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Loneliness in Older Persons A Predictor of Functional Decline and Death
Abstract
Loneliness is a common source of distress, suffering, and impaired quality of life in older persons. We examined the relationship between loneliness, functional decline, and death in adults older than 60 years in the United States.
This is a longitudinal cohort study of 1604 participants in the psychosocial module of the Health and Retirement Study, a nationally representative study of older persons. Baseline assessment was in 2002 and follow-up assessments occurred every 2 years until 2008. Subjects were asked if they (1) feel left out, (2) feel isolated, or (3) lack companionship. Subjects were categorized as not lonely if they responded hardly ever to all 3 questions and lonely if they responded some of the time or often to any of the 3 questions. The primary outcomes were time to death over 6 years and functional decline over 6 years on the following 4 measures: difficulty on an increased number of activities of daily living (ADL), difficulty in an increased number of upper extremity tasks, decline in mobility, or increased difficulty in stair climbing. Multivariate analyses adjusted for demographic variables, socioeconomic status, living situation, depression, and various medical conditions.
The mean age of subjects was 71 years. Fifty-nine percent were women; 81% were white, 11%, black, and 6%, Hispanic; and 18% lived alone. Among the elderly participants, 43% reported feeling lonely. Loneliness was associated with all outcome measures. Lonely subjects were more likely to experience decline in ADL (24.8% vs 12.5%; adjusted risk ratio [RR], 1.59; 95% CI, 1.23-2.07); develop difficulties with upper extremity tasks (41.5% vs 28.3%; adjusted RR, 1.28; 95% CI, 1.08-1.52); experience decline in mobility (38.1% vs 29.4%; adjusted RR, 1.18; 95% CI, 0.99-1.41); or experience difficulty in climbing (40.8% vs 27.9%; adjusted RR, 1.31; 95% CI, 1.10-1.57). Loneliness was associated with an increased risk of death (22.8% vs 14.2%; adjusted HR, 1.45; 95% CI, 1.11-1.88).
Among participants who were older than 60 years, loneliness was a predictor of functional decline and death.
... Although the enacted public health measures have successfully limited the spread of infection in Austria and lasted only for several weeks, there could be negative psychosocial side effects such as increased loneliness due to social isolation. This might affect older adults particularly, who are not only more vulnerable to COVID-19, but who, already before the pandemic, had an increased risk of loneliness due to widowhood, living alone, or mobility limitations [4,5]. Particularly those who live alone might face an increased risk of loneliness, when social contacts with persons from outside the household are substantially reduced due to pandemic-related restriction measures [6,7]. ...
... In the cross-sectional data set, we used an established measure of loneliness, the three-item UCLA loneliness scale [19]. Specifically, respondents are asked how often they felt 'a lack of companionship', 'left out', or 'isolated' with answer categories ranging from 'never' (1) to 'often' (4). To keep the results comparable to the UCLA-3 loneliness scale used in SHARE, answer categories 1 (never) 4 . ...
... The median loneliness value in the UCLA-scale was 4 based on our cross-sectional sample from May 2020. In comparison, the median value of the UCLA scale in SHARE Austria from 2013, 2015, and 2017 was 3, i.e. lower by one point (on scale from[3][4][5][6][7][8][9]. This also shows (Panel A inFigure 1) in the distribution of values in the UCLA-scale (range=3-9) over time. ...
Background: To halt the spread of COVID-19, Austria implemented a 7-week shut-down of public life in March/April 2020 which was followed by a gradual withdrawal of these restriction measures in May/June 2020. We expect that the ensuing reduction in social contacts led to increased loneliness among older adults (60+).
Methods: We conducted three analyses to assess the association between COVID-19 public health restriction measures and loneliness: (1) A comparison between pre-pandemic (SHARE: 2013-2017) and pandemic (May 2020) levels of loneliness (UCLA-3 scale), (2) an analysis of
the correlation between being affected by COVID-19 restriction measures and loneliness based on cross-sectional survey data from early May 2020, and (3) a longitudinal analysis of weekly changes in loneliness (Corona panel data) from late March to early June 2020.
Results: We found (1) loneliness levels to have increased in 2020 in comparison with previous years, (2) an association between the number of restriction measures older adults reported to be affected from and loneliness, and (3) that loneliness was higher during shut-down compared to the subsequent re-opening phase, particularly among those who live alone.
Discussion: Our results provide evidence that COVID-19 restriction measures in Austria have indeed resulted in increased levels of loneliness among older adults. However, these effects seem to be short-lived, and thus we do not expect strong negative consequences for older adults mental health downstream. Nonetheless, effects of longer and/or repeated future restriction measures
aiming at social distancing should be closely monitored.
... Loneliness is a well-established correlate of mental health, quality of life [5][6][7], and early mortality in older adults [8][9][10][11][12][13][14]. Moreover, loneliness has previously been shown to relate to disability [15,16] and impaired mobility [17]. ...
... For example, loneliness predicted a faster rate of objectively-measured motor decline, defined by motor function and muscle strength, over five years of follow-up among 985 men and women, with a mean age of 80 [17]. Perissinotto and colleagues [13] found that loneliness was related to greater difficulty with activities of daily living and mobility at six year follow-up among over 14,000 men and women over the age of 60 in the Health and Retirement Study. Higher levels of loneliness also predicted frailty as defined by the Fried Formula at 4 year follow-up among 2,817 individuals over 60 years of age from the English Longitudinal Study of Aging [15]. ...
... ese scores for each of the items are summed to give a total score. e prevalence of loneliness has also been defined as reporting "Some of the time" or "Often" relative to "Hardly ever" for at least one of the three questions: "How often do you feel that you lack companionship?", "How often do you feel left out?" and "How often do you feel isolated from others?" [13]. e UCLA Brief Loneliness Scale was shown to have a strong correlation with the full UCLA Loneliness Scale (r � 0.82) and to have reasonable internal consistency (Cronbach's α � 0.72) [29]. ...
Objective. Little is known about the impact of loneliness on physical health among elderly individuals with diabetes. Here, we examined the relationship of loneliness with disability, objective physical function, and other health outcomes in older individuals with type 2 diabetes and overweight or obesity. Method. Data are drawn from the Look AHEAD study, a diverse cohort of individuals (ages 61–92) with overweight or obesity and type 2 diabetes measured 5–6 years after a 10-year weight loss randomized, controlled trial. Results. Loneliness scores were significantly associated with greater disability symptoms and slower 4-meter gait speed (). Loneliness did not differ across treatment arms. Discussion. Overall, these results extend prior findings relating loneliness to disability and decreased mobility to older individuals with type 2 diabetes and overweight or obesity.
1. Introduction
Loneliness is a subjective state, reflecting a lack of desired closeness with friends, family, and loved ones. Compared with structural measures of social contacts, counting an individual’s opportunities for interaction with other people, loneliness assesses the function of social interactions in allowing a person to feel connected to others [1]. Living alone, widowhood, poor health status, and poor functional status each increase risk for loneliness [2, 3]. Roughly, 25–43% of adults over the age of 70 report being lonely [4].
Loneliness is a well-established correlate of mental health, quality of life [5–7], and early mortality in older adults [8–14]. Moreover, loneliness has previously been shown to relate to disability [15, 16] and impaired mobility [17]. For example, loneliness predicted a faster rate of objectively-measured motor decline, defined by motor function and muscle strength, over five years of follow-up among 985 men and women, with a mean age of 80 [17]. Perissinotto and colleagues [13] found that loneliness was related to greater difficulty with activities of daily living and mobility at six year follow-up among over 14,000 men and women over the age of 60 in the Health and Retirement Study. Higher levels of loneliness also predicted frailty as defined by the Fried Formula at 4 year follow-up among 2,817 individuals over 60 years of age from the English Longitudinal Study of Aging [15]. Interestingly, Hoogendijk and colleagues [18] reported that frailty increased the risk for loneliness over 3 years, suggesting that the relationship between loneliness and physical function may be bidirectional [18].
Little is known about how loneliness relates to health status among older individuals with type 2 diabetes. In the United States, 25% of individuals over the age of 65 have type 2 diabetes [19] increasing the risk for early mortality, cardiovascular disease, renal disease, dementia, functional impairment, depression, and vision impairment [20]. Although less stringent treatment goals can be recommended for elderly individuals, the need for diabetes self-management remains including treatment adherence, nutrition, and exercise [21]. Social support improves diabetes self-management, medication adherence, diet change, active lifestyles and, in some cases, glycemic control [22]. Conversely, loneliness is associated with less physical activity [23, 24] and poorer sleep quality [25, 26]. As such, it is plausible that loneliness may relate to health outcomes among elderly individuals with type 2 diabetes but these associations have not been established.
Look AHEAD was a randomized controlled trial designed to determine whether 10 years of intensive lifestyle intervention (ILI), comprised of calorie restriction and physical activity promotion to achieve weight loss, improves health outcomes among older individuals with type 2 diabetes and overweight or obesity, relative to a Diabetes Support and Education (DSE) control group. The cohort was reassessed for aging-related outcomes at 15-year follow-up, including loneliness measured for the first time. The goal of this paper is to characterize the prevalence of loneliness among individuals with type 2 diabetes and overweight or obesity in the Look AHEAD cohort and to determine cross-sectional associations of loneliness score with self-reported disability and objective mobility and other health indicators, including HbA1c, quality of life, and depressive symptoms. It is hypothesized that loneliness will relate to (1) greater disability and decreased mobility and physical function, as defined by the 400 m walk, grip strength, and the Short Physical Performance Battery and (2) higher HbA1c and depressive symptoms and lower quality of life.
2. Methods
2.1. Research Design
Look AHEAD is a randomized, controlled trial designed to test whether 10 years of ILI, combining calorie restriction and physical activity to produce weight loss, improves health outcomes among individuals with type 2 diabetes and overweight or obesity, relative to DSE [27, 28] (see Supplementary File 2). The cohort was reassessed at year 15 to continue to follow diabetes and aging-related outcomes, including measuring loneliness for the first time. The study enrolled 5,145 men and women, aged 45–76 at baseline. The present study is cross-sectional and derives variables from 15 year follow-up when participants had a mean age of 75 (range: 61–92). All Look AHEAD participants who were attending clinical visits were included (n = 3187). Look AHEAD participants who were followed only through telephone interviews (n = 300) were excluded because loneliness was not queried.
2.2. Study Interventions
Eligible patients were randomly assigned to participate in ILI (intervention group) or DSE (comparison group), with stratification according to clinical site. Curricula for the two study groups were developed centrally and have been described in detail previously [27, 28].
2.3. Intensive Lifestyle Intervention (ILI)
The ILI included calorie restriction, low-fat diet, and increased physical activity and was designed to induce at least a 7% weight loss at year 1 and to maintain this weight loss in subsequent years. ILI participants were assigned a calorie goal (1200–1800 kcal/d based on initial weight), with less than 30% of total calories from fat (<10% from saturated fat) and a minimum of 15% of total calories from protein. The exercise goal was at least 175 minutes of physical activity per week, using activities similar in intensity to brisk walking. ILI participants were seen for 3 groups and one individual session per month for the first 6 months and 2 group, one individual session per month for the next 6 months, and at least monthly through year 10. ILI was effective in inducing and sustaining weight losses relative to the control condition throughout follow-up [28].
2.4. Diabetes Support and Education (DSE)
DSE featured three group sessions per year focused on diet, exercise, and social support during years 1 through 4. In subsequent years, the frequency was reduced to one session annually.
3. Measures
3.1. Loneliness
Loneliness was measured using the UCLA Brief Loneliness Scale [29]. The scale contains three questions: “How often do you feel that you lack companionship?”, “How often do you feel left out?”, and “How often do you feel isolated from others?” Each item has the response choices of “Hardly ever,” “Some of the time,” and “Often,” assigned scores 0, 1, and 2 respectively. These scores for each of the items are summed to give a total score. The prevalence of loneliness has also been defined as reporting “Some of the time” or “Often” relative to “Hardly ever” for at least one of the three questions: “How often do you feel that you lack companionship?”, “How often do you feel left out?” and “How often do you feel isolated from others?” [13]. The UCLA Brief Loneliness Scale was shown to have a strong correlation with the full UCLA Loneliness Scale (r = 0.82) and to have reasonable internal consistency (Cronbach’s α = 0.72) [29].
3.2. Disability and Physical Function
3.2.1. Pepper Assessment Tool for Disability (PAT-D)
The PAT-D is an 18-item self-report questionnaire designed to assess disability in older adults. Participants are asked to rate: “How much difficulty, if any, do you have with each of these activities? Think about the past month. How hard was it to do the activity because of your health?” Items include questions such as “Moving in and out of bed” and “Dressing yourself.” Responses range from “Usually did with no difficulty” (1) to “Unable to do” (5) with the possibility of endorsing “Usually did not do for other reasons.” Scores are averaged across the 18 items. The PAT-D has shown strong internal consistency (α = 0.82) and test-retest reliability (r > 0.70).
3.2.2. Physical Function Tests
Objective physical function was assessed in the full cohort at an average of 15–16 year follow-up. The Short Physical Performance Battery Expanded (SPPBexp) [30], a modestly expanded form of the Short Physical Performance Battery [31] designed to minimize ceiling effects of the SPPB when used in well-functioning populations, was administered to assess lower extremity physical function. The SPPB consists of standing balance tasks (side-by-side, semi- and full-tandem stands for 10 seconds each), a 4 m walk to assess usual gait speed and time to complete five repeated chair stands. The SPPBexp increased the holding time of the standing balance tasks to 30 seconds and added a single leg stand. The SPPBexp component scores are calculated as the ratio of observed performance to the best possible performance and summed to provide a continuous score ranging from 0 to 3, with higher scores indicative of better performance. Usual walking speed over 20 m and walking endurance over 400 m were measured [32]. The course was 20 m long and marked by cones at each end. Participants were instructed to walk at their usual pace, and time to complete the first 20 m and the longer 400 m was recorded. Grip strength (kg) was measured twice in each hand using an isometric Hydraulic Hand Dynamometer (Jamar, Bolingbrook, IL). The maximum force from two trials for the stronger hand was used in the analyses.
3.3. Other Health Indicators
3.3.1. Personal Health Questionnaire-9 (PHQ-9)
The PHQ-9 is a self-administered questionnaire assessing depressed mood and depression severity [33]. The questionnaire asks “How often, over the past two weeks, have you been bothered by any of the following problems?” for nine questions, including “Little interest or pleasure in doing things” and “Feeling down, depressed, or hopeless.” Response options include “Not at all,” “Several days,” “More than half of the days,” and “Nearly every day.” Depressed mood severity was calculated by assigning response options scores of 0–3 based on increasing frequency and summing the scores (range: 0–27). The PHQ-9 has strong internal consistency (α = 0.89) and test-retest reliability (r = 0.84) in clinical samples [33]. The PHQ-9 does not include a loneliness item.
3.3.2. Antidepressant Medications
Participants brought all prescription medications to their annual clinic assessment visits, and these medications (but not the dosages) were recorded by study staff. Antidepressant medications were identified using the Food and Drug Administration classification system.
3.3.3. Quality of Life
Quality of life was assessed using the SF-36 General Health questionnaire [34]. The questionnaire asks participants: “In general, would you say your health is…” with responses ranging from Excellent (1) to Poor (5) on a 1–5 scale. Lower values indicate better general health.
3.3.4. HbA1c and Diabetes Medications
HbA1c was assayed from fasting blood samples. Six major classes of diabetes medications were categorized from the Food and Drug Administration classification system and were used as covariates in analyses of HbA1c.
