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

研究一直表明，社会关系是老年人良好生活质量的关键（Bowling 2005）。孤独是衡量社会关系受损的一个指标，对老年人来说是一个重要问题，英格兰65岁以上的老年人中约有42%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。孤独的老年人的死亡率高出50%;急诊入院率高出三分之一（30%），全科医生咨询率高出三倍（孤独的人每年咨询10次）与不孤独的人相比。我们知道孤独的老年人的比例，以及晚年最有可能经历孤独的群体，包括那些丧偶的人，那些物质资源较少的人和那些健康状况不佳的人。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。我们没有很好的证据来研究孤独感如何随着人们年龄的增长而变化，我们不了解晚年孤独感的形成和消失的途径，也不了解可能帮助人们从孤独感中恢复的因素（或导致孤独感的发生）。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，我们不能确定这些研究结果是否适用于我们的人口。由于孤独作为老年人的一个问题的重要性，一系列对抗孤独的服务已经开发出来，但很少有人表明他们实际上实现了这一目标。我们认为，当前服务的失败部分是因为我们不了解进入和走出孤独的途径;那些进入和走出孤独的群体的特征;与孤独变化有关的因素以及社会和健康因素如何与孤独途径联系在一起。这些信息的可用性可能有助于我们设计更及时和更适合老年人个人需求的服务，从而有助于提高老年人的生活质量。在我们的项目中，我们将使用一个大型的现有数据集（英国老龄化纵向研究），从2002年到2010年纵向跟踪人们，探索50岁及以上人群孤独感随时间的变化。对于6,600人，我们将描述他们在研究中的8年中孤独感的变化，并确定与孤独感的发作或恶化以及与孤独感改善有关的因素。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和健康状况之间的联系。美国的研究已经报道了孤独和痴呆之间的联系，但这在英国还没有研究过。我们还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感的方法，并确定哪种方法最适合测量孤独感，哪种方法最适合观察孤独感的变化。我们的项目旨在为这一重要的学术，政策和实践议程，通过发展我们对晚年孤独感的形成和消除途径的理解，并建立健康状况和孤独感的服务使用后果，后来的生活。

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.