Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA.
Psychiatric Epidemiology Training Program, Columbia University Mailman School of Public Health, New York, USA.
J Gerontol A Biol Sci Med Sci. 2021 Oct 13;76(11):1997-2006. doi: 10.1093/gerona/glab128.
Loneliness and social isolation are emerging public health challenges for aging populations.
We followed N = 11 302 U.S. Health and Retirement Study participants aged 50-95 from 2006 to 2014 to measure persistence of experiences of loneliness and exposure to social isolation. We tested associations of longitudinal loneliness and social isolation phenotypes with disability, morbidity, mortality, and biological aging through 2018.
During follow-up, 18% of older adults met criteria for loneliness, with 6% meeting criteria at 2 or more follow-up assessments. For social isolation, these fractions were 21% and 8%. Health and Retirement Study participants who experienced loneliness and were exposed to social isolation were at increased risk for disease, disability, and mortality. Those experiencing persistent loneliness were at a 57% increased hazard of mortality compared to those who never experienced loneliness. For social isolation, the increase was 28%. Effect sizes were somewhat larger for counts of prevalent activity limitations and somewhat smaller for counts of prevalent chronic diseases. Covariate adjustment for socioeconomic and psychological risks attenuated but did not fully explain associations. Older adults who experienced loneliness and were exposed to social isolation also exhibited physiological indications of advanced biological aging (Cohen's d for persistent loneliness and social isolation = 0.26 and 0.21, respectively). For loneliness, but not social isolation, persistence was associated with increased risk.
Deficits in social connectedness prevalent in a national sample of U.S. older adults were associated with morbidity, disability, and mortality and with more advanced biological aging. Bolstering social connectedness to interrupt experiences of loneliness may promote healthy aging.
孤独和社会隔离是老龄化人口面临的新的公共卫生挑战。
我们跟踪了美国健康与退休研究中的 11302 名 50-95 岁的参与者，从 2006 年到 2014 年，以衡量孤独感的持续存在和社会隔离的暴露情况。我们通过 2018 年的测试，检验了纵向孤独和社会隔离表型与残疾、发病、死亡和生物衰老的相关性。
在随访期间，18%的老年人符合孤独标准，其中 6%在 2 次或更多次随访评估中符合标准。对于社会隔离，这两个分数分别为 21%和 8%。经历孤独和社会隔离的健康和退休研究参与者患疾病、残疾和死亡的风险增加。与从未经历过孤独的人相比，持续孤独的人死亡的风险增加了 57%。对于社会隔离，风险增加了 28%。在常见活动受限的数量上，效果大小略大，而在常见慢性疾病的数量上，效果大小略小。对社会经济和心理风险的协变量调整减弱了关联，但并未完全解释关联。经历孤独和社会隔离的老年人还表现出生物衰老的生理迹象（持续孤独和社会隔离的 Cohen's d 分别为 0.26 和 0.21）。对于孤独感，而不是社会隔离，持续存在与风险增加相关。
在美国老年人的全国样本中，社会联系不足与发病、残疾和死亡以及更严重的生物衰老有关。加强社会联系以中断孤独感的体验可能会促进健康老龄化。
