@article {11749, title = {The epidemiology of social isolation and loneliness among older adults during the last years of life.}, journal = {Journal of the American Geriatrics Society}, volume = {69}, year = {2021}, pages = {3081-3091}, abstract = {

BACKGROUND: Social isolation and loneliness are critical to the health of older adults, but they have not been well-described at the end of life.

OBJECTIVES: To determine the prevalence and correlates of social isolation and loneliness among older adults in the last years of life.

DESIGN: Nationally representative, cross-sectional survey.

SETTING: Health and Retirement Study, 2006-2016 data.

PARTICIPANTS: Adults age > 50 interviewed once in the last 4 years of life (n~=~3613).

MEASUREMENTS: We defined social isolation using a 15-item scale measuring household contacts, social network interaction, and community engagement, and frequent loneliness using the 3-item UCLA Loneliness Scale. We used multivariable logistic regression to determine their adjusted prevalence by time prior-to-death and by subgroups of interest.

RESULTS: Approximately 19\% experienced social isolation, 18\% loneliness, and 5\% both in the last 4 years of life (correlation~=~0.11). The adjusted prevalence of social isolation was higher for individuals nearer to death (4 years: 18\% vs 0-3 months: 27\%, p~=~0.05) and there was no significant change in loneliness (4 years: 19\% vs 0-3 months: 23\%, p~=~0.13). Risk factors for both isolation and loneliness included (p < 0.01): low net-worth (Isolation: 34\% vs 14\%; Loneliness: 29\% vs 13\%), hearing impairment (Isolation: 26\% vs 20\%; Loneliness: 26\% vs 17\%), and difficulty preparing meals (Isolation: 27\% vs 19\%; Loneliness: 29\% vs 15\%). Factors associated with loneliness, but not social isolation, included being female, pain, incontinence, and cognitive impairment.

CONCLUSIONS: Social isolation and loneliness are common at the end of life, affecting 1 in 4 older adults, but few experience both. Rates were higher for older adults who were poor and experienced functional or sensory impairments. Results can inform clinical efforts to identify and address end-of-life psychosocial suffering and health policies which prioritize social needs at the end of life.

}, keywords = {Cognition, end of life, Loneliness, Palliative care, social isolation}, issn = {1532-5415}, doi = {10.1111/jgs.17366}, author = {Ashwin A Kotwal and Irena Cenzer and Linda J. Waite and Kenneth E Covinsky and Perissinotto, Carla M and W John Boscardin and Louise C Hawkley and Dale, William and Smith, Alexander K} } @article {7692, title = {Loneliness, health, and mortality in old age: a national longitudinal study.}, journal = {Soc Sci Med}, volume = {74}, year = {2012}, month = {2012 Mar}, pages = {907-14}, publisher = {74}, abstract = {

This study examined the relationship between loneliness, health, and mortality using a U.S. nationally representative sample of 2101 adults aged 50 years and over from the 2002 to 2008 waves of the Health and Retirement Study. We estimated the effect of loneliness at one point on mortality over the subsequent six years, and investigated social relationships, health behaviors, and health outcomes as potential mechanisms through which loneliness affects mortality risk among older Americans. We operationalized health outcomes as depressive symptoms, self-rated health, and functional limitations, and we conceptualized the relationships between loneliness and each health outcome as reciprocal and dynamic. We found that feelings of loneliness were associated with increased mortality risk over a 6-year period, and that this effect was not explained by social relationships or health behaviors but was modestly explained by health outcomes. In cross-lagged panel models that tested the reciprocal prospective effects of loneliness and health, loneliness both affected and was affected by depressive symptoms and functional limitations over time, and had marginal effects on later self-rated health. These population-based data contribute to a growing literature indicating that loneliness is a risk factor for morbidity and mortality and point to potential mechanisms through which this process works.

