Loneliness as a Public Health Issue: The Impact of Loneliness on Health Care Utilization Among Older Adults

摘要

Objectives. We aimed to determine whether loneliness is associated with higher health care utilization among older adults in the United States. Methods. We used panel data from the Health and Retirement Study (2008 and 2012) to examine the long-term impact of loneliness on health care use. The sample was limited to community-dwelling persons in the United States aged 60 years and older. We used negative binomial regression models to determine the impact of loneliness on physician visits and hospitalizations. Results. Under 2 definitions of loneliness, we found that a sizable proportion of those aged 60 years and older in the United States reported loneliness. Regression results showed that chronic loneliness (those lonely both in 2008 and 4 years later) was significantly and positively associated with physician visits (β?=?0.075, SE?=?0.034). Loneliness was not significantly associated with hospitalizations. Conclusions. Loneliness is a significant public health concern among elders. In addition to easing a potential source of suffering, the identification and targeting of interventions for lonely elders may significantly decrease physician visits and health care costs. Social relationships are integral to human well-being, and research consistently documents that social integration and support have protective effects on morbidity and mortality outcomes. 1–4 Yet loneliness and social isolation are often overlooked, despite being vital public health concerns, with mortality risk comparable to well-established risk factors such as cigarette smoking and even exceeding the influence of physical activity and obesity. 5 Often described as the discrepancy between desired and perceived social relationships, 6 loneliness can be particularly important among older adults, for whom decreases in economic resources, increases in impairments, and the deaths of contemporaries can heighten the risk of social isolation and loneliness. 3 Prevalence statistics indicate that nearly 1 in 3 older adults report loneliness in the United States. 7 Although loneliness is not a problem exclusively for elders, the oldest old (those aged 80 years and older) appear to have relatively high rates of loneliness—by some estimates, 40% to 50% report that they are often lonely. 8 Research has consistently found that social relationships are associated with a variety of comorbid conditions, in addition to premature mortality. Negative health outcomes linked to loneliness include high blood pressure, 9 cardiovascular disease, 10 disability, 11 cognitive decline, 12 and depression. 13 Such morbidities may, in turn, create higher need for health care and be linked to higher health care utilization, 14 especially among older adults, who are more likely to suffer from multiple conditions. 15 Some research suggests that there may also be a direct link between loneliness and health care utilization, regardless of health status. Although relatively limited, research has found that socially isolated persons are more likely to seek medical assistance to satisfy their need for interaction and interpersonal stimulation. 16–18 In a study of older women in the San Francisco, California, area, Cheng found that loneliness–distress significantly explained higher physician utilization, independent of health factors. 18 Similar findings have been reported in Europe. In Sweden, researchers found that frail elders who were lonely used more outpatient services than those who were not lonely. This included contacts with a physician and more visits to an emergency department as an outpatient. 19 Among elders in Ireland, loneliness was independently associated with emergency hospitalization. 20 And in Scotland, researchers found that among their sample of people aged 40 and 60 years, those who were lonely reported greater frequency of consultation with a general practitioner or family doctor. 17 In essence, it is possible that lonely persons seek physician care less for medical needs than to have someone to talk to. Despite the high prevalence of loneliness and its clear implications on health outcomes, relatively little attention has been paid by public health officials and other medical professionals to the importance of loneliness, 5 especially in the United States. We examined the impact of loneliness on a tangible public health and public policy outcome: health care utilization.