Research focus: social isolation and its effect on mortality and ill health
Compiled by Vicki Leah, nurse consultant for older people, University College London Hospitals NHS Foundation Trust, London
Social isolation, or the perception of social isolation, is far from inevitable for older people and is not a ‘normal’ part of ageing. However, nurses in all settings will encounter older people who are lonely and it is becoming increasingly clear that loneliness plays an important part in older people’s health outcomes, as described in the three research articles summarised below.
At the end of the summaries is a link to a resource offering information and advice on choosing and using a scale to measure the effect of your services on loneliness in older age.
Feelings of loneliness and living alone as predictors of mortality in the elderly: the PAQUID study
This large population study carried out in France investigated how living alone and feelings of loneliness affected mortality rates in older community-dwelling people.
Participants’ (n=3,620) data were extracted from a large epidemiological prospective cohort study, set up to investigate the risk factors of dementia and incapacity, for use in this study.
Living alone and feelings of loneliness were measured using a variety of tests including the Center for Epidemiologic Studies Depression Scale. Mortality was determined from the time of completion of the baseline data for 22 years if the person was still alive or date of death for those who had died.
Statistical analysis was undertaken to determine the relationship between the variables in this population.
Living alone and feelings of loneliness were independent predictors of death over the 22-year follow-up period. However, the authors note these results are contrary to those reported by others.
They conclude a more holistic view of loneliness should prevail when considering the risk of loneliness to individuals in practice, not simply living alone and/or feelings of loneliness. Living alone may indicate a person’s choice to live in relative isolation and miss the rich social network that surrounds them, reducing feelings of loneliness and its associated risk.
Tabue Teguo M, Simo-Tabue N, Stoykova R et al (2016) Psychosomatic Medicine. 78, 8, 904-909.
Loneliness and quality of life in chronically ill rural older adults
This article reports on a pilot study of older residents in rural Virginia, US, with chronic illness and the effect loneliness had on their medication use, disease control and quality of life.
Based on the theory that the experience of stress can cause neurologic and immune system responses that have a negative effect on physical health, psychosocial functioning and quality of life, the study tested the hypothesis that loneliness, as the stressor, would lead to an increased level of chronic illness in this population, an increase in their prescription medication, poor chronic illness control and reduced quality of life.
Loneliness was measured using the 20-item University of California Los Angeles Loneliness Scale and laboratory tests were used to determine the level of control of chronic illnesses, for example, HbA1c for diabetes.
Loneliness was significantly increased in people with anxiety, depression, lung or heart disease. There was no evidence that those who reported feeling lonely had poor control over their illness, had more prescribed medication or reduced quality of life.
The authors stress the need for interventions for those with chronic illness, including routine screening in specialist clinics, and the development of guidelines to include interventions which address the social and emotional components of loneliness.
Theeke L, Mallow J (2013) American Journal of Nursing. 113, 9, 28-37.
Consequences of loneliness on physical activity and mortality in older adults and the power of positive emotions
This longitudinal study examined the effect of greater happiness on the mortality and physical activity rates in a population of community-dwelling older people. In effect, it looked at the ability of happiness to ‘undo’ the negative effects of loneliness.
Participants’ (n=228) data were collected from two ongoing ageing studies and the following aspects explored:
- Loneliness, measured using the De Jong Gierveld and Kamphuis 11-item loneliness scale.
- Happiness, measured by asking ‘How often did you feel happy in the past week?’
- Perceived physical activity.
- Actual activity, measured using an actigraph worn on the wrist.
- Depression, measured using the Center for Epidemiologic Studies Depression Scale.
The results revealed loneliness was an independent risk factor for mortality. While perceived physical activity levels were reduced in those who reported feeling lonely, their actual physical activity levels were not reflecting a reduction in motivation for activity.
Higher levels of happiness reduced the strength of association between loneliness and mortality and loneliness and physical activity. When depression was taken into account the results were the same, indicating that depression and loneliness are not one and the same.
Newall N, Chipperfield J, Bailis D et al (2013) Health Psychology. 32, 8, 921-924
Campaign to end loneliness in late life