The Impact of Loneliness on Health and Mortality Among Aging Populations
Living longer in a rapidly
changing environment lessons
from Singapore
Angelique Chan
Centre for Ageing Research and Education, Duke-NUS Medical School
Programme in Health Services and Systems Research, Duke-NUS Medical School
Department of Sociology, NUS
The Singapore context is changing……..
•
Ultra-low fertility
•
Increasing non-marriage/divorce
(Loneliness)
•
Increased migration
•
Increased prevalence of non-communicable diseases (
Healthy Life
Expectancy
)
•
Productive ageing (
Employment and Intergenerational Transfers
)
Source: Population Division of the
Department of Economic and Social
Affairs of the United Nation Secretariat,
World Population Prospects: The 2010
Revision,
http://esa.un.org/unpd/wpp/index.htm
Source: Population Division of the
Department of Economic and Social
Affairs of the United Nation Secretariat,
World Population Prospects: The 2010
Revision,
http://esa.un.org/unpd/wpp/index.htm
Social Isolation and
Loneliness
Loneliness and Mortality: Results from a
Longitudinal Survey of Social Isolation, Health, and Lifestyles
Angelique Chan, Prassana Rahman, Stefan Ma, and Rahul Malhotra
Duke-NUS Graduate Medical School, Singapore
Trends in living arrangements in Singapore, South Korea, and Japan
Source: UN Demographic Yearbook
Why is loneliness important?
Social relationships, or the relative lack thereof, constitute a major risk
factor for health - rivaling the effect of well-established health risk
factors such as cigarette smoking, blood pressure, blood lipids, obesity,
and physical activity.
(House, Landis, and Umberson;
Science
, 1988)
How does loneliness affect mortality?
Loneliness
Mortality
Main effects model
: Social relationships directly encourage protective health
behavior, and loneliness can alter human physiology (increased vascular
resistance, higher systolic blood pressure)
Buffering model
. Social relationships help dampen responses to stressors.
Pathways
Methods
•
PHASE -1 , 2009
•
Nationally representative survey conducted by MCYS of community-
dwelling adults aged 60 years and above (N=4,990)
•
PHASE – 2 2011
•
Follow-on to SIHLS
•
Sample restricted to only those who answered the social isolation questions
in 2009 (N=3,802)
•
Variables: Socio-demographics, chronic diseases, social isolation and
loneliness, cognitive impairment, depression, disability, functional
status, vision, sleep, lifestyle, dental health, mental health
Measuring social isolation
UCLA 3-item Loneliness Scale
•
How often do you feel that you lack companionship?
•
How often do you feel left out?
•
How often do you feel isolated from others?
Responses: Always, fairly often, occasionally, rarely, never
•
Score range: 0-12
Independent variables
Modified Lubben Social Network Scale (12 questions)
•
How many relatives/friends/neighbors …
•
do you see or hear from at least every month?
•
are close enough to ask for help or discuss private matters?
•
How often do relatives/friends/neighbors…
•
consult you before making an important decision?
•
available to talk when you have an important decision to make?
Living arrangements (categorical)
•
Living…
•
alone
•
only with spouse
•
only with child(ren),
•
with spouse AND child(ren)
•
only with others
Independent variables
•
Socio-demographic:
Age, gender, ethnicity, marital status,
housing type, and education
•
Health
: Number of comorbidities, ADL limitations, IADL
limitations, smoking status, depression, cognition
Independent variables
Distribution of responses on UCLA Loneliness Scale
Distribution of responses on UCLA Loneliness Scale,
by living arrangements
Results
* for p<0.05
Insight
•
Perceived loneliness
is associated with a greater risk
of death in Singapore
•
It is more predictive of mortality than living
arrangements and social networks
How can we apply what we learned to policy?
•
Multi-generational housing may be valuable,
but it is not sufficient
•
Policy should address perceived loneliness
•
Psychosocial services
•
Promote awareness by community and health care providers
Healthy Life Expectancy
Healthy
Productivity
How do we increase healthy life years among the older population?
