Prevalence and associated factors of incident and persistent loneliness among middle-aged and older adults in Thailand

Exploring the Association Between Loneliness, Subjective Cognitive Decline, and Quality of Life Among Older Thai Adults: A Convergent Parallel Mixed-Method Study

Examining the rising prevalence of subjective cognitive decline as an early indicator of dementia in adults, this study investigates its complex interaction with loneliness and quality of life in individuals with preclinical dementia. Using a convergent parallel mixed-method approach, we employed Structural Equation Modeling on a cohort of 149 older adults. Qualitative insights were derived from focused group discussions and in-depth semi-structured interviews with a cohort of 23 older adults. Loneliness emerges as a pivotal contributor, exerting a discernible partial indirect effect on quality of life through subjective cognitive decline (indirect effect = -0.145, p = .006). Noteworthy differentials surfaced, with the impact of subjective cognitive decline on quality of life heightened in those with chronic diseases (△χ2 = 6.139, p = .013). Loneliness, wielding a palpable impact, intricately interlaces with quality of life, the nexus of which is intricately mediated by subjective cognitive decline.

Multiple long-term conditions, loneliness and social isolation: A scoping review of recent quantitative studies

BACKGROUND

Multiple long-term conditions (MLTC), loneliness and social isolation are common in older adults. Recent studies have explored the association of MLTC with loneliness and social isolation. This scoping review aimed to map this current evidence and identify gaps in the literature.

METHODS

A scoping review was conducted following the PRISMA guidelines for scoping reviews. Ovid Medline, Embase, CINAHL, The Cochrane Library, PsycInfo, and Bielefeld Academic Search Engine were searched for studies published between January 2020-April 2023. Quantitative studies, published in any language, that assessed the association of MLTC with loneliness and/or social isolation were included.

RESULTS

1827 records were identified and screened. Of these, 17 met inclusion criteria. Most studies were cross-sectional and based on older adults. Studies were conducted in Europe, the US, Canada, and low- and middle-income countries. Ten studies focused on the association between MLTC and loneliness, six assessed the association between MLTC and social isolation and one examined associations with both loneliness and social isolation. Most studies reported a significant cross-sectional association of MLTC with loneliness, but there was weaker evidence for a longitudinal association between MLTC and loneliness and an association between MLTC and social isolation. Studies were heterogenous in terms of measures and definitions of loneliness/social isolation and MLTC, confounders adjusted for, and analytical models used, making comparisons difficult.

CONCLUSIONS

Further population-based longitudinal studies using consistent measures and methodological approaches are needed to improve understanding of the association of MLTC with both loneliness and social isolation.

Experiences of loneliness in lower- and middle-income countries: A systematic review of qualitative studies

Loneliness is understood as a subjective experience resulting from unmet social relationship expectations. As most loneliness research has been conducted in higher-income-countries, there is limited understanding of loneliness in relation to diverse cultural, economic, and socio-political factors. To address this gap, the present review systematically synthesises existing qualitative studies on the experience of loneliness and social relationship expectations in lower- and middle-income countries (LMICs). Between June and July 2022, six online databases (Embase, Ovid Medline, APA PsycINFO, Global Health, Web of Science, Google Scholar) were searched for peer-reviewed studies from LMICs on loneliness using qualitative methods. There were no restrictions on publication date, language, or study setting. Studies that solely focused on social isolation or were conducted with children (<16 years) were excluded. Risk of bias was assessed with the Critical Appraisal Skills Programme. After deduplication, a total of 7866 records were identified and screened for inclusion, resulting in 24 studies published between 2002 and 2022. The included studies represent data from 728 participants in 15 countries across West Africa (Ghana, Nigeria, Niger, Mali), East Africa (Uganda, Kenya), North Africa (Egypt), West Asia (Iran), South Asia (India, Pakistan, Sri Lanka) and Southeast Asia (Myanmar, Cambodia, Indonesia, Philippines). Data were analysed combining inductive and deductive coding, summarised using narrative synthesis, and examined by geographical region. Common features of loneliness included rejection, overthinking, and pain. Loneliness was related to depression across regions. Whereas loneliness tended to be distinguished from social isolation in studies from Africa, it tended to be related with being alone in studies from Asia. Poverty and stigma were common barriers to fulfilling social relationship expectations. This review illustrates how loneliness and expectations are contextually embedded, with some expectations possibly being specific to a certain culture or life stage, having implications for assessment of and interventions for loneliness worldwide.

Longitudinal associations of loneliness with mental ill-health, physical ill-health, lifestyle factors and mortality in ageing adults in Thailand

OBJECTIVES

The aim of this study was to assess the longitudinal association between loneliness, mental and physical ill-health indicators, lifestyle factors and mortality among middle-aged and older adults in Thailand.

METHODS

We analyzed prospective cohort data of participants 45 years and older from three consecutive waves in 2015 (n = 5616), 2017 (n = 3600), and in 2020 (n = 2863) of the Health, Aging and Retirement in Thailand (HART) study. Loneliness was assessed with a single item. To assess the longitudinal associations between loneliness and health outcomes between 2015 (baseline), 2017 (first follow-up) and 2020 (second follow-up), we conducted Generalized Estimating Equations analysis (GEE).

RESULTS

The proportion of loneliness was 21.6% in 2015, 23.8% in 2017 and 21.3% in 2020. In the adjusted GEE logistic regression model, loneliness was positively associated with mental ill-health (poor self-rated mental health status, poor quality of life/happiness, depressive symptoms, and insomnia symptoms), physical ill-health (poor self-rated physical health status, hypertension, kidney disease, osteoporosis, and ADL disability), and lifestyle factors (physical inactivity, and having underweight). Furthermore, in adjusted Cox proportional hazards regression, loneliness was associated with mortality. In adjusted logistic regression, compared to without loneliness in all three study waves, having loneliness in one wave and/or two to three waves was positively associated with incident mental ill-health (incident poor self-rated mental health status, incident poor quality of life/happiness, incident depressive symptoms, and incident insomnia symptoms), incident physical ill-health (incident poor self-rated physical health status, incident diabetes, incident kidney disease, and incident ADL disability), and incident lifestyle factors (having incident underweight).

CONCLUSION

We found that loneliness was associated with several mental and physical ill-health indicators, lifestyle factors and mortality. Enhanced screening and treatment of loneliness may reduce mental and physical ill-health indicators in Thailand.