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Eight-Year Trajectories of Late-Life Loneliness and Incident Dementia: A Nationally Representative Cohort Study

  • Author Footnotes
    † These authors contributed equally to this work.
    Yanzhi Li
    Footnotes
    † These authors contributed equally to this work.
    Affiliations
    Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China

    Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
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  • Author Footnotes
    † These authors contributed equally to this work.
    Xiaojie Wang
    Footnotes
    † These authors contributed equally to this work.
    Affiliations
    Department of Neurology, Shenzhen Shekou People's Hospital, Shenzhen, China
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  • Lan Guo
    Affiliations
    Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China

    Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
    Search for articles by this author
  • Liwan Zhu
    Affiliations
    Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China

    Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
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  • Jingman Shi
    Affiliations
    Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China

    Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
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  • Wanxin Wang
    Correspondence
    Send correspondence and reprint requests to Wanxin Wang, Ph.D., Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, Zhongshan Rd. 2, Guangzhou 510080, China.
    Affiliations
    Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China

    Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
    Search for articles by this author
  • Ciyong Lu
    Affiliations
    Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China

    Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
    Search for articles by this author
  • Author Footnotes
    † These authors contributed equally to this work.
Published:December 05, 2022DOI:https://doi.org/10.1016/j.jagp.2022.12.002

      Highlights

      • What is the primary question addressed by this study?
        We explored the association between long-term trajectories of late-life loneliness and incident dementia.
      • What is the main finding of this study?
        Five distinct loneliness trajectories were found: long-term low, persistently decreasing, persistently increasing, long-term moderate, and long-term high. Compared with long-term low loneliness, persistently increasing, long-term moderate, and long-term high loneliness significantly increases the risk of dementia in older adults.
      • What is the meaning of the finding?
        To prevent dementia, we should pay attention to the elderly with long-term loneliness and persistently increasing loneliness, especially the elderly with long-term high loneliness.

      ABSTRACT

      Objective

      Some older adults with loneliness might have transient loneliness, followed by full remission, while others might have persistent loneliness. Such different courses might differ in predicting the risk of dementia, but most previous studies assessed short-term loneliness at a single time point, ignoring the long-term changes of loneliness. This study aimed to explore the association between 8-year trajectories of late-life loneliness and incident dementia.

      Methods

      Data were from the English Longitudinal Study of Ageing (waves 2−9). This study included 6,722 older adults measured for loneliness greater than or equal to three times from wave 2 (2004−2005) to wave 6 (2012−2013) and free from dementia in wave 6. Loneliness was assessed using the short 1980 version of the University of California, Los Angeles Loneliness Scale. Group-based trajectory modeling was used to explore loneliness trajectories during waves 2−6. Cox proportional hazard models were used to investigate the association of loneliness trajectories with incident dementia during waves 6−9.

      Results

      Five distinct loneliness trajectories were identified: long-term low, persistently decreasing, persistently increasing, long-term moderate, and long-term high. Compared with long-term low loneliness, the HRs (95% confidence intervals) for persistently decreasing, persistently increasing, long-term moderate, and long-term high loneliness were 1.29 (0.83−2.00), 1.55 (1.04−2.31), 1.56 (1.03−2.38), and 3.35 (1.89−5.91), respectively.

      Conclusion

      The elderly show distinct patterns of loneliness over time, which cannot be captured by a single assessment of loneliness. The elderly with long-term loneliness and persistently increasing loneliness might be the high-risk group for dementia. Further studies are needed to determine whether reducing loneliness can prevent dementia.

      Key Words

      Abbreviations:

      CES-D (Center for Epidemiologic Studies Depression Scale), CI (Confidence interval), ELSA (English Longitudinal Study of Ageing), GBTM (Group-based trajectory modeling), HR (Hazard ratio), IQCODE (Informant Questionnaire on Cognitive Decline in the Elderly), R-UCLA (Short 1980 version of the University of California, Los Angeles Loneliness Scale)
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