Healthy Life Expectancy
•
The proportion of years a person can expect to live without
disability.
•
Differs from total life expectancy, 80 years for males and 84.9 for
females in Singapore.
Determinants of HLE
•
Gender
–
At age 60 women spend 70% of their life healthy versus 88% for men
•
Education
–
TLE and HLE ~ both are higher among those with high education
•
Ethnicity is
–
HLE ~ Higher among the Chinese
Women live longer but in poorer health
•
Gender is associated with
–
TLE, IALE ~ both are higher among Women
–
ALE ~ it is higher among men
•
Education is associated with
–
TLE and ALE ~ both are higher among those with high education
–
Higher educated have higher TLE due to higher ALE.
•
Ethnicity is associated with ALE ~ Higher among the Chinese
After the age of 60:
women spend 70% of their life
healthy
Vs
88% for men
Healthy Ageing Policies
•
Need to be gender specific
•
Target minorities
•
Screening is necessary but not sufficient
•
More programmes to promote self management of chronic
conditions – practical solutions, e.g., SCOPE
Productive Ageing
Policies to encourage
employment among older
persons = Positive outcomes
What happens after older workers retire?
•
Longitudinal analyses of the effects of retirement on well being.
•
N = 365
•
Findings were adjusted with age, gender, ethnicity, education level,
and housing type (proxy of household income).
Benefits of work (vs. retirement)
•
Overall, employees reported better subjective health than retirees over time. Those
individuals who kept working perceived improved health whereas those who had
retired perceived deteriorated health.
Benefits of work (vs. retirement)
•
Retirees felt lonelier than employees at Time 2. In fact, retirees, but not employees
reported increased loneliness over time.
Policies to encourage
intergenerational relationships -
Necessary
Productivity within families
•
Older adults provide informal support to other family members
•
Intergenerational transfers of money, material support, and time
were collected and analyzed in a longitudinal study
•
Significant gender differences – older women provide more time
and money to other family members
Intergenerational
Financial
Support Flows
Source: PHASE 2011, elderly 62+
33
Intergenerational
Material
Support Flows
34
Source: PHASE 2011, elderly 62+
Notes: Material support includes food, clothes, and other material goods
Intergenerational
Time
Support Flows
35
Source: PHASE 2011, elderly 62+
Notes: Time support includes providing help for childcare and housework; receiving help for housework, ADL-related care, IADL related care
Intergenerational Emotional Support Flows
36
Source: PHASE 2011, elderly 62+
Discussion questions
•
Social isolation is an increasingly common issue, how can we
prevent it?
•
Adding life to years, not just years to life – How?
•
Should there be a mandatory retirement age?
•
Can monetary transfers replace time and emotional support within
families?
Thank you
Loneliness in older adults is a significant concern that can have detrimental effects on health and mortality rates. Research shows that social relationships play a crucial role in shaping health outcomes, with loneliness being comparable to well-known risk factors like smoking and high blood pressure. Understanding the impact of loneliness on physiology and mortality can help in developing interventions to address this issue.
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Presentation Transcript
Figure 1: Percentage of Population aged 65+ 45 40 35 30 Percentage of Population (%) China 25 Japan Malaysia 20 R. of Korea Singapore 15 Source: Population Division of the Department of Economic and Social Affairs of the United Nation Secretariat, World Population Prospects: The 2010 Revision, http://esa.un.org/unpd/wpp/index.htm 10 5 0 1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050
Figure 2:Percentage of Population aged 80+ 18 16 14 12 Percentage of Population (%) China 10 Japan Malaysia 8 R. of Korea Singapore 6 Source: Population Division of the Department of Economic and Social Affairs of the United Nation Secretariat, World Population Prospects: The 2010 Revision, http://esa.un.org/unpd/wpp/index.htm 4 2 0 1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050
Loneliness and Mortality: Results from a Longitudinal Survey of Social Isolation, Health, and Lifestyles Angelique Chan, Prassana Rahman, Stefan Ma, and Rahul Malhotra Duke-NUS Graduate Medical School, Singapore
Trends in living arrangements in Singapore, South Korea, and Japan 1-person 2-person 3 or more Household Types in Asia 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Singapore (2000) Singapore (2010) South Korea (2005) South Korea (2010) Japan (2000) Japan (2000) Source: UN Demographic Yearbook
Why is loneliness important? Social relationships, or the relative lack thereof, constitute a major risk factor for health - rivaling the effect of well-established health risk factors such as cigarette smoking, blood pressure, blood lipids, obesity, and physical activity. (House, Landis, and Umberson; Science, 1988)
How does loneliness affect mortality? Pathways Main effects model: Social relationships directly encourage protective health behavior, and loneliness can alter human physiology (increased vascular resistance, higher systolic blood pressure) Mortality Loneliness Buffering model. Social relationships help dampen responses to stressors.
