Abstract
BackgroundAlthough 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.MethodsIn 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.ResultsLiving 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).ConclusionsLiving 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.
Highlights
It has been suggested that loneliness is a risk factor for adverse health outcomes, living arrangement may confound the association
Both living alone (LA) and feeling lonely (FL) were more prevalent among older adults who were female, separated/divorced/ widowed (SDW), lived in rural, had non-professional occupations, less education, lower BMI, worse financial status, lower social/leisure activity score, and poor self-reported health
At the 3-year follow-up, LA was significantly associated with higher risk of loneliness only when no covariate was adjusted (OR = 1.73, 95% confidence intervals (CIs) = 1.46–2.05, P < 0.001); Table 1 Baseline Characteristics by Living Arrangements and Feelings of Loneliness
Summary
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. It has been found that loneliness increased the risk of developing dementia among older adults especially in men [7], and was associated with mental disorders such as depression, physical decline and increased risk of death [4, 8, 9]. With the development of our society and increasing preferences for individual privacy and independence, older adults’ desire for living alone is changing. Studies have found inconsistent associations of living alone with adverse health outcomes. Some found that living alone was a risk factor for cognitive impairment and mortality [15, 16], and older adults living with others had better psychological well-being [17]; while other studies found that living alone older adults had fewer physical disabilities and lower mortality risk [12]
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