Volume 32 - Article 49 | Pages 1361–1382

Loneliness and all-cause mortality in community-dwelling elderly Singaporeans

By Angelique Chan, Prassanna Raman, Stefan Ma, Rahul Malhotra

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Date received:25 Jul 2014
Date published:03 Jun 2015
Word count:3835
Keywords:Asia, elderly, living alone, loneliness, Singapore, social isolation, social networks
Weblink:You will find all publications in this Special Collection “Living Alone: One-person households in Asia” at http://www.demographic-research.org/special/15/


Background: Loneliness is a significant risk factor for mortality among older adults. There are several pathways through which loneliness may operate to increase mortality risk, ranging from biological responses and individual perceptions to social interactions and environmental factors. The proportion of single older (65+) person households has doubled in the last ten years in Singapore. Yet little is understood about the relationship between loneliness, social isolation, and mortality risk among older adults, in Singapore and in Asian contexts in general.

Objective: To assess the impact of loneliness and social isolation on the risk of all-cause mortality over a four-year period, controlling for demographic characteristics and health status at baseline.

Methods: We used data from a longitudinal survey of community-dwelling Singaporean elderly (N=4,522). Loneliness was assessed using the UCLA three-item loneliness scale. Unadjusted and adjusted Cox proportional hazards regressions were used to estimate mortality risk.

Results: In the final adjusted model, living arrangements and social networks outside the household were not associated with all-cause mortality. Loneliness increased the risk of all-cause mortality; those sometimes lonely and mostly lonely were 44.0% (p=0.005) and 39.0% (p=0.059) more likely to die compared to those not lonely.

Conclusions: Loneliness is associated with higher mortality risks among Singaporean elderly. Mental health among the older population is a major public health concern and community interventions are needed to more efficiently identify, raise awareness of, and increase care for the lonely elderly in the community.

Author's Affiliation

Angelique Chan - National University of Singapore, Singapore [Email]
Prassanna Raman - National University of Singapore, Singapore [Email]
Stefan Ma - Ministry of Health, Singapore, Singapore [Email]
Rahul Malhotra - National University of Singapore, Singapore [Email]

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