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Journal ArticleDOI

Loneliness, depression and cognitive function in older U.S. adults

TL;DR: To examine reciprocal relations of loneliness and cognitive function in older adults, a large number of patients with a history of depression and/or substance abuse are surveyed.
Abstract: Objective To examine reciprocal relations of loneliness and cognitive function in older adults. Methods Data were analyzed from 8382 men and women, age 65 and older, participating in the US Health and Retirement Study from 1998 to 2010. Participants underwent biennial assessments of loneliness and depression (classified as no, low or high depression) determined by the Center for Epidemiologic Studies Depression scale (8-item version), cognition (a derived memory score based on a word list memory task and proxy-rated memory and global cognitive function), health status and social and demographic characteristics from 1998 to 2010. We used repeated measures analysis to examine the reciprocal relations of loneliness and cognitive function in separate models controlling sequentially and cumulatively for socio-demographic factors, social network, health conditions and depression. Results Loneliness at baseline predicted accelerated cognitive decline over 12 years independent of baseline socio-demographic factors, social network, health conditions and depression (β = −0.2, p = 0.002). After adjustment for depression interacting with time, both low and high depression categories were related to faster cognitive decline and the estimated effect of loneliness became marginally significant. Reciprocally, poorer cognition at baseline was associated with greater odds of loneliness over time in adjusted analyses (OR 1.3, 95% CI (1.1–1.5) p = 0.005), but not when controlling for baseline depression. Furthermore, cognition did not predict change in loneliness over time. Conclusion Examining longitudinal data across a broad range of cognitive abilities, loneliness and depressive symptoms appear to be related risk factors for worsening cognition but low cognitive function does not lead to worsening loneliness over time. Copyright © 2016 John Wiley & Sons, Ltd.

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Citations
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Journal ArticleDOI
TL;DR: Perceived levels of loneliness under strict lockdown measures due to COVID-19 were relatively stable in the UK, but for many people these levels were high with no signs of improvement, suggesting that more efforts are needed to address loneliness.

231 citations


Cites background from "Loneliness, depression and cognitiv..."

  • ...…are more likely to develop cardiovascular disease, stroke, and coronary heart disease (Steptoe et al., 2004; Valtorta et al., 2016) as well as experience cognitive decline and develop dementia (Boss et al., 2015; Donovan et al., 2017; Gerst-Emerson and Jayawardhana, 2015; Kuiper et al., 2015)....

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BookDOI
27 Feb 2020
TL;DR: This report makes recommendations specifically for clinical settings of health care to identify those who suffer the resultant negative health impacts of social isolation and loneliness and target interventions to improve their social conditions.
Abstract: Social isolation and loneliness are serious yet underappreciated public health risks that affect a significant portion of the older adult population. Approximately one-quarter of community-dwelling Americans aged 65 and older are considered to be socially isolated, and a significant proportion of adults in the United States report feeling lonely. People who are 50 years of age or older are more likely to experience many of the risk factors that can cause or exacerbate social isolation or loneliness, such as living alone, the loss of family or friends, chronic illness, and sensory impairments. Over a life course, social isolation and loneliness may be episodic or chronic, depending upon an individual's circumstances and perceptions. A substantial body of evidence demonstrates that social isolation presents a major risk for premature mortality, comparable to other risk factors such as high blood pressure, smoking, or obesity. As older adults are particularly high-volume and high-frequency users of the health care system, there is an opportunity for health care professionals to identify, prevent, and mitigate the adverse health impacts of social isolation and loneliness in older adults. Social Isolation and Loneliness in Older Adults summarizes the evidence base and explores how social isolation and loneliness affect health and quality of life in adults aged 50 and older, particularly among low income, underserved, and vulnerable populations. This report makes recommendations specifically for clinical settings of health care to identify those who suffer the resultant negative health impacts of social isolation and loneliness and target interventions to improve their social conditions. Social Isolation and Loneliness in Older Adults considers clinical tools and methodologies, better education and training for the health care workforce, and dissemination and implementation that will be important for translating research into practice, especially as the evidence base for effective interventions continues to flourish.

