Loneliness in Older Persons: A Predictor of Functional Decline and Death

Study Questions:

What is the relationship between loneliness, functional decline, and death in adults older than 60 years in the United States?

Methods:

This was a longitudinal cohort study of 1,604 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 three questions and lonely if they responded some of the time or often to any of the three questions. The primary outcomes were time to death over 6 years and functional decline over 6 years on the following four 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.

Results:

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% confidence interval [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).

Conclusions:

The authors concluded that among participants who were older than 60 years, loneliness was a predictor of functional decline and death.

Perspective:

This study reports that loneliness is a risk factor for poor health outcomes including death and multiple measures of functional decline in older persons. Furthermore, the risk persists after accounting for a large number of confounders including illness severity and depression. By identifying loneliness, clinicians will be better able to target interventions intended to prevent functional decline and disability, and loneliness may be amenable to psychosocial interventions, and more treatable than other determinants of functional decline such as age-associated chronic disease.

Clinical Topics: Noninvasive Imaging, Computed Tomography, Nuclear Imaging

Keywords: Odds Ratio, Depressive Disorder, Follow-Up Studies, Atherosclerosis, Multivariate Analysis, Chronic Disease, Tomography, X-Ray Computed, Social Isolation, European Continental Ancestry Group, Risk Factors, Hispanic Americans, Social Support, Outpatients, Cardiovascular Diseases, Confidence Intervals, Retirement, African Continental Ancestry Group, Antirheumatic Agents, Loneliness, United States


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