Social isolation, loneliness, and all-cause mortality in older men and women

Abstract

Both social isolation and loneliness are associated with increased mortality, but it is uncertain whether their effects are independent or whether loneliness represents the emotional pathway through which social isolation impairs health. We therefore assessed the extent to which the association between social isolation and mortality is mediated by loneliness. We assessed social isolation in terms of contact with family and friends and participation in civic organizations in 6,500 men and women aged 52 and older who took part in the English Longitudinal Study of Ageing in [2004][2005]. A standard questionnaire measure of loneliness was administered also. We monitored all-cause mortality up to March 2012 (mean follow-up 7.25 y) and analyzed results using Cox proportional hazards regression. We found that mortality was higher among more socially isolated and more lonely participants. However, after adjusting statistically for demographic factors and baseline health, social isolation remained significantly associated with mortality (hazard ratio 1.26, 95% confidence interval, 1.08-1.48 for the top quintile of isolation), but loneliness did not (hazard ratio 0.92, 95% confidence interval, 0.78-1.09). The association of social isolation with mortality was unchanged when loneliness was included in the model. Both social isolation and loneliness were associated with increased mortality. However, the effect of loneliness was not independent of demographic characteristics or health problems and did not contribute to the risk associated with social isolation. Although both isolation and loneliness impair quality of life and well-being, efforts to reduce isolation are likely to be more relevant to mortality.

The relationship between wealth and loneliness among older people across Europe: Is social participation protective?

“…Angeles Loneliness scale (R-UCLA) (Hughes et al, 2004), which is a frequently used and validated indicator of loneliness (Boss et al, 2015;Samuel et al, 2015), particularly within the United States and United Kingdom (Luo et al, 2012;Pikhartova et al, 2014;Steptoe et al, 2013). The scale was recently harmonised for use in SHARE , and few studies have used it in a cross-national context, to date (Shiovitz-Ezra, 2015;Wagner and Brandt, 2015).…”

Living Alone, Socially Isolated or Lonely—What are We Measuring?

“…1 Much attention has been placed on older adults who are living alone, because of the recent studies that have shown that both loneliness and social isolation are associated with poor health outcomes. [1][2][3][4] These studies have also suggested that living alone is not necessarily indicative of having poor social support or of feeling lonely. While it may be reasonable to believe that living alone is a good proxy for these types of social measures, there is increasing recognition that the measures of social well-being are complex concepts and go beyond simply describing the situational facts of a person's life.…”

Loneliness and Social Isolation: Risk Factors Long Overdue for Surveillance

“…9 Other researchers in this area define social isolation in a more structured manner, describing it as an objective and quantifiable reflection of the paucity of one's social contacts and the reduced size of their social network. 10 …”

“…45 • In contrast to the Dutch study, 45 a 2013 United Kingdom assessment of 6500 men and women 52 years and older over 7.25 years found that although loneliness and social isolation were both associated with increased mortality, after adjusting for other potentially influential variables, social isolation remained significantly associated with mortality (HR = 1.26; 95% CI, 1.08-1.48 for the most isolated), whereas loneliness did not (HR = 0.92; 95% CI, 0.78-1.09), indicating that social isolation was an independent factor raising mortality, but loneliness was not. 10 • To more closely examine the relationship between social isolation and mortality and to compare the predictive power of social isolation to that of traditional risk factors (elevated cholesterol, hypertension, smoking, obesity), California investigators used a nationally representative sample of 16 849 adults and found that socially isolated men and women had higher mortality than less socially isolated individuals and that social isolation predicted mortality for both genders, as did smoking and high blood pressure. The authors concluded that the strength of social isolation as a predictor of mortality is comparable to that of established risk factors, so its assessment by health care professionals is comparably important.…”