“Resilience factors,” such as engaging in more activities, expanding one’s social network, and increasing the use of technology, can lower the risk of loneliness among the elderly, new research finds.

These resilience factors help decrease the negative physical and mental health consequences that are associated with loneliness, said lead author Julianna Liu, a Medical Student Training in Aging Research scholar at Hebrew SeniorLife's Hinda and Arthur Marcus Institute for Aging Research.  

These actions can be accomplished through strategies such as involvement at senior centers, participating in volunteer activities, and increasing access to and knowledge of modern technological devices that allow for virtual social connection, Liu said. These actions are practical ways to decrease the detrimental effects of loneliness, she said.

At the same time researchers found that several risk factors increased one’s likelihood of experiencing loneliness: older age, inability to complete daily activities, vision impairment, depression, and anxiety.  Loneliness, a feeling of distress or discomfort in response to perceived isolation, is common among older adults, particularly during periods of social isolation. It can be associated with poor health outcomes, and is therefore an important topic to talk about and prevent if possible.

Researchers used data collected both before and during the COVID-19 pandemic from participants of the Successful Aging after Elective Surgery (SAGES) study during the COVID-19 pandemic shutdown. Participants in the SAGES study have been completing interviews with Hebrew SeniorLife for approximately 10 years; therefore, Hebrew SeniorLife already had a robust dataset with many variables assessing cognition and functioning that were utilized for this COVID-related study.

“This study found several risk factors that increased the chance of experiencing loneliness during the COVID-19 pandemic shutdown,” Liu said.  “Importantly, it also identified actionable ‘resilience factors’ that helped mitigate some negative effects of loneliness on physical and mental health outcomes,” said Dr. Tamara G. Fong, co-senior author and mentor. These findings were published in the publication, American Journal of Geriatric Psychiatry, in the paper, Association of Loneliness With Change in Physical and Emotional Health of Older Adults During the COVID-19 Shutdown.

Collaborating Institutions and Researchers

Hebrew SeniorLife: Ray Yun Gou, Eva M. Schmitt, Franchesca Arias, Tammy T. Hshieh, Thomas G. Travison, Tamara G. Fong, Sharon K. Inouye, Eran Metzger
Brown University: Richard N. Jones
Connell School of Nursing, Boston College: Patricia A. Tabloski
Harvard Medical School: Franchesca Arias, Tammy T. Hshieh, Thomas G. Travison, Edward R. Marcantonio, Tamara G. Fong, Sharon K. Inouye
Brigham and Women’s Hospital: Franchesca Arias, Tammy T. Hshieh
Beth Israel Deaconess Medical Center: Eran Metzger, Edward R. Marcantonio, Tamara G. Fong, Sharon K. Inouye

Funding information or grantor requirements

National Institute on Aging, Grant no. 3P01AG031720-08S1 and R33AG071744 to Sharon K. Inouye, and 5T35AG038027-13 (MSTAR fellowship) to Julianna Liu.

About Hebrew SeniorLife

Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching, and redefining the possibilities of aging. Hebrew SeniorLife cares for more than 4,500 seniors a day across six campuses throughout Greater Boston. Locations include: Hebrew Rehabilitation Center-Boston and Hebrew Rehabilitation Center-NewBridge in Dedham; NewBridge on the Charles, Dedham; Orchard Cove, Canton; Simon C. Fireman Community, Randolph; Center Communities of Brookline, Brookline; and Jack Satter House, Revere. Founded in 1903, Hebrew SeniorLife also conducts influential research into aging at the Hinda and Arthur Marcus Institute for Aging Research, which has a portfolio of more than $85 million, making it one of the largest gerontological research facilities in the U.S. in a clinical setting. It also trains more than 1,000 geriatric care providers each year. For more information about Hebrew SeniorLife, visit our website or follow us on our blog, Facebook, Instagram, Twitter, and LinkedIn.

BOSTON - Researchers from the Harvard affiliated Hebrew SeniorLife Institute for Aging Research (IFAR), in collaboration with scientists from Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School (HMS), and Brown University, have found increasing evidence that the level of delirium in post-surgical patients is associated with the level of later cognitive decline in those same patients. Findings from this study were published today in the Journal of Alzheimer’s Disease.

