Hostname: page-component-669899f699-2mbcq Total loading time: 0 Render date: 2025-04-25T14:55:13.494Z Has data issue: false hasContentIssue false
  • English
  • Français

Increased risk of mortality associated with social isolation in older men: only when feeling lonely? Results from the Amsterdam Study of the Elderly (AMSTEL)

Published online by Cambridge University Press:  06 September 2011

T. J. Holwerda ,
A. T. F. Beekman ,
D. J. H. Deeg ,
M. L. Stek ,
T. G. van Tilburg ,
P. J. Visser ,
B. Schmand ,
C. Jonker  and
R. A. Schoevers
T. J. Holwerda*
Affiliation:
Department of Psychiatry, ARKIN Institute of Mental Health Care, Amsterdam, The Netherlands EMGO Institute, Vrije Universiteit Medisch Centrum Amsterdam (VUMC), Amsterdam Study of the Elderly (AMSTEL), Amsterdam, The Netherlands
A. T. F. Beekman
Affiliation:
EMGO Institute, Vrije Universiteit Medisch Centrum Amsterdam (VUMC), Amsterdam Study of the Elderly (AMSTEL), Amsterdam, The Netherlands Department of Psychiatry, INGEEST Institute of Mental Health Care, Amsterdam, The Netherlands
D. J. H. Deeg
Affiliation:
EMGO Institute, Vrije Universiteit Medisch Centrum Amsterdam (VUMC), Amsterdam Study of the Elderly (AMSTEL), Amsterdam, The Netherlands
M. L. Stek
Affiliation:
EMGO Institute, Vrije Universiteit Medisch Centrum Amsterdam (VUMC), Amsterdam Study of the Elderly (AMSTEL), Amsterdam, The Netherlands Department of Psychiatry, INGEEST Institute of Mental Health Care, Amsterdam, The Netherlands
T. G. van Tilburg
Affiliation:
EMGO Institute, Vrije Universiteit Medisch Centrum Amsterdam (VUMC), Amsterdam Study of the Elderly (AMSTEL), Amsterdam, The Netherlands Department of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
P. J. Visser
Affiliation:
EMGO Institute, Vrije Universiteit Medisch Centrum Amsterdam (VUMC), Amsterdam Study of the Elderly (AMSTEL), Amsterdam, The Netherlands
B. Schmand
Affiliation:
Department of Psychology, Universiteit van Amsterdam, Amsterdam, The Netherlands
C. Jonker
Affiliation:
EMGO Institute, Vrije Universiteit Medisch Centrum Amsterdam (VUMC), Amsterdam Study of the Elderly (AMSTEL), Amsterdam, The Netherlands
R. A. Schoevers
Affiliation:
Department of Psychiatry, ARKIN Institute of Mental Health Care, Amsterdam, The Netherlands EMGO Institute, Vrije Universiteit Medisch Centrum Amsterdam (VUMC), Amsterdam Study of the Elderly (AMSTEL), Amsterdam, The Netherlands Department of Psychiatry, Universitair Medisch Centrum Groningen (UMCG), Groningen, The Netherlands
*
*Address for correspondence: T. J. Holwerda, M.D., Vrije Universiteit Medisch Centrum Amsterdam, AMTEL-LASA, room A 515, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Loneliness has a significant influence on both physical and mental health. Few studies have investigated the possible associations of loneliness with mortality risk, impact on men and women and whether this impact concerns the situation of being alone (social isolation), experiencing loneliness (feeling lonely) or both. The current study investigated whether social isolation and feelings of loneliness in older men and women were associated with increased mortality risk, controlling for depression and other potentially confounding factors.

Method

In our prospective cohort study of 4004 older persons aged 65–84 years with a 10-year follow-up of mortality data a Cox proportional hazard regression analysis was used to test whether social isolation factors and feelings of loneliness predicted an increased risk of mortality, controlling for psychiatric disorders and medical conditions, cognitive functioning, functional status and sociodemographic factors.

Results

At 10 years follow-up, significantly more men than women with feelings of loneliness at baseline had died. After adjustment for explanatory variables including social isolation, the mortality hazard ratio for feelings of loneliness was 1.30 [95% confidence interval (CI) 1.04–1.63] in men and 1.04 (95% CI 0.90–1.24) in women. No higher risk of mortality was found for social isolation.

Conclusions

Feelings of loneliness rather than social isolation factors were found to be a major risk factor for increasing mortality in older men. Developing a better understanding of the nature of this association may help us to improve quality of life and longevity, especially in older men.

