Domains of Functional Impairment and Their Associations with Thwarted Belonging and Perceived Burden in Older Adults

ABSTRACT

Objectives: Functional impairment and social disconnection are risk factors for suicide in later life. This paper examines associations between domains of functional impairment and two forms of social disconnection that are empirically linked to suicide in later life – low (or thwarted) belonging and perceived burden on others.

Methods: Participants are 62 older primary care patients (67.68% female, mean age = 72.05) who endorsed feeling lonely or like a burden. Participants completed self-report measures of low belonging and perceived burden (INQ-R) and domains of functional impairment (WHODAS 2.0) at a single time point.

Results: Greater perceived burden was associated with greater impairment in activities of daily living (“self-care”), while greater thwarted belonging was associated with greater impairment in social functioning, when controlling for depressive symptoms and age. Domains of mobility, cognition and social participation were not associated with either belonging or perceived burden.

Conclusions: Impairment in self-care (ADLs) and social functioning may be more strongly associated with perceived burden and thwarted belonging than other domains of functional impairment.

Clinical Implications: Considering specific domains of functional impairment – rather than functioning more broadly – may facilitate tailored interventions to target suicide risk.

KEYWORDS:

• Older adults
• suicide
• disability
• functional impairment
• social connectedness
• perceived burden
• belonging
• interpersonal theory of suicide

Clinical Implications

• Functional impairment and social disconnection are key risk factors for suicide in later life.

• Impairment in activities of daily living (ADLs) and social functioning may be more strongly associated with perceived burden and thwarted belonging than other domains of functional impairment.

• Considering specific domains of functional impairment—rather than functioning more broadly—may allow tailoring of interventions to target suicide risk factors.

• Interventions for functional impairment could prioritize domains linked to social disconnection to simultaneously improve two risk factors for suicide.

Acknowledgments

The authors would like to thank the clinicians and staff of the Rochester Practice-Based Research Network and the Older Adults Service of the University of Rochester for their support of recruitment efforts for this study. This study was supported from a career development award from the National Institutes of Mental Health (K23MH096936, Van Orden, PI). Preparation of this manuscript was supported by the U. S. Department of Veterans Affairs.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the National Institute of Mental Health [K23MH096936].