3.4. Statistical Analysis
Primary analyses were conducted using linear or logistic regression depending on the outcome. Model 1 tested the association of loneliness, age, sex, race, and ethnicity with the function- and health-related variables. Model 2 added depressive symptoms and antidepressant medications to determine whether loneliness relates to the other variables independent of correlated constructs also known to relate to health outcomes. For the relationship of loneliness to HbA1c, the six major categories of diabetes medications were added as covariates to Model 2. Treatment arm was added in Model 3 to determine whether loneliness differs by ILI.
PHQ-9 and PAT-D scales are extremely skewed, even after log transformation, and thus were dichotomized at their lowest value vs anything else.
4. Results
4.1. Descriptive Statistics
Descriptive statistics for baseline and the Look AHEAD E visit (15-year follow-up) are presented in Table 1. The balance afforded by the original randomization was maintained at the 15-year visit: no differences in baseline age, sex, race, or Hispanic ethnicity were observed. However, several health indices continued to show intervention effects, including lower BMI (32.9 vs 33.6; ), faster gait speed (4.85 vs 5.00 seconds; ), and less insulin use (43.4% vs 49.5%; ) in the ILI compared with DSE groups. No differences in loneliness by Look AHEAD treatment arm were observed ().
Nonmissing
Overall
Intervention arm
value
DSE
ILI
N
3190
1553
1634
Baseline characteristics
Age
3190
58.3 (6.4)
58.3 (6.4)
58.2 (6.3)
0.7042
BMI
3190
35.9 (6.0)
36.0 (5.8)
35.7 (6.1)
0.1338
Gender
3190
0.4756
Male
1214 (38.1%)
581 (37.4%)
633 (38.7%)
Female
1976 (61.9%)
973 (62.6%)
1003 (61.4%)
Race/ethnicity
3190
0.6896
White
1939 (60.8%)
950 (61.1%)
989 (60.5%)
Black
524 (16.4%)
260 (16.7%)
264 (16.2%)
Hispanic
440 (13.8%)
203 (13.1%)
237 (14.5%)
Others
287 (9.0%)
142 (9.1%)
145 (8.9%)
LA-E visit
Age
3190
72.7 (6.2)
72.7 (6.3)
72.7 (6.1)
0.7424
BMI
3019
33.2 (6.2)
33.6 (6.2)
32.9 (6.1)
0.0012
HbA1c%
2665
7.5 (1.5)
7.5 (1.5)
7.5 (1.4)
0.5779
PHQ-9
3052
2.7 (3.3)
2.8 (3.4)
2.6 (3.2)
0.1786
PHQ-9 = 0
3052
937 (30.7%)
458 (30.8%)
479 (30.6%)
0.9079
SF-36 general health
3156
2.9 (0.8)
2.9 (0.8)
2.9 (0.8)
0.4558
PAT-D
3157
1.5 (0.5)
1.5 (0.5)
1.5 (0.5)
0.5800
PAT-D = 1
3157
419 (13.3%)
212 (13.8%)
207 (12.8%)
0.4165
400 m walk time (min)
2632
6.7 (1.9)
6.8 (2.0)
6.7 (1.9)
0.6073
Gait speed test (sec)
2949
4.93 (1.67)
5.00 (1.71)
4.85 (1.62)
0.0168
Grip strength (right hand)
2702
23.9 (9.4)
23.8 (9.5)
24.0 (9.3)
0.5225
Taking antidepressants
2822
699 (24.8%)
337 (24.5%)
362 (25.0%)
0.7546
Taking any diabetes med
3067
2814 (91.8%)
1380 (92.3%)
1434 (91.2%)
0.2744
Biguanide
2967
2063 (69.5%)
1008 (69.5%)
1055 (69.6%)
0.9868
Insulin
2894
1344 (46.4%)
704 (49.5%)
640 (43.5%)
0.0010
Sulfonylurea
2863
979 (34.2%)
490 (35.1%)
489 (33.4%)
0.3460
TZD
2758
198 (7.2%)
94 (7.0%)
104 (7.4%)
0.6900
Loneliness
3190
3.86 (1.38)
3.90 (1.42)
3.82 (1.34)
0.1164
Values are given as mean (SD) or N (%)
... Previous research (Wright-St Clair et al., 2017) has shown that social isolation can be self-sought (e.g. solitude) and is considered one of the causes of loneliness, but an individual may perceive loneliness with or without being socially isolated as a direct association has been reported between social isolation and loneliness (Coyle & Dugan, 2012;Perissinotto & Covinsky, 2014;Perissinotto, Cenzer, & Covinsky, 2012). Coyle and Dugan (2012) reported that among 11,852 older adults aged 50 years and above, social isolation and loneliness was positively correlated, i.e. the adults who felt socially isolated also reported high loneliness scores (Coyle & Dugan, 2012). ...
... Coyle and Dugan (2012) reported that among 11,852 older adults aged 50 years and above, social isolation and loneliness was positively correlated, i.e. the adults who felt socially isolated also reported high loneliness scores (Coyle & Dugan, 2012). Furthermore, Perissinotto et al. (2012) examined the relationships between social isolation, loneliness, functional decline, and deaths among 1604 older adults aged 60 years and above and reported a relationship between social isolation and loneliness. The findings revealed that whether or not the older adults were living with families or alone, they still felt social isolation and loneliness (Perissinotto & Covinsky, 2014;Perissinotto et al., 2012). ...
... Furthermore, Perissinotto et al. (2012) examined the relationships between social isolation, loneliness, functional decline, and deaths among 1604 older adults aged 60 years and above and reported a relationship between social isolation and loneliness. The findings revealed that whether or not the older adults were living with families or alone, they still felt social isolation and loneliness (Perissinotto & Covinsky, 2014;Perissinotto et al., 2012). This was an important finding as it busted the myth that older adults who lived alone were the only ones who felt socially isolated and lonely (Perissinotto & Covinsky, 2014). ...
Purpose:
To examine the experiences and needs of Asian older adults who are socially isolated and lonely living in Asian and western countries.
Materials and methods:
Six databases were searched for qualitative studies from each database's inception to December 2019. Qualitative data were meta-summarized and then meta-synthesized.
Results:
Fourteen studies were included in this review. Five themes emerged: (1) association with older adults' well-being, (2) loss of social support, (3) dealing with social isolation and loneliness (4) unique experiences of Asian older adults in western countries, and (5) wish list of older adults. The older adults felt psychologically down and experienced a lack of social support from their family members. They coped using strategies such as religious reliance and social engagement with peers. Asian older adults in western countries faced cultural barriers and tried to form ethnic communities. The older adults wished for more community resources and care.
Conclusion:
There were multiple associations of social isolation and loneliness on the Asian older adults' well-being and social support. Coping mechanisms such as acceptance and social engagement were adopted. They expressed support needs such as social programs and healthcare services. More geographically distributed studies are needed to gather a more comprehensive and causality-related perspectives of socially isolated and lonely older adults. Lay-led programs, technology, and active coping strategies are proposed and can be incorporated in healthcare services and social programs to assist these older adults.
... According to the literature on loneliness and health status [27][28][29][30][31][32][33][34], loneliness is a strong predictor of mental health problems, depression, heart disease, blood pressure issues, poorer health status, and functional decline, and is a risk factor for mortality and morbidity. In many cases, and in particular among older people, these illnesses and health concerns may lead individuals to experience functional disabilities, thus reducing their levels of social contact, engagement with other peers, and participation in leisure activities [35][36][37][38][39]. ...
... In our case, we can assume that older females with severe disabilities are more likely to suffer from these mobility problems and other health limitations as compared to younger females. For example, Perissinotto et al. [32] found a 78% higher risk of experiencing limited physical ability among lonely adults aged 60 years or over. These mobility problems can become important limitations and obstacles to participating in leisure activities and maintaining social contacts, and thereby reporting higher loneliness scores [39,57,90]. ...
This study examines the relationship between loneliness, gender and age for people without and with disabilities (moderate versus severe) in Germany. Using data taken from the German Socio-Economic Panel (SOEP) for the years 2013 and 2017 and using the UCLA Loneliness Scale, in general we find that males report lower loneliness scores as compared to those for females. Furthermore, we find a strong association between loneliness and the individual’s age, but with differences according to gender and disability status. For example, for males with severe disabilities, levels of loneliness decrease with age, whereas for females with severe disabilities, the opposite result is found. In addition, we find how participation in leisure activities and having a higher frequency of contacts with family, friends, and social online networks (measured by the relational time index) contribute to reducing loneliness for all individuals. From a public policy perspective, it is necessary to undertake the design, promotion and implementation of instrumental, emotional and social support for people with disabilities (in particular, for females severely limited in their daily activities) that contribute to reducing their loneliness scores and increasing their levels of life satisfaction.
... Concerning the assessment of differences between subgroups, our study found an increase in loneliness among participants who were living with at least one other person but not in participants living alone. Participants who were living alone reported higher loneliness than those in a multi-person household at both time points, which is in accordance with previous scientific work (Victor et al., 2005;Perissinotto et al., 2012). However, persons living alone did not show significantly higher loneliness during the pandemic as compared to before the pandemic. ...
... It is plausible that people living alone did not experience the safety measures equally as restrictive, as persons living with at least one another person, possibly, as they were more used to being alone. Being alone has also been shown to be related but not equal to loneliness, with previous work pointing out that a person may feel lonely even when surrounded by others (Hawkley and Cacioppo, 2010;Perissinotto et al., 2012). It may also be the case that persons in single-person households were more self-effective and therefore more resilient during safety measures or (virtual) social contacts have increasingly concentrated on people living alone. ...
Old-age loneliness is a global problem with many members of the scientific community suspecting increased loneliness in the elderly population during COVID-19 and the associated safety measures. Although hypothesized, a direct comparison of loneliness before and during the pandemic is hard to achieve without a survey of loneliness prior to the pandemic. This study provides a direct comparison of reported loneliness before and during the pandemic using 1:1 propensity score matching (PSM) on a pre- and a peri-pandemic sample of elderly (60+ years) individuals from Lower Austria, a county of Austria (Europe). Differences on a loneliness index computed from the short De Jong Gierveld scale were found to be significant, evidencing that loneliness in the elderly population had in fact risen slightly during the COVID-19 pandemic and its associated safety measures. Although the reported loneliness remained rather low, this result illustrated the effect of the “new normal” under COVID-19. As loneliness is a risk factor for physical and mental illness, this result is important in planning the future handling of the pandemic, as safety measures seem to have a negative impact on loneliness. This work confirms the anticipated increase in loneliness in the elderly population during COVID-19.
... How do you engage residents socially? " The families care about the seniors having an engaged lifestyle as it leads to motivation [18,19] -an active and engaged lifestyle reduces loneliness and functional decline [23,24,25,30]. You show them the different activity rooms you have on the property for an enhanced social life ( Figure 6) and mention the group classes you offer like Yoga for a healthy lifestyle. ...
... In addition, automation encourages an active lifestyle with more exercise, high quality sleep, healthy eating habits, and sufficient water intake [18,19,30,23,24,25]. Caspar AI helps by providing an automated lifestyle coach that helps residents lead healthier lives. ...
There is a historically unprecedented shift in demographics towards seniors, resulting in an acute shortage of senior housing. This is an enormous opportunity for real-estate operators. However, investments in this area are fraught with risk. Seniors often have more health issues, and Covid-19 has exposed just how vulnerable they are -- especially those living in close proximity. Conventionally, most services for seniors are "high-touch", requiring close physical contact with trained caregivers. Not only are trained caregivers short in supply, but the pandemic has made it evident that conventional high-touch approaches to senior care are high-cost and greater risk. There are not enough caregivers to meet the needs of this emerging demographic, and even fewer who want to undertake the additional training and risk of working in a senior facility, especially given the current pandemic. In this article, we rethink the design of senior living facilities to mitigate the risks and costs using automation. With AI-enabled pervasive automation, we claim there is an opportunity, if not an urgency, to go from high-touch to almost "no touch" while dramatically reducing risk and cost. Although our vision goes beyond the current reality, we cite measurements from Caspar AI-enabled senior properties that show the potential benefit of this approach.
... 8,9 Further, subjective feelings of isolation, or loneliness, emerge as an independent risk factor for deleterious physical and mental health outcomes as well as increased health care utilization, in addition to the effects of objectively measured social disconnectedness. [9][10][11][12] Older adults face unique challenges that put them at risk for being socially disconnected and feeling lonely, including increased social losses (e.g., widowhood) and functional impairment (e.g., sensory loss, mobility difficulty). These changes reduce older adults' opportunities for socialization and ability to participate social activities, [13][14][15][16] which contributes to increased loneliness with older age, particularly for the oldestold. ...
... Nevertheless, the decrease in level of loneliness among attendees is encouraging, as loneliness has been implicated as a public health issue due to its association with increased mortality, functional decline and physician visits. [9][10][11][12] This is particularly true for military Veterans, as loneliness has been consistently found to be closely linked with mental health symptoms and is a precursor of mental health crisis. [20][21][22][23] Loneliness has been implicated as an underappreciated yet important target for mental health interventions because it addresses the often overlooked social determinants of health. ...
Loneliness is a public health issue, particularly for older Veterans. To increase older Veterans’ access for socialization opportunities, a community-based telephone-delivered activity program was developed, in which Veterans can call in and engage in social activities through telephone. This paper illustrates the feasibility, acceptance, and preliminary outcomes of this program using a mixed-methods design. Thirty-two Veterans enrolled in the program, with 14 attendees who called in to the program at least once. Attendees were more likely to be depressed than those who did not call in at baseline. Program was acceptable with high client satisfaction. Perceived benefits included a structured program with interesting topics to spend time on and the opportunity to socialize, exchange ideas, and connect with other Veterans. Individual challenges (e.g., hearing difficulty) and program-level challenges (e.g., complicated procedures) were reported during qualitative interviews. Among attendees, a significant decrease in loneliness from baseline to 3-months was found but should be interpreted with caution based on the small sample size. While positive findings emerged regarding feasibility, acceptance, preliminary benefits of this program, further refinement is needed to improve future program implementation.
... Loneliness has been shown to prospectively predict increased depressive symptomatology, impaired cognitive performance, dementia progression, signi cant likelihood of nursing home admission, and multiple disease outcomes with functional limitations in elderly people (e.g., hypertension, heart disease, and stroke in older persons) (1,6,7,17,(27)(28)(29)(30)(31). So decreased physical and mental quality of life and early mortality are among others associated with loneliness particularly among the elderly (15,21,25,(32)(33)(34)(35). ...
... Some authors in one of their studies (19) empathized the complex nature of the relationship of multimorbidity with loneliness and social network size, and a rm that little is known about the underlying mechanisms so far, and further researches on relationship quality and the subjective perception of one's social network and their relationship with loneliness and multimorbidity are of great interest. Other authors suggest that materialist models of multimorbidity and functional limitation at older age cannot, on their own, explain the health inequalities as the behavioural and psycho-social factors play an important role (6,15,27,30,31,43). Given the limited number of research on the association between (physical) multimorbidity and loneliness and the sense of loneliness, and the mixed ndings from research that has focused on the multimorbidity-loneliness association in middle-aged and older adults, this study had the following objectives: (1) to examine the association between physical multimorbidity and loneliness in elderly population sample; and (2) to determine if any factors might be important for this association. ...
