Prevalence of loneliness and its associated factors in middle-aged and older adults with breathlessness: a nationally representative cohort study.

backgroundBreathlessness has functional, psychological and social impacts. Loneliness is a health priority under-researched in relation to breathlessness, despite breathlessness impacting social interactions.

methodsWe estimated the prevalence of loneliness and associated characteristics in adults (≥50 years) with breathlessness in the English Longitudinal Study of Ageing (ELSA, 2010-11). Breathlessness was assessed using the adapted modified Medical Research Council Dyspnoea Scale from grade 0 (none) to 3 (stops on level due to breathlessness). Grade 4 was not assessed in ELSA. Loneliness was measured using the 3-Item University of California, Los Angeles Loneliness Scale (scores ≥6 = lonely). Logistic regression was adjusted for age, sex and ethnicity.

resultsOf the 8195 participants, 28.4% reported breathlessness and 19.3% were lonely. Greater breathlessness was associated with older age, female sex and lower wealth (p<0.001). Those with greater breathlessness were more likely to be lonely (16.3% for no breathlessness vs 34.9% for grade 3), live alone (18.2% vs 36.6%) and be unmarried (26.7% vs 45.7%) (all p<0.001). Greater breathlessness was associated with depressive symptoms, limiting longstanding illness, mobility issues (all p<0.001) and social isolation (p=0.012). Of those with worse breathlessness (graded 2-3, n=1149), 32.8% were lonely. Characteristics associated with loneliness in those with grade 2-3 breathlessness were female sex (OR 1.32, 95% CI 1.02 to 1.71), lower wealth (OR 2.75, 95% CI 1.63 to 4.64), no qualifications versus having a degree (OR 1.65, 95% CI 1.03 to 2.66), being unmarried (OR 3.45, 95% CI 2.64 to 4.52), living alone (OR 3.71, 95% CI 2.80 to 4.91), depressive symptoms (OR 1.58, 95% CI 1.47 to 1.69), limiting longstanding illness (OR 1.76, 95% CI 1.30 to 2.38), smoking (OR 1.42, 95% CI 1.04 to 1.97), difficulties with activities of daily living (OR 1.34, 95% CI 1.21 to 1.47) or mobility (OR 1.15, 95% CI 1.10 to 1.21). Age, ethnicity or social isolation was not significantly associated with loneliness in adults with breathlessness.

conclusionsAdults with breathlessness are more likely to be lonely, especially those with lower socio-economic status, who are unmarried or live alone or who have poorer physical function. Findings highlight priority groups for loneliness interventions among adults with breathlessness.