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

To examine all-cause 1-year risk of mortality associated with loneliness for home care recipients after adjusting for potential confounders. Survival analyses with parallel designs using interRAI Home Care assessments and mortality. 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. 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. 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. 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.