Multi-morbidity has been associated with adverse health outcomes, such as reduced physical function, poor quality-of-life(QoL), poor self-rated health. The adverse impact of multi-morbidity on other health domains is further exacerbated by other factors. In this study the association between quality of life, social support, sense of loneliness and sex, age in elderly patients affected by two or more chronic diseases (multi- morbidity) was evaluated. Patients n. 216 affected by tumors hypertension, cardiovascolar diseases, ictus, diabetes, all self-sufficient and living with family members. Tests: MMSE-Mini-Mental-State-Examination; ADL-Activities of Daily Living; Social-Schedule: demographic variables; Loneliness Scale -de Jong Gierveld; Quality-of-Life - FACT-G; WHOQOL-BRIEF social relationships. Statistical analysis: Multivariate Regression Analysis. The patients with three or more diseases have worse dimensions of QoL Physical-well-being(p = .003), Social well-being (p = .003), Emotional-well-being(p = .012), Functional-well-being(p < .001), than those with two. Multiple linear regression. QoL: PWB, SWB, EWB,FWB as dependent variables.In the presence of multi-morbidity with an increase in the patient's age PWB (B = − .131, p = .014), SWB (B = − .170, p = .009) EWB (B = − .457, p < .000), FWB (B=-.139,p = .013), decreases by an average of 0.1, and as the sense of solitude increases PWB (B=-.425, p < .000), SWB(B=-.464,p < .000),EWB(B=-.457,p < .000),FWB(B=-468,p < .000) decrease by 0.4. The sense of loneliness and increasing age are associated with bad quality-of life in self-sufficient elderly patients with multi-morbidity. Demonstrating that loneliness, also in presence of interpersonal relations, predicted worse quality of life helps identify people most at risk for common symptoms and lays the groundwork for research about diagnosis and treatment.
... Furthermore, there is considerable evidence about loneliness and its correlations with physical and mental health, but its health effects are not totally understood [27]. Research has shown that loneliness is significantly associated with functional decline among the aged [27][28][29]. A recent study found significant associations between loneliness and physical and mental functioning in an ageing population [30]. ...
... Overall, these previous results in physical functioning are supported by our findings, indicating cumulation in terms of education and continuity according to income. Previous studies have shown that loneliness is significantly associated with functional decline among the aged [27][28][29]. A recent study that also used the De Jong Gierveld loneliness scale found significant associations between loneliness and physical and mental functioning in an ageing population [30]. ...
Background: This study examines if education, income, and loneliness are associated with physical functioning and optimism in an ageing population in Germany. Furthermore, time trends of physical functioning and optimism as well as of associations with social inequality and loneliness are analyzed. Methods: The German Ageing Survey (DEAS), a longitudinal population-based survey of individuals aged 40 years and older, was used (four waves between 2008 and 2017, total sample size N = 23,572). Physical functioning and optimism were introduced as indicators of ageing well. Educational level, net equivalent income, and loneliness were used as predictors in linear mixed models for longitudinal data. Results: Time trends show that physical functioning decreases over time, while optimism slightly increases. Education and income are positively associated with physical functioning, while higher loneliness correlates with lower physical functioning. Higher optimism was associated with higher income and particularly with lower loneliness. Income and notable educational inequalities in physical functioning increase over time. Time trends of the associations with optimism show decreasing income inequalities and increasing disparities in loneliness. Conclusions: Increasing educational inequalities in physical functioning and a strong association of loneliness with optimism provide information for further interventions. Targeted health promotion among the aged and addressing maladaptive social cognition are options to tackle these issues. Key areas for action on healthy ageing include, for instance, the alignment of health systems to the needs of older populations or the creation of age-friendly environments.
... Although not unique to older adults, loneliness is prevalent in this population. In the United States (U.S.), estimates of loneliness prevalence range from 19% to 43% of older adults (Perissinotto et al., 2012;Theeke, 2009). In the United Kingdom (UK), estimates range from 18% to 29% of the older adult population (Steptoe et al., 2013;Yang and Victor, 2011). ...
... This resulted in 30% of 57-85 year-olds being classified as lonely. Applying a less stringent cutoff to the same 3-item scale (i.e., respondents were classified as lonely if they reported "some of the time" or "often" to any one of the items), 43% of adults at least 60-years-old in the U.S. Health and Retirement Study were lonely (Perissinotto et al., 2012). ...
The purpose of this study is to compare mean levels of loneliness, and correlates of loneliness, among older adults in the U.S. and England. Comparisons are conducted after attending to comparability of the loneliness measure between countries based on tests for discriminatory capacity and differential item functioning of the 3-item UCLA Loneliness Scale. Cross-sectional data from the 2015–16 wave of the National Social Life, Health and Aging Project (NSHAP) and the 2014–2015 wave of the English Longitudinal Study on Ageing (ELSA) were analyzed using graded item response models and multiple indicators and multiple causes (MIMIC) models. Risk factors included demographic variables, health characteristics, and social characteristics that were harmonized across surveys. Because of differences in the racial-ethnic composition of the U.S. and England, analyses were limited to white respondents (N = 2624 in NSHAP; N = 6639 in ELSA). Only respondents born 1925–1965 were included in analyses. Discriminatory capacity was evident in each item being able to distinguish a lonely from a nonlonely individual. Differential item functioning (DIF) was evident in country differences in the likelihood of endorsing the “lack companionship” item at a given level of trait loneliness, and in DIF among marital status, education, and gender subgroups that were comparable across countries. Overall loneliness levels are equivalent in England and the U.S. Risk factor impact did not differ between countries, but differences in risk factor prevalence between countries combined to produce a net result of slightly lower mean levels of loneliness in older adults in England than in the U.S. after risk factor adjustment. The fact that the impact of risk factors were similar across countries suggests that evidence of successful interventions in one country could be leveraged to accelerate development of effective interventions in the other.
... Intense interpersonal and professional competition and high internal and external pressure (Twenge, 2014;Verhaeghe, 2014) may considerably increase the number of stressful encounters that may negatively impact the young generations' abilities to adapt. Not surprisingly, the number of individuals suffering of mental health problems (depression, anxiety disorders, loneliness, etc.) is constantly increasing worldwide (Cunningham, Collins, Patel, Joestl, March, Insel, & Daar, 2011;Erzen & Çikrikçi, 2018;Hawkley & Cacioppo, 2010;Perissinotto, Stijacic Cenzer, & Covinsky, 2012;Prina, Victor & Bowling, 2012;WHO, 2017). Depression is one of the most frequently encountered mental health problems, over 298 million people suffering of depressive symptoms (i.e., over 4.4% of the population of the world) (Cuijpers, Smit, & van Straten, 2007;Ferrari, Charlson, Norman, Patten, Freedman, Murray, et al., 2013;WHO, 2017). ...
... Scientific literature has closely and rigorously followed the worldwide tendency of significant increases in time of mental health problems, depression, anxiety disorders, loneliness, etc., presenting an alarmingly increasing patterns (Banyard, Edwards, & Kendall-Tackett, 2009;Collins, Patel, Joestl, March, Insel, & Daar, 2011;Erzen & Çikrikçi, 2018;Hawkley & Cacioppo, 2010;Kendall-Tackett, 2009;Lanius, Vermetten, & Pain, 2010;Perissinotto, Stijacic Cenzer, & Covinsky, 2012;Prina, Victor & Bowling, 2012;Weehuizen, 2008;WHO, 2017). On the other hand, the specific changes in the western society (inclination towards consumerism, the constant pressure for excellence and success) may have to some degree contributed in recent years to the unexpected increase in two somewhat interrelated aspects of malfunctioning -narcissism and maladaptive perfectionism (Curran & Hill, 2017;Twenge & Campbell, 2009;Verhaeghe, 2014). ...
Despite significant increases of life-conditions specific to the western world, the increasing changes at social, economic, political, cultural, etc., levels, may have significantly contributed to the development of some malfunctioning patterns (mental health indicators, narcissism, perfectionism), which may have seriously impacted overall personal and interpersonal functioning. The major aim of our study was to investigate the relationship between the three dimensions of perfectionism, narcissism, and mental health indicators as depression tendencies, subjective and psychological well-being in a sample of Transylvanian Hungarian students. Our study included 305 Transylvanian Hungarian first and second year students, from Babes-Bolyai University in Cluj-Napoca, Sapientia, Targu-Mures, Romania, assessed on: depression symptoms, subjective well-being, psychological well-being, narcissistic traits, multidimensional perfectionism, and demographic variables (gender, age, satisfaction with family income). Our results indicate significant gender differences in narcissism. Male participants experienced significantly higher levels of happiness (subjective well-being), than female participants, who attained significantly higher levels of positive personal relationships with others, as measured with the relations sub-scale of the psychological well-being scale. Our findings also yield significant negative associations between subjective well-being and socially prescribed
... Related studies were mainly conducted in developed countries. A nationally representative study reported that 43% of older people in the United States felt lonely [2]; among the 25 European nations, loneliness of older adults was estimated to range from 19.6% to 34.0% [3]. Loneliness can cause a host of damages to both physical and mental health of older people, which may lead to a series of physiological effects and accelerate the ageing process [4]. ...
To explore the association between the personal social capital and loneliness among the widowed older adults in China. Data from 1497 widowed older adults were extracted from China’s Health-Related Quality of Life Survey for Older Adults 2018. The Chinese version of the Personal Social Capital Scale (PSCS-16) was used to evaluate the participants’ status of bonding and bridging social capital (BOC and BRC). Loneliness was assessed by the short-form UCLA Loneliness Scale (ULS-8). Multiple linear regression models were established to examine the relationship between social capital and loneliness. The BOC and BRC of rural widowed older people were significantly lower than those of widowed older people in urban areas, while loneliness of rural widowed older people was higher than that of widowed older people in urban areas. The result of the final model showed that loneliness of rural participants was significantly associated with both BOC (B = 0.141, p = 0.001) and BRC (B = −0.116, p = 0.003). The loneliness of the urban widowed sample had no association with both BOC and BRC (p > 0.05). These findings suggested that more social support and compassionate care should be provided to enrich the personal social capital and thus to reduce loneliness of widowed older adults, especially those in rural areas.
... In accordance with prior studies, UCLA scores of four or greater were considered lonely (19). for which there was a change in unstandardized B >10% between DJG and the olfactory measure in comparison to the crude, unadjusted value of DJG and the olfactory measure alone were considered to be confounders. ...
Background: Olfactory dysfunction (OD) has been reported to impact social interactions. However, the relationship between OD and loneliness has received little attention. The purpose of this study was to determine the association between OD and loneliness, controlling for patient factors.
Methods: Subjects without otolaryngic complaints were enrolled and olfactory function was assessed using: Sniffin' Sticks test to measure threshold, discrimination and identification (TDI), Questionnaire of Olfactory Disorders Negative Statements (QOD-NS) and 9-item Olfactory-Visual Analogue Scale (VAS). Loneliness was assessed using the De Jong Gierveld (DJG) and University of California Los Angeles (UCLA) loneliness scales. Bivariate analysis was performed followed by regression analysis, controlling for confounders.
Results: Results: In total, 221 subjects were included with a mean age of 50.5 years (range 20 to 93), 133 (60.2%) females and 161 (72.9%) white. Mean TDI score was 29.3 (7.0) and 49.5% of the cohort was dysosmic. Using DJG, 36.4% of the cohort were classified as lonely, whereas 35.0% were lonely using UCLA. Olfactory measures were significantly associated with DJG, including TDI (β = -0.03, p=0.050), olfactory discrimination (β = -0.111, p=0.005), QOD-NS (β = 0.058, p<0.001) and olfactory-VAS (β = 0.032, p<0.001). UCLA scores were significantly associated with QOD-NS (PR 1.061 [CI 1.018-1.107], p=0.005) and olfactory-VAS scores (PR 1.027, [CI 1.007-1.049], p=0.009). After controlling for confounders, the association between DJG and olfactory discrimination, as well as DJG and olfactory-VAS remained significant.
Conclusions: In this community-based sample of older adults, both OD and loneliness were common. Those subjects with worse olfactory function were more likely to report loneliness. Further research is necessary to establish causality, as well as explore the role of depression.
... 14-15 Perissinotto et al. showed that 29% of respondents over 75 years old were lonely, while the American Association of Retired Persons (AARP) found about 25% of respondents over 70 years old were lonely; both using the UCLA Loneliness Scale. [16][17] The 25-29% range seen in the United States is comparable to studies from across Europe and Asia. [18][19] In addition to their prevalence, both social isolation and loneliness are associated with considerable morbidity and mortality. ...
Objectives
The global COVID‐19 pandemic has caused rapid and monumental changes around the world. Older people, who already experience higher rates of social isolation and loneliness, are more susceptible to adverse effects as a result of the social distancing protocols enacted to slow the spread of COVID‐19. Based on prior outbreaks, we speculate the detrimental outcomes and offer solutions.
Methods
Reviewing the literature on the detrimental effects of social isolation and loneliness and higher mortality in the older population. Utilizing psychological study outcomes from prior major outbreaks such as in SARS, Ebola, H1N1 influenza, and Middle East respiratory syndrome (MERS) offer predictions and the susceptibility in the geriatric age group.
Results
Organizations such as the WHO, CDC, and AARP have put measures in place to provide networking on a local, regional and national level. These efforts are designed to start mitigating such detrimental effects. A necessary follow‐up to this pandemic will be gathering data on unique populations such as the geriatric community, to better mitigate adverse outcomes given the certainty that COVID‐19 will not be the last global viral outbreak.
Conclusions
The results of worsened social isolation and loneliness is associated with significantly increased morbidity and mortality in the geriatric population. Various solutions including virtual interactions with loved ones, engaging in physical activity, continuing any spiritual or religious prayers remotely, and community services to provide aid for the older population are all efforts to minimize social isolation and loneliness.
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... Loneliness is a common and dissatisfaction feeling of one's social relationship which is nowadays becoming a serious public health issue for old people [20,21]. Loneliness has been observed to be associated with subsequent adverse outcomes, such as mortality [22,23], comorbidity [24,25], poor functional ability [26,27], depression [28], and cognitive decline [29]. At the biological level, a large number of studies had found that the feeling of loneliness is associated with increased blood pressure [30,31], increased risk of cardio-cerebrovascular and in ammatory diseases [32][33][34], impaired immune function [35], and increased likelihood of sarcopenia [36]. ...
Background: Previous literature has reported that loneliness is a strong predictor of frailty risk. However, less is known about the role of loneliness in frailty transition types. This study aimed to examine whether and how loneliness are related to frailty transition among older Chinese people.
Methods: Our study used participants (aged ≥60 years) from 2008/2009, 2011/2012 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Loneliness was assessed by a single question asking how often the respondent feels lonely. The FRAIL Scale was created to measure physical frailty for our study, and frailty was also assessed by a broader definition of the frailty index. Frailty transition as an outcome variable has been designed as two types according to the measurement of frailty.
Results: Greater loneliness at baseline reduced the possibility of remaining in a robust or prefrail physical frailty state after 3 years (OR=0.78, 95%CI: 0.68–0.91, p<0.01). Greater loneliness was associated with an increased risk of worsening physical frailty over time: compared with those who had never felt lonely, the odds ratios for people who often felt lonely were 1.19 (95%CI: 1.01–1.41, p<0.05) after 3 years and 1.34 (95%CI: 1.08–1.66, p<0.01) after 6 years. The association between loneliness and change in the frailty index differed in the survey periods: loneliness at baseline was found to increase the possibility of participants remaining in frailty (seldom loneliness: OR= 1.78, 95%CI: 1.25–2.55, p<0.01; often loneliness: OR= 1.74, 95%CI: 1.21–2.50, p<0.01) after 6 years, but no significance was shown in the 3-year follow up. Additionally, loneliness at baselines was significantly associated with frailty transition at follow up among the male participants. However, a similar association was not observed among the female participants.
