Associations of Loneliness and Social Isolation With Health Span and Life Span in the U.S. Health and Retirement Study

Abstract

Background Loneliness and social isolation are emerging public health challenges for aging populations. Methods We followed N=11,302 US Health and Retirement Study (HRS) participants aged 50-95 from 2006-2014 to measure persistence of experiences of loneliness and exposure to social isolation. We tested associations of longitudinal loneliness and social isolation phenotypes with disability, morbidity, mortality, and biological aging through 2018. Results During follow-up, 18% of older adults met criteria for loneliness, with 6% meeting criteria at two or more follow-up assessments. For social isolation, these fractions were 21% and 8%. HRS participants who experienced loneliness and were exposed to social isolation were at increased risk for disease, disability, and mortality. Those experiencing persistent loneliness were at a 57% increased hazard of mortality compared to those who never experienced loneliness. For social isolation, the increase was 28%. Effect-sizes were somewhat larger for counts of prevalent activity limitations and somewhat smaller for counts of prevalent chronic diseases. Covariate adjustment for socioeconomic and psychological risks attenuated but did not fully explain associations. Older adults who experienced loneliness and were exposed to social isolation also exhibited physiological indications of advanced biological aging (Cohen’s-d for persistent loneliness and social isolation=0.26 and 0.21, respectively). For loneliness, but not social isolation, persistence was associated with increased risk. Conclusion Deficits in social connectedness prevalent in a national sample of US older adults were associated with morbidity, disability, and mortality and with more advanced biological aging. Bolstering social connectedness to interrupt experiences of loneliness may promote healthy aging.

The prevalence of loneliness across 113 countries: systematic review and meta-analysis

“…Subgroup effect was statistically significant (P<0.01); however, variance between studies was high in western and eastern European countries (τ 2 =0.047 and 0.224, respectively, P<0.01), with this variance mostly related to true differences between populations (I 2 =94% and 99%, respectively). In the meta-analysis of 13 estimates derived from the three item UCLA Loneliness Scale for older adults (including subgroup analysis based on different cut-off points), 52 53 54 55 56 four countries (England, Poland, Spain, and US) had estimates ranging from 9% to 19%. A fifth country, Finland, had a reported prevalence of 5.9% (95% confidence interval 4.7% to 7.2%).…”

Long-term services and supports and disease management among older Chinese adults in different stages of cognitive impairment

“…Of the remaining 9,080 participants, less than 40% complete all 30 items of MMSE tests, with the remaining 60% have at least some MMSE items missing. To account for the item-level missing data and alleviate the sample attrition, we follow the prior literature to prorate scale the non-missing cognitive scores among participants who completed at least 80% of the MMSE items (≥ 24 of the 30 items) (Andrew and Rockwood, 2010;Craft et al, 2020;Crowe et al, 2021;Ramirez et al, 2022;White et al, 2011;Zheng et al, 2018). For each individual, the prorating involves calculating his/her non-missing item scores, dividing by the number of non-missing items, and multiplying by the total number of MMSE items (i.e., 30 items).…”

“…In the main specification, following prior literature, we prorate scale the non-missing MMSE items for participants who respond to at least 80% of the MMSE items (i.e., at least 24 of the 30 items) (Andrew and Rockwood, 2010;Craft et al, 2020;Crowe et al, 2021;Ramirez et al, 2022;White et al, 2011;Zheng et al, 2018). For each individual, the prorating involves calculating his/her non-missing item scores, dividing by the number of non-missing items, and multiplying by the total number of MMSE items (i.e., 30 items).…”

The association between mental status, personality traits, and discrepancy in social isolation and perceived loneliness among community dwellers

“…Although a variety of definitions and measurements for social isolation exist with no golden standard, we used criteria with reference to previous research in the ELSA and the HRS. [25][26][27][28] We assigned one point for each of six criteria: (i) lived alone, (ii) unmarried, (iii)-(v) had less than monthly contact with family, children, and friend, and (vi) had less than monthly participation in any social groups or organizations. The score ranged from 0-6, and a higher rating corresponded to severe isolation.…”