208 citations

Journal ArticleDOI
TL;DR: Although social and health system realignments in response to COVID-19 are unavoidable, clinicians can help reduce their potentially negative effects on the health of older adults by identifying and addressing the risks and helping patients compensate.
Abstract: The dramatic shift toward social distancing measures presents important challenges to the health and wellbeing of community-dwelling older adults, particularly those who are frail, very old, or have multiple chronic conditions. Such older adults are at high risk of dying from COVID-19.1 Yet they also have high rates of morbidity and mortality from other acute and chronic conditions—and may adapt poorly to aggressive physical distancing and the changing health system structures that accompany it. In this Viewpoint, we highlight the health challenges for community-dwelling older adults and offer targeted suggestions for actions clinicians can take to mitigate these threats. Although loneliness and depression may result from or coexist with social isolation, they only represent the tip of the iceberg of potential harm. For many older adults, health is influenced more by their daily lives than by medical interventions. Changes in the types of foods eaten due to changes in food availability during shelterin-place orders may precipitate the exacerbation of heart failure, for example. Lack of exercise due to isolating at home may lead to deconditioning with subsequent weakness and falls. Reduction in the cognitive stimulation that comes with socializing and engaging with the wider world may worsen cognitive and behavioral symptoms of dementia.2 Older adults with medical, cognitive, or social frailty have less reserve to compensate when their homeostasis is threatened. When facing the challenges of social isolation, they are particularly vulnerable to rapid declines. Withdrawal of the formal and informal functional supports on which many vulnerable older adults rely may compound these problems. These supports can make all the difference between staying in their home or ending up in a hospital, residential care, or long-term care facility. Although policies and practices for those who provide professional services for older adults continue to evolve, many have substantially cut back on inhome supportive services, adult day health care, and other programs. Family and friends who have served as caregivers may be afraid or unable to visit. While it has been heartening to see voluntary networks spring up to help older adults buy groceries and the like, other basic needs such as assistance with bathing, basic home cleaning, and dementia supports may be unmet. Finally, when declines in health occur, fear of going to medical facilities may prevent people from receiving the care they need—a likely contributor to anecdotal reports of marked declines in hospitalization for non-COVID serious illness that have been observed in some hospitals. Moreover, the telephone and video substitutes for inperson evaluation pose special challenges for some older adults. Hearing loss, cognitive impairment, and unfamiliarity with new technology may compromise their ability to effectively use these modalities. These technology platforms have not been rigorously evaluated in older adults and may not be configured for easy use.3 Yet for many older adults they have become the sole source of connection with the health care system. All is not doom and gloom, however. Although social and health system realignments in response to COVID-19 are unavoidable, clinicians can help reduce their potentially negative effects on the health of older adults by identifying and addressing the risks and helping patients compensate. First, telephone or video visits may be improved with simple, common sense interventions. Ensure that vulnerable patients are wearing their hearing aids (or using telephonic adaptive devices, if they have them). Enlist the help of a family member, friend, paid caregiver, or staff member in advance of the visit to familiarize older adults with video-call technology. By practicing ahead of time, the UCSF Care at Home program has rapidly increased utilization of such technologies. It may also be useful to engage caregivers in a visit through a 3-way call, which can be done using apps such as Facetime or Skype, which can be used during the COVID-19 national health emergency as part of the expanded Medicare telemedicine services.4 Telemedicine only goes so far, however. There is a risk that reflexive thinking and fear among both clinicians and patients may override clinical common sense about which in-person visits are in fact essential. Clinicians should be mindful of this potential cognitive trap and advise their patients to avoid it as well. When a trip to the clinic or lab may be particularly risky or challenging, creative solutions such as home health nursing evaluation, phlebotomy, or a house call (while maintaining stringent infection control safeguards) should be considered. Second, when meeting with older patients face-toface or virtually, clinicians should inquire about unmet social or functional needs. Have informal or formal services and supports been withdrawn, and, if so, how is the person managing? How is the person getting food and staying active? If answers are concerning, additional or novel supports such as home meal delivery or emergency on-call home care services should be considered, with health system social workers and Area Agencies on Aging often having the best knowledge of options.5 Early identification of these issues may help prevent hospitalizations. Where appropriate, patients should also be encouraged to accept available home care services, which may be essential to preserve their health, but which they may have previously declined because of concerns about exposure to COVID-19. Health sysVIEWPOINT

