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Social isolation, rather than loneliness, is associated with cognitive decline in older adults: the China Health and Retirement Longitudinal Study

Published online by Cambridge University Press:  27 April 2020

Bin Yu Open the ORCID record for Bin Yu [Opens in a new window] ,
Andrew Steptoe ,
Yongjie Chen  and
Xiaohua Jia
Bin Yu*
Affiliation:
Department of Psychiatry and Psychology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
Andrew Steptoe
Affiliation:
Department of Behavioural Science and Health, University College London, London, UK
Yongjie Chen
Affiliation:
Department of Epidemiology and Statistics, School of Public Health, Tianjin Medical University, Tianjin, China
Xiaohua Jia
Affiliation:
Department of Ultrasound, General Hospital of People's Liberation Army, Beijing, China Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China
*
Author for correspondence: Bin Yu, E-mail: [email protected]
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Abstract

Background

Social isolation and loneliness have each been associated with cognitive decline, but most previous research is limited to Western populations. This study examined the relationships of social isolation and loneliness on cognitive function among Chinese older adults.

Methods

This study used two waves of data (2011 and 2015) from the China Health and Retirement Longitudinal Study (CHARLS) and analyses were restricted to those respondents aged 50 and older. Social isolation, loneliness, and cognitive function were measured at baseline. Follow-up measures on cognitive function were obtained for 7761 participants (mean age = 60.97, s.d. = 7.31; male, 50.8%). Lagged dependent variable models adjusted for confounding factors were used to evaluate the association between baseline isolation, loneliness, and cognitive function at follow-up.

Results

Loneliness was significantly associated with the cognitive decline at follow-up (episodic memory: β = −0.03, p < 0.01; mental status: β = −0.03, p < 0.01) in the partially adjusted models. These associations became insignificant after additional confounding variables (chronic diseases, health behaviors, disabilities, and depressive symptoms) were taken into account (all p > 0.05). By contrast, social isolation was significantly associated with decreases in all cognitive function measures at follow-up (episodic memory: β = −0.05, p < 0.001; mental status: β = −0.03, p < 0.01) even after controlling for loneliness and all confounding variables.

Conclusions

Social isolation is associated with cognitive decline in Chinese older adults, and the relationships are independent of loneliness. These findings expand our knowledge about the links between social relationships and the cognitive function in non-Western populations.

Keywords

Cognitive functionlonelinessolder adultssocial isolation
Type
Original Article
Information
Psychological Medicine , Volume 51 , Issue 14 , October 2021 , pp. 2414 - 2421
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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References

