Social Isolation, Loneliness, and Health Behaviors at Older Ages: Longitudinal Cohort Study

Kobayashi, Lindsay C.; Steptoe, Andrew

doi:10.1093/abm/kax033

Cited by 244 publications

(229 citation statements)

References 61 publications

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“…Loneliness is considered a public health issue because of the association with a range of negative outcomes including decreased well-being and quality of life [6], increased risk of deteriorating physical [7,8] and mental health [9,10], and increased mortality [11,12] alongside unhealthy behaviours [13,14,15] and health and social care services utilization [16]. Loneliness has attracted the attention of policy makers and service providers leading to extensive investment into loneliness interventions although evidence of effectiveness remains limited [19][20][21][22].…”

Section: Background Lonelinessmentioning

confidence: 99%

Lonely places or lonely people? Investigating the relationship between loneliness and place of residence

Victor¹,

Pikhartova

2019

Preprint

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Background: Loneliness in later life is largely presented as a problem of the individual focusing upon antecedents of loneliness such as demographic or health factors. Research examining the role of the broader living environments is rarer. We examined the relationship between loneliness and three elements of the lived environment: geographical region, deprivation, and area classification (urban or rural). Methods: Our sample consisted of 4,663 core members (44% males) aged 50+ (base wave mean age 65.5, S.D=.7.9) present in waves 3 (2008) and 7 (2014) of the English Longitudinal Study of Ageing (ELSA) which both included questions about individual-based and area-based loneliness. Loneliness was measured using two approaches- the three item University of California Los Angeles (UCLA) scale (ranging from 3 =not lonely to 9= lonely and using cut off at level 6+ marking loneliness) which assessed individual-based (self-reported) loneliness, and a novel self-rated evaluation by participants of how often they felt lonely in their area of residence (area-based; ranging from 1=often to 7=never, using cut off 4+). The lived environment was classified in three different ways: the Index of Multiple Deprivation (IMD), Government Office Regions (GOR), and as urban or rural. Covariates with established relationship with loneliness including demographic factors, social engagement and health, were included in the analyses. Results: In wave 7, individual-based loneliness was reported by 18% and area-based loneliness by 25% of participants. There was limited congruence between measures: 68% participants reported no individual- or area-based loneliness and 9% reported loneliness in both areas. Adjusting for individual co-variates, a significant association was observed only for the association between area-based loneliness and deprivation measure area characteristic, with higher levels of loneliness in more deprived areas (OR=1.4 for highest quintile of deprivation). No other significant relationships were observed regarding other types of area characteristics. Conclusions: Our results indicate that loneliness in older adults is higher in the most deprived areas independent of individual-level factors. In order to develop appropriate interventions further research is required to investigate how area-level factors combine with individual-level loneliness vulnerability measures to generate increased levels of loneliness in deprived areas.

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Section: Background Lonelinessmentioning

confidence: 99%

Lonely places or lonely people? Investigating the relationship between loneliness and place of residence

Victor¹,

Pikhartova

2019

Preprint

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“…In a cross‐sectional analysis of the English Longitudinal Study of Ageing (ELSA) including 136 men and 131 women aged 50 years or older, loneliness was associated with low levels of physical activity as assessed by wrist‐mounted accelerometers in univariate analyses, but not in multivariate analyses controlling for poor health, mobility limitations and depressive symptoms . In a longitudinal analysis of the ELSA over 10 years in 3,392 men and women aged 52 years or older, only social isolation but not loneliness was related to low levels of physical activity . In a random sample of 1663 older Israeli adults aged 65 years or older, loneliness contributed significantly to explaining the self‐reported level of participation in physical activity in women, but not in men .…”

Section: Introductionmentioning

confidence: 97%

“…17 In a longitudinal analysis of the ELSA over 10 years in 3,392 men and women aged 52 years or older, only social isolation but not loneliness was related to low levels of physical activity. 18 In a random sample of 1663 older Israeli adults aged 65 years or older, loneliness contributed significantly to explaining the self-reported level of participation in physical activity in women, but not in men. 19 However, to date, associations between loneliness and physical activity have not been explored in middle-aged and older adults in low-and middleincome countries (LMICs).…”

Section: Introductionmentioning

confidence: 97%

Physical activity and loneliness among adults aged 50 years or older in six low‐ and middle‐income countries