Conclusion: Older people with a high level of loneliness tend to be frail in the future, and greater loneliness is related to an increased risk of worsening frailty and remaining frail. Male elderly with a high level of loneliness were more likely to have a worse frailty transition than female elderly in China.
... Scientific literature has closely and rigorously followed the worldwide tendency of significant increases in time of mental health problems, depression, anxiety disorders, loneliness, etc., presenting an alarmingly increasing patterns (Banyard, Edwards, & Kendall-Tackett, 2009;Collins, Patel, Joestl, March, Insel, & Daar, 2011;Erzen & Çikrikçi, 2018;Hawkley & Cacioppo, 2010;Kendall-Tackett, 2009;Lanius, Vermetten, & Pain, 2010;Perissinotto, Stijacic Cenzer, & Covinsky, 2012;Prina, Victor & Bowling, 2012;Weehuizen, 2008;WHO, 2017). On the other hand, the specific changes in the western society (inclination towards consumerism, the constant pressure for excellence and success) may have to some degree contributed in recent years to the unexpected increase in two somewhat interrelated aspects of malfunctioning -narcissism and maladaptive perfectionism (Curran & Hill, 2017;Twenge & Campbell, 2009;Verhaeghe, 2014). ...
... In the present study, we tested our hypotheses in the context of rapid urbanization in China, which has revealed the beneficial effects of grandparental caregiving. One possibility is that the Chinese culture (or collectivistic cultures in general) might emphasize interpersonal harmony, familism, and intergenerational transfers to a larger extent (Chen et al., 2011), and making grandparental caregiving an important alternative to reach intergenerational harmony and fulfill the responsibility of intergenerational transfers through grandparent-grandchild intergenerational exchange could eventually promote older adults' mental health (Perissinotto et al., 2012). The generalizability of the present findings might be unclear. ...
Objective:
The purpose of the present study is twofold: (1) to investigate the differences in terms of physical and mental health between those who provide grandparental care and those who do not and (2) to explore the mechanism that connects grandparental caregiving and health-related outcomes.
Methods:
Two studies (a cross-sectional and a short-term longitudinal follow-up) were conducted. The cross-sectional study (Study 1) examined 148 older adults who provided grandparental care and another 150 older adults who did not. A small longitudinal follow-up study (Study 2) was conducted among 102 older adults randomly selected from Study 1, of which 52 were older adults who provided grandparental care, and another 50 older adults were those who did not. Health status (measured by SF-36), lonely dissatisfaction (measured by Lonely Dissatisfaction Subscale of PGC-MS), and cognitive functions (measured by subscales of WAIS) as well as demographics were measured in both studies.
Results:
Results of both the cross-sectional and longitudinal studies showed that, compared with older adults who did not provide grandparental care, those providing grandparental care had significantly better physical and mental health as well as reduced lonely dissatisfaction. Further path analysis showed that lonely dissatisfaction mediated the association between providing grandparental care and enhancement in functions such that providing grandparental care could reduce lonely dissatisfaction, which, in turn, could improve their physical and mental health even after controlling for their cognitive functions.
Discussion:
These results suggest that providing grandparental care can improve older adults' physical and mental health through reduced lonely dissatisfaction.
... For example, in the case of an emergency or a long-term illness, social contact and friendships are associated with increased survival rates, primarily as there is someone to offer support and to be around to aid recovery (Kroenke et al, 2006;Marmot, 2010). By contrast, in a study of older people who reported they felt left out, isolated or lacked companionship, the ability to perform daily activities like bathing, grooming and preparing meals declined relative to people who reported none of these feelings (Perissinotto et al., 2012). Effects of loneliness thus occur more through reductions in self-esteem, while those for social isolation through lower self-efRicacy. ...
Social isolation and loneliness have received substantial attention for their impacts on well-being and mortality. Both social isolation and loneliness can be experienced by anyone across the life course, but some are more vulnerable than others. One risk factor for poorer social outcomes is disability. We draw on data from three longitudinal studies, the National Child Development Study (Great Britain), Next Steps (England) and the Millennium Cohort Study (UK) to compare social relationships across three generations, born between 1958 and 2000/02 in countries of the UK. We examine social relationships at different life stages and how they differ between those who were and were not identified as disabled when they were teenagers. Adjusting for family background and educational attainment, which are associated with both disability and poorer social outcomes, we identify the long-term consequences of childhood disability for risks of social isolation among the older cohort. For the younger cohorts, we evaluate early indications of such patterns. We find substantially smaller intimate and friendship networks, and lower perceived social support among 50-year-olds who were disabled in childhood. Today’s disabled youth and teenagers also experience greater social isolation and risks of loneliness than their non-disabled contemporaries.
... Loneliness can be emotional (e.g., negative feelings because of not having a companion or emotional support) or social (e.g., negative feelings because of a perceived lack of a wider social network) (16). Like with social isolation, older persons who are lonely have greater risk of negative functional and health outcomes and premature death (20). ...
Social isolation is an important public health issue that has gained recognition during the COVID-19 pandemic because of the risks posed to older adults based on physical distancing. The primary purposes of this article are to provide an overview of the complex interconnectedness between social isolation, loneliness, and depression while introducing the COVID-19 Connectivity Paradox, a new concept used to describe the conflicting risk/harm continuum resulting from recommended physical distancing. In this context, examples will be provided for practical and feasible community-based models to improve social connectivity during COVID-19 by adjusting the processes and modalities used to deliver programs and services to older adults through the aging social services network. The COVID-19 pandemic has highlighted the need for clinical and community-based organizations to unite and form inter-sectorial partnerships to maintain the provision of services and programs for engaging and supporting older adults during this difficult time of physical distancing and shelter-in-place and stay-at-home orders. The aging social services network provides a vital infrastructure for reaching older underserved and/or marginalized persons across the U.S. to reduce social isolation. Capitalizing on existing practices in the field, older adults can achieve distanced connectivity to mitigate social isolation risk while remaining at safe physical distances from others.
... Moreover, for frail older individuals social contact is the most important factor for their life, while non-frail subjects consider health as the most critical one (17). It has been shown that loneliness is an independent determinant for functional decline and mortality in old age (20,21). Thus, social factors are paramount in elderly populations; however, the present form of senior organizations seems to be ineffective in improving social life. ...
Purpose: The study explores how the involvement in community-based senior organizations affects the prevalence of multidimensional and physical frailty among community dwelling elderly people. Materials and Methods: The group of 1,024 elderly people (270 males) over the age of 65 years (mean age 72.6 ± 6.3 years; range 65–93 years) took part in this study. The subjects completed a questionnaire regarding multidimensional (i.e., the Tilburg Frailty Indicator, TFI) and physical frailty (i.e., the FRAIL scale), as well as factors associated with frailty and participation in senior organizations. Results: The prevalence of multidimensional frailty (if at least 5 points in the TFI) was 54.6%, and the prevalence of physical frailty (if at least 3 points in the FRAIL scale) and a non-robust status (if any point in the FRAIL scale was positive) was 6.3 and 52.9%, respectively. The most prevalent frailty deficits were missing other people (66.6%), feeling nervous or anxious (65.9%), and feeling down (65.5%). Members of senior organizations presented a lower prevalence of multidimensional and physical frailty comparing with non-members. This was mainly caused by a lower prevalence of physical deficits and problems with memory; however, the prevalence of social deficits was similar in both groups. Senior organizations had no influence on the most widespread frailty deficits, i.e., missing other people, feeling nervous or anxious, and feeling down. Conclusions: Multidimensional frailty and physical non-robust status are common among people over the age of 65 years. Participation in senior organizations is associated with lower risk of physical frailty; however, it has no effect on social frailty and the most prevalent psychological deficits. This information has important implications for practical management with senior problems and may influence community strategies concerning elderly people.
... Limited or poor social relationships have been shown to increase the risk of dementia by 60 percent [6]. Loneliness is a known risk factor for depression [7] and has been associated with increased risk of death and with functional decline [8]. A meta-analytic review of 70 studies [9] has shown that the likelihood of mortality increased by roughly 30 percent for reported loneliness, social isolation, and living alone, an effect comparable to those of smoking and obesity. ...
Background:
This review studies technology-supported interventions to help older adults, living in situations of reduced mobility, overcome loneliness, and social isolation. The focus is on long-distance interactions, investigating the (i) challenges addressed and strategies applied; (ii) technology used in interventions; and (iii) social interactions enabled.
Methods:
We conducted a search on Elsevier's Scopus database for related work published until January 2020, focusing on (i) intervention studies supported mainly by technology-mediated communication, (ii) aiming at supported virtual social interactions between people, and (iii) evaluating the impact of loneliness or social isolation.
Results:
Of the 1178 papers screened, 25 met the inclusion criteria. Computer and Internet training was the dominant strategy, allowing access to communication technologies, while in recent years, we see more studies aiming to provide simple, easy-to-use technology. The technology used was mostly off-the-shelf, with fewer solutions tailored to older adults. Social interactions targeted mainly friends and family, and most interventions focused on more than one group of people. Discussion. All interventions reported positive results, suggesting feasibility. However, more research is needed on the topic (especially randomized controlled trials), as evidenced by the low number of interventions found. We recommend more rigorous methods, addressing human factors and reporting technology usage in future research.
... Given living alone in older age has been repeatedly implicated as a risk factor for premature mortality (14,15), we examined effects across individuals who do and do not live alone. In addition, we sought to examine functional status as a possible moderator of effects, given its relevance as a crucial marker of health in old age, in addition to being implicated in loneliness (16,17). Furthermore, personality traits have been repeatedly associated with loneliness (18) and health processes and mortality (16,19,20), and as such, it was of importance to determine whether they may act as a further potential moderator in the association between loneliness and mortality. ...
OBJECTIVE: To examine the predictive value of social and emotional loneliness for all-cause mortality in the oldest-old who do, and do not live alone and to test whether these varied by functional status and personality. METHODS: Participants were 413 older adults from the Berlin Aging Study (M ± SD = 84.53 ± 8.61 years of age) who either lived alone (n = 253) or did not live alone (n = 160). Significance values for hazard ratios are reported having adjusted for age, sex, education, income, marital status, depressive illness, and both social and emotional loneliness. RESULTS: While social loneliness was not associated with mortality in those living alone, emotional loneliness was; with each 1 SD increase in emotional loneliness there was a 18.6% increased risk of all-cause mortality in the fully adjusted model (HR = 1.186; p = 0.029). No effects emerged for social or emotional loneliness for those not living alone. No associations emerged for social or emotional loneliness among those not living alone. Examinations of potential moderators revealed that with each 1 SD increase in functional status, the risk associated with emotional loneliness for all-cause mortality increased by 17.9% (HRinteraction = 1.179; p = 0.005) in those living alone. No interaction between personality traits with loneliness emerged. CONCLUSIONS: Emotional loneliness is associated with an increased risk of all-cause mortality in older aged adults who live alone. Functional status was identified as one potential pathway of accounting for the adverse consequences of loneliness. Emotional loneliness that can arise out of the loss or absence of a close emotional attachment figure appears to be the toxic component of loneliness.
... Loneliness is a common and dissatisfaction feeling of one's social relationship which is nowadays becoming a serious public health issue for old people [20,21]. Loneliness has been observed to be associated with subsequent adverse outcomes, such as mortality [22,23], comorbidity [24,25], poor functional ability [26,27], depression [28], and cognitive decline [29]. At the biological level, a large number of studies had found that the feeling of loneliness is associated with increased blood pressure [30,31], increased risk of cardio-cerebrovascular and in ammatory diseases [32][33][34], impaired immune function [35], and increased likelihood of sarcopenia [36]. ...
Background: previous literature has reported that loneliness is a strong predictor of frailty risk, yet less is known about the role of loneliness in frailty transition types. In this study, we examined whether and how loneliness is related to frailty transition among Chinese old people.
Methods: our study used participants (aged>=60) from 2008/2009, 2011/2012 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Loneliness was assessed by a single question asking how often the respondent feels lonely. FRAIL Scale was created to measure physical frailty for our study, and frailty was also assessed by a broader definition of frailty index. Frailty transition as an outcome variable has been designed as two types according to the measurement of frailty.
Results: greater loneliness at baseline reduced the possibility of remaining robust or prefrail physical frailty state after 3 years (OR=0.78, 95%CI: 0.68 - 0.91, p<0.01), adjusted for all confounding variables. Greater loneliness was associated with an increased risk of worsening physical frailty after years: compared with those who had never felt lonely, the odds ratios for people who often felt lonely were 1.19 (95%CI: 1.01 - 1.41, p<0.05) after 3 years and 1.34 (95%CI: 1.08 - 1.66, p<0.01) after 6 years, adjusted for confounding variables. The association between loneliness and change in the frailty index differed in survey periods: loneliness at baselines was found to increase the possibility of participants remaining in frailty (seldom loneliness: OR= 1.78, 95%CI: 1.25 - 2.55, p<0.01; often loneliness: OR= 1.74, 95%CI: 1.21 - 2.50, p<0.01) after 6 years, but no significant sign was shown in 3 years follow-up. Besides, loneliness at baselines was significantly associated with frailty transition at follow-up among males, even after adjusting for all potential confounding variables. However, a similar association was not observed among females.
Conclusion: old people with a high level of loneliness tend to be frail in the future, and greater loneliness is related to increased risk of worsening frailty and remaining frail. Male elderly with a high level of loneliness were more likely to suffer from frailty transition than female elderly in China.
... Social isolation, a psychosocial determinant of health, refers to objective measurable characteristics resulting in social disconnectedness: a lack of engagement with peers and the larger community [1,2]. This construct is distinct from that of loneliness, which refers to subjective feelings of isolation, suggesting that loneliness and social isolation do not necessarily co-occur and should be assessed independently [3][4][5]. The prevalence of social isolation is increasing in contemporary society and carries with it a potentially underestimated impact on human health [6]. ...
Social isolation, a risk factor for poor health within the general population, may be exacerbated by unique challenges faced by people living with HIV (PLHIV). This analysis examines the association between social isolation and all-cause mortality among a cohort of PLHIV experiencing multiple social vulnerabilities. The analytical sample included 936 PLHIV ≥ 19 years, living in British Columbia, Canada, and enrolled in the Longitudinal Investigation into Supportive and Ancillary Health Services (LISA) Study (2007–2010). Participants were classified as Socially Connected (SC), Minimally Isolated (MI) or Socially Isolated (SI) via latent class analysis. Cross-sectional survey data was linked to longitudinal clinical data from a provincial HIV treatment database. Mortality was assessed longitudinally up to and including December 31st, 2017. Through multivariable logistic regression, an association between SI and all-cause mortality was found (adjusted OR: 1.48; 95% CI 1.08, 2.01). These findings emphasize the need to mitigate effects of social isolation among PLHIV.
... Since the 2000s, there has been a sharp increase in research in this field (3). On the one hand, functional and cognitive impairment, chronic diseases, a diminishing social network, and a low level of physical activities have been identified as hindered aging in place (4)(5)(6)(7). On the other hand, neighborhood outdoor environments have been revealed as better for older adults' wellbeing through helping retain their preferred lifestyles, social connections, and sense of control, together with better clinical outcomes compared with their institutionalized counterparts (8). ...