Category (n=4536) Never Lonely 49% Sometimes Lonely 32% Mostly Lonely 19%
60 50 40 30 20 10 0 Never Lonely Sometimes Lonely Mostly Lonely Alone With spouse only With children only With spouse and children With others only or maid only
Results Covariates / Model Model 1 Model 2 Model 3 Model 4 Loneliness (95% CI) Lubben Scale (95% CI) Living arrangements (95% CI) Alone Living with spouse Living with child Spouse and child Others only 1.10 * (1.05-1.15) - 1.10 * (1.05-1.15) 0.99 * (0.98-1.00) - 1.10 * (1.06-1.16) 0.99 * (0.98-1.00) 1.07 * (1.02-1.12) 0.99 (0.98-1.00) - 0.44 * (0.22-0.85) 0.88 (0.62-1.25) 0.63 * (0.43-0.92) Ref. 0.93 (0.54-1.60) 0.63 (0.31-1.29) 0.86 (0.61-1.22) 0.94 (0.63-1.39) Ref. 1.32 (0.77-2.25) * for p<0.05
Insight Perceived loneliness is associated with a greater risk of death in Singapore It is more predictive of mortality than living arrangements and social networks
How can we apply what we learned to policy? Multi-generational housing may be valuable, but it is not sufficient Policy should address perceived loneliness Psychosocial services Promote awareness by community and health care providers
Gender At age 60 women spend 70% of their life healthy versus 88% for men Education TLE and HLE ~ both are higher among those with high education Ethnicity is HLE ~ Higher among the Chinese
Gender is associated with TLE, IALE ~ both are higher among Women ALE ~ it is higher among men Education is associated with TLE and ALE ~ both are higher among those with high education Higher educated have higher TLE due to higher ALE. Ethnicity is associated with ALE ~ Higher among the Chinese
Policies to encourage employment among older persons = Positive outcomes
Loneliness 2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0 Time 1 Time2 still working at Time 2 not working (retired) at Time 2
Policies to encourage intergenerational relationships - Necessary
100% 90% 21 32 80% 41 7 70% 5 60% 4 50% 48 44 40% 41 30% 20% 24 10% 18 14 0% Men Women Total Neither receiving nor providing Only receiving Only providing Receiving and providing Source: PHASE 2011, elderly 62+ 33
100% 7 8 9 3 3 90% 3 80% 29 32 34 70% 60% 50% 40% 30% 59 57 56 20% 10% 0% Men Women Total Neither receiving nor providing Only receiving Only providing Receiving and providing Source: PHASE 2011, elderly 62+ Notes: Material support includes food, clothes, and other material goods 34
100% 4 10 16 90% 18 18 80% 18 70% 21 21 60% 21 50% 40% 30% 57 51 45 20% 10% 0% Men Women Total Neither receiving nor providing Only receiving Only providing Receiving and providing Source: PHASE 2011, elderly 62+ Notes: Time support includes providing help for childcare and housework; receiving help for housework, ADL-related care, IADL related care 35
100% 18 19 90% 20 80% 7 5 4 9 9 70% 9 60% 50% 40% 67 66 66 30% 20% 10% 0% Men Women Total Neither receiving nor providing Only receiving Only providing Receiving and providing Source: PHASE 2011, elderly 62+ 36
