Loneliness and health care consumption among older people

Abstract

Few studies have investigated loneliness in relation to health care consumption among frail older people. The aim of this study was to examine loneliness, health-related quality of life (HRQoL), and health complaints in relation to health care consumption of in- and outpatient care among frail older people living at home. The study, with a cross-sectional design, comprised a sample of 153 respondents aged from 65 years (mean age 81.5 years) or older, who lived at home and were frail. Data was collected utilising structured interviews in the respondent's home assessing demographic data, loneliness, HRQoL and health complaints. Patient administrative registers were used to collect data on health care consumption. Loneliness was the dependent variable in the majority of the analyses and dichotomised. For group comparisons Student's t-test, Mann-Whitney U-test and Chi-square test were used. The results showed that 60% of the respondents had experienced loneliness during the previous year, at least occasionally. The study identified that lonely respondents had a lower HRQoL (p = 0.022), with a higher total number of reported health complaints (p = 0.001), and used more outpatient services including more acute visits at the emergency department, compared to not lonely respondents (p = 0.026). Multiple linear regression analysis showed that a depressed mood was independently associated to total use of outpatient care (B = 7.4, p < 0.001). Therefore, it might not be loneliness, per se, that is the reason for seeking health care. However, reasons for using health care services are difficult to determine due to the complex situation for the frail older person. To avoid emergency department visits and to benefit the well-being of the frail older person, interventions targeting the complex health situation, including loneliness, are suggested.

Loneliness is adversely associated with physical and mental health and lifestyle factors: Results from a Swiss national survey

“…This association was observed in middle-aged and older but not younger individuals, which confirms results of previous studies [77–79]. Overall, lonely individuals might need to see a medical doctor more often because of their poor health.…”

Living on the Edge: Social Exclusion and the Receipt of Informal Care in Older People

“…However, this group had the highest level of recent contact with medical services, a relationship also found in the Spanish study mentioned above [26]. Similarly, recent research has found that lonely older people have a higher use of health care services than nonlonely people [41] and that loneliness and social isolation are a common nonmedical problem presented by noncritically ill older people in emergency departments ([42], for a review, see [43]). One interpretation of this finding is that, in the absence of informal care and in the presence of need, older people will turn to medical services (perhaps primary care practitioners) in order to address their unmet need.…”

The Impact of Loneliness on Quality of Life and Patient Satisfaction Among Older, Sicker Adults

“…While not an experience unique to old age, loneliness is common among older adults, with 12% to 46% reporting at least some level of loneliness (Aartsen & Jylha, 2011; Dahlberg & McKee, 2014; Ellwardt, Aartsen, Deeg, & Steverink, 2013; Golden et al, 2009; Hawkley, Thisted, Masi, & Cacioppo, 2010; Holwerda et al, 2014; Lim & Kua, 2011; Netz, Goldsmith, Shimony, Arnon, & Zeev, 2013; Perissinotto, Cenzer, & Covinsky, 2012; Steptoe, Shankar, Demakakos, & Wardle, 2013; Victor & Bowling, 2012; van Beljouw et al, 2014). Loneliness among older adults is a concern of many countries around the world and has been documented in research studies in the United States (Hawkley et al, 2010; Perissinotto et al, 2012), the United Kingdom (Dahlberg & McKee, 2014; Steptoe et al, 2013), Ireland (McHugh & Lawlor, 2013; Schnittger, Wherton, Prendergast, & Lawlor, 2012), France (Amieva et al, 2010), Norway (Aanes, Hetland, Pallesen, & Mittelmark, 2011), the Netherlands (Ellwardt et al, 2013; van Beljouw et al, 2014), Finland (Aartsen & Jylha, 2011), Sweden (Taube, Kristensson, Sandberg, Midlov, & Jakobsson, 2014), Singapore (Lim & Kua, 2011), and Israel (Netz et al, 2013). Although estimates of loneliness vary due to differences in older populations studied as well as measures and definitions of loneliness used, prevalence rates for loneliness are remarkably consistent and stable over time across the scientific literature (Cacioppo, Hughes, Waite, Hawkley, & Thistel, 2006; Hawkley et al, 2010; Victor & Bowling, 2012).…”

“…Characteristics associated with loneliness generally include older age, widowhood/single status, lower income, poor health, functional limitations, hearing or vision impairments, depression, cognitive impairment, and loss of social networks/support (Aartsen & Jylha, 2011; Cacioppo et al, 2006; Cohen-Mansfield & Parpura-Gill, 2007; Dahlberg & McKee, 2014; Golden et al, 2009; Hawkley et al, 2010; Lim & Kua, 2011; Netz et al, 2013; Perissinotto et al, 2012; Pronk et al, 2011; Schnittger et al, 2012; Steptoe et al, 2013; Taube et al, 2014; van Beljouw et al, 2014; Victor & Bowling, 2012). Clinical outcomes associated with loneliness include depression, reduced sleep quality, increased blood pressure, physical inactivity, functional decline, cognitive impairment, and increased mortality (Aanes et al, 2011; Amieva et al, 2010; Buchman et al, 2010; Cacioppo et al, 2006; Cohen-Mansfield & Parpura-Gill, 2007; Dahlberg & McKee, 2014; Ellwardt et al, 2013; Hawkley et al, 2010; Holwerda et al, 2014; Lim & Kua, 2011; Luo et al, 2012; McHugh & Lawlor, 2013; Netz et al, 2013; Perissinotto et al, 2012; Steptoe et al, 2013; Taube et al, 2014; van Beljouw et al, 2014; Victor & Bowling, 2012).…”