Background 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 over age 60 in the United States. Methods This is a longitudinal cohort study of 1604 participants in the psychosocial module of the Health and Retirement Study (HRS), a nationally representative study of older persons. Baseline assessment was in 2002 and follow-up occurred every two years until 2008. Subjects were asked if they feel 1) Left Out 2) 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 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. Results The mean age of subjects was 71 years, 59% were women, 81% White, 11% Black, 6% Hispanic, and 18% lived alone. 43% of elders reported feeling lonely. Loneliness was associated with all outcome measures. Lonely subjects were more likely to experience decline in ADLs, (24.8% vs. 12.5%, Adjusted Risk Ratio 1.59, 1.23-2.07); develop difficulties with upper extremity tasks (41.5% vs. 28.3%, ARR 1.28, 1.08-1.52); decline in mobility (38.1% v. 29.4%, ARR 1.18, 0.99-1.41); or difficulty in climbing (40.8% vs. 27.9%, ARR 1.31, 1.10-1.57). Loneliness was associated with an increased risk of death (22.8% vs. 14.2%, AHR 1.45, 1.11-1.88). Conclusions Among participants who were older than 60, loneliness was a predictor of functional decline and death.
Background/Objectives Physical distancing during the COVID‐19 pandemic may have unintended, detrimental effects on social isolation and loneliness among older adults. Our objectives were to investigate 1) experiences of social isolation and loneliness during shelter‐in‐place orders and 2) unmet health needs related to changes in social interactions. Design Mixed‐methods, longitudinal phone‐based survey administered every 2 weeks. Setting Two community sites and an academic geriatrics outpatient clinical practice. Participants 151 community‐dwelling older adults. Measurements We measured social isolation using a 6‐item modified Duke Social Support Index, social interaction sub‐scale, which included assessments of video‐based and internet‐based socializing. Measures of loneliness included self‐reported worsened loneliness due to the COVID‐19 pandemic, and loneliness severity based on the 3‐item UCLA loneliness scale. Participants were invited to share open‐ended comments about their social experiences. Results Participants were on average 75 years old (SD = 10), 50% had hearing or vision impairment, 64% lived alone, and 26% difficulty bathing. Participants reported social isolation in 40% of interviews, 76% reported minimal video‐based socializing, and 42% minimal internet‐based socializing. Socially isolated participants reported difficulty finding help with functional needs, including bathing (20% vs 55%, p = .04). Over half (54%) of participants reported worsened loneliness due to COVID‐19, which was associated with worsened depression (62% vs 9%, p < .001) and anxiety (57% vs 9%, p < .001). Rates of loneliness improved on average by time since shelter‐in‐place orders (4–6 weeks: 46% vs 13–15 weeks: 27%, p = .009), however, loneliness persisted or worsened for a subgroup of participants. Open‐ended responses revealed challenges faced by the subgroup experiencing persistent loneliness, including poor emotional coping and discomfort with new technologies. Conclusions Many older adults are adjusting to COVID‐19 restrictions since the start of shelter‐in‐place orders. Additional steps are critically needed to address the psychological suffering and unmet medical needs of those with persistent loneliness or barriers to technology‐based social interaction.
In addition to helping employees with depression obtain high-quality depression treatment, new interventions may be needed to help them to overcome the substantial job upheaval that this population experiences.
Loneliness and social isolation are strongly associated with several adverse health outcomes in older persons including death and functional impairments. The strength of these associations has been compared with smoking. Accordingly, loneliness and isolation have significant public health implications. Despite the adverse impacts of loneliness and social isolation on quality of life, and their strong association with health outcomes, the evaluation of loneliness and isolation have not been integrated into medical care. The risks for loneliness may be of particular concern to persons with serious illness as patients and caregivers cope with the experience of loss, loss of independence, and increasing care needs. To date, there has been no uniform way of evaluating and documenting loneliness and social isolation as a part of a review of a patient's social determinants of health. This article provides a framework for healthcare systems, providers, and community members working with older adults to (1) understand loneliness, isolation, and its counterpart social connection; (2) describe the different ways loneliness affects health; and (3) create a framework for asking about and documenting these experiences. Finally, because the lack of studies assessing whether targeting loneliness can improve health outcomes is a major gap, we provide guidance on the future of interventions. J Am Geriatr Soc 67:657–662, 2019.
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