Background and objective Loneliness is associated with increased rates of morbidity and mortality, and is a growing public health concern in later life. This study aimed to produce an evidence-based estimate of the prevalence of loneliness amongst older people (aged 60 years and above). Study design and setting Systematic review and random-effects meta-analysis of observational studies from high income countries 2008 to 2020, identified from searches of five electronic databases (Medline, EMBASE, PsychINFO, CINAHL, Proquest Social Sciences Premium Collection). Studies were included if they measured loneliness in an unselected population. Results Thirty-nine studies reported data on 120,000 older people from 29 countries. Thirty-one studies were suitable for meta-analysis. The pooled prevalence estimate of loneliness was 28.5% (95%CI: 23.9% - 33.2%). In twenty-nine studies reporting loneliness severity, the pooled prevalence was 25.9% (95%CI: 21.6% - 30.3%) for moderate loneliness and 7.9% (95%CI: 4.8% - 11.6%) for severe loneliness (z = -6.1, p < 0.001). Similar pooled prevalence estimates were observed for people aged 65–75 years (27.6%, 95%CI: 22.6% - 33.0%) and over 75 years (31.3%, 95%CI: 21.0% - 42.7%, z = 0.64, p = 0.52). Lower levels of loneliness were reported in studies from Northern Europe compared to South and Eastern Europe. Conclusions Loneliness is common amongst older adults affecting approximately one in four in high income countries. There is no evidence of an increase in the prevalence of loneliness with age in the older population. The burden of loneliness is an important public health and social problem, despite severe loneliness being uncommon. PROSPERO registration CRD42017060472.
DESCRIPTIONA 14-month-old boy, independently mobile for 1 month, presented after refusing to walk for 2 days. He was afebrile, with no preceding coryzal illness. A diagnosis of transient synovitis was made. Owing to the lack of improvement and ongoing symptoms for 5 weeks, he underwent blood tests, which showed a C reactive protein of 7, an erythrocyte sedimentation rate of 38 and a platelet count of 511.Apart from the inability to weight bear, he was systemically well in himself. Septic arthritis, osteomyelitis 1 and leukaemia were deemed unlikely diagnoses. Serial blood tests showed static infection markers. A pelvic X-ray and an ultrasound of the hips were unremarkable.In view of the possible hip pathology, the child was booked for an MRI of his pelvis, with a plan to include the spine if the oral sedation lasted long enough. The spinal MRI showed L4/L5 discitis (figure 1).Forty-eight hours into intravenous flucloxacillin, he started walking again. His blood cultures were negative. He continued on intravenous antibiotics for 6 weeks.Discitis was not in our top differentials. It is an uncommon disease in toddlers. It is believed to be of infectious aetiology with the haematogenous transfer of the causative organism (most likely Staphylococcus aureus) to the disc space, despite sterile blood cultures. 2Management involves immobilisation and antibiotic therapy.3 It is a selflimiting illness, but awareness of this condition must be raised, with the aim of facilitating its diagnosis and management.Learning points ▸ In a limping child, remember to assess for spinal pathology. ▸ A spinal MRI is the investigation of choice for discitis. ▸ Treatment of discitis entails a prolonged course of antibiotics, even in the presence of negative blood cultures.Competing interests None declared. Patient consent Obtained.Provenance and peer review Not commissioned; externally peer reviewed. REFERENCES1 Fernadez M, Carrol CL, Baker CJ. Discitis and vertebral osteomyelitis in children: an 18-year review.
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