Social distancing and "stay-at-home" orders are essential to contain the coronavirus outbreak (COVID-19), but there is concern that these measures will increase feelings of loneliness, particularly ...in vulnerable groups. The present study examined change in loneliness in response to the social restriction measures taken to control the coronavirus spread. A nationwide sample of American adults (N = 1,545; 45% women; ages 18 to 98, M = 53.68, SD = 15.63) was assessed on three occasions: in late January/early February 2020 (before the outbreak), in late March (during the President's initial "15 Days to Slow the Spread" campaign), and in late April (during the "stay-at-home" policies of most states). Contrary to expectations, there were no significant mean-level changes in loneliness across the three assessments (d = .04, p > .05). In fact, respondents perceived increased support from others over the follow-up period (d = .19, p < .01). Older adults reported less loneliness overall compared to younger age groups but had an increase in loneliness during the acute phase of the outbreak (d = .14, p < .05). Their loneliness, however, leveled off after the issuance of stay-at-home orders. Individuals living alone and those with at least one chronic condition reported feeling lonelier at baseline but did not increase in loneliness during the implementation of social distancing measures. Despite some detrimental impact on vulnerable individuals, in the present sample, there was no large increase in loneliness but remarkable resilience in response to COVID-19.
Public Significance Statement
This study tests for change in loneliness prior and during the outbreak of the coronavirus in the United States. While continued attention should be directed to vulnerable groups, the study did not find a large increase in loneliness despite the social distancing measures undertaken to contain the outbreak. Even when physically isolated, the feeling of increased social support and of being in this together may help limit increases in loneliness.
•Social isolation among older adults living alone leads to cognitive impairment.•Living alone may be associated with cognitive impairment, but findings remain inconsistent.•Regardless of living ...alone, social isolation was associated with cognitive impairment.•Healthcare workers should focus on social interactions to prevent cognitive impairment.
Living alone has been associated with cognitive impairment; however, findings have been inconsistent. Social isolation among older adults who live alone may contribute to cognitive impairment. This study was carried out to examine the association of social isolation and living alone with cognitive impairment in community-dwelling older adults.
In this cross-sectional study, data from the Integrated Research Initiative for Living Well with Dementia Cohort Study, which comprises pooled data from five community-based geriatric cohorts, was used. Social isolation was defined as infrequent interactions with others. Participants were categorized into four groups based on their social isolation and living alone statuses. Cognitive function was assessed using the Mini-Mental State Examination, with a score <24 indicating cognitive impairment. The association between social isolation combined with living alone and cognitive impairment was analyzed using logistic regression.
Of the 4362 participants included in the analysis (mean age 75.6 years, 44.3 % male), 11 % had cognitive impairment. Regardless of living alone, social isolation was associated with cognitive impairment (no social isolation x not living alone: reference, social isolation x not living alone; odds ratio (OR): 1.74, 95 % confidence interval (CI): 1.29–2.33, social isolation x living alone; OR: 2.10, 95 % CI: 1.46–3.01).
Social isolation is associated with cognitive impairment; however, living alone is not intrinsically associated with cognitive impairment in older adults. Healthcare providers must focus on social interactions to prevent cognitive impairment in older adults rather than simply focusing on living arrangements.
•Social isolation is strongly associated with suicidal outcomes.•The subjective feeling of loneliness has a major impact, even transculturally.•Objective and subjective social isolation should be ...added in suicide risk assessment.
Social isolation is one of the main risk factors associated with suicidal outcomes. The aim of this narrative review was to provide an overview on the link between social isolation and suicidal thoughts and behaviors.
We used the PubMed database to identify relevant articles published until April 13, 2018. We focused on: (a) systematic reviews, meta-analyses, and narrative reviews; (b) original observational studies with large samples (N ≥ 500); and (c) qualitative studies. We included all relevant suicidal outcomes: suicidal ideation (SI), suicidal planning, non-suicidal self-injury, deliberate self-harm, suicide attempt (SA), and suicide.
