It’s known that older people living alone suffer higher levels of chronic disease, depression and cognitive decline. New research now indicates that men who live alone have particular trouble managing their chronic conditions and medications, putting them at greater risk of poor cardiovascular disease outcomes.
Researchers led by Stanford Health Policy’s Mark A. Hlatky took advantage of Denmark’s national network of linked population level databases to identify individuals with atrial fibrillation (AF) and assess whether they lived by themselves or with others. They studied 4,772 patients with AF who, between 1997 and 2012, were monitored for at least six months after starting an oral anticoagulant to reduce their risk of stroke.
They looked at how long each patient’s anticoagulation level was in the right range: neither too high nor too low. The anticoagulation level is very sensitive to whether the patient takes their pills every day, adjusts the dose correctly according to the results of blood tests, keeps to their diet, and comes in regularly to clinic. The researchers hypothesized that people who lived alone, especially men who lived alone, would have more trouble managing their medications, diet and testing, and therefore would spend less time in the therapeutic range for anticoagulation.
The 15% of the cohort who were men living alone had significantly worse control of their anticoagulation and came less often to the clinic to have their anticoagulation levels checked, even after controlling for other factors that might affect anticoagulation control. The effect of being a man living alone on the time in therapeutic range of anticoagulation (-3.6%) was larger than the effect of known medical factors such as diabetes (-1.8%), depression (-3.2%), heart failure (-3.0%) or cancer (-2.5%).
The paper published in the American Heart Journal, notes that all residents of Denmark are required by law to register where they live within five days of moving, which allowed the researchers to identify cohabitation status accurately.
“The data resources in Denmark are remarkable, and allowed us to study the effects of socioeconomic factors on health care and health outcomes in a way that would be simply impossible in the United States” said Hlatky, MD, the study’s senior author, who is a professor of health policy and of cardiovascular medicine.
“The results of this study might have very broad implications because anticoagulation control is a sensitive marker of how well someone can manage chronic medical problems,” he said. “Our study suggests that men who live alone have more difficulty managing chronic diseases, especially conditions that depend on medication adherence, eating a good diet, and making regular clinic visits to adjust medications.”
The researchers noted that even in Denmark — which has one of the world’s strongest social safety nets — men living alone still had particular difficulty with managing anticoagulation.
“This might be even more of a problem in countries like the United States that lack universal health care and many of the social services of Scandinavian countries,” Hlatky said. “It may be that men living alone are particularly isolated, and less connected with the medical care system. They might benefit from more social support.”
Hlatky said the findings suggest clinicians should pay particular attention to older patients who live alone, especially men, as they are at higher risk of poorer outcomes.