Reported loneliness rather than social isolation is a risk factor for 10-year mortality in older men

Abstract

QUESTION Question: Do social isolation factors and feelings of loneliness predict an increased risk of mortality in older people, and does this relationship differ between men and women? Population: 4004 city of Amsterdam residents aged between 65 and 84 years from the Amsterdam Study of the Elderly (AMSTEL). Participants were randomly selected from four age categories consisting of 5-year brackets and were representative of Amsterdam’s elderly population. Structured interviews were conducted in each resident’s home by trained and supervised interviewers. Setting: Amsterdam city, The Netherlands; 1991–2001. Prognostic factors: Feelings of loneliness, defined in the structured interview as the experience or subjective feeling of loneliness by the participant when asked the question ‘do you feel lonely?’. Social isolation, defined as either a lack of social support (assessed by asking participants if they had help from family, neighbours or home support), or being no longer married, single or living alone. Potential confounders were assessed in the structured interview at baseline including psychiatric disorders, medical disorders and conditions, smoking and drinking behaviours, cognitive functioning and functional status and demographic characteristics including education. Associations between social isolation, feelings of loneliness and mortality were calculated using Cox proportional hazard regression models after controlling for potential confounders. Interactions between feelings of loneliness and gender were also calculated and included in the regression model. Outcomes: Death (identified through linkage with local registries). METHODS Design: Prospective cohort study. Follow-up period: Average 9.8 years. MAIN RESULTS At baseline, more women (27.4%) reported feelings of loneliness than men (12%; p<0.001). Women were also more socially isolated in terms of being single or no longer married and living alone (p<0.001) but did receive more social support than men (p<0.001). At 10 years’ follow-up, 53% of participants had died (60.8% of men and 47.2% of women). The death rate was higher in men reporting feelings of loneliness at baseline (78.9%) compared to women reporting loneliness (53.9%). The death rate was also higher for men with social isolation than women with social isolation. Following adjustment for social isolation and other identified confounders, reporting feelings of loneliness was associated with a significantly increased risk of mortality in men (HR 1.30, 95% CI 1.04 to 1.63), but not women (HR 1.04, 95% CI 0.90 to 1.24). Following adjustment, no higher risk of mortality was found in men or women reporting social isolation. CONCLUSIONS Reporting feelings of loneliness is associated with a significantly increased risk of mortality in the next 10 years in older men, but not older women. This relationship is independent of social isolation. Reporting social isolation is not an independent risk factor for mortality in the next 10 years in older men or women. NOTES Men and women differed significantly for most conditions at baseline. The severity and extent of loneliness were not determined. Feelings of loneliness and social support were identified at baseline only and the study did not account for changes in marital status, living arrangement, social network and feelings of loneliness throughout the 10-year follow-up.