Gender-specific association of loneliness and health care use in community-dwelling older adults

Friederike Hildegard Boehlen; Dirk Heider; Dieter Schellberg; Johanna Katharina Hohls; Ben Schöttker; Hermann Brenner; Hans-Christoph Friederich; Hans-Helmut König; Beate Wild

doi:10.1186/s12877-023-04201-9

journal article Open Access Aug 21, 2023

Gender-specific association of loneliness and health care use in community-dwelling older adults

Friederike Hildegard Boehlen Dirk Heider Dieter Schellberg Johanna Katharina Hohls Ben Schöttker

Hermann Brenner

Hans-Christoph Friederich

Hans-Helmut König

Beate Wild

BMC Geriatrics Vol. 23 No. 1 · Springer Science and Business Media LLC

View at Publisher Save 10.1186/s12877-023-04201-9

Abstract

Abstract
Background
Loneliness in older adults is common, particularly in women. In this article, gender differences in the association of loneliness and health care use are investigated in a large sample of community-dwelling older adults.

Methods
Data of 2525 persons (ages 55–85 years)—participants of the fourth follow- up (2011–2014) of the ESTHER study- were analyzed. Loneliness and health care use were assessed by study doctors in the course of a home visit. Gender-specific regression models with Gamma-distribution were performed using loneliness as independent variable to predict outpatient health care use, adjusted for demographic variables.

Results
In older women, lonely persons were shown to have significantly more visits to general practitioners and mental health care providers in a three-month period compared to less lonely persons (p = .005). The survey found that outpatient health care use was positively associated with loneliness, multimorbidity, and mental illness in older women but not in older men. Older men had significantly more contact with inpatient care in comparison to women (p = .02).

Conclusions
It is important to consider gender when analyzing inpatient and outpatient health care use in older persons. In older women loneliness is associated with increased use of outpatient services.

Topics

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References

47

[1]

Fulton L, Jupp B. Investing to tackle loneliness—a discussion paper 2015. Available from: https://gulbenkian.pt/uk-branch/publication/investing-to-tackle-loneliness-a-discussion-paper/. Assessed 13 August 2022.

[2]

Boehlen F, Herzog W, Quinzler R, Haefeli WE, Maatouk I, Niehoff D, et al. Loneliness in the elderly is associated with the use of psychotropic drugs. Int J Geriatr Psychiatr. 2015;30(9):957–64. 10.1002/gps.4246

[3]

Marty PK, Novotny P, Benzo RP. Loneliness and ED visits in chronic obstructive pulmonary disease. J Mayo Clin Proceed: Innovations Quality. 2019;3(3):350–7.

[4]

Wang J, Lloyd-Evans B, Marston L, Ma R, Mann F, Solmi F, et al. Epidemiology of loneliness in a cohort of UK mental health community crisis service users. Soc Psychiatry Psychiatr Epidemiol. 2020;55(7):811–22. 10.1007/s00127-019-01734-6

[5]

Feelings of loneliness, but not social isolation, predict dementia onset: results from the Amsterdam Study of the Elderly (AMSTEL)

T. J. Holwerda, D. J. H. Deeg, A. T. F. Beekman et al.

Journal of Neurology, Neurosurgery &amp; Psych... 2014 10.1136/jnnp-2012-302755

[6]

Boehlen F, Herzog W, Schellberg D, Maatouk I, Saum K, Brenner H et al. Gender differences in Self-Perceived Personal Resources of older adults with generalized anxiety symptoms. J Aging Science. 2017;5. 10.4172/2329-8847.1000178

[7]

Domenech-Abella J, Mundo J, Haro JM, Rubio-Valera M. Anxiety, depression, loneliness and social network in the elderly: longitudinal associations from the irish longitudinal study on Ageing (TILDA). J Affect Disord. 2019;246:82–8. 10.1016/j.jad.2018.12.043

[8]

Palgi Y, Shrira A, Ring L, Bodner E, Avidor S, Bergman Y, et al. The loneliness pandemic: loneliness and other concomitants of depression, anxiety and their comorbidity during the COVID-19 outbreak. J Affect Disord. 2020;275:109–11. 10.1016/j.jad.2020.06.036

[9]

Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis

Ziggi Ivan Santini, Paul E Jose, Erin York Cornwell et al.

The Lancet Public Health 10.1016/s2468-2667(19)30230-0

[10]

Loneliness in the general population: prevalence, determinants and relations to mental health

Manfred E. Beutel, Eva M. Klein, Elmar Brähler et al.

BMC Psychiatry 2017 10.1186/s12888-017-1262-x

[11]

Victor CR. Loneliness and later life: Concepts, prevalence, and consequences. 2015. In A. Sha’ked & A. Rokach, editors, Addressing loneliness: Coping, prevention and clinical interventions Routledge/Taylor & Francis Group. p. 185–204.