Beller, J., & Wagner, A. (2018). Disentangling loneliness: Differential effects of subjective loneliness, network quality, network size, and living alone on physical, mental, and cognitive health. Journal of Aging and Health, 30(4), 521–539.CrossRefGoogle ScholarPubMed
Bennett, D. A., Wilson, R. S., Schneider, J. A., Evans, D. A., Beckett, L. A., Aggarwal, N. T., … Bach, J. (2002). Natural history of mild cognitive impairment in older persons. Neurology, 59(2), 198–205. doi: 10.1212/wnl.59.2.198CrossRefGoogle ScholarPubMed
Boss, L., Kang, D.-H., & Branson, S. (2015). Loneliness and cognitive function in the older adult: A systematic review. International Psychogeriatrics, 27(4), 541–553.10.1017/S1041610214002749CrossRefGoogle ScholarPubMed
Cacioppo, J. T., & Hawkley, L. C. (2009). Perceived social isolation and cognition. Trends in Cognitive Sciences, 13(10), 447–454.CrossRefGoogle ScholarPubMed
Chan, K. Y., Wang, W., Wu, J. J., Liu, L., Theodoratou, E., Car, J., … Campbell, H. (2013). Epidemiology of Alzheimer's disease and other forms of dementia in China, 1990–2010: A systematic review and analysis. The Lancet, 381(9882), 2016–2023.10.1016/S0140-6736(13)60221-4CrossRefGoogle ScholarPubMed
Cornwell, E. Y., & Waite, L. J. (2009). Social disconnectedness, perceived isolation, and health among older adults. Journal of Health and Social Behavior, 50(1), 31–48.CrossRefGoogle ScholarPubMed
Courtin, E., & Knapp, M. (2017). Social isolation, loneliness and health in old age: A scoping review. Health & Social Care in the Community, 25(3), 799–812.10.1111/hsc.12311CrossRefGoogle ScholarPubMed
Crimmins, E. M., Kim, J. K., Langa, K. M., & Weir, D. R. (2011). Assessment of cognition using surveys and neuropsychological assessment: The Health and Retirement Study and the Aging, Demographics, and Memory Study. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 66(suppl_1), i162–i171.CrossRefGoogle ScholarPubMed
Evans, I. E., Martyr, A., Collins, R., Brayne, C., & Clare, L. (2018). Social isolation and cognitive function in later life: A systematic review and meta-analysis. Journal of Alzheimer's disease, 70, S119–S144.Google Scholar
Fratiglioni, L., Paillard-Borg, S., & Winblad, B. (2004). An active and socially integrated lifestyle in late life might protect against dementia. The Lancet Neurology, 3(6), 343–353.10.1016/S1474-4422(04)00767-7CrossRefGoogle ScholarPubMed
Fung, A. W., Lee, A. T., Cheng, S.-T., & Lam, L. C. (2019). Loneliness interacts with family relationship in relation to cognitive function in Chinese older adults. International Psychogeriatrics, 31(4), 467–475.CrossRefGoogle ScholarPubMed
Ganguli, M., Belle, S., Ratcliff, G., Seaberg, E., Huff, F. J., von der Porten, K., & Kuller, L. H. (1993). Sensitivity and specificity for dementia of population-based criteria for cognitive impairment: The MoVIES project. Journal of Gerontology, 48(4), M152–M161.10.1093/geronj/48.4.M152CrossRefGoogle ScholarPubMed
Glei, D. A., Goldman, N., Ryff, C. D., Lin, Y.-H., & Weinstein, M. (2012). Social relationships and inflammatory markers: An analysis of Taiwan and the US. Social Science & Medicine, 74(12), 1891–1899.CrossRefGoogle Scholar
Gow, A. J., Corley, J., Starr, J. M., & Deary, I. J. (2013). Which social network or support factors are associated with cognitive abilities in old age? Gerontology, 59(5), 454–463.CrossRefGoogle ScholarPubMed
Griffin, S. C., Mezuk, B., Williams, A. B., Perrin, P. B., & Rybarczyk, B. D. (2018). Isolation, not loneliness or cynical hostility, predicts cognitive decline in older Americans. Journal of Aging and Health, 32(1), 52–60.Google ScholarPubMed
Hofstede, G., Hofstede, G. J., & Minkov, M. (2005). Cultures and organizations: Software of the mind. New York: McGraw-Hill.Google Scholar
Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 10(2), 227–237.CrossRefGoogle ScholarPubMed
