Women, loneliness, and incident coronary heart disease

Social isolation and loneliness as risk factors for the progression of frailty: the English Longitudinal Study of Ageing

Background

loneliness and social isolation have been associated with mortality and with functional decline in older people. We investigated whether loneliness or social isolation are associated with progression of frailty.

Methods

participants were 2,817 people aged ≥60 from the English Longitudinal Study of Ageing. Loneliness was assessed at Wave 2 using the Revised UCLA scale (short version). A social isolation score at Wave 2 was derived from data on living alone, frequency of contact with friends, family and children, and participation in social organisations. Frailty was assessed by the Fried phenotype of physical frailty at Waves 2 and 4, and by a frailty index at Waves 2–5.

Results

high levels of loneliness were associated with an increased risk of becoming physically frail or pre-frail around 4 years later: relative risk ratios (95% CI), adjusted for age, sex, level of frailty and other potential confounding factors at baseline were 1.74 (1.29, 2.34) for pre-frailty, and 1.85 (1.14, 2.99) for frailty. High levels of loneliness were not associated with change in the frailty index—a broadly based measure of general condition—over a mean period of 6 years. In the sample as a whole, there was no association between social isolation and risk of becoming physically frail or pre-frail, but high social isolation was associated with increased risk of becoming physically frail in men. Social isolation was not associated with change in the frailty index.

Conclusion

older people who experience high levels of loneliness are at increased risk of becoming physically frail.

The effectiveness of mI SMART: A nurse practitioner led technology intervention for multiple chronic conditions in primary care

AIMS

Used as integrated tools, technology may improve access and outcomes of care. A new intervention that integrates multiple technologies called mI SMART has been developed, implemented, and evaluated by Nurse Practitioners. The aim of this paper is to present the initial effectiveness of a web-based, structure of sensors and mobile devices designed to overcome the known health determinant of access to care for rural, chronically ill patients by using technology.

METHODS

The study was conducted at a community primary-care clinic that provides free healthcare to impoverished adults. Adults with at least one chronic condition, a minimum of 3rd grade reading level, and without dementia/psychosis were recruited. Participants were given a Nexus7 tablet and Bluetooth self-monitoring devices. The intervention lasted for 12 weeks. Blood glucose, blood pressure, and weight were collected using the provided Bluetooth devices and means were evaluated with paired-samples t-tests before and after the intervention.

RESULTS

Thirty participants were majority female, white, married, high-school educated or less, earning less than $20,000 per annum, and had multiple chronic conditions. Pre-intervention glucose, systolic blood pressure, diastolic blood pressure, weight and Body Mass Index were all reduced after the 12-week intervention.

CONCLUSIONS

The mI SMART intervention is efficacious for use in improvised adults living in rural areas with multiple chronic conditions. As previously reported, the intervention was also shown to be feasible and acceptable to patients. The next step is a larger randomized controlled trial.

Loneliness Among Persons With Severe Mental Illness

Although studies show that loneliness increases risk of illness and hastens death, it is poorly understood among persons with severe mental illness (SMI). Using data on 150 people with SMI, we used logistic regression to predict (1) loneliness from sociodemographic and clinical characteristics, and (2) psychiatric hospitalization from presence of loneliness. We also examined mediating effects. Study participants who were most willing to ask for help were 70% less likely (odds ratio [OR], 0.30; confidence interval [CI], 0.09-0.99; p < 0.05) to be lonely than those who were least willing, and participants with high levels of internalized stigma were 9.25 times as likely (CI, 9.25; OR, 2.29-37.32; p < 0.01) as other participants to be lonely. Participants who were most lonely were 2.69 times (CI, 1.03-7.04, p < 0.05) as likely to be placed in psychiatric hospitals as those who were less lonely. Loneliness mediates the association between internalized stigma and psychiatric hospitalization (OR, 1.30; CI, 1.04-1.73). Findings can be used to help prevent inpatient stay.

Physical multimorbidity and loneliness: A population-based study

Multimorbidity has been linked to a variety of negative outcomes although as yet, there has been little research on its association with loneliness. This study examined the association between physical multimorbidity (≥ 2 physical diseases) and loneliness in the general population and its potential mediators. Data came from the Adult Psychiatric Morbidity Survey 2007 (N = 7403, aged ≥16 years). Information was obtained on 20 doctor diagnosed physical conditions that were present in the previous year. An item from the Social Functioning Questionnaire (SFQ) was used to obtain information on loneliness. Multivariable logistic regression analysis was used to examine associations. An increasing number of physical diseases was associated with higher odds for loneliness. Compared to no physical diseases, the odds ratio (OR) (95% confidence interval: CI) for loneliness increased from 1.34 (1.13–1.59) to 2.82 (2.11–3.78) between one and ≥5 physical diseases. This association was particularly strong in the youngest age group (i.e. 16–44 years). The loneliness-physical multimorbidity association was significantly mediated by stressful life events (% mediated 11.1%-30.5%), anxiety (30.2%), and depression (15.4%). Physical multimorbidity is associated with increased odds for loneliness. Prospective research is now needed to further elucidate this association and the factors that underlie it.

Loneliness and cardiovascular disease and the role of late-life depression

OBJECTIVE

Loneliness and depression have a strong reciprocal influence, and both predict adverse health outcomes at old age. Therefore, this study examines whether loneliness is associated with the presence of cardiovascular diseases taking into account the role of late-life depression.

METHODS

Cross-sectional data of 477 older adults in the Netherlands Study of Depressed Older Persons were used. Logistic regression analysis was performed to examine the relation between loneliness and cardiovascular disease. Depression was added to the regression model to examine whether depression is an explanatory factor in the association between loneliness and cardiovascular disease. Interaction terms between loneliness and depression and between loneliness and sex were introduced in the regression model to investigate whether depressed and non-depressed participants, and men and women differed in their association between loneliness and cardiovascular disease.

RESULTS

Of the overall group, 61% were lonely, 28% had a history of cardiovascular disease and 74% were depressed. Loneliness and cardiovascular disease were not associated in the overall group after adjustment for confounders (continuous: odds ratio [OR] = 1.04, 95% confidence interval [CI] = 0.98-1.10), p = 0.25; dichotomous: OR = 1.27, 95% CI = 0.80-2.03, p = 0.32). For women, there was an association between loneliness and cardiovascular diseases (continuous: OR = 1.13, 95% CI = 1.06-1.21, p < 0.001; dichotomous: OR = 2.64, 95% CI = 1.50-4.65, p = 0.001), but this association was not present in men (OR = 0.96, 95% CI = 0.88-1.05, p = 0.38). This association remained significant after adjustment for confounders, but it lost significance after adding depression to the model.

CONCLUSION

For women only, there was an association between loneliness and cardiovascular disease. However, this association was explained by depression, indicating that loneliness in its own right seems not related with cardiovascular disease. Copyright © 2017 John Wiley & Sons, Ltd.

Characterizing emotional overeating among patients with and without binge-eating disorder in primary care

OBJECTIVE

Emotional overeating and loss-of-control eating are associated with poorer weight-related and psychiatric outcomes, yet our understanding of the relationship between these variables is limited, particularly among individuals in primary care. This study examined the frequency of emotional overeating and relationship with loss-of-control eating among patients with and without binge-eating disorder (BED) seeking weight loss treatment in primary care.

