Social isolation, social support and loneliness as independent concepts, and their relationship with health-related quality of life among older women

Abstract

Objectives: To assess whether social isolation, social support, and loneliness are independently associated with health-related quality of life (HRQoL).

Method: Retrospective analysis including 10,517 women aged 70–75 years from the Australian Longitudinal Study on Women’s Health (ALSWH). Social isolation, social support (Duke Social Support Index), and loneliness (single item) were investigated for their association with standardised HRQoL (physical [PCS] and mental [MCS] components of the SF-36® questionnaire). Analyses were adjusted for sociodemographic variables and number of medical conditions.

Results: Only 3% reported being socially isolated, having low social support and being lonely, and 34% reported being not socially isolated, high social support and not being lonely. Each construct was independently associated with HRQoL, with loneliness having the strongest inverse association (PCS: isolation −0.98, low support −2.01, loneliness −2.03; MCS: isolation −1.97, low support −4.79, loneliness −10.20; p-value < 0.001 for each). Women who were not isolated or lonely and with high social support had the greatest HRQoL (compared to isolated, low social support and lonely; MCS: 17 to 18 points higher, PCS: 5 to 8 points higher). Other combinations of social isolation, social support and loneliness varied in their associations with HRQoL.

Conclusion: Ageing populations face the challenge of supporting older people to maintain longer, healthy, meaningful and community-dwelling lives. Among older women, social isolation, low social support and loneliness are distinct, partially overlapping yet interconnected concepts that coexist and are each adversely associated with HRQoL. Findings should be replicated in other cohorts to ensure generalisability across other age groups and men.

Keywords:

• Geriatrics
• aged
• 80 and over
• ageing
• age factors
• interpersonal relations
• social support
• social isolation
• loneliness
• socioeconomic factors
• social interaction
• social connection
• socioeconomic position
• older adult
• mental health
• quality of life

Acknowledgements

We gratefully acknowledge the contribution of participants, our funding bodies, the many colleagues who provided advice for the development and refinement of the questionnaires, and the administration team for their printing, posting and scanning of questionnaires.

Disclosure statement

None declared. The data collection, analysis and interpretation of data; the writing of the manuscript; and the decision to submit the manuscript for publication were solely at the discretion of the researchers, independent of the funders.

Funding

The ALSWH is conducted by researchers at the University of Queensland and the University of Newcastle and supported with funding from the Australian Government Department of Health. RFP is supported by an Australian Heart Foundation post-doctoral fellowship (101927). MB is supported by a National Health and Medical Research Council (NHMRC) Senior Principal Research Fellowship (APP1059660 and APP1156072). JF is supported by the Finkel Professorial Fellowship which is funded by the Finkel Family Foundation. TT is supported by a Monash Strategic Bridging Fellowship.

Author contributions

RFP takes responsibility for the analysis design, the integrity of the data, the accuracy of the data analysis and the critical interpretation of the data. JB, JR, TT & AO contributed to data analysis decisions. All authors contributed to the final version of the paper and have read, as well as, approved the final manuscript.