Holwerda, T. J., Deeg, D. J., Beekman, A. T., van Tilburg, T. G., Stek, M. L., Jonker, C., & Schoevers, R. A. (2014). Feelings of loneliness, but not social isolation, predict dementia onset: Results from the Amsterdam Study of the Elderly (AMSTEL). Journal of Neurology Neurosurgery & Psychiatry, 85(2), 135–142.CrossRefGoogle Scholar
Hu, Z., & Peng, X. (2015). Household changes in contemporary China: An analysis based on the four recent censuses. The Journal of Chinese Sociology, 2(1), 9.CrossRefGoogle Scholar
Hultsch, D. F., Hertzog, C., Small, B. J., & Dixon, R. A. (1999). Use it or lose it: Engaged lifestyle as a buffer of cognitive decline in aging? Psychology and Aging, 14(2), 245–263.CrossRefGoogle Scholar
Johnson, D. (2005). Two-wave panel analysis: Comparing statistical methods for studying the effects of transitions. Journal of Marriage and Family, 67(4), 1061–1075.CrossRefGoogle Scholar
Kuiper, J. S., Zuidersma, M., Zuidema, S. U., Burgerhof, J. G., Stolk, R. P., Oude Voshaar, R. C., & Smidt, N. (2016). Social relationships and cognitive decline: A systematic review and meta-analysis of longitudinal cohort studies. International Journal of Epidemiology, 45(4), 1169–1206.Google ScholarPubMed
Lei, X., Hu, Y., McArdle, J. J., Smith, J. P., & Zhao, Y. (2012). Gender differences in cognition among older adults in China. Journal of Human Resources, 47(4), 951–971.CrossRefGoogle ScholarPubMed
Lei, X., Sun, X., Strauss, J., Zhao, Y., Yang, G., Hu, P., … Yin, X. (2014). Health outcomes and socio-economic status among the mid-aged and elderly in China: Evidence from the CHARLS national baseline data. The Journal of the Economics of Ageing, 3, 29–43. doi: https://doi.org/10.1016/j.jeoa.2014.05.001CrossRefGoogle Scholar
Luo, Y., & Waite, L. J. (2014). Loneliness and mortality among older adults in China. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 69(4), 633–645.CrossRefGoogle ScholarPubMed
McArdle, J. J., Fisher, G. G., & Kadlec, K. M. (2007). Latent variable analyses of age trends of cognition in the Health and Retirement Study, 1992–2004. Psychology and Aging, 22(3), 525–545.CrossRefGoogle ScholarPubMed
McHugh, J., Kenny, R., Lawlor, B., Steptoe, A., & Kee, F. (2017). The discrepancy between social isolation and loneliness as a clinically meaningful metric: Findings from the Irish and English longitudinal studies of ageing (TILDA and ELSA). International Journal of Geriatric Psychiatry, 32(6), 664–674.CrossRefGoogle Scholar
Newall, N. E., & Menec, V. H. (2019). Loneliness and social isolation of older adults: Why it is important to examine these social aspects together. Journal of Social and Personal Relationships, 36(3), 925–939.10.1177/0265407517749045CrossRefGoogle Scholar
Nummela, O., Seppanen, M., & Uutela, A. (2011). The effect of loneliness and change in loneliness on self-rated health (SRH): A longitudinal study among aging people. Archives of Gerontology and Geriatrics, 53(2), 163–167. doi: 10.1016/j.archger.2010.10.023CrossRefGoogle ScholarPubMed
Okely, J. A., & Deary, I. J. (2018). Longitudinal associations between loneliness and cognitive ability in the Lothian Birth Cohort 1936. The Journals of Gerontology: Series B, 74(8), 1376–1386.CrossRefGoogle Scholar
Pan, X., Luo, Y., & Roberts, A. R. (2018). Secondhand smoke and women's cognitive function in China. American Journal of Epidemiology, 187(5), 911–918.CrossRefGoogle ScholarPubMed
Peplau, L. A., & Perlman, D. (1982). Loneliness: A Sourcebook of Current Theory, Research and Therapy. New York: Wiley-Interscience.Google Scholar
Petersen, J., Kaye, J., Jacobs, P. G., Quinones, A., Dodge, H., Arnold, A., & Thielke, S. (2016). Longitudinal relationship between loneliness and social isolation in older adults: Results from the cardiovascular health study. Journal of Aging and Health, 28(5), 775–795. doi: 10.1177/0898264315611664CrossRefGoogle ScholarPubMed
Rafnsson, S. B., Orrell, M., d'Orsi, E., Hogervorst, E., & Steptoe, A. (2017). Loneliness, social integration, and incident dementia over 6 years: Prospective findings from the English Longitudinal Study of Ageing. The Journals of Gerontology: Series B, 75(1), 114–124.CrossRefGoogle Scholar
