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Loneliness, living alone, and all-cause mortality

The role of emotional and social loneliness in the elderly during 19 years of follow-up

O’Súilleabháin, Páraic S., PhD1; Gallagher, Stephen, PhD2; Steptoe, Andrew, PhD3

doi: 10.1097/PSY.0000000000000710
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Objective To examine the predictive value of social and emotional loneliness for all-cause mortality in the oldest-old who do, and do not live alone and to test whether these varied by functional status and personality.

Methods Participants were 413 older adults from the Berlin Aging Study (M ± SD = 84.53 ± 8.61 years of age) who either lived alone (n = 253) or did not live alone (n = 160). Significance values for hazard ratios are reported having adjusted for age, sex, education, income, marital status, depressive illness, and both social and emotional loneliness.

Results While social loneliness was not associated with mortality in those living alone, emotional loneliness was; with each 1 SD increase in emotional loneliness there was a 18.6% increased risk of all-cause mortality in the fully adjusted model (HR = 1.186; p = 0.029). No effects emerged for social or emotional loneliness for those not living alone. No associations emerged for social or emotional loneliness among those not living alone. Examinations of potential moderators revealed that with each 1 SD increase in functional status, the risk associated with emotional loneliness for all-cause mortality increased by 17.9% (HRinteraction = 1.179; p = 0.005) in those living alone. No interaction between personality traits with loneliness emerged.

Conclusions Emotional loneliness is associated with an increased risk of all-cause mortality in older aged adults who live alone. Functional status was identified as one potential pathway of accounting for the adverse consequences of loneliness. Emotional loneliness that can arise out of the loss or absence of a close emotional attachment figure appears to be the toxic component of loneliness.

1 School of Psychology, National University of Ireland Galway, Galway, Ireland

2 Department of Psychology, Health Research Institute, University of Limerick, Limerick, Ireland

3 Department of Behavioural Science and Health, University College London, London, UK

Corresponding author: Páraic S. O’Súilleabháin, PhD, School of Psychology, National University of Ireland, Galway, University Road, Galway, Ireland. Tel.: +353-91-493101. Email:

Funding: This article reports on data from the Berlin Aging Study (BASE). Funding stemmed from the Max Planck Society, the Free University of Berlin, the German Federal Ministry for Research and Technology (1989-1991, 13 TA 011 12 TA 011/A), the German Federal Ministry for Family, Senior Citizens, Women, and Youth (1992-1998, 314-1722-102/9 314-1722-102/9a), and the Berlin-Brandenburg Academy of Sciences’ Research Group on Aging and Societal Development (1994-1999) for BASE. Irish Research Council New Horizons (REPRO/2016/72).

Conflict of interest: The authors report no conflicts of interest.

Acknowledgement: The authors wish to thank all the researchers and participants who were part of the Berlin Aging Study. The authors are also very grateful for the assistance of Dr. Julia Delius and Mr. Martin Becker.

Received for publication November 19, 2018; revision received March 19, 2019.

Copyright © 2019 by American Psychosomatic Society
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