from the National Social Life, Health and Aging Project (NSHAP) Round 4 (2021-2023) and Round 4.2 (2024) included 1630 older adults. Social measures included loneliness, living alone, and at least monthly volunteering, socializing, and attending community groups and religious services. Scores of 8 or higher on the Lee Index (range: 0-26) indicated high mortality risk. Survey-weighted logistic regressions adjusting for sociodemographic and health covariates were used to compare baseline and 2-year changes in social wellbeing in the high versus low mortality risk group. RESULTS: Participants had a mean age of 70.3 years, and were 54% female, 62% White, 20% Black, and 14% non-Black Hispanic. At baseline, higher mortality risk participants had poorer social wellbeing on all measures except socializing. Among those not lonely at baseline, 24.2% of higher versus 15.6% of lower risk participants became lonely at follow-up (aOR 1.47; 95% CI: 1.01-2.14). Among those socializing at least monthly at baseline, 19.0% of higher versus 12.3% of lower risk participants transitioned to less-than-monthly socializing (aOR 1.60; 95% CI: 0.97-2.65). Higher risk participants had larger declines in all measures of social wellbeing at follow-up. CONCLUSIONS: Older adults with higher mortality risk had poorer social wellbeing at baseline and were more likely to become lonely and decrease social participation at follow-up. Prognostic information may help clinicians avoid low-value medical interventions while prioritizing interventions to support meaningful social connection.