Abstract
AimConcerns around loneliness leading to increased healthcare use persist in spite of a mixed evidence base and lack of adjustment for key potential confounders. We investigated the associations among loneliness, health and healthcare use in older adults including stratification to investigate whether these associations differ by gender.Subject and methodsSecondary analysis of a nationally representative sample of 8175 community-dwelling adults aged 50 years and over from The Irish Longitudinal Study on Ageing (TILDA). Primary outcomes were self-reported general practitioner (GP) and emergency department (ED) visits in the past 12 months. Negative binomial and logistic regression analysis was used to investigate associations between loneliness and healthcare use, later adjusting for potential mediators (health and health behaviours).ResultsLoneliness was consistently positively associated with number of GP visits according to both cross-sectional and longitudinal analyses, with incidence rate ratios (IRRs) ranging from 1.08 to 1.33 in the sample overall. Associations with ED visits were less consistent. After adjusting for health and health behaviours, male loneliness does not appear to influence ED or GP visits. However, women who reported loneliness had an elevated risk of an ED visit at wave 1 (W1; odds ratio (OR) 1.08 [1.01–1.16]), as well as increased GP visits at both waves (IRRs ranging from 1.05 [1.02–1.07] to 1.16 [1.07–1.26]).ConclusionOlder women experiencing loneliness visit their GP more often irrespective of health, health behaviours or social isolation. While effect sizes were small, there are implications for health service resources at a population level. Importantly, however, this may also be a useful opportunity to redirect towards appropriate services and tailored resources.
Highlights
Loneliness is experienced by all age groups, research has tended to focus on older adults for whom the prevalence of intense loneliness is consistently estimated at 8–9% (Victor et al 2002)
In the case of University of California-Los Angeles (UCLA) item 5, which directly asks about loneliness, 35% (n = 2410/6805) reported that they felt lonely ‘some of the time’ (29%) or ‘often’ (6%)
The data indicate that loneliness was consistently positively associated with number of general practitioner (GP) visits according to both crosssectional and longitudinal analyses, with incidence rate ratios (IRRs) ranging from 1.08 to 1.33 in the sample overall
Summary
Loneliness is experienced by all age groups, research has tended to focus on older adults for whom the prevalence of intense loneliness (often or always lonely) is consistently estimated at 8–9% (Victor et al 2002). J Public Health (Berl.): From Theory to Practice et al 2015; Taube et al 2015; Theeke 2010; Wang et al 2019; Zhang et al 2018) and emergency department (ED) visits and hospitalisations (Geller et al 1999; Molloy et al 2010; Taube et al 2015), as well as with outpatient care visits in general in one study (Taube et al 2015) These associations are often weak or only explain a small amount of the variance, e.g. 11% (Almind et al 1991; Taube et al 2015), and, at times, no association with HCU [planned hospitalisations (GerstEmerson and Jayawardhana 2015; Molloy et al 2010); GP home visits (Ellaway et al 1999); admission to hospital (Newall et al 2015)] or, in the case of one study, a significant negative association was found, with significantly lower odds of physician visits among older adults who were lonely in Singapore (Lim and Chan 2017). Given that beliefs related to explanations of distress and coping are often culturally embedded, rational explanations for help-seeking may not be attainable (Kleinman 2004)
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