Loneliness and health: potential mechanisms

Health Factors as Potential Mediators of the Longitudinal Effect of Loneliness on General Cognitive Ability

OBJECTIVE

Higher levels of loneliness in older adulthood predict cognitive decline, but research on mediating mechanisms is sparse. We examine multisystemic physiological risk, functional ability, self-rated health, depressive symptoms, and social participation as mediating processes for the association between loneliness and general cognitive ability over a 10-year follow-up in an older adult sample.

METHODS

Three waves of data from 3,005 individuals (mean intake age: 69.30 (SD: 7.85) years; female = 51.61%) recruited during Wave 1 of the National Social Life, Health, and Aging Project were used to test whether hypothesized mediators collected at the 5-year follow-up explained effects of baseline loneliness on 10-year general cognitive ability.

RESULTS

The relationship between baseline loneliness and 10-year general cognitive ability was not mediated by multisystemic physiological risk. Functional ability (b = -0.24, SE = 0.05, p <0.001), self-rated health (b = -0.08, SE = 0.02, p <0.001), depressive symptoms (b= -0.20, SE = 0.05, p <0.001), and social participation (b = -0.03, SE = 0.01, p = 0.016) significantly mediated effects. Indirect effects remained significant after adjusting for demographic covariates and 5-year general cognitive ability, except social participation.

DISCUSSION

Loneliness may influence cognitive ability indirectly, signaling waning physical and psychiatric health more proximally correlated with cognitive ability. These mechanisms may serve as targets of intervention for cognitive maintenance in lonely older adults.

The Current State of HIV and Aging: Findings Presented at the 10th International Workshop on HIV and Aging

With increasing effectiveness of antiretroviral therapy, people with HIV (PWH) are living longer and the prevalence of older PWH continues to increase. Accordingly, PWH are experiencing an increased burden of age-related comorbidities. With this shifting demographics, clinicians and researchers face additional challenges in how to identify, address, and manage the complex intersections of HIV- and aging-related conditions. Established in 2009, the International Workshop on HIV and Aging brings together clinicians and researchers in cross-disciplinary fields along with community advocates and PWH to address the multidisciplinary nature of HIV and aging. This article summarizes plenary talks from the 10th Annual International Workshop on HIV and Aging, which took place in New York City on October 10 and 11, 2019. Presentation topics included the following: the burdens of HIV-associated comorbidities, aging phenotypes, community engagement, and loneliness; these issues are especially important for older PWH, considering the current COVID-19 pandemic. We also discuss broad questions and potential directions for future research necessary to better understand the interaction between HIV and aging.

Social Isolation and Loneliness in Older Adults: Review and Commentary of a National Academies Report

The authors of this review both served on the National Academy of Science, Engineering, and Medicine Committee that produced the report, "Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System." In 2018, the AARP Foundation commissioned the National Academies to establish a committee to research and develop a report on social isolation and loneliness in persons 50 years of age and older. Emphasis was placed upon the role of the healthcare system in addressing this fundamental public health problem. The committee released the report in February 2020 as the Corona Virus Disease 2019 pandemic was beginning to spread to North America. In this review, the authors share central findings and conclusions from the report as well as how these findings may be relevant to the care and well-being of older adults during this historic pandemic. The health protective benefits of social distancing must be balanced by the essential need for sustaining social relationships.

COVID-19: A Psychosocial Perspective

The World Health Organization declares coronavirus disease 2019 (COVID-19) as a pandemic, and The World Economic Forum argues that the COVID-19-induced global lockdown is the biggest psychological experiment. This study is an attempt to empirically evaluate the possible adverse psychosocial effects caused by COVID-19-related lockdown, if any. To do so, a cross-sectional study is conducted based on a comprehensive online survey using snowball sampling to analyze the level of social and psychological impacts (i.e., stress, belief in stakeholders, fear of losing job, and life satisfaction) during the early stage of the outbreak in Pakistan. The questionnaire is filled out by the residents in Pakistan including working professionals and students (sample size is 428). We find that the development of stress due to COVID-19-induced lockdown is particularly because of mood swings. Additionally, a higher prevalence of stress in the children of highly educated mothers is evident (95% confidence). To assess the belief in stakeholders, we focus gender, demographics, and education. It is observed that parental education and age significantly affect the belief in several stakeholders (i.e., government, media, religious clerics, and family). The lockdown-induced fear of losing job is lower in female and male children whose fathers are graduates. Lastly, we observe that food storage and "no fear of losing job" significantly increases the odds of life satisfaction. These findings have important implications in the context of social insurance, parental education, and policy related to COVID-19 at various levels. This study further facilitates to understand the factors that might affect the mental health and life satisfaction of people during such pandemics.

Nonverbal Immediacy Mediates the Relationship Between Interpersonal Motives and Belongingness

While belongingness is a predictor of mental and physical health, the lack of social bonds is an issue for many people in occidental countries. This issue calls for global and affordable solutions. In this study, we notably investigated (a) the presumed positive relationships between agentic and communal interactional motives and belongingness, and (b) the mediating role of self-reported non-verbal immediacy-an indicator of availability to interact-in these relationships. Cross-sectional and longitudinal data were collected by means of questionnaires to test these hypotheses (N Crossectional = 344; N Longitudinal = 126) using the General Belongingness Scale, the Non-verbal Immediacy Scale, and the Bem Sex Role Inventory. Results supported the hypotheses: Interpersonal motives and non-verbal immediacy are associated cross-sectionally to belongingness, non-verbal immediacy mediates the interpersonal motives-belongingness relationship and positive changes in non-verbal immediacy are also related to increased belongingness. Practical and research implications are discussed.

Mental Health, Sense of Coherence, and Interpersonal Violence during the COVID-19 Pandemic Lockdown in Germany

Preliminary data indicates that the Coronavirus SARS-CoV-2 disease (COVID-19) pandemic may have a substantial impact on mental health and well-being. We assessed mental health in response to the lockdown in Germany between 1 April 2020 and 15 April 2020 using a cross-sectional online survey (n = 3545) with a mixed-methods approach. We found increased levels of psychosocial distress (Patient Health Questionnaire (PHQ) stress module), anxiety, depressive symptoms (PHQ-4), irritability, and a decrease in overall well-being (WHO-Five Well-Being Index (WHO-5)), sense of coherence (Short Form of the Sense of Coherence Scale (SOC-L9)), sexual contentment, and sleep quality. The four-week-prevalence of interpersonal violence was yet at 5% and included verbal, physical, and sexual violence. Participants reported finding comfort in family, friends, conversation, exercise, and activity. Findings are also in line with research showing that women seem to have more trouble coping with the pandemic and lockdown measures. Our observations demonstrate that the COVID-19 pandemic and related measures lead to a mental health burden even in a highly developed Western country and should, therefore, be taken seriously. The findings for interpersonal violence are alarming. Thus, we should sharpen our focus on the matter and activate and enhance supporting systems to help protect those affected.