}, keywords = {Aged, Aged, 80 and over, Aging, Cohort Studies, depression, Female, Health Behavior, Health Status, Humans, Interpersonal Relations, Loneliness, Longitudinal Studies, Male, Middle Aged, Mortality, Social Support, Socioeconomic factors, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2011.11.028}, url = {http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2601961601andFmt=7andclientId=17822andRQT=309andVName=PQD}, author = {Ye Luo and Louise C Hawkley and Linda J. Waite and John T. Cacioppo} } @article {7117, title = {Loneliness as a specific risk factor for depressive symptoms: cross-sectional and longitudinal analyses.}, journal = {Psychol Aging}, volume = {21}, year = {2006}, month = {2006 Mar}, pages = {140-51}, publisher = {21}, abstract = {

The extent to which loneliness is a unique risk factor for depressive symptoms was determined in 2 population-based studies of middle-aged to older adults, and the possible causal influences between loneliness and depressive symptoms were examined longitudinally in the 2nd study. In Study 1, a nationally representative sample of persons aged 54 and older completed a telephone interview as part of a study of health and aging. Higher levels of loneliness were associated with more depressive symptoms, net of the effects of age, gender, ethnicity, education, income, marital status, social support, and perceived stress. In Study 2, detailed measures of loneliness, social support, perceived stress, hostility, and demographic characteristics were collected over a 3-year period from a population-based sample of adults ages 50-67 years from Cook County, Illinois. Loneliness was again associated with more depressive symptoms, net of demographic covariates, marital status, social support, hostility, and perceived stress. Latent variable growth models revealed reciprocal influences over time between loneliness and depressive symptomatology. These data suggest that loneliness and depressive symptomatology can act in a synergistic effect to diminish well-being in middle-aged and older adults.

}, keywords = {Aged, Cross-Sectional Studies, depression, Female, Follow-Up Studies, Health Status, Hostility, Humans, Loneliness, Male, Middle Aged, Risk Factors, Severity of Illness Index, Social Support, Stress, Psychological, Surveys and Questionnaires}, issn = {0882-7974}, doi = {10.1037/0882-7974.21.1.140}, author = {John T. Cacioppo and Mary Elizabeth Hughes and Linda J. Waite and Louise C Hawkley and Ronald A. Thisted} } @inbook {5202, title = {Integrating Biology into the Study of Health Disparities}, booktitle = {Aging, Health, and Public Policy: Demographic and Economic Perspectives}, series = {Population and Development Review}, volume = {30}, year = {2005}, note = {ProCite field 6 : In ProCite field 8 : ed.}, pages = {89-107}, publisher = {Population Council}, organization = {Population Council}, address = {New York}, keywords = {Methodology}, author = {Eileen M. Crimmins and Teresa Seeman}, editor = {Linda J. Waite} } @article {6954, title = {A Short Scale for Measuring Loneliness in Large Surveys: Results From Two Population-Based Studies.}, journal = {Res Aging}, volume = {26}, year = {2004}, month = {2004}, pages = {655-672}, publisher = {26}, abstract = {

Most studies of social relationships in later life focus on the amount of social contact, not on individuals{\textquoteright} perceptions of social isolation. However, loneliness is likely to be an important aspect of aging. A major limiting factor in studying loneliness has been the lack of a measure suitable for large-scale social surveys. This article describes a short loneliness scale developed specifically for use on a telephone survey. The scale has three items and a simplified set of response categories but appears to measure overall loneliness quite well. The authors also document the relationship between loneliness and several commonly used measures of objective social isolation. As expected, they find that objective and subjective isolation are related. However, the relationship is relatively modest, indicating that the quantitative and qualitative aspects of social relationships are distinct. This result suggests the importance of studying both dimensions of social relationships in the aging process.

}, issn = {1552-7573}, doi = {10.1177/0164027504268574}, author = {Mary Elizabeth Hughes and Linda J. Waite and Louise C Hawkley and John T. Cacioppo} }