BACKGROUND: Recent studies indicate that loneliness is a significant risk factor for many ailments from colds to heart disease. If lonely patients are at greater risk for illness, then we might expect that they would use the emergency department (ED) more often and incur greater medical costs than those who are not lonely. Our goal was to determine the prevalence of loneliness in patients in an ED and to evaluate it as a predictor of ED use, hospital admission, and chronic illness.
METHODS: We evaluated a convenience sample of 164 ED patients with the University of California–Los Angeles Loneliness Scale, Version 3 and a survey of patient characteristics. Using medical record review and patient self-report, we determined total ED visits, the presence of chronic illness, and discharge diagnoses during a 1-year retrospective period. We evaluated data with least mean square regression and a 2-tailed t test.
RESULTS: We found a statistically significant correlation between loneliness score and total hospital ED visits (P <.001). The mean loneliness score (39) was equal to that of normal populations. Patients scoring higher than the mean used the ED 60% more per year than patients who scored lower (P = .008). There was no association between a patient’s loneliness score and baseline chronic illness or severity of current illness (P = .56). Spanish-speaking patients had higher loneliness scores than English-speaking patients (P = .001).
CONCLUSION: Loneliness is a predictor of hospital ED use independent of chronic illness and is potentially very expensive to society. We recommend further studies be done to examine if allocating resources for preventing, diagnosing, and treating loneliness would be cost effective.
Many recent studies indicate that people who are lonely are at a significant health risk. Lonely people are 4 times1 more likely to suffer a heart attack and 4 times2 more likely to die from such an event than those who are not lonely. They have been shown to be twice as likely to suffer from colds.3 Even the old wives’ tale that a partner’s life expectancy diminishes with the death of a spouse has been proved true.4 A person’s perceived interaction with others within a community may be a better predictor of health than smoking, cholesterol, or even genetics.
We studied 164 patients who received treatment at the Lawrence General Hospital emergency department (ED). Our goals were to determine the prevalence of loneliness in an ED population and to evaluate it as a predictor of ED use, hospital admission, and chronic illness.
Methods
Study Population and Data Collection
The Greater Lawrence Family Health Center research team administered the University of California–Los Angeles (UCLA) Loneliness Questionnaire Figure 1 to 182 patients seen at the Lawrence General Hospital ED. A second brief questionnaire was administered to address potentially confounding factors (ie, primary medical provider, preferred language, age, sex, and self-reported ED visits). We used a convenience sample of consecutive adult patients seen by 3 physicians during varying weekday shifts in the ED over a 1-month period beginning March 8, 1998. Readers were provided to assist the illiterate segment of the population in responding to the questionnaire. Material was available in English and Spanish. A total of 180 questionnaires were collected. This represents approximately 11% of the 1624 patients seen during that time.
Comprehensive data were collected from hospital records to verify each patient’s number of ED visits, admissions following an ED visit, and direct admissions during a 1-year period. We performed a blinded review of medical records to establish discharge diagnoses and the number of chronic illnesses per patient. Because loneliness scale results were tabulated at the end of the 1-month data collection period, the research team was unaware of those scores at the time of admission or discharge diagnosis.
Definitions
Loneliness. The loneliness associated with health risk is related to a person’s perception of his or her personal support system.5 Women tend to overreport loneliness, while men traditionally underreport it.6 Self-report is usually a poor indicator of a person’s actual loneliness,5 therefore we felt a previously tested standardized questionnaire was most desirable for interpreting data. The UCLA Loneliness Scale, Version 3 was chosen because of its brevity, sensitivity, and specificity, as well as its continuous numerical result.5 Scores range from 20 (little loneliness) to 80 (great loneliness). The mean loneliness score for a general population is 40.5 The questionnaire also has excellent test/retest reliability (r = 0.73) over a 1-year period, and is negatively associated with social isolation, so it can be used to study loneliness as an independent risk factor.5 A version was translated into Spanish and translated back into English. Both versions were tested on a bilingual blinded group of 20 nurses and nurses aides at the Greater Lawrence Family Health Center. There was almost an exact correlation between scores (mean = 39.5 vs 39.0).