Research challenges link between loneliness and mortality for older adults receiving home care

Various reports have linked loneliness to premature death, with some—including the U.S. Surgeon General—suggesting that loneliness is as harmful to one’s health as smoking 15 cigarettes a day.

However, a new international study led by researchers at the University of Waterloo’s School of Public Health Sciences has found that while loneliness is common among older adults receiving home care, it is not associated with an increased risk of death.

The study, “Cross-National Evidence on Risk of Death Associated with Loneliness: A Survival Analysis of 1-Year All-Cause Mortality among Older Adult Home Care Recipients in Canada, Finland, and Aotearoa in New Zealand,” was published in the Journal of the American Medical Directors Association.

The researchers analyzed data from more than 380,000 home care recipients aged 65 and older in Canada, Finland and New Zealand. Using standardized assessments and survival analysis, they found that lonely individuals had a lower risk of dying within one year compared to their non-lonely counterparts after adjusting for health conditions, age and other risk factors.

“Our findings suggest that loneliness may not independently increase the risk of death after controlling for other health risk factors among older adults in home care,” said the study’s lead author, Dr. Bonaventure Egbujie, a professor in Waterloo’s School of Public Health Sciences. “This contradicts much of the existing literature based on the general population.”

Loneliness prevalence—defined as the number of people per 100 who report feeling lonely—ranged from 15.9% of home care recipients in Canada to 24.4% in New Zealand. Interestingly, people in better physical shape and who got less help from family or friends were likelier to feel lonely, suggesting a complex link between health status, caregiving needs, and social connection.

The study urges policymakers and health-care providers to treat loneliness as a quality-of-life issue rather than focusing solely on its potential link to mortality.

“Loneliness is a serious threat to psychological well-being. The mental health consequences of loneliness make it an important priority for public health, even if loneliness doesn’t kill you,” said the study’s senior author, Dr. John Hirdes, a professor in Waterloo’s School of Public Health Science.

“Home and community care services must play a protective role by supporting social contact for isolated people.”

The authors call for longer-term studies to better understand the causal relationship between loneliness and health outcomes and to explore how cultural and care system differences influence these dynamics.