Loneliness and Healthcare Use in Older Adults: Evidence From a Nationally Representative Cohort in Northern Ireland—A Cross-Sectional Replication Study

Abstract

Background: Few have explored associations between loneliness and healthcare use independent of health and health behaviors. Recent indication of gender effects also requires validation across health service and cultural settings. We investigated the associations among loneliness, health and healthcare use (HCU) in older adults including stratification to investigate whether associations differed by gender.Methods: Secondary analysis of a nationally representative sample of 8,309 community-dwelling adults aged 50 and over from the Northern Ireland Cohort for the Longitudinal Study of Aging. Primary outcomes were: self-reported General Practice (GP) and emergency department (ED) visits in past year. Negative binomial and logistic regression analysis were used to investigate associations between loneliness and HCU, later adjusting for potential confounders (health and health behaviors).Results: Loneliness was consistently positively associated with both GP and ED visits (with IRRs ranging from 1.10 to 1.49 for GP visits, 1.16 to 1.98 for ED visits and ORs ranging from 1.13 to 1.51 for reporting at least one ED visit). With addition of health and health behaviors, all associations between loneliness and HCU became non-significant, excepting a small independent association between UCLA score and GP visits [IRR 1.03 (95% CI 1.01–1.05)]. Stratification of models revealed no gender effects.Conclusion: All but one association between loneliness and HCU became non-significant when health and health behaviors were included. The remaining association was small but implications remain for health service resources at population level. No gender effects were present in contrast to recent findings in the Republic of Ireland. Further studies on gender, loneliness and healthcare use needed.

The Association of Loneliness With Health and Social Care Utilization in Older Adults in the General Population: A Systematic Review

“…Journal of Community Psychology, 20(1), 43-56. https://doi.org/10.1002/1520-6629(199201)20:1<43::AID-JCOP2290200107>3.0.CO;2-3 Cohen-Mansfield, J., Hazan, H., Lerman, Y., & Shalom, V. (2016) Fair (Burns et al, 2020;2021;Ellaway et al, 1999;Houle et al, 2001) Three studies found loneliness associated with increased visits in previous year (Burns et al, 2020;Ellaway et al, 1999;Houle et al, 2001), one study also found this association for chronic loneliness (Burns et al, 2020) One study found no association between loneliness with number of visits in previous year (Burns et al, 2021) One study found no association between loneliness with the number of home visits from a GP in the previous 12 months ( Ellaway et al, 1999) Whether service used at all: cross-sectional 1 Self-reportprevious 12 months (Mosen et al, 2020) Single-item (Mosen et al, 2020) General population sample (Medicaid database)representative sampling (Mosen et al, 2020) Inadequate analysis (unadjusted Chi-Square analysis) (Mosen et al, 2020) Poor (Mosen et al, 2020) One study found that those people who were sometimes or often/always lonely were more likely to have visited primary care once or more in the previous year than those who were never lonely (Mosen et al, 2020).…”

“…This association was not observed for people who were often lonely. Relationship between loneliness and healthcare utilization condition: longitudinal 9 years for CVD , falls , or respiratory disease 2020a; 2020b, 2020c) sampling (Bu et al, 2020a;2020b, 2020c confounder control (Bu et al, 2020a;2020b, 2020c 2020b, 2020c) adjusted risk of being hospitalised for CVD over follow-up One study found increasing levels of loneliness predicted an increased risk of being hospitalised due to falls, though this association was attenuated after adjustment for confounders One study found increasing levels of loneliness were not associated with the risk of hospitalisation due to respiratory disease over a median of 9 years (Bu et Two studies found non-significant adjusted associations (there were some significant unadjusted associations) between loneliness and emergency department visits over the previous 12 months robust to how loneliness was measured and gender stratification (Burns et al, 2020;Burns et al, 2021).…”

“…Gerst-Emerson and Jayawarda (2015) found that loneliness was not associated with hospital visits, whereas Shaw et al (2017) found that loneliness was associated with a decreased likelihood of hospitalisation. Furthermore, two cross-sectional studies from Ireland found that associations between loneliness and HSCU were not always robust to different ways of classifying and categorising loneliness (Burns et al, 2021;Burns et al, 2020). These studies all show directly the impact that heterogeneity in study design and measurement can have on results.…”

“…One study found no association between loneliness with home visits from a physician in the previous year (Ellaway et al, 1999), and another that people who were sometimes or often lonely were more likely to have seen a physician in the previous month (Almind et al, 1991). Two studies indicated no association between loneliness and physician visits (Burns et al, 2021;Lim and Chan., 2017).…”

Healthcare Professionals’ Perceptions of Loneliness amongst Older Adults: A Qualitative Study

“…The majority emphasize that the somatision is a direct consequence of feeling neglected and lonely [70]. The need to communicate and fill the void of loneliness is evident on a physical level, and it is used as a way to connect with one's surroundings in an attempt to avoid one's soul becoming lonely [47,71,72]. Loneliness is self-reinforcing, leading to an even greater sense of isolation [27].…”