Differentiating objective and subjective dimensions of social isolation and apprasing their relations with physical and mental health in italian older adults

Background

International research shows that social isolation is harmful for health, especially for the elderly. Its objective and subjective dimensions are important to distinguish as each stands in a different relation with health. The first aim of the present study is the validation of three scales measuring objective and subjective isolation in an Italian elderly population. The second aim is to analyze subjective and objective social isolation and to appraise their association with health among seniors.

Methods

This cross-sectional survey collected data from 306 over 65 s participants. Questionnaires were administered face-to-face by one author and encompassed: social disconnectedness scale; perceived isolation scale; abbreviated Lubben Social Network Scale; measures of general and mental health, and depression.

Results

The three scales measuring social isolation demonstrated acceptable psychometric properties and validity. Objective and subjective social isolation were not directly associated with physical health, whereas subjective isolation is strongly linked to worse mental health and depression. Higher level of subjective isolation was associated with lower level of physical health through the mediation of mental health. Subjective isolation served as a mediator in the relation between objective isolation and health. Moderation analysis demonstrated that low values of objective isolation predicted high values of mental health but only when subjective isolation was low. None of these relations were moderated by socio-demographic variables.

Conclusion

Subjective and objective isolation are clearly two separate dimensions and the scales validated in this paper showed to be potentially culturally invariant. Researchers should work to find instruments able to depict the complexity of the construct of social isolation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-020-01864-6.

Predictors of Loneliness by Age Decade: Study of Psychological and Environmental Factors in 2,843 Community-Dwelling Americans Aged 20-69 Years

OBJECTIVE

Loneliness is a prevalent and serious public health problem due to its effects on health, well-being, and longevity. Understanding correlates of loneliness is critical for guiding efforts toward the development of evidence-based strategies for prevention and intervention. Considering that patterns of association between age and loneliness vary, the present study sought to examine age-related differences in risk and protective factors for loneliness.

METHODS

Correlates of loneliness were examined through a large web-based survey of 2,843 participants (aged 20-69 years) from across the United States from April 10, 2019, through May 10, 2019. Participants completed the 4-item UCLA Loneliness Scale, San Diego Wisdom Scale (with the following subscales measuring components of wisdom: Prosocial Behaviors, Emotional Regulation, Self-Reflection, Acceptance of Divergent Values, Decisiveness, and Social Advising), and other scales measuring psychosocial variables. Multivariate regression analyses were conducted to identify the best model of loneliness and examine potential age-related differences.

RESULTS

Age demonstrated a nonlinear quadratic relationship with loneliness (Wald statistic = 5.48, P = .019); levels were highest in the 20s and lowest in the 60s with another peak in the mid-40s. Across all decades, loneliness was associated with not having a spouse or partner (P < .001), sleep disturbance (P < .02), lower prosocial behaviors (P < .001), and smaller social network (P < .001). Lower social self-efficacy (P < .001) and higher anxiety (P < .005) were associated with worse loneliness in all age decades, except the 60s. Loneliness was uniquely associated with decisiveness in the 50s (P = .012) and with education (P = .046) and memory complaints (P = .013) in the 60s.

CONCLUSIONS

Our findings identify several potentially modifiable targets related to loneliness, including several aspects of wisdom and social self-efficacy. Differential predictors at different decades suggest a need for a personalized and nuanced prioritizing of prevention and intervention targets.

Teacher support and the social classroom environment as predictors of student loneliness

This study examined the relationships between students’ perceptions of teacher support, the social classroom environment, school loneliness, and possible gender differences among 2099 first year upper secondary school students in Norway. Data were collected in the fall (t1) and spring (t2) of the school year. Results from structural equation modelling (SEM) analyses showed that perceived emotional and instrumental teacher support were directly related to students’ perceptions of the social classroom environment, and indirectly to student loneliness through the social classroom environment. While for boys, both types of teacher support were significantly related to these variables, only emotional teacher support was of significance to girls. The strongest contributing factor to students’ school loneliness was their perceptions of the social classroom environment. Some implications of this study are that a positive social classroom environment is an important safeguard against student loneliness, and that teachers can aid in preventing loneliness among students through facilitating a positive social environment in the class.

Correlation Between Aspects of Perceived Patient Loneliness and Spinal Cord Stimulation Outcomes

OBJECTIVES

Loneliness as a whole has been characterized as a health-related risk factor and is associated with worse outcomes after cardiac procedures. Evidence suggests that chronic pain patients are particularly vulnerable to feeling lonely. We examined the relationship between different aspects of loneliness and one-year postoperative outcomes after spinal cord stimulation (SCS) for chronic pain.

MATERIALS AND METHODS

We contacted 69 patients with thoracic SCS who had participated in our prospective outcomes database with one-year follow-up to complete the validated, abbreviated UCLA Loneliness Scale (UCLA-3). We examined responses on question 9 of the Oswestry Disability Index (ODI), question 12 of the Beck Depression Inventory (BDI), and UCLA-3 due to their relevance to different aspects of loneliness. We conducted regression analyses to determine the relationship between aspects of loneliness and pain outcomes.

RESULTS

We identified that loss of interest in people, companionship, and feeling excluded were associated with pain outcomes. Loss of interest in people was associated with improvement in pain (NRS worst p = 0.021, r = 0.32, NRS least p = 0.004, r = 0.4; NRS right now p = 0.016, r = 0.33). Companionship and feeling excluded were also associated with pain. We examined the interface between depression and total loneliness and found that while both were related to each other, depression was not associated with pain outcomes.

CONCLUSIONS

This study demonstrates an association between loss of interest in people, companionship, and feeling excluded and worse postoperative pain outcomes after receiving SCS. It identifies aspects of loneliness as important factors to consider when predicting the outcomes of SCS therapy for chronic pain control.

Social Isolation and Loneliness Among San Francisco Bay Area Older Adults During the COVID-19 Shelter-in-Place Orders

BACKGROUND/OBJECTIVES

Physical distancing during the COVID‐19 pandemic may have unintended, detrimental effects on social isolation and loneliness among older adults. Our objectives were to investigate (1) experiences of social isolation and loneliness during shelter‐in‐place orders, and (2) unmet health needs related to changes in social interactions.

