Loneliness Not Tied to Mortality in Older Adult Home Care

Medscape

9 hours ago

Loneliness is not associated with an increased risk for death among older adults receiving home care in three countries, researchers reported.
Bonaventure A. Egbujie, MD, PhD
In fact, after adjustment for multiple possible confounders, the survival analysis showed that loneliness was associated with reductions in the 1-year risk for mortality of 18% in Canada, 15% in Finland, and 23% in New Zealand.
Nevertheless, 'Loneliness doesn't have to kill you to be a major public health issue,' study author Bonaventure A. Egbujie, MD, PhD, adjunct professor of public health sciences at the University of Waterloo in Waterloo, Ontario, told Medscape Medical News. 'We would like to see policymakers begin to take the issue of loneliness seriously, consider it a quality-of-life issue, and not treat it as a mortality issue, because when you make it a mortality issue, it becomes less likely to be something that you can intervene on.'
The findings were published in the Journal of the American Medical Directors Association .
Pervasive but Not Deadly
The investigators used population-based home care data on 178,611 home care recipients from Canada, 35,073 home care recipients from Finland, and 85,065 home care recipients from New Zealand. Participants were between 65 and over 85 years old, and about 38% were men.
Of the Canadian cohort, 15.9% reported being lonely; 20.5% of the Finnish cohort reported being lonely, and 24.2% of the New Zealand cohort reported being lonely. The prevalence of loneliness generally increased with age across the three countries.
Loneliness was higher among recipients who had better baseline physical function and worse pain and cognitive performance across the three countries.
After adjusting for confounding factors, including age, sex, Alzheimer's disease or dementia, marital status, and living alone or not living alone, the researchers calculated the adjusted hazard ratio (HR) of loneliness and mortality risk as 0.82 in the Canadian cohort, 0.85 in the Finnish cohort, and 0.77 in New Zealand.
The findings contrast with existing evidence in the literature suggesting a link between loneliness and death, Egbujie acknowledged. He suggested that the difference may result from the fact that this study was done in a specific group of individuals, whereas other meta-analyses examined the general population.
'One of the reasons we studied the effect of loneliness on older home care recipients is because this group has not been specifically studied,' he said. 'There has been a focus on people in other places, including those in the community, those in hospital, and in nursing homes, but not on this group.'
The team also found that the two strongest independent predictors of mortality across the three countries were cancer (Canada, HR, 2.88; Finland, HR, 2.57; and New Zealand, HR, 2.07) and Changes in Health and End-Stage Disease and Symptoms and Signs scores of 3 or more (Canada, HR, 2.66; Finland, HR, 2.61; and New Zealand, HR, 2.65).
A limitation of the study was the 1-year follow-up, as health consequences of loneliness may take more time to manifest themselves, the authors noted. In addition, they relied on a single-item measure of loneliness rather than a multi-item summary scale.
Egbujie would like to see longer-term studies to better understand whether there is a causal relationship between loneliness and adverse health outcomes and mortality.
A shortcoming of the current study, he said, 'is that we don't know the sequence of events. Which appeared first? Was it loneliness that appeared first and led to the health condition, or was it the health condition that appeared first and led to individuals being lonely?'
Regardless, 'for clinicians and policymakers, this finding highlights the need to examine home care more carefully,' the authors wrote. 'Loneliness should be addressed as a quality-of-life concern for home care clients in its own right without the need to justify intervention based on mortality risks.'
'Important Public Health Issue'
Rachel Savage, PhD, a scientist at Women's College Hospital, an assistant professor at the University of Toronto, Toronto, and a public health researcher who investigates the impact of loneliness on health system use and mortality, commented on the study for Medscape Medical News . She noted that the study is 'methodologically sound, led by a highly respected researcher who is an expert in home care,' and has the key strength of having been replicated across three countries. Savage did not participate in the study.
Rachel Savage, PhD
She agreed with the authors that the absence of evidence of an increased risk for death from loneliness does not make loneliness unimportant.
'It's not an either/or quality-of-life issue or a mortality risk; it's potentially both,' said Savage. 'We know that loneliness is an important predictor of quality of life and mental health, so even if we do find that it does not increase mortality risk among certain populations, it's still a very important public health issue.'
'There is something unique about the home care population,' she added. 'It's wonderful that these authors have started to build some of the evidence in this group, because, as they state, most of the large meta-analyses that have shown a link between loneliness and an increased risk for premature death are set in the general population.'
She noted that females consistently report higher rates of loneliness than males. There could be a few different reasons for this, she said.
'The most obvious one, especially for older adults, is that females on average have a longer life expectancy and so are more likely to experience widowhood and living alone, which are big risk factors for loneliness. Women are also more likely to be caregivers and to have lower incomes, both of which are associated with loneliness. And the last thing is women are more likely to admit their feelings than are men because of social norms.'