Are loneliness and social isolation risk factors for ill health?

Introduction: Social relationships are increasingly being acknowledged as determinants of wellbeing and health in later life. We know that people who feel lonely – i.e. who are unhappy about their relationships – or who are socially isolated – i.e. have few ties or contacts with others – are more likely to experience early death. Whether they are at greater risk of morbidity is unclear. Aim: This thesis examines whether loneliness and social isolation are risk factors for developing ill health, with a primary focus on incident cardiovascular disease (CVD). The aim is to gauge the potential health gain from tackling loneliness and social isolation. Methods: Four pieces of empirical research make up the main body of my thesis. First, I designed a novel framework for distinguishing between measures of loneliness and social isolation. I then systematically reviewed the evidence from longitudinal observational studies on loneliness, social isolation and incident CVD. I studied changes in loneliness and social isolation over time in the English Longitudinal Study of Ageing (ELSA), a cohort of adults aged over 50 years old. Finally, I investigated associations between loneliness and social isolation over time, and incident CVD. Results: My systematic review found that loneliness and social isolation were associated with a 29% increase in risk of incident coronary heart disease (relative risk: 1.29, 95% CI 1.04 to 1.59) and a 32% increase in risk of stroke (relative risk: 1.32, 95% CI 1.04 to 1.68). Among ELSA participants, patterns of social relationships varied substantially over time, both within and between individuals. In survival analyses of ELSA data, loneliness but not social isolation was identified as a risk factor for incident CVD. Conclusions: Weaker social relationships are risk factors for developing CVD. Intervening to tackle loneliness and social isolation has the potential to improve health outcomes in later life

Loneliness as a risk factor for care home admission in the English Longitudinal Study of Ageing

Background: loneliness has an adverse effect on health and well-being, and is common at older ages. Evidence that it is a risk factor for care home admission is sparse. Objective: to investigate the association between loneliness and care home admission. Setting: English Longitudinal Study of Ageing (ELSA). Participants: two-hundred fifty-four individuals across seven waves (2002-15) of ELSA who moved into care homes were age, sex matched to four randomly selected individuals who remained in the community. Methods: logistic regression models examined associations between loneliness, socio-demographic factors, functional status and health on moving into care homes. Results: loneliness (measured by the University of California, Los Angeles (UCLA) Loneliness Scale and a single-item question from the Center for Epidemiological Studies Depression Scale (CES-D)) was associated with moving into a care home (CES-D OR 2.13, 95% CI 1.43-3.17, P = 0.0002, UCLA OR 1.81, 95% CI 1.01-3.27, P = 0.05). The association persisted after adjusting for established predictors (age, sex, social isolation, depression, memory problems including diagnosis of Alzheimer's disease, disability, long-term physical health and wealth). The impact of loneliness (measured by CES-D) on admission accounted for a population attributable fraction of 19.9% (95% CI 7.8-30.4%). Conclusions: loneliness conveys an independent risk of care home admission that, unlike other risk factors, may be amenable to modification. Tackling loneliness amongst older adults may be a way of enhancing wellbeing and delaying or reducing the demand for institutional care

Older adults’ social relationships and health care utilization:A systematic review

Background. Deficiencies in older people’s social relationships (including loneliness, social isolation, and low social support) have been implicated as a cause of premature mortality and increased morbidity. Whether they affect service use is unclear. Objectives. To determine whether social relationships are associated with older adults’ use of health services, independently of health-related needs. Search Methods. We searched 8 electronic databases (MEDLINE, Embase, CINAHL, Web of Science, PsycINFO, Scopus, the Cochrane Library, and the Centre for Reviews and Dissemination) for data published between 1983 and 2016. We also identified relevant sources from scanning the reference lists of included studies and review articles, contacting authors to identify additional studies, and searching the tables of contents of key journals. Selection Criteria. Studies met inclusion criteria if more than 50% of participants were older than 60 years or mean age was older than 60 years; they included a measure of social networks, received social support, or perceived support; and they reported quantitative data on the association between social relationships and older adults’ health service utilization. Data Collection and Analysis. Two researchers independently screened studies for inclusion. They extracted data and appraised study quality by using standardized forms. In a narrative synthesis, we grouped the studies according to the outcome of interest (physician visits, hospital admissions, hospital readmissions, emergency department use, hospital length of stay, utilization of home- and community-based services, contact with general health services, and mental health service use) and the domain of social relationships covered (social networks, received social support, or perceived support). For each service type and social relationship domain, we assessed the strength of the evidence across studies according to the quantity and quality of studies and consistency of findings. Main Results. The literature search retrieved 26 077 citations, 126 of which met inclusion criteria. Data were reported across 226 678 participants from 19 countries. We identified strong evidence of an association between weaker social relationships and increased rates of readmission to hospital (75% of high-quality studies reported evidence of an association in the same direction). In evidence of moderate strength, according to 2 high-quality and 3 medium-quality studies, smaller social networks were associated with longer hospital stays. When we considered received and perceived social support separately, they were not linked to health care use. Overall, the evidence did not indicate that older patients with weaker social relationships place greater demands on ambulatory care (including physician visits and community- or home-based services) than warranted by their needs. Authors’ Conclusions. Current evidence does not support the view that, independently of health status, older patients with lower levels of social support place greater demands on ambulatory care. Future research on social relationships would benefit from a consensus on clinically relevant concepts to measure. Public Health Implications. Our findings are important for public health because they challenge the notion that lonely older adults are a burden on all health and social care services. In high-income countries, interventions aimed at reducing social isolation and loneliness are promoted as a means of preventing inappropriate service use. Our review cautions against assuming that reductions in care utilization can be achieved by intervening to strengthen social relationships