With rapid growth in the aging population around the world, the promotion of aging in place has become more significant in recent years. Many neighborhood landscape elements and features have been revealed by accumulating research findings to be critical to aging in place. However, they are usually studied separately or in small groups. Little has been done to examine the relative importance of these elements and features when brought together, from the older adult's point of view. In this context, the current study investigated the perceived importance for older adults of 22 selected neighborhood landscape elements and features. A questionnaire survey was conducted in 17 public rental housing estates in Hong Kong with proportions of older residents (aged 65 or above) between 20 and 40%. According to the 426 collected samples, older adults considered as highly important landscape elements and features that contribute to comfort and help them avoid hazards, such as good ventilation, protection from severe sunshine/rain, body support, and good hygiene, while elements were thought to potentially bring hazards while not being necessities for older adults' outdoor experience were considered least important, including portable chairs, outdoor tables, plants that can be touched, closeness to children's playgrounds, small spaces for solitude, water features, and fitness equipment. After integrally interpreting the findings regarding perceived importance with other collected data, some landscape design suggestions are generated to supplement existing guidelines and recommendations concerning older adults' well-being and quality of life. These findings can inspire future research and landscape design that prioritize promoting aging in place.
... Loneliness is a common and dissatisfaction feeling of one's social relationship that is presently becoming a serious public health issue for older people [20,21]. Loneliness has been observed to be associated with subsequent adverse outcomes, such as mortality [22,23], comorbidity [24,25], poor functional ability [26,27], depression [28], and cognitive decline [29]. At the biological level, many studies have found that the feeling of loneliness is associated with increased blood pressure [30,31], increased risk of cardio-cerebrovascular and in ammatory diseases [32][33][34], impaired immune function [35], and increased likelihood of sarcopenia [36]. ...
Background: Previous literature has reported that loneliness is a strong predictor of frailty risk. However, less is known about the role of loneliness in frailty transition types. This study aimed to examine whether and how loneliness are related to frailty transition among older Chinese people.
Methods: Our study used participants (aged ≥60 years) from 2008/2009, 2011/2012 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Loneliness was assessed by a single question asking how often the respondent feels lonely. The FRAIL Scale was created to measure physical frailty for our study, and frailty was also assessed by a broader definition of the frailty index. Frailty transition as an outcome variable has been designed as two types according to the measurement of frailty.
Results: Greater loneliness at baseline reduced the possibility of remaining in a robust or prefrail physical frailty state after 3 years (OR=0.78, 95%CI: 0.68–0.91, p<0.01). Greater loneliness was associated with an increased risk of worsening physical frailty over time: compared with those who had never felt lonely, the odds ratios for people who often felt lonely were 1.19 (95%CI: 1.01–1.41, p<0.05) after 3 years and 1.34 (95%CI: 1.08–1.66, p<0.01) after 6 years. The association between loneliness and change in the frailty index differed in the survey periods: loneliness at baseline was found to increase the possibility of participants remaining in frailty (seldom loneliness: OR= 1.78, 95%CI: 1.25–2.55, p<0.01; often loneliness: OR= 1.74, 95%CI: 1.21–2.50, p<0.01) after 6 years, but no significance was shown in the 3-year follow up. Additionally, loneliness at baselines was significantly associated with frailty transition at follow up among the male participants. However, a similar association was not observed among the female participants.
Conclusion: Older people with a high level of loneliness tend to be frail in the future, and greater loneliness is related to an increased risk of worsening frailty and remaining frail. Male elderly with a high level of loneliness were more likely to have a worse frailty transition than female elderly in China.
... 16,17 The previously validated, three-item UCLA loneliness scale scored each item from 1 to 3 for a maximum score of 9. 18 In accordance with prior studies, UCLA scores of four or greater were considered lonely. 19 ...
Background: Olfactory dysfunction (OD) has been reported to impact social interactions. However, the relationship between OD and loneliness has received little attention. The purpose of this study was to determine the association between OD and loneliness, controlling for patient factors.
Methods: Subjects without otolaryngic complaints were enrolled and olfactory function was assessed using: Sniffin’ Sticks test to measure threshold, discrimination and identification (TDI), Questionnaire of Olfactory Disorders Negative Statements (QOD-NS) and 9 – item Olfactory- Visual Analogue Scale (VAS). Loneliness was assessed using the De Jong Gierveld (DJG) and University of California Los Angeles (UCLA) loneliness scales. Bivariate analysis was performed followed by regression analysis, controlling for confounders.
Results: In total, 221 subjects were included with a mean age of 50.5 years (range 20 to 93), 133 (60.2%) females and 161 (72.9%) white. Mean TDI score was 29.3 (7.0) and 49.5% of the cohort was dysosmic. Using DJG, 36.4% of the cohort were classified as lonely, whereas 35.0% were lonely using UCLA. Olfactory measures were significantly associated with DJG, including TDI (β = -0.03, p=0.050), olfactory discrimination (β = -0.111, p=0.005), QOD-NS (β = 0.058, p<0.001) and olfactory-VAS (β = 0.032, p<0.001). UCLA scores were significantly associated with QOD-NS (PR 1.061 [CI 1.018-1.107], p=0.005) and olfactory-VAS scores (PR 1.027, [CI 1.007-1.049], p=0.009). After controlling for confounders, the association between DJG and olfactory discrimination, as well as DJG and olfactory-VAS remained significant.
Conclusions: In this community-based sample of older adults, both OD and loneliness were common. Those subjects with worse olfactory function were more likely to report loneliness. Further research is necessary to establish causality, as well as explore the role of depression.
... Loneliness, a key aspect of social disconnection, is synonymous with perceived social isolation, and has been associated with a number of adverse health outcomes and increased healthcare utilization. 9 Although only 27% of the Social disconnection among hospital emergency department users, Elwy et al. 190 Patient Experience Journal, Volume 7, Issue 3 -2020 U.S. population lives alone, 20-43% report experiencing frequent or intense loneliness, 10 with loneliness increasing in older age. 11,12 Loneliness and weak social connections are associated with a reduction in lifespan similar to that caused by smoking 15 cigarettes a day and even greater than that associated with obesity. ...
... Loneliness is a common and dissatisfaction feeling of one's social relationship that is presently becoming a serious public health issue for older people [20,21]. Loneliness has been observed to be associated with subsequent adverse outcomes, such as mortality [22,23], comorbidity [24,25], poor functional ability [26,27], depression [28], and cognitive decline [29]. At the biological level, many studies have found that the feeling of loneliness is associated with increased blood pressure [30,31], increased risk of cardio-cerebrovascular and inflammatory diseases [32][33][34], impaired immune function [35], and increased likelihood of sarcopenia [36]. ...
Background:
Previous literature has reported that loneliness is a strong predictor of frailty risk. However, less is known about the role of loneliness in frailty transition types. This study aimed to examine whether and how loneliness are related to frailty transition among older Chinese people.
Methods:
Our study used participants (aged ≥60 years) from 2008/2009, 2011/2012 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Loneliness was assessed by a single question asking how often the respondent feels lonely. The FRAIL Scale was created to measure physical frailty for our study, and frailty was also assessed by a broader definition of the frailty index. Frailty transition as an outcome variable has been designed as two types according to the measurement of frailty.
Results:
Greater loneliness at baseline reduced the possibility of remaining in a robust or prefrail physical frailty state after 3 years (OR = 0.78, 95%CI: 0.68-0.91, p < 0.01). Greater loneliness was associated with an increased risk of worsening physical frailty over time: compared with those who had never felt lonely, the odds ratios for people who often felt lonely were 1.19 (95%CI: 1.01-1.41, p < 0.05) after 3 years and 1.34 (95%CI: 1.08-1.66, p < 0.01) after 6 years. The association between loneliness and change in the frailty index differed in the survey periods: loneliness at baseline was found to increase the possibility of participants remaining in frailty (seldom loneliness: OR = 1.78, 95%CI: 1.25-2.55, p < 0.01; often loneliness: OR = 1.74, 95%CI: 1.21-2.50, p < 0.01) after 6 years, but no significance was shown in the 3-year follow up. Additionally, loneliness at baselines was significantly associated with frailty transition at follow up among the male participants. However, a similar association was not observed among the female participants.
Conclusion:
Older people with a high level of loneliness tend to be frail in the future, and greater loneliness is related to an increased risk of worsening frailty and remaining frail. Male elderly with a high level of loneliness were more likely to have a worse frailty transition than female elderly in China.
... which was higher than that found by Hughes et al. [61] in a US sample. The scale did not demonstrate normal distribution, so it was dichotomized in all responses as 'hardly ever' ('without loneliness') and those who answer 'some of the time' or 'often' on at least one question (coded as 'with loneliness') [62]. ...
PurposeThe increased population aging has resulted in a growing need for longitudinal studies about the quality of life among older people. Nevertheless, the results of these investigations could be biased because more disadvantaged people leave the original sample. The purpose of this study is to examine how the selective attrition observed in a panel survey affect multivariate models of subjective well-being (SWB). The question is if we could do reliable longitudinal investigations concerning the predictors of SWB in old age.Methods
This paper examines attrition in a panel of older people in Chile. Attrition was evaluated in the variables that affect elderly SWB. Probit models were fitted to compare dropouts with nondropouts. Then, multivariate probit models were estimated on satisfaction and depressive symptoms, comparing dropouts and nondropouts. Finally, we compared weighted and unweighted multivariate probit models on SWB.ResultsThe attrition rate in 2 years was 38.8%, including deaths and 32.9%, excluding them. Survey dropouts had lower satisfaction but not higher depressive symptoms. Among SWB predictors, people without a partner and with lower self-efficacy abandoned more the study. When applying the Becketti, Gould, Lillard, and Welch test, the probit coefficients of the predictor variables on SWB outcome variables were similar for dropouts and nondropouts. Finally, the comparison of multivariate models on SWB with weighting methods did not find substantial differences in the explanatory coefficients.Conclusion
Although some predictors of attrition were associated with SWB, attrition did not produce biased estimates in multivariate models of life satisfaction life or depressive symptoms in old age.
... Studies of loneliness demonstrated a correlation between ischemic heart disease events and the diversity of one's social contacts, with the latter presumably preventing the former ( Barefoot et al. 2005), and a correlation between poor survival rates from coronary artery disease and isolation or rare contacts with one's social support network (Brummett et al. 2001). Loneliness has also been proved to be connected with increased risk of functional decline and death in a longitudinal cohort study of American adults aged sixty and over (Perissinotto et al. 2012). Psychological studies confirm loneliness to be a risk factor for depression, although not only in respect to older adults (Cacioppo et al. 2005). ...
Loneliness among older adults has emerged as a specific social phenomenon
relatively recently– in developed countries just a few decades ago. In Russia,
due to its initially strong family-oriented culture, this problem presented
itself even later, following the collapse of Soviet society. This article analyses
probable social policy adjustments aimed at reducing the negative impact
of loneliness on the older generation. We address the issue of loneliness assessment and prevention involving older adults themselves and social
workers as experts. The methodology of 'expert seminars' involves comparing
preliminary subjective assessments of the phenomenon under consideration
with a final assessment of its contributing factors. Two groups of experts
disagree on both the general assessment of loneliness and how to outline the
loneliness-provoking factors and solutions suggested to combat it. Social
workers have assumed that loneliness can be mitigated by developing an
age-friendly environment, which improves the quality of life of the older
generation. Older adults, however, clearly revealed in discussions during
expert seminars and in their final recommendations that impersonal
environment-oriented measures are not specific enough to tackle loneliness.
In recent decades, political elites have made significant efforts to promote
the importance, necessity and, to a large extent, the inevitability of delegating
greater responsibility for the well-being of older adults to older adults
themselves. However, participants of our Tomsk expert seminars were
unwilling to take responsibility and continued to rely heavily on the social
protection system rather than on personal resources or family support.
... Approximately 30% of the population aged 57-80 years in the United States experience loneliness some of the time or often (Hawkley & Kocherginsky, 2018), a prevalence high enough that some scholars suggest that we are facing a loneliness epidemic (Holt-Lunstad, 2017). Furthermore, some researchers have proposed that loneliness may be more treatable than other sources of functional decline and death such as chronic conditions (Perissinotto, Cenzer, & Covinsky, 2012). Relationships with children help protect older adults against feelings of loneliness (Shiovitz-Ezra & Leitsch, 2010), but this protective effect may vary based on the quality of the parent-child relationship. ...
Objective
This brief report examined the relationship between intergenerational ambivalence and loneliness in later life among a group of older adults with at least one child.
Background
Previous work has explored the links between intergenerational ambivalence and other indicators of well‐being but has not examined loneliness. Although studies show an association between positive and negative relationship quality with children and loneliness, there are conflicting findings, and there is also insufficient exploration of the role of gender.
Method
Utilizing pooled data from the 2012 and 2014 waves of the Health and Retirement Study (HRS) (n = 10,967) ( https://hrs.isr.umich.edu/documentation), structural equation models were used to examine the hypothesized relationships, and multiple group analysis was utilized to assess potential gender differences.
Results
The results indicated that greater intergenerational ambivalence was associated with increased loneliness in later life. However, there were no significant gender or marital status differences in the relationships.
Conclusion
This study adds to the existing literature on ambivalence and well‐being by showing that ambivalent relationships are related to loneliness. Results underscore the emotional complexity of parent–child relationships and suggest the need for investigating the consequences of holding contradictory feelings.
... 16,17 The previously validated, three-item UCLA loneliness scale scored each item from 1 to 3 for a maximum score of 9. 18 In accordance with prior studies, UCLA scores of four or greater were considered lonely. 19 ...
Background
Olfactory dysfunction (OD) has been reported to impact social interactions. However, the relationship between OD and loneliness has received little attention. The purpose of this study was to determine the association between OD and loneliness, controlling for patient factors.
Methods
Subjects without otolaryngic complaints were enrolled and olfactory function was assessed using: Sniffin’ Sticks test to measure threshold, discrimination and identification (TDI), Questionnaire of Olfactory Disorders Negative Statements (QOD-NS) and 9 – item Olfactory-Visual Analogue Scale (VAS). Loneliness was assessed using the De Jong Gierveld (DJG) and University of California Los Angeles (UCLA) loneliness scales. Bivariate analysis was performed followed by regression analysis, controlling for confounders.
Results
In total, 221 subjects were included with a mean age of 50.5 years (range 20 to 93), 133 (60.2%) females and 161 (72.9%) white. Mean TDI score was 29.3 (7.0) and 49.5% of the cohort was dysosmic. Using DJG, 36.4% of the cohort were classified as lonely, whereas 35.0% were lonely using UCLA. Olfactory measures were significantly associated with DJG, including TDI (β = −0.03, p = 0.050), olfactory discrimination (β = −0.111, p = 0.005), QOD-NS (β = 0.058, p < 0.001) and olfactory-VAS (β = 0.032, p < 0.001). UCLA scores were significantly associated with QOD-NS (PR 1.061 [CI 1.018–1.107], p = 0.005) and olfactory-VAS scores (PR 1.027, [CI 1.007–1.049], p = 0.009). After controlling for confounders, the association between DJG and olfactory discrimination, as well as DJG and olfactory-VAS remained significant.
Conclusions
In this community-based sample of older adults, both OD and loneliness were common. Those subjects with worse olfactory function were more likely to report loneliness. Further research is necessary to establish causality, as well as explore the role of depression.
... Loneliness, a key aspect of social disconnection, is synonymous with perceived social isolation, and has been associated with a number of adverse health outcomes and increased healthcare utilization. 9 Although only 27% of the Social disconnection among hospital emergency department users, Elwy et al. 190 Patient Experience Journal, Volume 7, Issue 3 -2020 U.S. population lives alone, 20-43% report experiencing frequent or intense loneliness, 10 with loneliness increasing in older age. 11,12 Loneliness and weak social connections are associated with a reduction in lifespan similar to that caused by smoking 15 cigarettes a day and even greater than that associated with obesity. ...