METHOD

Participants were 131 adults (n = 105 female) with overweight/obesity seeking weight loss treatment in primary care. Participants completed the Eating Disorder Examination (semi-structured interview) and Yale Emotional Overeating Scale, which measures emotional overeating episodes. Height and weight were measured. Mean age and BMI were 47.60 years and 35.31 kg/m², respectively. BED criteria were met by n = 35 (26.7%) participants.

RESULTS

Participants with BED endorsed more frequent emotional overeating episodes compared to those without BED. While total emotional overeating scores were not associated with loss-of-control eating, discrete types of emotional overeating episodes (e.g., loneliness) were associated with loss-of-control eating. Emotional overeating was most often reported in response to loneliness, boredom, or anxiety, which varied by BED status.

CONCLUSIONS

Most participants endorsed recent episodes of emotional overeating; those with BED endorsed more frequent episodes. Future research examining the impact of emotional overeating on weight loss treatment outcomes is warranted.

Emotional states and future risk of venous thromboembolism

Emotional states of depression and loneliness are reported to be associated with higher risk and optimism with lower risk of arterial cardiovascular disease (CVD) and death. The relation between emotional states and risk of venous thromboembolism (VTE) has not been explored previously. We aimed to investigate the associations between self-reported emotional states and risk of incident VTE in a population-based, prospective study. The frequency of feeling depressed, lonely and happy/optimistic were registered by self-administered questionnaires, along with major co-morbidities and lifestyle habits, in 25,964 subjects aged 25–96 years, enrolled in the Tromsø Study in 1994–1995. Incident VTE-events were registered from the date of inclusion until September 1, 2007. There were 440 incident VTE-events during a median of 12.4 years of follow-up. Subjects who often felt depressed had 1.6-fold (95% CI:1.02–2.50) higher risk of VTE compared to those not depressed in analyses adjusted for other risk factors (age, sex , body mass index, oes-trogens), lifestyle (smoking, alcohol consumption, educational level) and co-morbidities (diabetes, CVD, and cancer). Often feeling lonely was not associated with VTE. However, the incidence rate of VTE in subjects who concurrently felt often lonely and depressed was higher than for depression alone (age-and sex-adjusted incidence rate: 3.27 vs. 2.21). Oppositely, subjects who often felt happy/optimistic had 40% reduced risk of VTE (HR 0.60, 95% CI: 0.41–0.87). Our findings suggest that self-reported emotional states are associated with risk of VTE. Depressive feelings were associated with increased risk, while happiness/ optimism was associated with reduced risk of VTE.

Loneliness and acute stress reactivity: A systematic review of psychophysiological studies

Physiological reactivity to acute stress has been proposed as a potential biological mechanism by which loneliness may lead to negative health outcomes such as cardiovascular disease. This review was conducted to investigate the association between loneliness and physiological responses to acute stress. A series of electronic databases were systematically searched (PsycARTICLES, PsycINFO, Medline, CINAHL Plus, EBSCOhost, PubMed, SCOPUS, Web of Science, Science Direct) for relevant studies, published up to October 2016. Eleven studies were included in the review. Overall, the majority of studies reported positive associations between loneliness and acute stress responses, such that higher levels of loneliness were predictive of exaggerated physiological reactions. However, in a few studies, loneliness was also linked with decreased stress responses for particular physiological outcomes, indicating the possible existence of blunted relationships. There was no clear pattern suggesting any sex- or stressor-based differences in these associations. The available evidence supports a link between loneliness and atypical physiological reactivity to acute stress. A key finding of this review was that greater levels of loneliness are associated with exaggerated blood pressure and inflammatory reactivity to acute stress. However, there was some indication that loneliness may also be related to blunted cardiac, cortisol, and immune responses. Overall, this suggests that stress reactivity could be one of the biological mechanisms through which loneliness impacts upon health.

Loneliness and depression among rural empty-nest elderly adults in Liuyang, China: a cross-sectional study

OBJECTIVE

To compare loneliness, depressive symptoms and major depressive episodes between empty-nest and not-empty-nest older adults in rural areas of Liuyang city, Hunan, China.

METHODS

A cross-sectional multi-stage random cluster survey was conducted from November 2011 to April 2012 in Liuyang, China. A total of 839 rural older residents aged 60 or above completed the survey (response rate 97.6%). In line with the definition of empty nest, 25 participants who had no children were excluded from the study, while the remaining 814 elderly adults with at least one child were included for analysis. Loneliness and depressive symptoms in rural elderly parents were assessed using the short-form UCLA Loneliness Scale (ULS-6) and the Geriatric Depression Scale (GDS). Major depressive episodes were diagnosed using the Structured Clinical Interview for DSM-IV (SCID-I).

RESULTS

Significant differences were found between empty-nest and not-empty-nest older adults regarding loneliness (16.19±3.90 vs. 12.87±3.02, Cohen's d=0.97), depressive symptoms (8.50±6.26 vs. 6.92±5.19, Cohen's d=0.28) and the prevalence of major depressive episodes (10.1% vs. 4.6%) (all p<0.05). After controlling for demographic characteristics and physical disease, the differences in loneliness, depressive symptoms and major depressive episodes remained significant. Path analysis showed that loneliness mediated the relationship between empty-nest syndrome and depressive symptoms and major depressive episodes.

CONCLUSION

Loneliness and depression are more severe among empty-nest than not-empty-nest rural elderly adults. Loneliness was a mediating variable between empty-nest syndrome and depression.

Longitudinal associations of hopelessness and loneliness in older adults: results from the US health and retirement study

BACKGROUND

Hopelessness and loneliness are potent risk factors for poor mental and physical health in later life, although the nature of their relationships with each other over time is not clear. The aim of the current study was to examine relationships between hopelessness and loneliness over an eight-year study period.

METHODS

Three waves of data from the US Health and Retirement Study (2006, 2010, 2014) were used to test a cross-lagged model of hopelessness and loneliness (N = 7,831), which allows for the simultaneous evaluation of the reciprocal associations of loneliness and hopelessness. Age in 2006, gender, years of education, number of medical conditions, and depressive symptoms were included as covariates.

RESULTS

The autoregressive effects of loneliness (B (SE) = 0.63 (0.02), p < 0.001) and hopelessness (B (SE) = 0.63 (0.02), p < 0.001) were substantive and significant across the three waves, pointing to the stability of both constructs over the eight-year study period. The lagged effect of loneliness on hopelessness was non-significant (B (SE) = 0.05 (0.03), p = 0.16), whereas the lagged effect of hopelessness on loneliness was significant (B (SE) = 0.01 (0.01), p = 0.03). These lagged effects were not significantly different from each other, however, χ2 (1) = 2.016, p = 0.156.

CONCLUSIONS

Participants who were more hopeless tended to become lonelier four years later, but lonelier participants did not become more hopeless four years later. Findings are tentative given the small magnitude and lack of difference between the cross-lagged effects. Future directions include replicating these findings in different samples and time frames, examining potential mechanisms of relationships between hopelessness and loneliness, and potential intervention strategies that might improve both conditions.