DESIGN

Mixed‐methods longitudinal phone‐based survey administered every 2 weeks.

SETTING

Two community sites and an academic geriatrics outpatient clinical practice.

PARTICIPANTS

A total of 151 community‐dwelling older adults.

MEASUREMENTS

We measured social isolation using a six‐item modified Duke Social Support Index, social interaction subscale, that included assessments of video‐based and Internet‐based socializing. Measures of loneliness included self‐reported worsened loneliness due to the COVID‐19 pandemic and loneliness severity based on the three‐item University of California, Los Angeles (UCLA) Loneliness Scale. Participants were invited to share open‐ended comments about their social experiences.

RESULTS

Participants were on average aged 75 years (standard deviation = 10), 50% had hearing or vision impairment, 64% lived alone, and 26% had difficulty bathing. Participants reported social isolation in 40% of interviews, 76% reported minimal video‐based socializing, and 42% minimal Internet‐based socializing. Socially isolated participants reported difficulty finding help with functional needs including bathing (20% vs 55%; P = .04). More than half (54%) of the participants reported worsened loneliness due to COVID‐19 that was associated with worsened depression (62% vs 9%; P < .001) and anxiety (57% vs 9%; P < .001). Rates of loneliness improved on average by time since shelter‐in‐place orders (4–6 weeks: 46% vs 13–15 weeks: 27%; P = .009), however, loneliness persisted or worsened for a subgroup of participants. Open‐ended responses revealed challenges faced by the subgroup experiencing persistent loneliness including poor emotional coping and discomfort with new technologies.

CONCLUSION

Many older adults are adjusting to COVID‐19 restrictions since the start of shelter‐in‐place orders. Additional steps are critically needed to address the psychological suffering and unmet medical needs of those with persistent loneliness or barriers to technology‐based social interaction.

"My own corner of loneliness:" Social isolation and place among Mexican immigrants in Arizona and Turkana pastoralists of Kenya

This article explores the intersection of two growing health concerns: the rising incidence of loneliness and the negative health impacts of migration and displacement. To better evaluate loneliness across diverse populations, we emphasize the cultural shaping of expectations for social lives and the ways in which structural vulnerability and violence can undermine these expectations. We draw on ethnographic research with two groups of migrants: Mexican immigrants living in southern Arizona and Turkana pastoralists of Kenya who experience displacement and unpredictable mobility as a result of low intensity violence. For Mexican immigrants, feelings of loneliness intertwine with the emotions of fear, trauma, and sadness, all closely associated with social isolation. The Turkana describe loneliness associated with the loss of their animals, or the shifting social landscapes they must traverse to keep their families safe. The culturally salient experiences described by these two communities highlight the complexity of defining loneliness. Given the pace of global migration and the number of refugees and displaced persons, closer scrutiny of how cultural expectations and structural violence interact to produce feelings of loneliness seems overdue.

Psychological predictors of loneliness among Palestinian university students in the West Bank

The purpose of this study was to examine the predictive role of life satisfaction, perceived social support, and psychological problems on loneliness among Palestinian university students in the West Bank. Participants were 254 volunteer undergraduate students (50.4% males and 49.6% females), ranging from 18 to 26 years of age. Data was collected using the Loneliness Scale (UCLA), Satisfaction with Life Scale (SWLS), Multidimensional Scale of Perceived Social Support (MSPSS), Psychological Problems Scale and a Demographic Information Form. There was a significant gender bias towards loneliness, male students being lonelier than female students. Results showed that students who had higher loneliness, felt less satisfied with their life and perceived less support from friends, family and significant others. Furthermore, students who had high loneliness also presented more psychological problems. These results also indicated that, after accounting for psychological problems, life satisfaction, and social support from friends and significant others are negative predictors of loneliness. These findings suggest that universities should create strategies to improve well-being and social support to protect students from the negative effects of loneliness.

Big smile, small self: Awe walks promote prosocial positive emotions in older adults

Aging into later life is often accompanied by social disconnection, anxiety, and sadness. Negative emotions are self-focused states with detrimental effects on aging and longevity. Awe-a positive emotion elicited when in the presence of vast things not immediately understood-reduces self-focus, promotes social connection, and fosters prosocial actions by encouraging a "small self." We investigated the emotional benefits of a novel "awe walk" intervention in healthy older adults. Sixty participants took weekly 15-min outdoor walks for 8 weeks; participants were randomly assigned to an awe walk group, which oriented them to experience awe during their walks, or to a control walk group. Participants took photographs of themselves during each walk and rated their emotional experience. Each day, they reported on their daily emotional experience outside of the walk context. Participants also completed pre- and postintervention measures of anxiety, depression, and life satisfaction. Compared with participants who took control walks, those who took awe walks experienced greater awe during their walks and exhibited an increasingly "small self" in their photographs over time. They reported greater joy and prosocial positive emotions during their walks and displayed increasing smile intensity over the study. Outside of the walk context, participants who took awe walks reported greater increases in daily prosocial positive emotions and greater decreases in daily distress over time. Postintervention anxiety, depression, and life satisfaction did not change from baseline in either group. These results suggest cultivating awe enhances positive emotions that foster social connection and diminishes negative emotions that hasten decline. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Impact of Stress and Loneliness on Health-Related Quality of Life Among Low Income Senior African Americans

Low income senior African Americans are at risk for low health-related quality of life (HRQoL). Loneliness may exacerbate the effects of stress on health. The purpose of this study was to examine the impact of perceived stress and loneliness on the HRQoL of low income senior African Americans (N = 281). Results indicate that loneliness may exacerbate the inverse relationship of perceived stress with psychological HRQoL among this sample. Additionally, both loneliness and perceived stress were associated with poorer physical HRQoL. The present study has implications for interventions seeking to improve HRQoL among a similar sample of senior adults given that loneliness is a modifiable variable.

Social isolation and vulnerability to heatwave-related mortality in the urban elderly population: A time-series multi-community study in Korea

Although several studies have reported that social isolation is one of the important health risk factors in the elderly population living in urban areas, its effects on vulnerability to heatwaves have been studied relatively less than climatic and other socio-economic factors. Thus, we investigated the association between social isolation levels and heatwave-related mortality risk in the elderly population in 119 urban administrative districts in Korea, using a time-series multi-city dataset (2008-2017). We used a two-stage analysis. In the first stage, we estimated the heatwave-related mortality risk in the elderly population (age ≥ 65) for each district using a time-series regression with a distributed lag model. Subsequently, in the second stage, we applied meta-regressions to pool the estimates across all the districts and estimate the association between social isolation variables and heatwave-related mortality risk. Our findings showed that higher social gathering and mutual aid levels were associated with lower heatwave-related mortality risk. Further, the lower percentage of single elderly households living in detached houses was also related to higher heatwave-related mortality risk. The associations were generally more evident in males compared to females. Our findings suggest that vulnerability to heatwave-related mortality among the urban, city-dwelling, elderly population may be amplified by higher isolation indicators.