Keywords

Feelings of lonelinesslonelinessmortalitysocial isolation
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 4 , April 2012 , pp. 843 - 853
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Beck, AT, Ward, CH, Mendelson, M, Mock, J, Erbaugh, J (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561–571.Google Scholar
Berkman, LF, Glass, T, Brisette, I, Seeman, TE (2000). From social integration to health: Durkheim in the new millennium. Social Science and Medicine 51, 843–857.CrossRefGoogle ScholarPubMed
Berkman, LF, Syme, SL (1979). Social networks, host resistance, and mortality: a nine-year follow-up study of Almeda county residents. American Journal of Epidemiology 109, 186–204.Google Scholar
Boomsma, DI, Willemsen, G, Dolan, CV, Hawkly, LC, Cacioppo, JT (2005). Genetic and environmental contributions to loneliness in adults: The Netherlands Twin Register Study. Behavior Genetics 35, 745–752.Google Scholar
Cacioppo, JT, Ernst, JM, Burleson, MH, McClintock, MK, Malarkey, WB, Kowalewski, RB, Paulsen, A, Hobson, JA, Hugdahl, K, Spiegel, D, Berntson, GG (2000). Lonely traits and concomitant physiological processes: the MacArthur social neuroscience studies. International Journal of Psychophysiology 35, 143–154.CrossRefGoogle ScholarPubMed
Cacioppo, JT, Hawkley, LC, Berntson, GG, Ernst, JM, Gibbs, AC, Stickgold, R, Hobson, JA (2002 a). Do lonely days invade the nights? Potential social modulation of sleep efficiency. Psychological Science 13, 384–387.CrossRefGoogle ScholarPubMed
Cacioppo, JT, Hawkley, LC, Crawford, E, Ernst, JM, Burleson, MH, Kowalewski, RB, Malarkey, WB, Cauter, EV, Berntson, GG (2002 b). Loneliness and health: potential mechanisms. Psychosomatic Medicine 64, 407–417.Google Scholar
Candore, G, Balisteri, CR, Listi, F, Grimaldi, MP, Vasto, S, Colonna-Romano, G, Franceschi, C, Lio, D, Caselli, G, Caruso, C (2006). Immunogenetics, gender and longevity. Annals of the New York Academy of Sciences 1089, 516–537.CrossRefGoogle ScholarPubMed
Cattan, M, White, M, Bond, J, Learmouth, A (2005). Preventing social isolation and loneliness among older people: a systematic review of health promotion interventions. Ageing and Society 25, 41–67.Google Scholar
Choi, BG, McLaughlin, MA (2007). Why men's hearts break: cardiovascular effects of sex steroids. Endocrinology Metabolism Clinics of North America 36, 365–377.Google Scholar
Copeland, JR, Davidson, IA, Dewey, ME, Gilmore, C, Larkin, BA, McWilliam, C, Saunders, PA, Scott, A, Sharma, V, Sullivan, C (1992). Alzheimer's disease, other dementias, depression and pseudodementia: prevalence, incidence and three-year outcome in Liverpool. British Journal of Psychiatry 161, 230–239.Google Scholar
Copeland, JR, Dewey, ME, Giffith-Jones, HM (1986). A computerized psychiatric diagnostic system and case nomenclature for elderly subjects: GMS AGECAT. Psychological Medicine 16, 89–99.Google Scholar
Copeland, JR, Dewey, ME, Wood, N, Searle, R, Davidson, IA, McWilliam, C (1987). Range of mental illness among the elderly in the community. Prevalence in Liverpool using the GMS-AGECAT package. British Journal of Psychiatry 150, 815–823.Google Scholar
De Jong Gierveld, J, Van Tilburg, T (2008). A shortened scale for overall, emotional and social loneliness. Tijdschrift voor Gerontologie en Geriatrie 39, 4–15.Google Scholar
Donnan, GA, Fisher, M, Macleod, M, Davis, SM (2008). Stroke. Lancet 371, 1612–1623.CrossRefGoogle ScholarPubMed
Dykstra, PA, De Jong Gierveld, J (2004). Gender and marital-history differences in emotional and social loneliness among Dutch older adults. Canadian Journal on Aging 23, 141–155.CrossRefGoogle ScholarPubMed
Folstein, MF, Folstein, SF, McHugh, PR (1975). ‘Mini mental state’. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189–198.CrossRefGoogle Scholar
Foster, JA, MacQueen, G (2008). Neurobiological factors linking personality traits and major depression. Canadian Journal of Psychiatry 53, 6–13.CrossRefGoogle ScholarPubMed
