How social isolation and loneliness effect medication adherence among elderly with chronic diseases: An integrated theory and validated cross-sectional study

Introduction: Social isolation and loneliness have been described as epidemics among elderly patients with chronic disease. Those epidemics also associates with these elderly's low medication adherence behavior. However, there is a scarcity of research on establishing mechanisms of elderly patients' medication adherence referred to their social isolation and loneliness. Methods: A mixed-methods design with integrated theory and validated cross-sectional study was used. The integrated theory was constructed by Berkman's conceptual model and the mechanism model of loneliness. The cross-sectional survey was conducted in six districts of Taiyuan, China, through a stratified random cluster sampling method. Results: Low social support mediated the association between social isolation and suboptimal medication adherence in the whole sample, also in multimorbidity patients. Social isolation was positively associated with loneliness, but loneliness couldn't be considered as a mediator between social isolation and medication adherence. In serial mediation model, social isolation caused less social support and more loneliness, and resulted in suboptimal medication adherence in whole sample. In addition, this serial mediational model was not different between patients in non-multimorbidity and multimorbidity. Conclusions: Social isolation and loneliness are related but independent constructs. Interconnected psychosocial mechanisms explain the influence the mechanism of medication adherence from social isolation and loneliness, and the effective paths of social isolation will increase as the chronic disease evolves. The interventions should initially focus on emotional health to establish a multi-perspective supporting system, which contains tangible support, informational and emotional support, positive social interaction, and affectionate support, especially for the multimorbidity patients.