Loneliness as a risk factor for frailty transition among older Chinese people

Background

Previous literature has reported that loneliness is a strong predictor of frailty risk. However, less is known about the role of loneliness in frailty transition types. This study aimed to examine whether and how loneliness are related to frailty transition among older Chinese people.

Methods

Our study used participants (aged ≥60 years) from 2008/2009, 2011/2012 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Loneliness was assessed by a single question asking how often the respondent feels lonely. The FRAIL Scale was created to measure physical frailty for our study, and frailty was also assessed by a broader definition of the frailty index. Frailty transition as an outcome variable has been designed as two types according to the measurement of frailty.

Results

Greater loneliness at baseline reduced the possibility of remaining in a robust or prefrail physical frailty state after 3 years (OR = 0.78, 95%CI: 0.68–0.91, p < 0.01). Greater loneliness was associated with an increased risk of worsening physical frailty over time: compared with those who had never felt lonely, the odds ratios for people who often felt lonely were 1.19 (95%CI: 1.01–1.41, p < 0.05) after 3 years and 1.34 (95%CI: 1.08–1.66, p < 0.01) after 6 years. The association between loneliness and change in the frailty index differed in the survey periods: loneliness at baseline was found to increase the possibility of participants remaining in frailty (seldom loneliness: OR = 1.78, 95%CI: 1.25–2.55, p < 0.01; often loneliness: OR = 1.74, 95%CI: 1.21–2.50, p < 0.01) after 6 years, but no significance was shown in the 3-year follow up. Additionally, loneliness at baselines was significantly associated with frailty transition at follow up among the male participants. However, a similar association was not observed among the female participants.

Conclusion

Older people with a high level of loneliness tend to be frail in the future, and greater loneliness is related to an increased risk of worsening frailty and remaining frail. Male elderly with a high level of loneliness were more likely to have a worse frailty transition than female elderly in China.

Robotic transformative service research: deploying social robots for consumer well-being during COVID-19 and beyond

Purpose

Besides the direct physical health consequences, through social isolation COVID-19 affects a considerably larger share of consumers with deleterious effects for their psychological well-being. Two vulnerable consumer groups are particularly affected: older adults and children. The purpose of the underlying paper is to take a transformative research perspective on how social robots can be deployed for advancing the well-being of these vulnerable consumers and to spur robotic transformative service research (RTSR).

Design/methodology/approach

This paper follows a conceptual approach that integrates findings from various domains: service research, social robotics, social psychology and medicine.

Findings

Two key findings advanced in this paper are (1) a typology of robotic transformative service (i.e. entertainer, social enabler, mentor and friend) as a function of consumers' state of social isolation, well-being focus and robot capabilities and (2) a future research agenda for RTSR.

Practical implications

This paper guides service consumers and providers and robot developers in identifying and developing the most appropriate social robot type for advancing the well-being of vulnerable consumers in social isolation.

Originality/value

This study is the first to integrate social robotics and transformative service research by developing a typology of social robots as a guiding framework for assessing the status quo of transformative robotic service on the basis of which it advances a future research agenda for RTSR. It further complements the underdeveloped body of service research with a focus on eudaimonic consumer well-being.

Subjective ratings of emotive stimuli predict the impact of the COVID-19 quarantine on affective states

The COVID-19 crisis resulted in a large proportion of the world's population having to employ social distancing measures and self-quarantine. Given that limiting social interaction impacts mental health, we assessed the effects of quarantine on emotive perception as a proxy of affective states. To this end, we conducted an online experiment whereby 112 participants provided affective ratings for a set of normative images and reported on their well-being during COVID-19 self-isolation. We found that current valence ratings were significantly lower than the original ones from 2015. This negative shift correlated with key aspects of the personal situation during the confinement, including working and living status, and subjective well-being. These findings indicate that quarantine impacts mood negatively, resulting in a negatively biased perception of emotive stimuli. Moreover, our online assessment method shows its validity for large-scale population studies on the impact of COVID-19 related mitigation methods and well-being.

Age differences in demographic, social and health-related factors associated with loneliness across the adult life span (19-65 years): a cross-sectional study in the Netherlands

BACKGROUND

Recognition of loneliness as a health concern among adults stresses the need to understand the factors associated with loneliness. Research into factors of influence in the various phases of the adult life span (19-65 years) is scarce. Therefore, the associations between demographic, social and health-related factors and loneliness among young (19-34 years), early middle-aged (35-49 years) and late middle-aged adults (50-65 years) were explored.

METHODS

A secondary analysis with a large cross-sectional dataset was performed. Data was collected from September to December 2016 in the Netherlands, by a self-report survey. Loneliness was measured using the De Jong-Gierveld Loneliness Scale. In total, 26,342 adults (19-65 years) participated (response rate: 34%). Multiple logistic regression analyses were performed to examine associations between demographic, social and health-related factors as independent variables, and loneliness as dependent variable among the three age groups.

RESULTS

Prevalence of loneliness among young, early and late middle-aged adults was 39.7, 43.3 and 48.2%, respectively. Living alone, frequency of neighbour contact, perceived social exclusion, psychological distress, psychological and emotional wellbeing were consistently associated with loneliness across the groups. The association between ethnicity and loneliness was stronger among young and early middle-aged adults, compared to late middle-aged adults. Young adults showed the strongest association between contact frequency with friends and loneliness. The strength of association between financial imbalance and loneliness gradually decreased from young to late middle-aged adults. Educational level was associated with loneliness among young adults only, while an association between employment status and loneliness was found solely among early middle-aged adults. For late middle-aged adults only, perceived health was associated with loneliness. Frequency of family contact was associated with loneliness, only among early and late middle-aged adults.

CONCLUSION

This study indicates that factors associated with loneliness across the adult life span may be understood from an age-normative life-stage perspective. Accordingly, there is no one-size-fits-all approach to reduce loneliness among adults, suggesting that a variety of interventions or an indirect approach may be necessary. Future research should focus on causal relations between factors and loneliness in different age groups, using a longitudinal research-design with, preferably, an even broader set of factors.

Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis

BACKGROUND

Research indicates that social isolation and loneliness increase the risk of mental disorders, but less is known about the distinct contributions of different aspects of isolation. We aimed to distinguish the pathways through which social disconnectedness (eg, small social network, infrequent social interaction) and perceptions of social isolation (eg, loneliness, perceived lack of support) contribute to anxiety and depression symptom severity in community-residing older adults aged 57-85 years at baseline.

METHODS

We did a longitudinal mediation analysis with data from the National Social Life, Health, and Aging Project (NSHAP). The study included individuals from the USA born between 1920 and 1947. Validated measures on social disconnectedness, perceived isolation, and depression and anxiety symptoms were used. Structural equation modelling was used to construct complete longitudinal path models.

FINDINGS

Using data from 3005 adults aged 57-85 years, we identified two significant longitudinal mediation patterns with symptoms of depression, and two with anxiety symptoms. Overall, social disconnectedness predicted higher subsequent perceived isolation (β=0·09; p<0·0001), which in turn predicted higher depression symptoms (β=0·12; p<0·0001) and anxiety symptoms (β=0·12; p<0·0001). The reverse pathways were statistically supported as well, suggesting bi-directional influences.

INTERPRETATION

Social network structure and function are strongly intertwined with anxiety and depression symptoms in the general population of older adults. Public health initiatives could reduce perceived isolation by facilitating social network integration and participation in community activities, thereby protecting against the development of affective disorders.

FUNDING

Nordea-fonden.

Surrendering to social emptiness: Chronic social exclusion longitudinally predicts resignation in asylum seekers

The current knowledge of the long-term consequences of social exclusion mostly relies on theoretical assumptions. (Williams, 2009, Adv. Exp. Soc. Psychol., 41, 275) hypothesized that chronic ostracism drives individuals into a stage of resignation (depression, alienation, unworthiness, helplessness). We focused on asylum seekers (N = 112) as a social group at risk of experiencing prolonged instances of exclusion. Applying a three-wave longitudinal design with a three-month interval between each wave, we sought to advance the knowledge of the temporal development of chronic social exclusion. Cross-lagged panel analyses showed that social exclusion influenced the development of feelings of resignation in the long term, from baseline to six months and between three and six months. In the same time frame, the perception of social exclusion became stable and chronic. These findings provide empirical evidence that chronic exclusion predicts resignation and shed light on the temporal development of the detrimental impact that pervasive exclusion can have on people belonging to marginalized social groups.

Neuroendocrine mechanisms of grief and bereavement: A systematic review and implications for future interventions

Bereavement is associated with many negative behavioural, psychological and physiological consequences and leads to an increased risk of mortality and morbidity. However, studies specifically examining neuroendocrine mechanisms of grief and bereavement have yet to be reviewed. This systematic review is a synthesis of the latest evidence in this field and aims to draw conclusions about the implications of neurobiological findings on the development of new interventions. PRISMA guidelines for systematic reviews were used to search for articles assessing neuroendocrine correlates of grief. Findings were qualitatively summarised. The National Heart, Lung, and Blood Institute Study Assessment Tool was used to assess the quality of the included studies. Out of 460 papers, 20 met the inclusion criteria. However, most were of fair quality only. As a neuroendocrine marker, the majority of the studies reported cortisol as the outcome measure and found elevated mean cortisol levels, flattened diurnal cortisol slopes and higher morning cortisol in bereaved subjects. Cortisol alterations were moderated by individual differences such as emotional reaction to grief, depressive symptoms, grief severity, closeness to the deceased and age or gender. Research on neuroendocrine mechanisms of grief is still in its early stages regarding grief measures and the use and timing of neuroendocrine assessments. Most of the studies focus on cortisol as outcome, and only limited data exist on other biomarkers such as oxytocin. Future research might consider assessing a broader range of neuroendocrine markers and use longitudinal designs with a focus on the psychobiological reactions to loss. Based on this, individually tailored psychosocial interventions, possibly in the palliative care context, might be developed to prevent prolonged grief disorder.

Loneliness and Health: The Moderating Effect of Cross-Cultural Individualism/Collectivism

Objectives: The adverse health effects of loneliness are well documented, but less is known about cultural moderators of this relationship. Contributing to the literature, we examined whether cross-cultural differences in individualism moderate the effect of loneliness on health. Methods: We used population-based longitudinal data of 14 countries (N = 40,797), as provided by the Survey of Health, Ageing, and Retirement in Europe data. Multilevel regression analyses were employed. Moderating effects were analyzed for multiple health outcomes: activities of daily living, instrumental activities of daily living, grip strength, life satisfaction, depression, memory performance, verbal fluency, and numeracy. Results: Cultural individualism significantly moderated the effect of loneliness on health regarding most health outcomes. In general, the effect of loneliness on health became stronger in less individualistic/more collectivistic countries. Discussion: Cultural individualism proved to be one important moderator of the loneliness-health relationship. As previous studies mostly used samples from highly individualistic countries, the current literature might severely underestimate the global public health burden of loneliness.

One Month into the Reinforcement of Social Distancing due to the COVID-19 Outbreak: Subjective Health, Health Behaviors, and Loneliness among People with Chronic Medical Conditions

We sought to examine how the near-lockdown measures, announced by the Israeli government in an effort to contain the COVID-19 outbreak, impacted the self-rated health (SRH), health behaviors, and loneliness of people with chronic illnesses. An online cross-sectional survey was carried out about one month (April 20-22, 2020) after the Israeli government reinforced the severe social distancing regulations, among a convenience sample of 315 participants (60% women) with chronic conditions (27% metabolic, 17% cardiovascular, 21% cancer/autoimmune, 18% orthopedic/pain, 12% mental-health). Results suggested that about half of the participants reported a decline in physical or mental SRH, and as many as two-thirds reported feeling lonely. A significant deterioration in health behaviors was reported, including a decrease in vegetable consumption (p = 0.008) and physical activity (p < 0.001), an increase in time spent on social media (p < 0.001), and a perception among about half of the participants that they were eating more than before. Ordinal regression suggested that a decline in general SRH was linked with female gender (p = 0.016), lack of higher education (p = 0.015), crowded housing conditions (p = 0.001), longer illness duration (p = 0.010), and loneliness (p = 0.008). Findings highlight the important role of loneliness in SRH during the COVID-19 lockdown period. Future studies are warranted to clarify the long-term effects of social-distancing and loneliness on people with chronic illnesses.

