A Social Genomics Model to Explore Loneliness and Systemic Inflammation in an Older Adult Population with Chronic Lower Extremity Ulcers

Introduction: Individuals with chronic wounds are highly susceptible to psychosocial stress, particularly loneliness which may negatively impact wound healing. Depression has been studied extensively, but loneliness has not been quantified and studied until now.Methods:Observational study using a convenience sample of 14 patients who scored higher lonely (L+) (40 score on UCLA Loneliness Scale range 20-80), and 24 less lonely (L-). All were > 50 years or older, and diagnosed with a chronic venous ulcer or diabetic foot ulcer in a nonhealing state for > 4 weeks prior to study enrollment.  Aims were to determine if psychosocial stressors (i.e social support) and symptoms (i.e fatigue, pain, depression, anxiety, sleep deprivation, reduced quality of life) and wound characteristics differed between L+ and L- over a 3 month study period, assessed using descriptive statistics and frequency distributions and to characterize a biomarker profile common to loneliness and leg ulcers using well-established  RNA sequencing and PCR methods from whole blood samples over a one month period using linear statistical models quantitfying gene expression.Results:The mean baseline loneliness score for the L+ group was 50.4 compared with 27.7 and demonstrated no substantial changes over the course of the study. Only 3 participants scored "no loneliness" on the UCLA Loneliness Scale. This finding suggests that the majority of the sample (89%) expressed some degree of loneliness with n=14/38 patients endorsing scores in the higher range ( >40). Individuals with the L+ group showed significantly elevated expression of of 18 genes that encode canonical pro-inflammatory cytokines (e.g., IL6, TNF), prostaglandin synthases (e.g. PTGS1, PTGS2) and 12 transcription factors (NF-kB1, FOSB).Discussion: These findings underscore the association of loneliness with lower social support, higher social isolation, increased anxiety, fatigue, pain interference, depression, larger wound size, longer wound duration, and elevated pro-inflammatory gene expression in a chronic wound population. Loneliness should be explored in overall patient assessment at the start of clinical care.References: