{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T09:23:35Z","timestamp":1787822615964,"version":"build-2784847793"},"reference-count":36,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K23AG065438"],"award-info":[{"award-number":["K23AG065438"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K24AG06831"],"award-info":[{"award-number":["K24AG06831"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["P01AG066605"],"award-info":[{"award-number":["P01AG066605"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["P30AG044281"],"award-info":[{"award-number":["P30AG044281"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["T32\u2010AG000212"],"award-info":[{"award-number":["T32\u2010AG000212"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["NIA U01AG009740"],"award-info":[{"award-number":["NIA U01AG009740"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Loneliness (subjective feeling of lacking connection) and social isolation (objective deficit in number of relationships or contact with others) are common at the end\u2010of\u2010life and can be detrimental to quality of life. Investigating the association between symptoms and end\u2010of\u2010life loneliness and social isolation could help inform targeted interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We used nationally\u2010representative, cross\u2010sectional Health and Retirement Study data, including adults &gt;\u200950\u2009years old (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20092385) who died while enrolled. Respondents self\u2010reported on validated loneliness and social isolation measures within 1\u2009year of death; 12 physical and psychological symptoms were determined via after\u2010death interviews with proxies. We use multivariable logistic regression to determine the adjusted probability of end\u2010of\u2010life loneliness or social isolation by each symptom, adjusting for socio\u2010demographic covariates.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Respondents were on average 76\u2009years old, 50% female, 82% identified as White, 10% Black, and 5% Latino. Loneliness was more common among the following symptoms (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05): pain (30% vs. 20%), depression (35% vs. 18%), fatigue (29% vs. 22%), drowsiness (32% vs. 25%), and agitation (38% vs. 24%). Social isolation was more common in decedents who had difficulty breathing (22% vs. 14%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03), drowsiness (30% vs. 17%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006), and persistent cough (24% vs. 15%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In the last year of life, multiple psychosocial symptoms were associated with experiences of loneliness whereas physical symptoms were associated more with social isolation. While these relationships are complex, addressing the social sequela of physical and psychological symptoms may be an opportunity to improve overall well\u2010being at the end\u2010of\u2010life.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.70398","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T05:16:13Z","timestamp":1773983773000},"page":"2208-2215","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["End\u2010of\u2010Life Loneliness, Social Isolation, and Symptom Burden: A Nationally\u2010Representative Study"],"prefix":"10.1111","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6400-3161","authenticated-orcid":false,"given":"Mara","family":"Rosenberg","sequence":"first","affiliation":[{"name":"Division of Geriatrics University of California, San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5839-1070","authenticated-orcid":false,"given":"Irena","family":"Cenzer","sequence":"additional","affiliation":[{"name":"Division of Geriatrics University of California, San Francisco  San Francisco California USA"},{"name":"Department of Epidemiology and Biostatistics University of California, San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander K.","family":"Smith","sequence":"additional","affiliation":[{"name":"Division of Geriatrics University of California, San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6137-8512","authenticated-orcid":false,"given":"Ashwin A.","family":"Kotwal","sequence":"additional","affiliation":[{"name":"Division of Geriatrics University of California, San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"HHS & Oash \u201cOur Epidemic of Loneliness and Isolation: The U.S. Surgeon General's Advisory on the Healing Effects of Social Connection and Community.\u201d"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/002214650905000103"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.16748"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.16354"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.17366"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.5559"},{"key":"e_1_2_10_8_1","volume-title":"Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System","author":"National Academies of Sciences Engineering and 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