Elwy AR, Koppelman E, Parker VA, Louis C. (2020) "Addressing social disconnection among frequent users of community hospital emergency departments: A statewide implementation evaluation,"
... Studies of loneliness demonstrated a correlation between ischemic heart disease events and the diversity of one's social contacts, with the latter presumably preventing the former ( Barefoot et al. 2005), and a correlation between poor survival rates from coronary artery disease and isolation or rare contacts with one's social support network (Brummett et al. 2001). Loneliness has also been proved to be connected with increased risk of functional decline and death in a longitudinal cohort study of American adults aged sixty and over (Perissinotto et al. 2012). Psychological studies confirm loneliness to be a risk factor for depression, although not only in respect to older adults (Cacioppo et al. 2005). ...
... [10][11][12][13][14] In addition, older adults suffering from social isolation are more likely to be re-hospitalized following heart failure, 15 and show overall higher rates of mortality. [16][17][18] Mobile technology such as tablet and smartphones allow face-to-face virtual communication and may help ALF residents experience social engagement that may contribute to better health outcomes. 19,20 Investigating how care centers for the elderly have made use of digital connectivity during the pandemic may offer important insights to leadership of ALFs and similar facilities. ...
Background and study objective:
The COVID-19 pandemic has forced assisted living facilities (ALF) to implement strict social isolation for residents. Social isolation in the geriatric population is known to negatively impact health. Here, we describe how ALFs in Rhode Island utilized device donations received from Connect for COVID-19, a nationwide nonprofit organization which has mobilized medical students to gather devices for donations to care centers.
Methods:
Rhode Island ALFs were contacted to determine if they were interested in receiving smart device donations. After donations were made, an impact survey was electronically administered. Primary Results: A total of 11 facilities completed the survey with a response rate of 24% (11/46). The facilities were located throughout all five counties in Rhode Island, with the majority located in Providence County. All but one of the facilities that responded to the survey (n=10, 90.9%) have used the devices to allow residents to video-call their family members. Seven responses (63.6%) indicated that devices were used for more than one purpose. Primary Conclusions: Smart devices were well received by Rhode Island ALFs and used for purposes beyond video conference calls. ALFs should consider advertising the need for devices to encourage community donations. Future studies should investigate the direct impact that digital connectivity has had on Rhode Island ALF residents.
... https://doi.org/10.1101/2020.10.06.20207571 doi: medRxiv preprint loneliness, 7,8 and that more than 40 percent of adults aged 60 and older report feeling lonely. 9 The extent to which individuals are socially isolated can have a profound impact on both physical and psychological well-being. 5 Social isolation is thought to influence health through behavioral and biological pathways. ...
Background
The imperative for physical distancing during the coronavirus disease 2019 (COVID-19) pandemic may deteriorate physical and mental health. We aimed at summarizing the strength of evidence in the published literature on the association of social isolation and loneliness with physical and mental health.
Methods
We conducted a systematic search in April 2020 to identify meta-analyses using the Medline, PsycINFO, and Web of Science databases. The search strategy included terms of social isolation, loneliness, living alone, and meta-analysis. Eligible meta-analyses needed to report any sort of association between an indicator of social isolation and any physical or mental health outcome. The findings were summarized in a narrative synthesis.
Results
Twenty-five meta-analyses met our criteria, of which 10 focused on physical health and 15 on mental health outcomes. A total of more than 3 million individuals had participated in the 692 primary studies. The results suggest that social isolation is associated with chronic physical symptoms, frailty, coronary heart disease, malnutrition, hospital readmission, reduced vaccine uptake, early mortality, depression, social anxiety, psychosis, cognitive impairment in later life, and suicidal ideation.
Conclusions
The existing evidence clearly indicates that social isolation is associated with a range of poor physical and mental health outcomes. A potential negative impact on these outcomes needs to be considered in future decisions on physical distancing measures.
Strengths and limitations of this study
This rapid umbrella review focuses on a timely and societally relevant issue.
The systematic literature search was conducted in three major databases from inception up to April 2020 warranting an extensive and up-to-date overview on relevant meta-analyses in the field.
Quality of included meta-analyses was rated with a standardized measure.
Different indicators of social isolation were included.
The utilized method did not allow for a quantitative comparison of associations with health outcomes.
Background: Despite the well-known health benefits of physical activity (PA), older adults are the least active citizens. Older adults are also at risk for loneliness. Given that lonely individuals are at risk for accelerated loss of physical functioning and health with age, PA interventions that aim to enhance social connectedness may decrease loneliness and increase long-term PA participation. The objectives of this mixed-method study are to: (1) evaluate whether an evidence-based PA intervention (Choose to Move; CTM) influenced PA and social connectedness differently among self-identified ‘lonely’ versus ‘not lonely’ older adults and (2) describe features of CTM that promote social connectedness.
Methods: Two community delivery partner organizations delivered 56 CTM programs in 26 urban locations across British Columbia. We collected survey data from participants (n=458 at baseline) at 0 (baseline), 3 (mid-intervention) and 6 (post-intervention) months. We conducted in depth interviews with a subset of older adults at baseline (n=43), mid-intervention (n=38) and post-intervention (n=19).
Results: PA increased from baseline to 3 months in lonely and not lonely participants. PA decreased from 3-6 months in lonely participants; however, PA at 6 months remained above baseline levels in both groups. Loneliness decreased from baseline to 3 and 6 months in participants identifying as lonely at baseline. Features of CTM that influence social connectedness include: Activity coach characteristics/personality traits and approaches; opportunity to share information and experiences and learn from others; engagement with others who share similar/familiar experiences; increased opportunity for meaningful interaction; and accountability.
Conclusion: PA interventions that focus on social connectedness, through group-based activities can improve the health of older adults by addressing both loneliness and PA. Building social connectedness within a PA intervention for older adults may support long term changes in PA behaviours.
Objective
Social isolation and loneliness are associated with morbidity and mortality in older adults. Limited evidence exists regarding which interventions improve connectedness in this population.
Design/Setting/Participants
In this pre-post study we assessed community-based group health class participants’ (age ≥50) loneliness and social isolation. Participants (n = 382) were referred by a Cedars-Sinai Medical Network (Los Angeles, California) healthcare provider or self-referred from the community (July 2017–March 2020).
Intervention
Participants met with a program coordinator and selected Arthritis Exercise, Tai Chi for Arthritis, EnhanceFitness, or the Healthier Living Workshop.
Measurements
We measured social isolation using the Duke Social Support Index (DSSI) and loneliness using the UCLA 3-item Loneliness Scale at baseline, class completion, and 6 months.
Results
Mean age was 76.8 years (standard deviation, SD = 9.1); 315 (83.1%) were female; 173 (45.9%) were Non-Hispanic white; 143 (37.9%) were Non-Hispanic Black; 173 (46.1%) lived alone; mean baseline DSSI score was 26.9 (SD = 4.0) and mean baseline UCLA score was 4.8 (SD = 1.8). On multivariable analysis adjusted for gender, race/ethnicity, income, self-rated health, and household size, DSSI improved by 2.4% at 6-week compared to baseline (estimated ratio, ER: 1.024; 95% confidence interval [CI]: 1.010–1.038; p-value = 0.001), and 3.3% at 6-month (ER: 1.033; 95% CI: 1.016–1.050; p-value <0.001). UCLA score after adjusting for age, gender, race/ethnicity, live alone, number of chronic conditions, income, and self-rated health, did not change at 6-week (ER: 0.994; 95% CI: 0.962–1.027; p-value = 0.713), but decreased by 6.9% at 6-months (ER: 0.931; 95% CI: 0.895–0.968; p-value <0.001).
Conclusion
Community-based group health class participants reported decreased loneliness and social isolation at 6-month follow-up.
The Acute Care for Elders (ACE) is a model of care addressed to reduce the incidence of loss of self-care abilities of older adults occurring during hospitalization for acute illness.
This observational study aimed to describe the effectiveness of an ACE unit at a long-term care facility to prevent functional decline (decrease in the Barthel Index score of >5 points from admission to discharge) in older adults with frailty (Clinical Frailty Scale score ≥5) and symptomatic COVID-19.
Fifty-one patients (mean age: 80.2 + 9.1 years) were included. Twenty-eight (54.9%) were women, with a median Barthel index of 50 (IQR:30–60) and Charlson of 6(IQR: 5–7), and 33 (64.7%) had cognitive impairment.
At discharge, 36(70.6%) patients had no functional decline, 6 (11.7%) were transferred to hospital and 4(7.8%) died.
An ACE unit at a long-term care facility constitutes an alternative to hospital care to prevent hospital-associated disability for frail older patients with COVID-19.
Under the rubric of the psychosocial dimension, multiple factors have been demonstrated to affect and also have a strong potential of affecting the nutritional status of patients with kidney disease. Among these are depression, anxiety, loneliness, self-efficacy, food insecurity, limited health literacy, and the relative availability of various forms of social support (Table 8.1). The aim of this chapter is to first provide an overview which broadens the perspective on psychosocial factors that can affect nutritional status in chronic kidney disease (CKD). A secondly aim is to suggest strategies for mitigating psychosocial factors that detrimentally impact nutrition and bolster those which can help to optimize it. As will be revealed through the overview, research on psychosocial factors has been uneven, and many knowledge gaps remain in fully understanding their impact on the nutritional status of patients with CKD.
This survey study aimed to examine the active ageing levels and investigate their time use patterns in high active ageing level. This study conducted with 145 elderly persons aged 60 and over, who were students at Pat Chimwai Sangsook School, Sansai sub district, Chiang Mai province, as well they had no cognitive impairment by obtaining a passing criterion of the using Mental State Examination: Thai version (MMSE-Thai 2002). This study comprised two stages to collect the data. The first stage was to examine the active ageing levels of older people in community by using an active ageing questionnaire and analyzing an active ageing index. The second stage was to investigate time use patterns in active ageing by using a time diary. The participants were asked to recall their activities being undertaken within the previous day (24-hours period). The activities were analyzed in six categories. Time spent on each activity was calculated in minutes. Then, time spent was summarized in 24-hour period. The result of the active ageing levels study showed that most elderly people had at moderate level. For investigating time use patterns show that the participants spent most of their time in sleeping and resting. This was followed by performing leisure, work, basic activity daily living (BADL) and instrumental activity daily living (IADL); whereas they spent the least of their time on social participation.
This short book is a meditation exploring the evolutionary perspective of chemical use, the origins of the Alcoholics Anonymous program, current understanding of the neuroscience of addiction, and how scientific evidence substantiates the Twelve-Step solution.
A população mundial está a envelhecer, nesse contexto, é possível observar uma tendência para um maior isolamento social e solidão entre os idosos. As intervenções com base tecnológica surgem como alternativa em situações em que intervenções presenciais não são possíveis de serem realizadas, como no período da pandemia COVID-19 ou em casos de isolamento geográfico ou incapacidade de deslocamento devido a condições de saúde. Sendo assim, o objetivo desta revisão integrativa de literatura passa por investigar e descrever as intervenções que utilizem a tecnologia com o propósito de minimizar os efeitos do isolamento social e da solidão nessa população. Efetuou-se uma pesquisa sistemática da literatura tendo em consideração artigos que estudassem intervenções com base tecnológica e os seus efeitos na solidão e no isolamento social nos idosos. Para tal, pesquisaram-se artigos científicos publicados em língua inglesa nas bases de dados PUBMED, B-ON e Web of Science entre os anos de 2000 e 2020. A pesquisa nas bases de dados possibilitou o acesso a 270 artigos e a pesquisa manual a 2 artigos. Por fim, e depois de aplicados os critérios de inclusão e exclusão, foram selecionados 13 artigos para análise. Foram avaliadas características sociodemográficas, objetivos, medidas, design e principais resultados em relação às variáveis: solidão e isolamento social. Por meio de uma análise temática, constatou-se que atividades sociais baseadas na Internet, treino das habilidades tecnológicas, jogos digitais, grupo de exercícios físicos online, serviço de amizade, videoconferências, robôs sociais, e terapia Cognitivo-Comportamental de baixa intensidade por WhatsApp foram os tipos de intervenção utilizados nos artigos selecionados. Os resultados encontrados são encorajadores; a maior parte dos estudos analisados demonstra o potencial e a eficácia das intervenções terapêuticas com base tecnológica na redução da solidão e do isolamento social nos idosos. No entanto, ainda existem barreiras que precisam de ser solucionadas e aspetos que carecem de investigação (e.g. iliteracia digital), de modo a que o acesso às novas ferramentas tecnológicas seja facilitado para a população sénior.
Objective
The purpose of this study was to examine the relationships of social isolation and loneliness, both individually and simultaneously, on changes in grip strength among Chinese older adults and whether these relations vary by gender.
Design
A 4-year prospective observational study.
Setting and Participants
This study used data from the China Health and Retirement Longitudinal Study (CHARLS). Analyses were conducted with data from 2 waves (2011 and 2015) and were restricted to those respondents aged 50 and older [n = 7025, mean age (SD) = 61.46 (7.59); male, 48.4%].
Methods
Social isolation, loneliness, and grip strength were measured at baseline. Follow-up measures of grip strength were obtained 4 years later. Multiple linear regression was used to evaluate the associations among baseline isolation, loneliness, and decline of grip strength between 2 waves after adjustment for age, gender, education, body mass index, chronic diseases, smoking and drinking status, activities of daily living (ADL) and instrumental ADL disabilities, and depressive symptoms.
Results
For women, baseline loneliness (β = 0.04, P = .035) rather than isolation (β = 0.03, P = .110) significantly predicted grip strength decline after 4 years when other confounding variables were taken into account. For men, baseline isolation (β = 0.05, P = .005) rather than loneliness (β = 0.01, P = .570) significantly predicted grip strength decline. No synergistic effect of isolation and loneliness on grip strength was found for either women or men.
Conclusions and Implications
In this prospective study, gender differences were found for the associations of social isolation and loneliness with grip strength decline. Our results suggest that older women and men may benefit from different social enhancement strategies for prevention of physical function decline.
Objective:
This study aimed to further knowledge of older Veterans' experiences with transitioning to the community from Veterans Affairs nursing homes (Community Living Centers or CLCs) with emphasis on social functioning.
Design:
A qualitative study design was used in addition to administration of standardized depression and mental status screens.
Setting and participants:
Veterans (n = 18) and caregivers (n = 14) were purposively sampled and recruited from 2 rural CLCs in Upstate New York.
Methods:
Semistructured interviews were completed with Veterans in the CLC prior to discharge (to explore experiences during the CLC stay and expectations regarding discharge and returning home) and in the home 2-4 weeks postdischarge (to explore daily routines and perceptions of overall health, mental health, and social functioning). Caregivers participated in 1 interview, completed postdischarge. The 9-item Patient Health Questionnaire and the Brief Interview for Mental Status were administered postdischarge.
Results:
Thematic analysis of verbatim transcriptions revealed 3 inter-related themes: (1) Veterans may experience improved social connectedness in CLCs by nature of the unique care environment (predominantly male, shared military experience); (2) Experiences of social engagement and connectedness varied after discharge and could be discordant with Veterans' expectations for recovery prior to discharge; and (3) Veterans may or may not describe themselves as "lonely" after discharge, when physically isolated. Veterans lacked moderate to severe cognitive impairment (Brief Interview for Mental Status: range = 14-15); however, they reported a wide range in depressive symptom severity postdischarge (9-item Patient Health Questionnaire: mean = 4.9, SD = 6.1, median/mode = 3, range = 0-23).
