The epidemiology of social isolation and loneliness among older adults during the last years of life

Ashwin A Kotwal; Irena S Cenzer; Linda J Waite; Kenneth E Covinsky; Carla M Perissinotto; W John Boscardin; Louise C Hawkley; William Dale; Alexander K Smith

doi:10.1111/jgs.17366

The epidemiology of social isolation and loneliness among older adults during the last years of life

J Am Geriatr Soc. 2021 Nov;69(11):3081-3091. doi: 10.1111/jgs.17366. Epub 2021 Jul 11.

Authors

Ashwin A Kotwal^{1

2}, Irena S Cenzer^{1

2}, Linda J Waite³, Kenneth E Covinsky^{1

2}, Carla M Perissinotto¹, W John Boscardin^{1

4}, Louise C Hawkley⁵, William Dale⁶, Alexander K Smith^{1

2}

Affiliations

¹ Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.
² Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.
³ Department of Sociology, University of Chicago, Chicago, Illinois, USA.
⁴ Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.
⁵ National Opinion Research Center, University of Chicago, Chicago, Illinois, USA.
⁶ Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, California, USA.

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.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Cross-Sectional Studies
Death*
Epidemiology / trends*
Female
Hearing Loss / psychology
Humans
Loneliness / psychology*
Male
Middle Aged
Risk Factors
Sex Factors
Social Isolation / psychology*
Surveys and Questionnaires

Abstract

Publication types

MeSH terms

Grants and funding