Feeling of loneliness among nursing homes residents: determinants and 1-year mortality

Loneliness is a subjective experience defined as the perceived discrepancy between desired and actual social relationships. Determinants and outcomes of loneliness have been little studied among nursing home residents. This study aimed to identify factors associated with loneliness in nursing homes and to assess its impact on one-year mortality. This study is a secondary analysis of the KASEHPAD cohort, a prospective observational study conducted over one year in six nursing homes in the French Caribbean. Loneliness was assessed using item 14 of the Center for Epidemiologic Studies Depression Scale (CES-D) (“I felt lonely”). Bivariate analyses were used to explore associations between loneliness and sociodemographic or clinical characteristics at baseline. Cox proportional hazards regression models were applied to assess the relationship between loneliness and one-year mortality. A total of 145 residents completed the CES-D questionnaire at baseline. The mean age of participants was 80.8 ± 10.0 years, and 52.4% were men. The prevalence of loneliness was 31.0% (95% CI: 23.5–38.6%). Younger age, depressive symptoms, dissatisfaction with social support, lower self-rated quality of life, poor adjustment to the nursing home environment, anxiety, and nighttime behavioral disturbances were associated with loneliness. In contrast, dependency level, cognitive status, gender, childlessness and major medical comorbidities were not significantly associated. After 12 months, 14 residents (10.0%) had died, including 7 (15.9%) among those reporting loneliness. In the Cox model (n = 139) adjusted for age, gender, dependency, and depression, loneliness was associated with an increased risk of mortality (HR = 5.7; 95% CI: 1.4–22.6; p = 0.013). Loneliness was highly prevalent among nursing home residents and could be associated with increased one-year mortality. Beyond standard geriatric assessments, promoting institutional environments that foster social connectedness appears to be an essential component of comprehensive care for older adults living in Caribbean nursing homes. NCT04587466 (2020 10) NCT04587466