Health-related social needs before and after critical illness among Medicare beneficiaries

Abstract

Objectives: Among older persons hospitalized in the intensive care unit (ICU) for critical illness, little is known about the health-related social needs (HRSNs) of food insecurity, social isolation, and transportation disadvantage in the year after discharge. This study aims to ascertain the prevalence of food insecurity, social isolation, and transportation disadvantage in the years preceding and following critical illness and to evaluate factors associated with each post-ICU HRSN. Methods: Data from community-living participants in Rounds 2–9 of the National Health and Aging Trends Study (NHATS) 2011 cohort were linked to Medicare claims to identify ICU hospitalizations. HRSNs, demographics, preadmission, and in-hospital factors were drawn from NHATS and claims data. The prevalence of each HRSN was determined before and after critical illness. Factors associated with each HRSN in the year after discharge were evaluated using population-weighted multivariable logistic regression. Results: Among 450 participants, the mean age was 80.1 (SD 7.1), 50.9% were women, and 110 (24.7%) were non-Hispanic Black individuals. All three HRSNs increased in the year after critical illness (food insecurity, 4.9%–7.8%, social isolation, 31.9%–39.4%, and transportation disadvantage, 10.5%–15.6%). Socioeconomic disadvantage was associated with greater odds of social isolation after critical illness (adjusted odds ratio [aOR], 3.26; 95% CI, 1.38–7.70). Mechanical ventilation was associated with greater odds of post-ICU transportation disadvantage (aOR, 2.69; 95% CI, 1.03–7.01). No factors were significantly associated with post-ICU food insecurity. Discussion: These findings emphasize the need for screening and interventions to address HRSNs among older survivors of critical illness.