A new study examining the role of social connection in shaping end-of-life outcomes among older adults has provided insightful findings that challenge prevalent notions about the social trajectories of individuals nearing the end of life. The research, published in The Lancet Healthy Longevity, utilised data from the Survey of Health, Ageing, and Retirement in Europe (SHARE), encompassing 19 countries and involving a large, representative sample of older adults.

Social connection is widely recognised as a key determinant of health, yet its role in end-of-life outcomes has been poorly understood. The primary objectives of the study were to determine changes in the structure, function, and quality components of social connection over time in the last years of life of older adults, and to investigate how these elements predict end-of-life outcomes, including symptoms such as pain, breathlessness, anxiety, or sadness, healthcare utilisation, and place of death.

The study used longitudinal data from SHARE, which collects individual-level data on health and social and family networks of home-dwelling older people across Europe and Israel. Data were drawn from waves 4, 6, and 7 of the SHARE project, focusing on participants who had died and for whom end-of-life interviews were available. These interviews, conducted with proxies, provided comprehensive information on the deceased participants’ social connections and health status in their final year of life.

The findings reveal multifaceted changes in social connection as older adults approach the end of life, countering the common assumption of a generally declining social trajectory. Key observations include:

• Marital status and social support. There was a notable decrease in the proportion of participants who were married or partnered in the final years of life. Despite this, the receipt of personal care or practical help increased significantly, indicating a rise in social support as health deteriorated.
• Loneliness. Loneliness increased slightly but significantly in the final years of life. This increase occurred alongside stable social networks in terms of size, contact frequency, and emotional closeness. This suggests that while social structures remain, the subjective experience of loneliness may intensify as death approaches.
• Predictive value of loneliness. Higher levels of loneliness one year before death were associated with a greater likelihood of experiencing burdensome symptoms such as pain, breathlessness, and anxiety or sadness in the last month of life. This finding underscores loneliness as a significant risk factor for adverse end-of-life outcomes.
• Place of death. Being married, often cited as a determinant of dying at home in North America and the UK, was associated with a higher probability of dying in the hospital in this study. This highlights the influence of regional and cultural differences on end-of-life care preferences and realities.

These findings have several important implications for public health policy, end-of-life care practices, and future research. They challenge the notion of inevitable social decline towards the end of life, instead suggesting that social connections undergo complex changes. Recognising and addressing loneliness as a significant factor in end-of-life care could improve quality of life for older adults.

The study shows how important it is to have clear conceptual frameworks when studying social connection and how it affects health outcomes. Future research should try to confirm the observed causal relationships and find out how they work, possibly by combining epidemiological studies with qualitative and ethnographic methods.

The study also underscores the importance of considering regional differences in end-of-life care preferences, as cultural contexts can significantly shape outcomes such as the place of death.