The Relationship of Loneliness to End-of-Life Experience in Older Americans: A Cohort Study

TitleThe Relationship of Loneliness to End-of-Life Experience in Older Americans: A Cohort Study
Publication TypeJournal Article
Year of Publication2020
AuthorsAbedini, NC, Choi, H, Wei, MY, Langa, KM, Chopra, V
JournalJournal of the American Geriatrics SocietyJournal of the American Geriatrics SocietyJ Am Geriatr Soc
Type of ArticleJournal
ISBN Number0002-8614
KeywordsAdvance care planning, aggressive care, end of life, Loneliness, symptoms

OBJECTIVES Little is known about the relationship between loneliness and end-of-life (EOL) experience including symptom burden, intensity of care, and advance care planning among older adults. DESIGN Secondary analysis of the Health and Retirement Study (HRS). SETTING Population based. PARTICIPANTS Decedents older than 50?years who died between 2004 and 2014 (n = 8700). Exclusions included those who were ineligible for surveys assessing loneliness (n = 2932) or had missing or incomplete loneliness or symptom data (n = 2872). MEASUREMENTS Individuals were characterized as lonely based on responses to the three-item Revised University of California, Los Angeles Loneliness Scale in the most recent HRS survey before death. Outcomes were proxy reports of total EOL symptom burden, intensity of EOL care (eg, late hospice enrollment, place of death, hospitalizations, use of life support), and advance care planning. Results were expressed as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). RESULTS One-third of 2896 decedents (n = 942) were lonely. After adjusting for demographics, socioeconomic status, multimorbidity, depressive symptoms, family and friends, and social support, loneliness was independently associated with increased total symptom burden at EOL (ß = .13; P =?.004). Compared with nonlonely individuals, lonely decedents were more likely to use life support in the last 2?years of life (35.5% vs 29.4%; aOR = 1.36; 95% CI = 1.08-1.71) and more likely to die in a nursing home (18.4% vs 14.2%; aOR = 1.78; 95% CI = 1.30-2.42). No significant differences in other measures of intense care (late hospice enrollment, number of hospitalizations, or dialysis use) or likelihood of advance care planning were observed. CONCLUSION Lonely older people may be burdened by more symptoms and may be exposed to more intense EOL care compared with nonlonely people. Interventions aiming to screen for, prevent, and mitigate loneliness during the vulnerable EOL period are necessary.


doi: 10.1111/jgs.16354

Short TitleJournal of the American Geriatrics Society
Citation Key10669
PubMed ID32128789
Grant List1-R18-HS-025891-01 / / Agency for Healthcare Research and Quality /
K01 AG057820 / AG / NIA NIH HHS / United States
P30 AG053760 / AG / NIA NIH HHS / United States
P30 AG024824 / AG / NIA NIH HHS / United States
K01AG057820 / AG / NIA NIH HHS / United States
/ / Department of Veterans Affairs HSR&D /
K23 AG056638 / AG / NIA NIH HHS / United States
U01 AG009740 / AG / NIA NIH HHS / United States
K23AG056638 / AG / NIA NIH HHS / United States
I01 HX001101-01 / / Health Services Research and Development /