Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Indiana University Center for Aging Research, Indianapolis, Indiana, USA.
J Am Geriatr Soc. 2024 Mar;72(3):811-821. doi: 10.1111/jgs.18762. Epub 2024 Jan 19.
Loneliness is a significant public health challenge in the United States, especially among older adults. The epidemiology of loneliness among older adults in primary care is lacking, and specific research is needed on how loneliness impacts older primary patients' physical, mental, and cognitive health. A large sample of older primary care patients were recruited for a trial during the COVID-19 pandemic to measure the relationship between loneliness and physical and mental quality of life (QOL).
Baseline data come from the Caregiver Outcomes of Alzheimer's Disease Screening (COADS) study, an ongoing randomized controlled trial evaluating benefits and risks of Alzheimer's disease and related dementias screening among primary care patients ages 65 and older, collected April 2020 to September 2021. Loneliness was measured with the 5-item, Loneliness Fixed Form Ages 18+ from The NIH Toolbox Emotion Battery, physical and mental health-related QOL was measured with the SF-36v2, and depression and anxiety severity were measured with the PHQ-9 and GAD-7, respectively.
Spearman correlation analyses revealed that loneliness was moderately correlated with mental health QOL (r[601] = -0.43, p < 0.001), anxiety severity (r[601] = 0.44, p < 0.001), and depression severity (r[601] = 0.42, p < 0.001), while weakly correlated with physical health QOL (r[601] = -0.15, p < 0.001). After conducting unadjusted and adjusted linear regression models, we found that loneliness was significantly associated with both lower mental (p < 0.001) and physical (p < 0.001) QOL. Furthermore, loneliness remained significantly associated with worse mental QOL after adjusting for age, gender, race, ethnicity, educational level, perceived income status, neighborhood disadvantage, severity of comorbidities, and comorbid depression and anxiety.
Primary care providers should discuss loneliness with their older adult patients and provide resources to help patients develop and maintain meaningful social relationships.
孤独在美国是一个严重的公共卫生挑战，尤其是在老年人中。初级保健中老年人群孤独的流行病学情况尚不清楚，需要具体研究孤独如何影响老年初级保健患者的身体、心理和认知健康。在 COVID-19 大流行期间，一项针对大量老年初级保健患者的试验招募了这些患者，以测量孤独感与身体和心理健康相关生活质量（QOL）之间的关系。
基线数据来自于正在进行的、针对初级保健患者（年龄在 65 岁及以上）的阿尔茨海默病筛查（COADS）的研究，该研究评估了阿尔茨海默病和相关痴呆症筛查的益处和风险，数据收集于 2020 年 4 月至 2021 年 9 月。孤独感通过 NIH 工具包情绪电池的 5 项孤独感固定表格（Loneliness Fixed Form Ages 18+）进行测量，身心健康相关 QOL 通过 SF-36v2 进行测量，抑郁和焦虑严重程度分别通过 PHQ-9 和 GAD-7 进行测量。
Spearman 相关分析显示，孤独感与心理健康 QOL（r[601] = -0.43，p<0.001）、焦虑严重程度（r[601] = 0.44，p<0.001）和抑郁严重程度（r[601] = 0.42，p<0.001）中度相关，而与身体健康 QOL 弱相关（r[601] = -0.15，p<0.001）。在进行未调整和调整后的线性回归模型后，我们发现孤独感与较低的心理健康（p<0.001）和身体健康（p<0.001）QOL 显著相关。此外，在调整年龄、性别、种族、民族、教育水平、收入感知状况、邻里劣势、合并症严重程度以及合并抑郁和焦虑后，孤独感仍与较差的心理健康 QOL 显著相关。
初级保健提供者应与老年患者讨论孤独感，并提供资源帮助患者建立和维持有意义的社会关系。
