Prevalence of loneliness and its associated factors in middle-aged and older adults with breathlessness: a nationally representative cohort study.
Breathlessness has functional, psychological and social impacts. Loneliness is a health priority under-researched in relation to breathlessness, despite breathlessness impacting social interactions.
We estimated the prevalence of loneliness and associated characteristics in adults (≥50 years) with breathlessness in the English Longitudinal Study of Ageing (ELSA, 2010-11). Breathlessness was assessed using the adapted modified Medical Research Council Dyspnoea Scale from grade 0 (none) to 3 (stops on level due to breathlessness). Grade 4 was not assessed in ELSA. Loneliness was measured using the 3-Item University of California, Los Angeles Loneliness Scale (scores ≥6 = lonely). Logistic regression was adjusted for age, sex and ethnicity.
Of the 8195 participants, 28.4% reported breathlessness and 19.3% were lonely. Greater breathlessness was associated with older age, female sex and lower wealth (p<0.001). Those with greater breathlessness were more likely to be lonely (16.3% for no breathlessness vs 34.9% for grade 3), live alone (18.2% vs 36.6%) and be unmarried (26.7% vs 45.7%) (all p<0.001). Greater breathlessness was associated with depressive symptoms, limiting longstanding illness, mobility issues (all p<0.001) and social isolation (p=0.012). Of those with worse breathlessness (graded 2-3, n=1149), 32.8% were lonely. Characteristics associated with loneliness in those with grade 2-3 breathlessness were female sex (OR 1.32, 95% CI 1.02 to 1.71), lower wealth (OR 2.75, 95% CI 1.63 to 4.64), no qualifications versus having a degree (OR 1.65, 95% CI 1.03 to 2.66), being unmarried (OR 3.45, 95% CI 2.64 to 4.52), living alone (OR 3.71, 95% CI 2.80 to 4.91), depressive symptoms (OR 1.58, 95% CI 1.47 to 1.69), limiting longstanding illness (OR 1.76, 95% CI 1.30 to 2.38), smoking (OR 1.42, 95% CI 1.04 to 1.97), difficulties with activities of daily living (OR 1.34, 95% CI 1.21 to 1.47) or mobility (OR 1.15, 95% CI 1.10 to 1.21). Age, ethnicity or social isolation was not significantly associated with loneliness in adults with breathlessness.
Adults with breathlessness are more likely to be lonely, especially those with lower socio-economic status, who are unmarried or live alone or who have poorer physical function. Findings highlight priority groups for loneliness interventions among adults with breathlessness.
We estimated the prevalence of loneliness and associated characteristics in adults (≥50 years) with breathlessness in the English Longitudinal Study of Ageing (ELSA, 2010-11). Breathlessness was assessed using the adapted modified Medical Research Council Dyspnoea Scale from grade 0 (none) to 3 (stops on level due to breathlessness). Grade 4 was not assessed in ELSA. Loneliness was measured using the 3-Item University of California, Los Angeles Loneliness Scale (scores ≥6 = lonely). Logistic regression was adjusted for age, sex and ethnicity.
Of the 8195 participants, 28.4% reported breathlessness and 19.3% were lonely. Greater breathlessness was associated with older age, female sex and lower wealth (p<0.001). Those with greater breathlessness were more likely to be lonely (16.3% for no breathlessness vs 34.9% for grade 3), live alone (18.2% vs 36.6%) and be unmarried (26.7% vs 45.7%) (all p<0.001). Greater breathlessness was associated with depressive symptoms, limiting longstanding illness, mobility issues (all p<0.001) and social isolation (p=0.012). Of those with worse breathlessness (graded 2-3, n=1149), 32.8% were lonely. Characteristics associated with loneliness in those with grade 2-3 breathlessness were female sex (OR 1.32, 95% CI 1.02 to 1.71), lower wealth (OR 2.75, 95% CI 1.63 to 4.64), no qualifications versus having a degree (OR 1.65, 95% CI 1.03 to 2.66), being unmarried (OR 3.45, 95% CI 2.64 to 4.52), living alone (OR 3.71, 95% CI 2.80 to 4.91), depressive symptoms (OR 1.58, 95% CI 1.47 to 1.69), limiting longstanding illness (OR 1.76, 95% CI 1.30 to 2.38), smoking (OR 1.42, 95% CI 1.04 to 1.97), difficulties with activities of daily living (OR 1.34, 95% CI 1.21 to 1.47) or mobility (OR 1.15, 95% CI 1.10 to 1.21). Age, ethnicity or social isolation was not significantly associated with loneliness in adults with breathlessness.
Adults with breathlessness are more likely to be lonely, especially those with lower socio-economic status, who are unmarried or live alone or who have poorer physical function. Findings highlight priority groups for loneliness interventions among adults with breathlessness.
Authors
Hackett Hackett, Norton Norton, Chilcot Chilcot, Cottrell Cottrell, Maddocks Maddocks, Higginson Higginson, Canfield Canfield, Philip Philip, Brighton Brighton
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