The role of oxidative stress in cardiovascular disease caused by social isolation and loneliness

Loneliness and social isolation are common sources of chronic stress in modern society. Epidemiological studies have demonstrated that loneliness and social isolation increase mortality risk as much as smoking or alcohol consumption and more than physical inactivity or obesity. Loneliness in human is associated with higher blood pressure whereas enhanced atherosclerosis is observed in animal models of social isolation. Loneliness and social isolation lead to activation of the hypothalamic-pituitary-adrenocortical (HPA) axis, enhanced sympathetic nerve activity, impaired parasympathetic function and a proinflammatory immune response. These mechanisms have been implicated in the development of cardiovascular disease conferred by social isolation although a causal relationship has not been established so far. There is evidence that oxidative stress is likely to be a key molecular mechanism linking chronic psychosocial stress to cardiovascular disease. NADPH oxidase-mediated oxidative stress in the hypothalamus has been shown to be required for social isolation-induced HPA axis activation in socially isolated rats. Oxidative stress in the rostral ventrolateral medulla is also a key regulator of sympathetic nerve activity. In the vasculature, oxidative stress increases vascular tone and promote atherogenesis through multiple mechanisms. Thus, preventing oxidative stress may represent a therapeutic strategy to reduce the detrimental effects of social stress on health.

Loneliness and Telomere Length: Immune and Parasympathetic Function in Associations With Accelerated Aging

BACKGROUND

Lonely people's heightened risks for chronic health conditions and early mortality may emerge in part through cellular aging. Lonelier people have more severe sympathetic responses to acute stress, increasing their risk for herpesvirus reactivation, a possible path to shorter telomeres. Parasympathetic function may modulate this risk.

PURPOSE

The current study aimed to examine the associations among loneliness, herpesvirus reactivation, and telomere length, with parasympathetic activity as a moderator, in healthy middle-aged and older adults.

METHODS

A sample of 113 healthy men and women of ages 40-85 provided blood samples that were assayed for telomere length, as well as the latent herpesviruses cytomegalovirus (CMV) and Epstein-Barr virus (EBV). They also provided heart rate variability (HRV), a measure of parasympathetic activity, and reported on their feelings of loneliness.

RESULTS

Lonelier people with lower HRV (i.e., lower parasympathetic activity) had greater CMV reactivation and shorter telomeres compared with their less lonely counterparts, above and beyond demographics, health behaviors, resting heart rate, and social network size. However, loneliness was not associated with viral reactivation or telomere length among those with higher HRV. In turn, greater CMV and EBV reactivation was associated with shorter telomeres.

CONCLUSIONS

Taken together, these data implicate parasympathetic function in novel links between loneliness and accelerated cellular aging.

Understanding loneliness in the twenty-first century: an update on correlates, risk factors, and potential solutions

PURPOSE

Loneliness is increasingly recognised as the next critical public health issue. A plausible reason for this concern may be related to emerging societal trends affecting the way we relate, communicate, and function in our social environment. In 2006, a prominent review of the clinical significance of loneliness was published. However, there has not been a comprehensive update on known and emerging risk factors and correlates of loneliness since then. Furthermore, there is no conceptual model that has been developed to better account for the complexity of loneliness and to inform the development of evidence-based solutions as we challenge the issues of the twenty-first century.

METHODS

We reviewed the current literature to identify either known or emerging risk factors and correlates of loneliness since 2006. This includes new or known evidence on: (1) demography; (2) health, including physical health; mental health; cognitive health; brain, biology, and genetics; and (3) socio-environmental factors including digital communication and the workplace.

RESULTS

We synthesized the literature according to a new proposed conceptual model of loneliness which showed the interplay between known and emerging correlates and risk factors from demography, health, to socio-environmental factors. In the conceptual model of loneliness, we illustrated how solutions can be delivered and tailored to an individual based on their life circumstances and preferences.

CONCLUSION

We concluded by making specific recommendations in advancing our scientific understanding of loneliness. Our knowledge can only be deepened if we increase scientific rigour via accounting for confounding variables and using longitudinal, multi-disciplinary, and multiple methodologies in research. We also call for the rigorous evaluation of programs targeting loneliness.

The effectiveness of interventions for reducing subjective and objective social isolation among people with mental health problems: a systematic review

PURPOSE

Subjective and objective social isolation are important factors contributing to both physical and mental health problems, including premature mortality and depression. This systematic review evaluated the current evidence for the effectiveness of interventions to improve subjective and/or objective social isolation for people with mental health problems. Primary outcomes of interest included loneliness, perceived social support, and objective social isolation.

METHODS

Three databases were searched for relevant randomised controlled trials (RCTs). Studies were included if they evaluated interventions for people with mental health problems and had objective and/or subjective social isolation (including loneliness) as their primary outcome, or as one of a number of outcomes with none identified as primary.

RESULTS

In total, 30 RCTs met the review's inclusion criteria: 15 included subjective social isolation as an outcome and 11 included objective social isolation. The remaining four evaluated both outcomes. There was considerable variability between trials in types of intervention and participants' characteristics. Significant results were reported in a minority of trials, but methodological limitations, such as small sample size, restricted conclusions from many studies.

CONCLUSION

The evidence is not yet strong enough to make specific recommendations for practice. Preliminary evidence suggests that promising interventions may include cognitive modification for subjective social isolation, and interventions with mixed strategies and supported socialisation for objective social isolation. We highlight the need for more thorough, theory-driven intervention development and for well-designed and adequately powered RCTs.

Why Loneliness Interventions Are Unsuccessful: A Call for Precision Health

Background

Loneliness has drawn increasing attention over the past few decades due to rising recognition of its close connection with serious health issues, like dementia. Yet, researchers are failing to find solutions to alleviate the globally experienced burden of loneliness.

Purpose

This review aims to shed light on possible reasons for why interventions have been ineffective. We suggest new directions for research on loneliness as it relates to precision health, emerging technologies, digital phenotyping, and machine learning.

Results

Current loneliness interventions are unsuccessful due to (i) their inconsideration of loneliness as a heterogeneous construct and (ii) not being targeted at individuals' needs and contexts. We propose a model for how loneliness interventions can move towards finding the right solution for the right person at the right time. Taking a precision health approach, we explore how transdisciplinary research can contribute to creating a more holistic picture of loneliness and shift interventions from treatment to prevention.

Conclusions

We urge the field to rethink metrics to account for diverse intra-individual experiences and trajectories of loneliness. Big data sharing and evolving technologies that emphasize human connection raise hope for realizing our model of precision health applied to loneliness. There is an urgent need for precise, integrated, and theory-driven interventions that focus on individuals' needs and the subjective burden of loneliness in the ageing context.

Review of the Association Between Number of Social Roles and Cardiovascular Disease: Graded or Threshold Effect?

