Associations of changes in social isolation and loneliness with all-cause mortality among older adults: a prospective cohort study.

Social isolation and loneliness are growing public health concerns worldwide; however, the independent and combined associations of change in social isolation and loneliness with mortality are yet to be elucidated. This study aimed to investigate these associations among older adults. This cohort study used data from the Chinese Longitudinal Healthy Longevity Survey, which recruited participants from 2002 to 2011. A total of 8,956 participants aged 65 years and older were included. We used data from visit 0 and visit 1 to evaluate the four change patterns (no, incident, transient, and persistent) for social isolation and loneliness across the 3-year interval, and created a 16-category variable to represent the joint changes. Cox proportional hazard models were used to examine the associations with all-cause mortality. Compared to those who never experienced social isolation, participants who experienced transient (HR: 1.28; 95% CI: 1.18-1.38) and persistent (HR: 1.39; 95% CI: 1.30-1.49) social isolation were associated with a higher all-cause mortality risk. Compared to those who never experienced loneliness, only participants who experienced persistent loneliness were associated with a higher all-cause mortality risk (HR: 1.27; 95% CI: 1.17-1.38). All participants who experienced transient or persistent social isolation were associated with a higher all-cause mortality risk, regardless of different loneliness change patterns. Persistent social isolation and loneliness were associated with an increase in all-cause mortality. Public health initiatives and policies to reduce the experience of social isolation and loneliness among older adults may hold promise for increasing population life expectancy.