180 citations

Journal ArticleDOI
TL;DR: The authors share central findings and conclusions from the report as well as how these findings may be relevant to the care and well-being of older adults during this historic pandemic.
Abstract: The authors of this review both served on the National Academy of Science, Engineering, and Medicine Committee that produced the report, "Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System." In 2018, the AARP Foundation commissioned the National Academies to establish a committee to research and develop a report on social isolation and loneliness in persons 50 years of age and older. Emphasis was placed upon the role of the healthcare system in addressing this fundamental public health problem. The committee released the report in February 2020 as the Corona Virus Disease 2019 pandemic was beginning to spread to North America. In this review, the authors share central findings and conclusions from the report as well as how these findings may be relevant to the care and well-being of older adults during this historic pandemic. The health protective benefits of social distancing must be balanced by the essential need for sustaining social relationships.

150 citations


Cites background from "Loneliness, depression and cognitiv..."

  • ...Notably, SI/L have been found to be independent risk factors with a cumulative effect on cognitive decline and dementia risk in some studies, suggesting both shared and distinct mechanisms.(1,23) Social interactions are thought to enhance cognitive capacity through activation and maintenance of the efficiency of brain networks....

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Journal ArticleDOI
TL;DR: A novel association of loneliness with cortical amyloid burden in cognitively normal older adults is reported, suggesting that loneliness is a neuropsychiatric symptom relevant to preclinical AD.
Abstract: Importance Emotional and behavioral symptoms in cognitively normal older people may be direct manifestations of Alzheimer disease (AD) pathophysiology at the preclinical stage, prior to the onset of mild cognitive impairment. Loneliness is a perceived state of social and emotional isolation that has been associated with cognitive and functional decline and an increased risk of incident AD dementia. We hypothesized that loneliness might occur in association with elevated cortical amyloid burden, an in vivo research biomarker of AD. Objective To determine whether cortical amyloid burden is associated with greater loneliness in cognitively normal older adults. Design, Setting, and Participants Cross-sectional analyses using data from the Harvard Aging Brain Study of 79 cognitively normal, community-dwelling participants. A continuous, aggregate measure of cortical amyloid burden, determined by Pittsburgh Compound B–positron emission tomography (PiB-PET), was examined in association with loneliness in linear regression models adjusting for age, sex, apolipoprotein E e4 (APOEe4), socioeconomic status, depression, anxiety, and social network (without and with the interaction of amyloid and APOEe4). We also quantified the association of high amyloid burden (amyloid-positive group) to loneliness (lonely group) using logistic regression, controlling for the same covariates, with the amyloid-positive group and the lonely group, each composing 32% of the sample (n = 25). Main Outcomes and Measures Loneliness, as determined by the 3-item UCLA Loneliness Scale (possible range, 3-12, with higher score indicating greater loneliness). Results The 79 participants included 43 women and 36 men with a mean (SD) age of 76.4 (6.2) years. Mean (SD) cortical amyloid burden via PiB-PET was 1.230 (0.209), and the mean (SD) UCLA-3 loneliness score was 5.3 (1.8). Twenty-two (28%) had positive APOEe4 carrier status, and 25 (32%) were in the amyloid-positive group with cortical PiB distribution volume ratio greater than 1.2. Controlling for age, sex, APOEe4, socioeconomic status, depression, anxiety, and social network, we found that higher amyloid burden was significantly associated with greater loneliness: compared with individuals in the amyloid-negative group, those in the amyloid-positive group were 7.5-fold (95% CI, 1.7-fold to 34.0-fold) more likely to be classified as lonely than nonlonely (β = 3.3, partialr = 0.4,P = .002). Furthermore, the association of high amyloid burden and loneliness was stronger in APOEe4 carriers than in noncarriers. Conclusions and Relevance We report a novel association of loneliness with cortical amyloid burden in cognitively normal older adults, suggesting that loneliness is a neuropsychiatric symptom relevant to preclinical AD. This work will inform new research into the neural underpinnings and disease mechanisms involved in loneliness and may enhance early detection and intervention research in AD.

