Regular Research Article|Articles in Press

Association Between Types of Loneliness and Risks of Functional Disability in Older Men and Women: A Prospective Analysis

Published:February 24, 2023DOI:


      • What is the primary question addressed by this study?
        Could the effect of loneliness on physical health consequences differ by its patterns and duration and whether there are sex differences in its effect.
      • What is the main finding of this study?
        Chronic loneliness is an independent risk factor for new-onset ADL disability in both men and women, but transient loneliness is not.
        Chronic loneliness was associated with the risk of IADL disability in women, not in men.
      • What is the meaning of the finding?
        Tailored interventions are needed for the right people at the right time to avoid loneliness chronicity and prevent functional disability.



      To examine the association between types of loneliness (transient, incident, and chronic) and the risk of functional disability.


      Data were from the Health and Retirement Study 2006/2008-2016/2018. A total of 7,148 adults aged ≥50 was included. Functional status was measured by activities of daily living (ADL) and instrumental activities of daily living (IADL). Loneliness was assessed using the 3-item UCLA Loneliness Scale. We defined loneliness as no/transient/incident/chronic loneliness based on the pattern and duration of loneliness across 2006/2008 and 2010/2012. We applied multivariate Cox proportional hazard models with the new-onset ADL/IADL disability as outcome.


      Overall, 69.3% respondents showed no loneliness; while 10.3%, 8.9%, and 11.5% showed transient, incident, and chronic loneliness, respectively. A total of 1,298 (18.16%) and 1,260 (17.63%) functionally normal respondents developed ADL and IADL disability during 36,294 person-years of follow-up, respectively. After adjusting for socio-demographic, behavioral, and health factors, chronic loneliness was associated with higher risks of ADL (hazard ratio [HR] = 1.37, 95% confidence interval [CI] = 1.16–1.63, p <0.001, χ2 = 3.60, degree of freedom [df] = 1) and IADL disability (HR = 1.25, 95% CI = 1.09–1.44, p = 0.002, χ2 = 3.17, df = 1) compared to no loneliness. By contrast, no significant associations between transient loneliness and ADL (HR = 1.17, 95% CI = 0.88–1.57, p = 0.273, χ2 = 1.10, df = 1) or IADL disability (HR = 1.16, 95% CI = 0.97–1.39, p = 0.112, χ2 = 1.59, df = 1) were found. Chronic loneliness was not associated with the risk of IADL disability in men (HR = 1.13, 95% CI = 0.91–1.40, p = 0.263, χ2 = 1.12, df = 1).


      Chronic loneliness, rather than transient loneliness, is an independent risk factor for functional disability in middle-aged and older adults, especially for women.


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