Loneliness and Healthcare Use in Older Adults: Evidence From a Nationally Representative Cohort in Northern Ireland-A Cross-Sectional Replication Study.

Annette Burns,Gerard Leavey,Roger O'Sullivan

doi:10.3389/fpubh.2021.620264

Abstract

Background: Few have explored associations between loneliness and healthcare use independent of health and health behaviors. Recent indication of gender effects also requires validation across health service and cultural settings. We investigated the associations among loneliness, health and healthcare use (HCU) in older adults including stratification to investigate whether associations differed by gender.Methods: Secondary analysis of a nationally representative sample of 8,309 community-dwelling adults aged 50 and over from the Northern Ireland Cohort for the Longitudinal Study of Aging. Primary outcomes were: self-reported General Practice (GP) and emergency department (ED) visits in past year. Negative binomial and logistic regression analysis were used to investigate associations between loneliness and HCU, later adjusting for potential confounders (health and health behaviors).Results: Loneliness was consistently positively associated with both GP and ED visits (with IRRs ranging from 1.10 to 1.49 for GP visits, 1.16 to 1.98 for ED visits and ORs ranging from 1.13 to 1.51 for reporting at least one ED visit). With addition of health and health behaviors, all associations between loneliness and HCU became non-significant, excepting a small independent association between UCLA score and GP visits [IRR 1.03 (95% CI 1.01–1.05)]. Stratification of models revealed no gender effects.Conclusion: All but one association between loneliness and HCU became non-significant when health and health behaviors were included. The remaining association was small but implications remain for health service resources at population level. No gender effects were present in contrast to recent findings in the Republic of Ireland. Further studies on gender, loneliness and healthcare use needed.

Highlights

A number of papers have explored associations between loneliness and healthcare use (HCU) [1,2,3,4,5,6,7,8,9,10,11], with a subset of these controlling in some way for the potentially confounding role of health in these associations [2, 3, 5, 7, 10, 11] as well as health behaviors more recently [12]
The evidence base remains mixed with some support for the presence of significant positive associations between loneliness and HCU independent of health (mostly in relation to physician/ General Practise (GP) visits [2, 3, 5, 7, 10] but lack of associations with HCU reported at times [3, 5, 7, 8] as well as a negative association in one study where older adults who were lonely in Singapore had significantly lower odds of physician visits [13]
Our recent analysis of three waves of population level data in the Republic of Ireland, was the first to adjust for a more comprehensive picture of subjective and objective physical and mental health and to include health behaviors and, revealed an independent impact of loneliness on GP visits in older adults, which was specific to women when models were stratified by gender [12]

Summary

Introduction

A number of papers have explored associations between loneliness and healthcare use (HCU) [1,2,3,4,5,6,7,8,9,10,11], with a subset of these controlling in some way for the potentially confounding role of health in these associations [2, 3, 5, 7, 10, 11] as well as health behaviors more recently [12]. If one attends an emergency department without being referred by a GP a standard fee may apply This cross-sectional replication study will, following our previous analysis [12], be the second ever paper on loneliness and HCU, to our knowledge, to adjust for a comprehensive picture of subjective and objective physical and mental health and too include health behaviors. We investigated the associations among loneliness, health and healthcare use (HCU) in older adults including stratification to investigate whether associations differed by gender

Methods

Results

Conclusion