Conclusions and implications:
This study identified a potential for increased social isolation and disengagement after discharge from Veterans Affairs nursing homes. Nursing homes should integrate social functioning assessment for their residents, while extending care planning and transitional care to address patient-centered social functioning goals.
Hearing impairment impacts fluidity of communication and social interactions and thus may contribute to loneliness. We investigated the cross-sectional association between hearing impairment and loneliness in community-dwelling older U.S. adults using data from the National Social Life, Health, and Aging Project ( N = 3,196). Individuals reporting fair/poor hearing had 50% (95% confidence interval [CI] = [1.09–2.05]) higher odds of any loneliness compared with those reporting excellent hearing after adjusting for comorbidity index, functional and cognitive ability, self-reported health, and demographic characteristics. Test for trend suggests a dose–response relationship over levels of hearing impairment. Hearing impairment is highly prevalent and may be an important target for consideration in interventions to reduce loneliness. Further investigation of whether treatment of hearing impairment alleviates loneliness and its disabling effects is also needed.
Single prostate cancer (PCa) patients may face difficulties in starting a new relationship for various reasons. Here, we studied barriers and enablers to starting a relationship for PCa patients and characteristics of patients who were and were not in a relationship. PCa organizations distributed for us a 20-minute online survey, consisting of validated questionnaires (on treatment side effects, loneliness, social provision, and shyness) and questions on factors identified by patients as barriers and enablers to forming a new relationship. Participants were either single [n = 20] or had started a new relationship post-diagnosis [non-single, n = 15]. Three factors—confidence, sexual function, finding the right person—were perceived of as factors that can affect starting a relationship. Fourteen of twenty single patients were confident that they could find a partner and sixteen were comfortable in disclosing their cancer diagnosis to a potential partner. Non-single patients met their partners through various ways, including online dating and social events. They all revealed their cancer status prior to starting the relationship, and most partners reacted well to this disclosure. Single patients were lacking emotional support, more shy, and lonelier than non-single patients. Clinicians need to consider biopsychosocial factors when advising single patients who wish to start a new relationship.
Background
For decades, psychologists have studied the well-being and its importance in human prosperity.
Objective
In the present study, a mobile sensing approach was employed to explore the physiological correlates of daily well-being experiences.
Methods
19 participants were recruited for a 30-day continuous physiological measurement using a smartwatch that collected their heart rates, galvanic skin responses, skin temperatures, and walking steps. They also reported their daily well-being experiences every day, on the five well-being dimensions of the well-established PERMA (Positive emotion, Engagement, Relationship, Meaning, Accomplishment) model. The daily activity data were categorized into four mental states: asleep, relaxed, high mental load, and high physical load.
Results
344 valid samples of the participants’ daily physiological data were obtained from the 19 participants. Using the daily physiological signals of these four states as features, both stepwise regression analyses and binary classification analyses revealed that the five well-being experiences were significantly predicted, with regression r-square values ranging from 0.052 to 0.157 and classification accuracies ranging from 55.8% to 61.3%.
Conclusion
The findings provide evidence for the physiological basis of PERMA-based well-being.
Purpose
This study was carried out to determine the relationship between perceived loneliness and depression in the elderly and influencing factors
Design and Methods
This cross‐sectional descriptive study was conducted with 501 elderly. Data were collected with the questionnaire form, the elderly loneliness scale and the geriatric depression scale.
Findings
A positive relationship was found between depression and loneliness. Loneliness, applying to a family health center/hospitalization, educational level, social loneliness, and age were found to be the predictors of depression. Depression, applying to a family health center/hospitalization, and marital status were found to be the predictors of loneliness.
Practical Implications
Loneliness is the major factor affecting depression in elderly. It is recommended that attempts should be made to enable the elderly to live more actively.
In this study, the authors tested the relation between loneliness and subsequent admission to a nursing home over a 4-year time period in a sample of approximately 3,000 rural older Iowans. Higher levels of loneliness were found to increase the likelihood of nursing home admission and to decrease the time until nursing home admission. The influence of extremely high loneliness on nursing home admission remained statistically significant after controlling for other variables, such as age, education: income, mental status. physical health, morale, and social contact, that were also predictive of nursing horne admission, Several mechanisms are proposed to explain the link between extreme loneliness and nursing home admission. These include loneliness as a precipitant of declines in mental and physical health and nursing home placement as a strategy to gain social contact with others. Implications for preventative interventions are discussed.
Being alone, as measured by less frequent social interactions, has been reported to be associated with a more rapid rate of motor decline in older persons. We tested the hypothesis that feeling alone is associated with the rate of motor decline in community-dwelling older persons.
At baseline, loneliness was assessed with a 5-item scale in 985 persons without dementia participating in the Rush Memory and Aging Project, a longitudinal community-based cohort study. Annual detailed assessment of 9 measures of muscle strength and 9 motor performances were summarized in a composite measure of global motor function.
Linear mixed-effects models which controlled for age, sex and education, showed that the level of loneliness at baseline was associated with the rate of motor decline (Estimate, -0.016; S.E. 0.006, p = 0.005). For each 1-point higher level of loneliness at baseline, motor decline was 40% more rapid; this effect was similar to the rate of motor decline observed in an average participant 4 years older at baseline. Furthermore, this amount of motor decline per year was associated with about a 50% increased risk of death. When terms for both feeling alone (loneliness) and being alone were considered together in a single model, both were relatively independent predictors of motor decline. The association between loneliness and motor decline persisted even after controlling for depressive symptoms, cognition, physical and cognitive activities, chronic conditions, as well as baseline disability or a history of stroke or Parkinson's disease.
Among community-dwelling older persons, both feeling alone and being alone are associated with more rapid motor decline, underscoring the importance of psychosocial factors and motor decline in old age.
Loneliness is a prevalent social problem with serious physiological and health implications. However, much of the research to date is based on cross-sectional data, including our own earlier finding that loneliness was associated with elevated blood pressure (Hawkley, Masi, Berry & Cacioppo, 2006). In this study, we tested the hypothesis that the effect of loneliness accumulates to produce greater increases in systolic blood pressure (SBP) over a 4-year period than are observed in less lonely individuals. A population-based sample of 229 50- to 68-year-old White, Black, and Hispanic men and women in the Chicago Health, Aging, and Social Relations Study was tested annually for each of 5 consecutive years. Cross-lagged panel analyses revealed that loneliness at study onset predicted increases in SBP 2, 3, and 4 years later (B = 0.152, SE = 0.091, p < .05, one-tailed). These increases were cumulative such that higher initial levels of loneliness were associated with greater increases in SBP over a 4-year period. The effect of loneliness on SBP was independent of age, gender, race or ethnicity, cardiovascular risk factors, medications, health conditions, and the effects of depressive symptoms, social support, perceived stress, and hostility.
Loss of motor function is a common consequence of aging, but little is known about the factors that predict idiopathic motor decline. Our objective was to test the hypothesis that late-life social activity is related to the rate of change in motor function in old age.
Longitudinal cohort study with a mean follow-up of 4.9 years with 906 persons without stroke, Parkinson disease, or dementia participating in the Rush Memory and Aging Project. At baseline, participants rated the frequency of their current participation in common social activities from which a summary measure of social activity was derived. The main outcome measure was annual change in a composite measure of global motor function, based on 9 measures of muscle strength and 9 motor performances.
Mean (SD) social activity score at baseline was 2.6 (0.58), with higher scores indicating more frequent participation in social activities. In a generalized estimating equation model, controlling for age, sex, and education, global motor function declined by approximately 0.05 U/y (estimate, 0.016; 95% confidence interval [CI], -0.057 to 0.041 [P = .02]). Each 1-point decrease in social activity was associated with approximately a 33% more rapid rate of decline in motor function (estimate, 0.016; 95% CI, 0.003 to 0.029 [P = .02]). The effect of each 1-point decrease in the social activity score at baseline on the rate of change in global motor function was the same as being approximately 5 years older at baseline (age estimate, -0.003; 95% CI, -0.004 to -0.002 [P<.001]). Furthermore, this amount of motor decline per year was associated with a more than 40% increased risk of death (hazard ratio, 1.44; 95% CI, 1.30 to 1.60) and a 65% increased risk of incident Katz disability (hazard ratio, 1.65; 95% CI, 1.48 to 1.83). The association of social activity with the rate of global motor decline did not vary along demographic lines and was unchanged (estimate, 0.025; 95% CI, 0.005 to 0.045 [P = .01]) after controlling for potential confounders including late-life physical and cognitive activity, disability, global cognition depressive symptoms, body composition, and chronic medical conditions.
Less frequent participation in social activities is associated with a more rapid rate of motor function decline in old age.
In this study, the authors tested the relation between loneliness and subsequent admission to a nursing home over a 4-year time period in a sample of approximately 3,000 rural older Iowans. Higher levels of loneliness were found to increase the likelihood of nursing home admission and to decrease the time until nursing home admission. The influence of extremely high loneliness on nursing home admission remained statistically significant after controlling for other variables, such as age, education, income, mental status, physical health, morale, and social contact, that were also predictive of nursing home admission. Several mechanisms are proposed to explain the link between extreme loneliness and nursing home admission. These include loneliness as a precipitant of declines in mental and physical health and nursing home placement as a strategy to gain social contact with others. Implications for preventative interventions are discussed.
Significant symptoms of depression are common in the older community-dwelling population. Although depressive symptoms and disability may commonly occur in the same person, whether depressive symptoms contribute to subsequent functional decline has not been elucidated.
To determine whether depressive symptoms in older persons increase the risk of subsequent decline in physical function as measured by objective performance-based tests.
A 4-year prospective cohort study.
The communities of Iowa and Washington counties, Iowa.
A total of 1286 persons aged 71 years and older who completed a short battery of physical performance tests in 1988 and again 4 years later.
Baseline depressive symptoms were assessed by the Center for Epidemiological Studies Depression Scale. Physical performance tests included an assessment of standing balance, a timed 2.4-m (8-ft) walk, and a timed test of 5 repetitions of rising from a chair and sitting down.
After adjustment for baseline performance score, health status, and sociodemographic factors, increasing levels of depressive symptoms were predictive of greater decline in physical performance over 4 years (odds ratio for decline in those with depressed mood vs those without, 1.55; 95% confidence interval [CI], 1.02-2.34). Even among those at the high end of the functional spectrum, who reported no disability, the severity of depressive symptoms predicted subsequent decline in physical performance (odds ratio for decline, 1.03; 95% CI, 1.00-1.08).
This study provides evidence that older persons who report depressive symptoms are at higher risk of subsequent physical decline. These results suggest that prevention or reduction of depressed mood could play a role in reducing functional decline in older persons.
The study discussed in this article examined the relationship between depression symptomatology and functional impairment
among white and African American elderly people and investigated the effect of race, religiosity, and social support on this
relationship. Study results indicate that although African American elderly people were more impaired in the performance of
activities of daily living (ADL) and instrumental activities of daily living (IADL) than white elderly people, they did not
experience higher levels of depression. However, African Americans did report significantly higher levels of religiosity and
social support.
This paper reports a study investigating quality of life in relation to loneliness, caregiving, social network, gender, age and economic status among caregiving men and women in a population-based sample aged 75 years or older.
Because of demographic changes, in the future more care for older people will be given by informal caregivers who are themselves older. Being old and caring for another older person may affect various aspects of life, such as physical and emotional health and decreased time for respite, which may affect social life and quality of life.
A postal questionnaire including the Short Form Health Survey was used. The sample consisted of 4278 people, aged 75 years and over, living in Sweden. Of these, 783 (18%) were caregivers.
Caregivers had a larger social network and reported feelings of loneliness less often than non-caregivers. Forty per cent of caregivers helped every day. There were gender differences in experiences of loneliness during the last year, with the frequency of intense feelings of loneliness being higher among women. Loneliness and a small or non-existent network were significantly associated with low quality of life among caregivers, as well as in the total sample. The results showed significant association between loneliness, weak social network and low mental quality of life.
The fact that loneliness was the most important factor predicting low quality of life among caregivers, as well as older people in general, indicates that it is crucial in the care of older people. From a nursing perspective, the findings indicate the advantage of helping older people to keep up and develop their social networks. Nursing care should involve steps to maintain the social network before an older person becomes too weak, since decreased health status makes social contacts more difficult.
Most studies of social relationships in later life focus on the amount of social contact, not on individuals' perceptions of social isolation. However, loneliness is likely to be an important aspect of aging. A major limiting factor in studying loneliness has been the lack of a measure suitable for large-scale social surveys. This article describes a short loneliness scale developed specifically for use on a telephone survey. The scale has three items and a simplified set of response categories but appears to measure overall loneliness quite well. The authors also document the relationship between loneliness and several commonly used measures of objective social isolation. As expected, they find that objective and subjective isolation are related. However, the relationship is relatively modest, indicating that the quantitative and qualitative aspects of social relationships are distinct. This result suggests the importance of studying both dimensions of social relationships in the aging process.
Levels of loneliness are relatively stable across most of adult life, but correlates of loneliness show age differences. We review evidence of age differences in associations between loneliness and individual differences in health behaviors, stress exposure, physiological stress responses, appraisal and coping, and restorative processes. The effects of each of these pathways endow loneliness with the capacity to accelerate the rate of physiological decline with age. Additional research across the lifespan is required to understand the nature of accrued loneliness effects on health behavior and physiology in the short and long term.
There is increasing policy recognition that the alleviation of social isolation and loneliness in older people should be prioritised. Recently, technology, such as telephone networks and the Internet, has received attention in supporting isolated and lonely older people. Despite lack of evidence, telephone befriending has been considered an effective low-level method to decrease loneliness among older people. This study evaluated the impact of a national befriending scheme for isolated and/or lonely older people, involving eight project sites across the UK 2007–2008. The purpose was to assess the impact of different models of telephone-based befriending services on older people’s health and well-being. A mixed methods approach was used. This paper reports on the findings from 40 in-depth interviews with older service recipients. The most important finding was that the service helped older people to gain confidence, re-engage with the community and become socially active again. Three topics were identified: why older people valued the service, what impact it had made on their health and well-being and what they wanted from the service. In addition, nine subthemes emerged: life is worth living, gaining a sense of belonging, knowing they had a friend, a healthy mind is a healthy body, the alleviation of loneliness and anxiety, increased self-confidence, ordinary conversation, a trusted and reliable service, the future – giving something back. In conclusion, the findings present in-depth qualitative evidence of the impact of telephone befriending on older people’s well-being. Befriending schemes provide low-cost means for socially isolated older people to become more confident and independent and develop a sense of self-respect potentially leading to increased participation and meaningful relationships.
Social species, by definition, form organizations that extend beyond the individual. These structures evolved hand in hand with behavioral, neural, hormonal, cellular, and genetic mechanisms to support them because the consequent social behaviors helped these organisms survive, reproduce, and care for offspring sufficiently long that they too reproduced. Social isolation represents a lens through which to investigate these behavioral, neural, hormonal, cellular, and genetic mechanisms. Evidence from human and nonhuman animal studies indicates that isolation heightens sensitivity to social threats (predator evasion) and motivates the renewal of social connections. The effects of perceived isolation in humans share much in common with the effects of experimental manipulations of isolation in nonhuman social species: increased tonic sympathetic tonus and HPA activation; and decreased inflammatory control, immunity, sleep salubrity, and expression of genes regulating glucocorticoid responses. Together, these effects contribute to higher rates of morbidity and mortality in older adults.