Delirium is a common, serious, often fatal disorder affecting as many as 50% of older people during the course of surgery or hospitalization and costing more than $164 billion per year. Delirium has been associated with increased functional decline, prolonged hospital stays, higher rates of institutionalization and greater mortality. Delirium is also associated with a significant decline in cognitive ability. The authors of this study have found that for those patients who develop delirium and later cognitive impairment, the severity of cognitive impairment has a direct correlation to the severity of prior delirium.

Sarinnapha Vasunilashorn, Ph.D., Division of General Medicine and Primary Care at BIDMC and contributing author on this study said, “Although the short-term adverse affects of delirium are well-recognized, our results underscore important implications for longer-term prognosis. The findings suggest that for patients with moderate to severe delirium, the decline in cognition may be both substantial and long-term, and most notably, it exceeds the rate of decline observed in patients with dementia.”

Researchers studied a group of 566 patients over a total of 3 years. Before their surgeries, none of these patients displayed signs of dementia. After surgery, a total of 134 participants displayed signs of delirium, based on their evaluations using the Confusion Assessment Method (CAM). Of these 134 participants, those who displayed the highest severity of delirium later developed the most severe cognitive decline.

Sharon K Inouye, M.D., M.P.H, Director of the Aging Brain Center at Hebrew SeniorLife’s Institute for Aging Research and senior author on the study said, “These results challenge the idea that delirium is reversible with only acute complications. Though delirium generally subsides after a period of time, it appears to have lasting effects, the severity of which are related to the severity of the delirium itself. This work suggests the need to target patients with high delirium severity for strategies to prevent progressive cognitive decline as they are at increased risk for dementia.”

About Institute for Aging Research

Scientists at the Institute for Aging Research seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity and productivity into advanced age. The Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment and cure of disease; advance the standard of care for older people; and inform public decision-making. The Musculoskeletal Center within IFAR studies conditions affecting bone, muscle, and joint health with aging.

About Hebrew SeniorLife

Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching and redefining the possibilities of aging. Based in Boston, the non-profit, non-sectarian organization has provided communities and health care for seniors, research into aging, and education for geriatric care providers since 1903. For more information about Hebrew SeniorLife, visit http://www.hebrewseniorlife.org, follow us on Twitter @H_SeniorLife, like us on Facebook or read our blog.

BOSTON — Researchers from the Harvard Medical School - affiliated Hebrew SeniorLife Institute for Aging Research (IFAR) have found increasing evidence that delirium in older surgical patients may be associated with long-term cognitive decline. Findings from the study were published today in the July 2016 issue of Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.

Delirium is a common, serious, often fatal disorder affecting as many as 50% of older people during the course of surgery or hospitalization and costs more than $164 billion per year. However, until now, the relationship between delirium and long-term cognitive decline has not been well-explored. The Hebrew SeniorLife IFAR study, conducted in collaboration with Beth Israel Deaconess Medical Center, Brown University, and Northeastern University examined the trajectory of short-term and long-term cognitive decline in patients who experienced delirium for 36 months following a surgery.

Delirium occurred in 134 of the original 560 participants in the study. Both groups of participants, those who experienced delirium and those who did not, showed a significant cognitive decline at one month, followed by a recovery above baseline at two months and then a gradual decline for the next 34 months. The 560 participants in the study were aged 70 years or older, had no previous signs of dementia, and were scheduled to undergo surgery with an anticipated length stay in the hospital of three days or greater.

The delirium group, however, had a significantly greater decline at one month compared to those without delirium. Although they too recovered at two months, this group had a more significant decline after the two- month mark than the non-delirium group. Beyond two months, both groups declined on average, but the delirium group declined significantly more. When researchers compared changes from baseline to 36 months, there was no significant change for the group who did not experience delirium, but a marked decline for those who did.

According to the researchers, the fact that both the delirium and non-delirium groups suffered cognitive decline at month one, and then a return to baseline at month two, likely represents the immediate impact of events such as anesthesia, surgery, and hospitalization. However, the higher rate of cognitive decline after month one for those with delirium suggests that delirium may set off a cascade of events which leads to progressive, long-lasting effects. Or, it is alternatively possible that delirium is associated with a pre-existing higher rate of cognitive decline that is not detectable at baseline. In either case, delirium may serve as a marker for seniors with poor cognitive reserve.

