A new study has found that for older adults receiving in-home care, loneliness doesn’t increase the risk of death. The findings contradict much of the existing research into the link between loneliness and health.
There have been a lot of studies investigating the link between social isolation or loneliness and health, including the risk of mortality. Much of this research has shown that loneliness increases the risk of disease and premature death.
However, a new study led by researchers at the University of Waterloo in Canada has challenged that consensus. It found that while loneliness was common among older adults receiving home care, it wasn’t associated with an increased risk of death.
“Our findings suggest that loneliness may not independently increase the risk of death after controlling for other health risk factors among older adults in home care,” said lead author Bonaventure Egbujie, MD, PhD, a professor in Waterloo’s School of Public Health Sciences. “This contradicts much of the existing literature based on the general population.”
The researchers looked at whether feeling lonely affected the chance of dying within one year among older adults receiving home care in Canada, Finland and New Zealand. While definitions of home care vary between countries, they generally encompass ongoing services, such as nursing and personal care, provided in the home as an alternative to in-hospital or nursing home care. The purpose of home care is to foster independent community living for as long as possible.
Data from 383,386 home care recipients aged over 65 was analyzed using a standardized and comprehensive health assessment tool called interRAI Home Care (HC). The tool assesses a person’s needs and strengths in a home care setting, focusing on their functional abilities and quality of life. They compared lonely and non-lonely individuals using survival analysis, adjusting for many factors like age, sex, medical diagnosis, cognitive ability, physical function, and pain.
The researchers found that lonely individuals had a lower risk of dying within one year, even after adjusting for health status and other variables. In Canada, the risk was 18% lower; in Finland, it was 15% lower; and in New Zealand, it was 24% lower. Loneliness was more common among women, those living alone, unmarried individuals, and those who reported more pain or had worse cognition scores. Surprisingly, the researchers found that loneliness was less common in people with cancer.
There are several explanations for why this study’s findings contradict the findings of other studies. First, most previous studies looked at the general older population, including healthy or mildly ill people, whereas this study focused on frail, vulnerable individuals receiving home care who might be more functionally limited but also better connected to formal care systems.
Second, the researchers in the present study controlled for many confounding health variables. Previous studies may have overestimated the loneliness-mortality link by not adequately accounting for these factors.
Third, the lonely group in this study sometimes had better physical function, possibly indicating less severe illness at the outset. It’s possible, therefore, that loneliness follows health decline, rather than causing it.
Fourth, variability in cultural perceptions of loneliness and how home care is delivered in different countries may influence how loneliness is reported or experienced.
Fifth, the present study only followed individuals for a year. It’s possible that loneliness affects mortality over a longer period, which wasn’t captured here.
And sixth, a single-question item was used to assess loneliness, which may be less nuanced than the multi-item scales often used in other studies.
Nonetheless, the study’s findings raise interesting considerations. Primarily, that loneliness may not directly contribute to premature death, at least not in the short term, for older adults in home care. However, loneliness is still a significant mental health concern and should be addressed to improve quality of life, not just survival. Importantly, the study shows that healthcare providers shouldn’t wait for evidence of mortality risk to justify interventions to combat loneliness in aged care.
“Loneliness is a serious threat to psychological well-being,” said Professor John Hirdes, who is also from Waterloo’s School of Public Health Sciences. “Home and community care services must play a protective role by supporting social contact for isolated people.”
Longer-term studies should provide a better understanding of the causal relationship between loneliness and health, as well as the factors that influence this relationship.
The study was published in the Journal of the American Medical Directors Association.
Source: University of Waterloo