OBJECTIVE

There is increasing evidence for an inverse association between the number of social roles (e.g., spouse, friend, and neighbor) we engage in and our risk of disease, especially cardiovascular disease (CVD). Two mechanistic models have been proposed to explain this association. The social integration model refers to a graded association where every additional social role is associated with an increase in resistance to disease. The social isolation model refers to a threshold effect where the lack of a minimal criterion number of roles increases risk of disease.

METHODS

We conducted a systematic review of prospective studies examining the association between number of social roles and CVD risk.

RESULTS

When we include all studies assessing number of social roles, irrespective of whether associations are attributable to graded effects (social integration) and threshold effects (social isolation) or cannot be determined by the data presented, those holding fewer social roles were found to be at greater risk of CVD incidence, CVD mortality (evidence stronger for men than women), and greater progression of disease (only for short [≤5 years] follow-ups). However, closer analyses indicate that the association between a greater number of social roles and decreased CVD incidence was attributable to graded effects among men but to both effects among women. In contrast, the association of number of social roles and disease progression was driven by threshold effects (social isolation) for both sexes, whereas mortality studies included evidence for both effects.

CONCLUSIONS

These results suggest underlying mechanisms linking social roles to different CVD outcomes.

Absence and Presence of Human Interaction: The Relationship Between Loneliness and Empathy

Loneliness is the negative experience of a discrepancy between the desired and actual personal network of relationships. Whereas past work have focused on the effect of loneliness on prosocial behaviors, the present research addressed the gap by exploring the effect of loneliness on empathy. Empathy is the emotional reaction of sharing in others' internal experiences. We adopted a new paradigm-empathy selection task, which uses free choices to assess the desire to empathize. Participants made a series of binary choices, selecting situations that instructed them to empathize or objectively describe. Results from two studies showed that, compared to non-lonely people, lonely people were more likely to choose positive empathy but to avoid negative empathy. The pattern occurs because lonely people perceived higher (vs. lower) social support in the positive (vs. negative) empathy tasks. Moreover, empathy served to be an adaptive emotion regulation strategy developed by lonely people to reduce their loneliness effectively. This research has resulted in both theoretical contributions to prosocial behavior literature and the further discovery of practical implications for loneliness intervention.

Motivation and preference in isolation: a test of their different influences on responses to self-isolation during the COVID-19 outbreak

This multi-wave study examined the extent that both preference and motivation for time alone shapes ill-being during self-isolation. Individuals in the USA and the UK are self-isolating in response to the COVID-19 outbreak. Different motivations may drive their self-isolation: some might see value in it (understood as the identified form of autonomous motivation), while others might feel forced into it by authorities or close others (family, friends, neighbourhoods, doctors; the external form of controlled motivation). People who typically prefer company will find themselves spending more time alone, and may experience ill-being uniformly, or as a function of their identified or external motivations for self-isolation. Self-isolation, therefore, offers a unique opportunity to distinguish two constructs coming from disparate literatures. This project examined preference and motivation (identified and external) for solitude, and tested their independent and interacting contributions to ill-being (loneliness, depression and anxiety during the time spent alone) across two weeks. Confirmatory hypotheses regarding preference and motivation were not supported by the data. A statistically significant effect of controlled motivation on change in ill-being was observed one week later, and preference predicted ill-being across two weeks. However, effect sizes for both were below our minimum threshold of interest.

Predicting Loneliness from Where and What People Do

The many devastating mental health outcomes associated with chronic loneliness is the motivation behind research into examining personal and demographic characteristics of the lonely. The present study sought to examine the connection of where people live (degree of urbanization) and what people do (leisure activities) with self-report of loneliness in a large sample (N = 8356) of unrelated Dutch adults. Information regarding where people live and what they do in their leisure time was entered into a regression analysis for self-reported loneliness. The overall regression was significant and accounted for 2.8% of the loneliness scale scores. Significant independent predictors for loneliness were living in heavily urbanized areas and engaging in fewer social activities. People who went sightseeing or to amusement parks/zoos or who participated in clubs reported being less lonely. Spending time using a computer predicted higher self-report loneliness scores. Consistent with previous research, after controlling for other variables, gender was not a significant predictor of loneliness but both a younger age and a curvilinear or U-shaped curve of age predicted loneliness (the younger and the much older). The results suggest that meaningful interpersonal interactions may result in lower feelings of loneliness.

Loneliness and sleep: A systematic review and meta-analysis

Despite the mounting evidence linking loneliness with health, the mechanisms underlying this relationship remain obscure. This systematic review and meta-analysis on the association between loneliness and one potential mechanism—sleep—identified 27 relevant articles. Loneliness correlated with self-reported sleep disturbance (r = .28, 95% confidence interval (.24, .33)) but not duration, across a diverse set of samples and measures. There was no evidence supporting age or gender as moderators or suggesting publication bias. The longitudinal relationship between loneliness and sleep remains unclear. Loneliness is related to sleep disturbance, but research is necessary to determine directionality, examine the influence of other factors, and speak to causality.

Social isolation, loneliness, socioeconomic status, and health-risk behaviour in deprived neighbourhoods in Denmark: A cross-sectional study

The importance of social isolation and loneliness on our health is widely recognised in previous research. This study compares loneliness in deprived neighbourhood with that in the general population. It further examines whether social isolation and loneliness are associated with health-risk behaviours (including low intake of fruit or vegetables, daily smoking, high-risk alcohol intake, and physical inactivity and their co-occurrence) in deprived neighbourhoods, and whether social isolation and loneliness modify the associations between socioeconomic status and health-risk behaviours. Cross-sectional data from 5113 residents of 12 deprived neighbourhoods in Denmark were analysed using multiple logistic regression. Data on 14,686 individuals from the nationally representative Danish Health and Morbidity Survey 2010 were used as a comparison group with regard to loneliness. Cohabitation status, frequency of meeting with family and friends, participation in voluntary work were used as an indicator to measure social isolation. A question on feeling often unwillingly alone was used as an indicator to measure loneliness. Compared with the general population, residents of deprived neighbourhoods had higher odds of loneliness. Both social isolation and loneliness were significantly associated with higher odds of health-risk behaviour. When social isolation and loneliness were combined with low socioeconomic status, strong associations with health-risk behaviours were found. Social isolation and loneliness did not significantly modify the associations between socioeconomic status and health-risk behaviour. The findings in this study have important implications for the future planning of health promotion intervention programmes aimed to reduce health-risk behaviour in deprived neighbourhoods.