Loneliness is adversely associated with physical and mental health and lifestyle factors: Results from a Swiss national survey

Introduction

Loneliness is a common, emotionally distressing experience and is associated with adverse physical and mental health and an unhealthy lifestyle. Nevertheless, little is known about the prevalence of loneliness in different age groups in Switzerland. Furthermore, the existing evidence about age and gender as potential effect modifiers of the associations between loneliness, physical and mental health and lifestyle characteristics warrants further investigation. Thus, the aim of the study was to examine the prevalence of loneliness among adults in Switzerland and to assess the associations of loneliness with several physical and mental health and behavioral factors, as well as to assess the modifying effect of sex and age.

Methods

Data from 20,007 participants of the cross-sectional population-based Swiss Health Survey 2012 (SHS) were analyzed. Logistic regression analyses were used to assess associations of loneliness with physical and mental health or lifestyle characteristics (e.g. diabetes, depression, physical activity). Wald tests were used to test for interactions.

Results

Loneliness was distributed in a slight U-shaped form from 15 to 75+ year olds, with 64.1% of participants who had never felt lonely. Lonely individuals were more often affected by physical and mental health problems, such as self-reported chronic diseases (Odds ratio [OR] 1.41, 95% confidence interval [CI] 1.30–1.54), high cholesterol levels (OR 1.31, 95% CI 1.18–1.45), diabetes (OR 1.40, 95% CI 1.16–1.67), moderate and high psychological distress (OR 3.74, 95% CI 3.37–4.16), depression (OR 2.78, 95% CI 2.22–3.48) and impaired self-perceived health (OR 1.94, 95% CI 1.74–2.16). Loneliness was significantly associated with most lifestyle factors (e.g. smoking; OR 1.13, 95% 1.05–1.23). Age, but not sex, moderated loneliness’ association with several variables.

Conclusion

Loneliness is associated with poorer physical and mental health and unhealthy lifestyle, modified by age, but not by sex. Our findings illustrate the importance of considering loneliness for physical and mental health and lifestyle factors, not only in older and younger, but also in middle-aged adults. Longitudinal studies are needed in Switzerland to elucidate the causal relationships of these associations.

Social Integration and Reduced Risk of Coronary Heart Disease in Women: The Role of Lifestyle Behaviors

RATIONALE

Higher social integration is associated with lower cardiovascular mortality; however, whether it is associated with incident coronary heart disease (CHD), especially in women, and whether associations differ by case fatality are unclear.

OBJECTIVES

This study sought to examine the associations between social integration and risk of incident CHD in a large female prospective cohort.

METHODS AND RESULTS

Seventy-six thousand three hundred and sixty-two women in the Nurses' Health Study, free of CHD and stroke at baseline (1992), were followed until 2014. Social integration was assessed by a simplified Berkman-Syme Social Network Index every 4 years. End points included nonfatal myocardial infarction and fatal CHD. Two thousand three hundred and seventy-two incident CHD events occurred throughout follow-up. Adjusting for demographic, health/medical risk factors, and depressive symptoms, being socially integrated was significantly associated with lower CHD risk, particularly fatal CHD. The most socially integrated women had a hazard ratio of 0.55 (95% confidence interval, 0.41-0.73) of developing fatal CHD compared with those least socially integrated (P for trend <0.0001). When additionally adjusting for lifestyle behaviors, findings for fatal CHD were maintained but attenuated (P for trend =0.02), whereas the significant associations no longer remained for nonfatal myocardial infarction. The inverse associations between social integration and nonfatal myocardial infarction risk were largely explained by health-promoting behaviors, particularly through differences in cigarette smoking; however, the association with fatal CHD risk remained after accounting for these behaviors and, thus, may involve more direct biological mechanisms.

CONCLUSIONS

Social integration is inversely associated with CHD incidence in women, but is largely explained by lifestyle/behavioral pathways.

Loneliness predicts self-reported cold symptoms after a viral challenge

OBJECTIVE

Loneliness is a well-established risk factor for poor physical health. Much less is known about how loneliness affects patient-reported outcomes (PROs), such as somatic symptoms, which are increasingly important for guiding symptom management and assessing quality of patient care. The current study investigates whether (a) loneliness and social isolation predict cold symptoms independent of each other, and (b) whether loneliness is a more robust risk factor than objective social isolation for experiencing cold symptoms.

METHOD

As part of a larger parent study, 213 healthy participants completed the Short Loneliness Scale (LON) and the Social Network Index (SNI) at baseline. They were given nasal drops containing rhinovirus 39 (RV39; i.e., a common cold virus), then quarantined for 5 days during which they reported on subjective cold symptoms in addition to being monitored for objective indicators of infection. Data from 160 of the participants (who were infected with the virus) were used in the present analyses.

RESULTS

A hierarchical multiple regression revealed that baseline loneliness predicted self-reported cold symptoms over time (assessed via area under the curve), over and above demographic variables, season of participation, and depressive affect. Interestingly, social network size and diversity did not predict cold symptoms.

CONCLUSIONS

These findings suggest that the perception of loneliness is more closely linked to self-reported illness symptoms than objectively measured social isolation. Assessing psychosocial factors such as loneliness when treating and evaluating the common cold could contribute to health care practitioners' understanding of their patients' experiences with acute illness. (PsycINFO Database Record

Social Isolation in Chinese Older Adults: Scoping Review for Age-Friendly Community Planning

Chinese older adults may be at increased risk of social isolation and loneliness, and a fragmented understanding exists about the challenges they face for social participation in their neighbourhoods and communities. A scoping review was undertaken to describe the current knowledge on social isolation and loneliness in urban-dwelling Chinese older adults living in Western societies to inform future research, practice, and policy in Canada. Nineteen articles met the inclusion criteria. The World Health Organization's age-friendly community framework contextualized the study findings. Studies identified issues related to (1) social participation; (2) community support and health services; (3) housing; (4) community and information; (5) respect and social inclusion; (6) outdoor spaces and public buildings; (7) civic participation and employment; and (8) transportation. Social isolation and loneliness is a growing concern in this population in Canada, and additional research is needed to identify its scope and effective interventions.

Study on the Health Status and Health Service Utilization of the Elderly of a Remote and Poor Village in a Mountainous Area in Jinzhai, Anhui

Background: Despite the rapid development of China's economy, a number of poor areas in China continue to exist. The health status of the elderly in the poor areas is a matter of concern. This study aims to explore the status of the elderly in terms of their health status, health service needs, and utilization among rural residents of a remote and poor village in a mountainous area in Jinzhai, Anhui. Furthermore, this study aims to explore the differences between the nation rural area average level and the remote and poor village in the mountainous area in terms of health status and health service utilization. Methods: Cluster sampling was used to obtain the sample. A total of 110 elderly people were selected from the village, and face-to-face interviews were conducted with questionnaires by trained investigators to collect data. Results: All items except vision, language disability, and self-care disability were found to be higher than the national average level. In terms of mental health, Zishu Village has a ratio of 44.1% for the symptoms of anxiety and depression, which is higher than the average for the national rural areas. The two-week prevalence rate, prevalence of chronic diseases, and non-hospitalization rate of those who need hospitalization (%) in Zishu Village was 62.7%, 88.2%, and 47.6% respectively, which was higher than the rural values of the National Survey (2008). Most of the outpatient visits were to the village clinics, while the hospitalizations were mainly to county hospitals. The two-week visiting rate was 24.1%, which was lower than 2008. The hospitalization rate in Zishu Village was 10.8%, which is similar to the level of 2008. Conclusions: The health level and the utilization of health services of the people in Zishu Village, Jinzhai, are generally lower than the national average. Financial difficulties continue to remain the major factor affecting the utilization of hospitalization services of this remote and poor village in Jinzhai, Anhui.

