Living arrangement modifies the associations of loneliness with adverse health outcomes in older adults: evidence from the CLHLS

Abstract

Background Although it has been suggested that loneliness is a risk factor for adverse health outcomes, living arrangement may confound the association. This study aimed to investigate whether the associations of loneliness with adverse health outcomes differ in community-dwelling older adults according to different living arrangements. Methods In the 2008/2009 wave of Chinese Longitudinal Healthy Longevity Survey, 13,738 community-dwelling older adults (≥65 years) were included for analyses. Living arrangements and loneliness were assessed. Health outcomes including cognitive and physical functions were assessed using MMSE, ADL/IADL scales and Frailty Index in the 2008/2009 and 2011/2012 waves; mortality was assessed in the 3-year follow-up from 2008/2009 to 2011/2012. The effect modificaitons of loneliness on adverse health outcomes by living arrangements were estimated using logistic regression or Cox proportional hazards regression models. Results Living alone older adults were significantly more likely to be lonely at baseline (52% vs 29.5%, OR = 1.90, 95% CI = 1.67–2.16, P < 0.001), compared with those living with others. Loneliness in older adults was a significant risk factor for prevalent cognitive impairment and frailty, and 3-year mortality, especially among those who lived with others (OR = 1.32, 95% CI = 1.15–1.52, P < 0.001; OR = 1.39, 95% CI = 1.24–1.57, P < 0.001; HR = 1.14, 95% CI = 1.05–1.24, P = 0.002, respectively). In contrast, among the living alone older adults, loneliness was only significantly associated with higher prevalence of frailty (OR = 1.42, 95% CI = 1.07–1.90, P = 0.017). Living arrangement significantly modified the associations of loneliness with prevalent cognitive impairment and 3-year mortality (P values for interaction = 0.005 and 0.026, respectively). Conclusions Living arrangement modifies the associations of loneliness with adverse health outcomes in community-dwelling older adults, and those who lived with others but felt lonely had worse cognitive and physical functions as well as higher mortality. Special attention should be paid to this population and more social services should be developed to reduce adverse health outcomes, in order to improve their quality of life and promote successful aging.

Living alone reduces the decline of calf circumference among Chinese older adults: A 4-year longitudinal study

“…These variables with statistical difference above, such as lower economic status and educational level in LA group, didn’t seem to be beneficial for skeletal muscle mass maintenance and sarcopenia prevention ( Brennan-Olsen et al, 2020 ). In addition, LA was often accompanied by decreased family and social support and social isolation for older adults ( Lou and Ng, 2012 ; Teerawichitchainan et al, 2015 ), and thus modified the associations of loneliness with adverse health outcomes in previous study ( Wei et al, 2022 ). Maybe less tobacco use could be protective ( Locquet et al, 2021 ).…”

Mediating Effect of Loneliness in the Relationship between Depressive Symptoms and Cognitive Frailty in Community-Dwelling Older Adults

“…At present, direct research on loneliness and cognitive frailty is lacking. Some studies have demonstrated that loneliness is associated with cognitive impairment and frailty [ 18 , 19 , 48 ], reflecting the relationship between loneliness and cognitive frailty from the side. Loneliness has a high prevalence in people with low physical activity [ 49 ].…”

“…The higher the degree of loneliness, the stronger the possibility of deterioration of frailty [ 17 ]. Among the Chinese community-dwelling elderly, loneliness is a robust factor for cognitive impairment and frailty [ 18 ]. The results of a study involving middle-aged and elderly people in several low- and middle-income countries illustrated that loneliness is related to mild cognitive impairment [ 19 ].…”

Association between caring for grandchildren based on living arrangements and cognitive function among Chinese middle-aged and older adults: The mediating roles of social activities and depressive symptoms

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