Fratiglioni, L, Wang, HX, Ericsson, K, Maytan, M, Winblad, B (2000). Influence of social network on occurrence of dementia: a community-based longitudinal study. Lancet 355, 1315–1319.Google Scholar
Garssen, MJ, Hoogenbeezem, J (2005). Backgrounds on recent trends in mortality in The Netherlands. Nederlands Tijdschrift voor Geneeskunde 149, 2554–2560.Google Scholar
Geerlings, MI, Schoevers, RA, Beekman, ATF, Jonker, C, Deeg, DJH, Schmand, B, Ader, HJ, Bouter, LM, Van Tilburg, W (2000). Depression and risk of cognitive decline and Alzheimer's disease. Results of two prospective community based studies in the Netherlands. British Journal of Psyhiatry 176, 568–575.Google Scholar
Hawkley, LC, Masi, CM, Berry, JD, Cacioppo, JT (2006). Loneliness is a unique predictor of age-related differences in systolic blood pressure. Psychology and Aging 21, 152–164.CrossRefGoogle ScholarPubMed
Heinrich, LM, Gullone, E (2006). The clinical significance of loneliness: a literature review. Clinical Psychology Review 26, 695–718.CrossRefGoogle ScholarPubMed
Helmer, C, Damon, D, Letenneur, L, Fabrigoule, C, Barberger-Gateau, P, Lafont, S, Fuhrer, R, Antonucci, T, Commenges, D, Orgogozo, M, Dartigues, JF (1999). Marital status and risk of Alzheimer's disease. A French population-based cohort study. Neurology 53, 1953–1958.Google Scholar
Holwerda, TJ, Schoevers, RA, Dekker, J, Deeg, DJH, Jonker, C, Beekman, ATF (2007). The relationship between generalized anxiety disorder, depression and mortality in old age. International Journal of Geriatric Psychiatry 22, 241–249.Google Scholar
Iwasa, H, Masui, Y, Gondo, Y, Inagaki, H, Kawaai, C, Suzuki, T (2008). Personality and all-cause mortality among older adults dwelling in a Japanese community: a five-year population-based prospective cohort study. American Journal of Geriatric Psychiatry 16, 399–405.CrossRefGoogle Scholar
Janssen, F, Kunst, AE, Mackenbach, JP (2008). Variations in the pace of mortality in elderly in 7 north-western European countries between 1950–1999: the impact of smoking. Nederlands Tijdschrift voor Geneeskunde 152, 1478–1484.Google Scholar
Katz, S, Ford, AB, Moskowitz, RW, Jackson, BA, Jaffe, MW (1963). Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. Journal of the American Medical Association 185, 914–919.Google ScholarPubMed
Kay, DWK, Beamish, P, Roth, M (1964). Old age mental disorders in Newcastle upon Tyne: a study of prevalence. British Journal of Psychiatry 110, 146–158.Google Scholar
Kriegsman, DMW, Penninx, BWJH, Van Eijk, JThM, Boeke, AJP, Deeg, DJH (1996). Self-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly. A study on the accuracy of patients' self reports and on determinants of inaccuracy. Journal of Clinical Epidemiology 49, 1407–1417.CrossRefGoogle Scholar
Launer, LJ, Wind, AW, Deeg, DJ (1994). Nonresponse pattern and bias in a community-based cross-sectional study of cognitive functioning among the elderly. American Journal of Epidemiology 139, 803–812.CrossRefGoogle Scholar
Lawton, MP, Brody, EM (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9, 179–186.CrossRefGoogle ScholarPubMed
Luanaigh, CO, Lawlor, BA (2008). Loneliness and the health of older people. International Journal of Geriatric Psychiatry 23, 1213–1221.CrossRefGoogle ScholarPubMed
Morgado, A, Raoux, N, Jourdain, G, Lecrubier, Y, Widlocher, D (1991 a). Over-reporting of maladjustment by depressed subjects. Findings from retesting after recovery. Social Psychiatry and Psychiatric Epidemiology 26, 68–74.CrossRefGoogle ScholarPubMed
Morgado, A, Smith, M, Lecrubier, Y, Widlocher, D (1991 b). Depressed subjects unwittingly overreport poor social adjustment which they reappraise when recovered. Journal of Nervous and Mental Disease 179, 614–619.Google Scholar
