Alcohol Use, Pain, and Subjective Cognitive Decline as Predictors of Loneliness in Adults: Evidence from the Health and Retirement Study

Loneliness is a psychosocial stressor related to cognitive and physical health, consistent with biopsychosocial and social-cognitive theories (Holt‐Lunstad, 2024). Chronic pain can increase isolation, and subjective cognitive decline (SCD) may heighten perceived vulnerability, reducing confidence in social engagement (Karayannis et al., 2019). Loneliness may, in turn, contribute to maladaptive coping strategies, including excessive alcohol use (Canham et al., 2016). Here, we examined how pain and SCD interact to predict loneliness and assessed the role of drinking patterns when identifying factors relevant to harm reduction. Data were drawn from cognitively intact older adults (50+) with pain in the Health and Retirement Study (HRS, 2020; N=1,389), with data on loneliness, alcohol use, pain severity, and cognitive complaints. A generalized linear model predicted loneliness from age, gender, race/ethnicity, education, pain severity, SCD, pain×SCD interaction, and alcohol use (non-drinker, moderate, excessive). The model was significant (p<.0001; R²=.059). Excessive drinkers reported lower loneliness than non-drinkers (β=-0.28, p=.008), whereas moderate drinkers did not differ. Pain predicted higher loneliness (β=0.10, p=.001), with effects amplified among adults with SCD (interaction β=0.12, p=.04; slope with SCD β=0.22, p<.0001). Age and education were protective. Hispanic adults reported higher loneliness. Results suggest adults experiencing pain and SCD are at heightened risk for loneliness and may use alcohol to cope. Excessive drinking may reflect participation in socially dense contexts, buffering loneliness. Findings support interventions targeting pain management, cognitive health, and social-connectedness, alongside harm-reduction strategies offering substance-free social opportunities. These results integrate evidence-based frameworks to inform prevention and intervention in vulnerable adult populations.
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