Empty-nest-related psychological distress is associated with progression of brain white matter lesions and cognitive impairment in the elderly

This study evaluated the association between empty-nest-related psychological distress and the progression of white matter lesions (WMLs) and cognitive impairment in 219 elderly subjects aged 60 years or over. Psychological distress was assessed using the University of California at Los Angeles Loneliness Scale (UCLA-LS) and Geriatric Depression Scale (GDS) Short-Form. Cognitive function was evaluated using the MMSE and MoCA. White matter hyperintensities (WMH) were assessed using magnetic resonance imaging. After 5.2-year follow-up, the reductions in MMSE and MoCA scores and the increases in periventricular (P)WMH, deep (D)WMH, and total WMH volumes in the empty-nest elderly were greater than those in the non-empty-nest elderly (P < 0.05). The reduced MMSE and MoCA scores and increased volumes of PWMH and total WMH in the empty-nest elderly living alone were greater than those in the empty-nest elderly living with a spouse (P < 0.05). UCLA-LS and GDS scores were significantly and independently associated with reduced MMSE and MoCA scores and the increased volumes of PWMH, DWMH, and total WMH. The results indicate that empty-nest-related psychological distress is associated with progression of WMLs and cognitive impairment in the elderly.

Social Support and Resilience Among Patients with Burn Injury in Lahore, Pakistan

INTRODUCTION

Social support and ego resiliency play a great role in maintaining the physical and mental health of patients with burn injuries. The present study has been designed to compare ego resiliency levels and the degree of social support in patients with a burn injury and their healthy counterparts.

METHODS

This study was conducted in two teaching hospitals in Lahore, Pakistan from May 2015 to July 2015. A total of 80 burn patients presenting in outpatient departments of general surgery, plastic surgery, and burn centers of these hospitals were surveyed conveniently, and for comparison, 80 patients presenting in outpatient departments with minor ailments, for routine checkups or follow-ups were recruited. The questionnaire comprised three sections: demographics, the Urdu versions of the Ego Resiliency Scale (ER-89), and the Multidimensional Scale of Perceived Social Support (MSPSS). All data were analyzed in SPSS v. 20 (IBM Corp., Armonk, NY).

RESULTS

Patients with a burn injury were associated with lower scores on the social support scale as well as its subscales assessing support from the significant other, family and friends than their healthy counterparts. However, no significant differences in scores on the ego resiliency scale were reported between these two groups.

CONCLUSION

Patients with a burn injury perceived low social support levels from society, which negatively affects their health outcomes. However, their resilience levels were not significantly different from their healthy counterparts.

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

OBJECTIVE

1. Examine the relationship between household wealth, social participation and loneliness among older people across Europe. 2. Investigate whether relationships vary by type of social participation (charity/volunteer work, sports/social clubs, educational/training course, and political/community organisations) and gender. 3. Examine whether social participation moderates the association between wealth and loneliness.

METHODS

Data (N=29,795) were taken from the fifth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE), which was collected during 2013 from 14 European countries. Loneliness was measured using the short version of the Revised-University of California, Los Angeles (R-UCLA) Loneliness Scale. We used multilevel logistic models stratified by gender to examine the relationships between variables, with individuals nested within countries.

RESULTS

The risk of loneliness was highest in the least wealthy groups and lowest in the wealthiest groups. Frequent social participation was associated with a lower risk of loneliness and moderated the association between household wealth and loneliness, particularly among men. Compared to the wealthiest men who often took part in formal social activities, the least wealthy men who did not participate had greater risk of loneliness (OR=1.91, 95% CI: 1.44 to 2.51). This increased risk was not observed among the least wealthy men who reported frequent participation in formal social activities (OR=1.12, 95% CI: 0.76 to 1.67).

CONCLUSION

Participation in external social activities may help to reduce loneliness among older adults and potentially acts as a buffer against the adverse effects of socioeconomic disadvantage.

Using Gene Expression Analysis to Examine Changes in Loneliness, Depression and Systemic Inflammation in Lonely Chronically Ill Older Adults

Purpose

The purpose of this study was to evaluate the effectiveness of LISTEN (Loneliness Intervention) on loneliness, depression, physical health, systemic inflammation, and genomic expression in a sample of lonely, chronically ill, older adults.

Methods

This was a prospective, longitudinal randomized trial of LISTEN, a novel intervention based on theories of narrative and cognitive restructuring to target specific aspects of loneliness. Twenty-three older, lonely, chronically ill adults were recruited from a family medicine clinic in West Virginia. Participants were randomized to two groups, 13 in LISTEN group (Loneliness Intervention) and 10 in attention control (healthy aging education). Participants attended an enrollment session where they completed consent, survey data (including sociodemographics and chronic illness diagnoses), baseline physical measures, and blood sampling for gene expression analysis. After completing the 5 weekly sessions, all participants attended a 12 week post data collection meeting (17 weeks post-baseline) for survey completion, physical measures and blood sampling.

Results

The results of this study show that the LISTEN intervention improves measures of physical and psychosocial health. Specifically, subjects enrolled in LISTEN showed reductions in systolic blood pressure, as well as decreased feelings of loneliness and depression. These changes may be due, in part, to a reduction in systemic inflammation, as measured by interleukin-2.

Conclusion

This study provides support for the use of LISTEN in reducing loneliness in chronically ill, older adults. Further, while some of our results are inconclusive, it provides rationale to expand our study population to evaluate the relationship between loneliness and systemic inflammation. In the future, enhancing knowledge about the relationships among loneliness, chronic illness, systemic inflammation, and gene expression of these particular targets, and how these relationships may change over time with intervention will inform translation of findings to clinical settings.

Effectiveness of LISTEN on loneliness, neuroimmunological stress response, psychosocial functioning, quality of life, and physical health measures of chronic illness

Objectives

Loneliness is a biopsychosocial determinant of health and contributes to physical and psychological chronic illnesses, functional decline, and mortality in older adults. This paper presents the results of the first randomized trial of LISTEN, which is a new cognitive behavioral intervention for loneliness, on loneliness, neuroimmunological stress response, psychosocial functioning, quality of life, and measures of physical health.

Methods

The effectiveness of LISTEN was evaluated in a sample population comprising 27 lonely, chronically ill, older adults living in Appalachia. Participants were randomized into LISTEN or educational attention control groups. Outcome measures included salivary cortisol and DHEA, interleukin-6, interleukin-2, depressive symptoms, loneliness, perceived social support, functional ability, quality of life, fasting glucose, blood pressure, and body mass index.

Results

At 12 weeks after the last intervention session, participants of the LISTEN group reported reduced loneliness (p = 0.03), enhanced overall social support (p = 0.05), and decreased systolic blood pressure (p = 0.02). The attention control group reported decreased functional ability (p = 0.10) and reduced quality of life (p = 0.13).

