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.