Vancampfort

Lara

Smith

et al. 2019

Int J Geriat Psychiatry

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Introduction Loneliness is widespread and associated with deleterious outcomes in middle‐aged and older age people in low‐ and middle‐income countries (LMICs). Physical activity is one potential psychosocial strategy with the potential to reduce loneliness in this population. Thus, the aim of this study was to explore associations between physical activity (PA) and loneliness in middle‐aged and older people from six LMICs. Materials and methods Data from the Study on Global Ageing and Adult Health (SAGE) were analyzed. Self‐reported data on loneliness and PA (as assessed by the Global Physical Activity Questionnaire) were collected. Participants were dichotomized into those who do and do not meet the international recommendation of 150 minutes of moderate to vigorous PA per week. Associations between loneliness and PA were examined using logistic regressions. Results Among 34 129 individuals aged 50 years or older, the prevalence of loneliness was higher among those not meeting the PA guidelines in all countries, although this difference was not significant in Mexico and South Africa. After full adjustment, not meeting PA guidelines was positively associated with loneliness in the meta‐analysis based on country‐wise estimates, with a moderate level of between‐country heterogeneity being observed (OR = 1.31; 95% CI, 1.07‐1.61; I2 = 48.7%). At an individual country level, statistical significance was only reached in Ghana (OR = 1.89; 95% CI = 1.44‐2.49). Discussion Our data suggest that physical inactivity and loneliness commonly co‐occur in adults aged 50 years or older in LMICs overall but that this association differs by country. Longitudinal studies are required to confirm these findings and investigate potential mechanisms that may inform future interventions.

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“…However, this finding is not surprising given lonely individuals’ propensity toward multimorbidity, cognitive decline, and poor physical functioning earlier in life . These health conditions, along with lower engagement in health‐promoting behaviors, can place lonely individuals at risk for higher symptom burden throughout life, not just near death. Longitudinal studies could shed light on the onset and duration of symptom‐related suffering for lonely older adults, informing interventions to improve quality of life in this population.…”

Section: Discussionmentioning

confidence: 99%

The Relationship of Loneliness to End‐of‐Life Experience in Older Americans: A Cohort Study

Abedini

Choi

Wei

et al. 2020

J American Geriatrics Society

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OBJECTIVES:Little is known about the relationship between loneliness and end-of-life (EOL) experience including symptom burden, intensity of care, and advance care planning among older adults. DESIGN: Secondary analysis of the Health and Retirement Study (HRS). SETTING: Population based. PARTICIPANTS: Decedents older than 50 years who died between 2004 and 2014 (n = 8700). Exclusions included those who were ineligible for surveys assessing loneliness (n = 2932) or had missing or incomplete loneliness or symptom data (n = 2872). MEASUREMENTS: Individuals were characterized as lonely based on responses to the three-item Revised University of California, Los Angeles Loneliness Scale in the most recent HRS survey before death. Outcomes were proxy reports of total EOL symptom burden, intensity of EOL care (eg, late hospice enrollment, place of death, hospitalizations, use of life support), and advance care planning. Results were expressed as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). RESULTS: One-third of 2896 decedents (n = 942) were lonely. After adjusting for demographics, socioeconomic status, multimorbidity, depressive symptoms, family and friends, and social support, loneliness was independently associated with increased total symptom burden at EOL (ß = .13; P = .004). Compared with nonlonely individuals, lonely decedents were more likely to use life support in the last 2 years of life (35.5% vs 29.4%; aOR = 1.36; 95% CI = 1.08-1.71) and more likely to die in a nursing home (18.4% vs 14.2%; aOR = 1.78; 95% CI = 1. 30-2.42). No significant differences in other measures of intense care (late hospice enrollment, number of hospitalizations, or dialysis use) or likelihood of advance care planning were observed. CONCLUSION: Lonely older people may be burdened by more symptoms and may be exposed to more intense EOL care compared with nonlonely people. Interventions aiming to screen for, prevent, and mitigate loneliness during the vulnerable EOL period are necessary.

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Social Isolation, Loneliness, and Health Behaviors at Older Ages: Longitudinal Cohort Study

Cited by 244 publications

References 61 publications

Lonely places or lonely people? Investigating the relationship between loneliness and place of residence

Lonely places or lonely people? Investigating the relationship between loneliness and place of residence

Physical activity and loneliness among adults aged 50 years or older in six low‐ and middle‐income countries

The Relationship of Loneliness to End‐of‐Life Experience in Older Americans: A Cohort Study

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