Conclusions

LISTEN can effectively diminish loneliness and decrease the systolic blood pressure in community-dwelling, chronically ill, older adults. Results indicate that this population, if left with untreated loneliness, may experience functional impairment over a period as short as 4 months. Further studies on LISTEN are needed with larger samples, in varied populations, and over longer periods of time to assess the long-term effects of diminishing loneliness in multiple chronic conditions.

Impact of loneliness and depression on mortality: results from the Longitudinal Ageing Study Amsterdam

BACKGROUND

Loneliness is highly prevalent among older people, has serious health consequences and is an important predictor of mortality. Loneliness and depression may unfavourably interact with each other over time but data on this topic are scarce.

AIMS

To determine whether loneliness is associated with excess mortality after 19 years of follow-up and whether the joint effect with depression confers further excess mortality.

METHOD

Different aspects of loneliness were measured with the De Jong Gierveld scale and depression with the Centre for Epidemiologic Studies Depression Scale in a cohort of 2878 people aged 55-85 with 19 years of follow-up. Excess mortality hypotheses were tested with Kaplan-Meier and Cox proportional hazard analyses controlling for potential confounders.

RESULTS

At follow-up loneliness and depression were associated with excess mortality in older men and women in bivariate analysis but not in multivariate analysis. In multivariate analysis, severe depression was associated with excess mortality in men who were lonely but not in women.

CONCLUSIONS

Loneliness and depression are important predictors of early death in older adults. Severe depression has a strong association with excess mortality in older men who were lonely, indicating a lethal combination in this group.

Does the mortality risk of social isolation depend upon socioeconomic factors?

This study considers whether socioeconomic status influences the impact of social isolation on mortality risk. Using data from the Alameda County Study, Cox proportional hazard models indicate that having a high income worsens the mortality risk of social isolation. Education may offset risk, however, and the specific pattern that emerges depends on which measures for socioeconomic status and social isolation are included. Additionally, lonely people who earn high incomes suffer especially high risk of accidents and suicides as well as cancer. Further research is needed that contextualizes the health risks of social isolation within the broader social environment.

Loneliness, Depression, and Inflammation: Evidence from the Multi-Ethnic Study of Atherosclerosis

Objective

Both objective and subjective aspects of social isolation have been associated with alterations in immune markers relevant to multiple chronic diseases among older adults. However, these associations may be confounded by health status, and it is unclear whether these social factors are associated with immune functioning among relatively healthy adults. The goal of this study was to examine the associations between perceived loneliness and circulating levels of inflammatory markers among a diverse sample of adults.

Methods

Data come from a subset of the Multi-Ethnic Study of Atherosclerosis (n = 441). Loneliness was measured by three items derived from the UCLA Loneliness Scale. The association between loneliness and C-reactive protein (CRP) and fibrinogen was assessed using multivariable linear regression analyses. Models were adjusted for demographic and health characteristics.

Results

Approximately 50% of participants reported that they hardly ever felt lonely and 17.2% felt highly lonely. Individuals who were unmarried/unpartnered or with higher depressive symptoms were more likely to report being highly lonely. There was no relationship between perceived loneliness and ln(CRP) (β = -0.051, p = 0.239) adjusting for demographic and health characteristics. Loneliness was inversely associated with ln(fibrinogen) (β = -0.091, p = 0.040), although the absolute magnitude of this relationship was small.

Conclusion

These results indicate that loneliness is not positively associated with fibrinogen or CRP among relatively healthy middle-aged adults.

Perceived social isolation, evolutionary fitness and health outcomes: a lifespan approach

Sociality permeates each of the fundamental motives of human existence and plays a critical role in evolutionary fitness across the lifespan. Evidence for this thesis draws from research linking deficits in social relationship--as indexed by perceived social isolation (i.e. loneliness)--with adverse health and fitness consequences at each developmental stage of life. Outcomes include depression, poor sleep quality, impaired executive function, accelerated cognitive decline, unfavourable cardiovascular function, impaired immunity, altered hypothalamic pituitary-adrenocortical activity, a pro-inflammatory gene expression profile and earlier mortality. Gaps in this research are summarized with suggestions for future research. In addition, we argue that a better understanding of naturally occurring variation in loneliness, and its physiological and psychological underpinnings, in non-human species may be a valuable direction to better understand the persistence of a 'lonely' phenotype in social species, and its consequences for health and fitness.

Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies

BACKGROUND

The influence of social relationships on morbidity is widely accepted, but the size of the risk to cardiovascular health is unclear.

OBJECTIVE

We undertook a systematic review and meta-analysis to investigate the association between loneliness or social isolation and incident coronary heart disease (CHD) and stroke.

METHODS

Sixteen electronic databases were systematically searched for longitudinal studies set in high-income countries and published up until May 2015. Two independent reviewers screened studies for inclusion and extracted data. We assessed quality using a component approach and pooled data for analysis using random effects models.

RESULTS

Of the 35 925 records retrieved, 23 papers met inclusion criteria for the narrative review. They reported data from 16 longitudinal datasets, for a total of 4628 CHD and 3002 stroke events recorded over follow-up periods ranging from 3 to 21 years. Reports of 11 CHD studies and 8 stroke studies provided data suitable for meta-analysis. Poor social relationships were associated with a 29% increase in risk of incident CHD (pooled relative risk: 1.29, 95% CI 1.04 to 1.59) and a 32% increase in risk of stroke (pooled relative risk: 1.32, 95% CI 1.04 to 1.68). Subgroup analyses did not identify any differences by gender.

CONCLUSIONS

Our findings suggest that deficiencies in social relationships are associated with an increased risk of developing CHD and stroke. Future studies are needed to investigate whether interventions targeting loneliness and social isolation can help to prevent two of the leading causes of death and disability in high-income countries.

STUDY REGISTRATION NUMBER

CRD42014010225.

What prevents old people living alone from feeling lonely? Findings from the KORA-Age-study

OBJECTIVES

Living alone in later life is an important risk factor of loneliness for elderly people unless they have resources to compensate for that. The aim of this investigation was to identify these resources.

METHOD

Data were drawn from the population-based KORA-Age-study (KOoperativen Gesundheitsforschung in der Region Augsburg) conducted in the Region of Augsburg, Germany in 2008/2009 with 1079 elderly men and women (64-94 years). Loneliness was measured by the short version of the UCLA-Loneliness-Scale in a face-to-face interview. Multiple logistic regression analyses were conducted to identify associations between loneliness and potential protecting resources.

RESULTS

A total of 346 (32%) subjects reported to be living alone, among them 70% (n = 241) expressed no feelings of loneliness. Participants with a stable social network had a fourfold higher chance (OR 4.08, 95% CI 1.20-13.88, p = 0.025) and with the absence of depression a threefold higher chance (OR 3.04, 95% CI 1.59-5.78, p-value < 0.001) of not feeling lonely. Physical or mental resources were not correlated with lower levels of loneliness.

CONCLUSION

Absence of depression and a functioning social network are the most important protecting resources against loneliness for elderly people living alone, while income, level of education and age-related limitations have no impact. These findings should be considered when supporting the elderly in successful aging.

