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

Abstract

Background and Objectives Loneliness is proposed to be linked with increased service use. This review examined the association of loneliness and health and social care utilisation (HSCU) in older adults from the general population. Research Design and Methods Four databases were screened for studies that examined the association of loneliness (predictor) with HSCU (outcome) in older adults (defined as majority of sample 60 or older). Study quality was assessed with the NIH scale for observational cohorts and cross-sectional studies. Results We identified 32 studies, of which 9 prospective studies were evaluated as being good or good-fair quality. Two good-fair quality studies found loneliness at baseline was associated with subsequent admission to a residential care home. There was emerging evidence that loneliness was associated with emergency department use (n=1), and CVD-specific hospitalisation (n=1). Once adjusted for confounders the highest quality studies found no association of baseline loneliness with physician utilisation, outpatient service utilisation, skilled nursing facility use, and planned or unplanned hospital admissions. The remaining, studies were cross-sectional, or of fair to poor quality, and inadequate to reliably determine whether loneliness was associated with a subsequent change in HSCU. Discussion and implications There was heterogeneity in study design, measurement, and study quality. This generated an inconsistent evidence base where we cannot determine clear inferences about the relationship between loneliness and HSCU. Only one consistent finding was observed between two good-fair quality studies regarding care home admission. To determine clinical implications and make reliable inferences additional good quality longitudinal research is needed.

Determinants of Outpatient Physician Visits in the General Adult German Population during Later Stages of the COVID-19 Pandemic

“…With regard to enabling resources, it appears quite counterintuitive that lower loneliness levels are associated with higher GP visits in our study because we initially assumed that GP visits may substitute missing social contacts (even during the pandemic). However, a recent systematic review also concluded that there is inconclusive evidence regarding the association between loneliness and outpatient physician visits [ 23 ]. Possible explanations for the association identified in our study may refer to the fact that individuals with higher loneliness levels may become phlegmatic (in terms of visiting the GP), whereas individuals with lower loneliness levels may be physically active and may have quite frequent preventive visits to the GP [ 24 ].…”

Retrospective cross-sectional study examining the association between loneliness and unmet healthcare needs among middle-aged and older adults using the Canadian Longitudinal Study of Aging (CLSA)

“…Loneliness was associated with increased likelihood of unmet healthcare needs in the previous 12 months, adjusted for various predisposing, enabling and need factors. While research on loneliness and healthcare utilisation is mixed and has methodological limitations,24 45 findings suggest that compared with those who are not lonely, lonely individuals are more likely to use certain types of health services, such as more frequent emergency department visits and more visits to general practitioners 19 26. Researchers examining loneliness and visits to primary care providers have found that those who are lonely have a greater number of visits to providers than those who are not lonely 25.…”

“…On the other hand, those who are lonely may exhibit avoidant behaviours, increasing likelihood of unmet needs 18. Research suggests that loneliness is somehow associated with increased use of health services such as more emergency department use and general practitioner visits; however, the evidence is mixed and the quality of studies varies due to differences in operational definitions, measurement, study samples and cross-sectional study designs 19–24. The results of these studies found that being lonely, as opposed to not lonely, may be associated with greater use of certain types of health services.…”

Sex‐based differences in the association between loneliness and polypharmacy among older adults in Ontario, Canada

“…Nonpsychotic mood and anxiety disorders, and other mental illnesses (psychoses, personality disorders, substance abuse) were included in the list of 18 conditions used to define multimorbidity (full list in Supplementary Table S3). 37 Covariates were selected because of their association with loneliness and healthcare use, based on prior research 38 . Age, sex, rurality, neighborhood income quintile, and multimorbidity were obtained from administrative data sources, while other covariates were self‐reported by respondents in the CCHS.…”

“…37 Covariates were selected because of their association with loneliness and healthcare use, based on prior research. 38 Age, sex, rurality, neighborhood income quintile, and multimorbidity were obtained from administrative data sources, while other covariates were selfreported by respondents in the CCHS. The source of data for sex in our study is self-report (with male or female options) at the time of health insurance registration; gender identity was not captured in either health administrative data nor in the CCHS-HA.…”