“This study is highly significant in demonstrating that delirium is associated with subsequent long-term cognitive decline at a pace similar to that of mild cognitive impairment, even in those with normal cognitive function at baseline,” says Sharon K. Inouye, M.D., M.P.H., Director of the Aging Brain Center at the Institute for Aging Research, Hebrew SeniorLife, a faculty member in the Division of Gerontology at Beth Israel Deaconess Medical Center, and Professor of Medicine at Harvard Medical School. “Whether or not delirium is causative, it identifies those at risk for subsequent cognitive decline and warrants both close clinical follow-up and preventive interventions.”

A total of 560 participants underwent a baseline assessment and medical review 30 days before surgery to ascertain their normal cognitive status. After surgery, participants were regularly assessed for up to 36 months. The delirium assessment during hospitalization included brief cognitive testing and interviews with family and nurses conducted daily. Delirium was rated using a standardized approach with high sensitivity. Cognitive performance was assessed using a comprehensive neuropsychological test battery which was administered before surgery and with each follow-up.

The study was funded by the National Institutes of Health (Grant No. P01AG031720 to Dr. Sharon Inouye)

About the Institute for Aging Research
Scientists at the Institute for Aging Research seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity and productivity into advanced age. The Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment and cure of disease; advance the standard of care for older people; and inform public decision-making. The Aging Brain Center within IFAR studies cognitive aging and conditions affecting brain health.

About Hebrew SeniorLife
Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching and redefining the possibilities of aging. Based in Boston, the non-profit, non-sectarian organization has provided communities and health care for seniors, research into aging, and education for geriatric care providers since 1903. For more information about Hebrew SeniorLife, visit https://www.hebrewseniorlife.org, follow us on Twitter @H_SeniorLife, like us on Facebook or read our blog.

About Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association
Alzheimer's & Dementia: The Journal of the Alzheimer's Association focuses on the scientific, medical and practical care issues for researchers and practitioners. Coverage extends from healthy brain aging to all forms of dementia and includes original peer-reviewed articles detailing clinical research advances as well as conference reports and abstracts. Specific areas of coverage include developments in early detection, intervention, prevention, and application of new technologies in health services.

BOSTON — Researchers from the Aging Brain Center at the Institute for Aging Research (IFAR) at Hebrew SeniorLife confirm that delirium is a significant and independent contributing factor to poor postsurgical outcomes in older adults. Findings published in JAMA Surgery suggest that the combination of major postoperative complications and delirium demonstrate a strong combined effect on adverse outcomes in older adults undergoing major surgery.

Of all inpatient operations in the U.S. in 2007, 36% were performed on patients 65 years of age or older, and that number is expected to climb with the aging population. Previous research shows that postoperative complications occur in up to 25% of older individuals and may cause adverse outcomes including disability, reduced quality of life, or even death.

Senior author Dr. Sharon K. Inouye, Director of the Aging Brain Center at IFAR, Hebrew SeniorLife in Boston, Massachusetts and Professor of Medicine, Harvard Medical School said, “Delirium, which is characterized by a sudden onset of confusion, is a concern for older adults having surgery or who are hospitalized. Our study explores the association of postoperative complications and delirium, with adverse results following surgery.”

For this prospective study, the research team included 566 patients without dementia or delirium who were age 70 or older at the time of elective major orthopedic, vascular, or abdominal surgeries. Participants had a minimum hospital stay of three days. Major postoperative complications were defined as life altering or threatening, and based on the Accordion Severity (grade 2 or more). Daily measures of delirium were determined using the Confusion Assessment Method and validated chart-review.

Study results report that a major complication occurred in 8% of study subjects and 24% of participants developed delirium. Major postoperative complications alone contributed to prolonged length of hospital stay. Delirium alone was found to significantly increase all adverse outcomes following surgery, including prolonged hospital stay, institutional discharge, and 30-day readmission.

Furthermore, the group who experience both major complications following surgery and delirium had the highest rates of all adverse outcomes. While, delirium alone exerted the highest risk of adverse outcomes at the population level compared to other major surgical complications.

First author, Dr. Lauren Gleason from the Division of Aging at Brigham and Women’s Hospital in Boston, Massachusetts, concludes, “Delirium is highly prevalent among older adults who undergo surgery or are hospitalized and should be considered a leading postoperative complication leading to adverse outcomes. Clinicians should be aware of the negative impact of delirium and look for ways to mitigate its effect on older patients in their care through use of preventative strategies such as the Hospital Elder Life Program (HELP), proactive geriatric consultation, and co-management services.”