A number of mechanisms have been proposed through which social isolation and loneliness may affect health, including health-related behavioral and biological factors. However, it is unclear to what extent isolation and loneliness are independently associated with these pathways. The objective of the present analysis was to determine the impact of social isolation and loneliness, individually as well as simultaneously, on health-related behavioral and biological factors using data from the English Longitudinal Study of Ageing (ELSA).
Data on health behaviors (smoking and physical activity) were analyzed from 8,688 participants and data on blood pressure, cholesterol, and inflammatory markers were analyzed from over 5,000 of these participants who were eligible for a nurse visit and blood sampling. Loneliness was measured using the short form of the Revised UCLA scale and an index of social isolation was computed incorporating marital status; frequency of contact with friends, family, and children; and participation in social activities.
Fewer than 2% of participants reported being lonely all the time, while nearly 7% had the highest possible scores on social isolation. Both social isolation and loneliness were associated with a greater risk of being inactive, smoking, as well as reporting multiple health-risk behaviors. Social isolation was also positively associated with blood pressure, C-reactive protein, and fibrinogen levels.
Loneliness and social isolation may affect health independently through their effects on health behaviors. In addition, social isolation may also affect health through biological processes associated with the development of cardiovascular disease.
The purpose of this study was to assess patterns of affect over the day in a representative sample of older people, with particular emphasis on the impact of loneliness and depression. Momentary assessments of positive and distressed affect were obtained four times over a single day from 4,258 men and women aged 52-79 years from the English Longitudinal Study of Ageing. Positive and distressed affect were only modestly correlated (r = -0.23). Positive affect was low on waking and peaked in the early evening, while distressed affect decreased progressively over the day. The diurnal variation in positive affect was greater in participants <65 years compared with older individuals. Positive affect was greater in men, married participants and in healthy individuals, while distressed affect was higher among women, unmarried and lower socioeconomic status respondents, and in those with limiting longstanding illnesses. Depressed individuals experienced lower positive affect throughout the day, while differences in distressed affect were more pronounced in the morning. Loneliness was associated with lower positive affect and greater distressed affect independently of age, sex, marital status, paid employment, socioeconomic status, health, and depression. This study demonstrates that ecological momentary assessment of affect is feasible on a large scale in older individuals, and generates information about positive affect and distress that is complementary to standard questionnaire measures. The associations with loneliness highlight the everyday distress and reduced happiness and excitement experienced by lonely older men and women, and these may contribute to enhanced risks to physical and mental health.
This study tested predictions that potentially explain why social support is associated with better health and loneliness is associated with poorer health. Social support was predicted to be associated with better health because it minimizes loneliness, which itself is associated with poor health. In particular, this study evaluated the role of recuperative processes, namely, sleep and leisure, in the association between loneliness and poor health. Participants were 224 adults aged 18-81 years who completed measures of social support, loneliness, health, sleep quality, and leisure. Results indicated that social support had an indirect association with better health, through lower loneliness. There was also evidence supporting or at least partially supporting the assumption that one mechanism by which loneliness is associated with poorer health is through less functional recuperative processes, specifically sleep and leisure. Finally, social support moderated the association between age and health such that among those with relatively high levels of social support, age and health were positively associated.
The purpose of this quasi-experimental study was to evaluate the effectiveness of a videoconference intervention program in improving nursing home residents' social support, loneliness, and depressive status.
Fourteen nursing homes were selected from various areas of Taiwan by purposive sampling. Elderly residents (N = 57) of these nursing homes, who met our inclusion criteria were divided into experimental (n = 24) and control (n = 33) groups. The experimental group received five min/week of videoconference interaction with their family members for three months, and the control group received regular care only. Data were collected through face-to face interviews on social support, loneliness, and depressive status using the Social Supportive Behavior Scale, University of California Los Angeles Loneliness Scale, and Geriatric Depression Scale, respectively, at three points (baseline, one week, and three months after baseline). Data were analyzed using the generalized estimating equation approach.
Subjects in the experimental group had significantly higher mean emotional and appraisal social support scores at one week and three months after baseline than those in the control group. Subjects in the experimental group also had lower mean loneliness scores at one week and three months after baseline than those in the control group, and lower mean depressive status scores at three months after baseline.
Our videoconference program alleviated depressive symptoms and loneliness in elderly residents in nursing homes. Our findings suggest that this program could be used for residents of long-term care institutions, particularly those with better ability to perform activities of daily living.
Prior research has established clear links between social support, loneliness, and various health outcomes. This study was designed to test several theoretically derived explanations for such associations. A survey of 265 adults ages 19-85 years was conducted with measures of social support, loneliness, stress, health behaviors, and general health. Results showed that loneliness was more strongly associated with number of close relationships than with sheer contact with social network members. Further, loneliness mediated the association between social support and better health. In addition, health behaviors, especially poor sleep and medical adherence, mediated the association between loneliness and poor health. These results provide confirmation of theoretical mechanisms postulated to explain why loneliness is associated with poor health.
This study compared levels of loneliness, quality of life (QOL) and social support among people with serious mental illness (SMI) living in two different types of housing: group homes and supportive community housing. Forty persons with SMI living in supportive community housing and 57 living in a group home completed measures of QOL, symptoms, perceived social support and loneliness. Analysis of variance tests were conducted to examine whether there were differences in degree of loneliness, QOL and social support between the groups living in the two residential types. No significant differences between the two housing models were found. Correlational analysis, however, indicated a strong relationship between loneliness and QOL. Subsequent regression analysis revealed that residence in group homes moderates the relationship between social loneliness and QOL, such that social loneliness impacted QOL only among group home residence. Implications of the findings for understanding the impact of housing on QOL are discussed.
A large proportion of the disease and disability which affects older persons occurs in the years just prior to death. Little prospective evidence is available which quantifies the burden of morbidity and disability during these years.
In three community-based cohorts of persons age 65 and older, chronic conditions and disability were evaluated for the three years prior to death in 531 persons who had three annual assessments and then died within one year of the third assessment. Number of chronic conditions, prevalence of disability in activities of daily living (ADLs), and prevalence of disability on a modified Rosow-Breslau scale were determined for these decedents and compared to 8821 members of the cohorts known to have survived.
Prevalence rates of disease and disability increased during the follow-up for both decedents and survivors, with decedents generally having higher rates than survivors. Disability rates prior to death, but not the number of diseases, increased with increasing age at death. The odds ratio for disability in ADLs at any of the three assessments for decedents versus survivors ranged from 3.0 to 4.2 in the three communities. In each community the odds ratio for ADL disability was higher in women decedents versus survivors than in men decedents versus survivors.
These results have important implications for disability levels in future older populations in which death is projected to occur at increasingly higher ages.
Two studies using cross-sectional designs explored four possible mechanisms by which loneliness may have deleterious effects on health: health behaviors, cardiovascular activation, cortisol levels, and sleep.
In Study 1, we assessed autonomic activity, salivary cortisol levels, sleep quality, and health behaviors in 89 undergraduate students selected based on pretests to be among the top or bottom quintile in feelings of loneliness. In Study 2, we assessed blood pressure, heart rate, salivary cortisol levels, sleep quality, and health behaviors in 25 older adults whose loneliness was assessed at the time of testing at their residence.
Total peripheral resistance was higher in lonely than nonlonely participants, whereas cardiac contractility, heart rate, and cardiac output were higher in nonlonely than lonely participants. Lonely individuals also reported poorer sleep than nonlonely individuals. Study 2 indicated greater age-related increases in blood pressure and poorer sleep quality in lonely than nonlonely older adults. Mean salivary cortisol levels and health behaviors did not differ between groups in either study.
Results point to two potentially orthogonal predisease mechanisms that warrant special attention: cardiovascular activation and sleep dysfunction. Health behavior and cortisol regulation, however, may require more sensitive measures and large sample sizes to discern their roles in loneliness and health.
Objectives:
Although cognitive impairment and depressive symptoms are associated with functional decline, it is not understood how these risk factors act together to affect the risk of functional decline. The purpose of this study is to determine the relative contributions of cognitive impairment and depressive symptoms on decline in activity of daily living (ADL) function over 2 years in an older cohort.
Design:
Prospective cohort study.
Setting:
A U.S. national prospective cohort study of older people, Asset and Health Dynamics in the Oldest Old.
Participants:
Five thousand six hundred ninety-seven participants (mean age 77, 64% women, 86% white) followed from 1993 to 1995.
Measurements:
Cognitive impairment and depressive symptoms were defined as the poorest scores: 1.5 standard deviations below the mean on a cognitive scale or 1.5 standard deviations above the mean on validated depression scales. Risk of functional decline in participants with depressive symptoms, cognitive impairment, and both, compared with neither risk factor, were calculated and stratified by baseline dependence. Analyses were adjusted for demographics and comorbidity.
Results:
Eight percent (n = 450) of subjects declined in ADL function. In participants who were independent in all ADLs at baseline, the relative risk (RR) of 2-year functional decline was 2.3 (95% confidence interval (CI) = 1.7-3.1) for participants with cognitive impairment, 1.9 (95% CI = 1.3-2.6) for participants with depressive symptoms, and 2.4 (95% CI = 1.4-3.7) for participants with cognitive impairment and depressive symptoms. In participants who were dependent in one or more ADLs at baseline, RR of 2-year functional decline was 1.9 (95% CI = 1.2-2.8) for participants with cognitive impairment, 0.6 (95% CI = 0.3-1.3) for participants with depressive symptoms, and 1.5 (95% CI = 0.8-2.6) for participants with cognitive impairment and depressive symptoms.
Conclusions:
In participants with no ADL dependence at baseline, cognitive impairment and depressive symptoms are risk factors for decline, but that, in participants with dependence in ADL at baseline, cognitive impairment, but not depressive symptoms, is a risk factor for additional decline.
To examine the relationship between persistently high depressive symptoms and long-term changes in functional disability in elderly persons.
A community-based, prospective, observational study.
Participant data from the Cardiovascular Health Study.
From the overall sample of 5,888 subjects, three types of participants were identified for this study: (1) persistently depressed individuals, who experienced an onset of depressive symptoms that persisted over 4 years (n=119); (2) temporarily depressed individuals, who experienced an onset of depressive symptoms that resolved over time (n=259); and (3) nondepressed individuals, with persistently low depressive symptoms throughout the follow-up period who were matched on baseline activity of daily living (ADL) scores, sex, and age to the previous two groups combined (n=378).
Four consecutive years of data were assessed: validated measures of depression (10-item CES-D), functional disability (10-item ADL/instrumental ADL measure), physical performance, medical illness, and cognition.
The persistently depressed group showed a greater linear increase in functional disability ratings than the temporarily depressed and nondepressed groups. This association between persistent depression and functional disability was robust even when controlling for baseline demographic and clinical/performance measures, including cognition. The persistently depressed group had an adjusted odds ratio (OR) of 5.27 (95% confidence interval (CI) 3.03-9.16) for increased functional disability compared with the nondepressed group over 3 years of follow-up, whereas the temporarily depressed group had an adjusted OR of 2.39 (95% CI=1.55-3.69) compared with the nondepressed group.
Persistently elevated depressive symptoms in elderly persons are associated with a steep trajectory of worsening functional disability, generating the hypothesis that treatments for late-life depression need to be assessed on their efficacy in maintaining long-term functional status as well as remission of depressive symptoms. These results also demonstrate the need for studies to differentiate between persistent and temporary depressive symptoms when examining their relationship to disability.
Both comorbid conditions and functional measures predict mortality in older adults, but few prognostic indexes combine both classes of predictors. Combining easily obtained measures into an accurate predictive model could be useful to clinicians advising patients, as well as policy makers and epidemiologists interested in risk adjustment.
To develop and validate a prognostic index for 4-year mortality using information that can be obtained from patient report.
Using the 1998 wave of the Health and Retirement Study (HRS), a population-based study of community-dwelling US adults older than 50 years, we developed the prognostic index from 11,701 individuals and validated the index with 8009. Individuals were asked about their demographic characteristics, whether they had specific diseases, and whether they had difficulty with a series of functional measures. We identified variables independently associated with mortality and weighted the variables to create a risk index.
Death by December 31, 2002.
The overall response rate was 81%. During the 4-year follow-up, there were 1361 deaths (12%) in the development cohort and 1072 deaths (13%) in the validation cohort. Twelve independent predictors of mortality were identified: 2 demographic variables (age: 60-64 years, 1 point; 65-69 years, 2 points; 70-74 years, 3 points; 75-79 years, 4 points; 80-84 years, 5 points, >85 years, 7 points and male sex, 2 points), 6 comorbid conditions (diabetes, 1 point; cancer, 2 points; lung disease, 2 points; heart failure, 2 points; current tobacco use, 2 points; and body mass index <25, 1 point), and difficulty with 4 functional variables (bathing, 2 points; walking several blocks, 2 points; managing money, 2 points, and pushing large objects, 1 point. Scores on the risk index were strongly associated with 4-year mortality in the validation cohort, with 0 to 5 points predicting a less than 4% risk, 6 to 9 points predicting a 15% risk, 10 to 13 points predicting a 42% risk, and 14 or more points predicting a 64% risk. The risk index showed excellent discrimination with a cstatistic of 0.84 in the development cohort and 0.82 in the validation cohort.
This prognostic index, incorporating age, sex, self-reported comorbid conditions, and functional measures, accurately stratifies community-dwelling older adults into groups at varying risk of mortality.
We sought to determine whether chronic conditions and functional limitations are equally predictive of mortality among older adults.
Participants in the 1998 wave of the Health and Retirement Study (N=19430) were divided into groups by decades of age, and their vital status in 2004 was determined. We used multivariate Cox regression to determine the ability of chronic conditions and functional limitations to predict mortality.
As age increased, the ability of chronic conditions to predict mortality declined rapidly, whereas the ability of functional limitations to predict mortality declined more slowly. In younger participants (aged 50-59 years), chronic conditions were stronger predictors of death than were functional limitations (Harrell C statistic 0.78 vs. 0.73; P=.001). In older participants (aged 90-99 years), functional limitations were stronger predictors of death than were chronic conditions (Harrell C statistic 0.67 vs. 0.61; P=.004).
The importance of chronic conditions as a predictor of death declined rapidly with increasing age. Therefore, risk-adjustment models that only consider comorbidities when comparing mortality rates across providers may be inadequate for adults older than 80 years.
HRS/AHEAD Documentation Report
- Diane E Steffick
Steffick, Diane E. HRS/AHEAD Documentation Report [Internet].
Alliance for Aging Research
- D C Washington
Washington DC: Alliance for Aging Research; 1999. Alliance for Aging Research. Available
from: http://www.silverbook.org/fact/31 [cited 2011 Aug 1]
Association Between late-Life Social Activity and Motor Decline in Older Adults
- A S Buchman
- P A Boyle
- R S Wilson
- D A Fleishman
- S Leurgans
- D A Bennett
Buchman AS, Boyle PA, Wilson RS, Fleishman DA, Leurgans S, Bennett DA. Association
Between late-Life Social Activity and Motor Decline in Older Adults. Arch Intern Med. 2009;
169(12):1139-1146. [PubMed: 19546415]
Sacramento: Center for Health Improvement
- N Policy Brands Wards
- Brief
Brands Wards, N. Policy Brief: New Perspectives: Investing in resilience to promote healthy aging
[Internet]. Sacramento: Center for Health Improvement; 2009. Available from: http://
www.chipolicy.org/pdf/6156.CHI_Brief_06-09.pdf [cited 2011 Aug 1]