Self-disgust, loneliness and mental health outcomes in older adults: An eye-tracking study

BACKGROUND

Self-disgust has been associated with loneliness and mental health difficulties in clinical and non-clinical populations, but there is limited research on the role of self-disgust in loneliness and mental health outcomes in older adults.

METHODS

In Study 1 (N = 102; M age = 68.4 years, SD = 10.9, 68% females) we used a cross-sectional survey to explore the association between loneliness, self-disgust and mental health outcomes. In Study 2 (N = 80; M age = 68.8 years, SD = 11.4, 57% females) we used eye-tracking to investigate attentional vigilance, maintenance and avoidance in individuals with high (vs. low) self-disgust.

RESULTS

In study 1 we found that self-disgust mediated the associations of loneliness with anxiety and depressive symptoms, and in study 2 it was demonstrated that older adults with high (vs. low) self-disgust displayed attentional avoidance to their own faces, compared to the faces of unknown others, a process that may perpetuate loneliness.

LIMITATIONS

The cross-sectional design used in Study 1 limits our potential to make causal inferences. Additionally, both studies included a wide age range of older adults.

CONCLUSIONS

Our findings are novel and highlight the importance of self-disgust experiences in the context of loneliness and mental health outcomes in older adults. Implications for practice and interventions against loneliness in this age group are discussed.

Chronic social isolation exerts opposing sex-specific consequences on serotonin neuronal excitability and behaviour

Social isolation raises the risk for mood disorders associated with serotonergic disruption. Yet, the underlying mechanisms by which the stress of social isolation increases risk are not well understood. Men and women are differently vulnerable; however, this modulating role of sex is challenging to study in humans under carefully controlled conditions. Therefore, we investigated this question in mice of both sexes, asking how the long-term stress of social isolation (from weaning into adulthood) affects the excitability of serotonin neurons in the dorsal raphe nucleus as well as mouse behaviour. The electrophysiological experiments and the first set of behavioural tests were conducted in young adult mice, with additional behavioural assays completed as the mice matured to assess the stability of their behavioural phenotype. We found that social isolation exerted seemingly-opposite effects in male and female mice, relative to their respective group-housed littermate controls. This distinctive pattern was observed for the effect of social isolation on the control of serotonergic neuron excitability via the SK family of calcium-activated potassium channels. Furthermore, we observed a similar and consistent pattern on tests relevant to assessing the efficacy of anti-depressant medicines, including the forced swim test, the novelty-suppressed feeding test, and the sucrose preference test. These findings underscore the concept that stress-elicited illness manifests distinctly in males and females and that treatments aimed at restoring serotonergic function may require a sex-specific approach. This article is part of the special issue entitled 'Serotonin Research: Crossing Scales and Boundaries'.

The Association of Loneliness and Non-prescribed Opioid Use in Patients With Opioid Use Disorder

OBJECTIVE

To investigate the relationship between loneliness and non-prescribed opioid use in patients diagnosed with opioid use disorder (OUD).

METHODS

This was a cohort study conducted at a federally qualified health center (FQHC) in New Haven, CT. Patients who were treated for OUD by health center providers and prescribed buprenorphine were eligible. Participants were asked to complete the UCLA-Loneliness Scale Version 3. From the electronic medical record, we collected patient demographic and clinical characteristics as well as the results of biological fluid testing obtained throughout their treatment course since entry into care. Multivariable logistic regression was performed to identify independent predictors of the detection of non-prescribed opioids within biological fluid.

RESULTS

Of the 82 patients enrolled in the study, 33 (40.3%) of the participants had at least 1 biological fluid test positive for non-prescribed opioids after maintenance onto buprenorphine treatment. A higher loneliness score was associated with increased odds of non-prescribed opioids (adjusted odds ratio 1.16; 95% confidence interval 1.06-1.27). Patient age, the number of problems on the problems list, and cocaine use were also positively associated with the presence of non-prescribed opioids whereas having diabetes was negatively associated.

CONCLUSIONS

Among the individuals being treated with buprenorphine for OUD, loneliness may be a risk factor for the use of non-prescribed opioids or treatment failure.

Effects of participating in community assets on quality of life and costs of care: longitudinal cohort study of older people in England

OBJECTIVES

Improving outcomes for older people with long-term conditions and multimorbidity is a priority. Current policy commits to substantial expansion of social prescribing to community assets, such as charity, voluntary or community groups. We use longitudinal data to add to the limited evidence on whether this is associated with better quality of life or lower costs of care.

DESIGN

Prospective 18-month cohort survey of self-reported participation in community assets and quality of life linked to administrative care records. Effects of starting and stopping participation estimated using double-robust estimation.

SETTING

Participation in community asset facilities. Costs of primary and secondary care.

PARTICIPANTS

4377 older people with long-term conditions.

INTERVENTION

Participation in community assets.

PRIMARY AND SECONDARY OUTCOME MEASURES

Quality-adjusted life years (QALYs), healthcare costs and social value estimated using net benefits.

RESULTS

Starting to participate in community assets was associated with a 0.017 (95% CI 0.002 to 0.032) gain in QALYs after 6 months, 0.030 (95% CI 0.005 to 0.054) after 12 months and 0.056 (95% CI 0.017 to 0.094) after 18 months. Cumulative effects on care costs were negative in each time period: £-96 (95% CI £-512 to £321) at 6 months; £-283 (95% CI £-926 to £359) at 12 months; and £-453 (95% CI £-1366 to £461) at 18 months. The net benefit of starting to participate was £1956 (95% CI £209 to £3703) per participant at 18 months. Stopping participation was associated with larger negative impacts of -0.102 (95% CI -0.173 to -0.031) QALYs and £1335.33 (95% CI £112.85 to £2557.81) higher costs after 18 months.

CONCLUSIONS

Participation in community assets by older people with long-term conditions is associated with improved quality of life and reduced costs of care. Sustaining that participation is important because there are considerable health changes associated with stopping. The results support the inclusion of community assets as part of an integrated care model for older patients.

Loneliness and sleep in older adults

PURPOSE

The present analysis aims to examine if loneliness is associated with sleep problems and duration over a 4-year period in a sample of older adults aged 50 years and over.

METHODS

Data on loneliness, sleep duration, sleep problems and covariates were obtained from 5698 participants from the English Longitudinal Study of Ageing at baseline (wave 4) and follow up (wave 6).

RESULTS

Following adjustment for covariates, baseline loneliness was associated with an increase in the odds of reporting short sleep, and more sleep problems at follow up.

CONCLUSIONS

Short sleep may represent an important mechanism through which loneliness affects health.