. 2018 Apr;108(4):e1–e10. doi: 10.2105/AJPH.2017.304256

TABLE 1—

Social Relationships and Health Care Service Use by Older Adults: Strength of, and Message From, the Evidence From a Systematic Review of the Literature: 1983 to 2016

		High-Strength Evidence
Dependent Variable	Measure of Social Relationships	Relationship With Service Use	Consistency^a	No. of Participants	Moderate-Strength Evidence^b: Relationship With Service Use
Family physician visits	Social network				No evidence of association^9,12,78
Family physician visits	Perceived support				No evidence of association^12,32,78
Physician visits (across specialties)	Combined measure				No evidence of association^{66–68, 81,113}
Hospital admission	Social network				No evidence of association^{10,20,25,27,29,103,105,106,108,125,127}
	Received support				No evidence of association^29,56
	Perceived support				No evidence of association^{13,25,105,108,110}
	Combined				No evidence of association^{42,45,67,68,81}
Readmission to hospital	Perceived support				No evidence of association^26,31,33
Readmission to hospital	Combined	Weaker social relationships were associated with greater likelihood of readmission^34,46,48	75 (3/4)	1 176
Length of hospital stay	Social network				Smaller social networks were associated with spending more days in hospital^{19,98,106,108,127}
	Perceived support				No evidence of association^33,108,110
	Combined				No effect^23,69,97
Emergency department visit	Social network	No evidence of association^11,77,125	75 (3/4)	3754
Emergency department visit	Perceived support				No evidence of association^11,77,104
General home- and community-based services	Social network	No evidence of association^{37,52,54,82,83,92,124,127}	89 (8/9)	10 029^c
	Received support				No evidence of association^{50,51,72,82,83,92,94,107,121,129}
	Perceived support	No evidence of association^{21,37,82,110,120}	83 (5/6)	4 049
Senior and day center use	Perceived support				No evidence of association^59,62
General health service use	Social network				No evidence of association^52,112

^{^a}

Percentage of high-quality studies reporting an effect in the same direction (number of high-quality studies reporting the same effect or number of high-quality studies included).

^{^b}

Domains for which the evidence was of low strength (e.g., received support and family physician visits), either because there were fewer than 3 medium-quality studies on the topic or because fewer than 50% of medium- or high-quality studies agreed, are not included in this table.

^{^c}

Two studies used data from the 1988 National Survey of Hispanic Elderly People; when totaling number of participants, we only entered the biggest sample number (Tran¹²⁴) to avoid counting individuals multiple times.