Functional Connectivity Density Mapping of Depressive Symptoms and Loneliness in Non-Demented Elderly Male

Background: Depression and loneliness are prevalent and highly correlated phenomena among the elderly and influence both physical and mental health. Brain functional connectivity changes associated with depressive symptoms and loneliness are not fully understood.

Methods: A cross-sectional functional MRI study was conducted among 85 non-demented male elders. Geriatric depression scale-short form (GDS) and loneliness scale were used to evaluate the severity of depressive symptoms and loneliness, respectively. Whole brain voxel-wise resting-state functional connectivity density (FCD) mapping was performed to delineate short-range FCD (SFCD) and long-range FCD (LFCD). Regional correlations between depressive symptoms or loneliness and SFCD or LFCD were examined using general linear model (GLM), with age incorporated as a covariate and depressive symptoms and loneliness as predictors.

Results: Positive correlations between depressive symptoms and LFCD were observed in left rectal gyrus, left superior frontal gyrus, right supraorbital gyrus, and left inferior temporal gyrus. Positive correlations between depressive symptoms and SFCD were observed in left middle frontal gyrus, left superior frontal gyrus, bilateral superior medial frontal gyrus, left inferior temporal gyrus, and left middle occipital region. Positive correlations between SFCD and loneliness were centered over bilateral lingual gyrus.

Conclusion: Depressive symptoms are associated with FCD changes over frontal and temporal regions, which may involve the cognitive control, affective regulation, and default mode networks. Loneliness is associated with FCD changes in bilateral lingual gyri that are known to be important in social cognition. Depressive symptoms and loneliness may be associated with different brain regions in non-demented elderly male.

The impact of the combination of income and education on the incidence of coronary heart disease in the prospective Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study

BACKGROUND

We investigated the association between income-education groups and incident coronary heart disease (CHD) in a national prospective cohort study.

METHODS

The REasons for Geographic And Racial Differences in Stroke study recruited 30,239 black and white community-dwelling adults between 2003 and 2007 and collected participant-reported and in-home physiologic variables at baseline, with expert adjudicated CHD endpoints during follow-up. Mutually exclusive income-education groups were: low income (annual household income <$35,000)/low education (< high school), low income/high education, high income/low education, and high income/high education. Cox models estimated hazard ratios (HR) for incident CHD for each exposure group, examining differences by age group.

RESULTS

At baseline, 24,461 participants free of CHD experienced 809 incident CHD events through December 31, 2011 (median follow-up 6.0 years; interquartile range 4.5-7.3 years). Those with low income/low education had the highest incidence of CHD (10.1 [95% CI 8.4-12.1]/1000 person-years). After full adjustment, those with low income/low education had higher risk of incident CHD (HR 1.42 [95% CI: 1.14-1.76]) than those with high income/high education, but findings varied by age. Among those aged <65 years, compared with those reporting high income/high education, risk of incident CHD was significantly higher for those reporting low income/low education and low income/high education (adjusted HR 2.07 [95% CI 1.42-3.01] and 1.69 [95% CI 1.30-2.20], respectively). Those aged ≥ 65 years, risk of incident CHD was similar across income-education groups after full adjustment.

CONCLUSION

For younger individuals, low income, regardless of education, was associated with higher risk of CHD, but not observed for ≥ 65 years. Findings suggest that for younger participants, education attainment may not overcome the disadvantage conferred by low income in terms of CHD risk, whereas among those ≥ 65 years, the independent effects of income and education are less pronounced.

Mindfulness and Cardiovascular Disease Risk: State of the Evidence, Plausible Mechanisms, and Theoretical Framework

The purpose of this review is to provide (1) a synopsis on relations of mindfulness with cardiovascular disease (CVD) and major CVD risk factors, and (2) an initial consensus-based overview of mechanisms and theoretical framework by which mindfulness might influence CVD. Initial evidence, often of limited methodological quality, suggests possible impacts of mindfulness on CVD risk factors including physical activity, smoking, diet, obesity, blood pressure, and diabetes regulation. Plausible mechanisms include (1) improved attention control (e.g., ability to hold attention on experiences related to CVD risk, such as smoking, diet, physical activity, and medication adherence), (2) emotion regulation (e.g., improved stress response, self-efficacy, and skills to manage craving for cigarettes, palatable foods, and sedentary activities), and (3) self-awareness (e.g., self-referential processing and awareness of physical sensations due to CVD risk factors). Understanding mechanisms and theoretical framework should improve etiologic knowledge, providing customized mindfulness intervention targets that could enable greater mindfulness intervention efficacy.

A narrative review of the theoretical foundations of loneliness

Loneliness has been found to relate to a wide range of harmful health outcomes. The adverse effects of loneliness upon people's lives emphasise the importance of understanding its nature and process. A number of theoretical and conceptual foundations have been proposed by scholars and are discussed and reflected upon in this article. The discussion and understanding of loneliness theoretical foundations provide useful insights toward the interpretation of its occurrence.

A Systematic Review of Loneliness and Common Chronic Physical Conditions in Adults

Loneliness is a prevalent and global problem for adult populations and has been linked to multiple chronic conditions in quantitative studies. This paper presents a systematic review of quantitative studies that examined the links between loneliness and common chronic conditions including: heart disease, hypertension, stroke, lung disease, and metabolic disorders. A comprehensive literature search process guided by the PRISMA statement led to the inclusion of 33 articles that measure loneliness in chronic illness populations. Loneliness is a significant biopsychosocial stressor that is prevalent in adults with heart disease, hypertension, stroke, and lung disease. The relationships among loneliness, obesity, and metabolic disorders are understudied but current research indicates that loneliness is associated with obesity and with psychological stress in obese persons. Limited interventions have demonstrated long-term effectiveness for reducing loneliness in adults with these same chronic conditions. Future longitudinal randomized trials that enhance knowledge of how diminishing loneliness can lead to improved health outcomes in persons with common chronic conditions would continue to build evidence to support the translation of findings to recommendations for clinical care.

Women's relative immunity to the socio-economic health gradient: artifact or real?

Background

Individual and area socio-economic status (SES) are significant predictors of morbidity and mortality in developed and developing countries. However, the span in health from poorest to richest, that is, the socio-economic gradient, appears steeper for men than women.

Objective

Our aim is to understand women's apparent immunity to the health harms of the SES gradient.

Design

Findings from a non-systematic search of Medline for population-based, SES gradient studies reporting results for both men and women and with health outcomes of morbidity, mortality or self-rated health (SRH) were reflectively analyzed.

Results

The 36 papers reviewed generally showed women to be relatively immune to the SES gradient for all but cardiovascular health outcomes. However, addressing the interconnected nature of socio-economic circumstances, exploring whether some measures of SES had ambiguous meanings for either women or men, including modifiers of SES such as household circumstances, social capital or area gender equity, or using indicators of area SES that were contextual rather than aggregates of individual, compositional measures increased the SES gradient for women. Outcome measures that combined mental and physical health, accounted for gender differences in SRH and adjusted for sex-specific differences in causes of mortality also explained some of the observed amelioration of the SES gradient among women.

Conclusions

Socio-economic circumstances have a real and sustained impact on individual health. The SES gradient appears stronger for men than for women for all health outcomes other than heart disease. However, some of the observed variability between men and women may be an artifact of biased methodology. Considering webs of causation rather than individual markers of SES along with other sources of gender bias can explain much of women's blunted socio-economic gradient and deepen understanding of the pathways from SES to morbidity and mortality overall.