150 citations

References
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Journal ArticleDOI
TL;DR: The psychometric properties of the UCLA Loneliness Scale (Version 3) were evaluated and it was indicated that the measure was highly reliable, both in terms of internal consistency and test-retest reliability over a 1-year period.
Abstract: In this article I evaluated the psychometric properties of the UCLA Loneliness Scale (Version 3). Using data from prior studies of college students, nurses, teachers, and the elderly, analyses of the reliability, validity, and factor structure of this new version of the UCLA Loneliness Scale were conducted. Results indicated that the measure was highly reliable, both in terms of internal consistency (coefficient alpha ranging from .89 to .94) and test-retest reliability over a 1-year period (r = .73). Convergent validity for the scale was indicated by significant correlations with other measures of loneliness. Construct validity was supported by significant relations with measures of the adequacy of the individual's interpersonal relationships, and by correlations between loneliness and measures of health and well-being. Confirmatory factor analyses indicated that a model incorporating a global bipolar loneliness factor along with two method factors reflecting direction of item wording provided a very goo...

3,661 citations


"Loneliness, depression and cognitiv..." refers methods in this paper

  • ...A number of instruments assessing loneliness have been developed, validated and implemented in studies of the elderly, such as the 20-item and 3-item versions of the UCLA Loneliness Scale and the De JongGierveld Loneliness Scale (De Jong and Van Tilburg, 2006; Hughes et al., 2004; Russell, 1996)....

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Journal ArticleDOI
TL;DR: A short loneliness scale developed specifically for use on a telephone survey is described, finding that objective and subjective isolation are related, indicating that the quantitative and qualitative aspects of social relationships are distinct.
Abstract: Most studies of social relationships in later life focus on the amount of social contact, not on individuals' perceptions of social isolation. However, loneliness is likely to be an important aspect of aging. A major limiting factor in studying loneliness has been the lack of a measure suitable for large-scale social surveys. This article describes a short loneliness scale developed specifically for use on a telephone survey. The scale has three items and a simplified set of response categories but appears to measure overall loneliness quite well. The authors also document the relationship between loneliness and several commonly used measures of objective social isolation. As expected, they find that objective and subjective isolation are related. However, the relationship is relatively modest, indicating that the quantitative and qualitative aspects of social relationships are distinct. This result suggests the importance of studying both dimensions of social relationships in the aging process.

2,513 citations


"Loneliness, depression and cognitiv..." refers methods in this paper

  • ...A number of instruments assessing loneliness have been developed, validated and implemented in studies of the elderly, such as the 20-item and 3-item versions of the UCLA Loneliness Scale and the De JongGierveld Loneliness Scale (De Jong and Van Tilburg, 2006; Hughes et al., 2004; Russell, 1996)....

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Journal ArticleDOI
TL;DR: This work argues that the causal structure underlying the bias in each example is essentially the same: conditioning on a common effect of 2 variables, one of which is either exposure or a cause of exposure and the other is either the outcome or acause of the outcome.
Abstract: The term "selection bias" encompasses various biases in epidemiology. We describe examples of selection bias in case-control studies (eg, inappropriate selection of controls) and cohort studies (eg, informative censoring). We argue that the causal structure underlying the bias in each example is essentially the same: conditioning on a common effect of 2 variables, one of which is either exposure or a cause of exposure and the other is either the outcome or a cause of the outcome. This structure is shared by other biases (eg, adjustment for variables affected by prior exposure). A structural classification of bias distinguishes between biases resulting from conditioning on common effects ("selection bias") and those resulting from the existence of common causes of exposure and outcome ("confounding"). This classification also leads to a unified approach to adjust for selection bias.