The main social constructs associated with suicidal outcomes were marital status (being single, separated, divorced, or widowed) and living alone, social isolation, loneliness, alienation, and belongingness. We included 40 original observational studies, the majority of them performed on adolescents and/or young adults (k = 23, 57.5%). Both the objective condition (e.g., living alone) and the subjective feeling of being alone (i.e., loneliness) were strongly associated with suicidal outcomes, in particular with SA and SI. However, loneliness, which was investigated in most studies (k = 24, 60%), had a major impact on both SI and SA. These associations were transculturally consistent.
Confounding factors can limit the weight of the results obtained in observational studies.
Data from the observational studies suggest that both objective social isolation and the subjective feeling of loneliness should be incorporated in the risk assessment of suicide. Interventional studies targeting social isolation for suicide prevention are needed.
Little is known about the collective patterns of health-related behaviors of older adults living alone. We aimed to identify subgroups of older adults living alone based on their health lifestyle and ...examine the relationship between these subgroups and sociodemographic characteristics, life satisfaction, and depressive symptoms.
A total of 3137 older adults living alone were sampled from the 2020 National Survey of Older Koreans. Latent class analysis was performed using 11 health-related behaviors: smoking; alcohol consumption; fruit, vegetable, and dairy product consumption; exercise; cultural leisure; social groups; educational activities; health check-ups; and dementia screening. Multinomial logistic and multiple linear regression analyses were performed.
Three classes were identified: Consistently Healthy (CH), Moderately Healthy but Inactive (MHI), and Unhealthy but Active (UA). Compared to the CH, members of the MHI tend to have no formal education and rarely meet relatives. Members of the UA were more likely to be male and employed. The MHI and UA were more likely to have lower incomes, meet with children less frequently or have no children, and rarely meet friends, neighbors, and acquaintances when compared to the CH. Members of the UA group had the highest risk of reduced life satisfaction and increased depressive symptoms.
The cross-sectional design precluded causal inferences.
Our study sheds light on the heterogeneity of health lifestyles among older adults living alone and highlights the need for tailored interventions to promote healthy aging in this population.
•There was heterogeneity in health lifestyles among older adults living alone.•Three groups were identified by performing latent class analysis.•Life satisfaction and depressive symptoms differ greatly among the three groups.
The subject, Ms. A, was a woman in her 80s who required long-term care level 2. She lived alone and had expressed concerns about managing her medication. She had been observed to make medication ...errors and often forgot to take her medication, especially those prescribed once a week. Ms. A had impaired hearing and vision and required a handrail to walk. To assist her, we designed a handmade medication card with better visibility for Ms. A. However, after a while, Ms. A suffered a fracture and was admitted to a hospital and care facility where she did not use the card. After a year, she returned home. Upon her return, she continued to take her weekly medication using the card. Several months later, she was still able to take her medication without forgetting it. One of the factors contributing to this success was that the color of the medication card was chosen by the patient herself. Moreover, the contrast between the color of the card and the medication bag was clear and easily distinguished.
Adults with cognitive impairment are prone to living alone in large numbers but receive relatively little attention. This study aimed to evaluate whether living alone with cognitive impairment was ...associated with a higher burden of functional disability but lack of informal care.
982 observations of adults living alone with cognitive impairment and 50,695 observations of adults living with others and with normal cognition were identified from 4 waves (2011/2012, 2013, 2015, and 2018) of the China Health and Retirement Longitudinal Study (CHARLS). A matched comparator was selected using propensity score matching (1:2). Functional disability included disability in Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), and mobility. The time of receiving informal care was measured in monthly hours.
Adults living alone with cognitive impairment demonstrated significantly higher odds ratio of ADL disability (OR = 1.59, 95 % CI: 1.30, 1.95), IADL disability (OR = 1.19, 95 % CI: 1.00, 1.44), mobility disability (OR = 1.38, 95 % CI: 1.12, 1.70), but received fewer hours of informal care (β = −127.7 h per month, standard error = 25.83, P < 0.001), compared to the adults living with others and with normal cognition.
This study highlights the high burden of functional disability but low coverage of informal care among Chinese adults living alone with cognitive impairment and calls for more resources to be allocated to this vulnerable subpopulation to improve the functional health and to increase the provision of long-term care services.
•Unique social-demographic features of adults living alone with cognitive impairment.•This vulnerable group experiences severe burden of functional disability.•Informal care coverage for such group in the community is low.•Propensity score matching is used to address the confounders and data imbalance.
