Social Strain Is Associated with Functional Health in Older Adults after Major Surgery

Introduction: Psychosocial impairments in older surgical patients may predict postoperative functional recovery. We investigated the association of social strain, an under-studied and important social variable, with 1-year functional health in older adults after major surgery.

Methods: With Health and Retirement Study-Medicare claims data, we identified N = 3868 participants, age ≥65 years, who underwent major surgery. Outcome included postoperative 1-year functional decline in activities of daily living (ADL) as compared with preoperative ADL function. Predictor social strain was determined by asking how often one’s spouse, children, family, or friends a) “criticize you?,” b) “make too many demands on you?,” c) “let you down,” or d) “get on your nerves?”; response of “a lot” to any classified strain from that specific relationship. Analysis included multivariable logistic regression adjusted for age, gender, race/ethnicity, education.

Results: Mean age 76±5 years, 54% women, 8% Black, 5% Hispanic, 32% reported social strain from any relationship source (spouse: 14%, children: 8%, family: 7%, friends: 3%). Over 15% sustained decline within 2 years of operation. Individuals experiencing social strain from children had higher rates of 2-year functional decline (15% vs 8%, p = 0.007), those with social strain from any source had higher rates of 2-year functional decline (11% vs 5%, p = 0.001). After multivariable adjustment, social strain was significantly associated with 2-year functional decline (odds ratio [OR]=1.44 (1.02, 2.02), p value 0.04).

Conclusion: Social strain was associated with 1-year ADL functional decline in older adults undergoing major surgery. Psychosocial vulnerability should be assessed preoperatively and intervention to help patients cope with social strain should be investigated in the surgical setting.