Rawtaer, I., Gao, Q., Nyunt, M. S. Z., Feng, L., Chong, M. S., Lim, W. S., … Ng, T. P. (2017). Psychosocial risk and protective factors and incident mild cognitive impairment and dementia in community dwelling elderly: Findings from the Singapore Longitudinal Ageing Study. Journal of Alzheimer's Disease, 57(2), 603–611.CrossRefGoogle ScholarPubMed
Shankar, A., Hamer, M., McMunn, A., & Steptoe, A. (2013). Social isolation and loneliness: Relationships with cognitive function during 4 years of follow-up in the English Longitudinal Study of Ageing. Psychosomatic Medicine, 75(2), 161–170.CrossRefGoogle ScholarPubMed
Shumaker, S. A., & Hill, D. R. (1991). Gender differences in social support and physical health. Health Psychology, 10(2), 102–111.10.1037/0278-6133.10.2.102CrossRefGoogle ScholarPubMed
Shye, D., Mullooly, J. P., Freeborn, D. K., & Pope, C. R. (1995). Gender differences in the relationship between social network support and mortality: A longitudinal study of an elderly cohort. Social Science & Medicine, 41(7), 935–947.CrossRefGoogle ScholarPubMed
Steptoe, A., Shankar, A., Demakakos, P., & Wardle, J. (2013). Social isolation, loneliness, and all-cause mortality in older men and women. Proceedings of the National Academy of Sciences, 110(15), 5797–5801.CrossRefGoogle ScholarPubMed
Teguo, M. T., Simo-Tabue, N., Stoykova, R., Meillon, C., Cogne, M., Amiéva, H., & Dartigues, J.-F. (2016). Feelings of loneliness and living alone as predictors of mortality in the elderly: The PAQUID study. Psychosomatic Medicine, 78(8), 904–909.CrossRefGoogle Scholar
Tilvis, R. S., Pitkala, K. H., Jolkkonen, J., & Strandberg, T. E. (2000). Social networks and dementia. Lancet (London, England), 356(9223), 77–78.CrossRefGoogle ScholarPubMed
UN DESA (2017). World population prospects, United Nations Department of Economic and Social Affairs. Population Division.Google Scholar
Victor, C., Grenade, L., & Boldy, D. (2005). Measuring loneliness in later life: A comparison of differing measures. Reviews in Clinical Gerontology, 15(01), 63–70.CrossRefGoogle Scholar
Wang, H.-X., Jin, Y., Hendrie, H. C., Liang, C., Yang, L., Cheng, Y., … Murrell, J. R. (2012). Late life leisure activities and risk of cognitive decline. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 68(2), 205–213.CrossRefGoogle ScholarPubMed
Weuve, J., Kang, J. H., Manson, J. E., Breteler, M. M., Ware, J. H., & Grodstein, F. (2004). Physical activity, including walking, and cognitive function in older women. JAMA, 292(12), 1454–1461.CrossRefGoogle ScholarPubMed
Wilson, R., Evans, D., Bienias, J., De Leon, C. M., Schneider, J., & Bennett, D. (2003). Proneness to psychological distress is associated with risk of Alzheimer's disease. Neurology, 61(11), 1479–1485.CrossRefGoogle ScholarPubMed
Wilson, R. S., Krueger, K. R., Arnold, S. E., Schneider, J. A., Kelly, J. F., Barnes, L. L., … Bennett, D. A. (2007). Loneliness and risk of Alzheimer disease. Archives of general psychiatry, 64(2), 234–240.CrossRefGoogle ScholarPubMed
Yang, K., & Victor, C. R. (2008). The prevalence of and risk factors for loneliness among older people in China. Ageing & Society, 28(3), 305–327.CrossRefGoogle Scholar
Zhao, Y., Hu, Y., Smith, J. P., Strauss, J., & Yang, G. (2012). Cohort profile: The China health and retirement longitudinal study (CHARLS). International Journal of Epidemiology, 43(1), 61–68.CrossRefGoogle Scholar
Zhong, B.-L., Chen, S.-L., & Conwell, Y. (2016). Effects of transient versus chronic loneliness on cognitive function in older adults: Findings from the Chinese Longitudinal Healthy Longevity Survey. The American Journal of Geriatric Psychiatry, 24(5), 389–398.10.1016/j.jagp.2015.12.009CrossRefGoogle ScholarPubMed
Zhong, B.-L., Chen, S.-L., Tu, X., & Conwell, Y. (2017). Loneliness and cognitive function in older adults: Findings from the Chinese longitudinal healthy longevity survey. The Journals of Gerontology: Series B, 72(1), 120–128.10.1093/geronb/gbw037CrossRefGoogle ScholarPubMed