Murphy, JM, Monson, RR, Olivier, DC (1987). Affective disorders and mortality. A general population based study. Archives of General Psychiatry 44, 473–480.Google Scholar
Murray, J, Banerjee, S, Byng, R, Tylee, A, Bhugra, D, McDonald, A (2006). Primary care professionals' perceptions of depression in older people: a qualitative study. Social Science and Medicine 63, 1363–1373.CrossRefGoogle ScholarPubMed
Oksuzyan, A, Juel, K, Vaupel, JW, Christensen, K (2008). Men: good health and high mortality. Sex differences in health and aging. Aging Clinical Experimental Research 20, 91–102.Google Scholar
Ostbye, T, Hill, G, Steenhuis, R (1999). Mortality in elderly Canadians with and without dementia. A 5-year follow-up. Neurology 53, 521–532.CrossRefGoogle ScholarPubMed
Penninx, BWJH, Geerlings, SW, Deeg, DJH, Van Eijk, JT, van Tilburg, W, Beekman, AT (1999). Minor and major depression and the risk of death in older persons. Archives of General Psychiatry 56, 889–895.CrossRefGoogle ScholarPubMed
Penninx, BWJH, Van Tilburg, T, Kriegsman, DMW, Deeg, DJH, Boeke, AJP, Van Eijk, JTM (1997). Effects of social support and personal coping resources on mortality in older age: The Longitudinal Aging Study Amsterdam. American Journal of Epidemiology 146, 510–519.CrossRefGoogle ScholarPubMed
Roth, M, Tym, E, Mountjoy, CQ, Huppert, FA, Hendrie, H, Verma, S, Goddard, R (1986). CAMDEX. A standardised instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. British Journal of Psychiatry 149, 698–709.Google Scholar
Schoevers, RA, Geerlings, MI, Beekman, ATF, Penninx, BWJH, Deeg, DJH, Jonker, C, Van Tilburg, W (2000). The association of depression and gender with mortality in late life. British Journal of Psychiatry 177, 336–342.CrossRefGoogle Scholar
Schoevers, RA, Geerlings, MI, Deeg, DJ, Holwerda, TJ, Jonker, C, Beekman, AT (2009). Depression and excess mortality: evidence for a dose response relation in community living elderly. International Journal of Psychiatry 24, 169–176.Google Scholar
Stek, ML, Vinkers, DJ, Gussekloo, J, Beekman, ATF, Van der Mast, RC, Westendorp, RGJ (2005). Is depression in old age fatal only when people feel lonely? American Journal of Psychiatry 162, 178–180.CrossRefGoogle ScholarPubMed
Steptoe, A, Owen, N, Kunz-Ebrecht, SR, Brydon, L (2004). Loneliness and neuroendocrine, cardiovascular and inflammatory stress responses in middle-aged men and women. Psychoneuroendocrinology 29, 593–611.Google Scholar
Tilvis, RS, Kähönene-Väre, MH, Jolkkonen, J, Valvanne, J, Pitkala, KH, Strandberg, TE (2004). Predictors of cognitive decline and mortality of aged people over a 10-year period. Journal of Gerontology 59, 268–274.Google ScholarPubMed
Van Grootheest, DS, Beekman, ATF, Broese van Groenou, MI, Deeg, DJH (1999). Sex differences in depression after widowhood. Do men suffer more? Social Psychiatry and Psychiatric Epidemiology 34, 391–398.CrossRefGoogle ScholarPubMed
Van Ojen, R, Hooijer, C, Jonker, C, Lindeboom, J, Van Tilburg, W (1995). Late-life depressive disorder in the community, early onset and the decrease of vulnerability with increasing age. Journal of Affective Disorders 33, 159–166.CrossRefGoogle ScholarPubMed
Van Tilburg, T, De Jong, Gierveld (2007). Zicht op eenzaamheid. Achtergronden, oorzaken en aanpak (Sight on Loneliness. Backgrounds, Origins and Approach). Van Gorcum: Assen, The Netherlands.Google Scholar
Victor, C (2005). Measuring loneliness in later life: a comparison of differing measures. Reviews in Clinical Gerontology 15, 63–70.CrossRefGoogle Scholar
Wilson, RS, Bienias, JL, Mendes de Leon, CF, Evans, DA, Bennett, DA (2003). Negative affect and mortality in older persons. American Journal of Epidemiology 158, 827–835.CrossRefGoogle ScholarPubMed
Wilson, RS, Krueger, KR, Arnold, SE, Schneider, JA, Kelly, JF, Barnes, LL, Tang, Y, Bennett, DA (2007). Loneliness and risk of Alzheimer disease. Archives of General Psychiatry 64, 234–240.CrossRefGoogle ScholarPubMed