Loneliness in later life: a longitudinal analysis using the English Longitudinal Study of Ageing

研究一致表明，社会关系是老年生活质量的关键（Bowling 2005）。孤独是社会关系受损的一种衡量标准，对老年人来说是一个严重的问题。在英国，大约42%的65岁以上的老年人报告孤独（10%报告严重孤独，32%报告中度孤独）。这相当于英格兰的320万人。孤独对老年人和社会都有重要的负面影响，与一系列负面的健康、社会和服务使用结果有关。孤独的老年人死亡率要高出50%；与不孤独的人相比，急诊住院率高出三分之一（30%），全科医生咨询率高出3倍（孤独者每年咨询10次）。我们知道孤独的老年人的百分比，以及晚年最有可能经历孤独的群体，包括丧偶者、物质资源较少者和健康状况不佳者。然而，我们对孤独的理解是基于在一个时间点测量孤独的研究。我们没有充分的证据来研究孤独是如何随着人们年龄的增长而变化的，我们也不了解晚年生活中进入和走出孤独的途径，也不了解可能帮助人们从孤独中恢复过来（或导致孤独开始）的因素。此外，许多描述孤独老年人健康状况不佳的证据都是基于在美国进行的研究，我们不能确定这些发现是否适用于我们的人口。由于孤独对老年人来说是一个重要的问题，因此已经开发了一系列与孤独作斗争的服务，但很少有表明它们真正实现了这一目标。我们认为，当前服务失败的部分原因是我们不了解进入和摆脱孤独的途径；那些进入或走出孤独的群体的特征；与孤独变化相关的因素以及社会和健康因素如何与孤独途径相关。这些信息的可用性可以帮助我们设计更及时和适合老年人个人需求的服务，从而有助于提高老年生活质量。在我们的项目中，我们将使用现有的大型数据集（英国老龄化纵向研究）来探索50岁及以上人群孤独感随时间的变化，该数据集从2002年到2010年对人们进行了纵向跟踪调查。对于6600人，我们将描述他们在8年的研究中孤独是如何变化的，并确定与孤独的开始或恶化以及与孤独改善有关的因素。我们还将研究研究开始时的孤独感与8年后的健康状况之间的联系。特别是，我们将能够研究孤独与健康状况之间的联系。美国的研究报告了孤独和痴呆之间的联系，但在英国还没有研究。我们也将能够验证经常被引用的说法，即孤独对健康的影响与吸烟的影响相当。我们还将能够比较两种不同的测量孤独的方法，并确定哪一种是最好的测量孤独的方法，哪一种是最好的观察孤独变化的方法。我们的项目旨在促进这一重要的学术，政策和实践议程，通过发展我们对晚年孤独的途径的理解，建立晚年孤独的健康状况和服务使用后果。

Research has consistently demonstrated that social relationships are key to a good quality of life in old age (Bowling 2005). Loneliness is one measure of compromised social relationships and is a significant problem for older people with approximately 42% of those aged 65+ in England reporting loneliness (10% reporting severe loneliness and 32% reporting moderate loneliness). This equates to 3.2 million individuals in England. Loneliness has important negative consequences for both older adults and society being linked with a range of negative health, social and service use outcomes. Death rates for older people who are lonely are 50% higher; emergency hospital admission rates are a third (30%) higher and GP consultation rates 3 times higher (the lonely consult 10 times year) compared with those who are not lonely.We know the percentage of older people who are lonely and the groups most likely to experience loneliness in later life including those who are widowed, those with fewer material resources and those with poor health. However our understanding of loneliness is based upon studies which measure loneliness at a single point in time. We do not have good evidence examining how loneliness may change as people grow older and we do not understand the pathways into and out of loneliness in later life nor the factors which might help people recover from loneliness (or contribute to the onset of loneliness). Also much of the evidence describing the poor health outcomes for lonely older people are based upon research undertaken in America and we cannot be certain that these findings apply to our population.Because of the importance of loneliness as a problem for older people a range of services to combat loneliness have been developed but few have shown that they actually achieve this aim. We suggest that part of the failure of current services is because we do not understand the pathways into and out of loneliness; the characteristics of those groups who move/into and out of loneliness; the factors that are linked with changes in loneliness and how social and health factors are linked to loneliness pathways. The availability of this information may help us to design services that are more timely and tailored to the needs of individual older people and so help to promote quality of life in old age. In our project we will explore changes in loneliness over time for people aged 50 and over using a large existing data set (the English Longitudinal Study of Ageing) which has followed people up from 2002 to 2010 longitudinally. For 6,600 people we will describe how loneliness has changed over the 8 years they have been in the study and identify the factors that are linked with both the onset or worsening of loneliness and those linked with improvements in loneliness. We will also examine the link between loneliness at the start of the study and health status 8 years later. In particular we will be able to examine the link between loneliness and health status. Research in America has reported a link between loneliness and dementia but this has not been studied in Britain. We will also be able to test out the oft quoted statement that the health effects of loneliness are equivalent in magnitude to those attributed to smoking. We will also be able to compare two different methods of measuring loneliness and determine which is the best to measure loneliness and which is the best way to look at changes in loneliness.Our project aims to contribute to this important academic, policy and practice agenda by developing our understanding of the pathways into and out of loneliness in later life and establishing the health status and service use consequences of loneliness in later life.