•Living alone has been considered as social vulnerability.•Information on living alone and frailty is scarce in the literature.•Living alone is cross-sectionally associated with physical frailty.•Men ...living alone are more likely to be frail while women are not.•No significant longitudinal association is observed.
To examine the association of living alone with frailty in cross-sectional and longitudinal studies by a systematic review and meta-analysis.
Systematic review and meta-analysis.
Community-dwelling older adults with a mean age of >60 years.
A systematic search of the literature was conducted according to the PRISMA guidelines. We searched PubMed in February 2019 without language restriction for cohort studies that examined the associations between living alone and frailty. The reference lists of the relevant articles and the included articles were reviewed for additional studies. We calculated pooled odds ratios (OR) of the presence and incidence of frailty for living alone from cross-sectional and longitudinal studies.
Among the 203 studies identified, data of 44 cross-sectional studies (46 cohorts) and 6 longitudinal studies were included in this review. The meta-analysis showed that older adults living alone were more likely to be frail than those who were not (46 cohorts: pooled OR = 1.28, 95 % confidence interval (CI) = 1.13–1.45, p < 0.001). Gender-stratified analysis showed that only men living alone were at an increased risk of being frail (20 cohorts: pooled OR = 1.71, 95 %CI = 1.49–1.96), while women were not (22 cohorts: pooled OR = 1.00, 95 %CI = 0.83–1.20). No significant association was observed in a meta-analysis of longitudinal studies (6 cohorts: pooled OR = 0.88, 95 %CI = 0.76–1.03).
The present systematic review and meta-analysis showed a significant cross-sectional association between living alone and frailty, especially in men. However, living alone did not predict incident frailty. More studies controlling for important confounders, such as social networks, are needed to further enhance our understanding of how living alone is associated with frailty among older adults.
Purpose To identify factors that affect the return to solitary living of patients with stroke who had lived alone prior to stroke onset. Participants and Methods From January 2017 to March 2020, we ...enrolled a total of 103 patients with stroke who had lived alone prior to stroke onset and retrospectively analyzed their age, gender, length of hospital stay, outcome (return to living alone or not), functional independence measure at discharge, and social score at discharge. We also analyzed the relationship between the above factors and the outcome. Results Functional independence measure and social score at discharge were significantly associated with the outcome. The cutoff value of the functional independence measure at discharge was 91 (area under the curve: 0.91; sensitivity: 0.96; specificity: 0.72), while the rate of return to living alone was 23.5% when the social score was ≥3. The sensitivity and specificity for return to living alone were 0.91 and 0.88, respectively, when cutoff values of the functional independence measure and social score at discharge were 91 and 3, respectively. Conclusion Social factors and ability to perform activities of daily living are important for return to solitary living for patients with stroke who lived alone prior to stroke onset.
The aims of the study were to examine the predictive value of social and emotional loneliness for all-cause mortality in the oldest-old who do and do not live alone and to test whether these varied ...by functional status and personality.
Participants were 413 older adults from the Berlin Aging Study (M SD = 84.53 8.61 years of age) who either lived alone (n = 253) or did not live alone (n = 160). Significance values for hazard ratios are reported having adjusted for age, sex, education, income, marital status, depressive illness, and both social and emotional loneliness.
Although social loneliness was not associated with mortality in those living alone, emotional loneliness was; with each 1 SD increase in emotional loneliness, there was an 18.6% increased risk of all-cause mortality in the fully adjusted model (HR = 1.186, p = .029). No associations emerged for social or emotional loneliness among those not living alone. Examinations of potential moderators revealed that with each 1 SD increase in functional status, the risk associated with emotional loneliness for all-cause mortality increased by 17.9% (hazard ratiointeraction = 1.179, p = .005) in those living alone. No interaction between personality traits with loneliness emerged.
Emotional loneliness is associated with an increased risk of all-cause mortality in older adults who live alone. Functional status was identified as one potential pathway accounting for the adverse consequences of loneliness. Emotional loneliness that can arise out of the loss or absence of a close emotional attachment figure seems to be the toxic component of loneliness.
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