Impact of living alone on institutionalization and mortality: a population-based longitudinal study.

BACKGROUND Living alone is common among elderly people in Western countries, and studies on its relationship with institutionalization and all-cause mortality have shown inconsistent results. We investigated that the impact of living alone on institutionalization and mortality in a population-based cohort of elderly people. METHODS Data originate from the Swedish National study on Aging and Care-Kungsholmen. Participants aged ≥66 years and living at home (n = 2404) at baseline underwent interviews and clinical examination. Data on living arrangements were collected in interviews. All participants were followed for 6 years; survival status and admission into institutions were tracked continuously through administrative registers from 2001 to 2007. Data were analysed using Cox proportional hazard models, competing risk regressions and Laplace regressions with adjustment for potential confounders. RESULTS Of the 2404 participants, 1464 (60.9%) lived alone at baseline. During the follow-up, 711 (29.6%) participants died, and 185 (15.0%) were institutionalized. In the multi-adjusted Cox model, the hazard ratio (HR) of mortality in those living alone was 1.35 (95% confidence interval [CI] 1.18 to 1.54), especially among men (HR = 1.44, 95% CI 1.18 to 1.76). Living alone shortened survival by 0.6 years and was associated with the risk of institutionalization (HR = 1.74, 95% CI 1.10 to 2.77) after taking death into account as a competing risk. CONCLUSIONS Living alone is associated with elevated mortality, especially among men and an increased risk of institutionalization. Over a 6-year period, living alone was related to a half year reduction in survival among elderly people in Sweden.

[1]  C. Vergani,et al.  Social vulnerability, mental health and correlates of frailty in older outpatients living alone in the community in Italy , 2010, Aging & mental health.

[2]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[3]  Health status in elderly persons living alone. , 2013, JAMA internal medicine.

[4]  Karen Glaser,et al.  Living arrangements among older people: an overview of trends in Europe and the USA. , 2004, Population trends.

[5]  P. Martikainen,et al.  Why older people living with a spouse are less likely to be institutionalized: The role of socioeconomic factors and health characteristics , 2008, Scandinavian journal of public health.

[6]  Andrew Steptoe,et al.  Loneliness, social isolation, and behavioral and biological health indicators in older adults. , 2011, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[7]  Kevin Kinsella,et al.  An aging world: 2001 , 2001 .

[8]  L. Fredman,et al.  Prospective study on the relation between living arrangement and change in functional health status of elderly women. , 1998, American journal of epidemiology.

[9]  D. Rubin,et al.  Multiple Imputation for Interval Estimation from Simple Random Samples with Ignorable Nonresponse , 1986 .

[10]  M. Mazzocchi,et al.  Sociodemographic determinants of diet quality of the EU elderly: a comparative analysis in four countries , 2013, Public Health Nutrition.

[11]  D. Wolf.  Changes in the living arrangements of older women: an international study. , 1995, The Gerontologist.

[12]  Herbert Matschinger,et al.  Predictors of nursing home admission of individuals without a dementia diagnosis before admission - results from the Leipzig Longitudinal Study of the Aged (LEILA 75+) , 2010, BMC health services research.

[13]  Carl Lachat,et al.  Editorial: highlights food insecurity. , 2014, Public health nutrition.

[14]  Douglas P Kiel,et al.  Competing Risk of Death: An Important Consideration in Studies of Older Adults , 2010, Journal of the American Geriatrics Society.

[15]  Ye Luo,et al.  Loneliness, health, and mortality in old age: a national longitudinal study. , 2012, Social science & medicine.

[16]  P Aspelin,et al.  Medial temporal lobe is vulnerable to vascular risk factors in men: a population‐based study , 2012, European journal of neurology.

[17]  Psychosocial enhancement of immunocompetence in a geriatric population. , 1985 .

[18]  T. Rantanen,et al.  Does social activity decrease risk for institutionalization and mortality in older people? , 2012, The journals of gerontology. Series B, Psychological sciences and social sciences.

[19]  Timothy B. Smith,et al.  Social Relationships and Mortality Risk: A Meta-analytic Review , 2010, PLoS medicine.

[20]  J. Guralnik,et al.  Social network ties and mortality among the elderly in the Alameda County Study. , 1987, American journal of epidemiology.

[21]  F. Jessen,et al.  Apart from nihilism and stigma: what influences general practitioners' accuracy in identifying incident dementia? , 2009, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[22]  Johan Berglund,et al.  A longitudinal study integrating population, care and social services data. The Swedish National study on Aging and Care (SNAC) , 2004, Aging clinical and experimental research.

[23]  A. Wolk,et al.  Evaluating percentiles of survival. , 2012, Epidemiology.

[24]  W. Dubin,et al.  Medication Adherence: A Review of the Literature and Implications for Clinical Practice , 2009, Journal of psychiatric practice.

[25]  Deepak L. Bhatt,et al.  Living alone and cardiovascular risk in outpatients at risk of or with atherothrombosis. , 2012, Archives of internal medicine.

[26]  J. Wardle,et al.  Social isolation, loneliness, and all-cause mortality in older men and women , 2013, Proceedings of the National Academy of Sciences.

[27]  K. Covinsky,et al.  Loneliness in older persons: a predictor of functional decline and death. , 2012, Archives of internal medicine.

[28]  Hui-Xin Wang,et al.  Lifestyle, social factors, and survival after age 75: population based study , 2012, BMJ : British Medical Journal.

[29]  Danielle Harari,et al.  Health risk appraisal in older people 1: are older people living alone an "at-risk" group? , 2007, The British journal of general practice : the journal of the Royal College of General Practitioners.

[30]  A. Gouliamos,et al.  Social factors influencing hospital arrival time in acute ischemic stroke patients , 2012, Neuroradiology.

[31]  K. Covinsky.  The differential diagnosis of living alone: comment on "Living alone and risk of mortality in older, community-dwelling adults". , 2013, JAMA internal medicine.

[32]  L. Berkman,et al.  Living arrangements, social integration, and change in functional health status. , 2001, American journal of epidemiology.

[33]  L. Launer,et al.  Weight, height and body mass index distributions in geographically and ethnically diverse samples of older persons. Ad Hoc Committee on the Statistics of Anthropometry and Aging. , 1996, Age and ageing.

[34]  C. Meisinger,et al.  Living alone is a risk factor for mortality in men but not women from the general population: a prospective cohort study , 2007, BMC public health.

[35]  A. Beekman,et al.  Increased risk of mortality associated with social isolation in older men: only when feeling lonely? Results from the Amsterdam Study of the Elderly (AMSTEL) , 2011, Psychological Medicine.

[36]  P. Mitchell,et al.  Living alone and risk of mortality in older, community-dwelling adults. , 2013, JAMA internal medicine.

[37]  Robert L Kane,et al.  Predicting nursing home admission in the U.S: a meta-analysis , 2007, BMC geriatrics.

[38]  H. Krumholz,et al.  Loneliness and living alone: what are we really measuring? , 2012, Archives of internal medicine.

[39]  Robert Gray,et al.  A Proportional Hazards Model for the Subdistribution of a Competing Risk , 1999 .

[40]  J. Simons,et al.  Impact of loneliness and living alone. , 2013, JAMA internal medicine.

[41]  Elmar Brähler,et al.  Prediction of institutionalization in the elderly. A systematic review. , 2010, Age and ageing.