Social connections in older adults: Associations with health and well-being Aparna Shankar Department of Epidemiology & Public Health, UCL
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Social connections in older adults: Associations with health and well-being
Aparna Shankar
Department of Epidemiology & Public Health, UCL
Social isolation
• Social isolation is an objective assessment of individuals’ social networks
• Social isolation has been defined in several ways including living arrangements, marital status, number of family & friends, frequency of contact with family & friends, participation/engagement in the community
• Can be seen as a ‘structural measure’
Loneliness
• Loneliness, in contrast, is dissatisfaction with existing relationships
• Refers to a discrepancy between actual and desired relationships
• Can be seen as a ‘functional measure’
The English Longitudinal Study of Ageing (ELSA)
• Nationally representative panel study of individuals aged 50 years and over
• Started in 2002 with 11,391 core sample members
• Participants are followed up every 2 years with a detailed interview on health, physical functioning, financial circumstances and social-psychological variables
• A nurse visit is carried out in every other wave (2004, 2008, 2012) including anthropometric measures and blood sampling
• We now have 10 years worth of data (Waves 1 – 6) and data are currently being collected for wave 7
ELSA - Main measures
• Social isolation: Index incorporating marital status, frequency of contact with family, friends & children and participation in social activities.
• Loneliness: Multiple measures are available in ELSA, including
Single item measure: How often do you feel lonely? (scored as hardly ever or never, some of the time, often)
UCLA Loneliness scale (Short form)
Isolation & loneliness among older adults
Social isolation – ELSA Wave 6
21.10%
29.90%
21%
9.90%
11.70%
6.30% • Just over 6% of
participants were highly isolated
• Levels of isolation increased with age
• Isolation decreased as wealth increased
• There were no gender differences in isolation levels
From wave 6 (2012/2013) of ELSA
Loneliness – ELSA wave 6
66.5%
25.8%
7.7%
• Around 8% of participants report being lonely often
• Loneliness increased with age
• Women reported being more lonely than men
• Loneliness decreased as wealth increased
From wave 6 (2012/2013) of ELSA
Associations with cognitive & physical function
Cognitive function
• We examined 2 different dimensions of cognitive function – recall & verbal fluency over a 4-year period
• Increased levels of loneliness and of isolation were associated with poorer recall over time
• Increased isolation (but not loneliness) was also associated with decreases in verbal fluency over time
• Recall was worse for individuals who were highly isolated and highly lonely
Social isolation, loneliness and change in recall over 6 years
5
5.25
5.5
5.75
6
3 6 9
Imm
edia
te r
ecal
l at
fo
llo
w-u
p
Loneliness at baseline
Low isolation Medium isolation High isolation
(Shankar et al., 2013)
Physical functioning • Objective measure
Walking speed over a distance of 8 feet
• Difficulties with 6 every day tasks
walking across a room,
dressing,
eating,
bathing/showering,
getting in and out of bed,
using the toilet
• Assessed changed over a 6-year period
• Analyses only conducted on participants aged 60 y. and over
Physical functioning (2)
(Figure values are unadjusted, baseline only)
• Loneliness was associated with an increase in difficulties with of activities of daily living over time
(Figure values are unadjusted, baseline only)
• Isolation was associated with reduced gait speed over time
0
0.2
0.4
0.6
0.8
1
Low Medium High
Mean gait speed (m/s)
0%
10%
20%
30%
Not lonely Lonely
Difficulty with 1 or more
ADLs
(Shankar et al., 2014)
Associations with well-being
Well-being in older age
• Increasing move towards placing national wellbeing at the centre of policy-making (Stiglitz et al., 2009)
• We examined 2 measures of well-being over a 6-year period:
- Life satisfaction, which is an evaluation of life in general
- Enjoyment of life or how happy individuals feel at this point in time
Wellbeing over the 6 years
8
9
10
11
2002 2004 2006 2008 2010 2012
En
joy
me
nt
of
life
Years
17
18
19
20
21
22
23
24
2002 2004 2006 2008 2010 2012L
ife
sati
sfac
tio
n
Years
• Levels of wellbeing were generally high in participants
• Although there were some decreases initially, wellbeing increased with time
(Shankar et al., 2014)
How does isolation affect wellbeing?
8
9
10
11
2002 2004 2006 2008 2010 2012
En
joy
me
nt
of
life
Years
18
19
20
21
22
23
24
2002 2004 2006 2008 2010 2012
Lif
e sa
tisf
acti
on
Years
• Individuals with low and intermediate levels of isolation had higher levels of wellbeing that those in the high isolation group; they also showed expected increases with time
• The low isolation group showed sustained decreases in enjoyment of life and only small increases in life satisfaction with time
Low isolation Intermediate isolation
High isolation
(Shankar et al., 2014)
How does loneliness affect wellbeing?
8
9
10
11
2003 2004 2005 2006 2007 2008 2009 2010 2011
En
joy
me
nt
of
life
Years
18
19
20
21
22
23
24
2002 2004 2006 2008 2010 2012L
ife
sati
sfac
tio
n
Years
• The low loneliness group showed consistently higher levels of wellbeing when compared with the high loneliness group
Not lonely Lonely
(Shankar et al., 2014)
What kind of social network characteristics matter?
Social network characteristics:
oNumber of close relationships – family, friends & children
oPresence of family, friends and children
oFrequency of contact with family, friends & children
We categorised each into low, medium & high
40
41
42
43
# of close relationships Frequency of contacts
CA
SP
-19
sco
res
Social network characteristics & change in quality of life over 4 years
Age & gender adjusted. Effects also persist after adjusting for other covariates like SES, health, and marital status
(Rafnsson et al., 2015)
Low
Medium
High
20
21
22
# of close relationships Frequency of contacts
Lif
e s
ati
sfacti
on
Social network characteristics & change in life satisfaction over 4 years
Age & gender adjusted. Effects also persist after adjusting for other covariates like SES, health, and marital status
(Rafnsson et al., 2015)
Low
Medium
High
Summary of findings
• Isolation and loneliness are both associated with poor health outcomes,
• Both variables also play an important part in determining well-being
• However, the pattern of associations may differ and this highlight the need to study and understand both constructs
Next steps
• Understanding the mechanisms of action
• Strong and weak ties
Acknowledgements The English Longitudinal Study of Ageing was developed by a team of researchers based at University College London, the Institute for Fiscal Studies, and the National Centre for Social Research. Funding was provided by Grants 2R01AG7644-01A1 and 2R01AG017644 from the National Institute on Aging and by a consortium of UK government departments coordinated by the Office for National Statistics. The data are lodged with the UK Data Service http://ukdataservice.ac.uk/
Work on social connections & well-being was funded by the ESRC Secondary Data Analysis Initiative (Grant: ES/K003178/1 )
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