College of Health and Life Sciences, Department of Clinical Sciences, Kingston Lane, Brunel University London, Uxbridge, Middlesex, UB8 3PH, UK.
Department of Epidemiology and Public Health, University College London, WC1E 6BT, London, UK.
BMC Public Health. 2020 May 27;20(1):778. doi: 10.1186/s12889-020-08703-8.
Loneliness in later life is largely presented as a problem of the individual focusing upon antecedents such as demographic or health factors. Research examining the role of the broader living environments is much rarer. We examined the relationship between loneliness and three dimensions of the lived environment: geographical region, deprivation, and area classification (urban or rural).
Our sample consisted of 4663 core members (44% males) aged 50+ (wave 7 mean age 72.8, S.D. = 7.1) present both in waves 3 (2006) and 7 (2014) of the English Longitudinal Study of Ageing (ELSA). Loneliness was measured using two approaches, individual and area-based, and both waves included these questions. Individual-based (self-reported) loneliness was assessed using the three item University of California Los Angeles (UCLA) scale (ranging from 3 = not lonely to 9 = lonely) with a score of 6+ defining loneliness. We also used a novel question which asked participants to evaluate how often they felt lonely in their area of residence (area-based; ranging from 1 = often to 7 = never, using cut off 4+ to define loneliness). The lived environment was classified in three different ways: the Index of Multiple Deprivation (IMD), Government Office Regions (GOR), and area classification (urban or rural). Covariates with established relationship with loneliness including demographic factors, social engagement and health, were included in the analyses.
In wave 7, the prevalence of individual-based loneliness was 18% and area-based was 25%. There was limited congruence between measures: 68% participants reported no individual- or area-based loneliness and 9% reported loneliness for both measures. After adjusting for individual co-variates only one significant relationship was observed between loneliness and area -based characteristics. A significant association was observed between area-based loneliness and deprivation score, with higher levels of loneliness in more deprived areas (OR = 1.4 for highest quintile of deprivation).
Our results indicate that loneliness in older adults is higher in the most deprived areas independent of individual-level factors. In order to develop appropriate interventions further research is required to investigate how area-level factors combine with individual-level loneliness vulnerability measures to generate increased levels of loneliness in deprived areas.
老年人的孤独感在很大程度上被视为个体问题,主要关注人口统计学或健康因素等因素。研究更广泛的生活环境的作用要少得多。我们研究了孤独感与生活环境的三个维度之间的关系:地理区域、贫困和区域分类(城市或农村)。
我们的样本由 4663 名核心成员(44%为男性)组成,年龄在 50 岁以上(第 7 波平均年龄为 72.8,标准差为 7.1),均出现在英国老龄化纵向研究(ELSA)的第 3 波(2006 年)和第 7 波(2014 年)。孤独感通过两种方法进行测量,一种是个体方法,另一种是基于区域的方法,这两个波次都包含这些问题。个体(自我报告)孤独感使用加利福尼亚大学洛杉矶分校(UCLA)的三个项目量表进行评估(范围从 3=不孤独到 9=孤独),得分 6+定义为孤独。我们还使用了一个新问题,要求参与者评估他们在居住地感到孤独的频率(基于区域;范围从 1=经常到 7=从不,使用 4+的截止值来定义孤独)。生活环境分为三种不同的方式:多重剥夺指数(IMD)、政府办公区域(GOR)和区域分类(城市或农村)。在分析中包括了与孤独感有既定关系的人口统计学因素、社会参与和健康等协变量。
在第 7 波中,个体孤独感的患病率为 18%,基于区域的孤独感为 25%。这两种测量方法之间的一致性有限:68%的参与者报告没有个体或基于区域的孤独感,9%的参与者报告两种测量方法都有孤独感。在调整个体协变量后,只有一种基于区域的孤独感与孤独感存在显著关系。基于区域的孤独感与贫困程度之间存在显著关联,在贫困程度较高的地区孤独感水平更高(最贫困五分位数的 OR=1.4)。
我们的研究结果表明,老年人的孤独感在最贫困的地区更高,而与个体因素无关。为了制定适当的干预措施,需要进一步研究区域因素与个体孤独感脆弱性测量相结合如何在贫困地区产生更高水平的孤独感。