Sex differences in the association between depression, anxiety, and type 2 diabetes mellitus

BACKGROUND

Depression and anxiety have been inconsistently associated with diabetes. Sex differences in the biological and behavioral correlates of these forms of distress could partially explain these inconsistencies. We investigated sex-specific associations between depression/anxiety symptoms and diabetes in two separate samples.

METHODS

The First National Health and Nutrition Examination Survey enrolled 3233 participants aged 25 to 74 years from 1971 to 1974. Depression and anxiety symptoms were measured via General Well Being schedule subscales. Incident diabetes for 17 years was defined by the following: a) death certificate, b) participant self-report, or c) health care facility discharge. The Detroit Neighborhood Health Study enrolled 1054 participants 18 years or older from 2008 to 2010. The Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 assessed depression and anxiety. Participants' self-reported physician-diagnosed prevalent diabetes.

RESULTS

In the First National Health and Nutrition Examination Survey, the risk ratio (RR; 95% confidence interval) for incident diabetes among men with high versus low anxiety symptoms was 0.85 (0.56-1.29) and that among women was 2.19 (1.17-4.09; p for interaction = .005). RRs comparing high versus low depressive symptoms for men and women were 0.69 (0.43-1.100) and 2.11 (1.06-4.19); p for interaction = .007. In the Detroit Neighborhood Health Study, the RRs for prevalent diabetes comparing those with high versus low anxiety symptoms were 0.24 (0.02-2.42) for men and 1.62 (0.61-4.32) for women (p for interaction = < .001), whereas RRs for depression were 1.30 (0.46-3.68) for men and 2.32 (1.10-4.89) for women (p for interaction = .16).

CONCLUSIONS

In two separate samples, depressive symptoms were related to increased diabetes risk among women but not men. Although less robust, findings for anxiety were differentially associated with diabetes by sex.

Loneliness predicts postprandial ghrelin and hunger in women

Loneliness is strongly linked to poor health. Recent research suggests that appetite dysregulation provides one potential pathway through which loneliness and other forms of social disconnection influence health. Obesity may alter the link between loneliness and appetite-relevant hormones, one unexplored possibility. We examined the relationships between loneliness and both postmeal ghrelin and hunger, and tested whether these links differed for people with a higher versus lower body mass index (BMI; kg/m(2)). During this double-blind randomized crossover study, women (N=42) ate a high saturated fat meal at the beginning of one full-day visit and a high oleic sunflower oil meal at the beginning of the other. Loneliness was assessed once with a commonly used loneliness questionnaire. Ghrelin was sampled before the meal and postmeal at 2 and 7h. Self-reported hunger was measured before the meal, immediately postmeal, and then 2, 4, and 7h later. Lonelier women had larger postprandial ghrelin and hunger increases compared with less lonely women, but only among participants with a lower BMI. Loneliness and postprandial ghrelin and hunger were unrelated among participants with a higher BMI. These effects were consistent across both meals. These data suggest that ghrelin, an important appetite-regulation hormone, and hunger may link loneliness to weight gain and its corresponding negative health effects among non-obese people.

The Experience of Older Women Living with Loneliness and Chronic Conditions in Appalachia

This phenomenological qualitative study explored the experience of living with loneliness and multiple chronic conditions for rural older women in Appalachia. The study took place in 2012 in Northern West Virginia. Participants were 14 older women who were chronically ill, community dwelling, and lonely (Score of 40 or higher on the Revised 20-item UCLA Loneliness Scale). Thematic content analysis revealed four categories that contained thirteen themes: (a) negative emotions of loneliness, which included themes of sadness, disconnection, fear, anger, and worry; (b) positive emotions when not lonely, which included themes of joy with others and pride in self; (c) loss of independence and loneliness, which included themes of functional decline contributes to loneliness, burden, and gratitude for help; and (d) ways of managing loneliness, which included remembering holidays and happier moments, staying busy, and getting out. The study contributes new knowledge about the experience of anger, fear, and worry when lonely. These emotions have not extensively been identified as significant to loneliness. Future studies exploring the links between loneliness and anger, fear, worry, and negative physical health outcomes could enhance knowledge of mechanisms by which loneliness contributes to health decline. Additionally, knowing that positive emotions such as joy are described as being linked to less lonely times could inform future work that aims to diminish loneliness and enhance positive emotional states. Finally, understanding that functional impairment is described as contributing to loneliness in this population reinforces the need to assess for and address functional limitations.

A Systematic Review of Loneliness and Smoking: Small Effects, Big Implications

BACKGROUND

Research supports an association between smoking and negative affect. Loneliness is a negative affective state experienced when a person perceives themselves as socially isolated and is associated with poor health behaviors and increased morbidity and early mortality.

OBJECTIVES

In this article, we systematically review the literature on loneliness and smoking and suggest potential theoretical and methodological implications.

METHODS

PubMed and PsycINFO were systematically searched for articles that assessed the statistical association between loneliness and smoking. Articles that met study inclusion criteria were reviewed.

RESULTS

Twenty-five studies met inclusion criteria. Ten studies were conducted with nationally representative samples. Twelve studies assessed loneliness using a version of the UCLA Loneliness Scale and nine used a one-item measure of loneliness. Seventeen studies assessed smoking with a binary smoking status variable. Fourteen of the studies were conducted with adults and 11 with adolescents. Half of the reviewed studies reported a statistically significant association between loneliness and smoking. Of the studies with significant results, all but one study found that higher loneliness scores were associated with being a smoker.

CONCLUSIONS/IMPORTANCE

Loneliness and smoking are likely associated, however, half of the studies reviewed did not report significant associations. Studies conducted with larger sample sizes, such as those that used nationally representative samples, were more likely to have statistically significant findings. Future studies should focus on using large, longitudinal cohorts, using measures that capture different aspects of loneliness and smoking, and exploring mediators and moderators of the association between loneliness and smoking.

Socio-Demographic Predictors of Loneliness Across the Adult Life Span in Portugal

Loneliness, a complex phenomenon, is experienced differently by people under diverse conditions. The factors influencing loneliness are numerous and may vary between cultures. The purpose of this study was to show socio-demographic factors contributing to loneliness in Portugal. The sample consisted of 3,144 participants with a mean age of 46.90 (SD = 22.56) and a range between 15 and 92 years. Loneliness was evaluated with the Revised UCLA Loneliness Scale (Russell, Peplau, & Cutrona, 1980). Age and marital status were significant predictors of loneliness. Loneliness increased with age, and divorced or windowed participants reported higher loneliness than single or married people. As expected, gender did not significantly contribute to loneliness. This work identified vulnerable people who are experiencing a perceived dissatisfaction with their social interactions that needs special attention. These vulnerable groups include the old, divorced and widowed. In particular, policy makers and other experts who work with old persons should promote interventions according to their needs.

