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Social Determinants of Health

The Elderly Hypertensive

Bui, Simonetti, Benson, Malek and Anderson 

A 71-year-old man presents to your clinic for a wellness visit.  He is healthy except for knee osteoarthritis and hypertension for which he takes hydrochlorothiazide daily and acetaminophen as needed.  His wife of 35 years passed away last year. They did not have children and he has few friends in town.  Besides going shopping once a week, he does no other activities.  He was a former truck driver, does not smoke, and drinks approximately 4 beers a week.  He does not exercise. He has no history of depression and denies feeling sad or hopeless. His physical examination reveals a BP of 142/74, BMI 32. 

Which of the following risk factors has been shown to be more strongly associated with mortality than hypertension?

a)      Physical inactivity

b)      Alcohol use

c)       Obesity

d)      Social isolation


What are possible interventions to help mitigate this risk factor?


Fast Fact: Social isolation, defined as disengagement from social ties, institutional connections, or community participation is a risk factor for poor health outcomes, including increased mortality. In a meta-analysis by Holt-Lunstad, stronger social relationships had a 50% increased likelihood of survival compared to lean body weight (22%), physical activity (21%) and controlled hypertension (13%). Prevalence of social isolation in community-dwelling older adults ranges from 10 to 43 %.  Clinicians may consider encouraging participation in community, volunteer or religious organizations in socially isolated adults.


  1. Pantell M, et al. Social isolation: a predictor of mortality comparable to traditional clinical risk factors. Am J Public Health 2013 Nov; 103(11):2056-62
  2. Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review.  Plos Med 2010; 7(7):e1000316
  3. Seeman TE. Social ties and health: the benefits of social integration. Ann Epidemiol. 1996; 6(5):442-451.