[12]

Pinquart M, Sorensen S. Influences on loneliness in older adults: a meta-analysis. Basic Appl Soc Psych. 2001;23(4):245–66. 10.1207/s15324834basp2304_2

[13]

Tesch-Römer C, Wiest M, Wurm S, Huxhold O. Loneliness trends in the second half of life: results from the german ageing survey (DEAS). Z Gerontol Geriatr. 2013;46(3):237–41. 10.1007/s00391-012-0359-6

[14]

Boehlen FH, Maatouk I, Friederich HC, Schöttker B, Brenner H, Wild B. Loneliness as a gender-specific predictor of physical and mental health-related quality of life in older adults. Qual Life Res. 2022;31(7):2023–33. https://doi.org/10.1007/s11136-021-03055-1. Epub 2021 Dec 2. 10.1007/s11136-021-03055-1

[15]

Ladwig K-H, Marten-Mittag B, Formanek B, Dammann, GJEjoe. Gender differences of symptom reporting and medical health care utilization in the german population. Eur J Epidemiol. 2000;16(6):511–8. 10.1023/a:1007629920752

[16]

Redondo-Sendino Á, Guallar-Castillón P, Banegas JR, Rodríguez-Artalejo F. Gender differences in the utilization of health-care services among the older adult population of Spain. BMC Public Health. 2006;6(1):1–9. 10.1186/1471-2458-6-155

[17]

Wild B, Heider D, Schellberg D, Bohlen F, Schottker B, Muhlack DC, et al. Caring for the elderly: a person-centered segmentation approach for exploring the association between health care needs, mental health care use, and costs in Germany. PLoS ONE. 2019;14(12):e0226510. 10.1371/journal.pone.0226510

[18]

Mihalopoulos C, Le LK-D, Chatterton ML, Bucholc J, Holt-Lunstad J, Lim MH, et al. The economic costs of loneliness: a review of cost-of-illness and economic evaluation studies. Soc Psychiatry Psychiatr Epidemiol. 2020;55(7):823–36. 10.1007/s00127-019-01733-7

[19]

Gao L, Weck MN, Raum E, Stegmaier C, Rothenbacher D, Brenner HJ. Sibship size, Helicobacter pylori infection and chronic atrophic gastritis: a population-based study among 9444 older adults from Germany. Int J Epidemiol. 2010;39(1):129–34. 10.1093/ije/dyp250

[20]

Löw M, Stegmaier C, Ziegler H, Rothenbacher D, Brenner H. Epidemiological investigations of the chances of preventing, recognizing early and optimally treating chronic diseases in an elderly population (ESTHER study). Dt Med Wschr. 2004;129(49):2643. 10.1055/s-2004-836089

[21]

König H-H, Born A, Heider D, Matschinger H, Heinrich S, Riedel-Heller SG, et al. Cost-effectiveness of a primary care model for anxiety disorders. Brit J Psychiatry. 2009;195(4):308–17. 10.1192/bjp.bp.108.058032

[22]

Heider D, Matschinger H, Müller H, Saum K-U, Quinzler R, Haefeli WE, et al. Health care costs in the elderly in Germany: an analysis applying Andersen’s behavioral model of health care utilization. BMC Health Services Res. 2014;14(1):71. 10.1186/1472-6963-14-71

[23]

van der Bielderman A, van Lieshout MR, de Greef MH, Boersma F, Krijnen WP, et al. Multidimensional structure of the Groningen Frailty Indicator in community-dwelling older people. BMC Geriatr. 2013;13:86. 10.1186/1471-2318-13-86

[24]

Peters LL, Boter H, Buskens E, Slaets JP. Measurement properties of the Groningen Frailty Indicator in home-dwelling and institutionalized elderly people. J Am Med Dir Assoc. 2012;13(6):546–51. 10.1016/j.jamda.2012.04.007

[25]

Kroenke K, Spitzer RL. The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann. 2002;32(9):509–15. 10.3928/0048-5713-20020901-06

[26]

Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Int Med. 2006;166(10):1092–7. 10.1001/archinte.166.10.1092

[27]

Kroenke K, Spitzer RL, Williams JB. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med. 2002;64(2):258–66. 10.1097/00006842-200203000-00008

[28]

Kroenke K, Strine TW, Spitzer RL, Williams JB, Berry JT, Mokdad AH. The PHQ-8 as a measure of current depression in the general population. J Affect Disord. 2009;114(1–3):163–73. 10.1016/j.jad.2008.06.026

[29]

Wild B, Eckl A, Herzog W, Niehoff D, Lechner S, Maatouk I, et al. Assessing generalized anxiety disorder in elderly people using the GAD-7 and GAD-2 scales: results of a validation study. Am J Geriatr Psychiatry. 2014;22(10):1029–38. 10.1016/j.jagp.2013.01.076

[30]

Wild B, Lechner S, Herzog W, Maatouk I, Wesche D, Raum E, et al. Reliable integrative assessment of health care needs in elderly persons: the INTERMED for the Elderly (IM-E). J Psychosom Res. 2011;70(2):169–78. 10.1016/j.jpsychores.2010.09.003

