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Reduce Differences in Health Status Build Healthy Public Policy Strengthen Community and Personal Action
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The Effects of Social Isolation and Lonliness on the Health of Older Women Madelyn Hall and Betty Havens, Department of Community Health Sciences, University of Manitoba, Prairie Women’s Health Centre of Excellence
Women are more vulnerable to higher levels of loneliness in part because of their average greater longevity compared to men: women often outlive spouses, friends and family who previously provided the social and emotional support important for good health and well-being. Many older women live with multiple chronic health conditions that can limit mobility and further restrict their capacity to socialize. Studies have found associations between loneliness, poor health and well-being.¹ Some, for instance, have found that older individuals who are very lonely are at an increased risk of nursing home placement.² What is not clear is whether loneliness results from fewer contacts with other people due to ill health, or if decreased contact and the possibility of loneliness precede ill health. Our study of older Manitobans was conducted within the framework of population health. This perspective views social isolation and loneliness as factors that potentially influence health and well-being, access to health care and the effectiveness and outcome of the care received. The term "social isolation" is an objective measure of social interaction, while "social loneliness" is considered to be the subjective expression of dissatisfaction with a low number of social contacts. We partnered with five community organizations to meet the following objectives: (1) to explore the gender differences related to social isolation and loneliness for older men and women in a representative population; (2) to determine the relationship among social isolation, social loneliness and the health and well-being of older women; (3) to develop recommendations for policies and programs to address situations of social isolation and social loneliness. The first two objectives were met by analyzing data from the Aging in Manitoba Study (AIM), which contains measures of social isolation and loneliness as well as sociodemographics and health utilization for older adults. The AIM is a long-term study conducted in waves since 1971. The 1996 wave used for our study included 1,868 men and women whose minimum age was 72. Forty percent of the sample was male and sixty was female, typical of the gender distribution for this age group in Manitoba at the time. Those living in nursing homes represented 13.6% of the sample. Fifteen items that have been found to indicate isolation were explored through bivariate analysis of the AIM data.³ The Loneliness Index used in our study is a composite of the Loneliness Scale developed by researchers in the Netherlands and two single-item loneliness questions from the Netherlands NESTOR studies on ageing.4 Our research showed that women in the sample could be described as being more socially isolated than the men, as a greater proportion of the women were widowed (3:1) and lived alone (2:1). The results of the objective 2 analyses showed that social loneliness was also more common for those women who lived alone, had few contacts with others and felt that their health was poor. These effects are additive: a widow who lives alone, sees few other people and feels her health is poor would be almost six times more likely to be lonely than a married individual who lives with a spouse, sees many people on a regular basis and is in good health. While female gender per se was not found to be a significant influence on loneliness, the implication from the analyses is that the women in the sample were more likely than the men to be lonely because more of the women lived alone and were widowed. Using health utilization data we also found that higher levels of loneliness were more likely for women who had more admissions to hospital, longer stays in hospital, a greater number of physician visits, a higher number of pharmacare claims, and used home care services. The AIM dataset includes health utilization for the year following the interview as well as the year prior. These measures allowed us to test whether loneliness and social isolation in 1996 could predict use of services one year later. Analyses of the data showed that both social contacts and loneliness were significant predictors of home care use when adjusted for age and gender. Women in our sample who were lonely or had few social contacts were more than one-and-a-half times as likely to be using home care services one year after the interview. The preliminary data were presented in public meetings throughout Manitoba. Participants, including professional caretakers and seniors, said that our findings concurred with their own experiences and knowledge. They also suggested that those in poor health have little enthusiasm for socializing, and that those who are socially isolated may be more likely to experience declines in health status because they may be at risk for decreased activity, poor nutrition, decreased mental stimulation and may lack awareness of their health conditions. The Executive Summary of this report (Project Number 6,
1999) and the address to contact to receive the full report can be downloaded from www.pwhce.ca/isol.htm. NOTES |
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