Study co-authors include Eva M. Schmitt, Ph.D.; Cyrus M. Kosar, MA; Patricia Tabloski, Ph.D.; Jane S. Saczynski, Ph.D.; Thomas Robinson, M.D.; Zara Cooper, M.D.; Selwyn O. Rogers, Jr., M.D., M.P.H.; Richard N. Jones, Sc.D.; Edward R. Marcantonio, M.D., S.M.

This work was funded by grants from the National Institute on Aging (P01AG031720, R01AG044518, R03AG045633, K07AG041835, K01AG033643, K24AG035075), HRSA Training Grant (D01HP08794) and the John A. Hartford Foundation. For a copy of the study, email the JAMA Network Media Relations department at mediarelations@jamanetwork.org.

About JAMA Surgery
JAMA Surgery (formerly Archives of Surgery), which began publication in 1920, is an international peerreviewed journal. JAMA Surgery is the official publication of the Pacific Coast Surgical Association and the Association of VA Surgeons and is a member of The JAMA Network family of journals, which include JAMA and 10 specialty journals.

About the Institute for Aging Research
Scientists at the Institute for Aging Research seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity and productivity into advanced age. The Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment and cure of disease; advance the standard of care for older people; and inform public decision-making. The Aging Brain Center within IFAR studies cognitive aging and conditions affecting brain health.

About Hebrew SeniorLife
Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching and redefining the possibilities of aging. Based in Boston, the nonprofit, non-sectarian organization has provided communities and health care for seniors, research into aging, and education for geriatric care providers since 1903. For more information about Hebrew SeniorLife, visit https://www.hebrewseniorlife.org, follow us on Twitter @H_SeniorLife, like us on Facebook, or read our blog.

New research published in the Journal of the American Geriatrics Society has presented preliminary experimental evidence that EEG and TMS–EEG measures of cerebral oscillatory activity and cortical plasticity might identify individuals at risk of post-operative delirium.  

Post-surgical delirium is associated with increased morbidity, lasting cognitive decline, and loss of functional independence. The identification of pre-operative predictors of post-operative delirium can help stratify individual risk and identify novel therapeutic targets for interventions to prevent delirium or mitigate its impact in predisposed individuals, according to the article, “Neurophysiologic predictors of individual risk for post-operative delirium after elective surgery,” published on October 13, 2022.

“This pilot study suggests that non-invasive and scalable neurophysiologic measures may identify individuals at risk of post-operative delirium,” wrote lead author Jessica M. Ross PhD.  “Specifically, abnormalities in resting-state EEG spectral power or TMS-plasticity may indicate sub-clinical risk for post-surgery delirium.”  Large scale collaborations are needed to validate and expand on these findings, and to facilitate the development of clinically useful tools.

Delirium is a common complication after surgery, particularly in older adults where it affects up to one in three individuals and has substantial morbidity including lengthier hospitalizations, deleterious effects on long-term wellbeing and cognitive health, loss of functional independence, and greater mortality. Recent research showed that the health care costs attributable to delirium after elective surgery are over $30 billion per year in the US alone.

Dr. Sharon Inouye, Director of the Aging Brain Center at Hebrew SeniorLife's Hinda and Arthur Marcus Institute for Aging Research, is the overall principal investigator for the SAGES II study, and Hebrew SeniorLife is the study coordinating center. Authors are Jessica M. Ross PhD¹,²,³,⁴  , Emiliano Santarnecchi PhD, PsyD¹,²,⁵ , Shu Jing Lian BA¹, Tamara G. Fong MD, PhD⁶,⁷ , Alexandra Touroutoglou PhD²,⁸ , Michele Cavallari MD, PhD⁹ , Thomas G. Travison PhD⁷,¹⁰ , Edward R. Marcantonio MD, SM¹⁰ , Towia A. Libermann PhD¹⁰ , Eva M. Schmitt PhD⁷ , Sharon K. Inouye MD, MPH¹⁰,¹¹ , Mouhsin M. Shafi MD, PhD¹,² , Alvaro Pascual-Leone MD, PhD²,¹¹,¹² , the SAGES II Study Group - *Sharon K. Inouye, Mouhsin M. Shafi, Alvaro Pascual-Leone contributed equally.

