The Epidemiology of Loneliness and Social Isolation Among Older Adults During the Last Years of Life (RP521)

Abstract

•Describe the prevalence of loneliness and social isolation among older adults in the last years of life.•Identify independent risk factors for loneliness and social isolation in the last years of life. While the last years of life have an intense focus on medical care, the same emphasis has not been placed on social well-being. Consequently, the epidemiology of key indicators of social health is unknown. To determine the prevalence and correlates of loneliness and social isolation among older adults during the last four years of life. We used nationally-representative health and retirement study data to examine adults age >50 who died while enrolled (N=3,540). Subjects were interviewed once in the last four years of life and classified into one of eight 6-month cohorts based on the number of months between the interview and death. We used validated measures of loneliness (3-item UCLA Loneliness Scale) and social isolation (13-item scale describing whether an individual lived alone, was unmarried/unpartnered, had minimal interaction with children, family, or friends, and had minimal community engagement). We modeled the relationship between loneliness or social isolation and time before death adjusting for sociodemographic and key health covariates. The mean age at death was 76 (SD=11.4) and 50% were female. The prevalence of loneliness and social isolation in the last 4 years of life was 51% and 9%, respectively, and these rates were constant for four years prior to death. After adjustment, there were distinct risk factors for loneliness and social isolation (p<0.01); cognitive impairment (Normal: 44%, CIND: 52%, Dementia: 56%), vision impairment (54% vs 46%), and incontinence (54% vs 46%) were risk factors for loneliness, whereas race (White: 11% vs Non-White: 5%), low income (20% vs 8%), and inability to walk a block (12% vs 8%) were risk factors for social isolation. Loneliness occurs in half of older adults and social isolation occurs in nearly 10% of older adults, with a consistent prevalence for the four years prior to death.