Loneliness in older adults tied to less healthcare utilization

20170112100500, Pearl Toh
Loneliness in older adults tied to less healthcare utilization

Older adults who felt lonely were less likely to visit physicians, regardless of whether the loneliness was chronic or recently developed, according to data from the PHASE* national survey in Singapore.

“Their lower contact with physicians could lead to undesirable health outcomes, such as a higher mortality rate among lonely older adults if they do have genuine health needs,” according to study authors Mr Lim Ka Keat and Associate Professor Angelique Chan of NUS-Duke Medical School in Singapore, noting that loneliness affected about three-quarter (75 percent) of the elderly respondents in the survey.    

The researchers analysed 2,738 respondents (mean age 73.1 years) comprising community-dwelling Singaporeans aged ≥60 years from the longitudinal national survey by the Ministry of Community Development, Youth and Sports, conducted in two waves (one in 2009 and another one in 2011). [Geriatr Gerontol Int 2017;doi:10.1111/ggi.12962] 

Among the total respondents, 23 percent reported feeling lonely in both waves of the survey (chronic loneliness). By the second survey period, a further 19 percent developed loneliness, while 33 percent recovered from loneliness.

Compared with individuals who were never lonely, those who reported feeling lonely were less likely to visit a physician, regardless of whether they felt lonely chronically (odds ratio [OR], 0.75; p=0.014) or became lonely in the second wave (OR, 0.71; p=0.004). 

On the other hand, although respondents who recovered from loneliness by the second wave were similarly likely to visit a physician as those who were never lonely (OR, 0.826; p=0.057), their frequency of visit was significantly lower than the “never-lonely” group (-0.71; p=0.001).

The respondents’ perceived need for physician care were strongly predictive of both odds and frequency of physician visit, as those who rated themselves as “unhealthy” were more than twice as likely to visit (OR, 2.38; p<0.001) as well as more frequently visited (0.92; p<0.001) physicians than those who self-rated as “average health”.

Other factors such as presence of at least one chronic disease or limited activities of daily living (ADL) and income were also significantly associated with greater odds of physician visit.

In terms of social network, household size was associated with higher frequency of visit (0.18; p<0.01) while those who were not married had lower odds of visit (OR, 0.82; p<0.05).

The effect of loneliness on physician visit was independent from social isolation, according to the authors, seeing that internal (such as marital status, household size, number of children) and external (strength of social network outside household) social networks had been adjusted for in the analyses.  

“As loneliness is a consequence of a mismatch between desired and the subjective perception of the size and quality of individuals’ social network, one might feel lonely even if they reside in a lively household or neighbourhood,” said Lim and Chan. “As the associations are independent of social isolation, any policy interventions need to go beyond providing physical company for older adults.”

“Strategies to cope with loneliness might also differ for older adults who perceive loneliness as disconnection from contemporary society, and those who emphasize intergenerational relationships and family support, such as among Asians,” they added.