¹Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, Massachusetts
²Department of Neurology, Harvard Medical School, Boston, Massachusetts
³Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center, Palo Alto, California
⁴Department of Psychiatry and Behavioral Sciences, Stanford Medical School, Stanford, California
⁵Precision Neuroscience & Neuromodulation Program (PNN), Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
⁶Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
⁷Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts
⁸Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
⁹Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
¹⁰Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
¹¹Hinda and Arthur Marcus Institute for Aging Research, and Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, Massachusetts
¹²Guttmann Brain Health Institute, Institut Guttmann, Barcelona, Spain

Funding Information 
The manuscript was funded by P01AG031720 (SKI) from the National Institute on Aging (SKI).

Method of research 
Electroencephalography (EEG) and transcranial magnetic stimulation (TMS) were collected from 23 patients prior to elective surgery. Resting-state EEG spectral power ratio (SPR) served as a measure of integrity of neural circuits. TMS–EEG metrics of plasticity (TMS-plasticity) were used as indicators of brain capacity to respond to stressors. Presence or absence of delirium was assessed using the confusion assessment method (CAM). Only individuals with no baseline clinically relevant cognitive impairment (MoCA scores ≥21) were included in order to focus on subclinical neurophysiological measures.

SAGES Study
The authors gratefully acknowledge the contributions of the patients, family members, nurses, physicians, staff members, and members of the Executive Committee who participated in the Successful Aging after Elective Surgery (SAGES) Study.

About Hebrew SeniorLife
Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching, and redefining the possibilities of aging. Hebrew SeniorLife cares for more than 3,000 seniors a day across six campuses throughout Greater Boston. Locations include: Hebrew Rehabilitation Center-Boston and Hebrew Rehabilitation Center-NewBridge in Dedham; NewBridge on the Charles, Dedham; Orchard Cove, Canton; Simon C. Fireman Community, Randolph; Center Communities of Brookline, Brookline; and Jack Satter House, Revere. Founded in 1903, Hebrew SeniorLife also conducts influential research into aging at the Hinda and Arthur Marcus Institute for Aging Research, which has a portfolio of more than $63 million, making it the largest gerontological research facility in the U.S. in a clinical setting. It also trains more than 1,000 geriatric care providers each year. For more information about Hebrew SeniorLife, visit our website or follow us on our blog, Facebook, Instagram, Twitter, and LinkedIn.

About the Hinda and Arthur Marcus Institute for Aging Research
Scientists at the Marcus Institute seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity, and productivity into advanced age. The Marcus Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment, and cure of disease; advance the standard of care for older people; and inform public decision-making.
 

After leading Hebrew SeniorLife for nearly a year, President and CEO Steven H. Landers, MD, MPH, is stepping down for personal reasons. It became evident that a relocation to Boston from New Jersey was not the best option for his family at this time. His last day will be May 17, 2024.

During his tenure, Landers led Hebrew SeniorLife in executing its strategic vision and ensuring its commitment to providing superior senior living, health care, research, and teaching to empower the lives of older adults.

Former President and CEO Lou Woolf, who led Hebrew SeniorLife for 14 years, has agreed to serve as interim president and CEO and support the senior leadership team while the Board conducts a search for Landers’ successor.

Hebrew SeniorLife is in a strong strategic, operational, and financial position with a committed Board and an experienced team of senior leaders who will ensure a smooth transition and propel Hebrew SeniorLife forward.

About Hebrew SeniorLife

Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching, and redefining the possibilities of aging. Hebrew SeniorLife cares for more than 4,500 seniors a day across six campuses throughout Greater Boston. Locations include: Hebrew Rehabilitation Center-Boston and Hebrew Rehabilitation Center-NewBridge in Dedham; NewBridge on the Charles, Dedham; Orchard Cove, Canton; Simon C. Fireman Community, Randolph; Center Communities of Brookline, Brookline; and Jack Satter House, Revere. Founded in 1903, Hebrew SeniorLife also conducts influential research into aging at the Hinda and Arthur Marcus Institute for Aging Research, which has a portfolio of more than $98 million, making it one of the largest gerontological research facilities in the U.S. in a clinical setting. It also trains more than 500 geriatric care providers each year. For more information about Hebrew SeniorLife, visit our website or follow us on our blog, Facebook, Instagram, Threads, and LinkedIn.