2,195 citations


"Loneliness, depression and cognitiv..." refers methods in this paper

  • ...All longitudinal analyses were adjusted for potential bias because of selective loss to follow-up and mortality using inverse probability weights (IPW) (Hernan et al., 2004)....

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  • ...The inverse of such probability was the IPW, and can be incorporated in the regression model to adjust for selective attrition because of survival and other forms of lossto-follow-up (Weuve et al., 2012)....

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Journal ArticleDOI
TL;DR: In this article, the authors examine the scientific, public policy, and organizational background out of which the Health and Retirement Study emerged and describe the evolution of the major parameters of the survey and the unique planning structure designed to ensure that the substantive insights of the research community were fully reflected in the content of the database, highlights key survey innovations contained in the HRS, and provides a preliminary assessment of the quality of the data as reflected by sample size, sample composition, response rate and survey content.
Abstract: This paper examines the scientific, public policy, and organizational background out of which the Health and Retirement Study emerged. It describes the evolution of the major parameters of the survey and the unique planning structure designed to ensure that the substantive insights of the research community were fully reflected in the content of the database, highlights key survey innovations contained in the HRS, and provides a preliminary assessment of the quality of the data as reflected by sample size, sample composition, response rate, and survey content. The paper also describes the several types of administrative data that are expected to be added to the HRS data: earnings and benefits from Social Security files, and health insurance and pension data from the employers of survey respondents.

1,380 citations


"Loneliness, depression and cognitiv..." refers background or methods in this paper

  • ...…from the Health and Retirement Study (HRS), a nationally representative cohort collecting information on the health, social, work and economic characteristics of older adults in the United States that has been conducted biennially since 1992 (Herringa and Connor, 1995; Juster and Suzman, 1995)....

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  • ...Data were derived from the Health and Retirement Study (HRS), a nationally representative cohort collecting information on the health, social, work and economic characteristics of older adults in the United States that has been conducted biennially since 1992 (Herringa and Connor, 1995; Juster and Suzman, 1995)....

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Journal ArticleDOI
TL;DR: Cross-lagged analyses indicated that loneliness predicted subsequent changes in depressive symptomatology, but not vice versa, and that this temporal association was not attributable to demographic variables, objective social isolation, dispositional negativity, stress, or social support.
Abstract: We present evidence from a 5-year longitudinal study for the prospective associations between loneliness and depressive symptoms in a population-based, ethnically diverse sample of 229 men and women who were 50-68 years old at study onset. Cross-lagged panel models were used in which the criterion variables were loneliness and depressive symptoms, considered simultaneously. We used variations on this model to evaluate the possible effects of gender, ethnicity, education, physical functioning, medications, social network size, neuroticism, stressful life events, perceived stress, and social support on the observed associations between loneliness and depressive symptoms. Cross-lagged analyses indicated that loneliness predicted subsequent changes in depressive symptomatology, but not vice versa, and that this temporal association was not attributable to demographic variables, objective social isolation, dispositional negativity, stress, or social support. The importance of distinguishing between loneliness and depressive symptoms and the implications for loneliness and depressive symptomatology in older adults are discussed.

1,235 citations


"Loneliness, depression and cognitiv..." refers background in this paper

  • ...Similarly, in a 5-year observational study of older adults, greater loneliness, using the 20-item UCLA scale, was found to significantly predict greater CES-D depression scores, but not the converse (Cacioppo et al., 2010)....

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  • ...Although loneliness is highly correlated with depression scores (Cacioppo et al., 2010) and unmarried status (Theeke, 2009) most lonely older individuals are married, live with others and are not clinically depressed (Perissinotto et al., 2012)....

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