Toward a neurology of loneliness

Social isolation has been recognized as a major risk factor for morbidity and mortality in humans for more than a quarter century. The brain is the key organ of social connections and processes, however, and the same objective social relationship can be experienced as caring and protective or as exploitive and isolating. We review evidence that the perception of social isolation (i.e., loneliness) impacts brain and behavior and is a risk factor for broad-based morbidity and mortality. However, the causal role of loneliness on neural mechanisms and mortality is difficult to test conclusively in humans. Mechanistic animal studies provide a lens through which to evaluate the neurological effects of a member of a social species living chronically on the social perimeter. Experimental studies show that social isolation produces significant changes in brain structures and processes in adult social animals. These effects are not uniform across the brain or across species but instead are most evident in brain regions that reflect differences in the functional demands of solitary versus social living for a particular species. The human and animal literatures have developed independently, however, and significant gaps also exist. The current review underscores the importance of integrating human and animal research to delineate the mechanisms through which social relationships impact the brain, health, and well-being.

Does owning a pet protect older people against loneliness?

BACKGROUND

Pet ownership is thought to make a positive contribution to health, health behaviours and the general well-being of older people. More specifically pet ownership is often proposed as a solution to the problem of loneliness in later life and specific 'pet based' interventions have been developed to combat loneliness. However the evidence to support this relationship is slim and it is assumed that pet ownership is a protection against loneliness rather than a response to loneliness. The aim of this paper is to examine the association between pet ownership and loneliness by exploring if pet ownership is a response to, or protection against, loneliness using Waves 0-5 from the English Longitudinal Study of Ageing (ELSA).

METHODS

Using data from 5,210 men and women in the English Longitudinal Study of Ageing, cross-sectional and longitudinal regression analysis was used to assess the bi-directional relationship between loneliness and pet ownership among adults aged 50 + .

RESULTS

In 2001 (wave 0) 41% of participants were pet owners compared with 30% in 2010 (Wave 5). The association between pet ownership and loneliness is stronger in women than men, and in both directions (i.e. pet ownership predicting loneliness and loneliness predicting pet ownership) and of the similar magnitude (OR 1.2-1.4). Age, social relationships, demographic factors and health behaviour variables have only a minimal influence upon the association between loneliness and pet ownership. The results of our longitudinal analysis showed that women who reported being lonely always in Waves 0 to 5 were more likely to have a pet in Wave 5.

CONCLUSION

Reported loneliness is dependent on socio-demographic characteristics such as gender, household income, household living arrangements and health status. Taking those factors into account, owning a pet significantly influences later reporting of loneliness in women in our longitudinal analysis. In the reverse direction, reported loneliness influences pet ownership in later waves. In both directions, the relatively strong gender interaction suggests the association is limited to women with effects for men minimal or non-existent.

Gender-differences in disease distribution and outcome in hospitalized elderly: data from the REPOSI study

BACKGROUND AND PURPOSE

Women live longer and outnumber men. On the other hand, older women develop more chronic diseases and conditions such as arthritis, osteoporosis and depression, leading to a greater number of years of living with disabilities. The aim of this study was to describe whether or not there are gender differences in the demographic profile, disease distribution and outcome in a population of hospitalized elderly people.

METHODS

Retrospective observational study including all patients recruited for the REPOSI study in the year 2010. Analyses are referred to the whole group and gender categorization was applied.

RESULTS

A total of 1380 hospitalized elderly subjects, 50.5% women and 49.5% men, were considered. Women were older than men, more often widow and living alone or in nursing homes. Disease distribution showed that malignancy, diabetes, coronary artery disease, chronic kidney disease and chronic obstructive pulmonary disease were more frequent in men, but hypertension, osteoarthritis, anemia and depression were more frequent in women. Severity and comorbidity indexes according to the Cumulative Illness Rating Scale (CIRS-s and CIRS-c) were higher in men, while cognitive impairment evaluated by the Short Blessed Test (SBT), mood disorders by the Geriatric Depression Scale (GDS) and disability in daily life measured by Barthel Index (BI) were worse in women. In-hospital and 3-month mortality rates were higher in men.

CONCLUSIONS

Our study showed a gender dimorphism in the demographic and morbidity profiles of hospitalized elderly people, emphasizing once more the need for a personalized process of healthcare.

[Gender-specific aspects of coronary heart disease]

The total number of deaths from cardiovascular diseases (CVD) is greater for women than for men, although the mean age at manifestation of CVD is about 10 years older. However, the annual number of cases treated for CVD in acute hospital settings in men exceeds that of women by 50 %. Remarkable gender differences exist in terms of morphological and physiological conditions (e.g. mean coronary vessel diameter; ability to adapt to protective exercise-induced myocardial hypertrophy), as well as of the frequency and clinical significance of somatic risk factors (e.g. smoking). Female body weight increases after menopause and the body shape assumes a more android fat distribution. Women report higher levels of unspecific and affective symptoms. They suffer more from anxiety and depression than men; however, the secondary impact on CVD onset may be less pronounced. The post-acute CVD course is more complicated in women, mainly because they are older and suffer more from multi-morbidity. Whilst male CVD patients aim for a rapid recovery, physical fitness and an increased life expectancy, female patients seek relief from everyday challenges, the maintenance of their independence and emotional support.

Psychometric analysis of the short-form UCLA Loneliness Scale (ULS-6) in older adults

The aim of this investigation was to present new empirical evidence regarding the psychometric properties of the short-form UCLA Loneliness Scale (ULS-6) among Portuguese older people. The study included 1,154 persons (60 % women and 40 % men), aged 60-90 (M = 71.26; SD = 6.66). The psychometric properties of the ULS-6 were analysed by means of confirmatory factor analysis, internal consistency, and criterion-related validity methods. Confirmatory factor analysis supported a unidimensional structure of the measure with adequate values of various fit indices. The ULS-6 presented satisfactory psychometric properties, with a high level of internal consistency. Furthermore, the ULS-6 showed a negative relationship with self-esteem, satisfaction with life, and positive affect; and a positive one with negative affect. The results confirm that the ULS-6 provides a brief, psychometrically sound measure of loneliness that is appropriate for use among older adults.

Social Relationships and Health: The Toxic Effects of Perceived Social Isolation

Research in social epidemiology suggests that the absence of positive social relationships is a significant risk factor for broad-based morbidity and mortality. The nature of these social relationships and the mechanisms underlying this association are of increasing interest as the population gets older and the health care costs associated with chronic disease escalate in industrialized countries. We review selected evidence on the nature of social relationships and focus on one particular facet of the connection continuum - the extent to which an individual feels isolated (i.e., feels lonely) in a social world. Evidence indicates that loneliness heightens sensitivity to social threats and motivates the renewal of social connections, but it can also impair executive functioning, sleep, and mental and physical well-being. Together, these effects contribute to higher rates of morbidity and mortality in lonely older adults.

Social Relationships and Health: The Toxic Effects of Perceived Social Isolation

Research in social epidemiology suggests that the absence of positive social relationships is a significant risk factor for broad-based morbidity and mortality. The nature of these social relationships and the mechanisms underlying this association are of increasing interest as the population gets older and the health care costs associated with chronic disease escalate in industrialized countries. We review selected evidence on the nature of social relationships and focus on one particular facet of the connection continuum - the extent to which an individual feels isolated (i.e., feels lonely) in a social world. Evidence indicates that loneliness heightens sensitivity to social threats and motivates the renewal of social connections, but it can also impair executive functioning, sleep, and mental and physical well-being. Together, these effects contribute to higher rates of morbidity and mortality in lonely older adults.