[31]

Barsky AJ, Peekna HM, Borus JF. Somatic symptom reporting in women and men. J Gen Int Med. 2001;16(4):266–75. 10.1046/j.1525-1497.2001.016004266.x

[32]

Hohls JK, Koenig H-H, Raynik YI, Hajek A. A systematic review of the association of anxiety with health care utilization and costs in people aged 65 years and older. J Affect Disord. 2018;232:163–76. 10.1016/j.jad.2018.02.011

[33]

The excess costs of depression: a systematic review and meta-analysis

H. König, H.-H. König, A. Konnopka

Epidemiology and Psychiatric Sciences 2019 10.1017/s2045796019000180

[34]

Luppa M, Sikorski C, Luck T, Ehreke L, Konnopka A, Wiese B, et al. Age-and gender-specific prevalence of depression in latest-life–systematic review and meta-analysis. J Affect Disord. 2012;136(3):212–21. 10.1016/j.jad.2010.11.033

[35]

Cacioppo JT, Hawkley LC, Thisted RA. Perceived social isolation makes me sad: 5-year cross-lagged analyses of loneliness and depressive symptomatology in the Chicago Health, Aging, and Social Relations Study. J Psychol Aging. 2010;25(2):453. 10.1037/a0017216

[36]

Luo Y, Hawkley LC, Waite LJ, Cacioppo JT. Loneliness, health, and mortality in old age: a national longitudinal study. Soc Sci Med. 2012;74(6):907–14. 10.1016/j.socscimed.2011.11.028

[37]

Cacioppo JT, Cacioppo S, Cole SW, Capitanio JP, Goossens L, Boomsma DI. Loneliness across phylogeny and a call for comparative studies and animal models. Perspect Psychol Sci. 2015;10(2):202–12. 10.1177/1745691614564876

[38]

Ko H, Park Y-H, Cho B, Lim K-C, Chang SJ, Yi YM, et al. Gender differences in health status, quality of life, and community service needs of older adults living alone. Arch Gerontol Geriatr. 2019;83:239–45. 10.1016/j.archger.2019.05.009

[39]

Bertakis KD. The influence of gender on the doctor–patient interaction. Patient Educ Couns. 2009;76(3):356–60. 10.1016/j.pec.2009.07.022

[40]

Glauber R. Gender differences in spousal care across the later life course. Res aging. 2017;39(8):934–59. 10.1177/0164027516644503

[41]

Hazra NC, Rudisill C, Gulliford MC. Determinants of health care costs in the senior elderly: age, comorbidity, impairment, or proximity to death? Eur J Health Econom. 2018;19(6):831–42. 10.1007/s10198-017-0926-2

[42]

Alemayehu B, Warner KE. The lifetime distribution of health care costs. Health Serv Res. 2004;39(3):627–42. 10.1111/j.1475-6773.2004.00248.x

[43]

Heinrich S, Luppa M, Matschinger H, Angermeyer MC, Riedel-Heller SG, König HH. Service utilization and health‐care costs in the advanced elderly. Value Health. 2008;11(4):611–20. 10.1111/j.1524-4733.2007.00285.x

[44]

Nagl A, Witte J, Hodek J-M, Greiner W. Relationship between multimorbidity and direct healthcare costs in an advanced elderly population. Z Gerontol Geriatr. 2012;45(2):146–54. 10.1007/s00391-011-0266-2

[45]

Bock J-O, König H-H, Brenner H, Haefeli WE, Quinzler R, Matschinger H, et al. Associations of frailty with health care costs–results of the ESTHER cohort study. BMC Health Services Res. 2016;16(1):128. 10.1186/s12913-016-1360-3

[46]

Bhandari A, Wagner T. Self-reported utilization of health care services: improving measurement and accuracy. Med Care Res Rev. 2006;63(2):217–35. 10.1177/1077558705285298

[47]

Huyse FJ, Lyons JS, Stiefel FC, Slaets JP, De Jonge P, Fink P, et al. INTERMED”: a method to assess health service needs: I. Development and reliability. Gen Hosp Psychiatry. 1999;21(1):39–48. 10.1016/s0163-8343(98)00057-7

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Citations

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References

Details

Published: Aug 21, 2023
Vol/Issue: 23(1)
License: View

Authors

F

Friederike Hildegard Boehlen

Johanna Katharina Hohls

Hans-Christoph Friederich

H

Hans-Helmut König

Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf ,

B

Beate Wild

Funding

Universitätsklinikum Heidelberg

Cite This Article

Friederike Hildegard Boehlen, Dirk Heider, Dieter Schellberg, et al. (2023). Gender-specific association of loneliness and health care use in community-dwelling older adults. BMC Geriatrics, 23(1). https://doi.org/10.1186/s12877-023-04201-9

Gender-specific association of loneliness and health care use in community-dwelling older adults

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