Cross-National Evidence on Risk of Death Associated with Loneliness: A Survival Analysis of 1-Year All-Cause Mortality among Older Adult Home Care Recipients in Canada, Finland, and Aotearoa | New Zealand

Objectives: To examine all-cause 1-year risk of mortality associated with loneliness for home care recipients after adjusting for potential confounders. Design: Survival analyses with parallel designs using interRAI Home Care assessments and mortality. Settings and Participants: Home care recipients in 3 countries—Canada, Finland, and Aotearoa | New Zealand (ANZ)—who were 65 years and older were selected for this retrospective analysis. Methods: We fit a multivariable Cox regression model to obtain the adjusted proportional hazards of 1-year mortality among home care recipients for each of the 3 countries. Results: A total of 178,610, 35,073, and 169,703 home care recipients in Canada, Finland, and ANZ respectively, were included in the study. The respective baseline rates of loneliness in the 3 countries were 15.9%, 20.5%, and 24.4% of recipients. In multivariate Cox regression analysis, being lonely was independently associated with a lower likelihood of mortality among home care recipients, with hazard ratios of 0.82 (95% CI 0.78-0.86) in Canada, 0.85 (95% CI 0.79-0.92) in Finland, and 0.77 (95% CI 0.74-0.81) in ANZ. Conclusions and Implications: Loneliness is pervasive in home care settings across the 3 countries; however, its association with mortality differs from reports for the general population. Loneliness was not associated with an increased risk of death after adjusting for health-related covariates. The causal order between changes in health, loneliness, and mortality is unclear. For example, loneliness may be a consequence of those health changes rather than their cause. Hence, temporal order needs better delineation. Health care systems should treat loneliness as an important mental health priority irrespective of a possible relationship with physical health.