The Relationship of Depression, Loneliness and Social Support on Health Among Older Adults with Multiple Chronic Conditions

Background and purpose: As the U.S. population ages, up to 65% may experience multiple chronic health conditions (MCC), which is related to poor coordination of clinical care and increased health care related expenditure. Additional health risks are known to increase with diminished social interaction. This may be a critical dimension in the health of older adults with MCC, as many are likely to face a greater likelihood of increased mortality, disability, and poor quality of life. However, few studies have examined how social interaction contributes to diminished health among persons who experience MCC. Thus, the goal of this study is to examine how the unique effects of depression, loneliness and social support impact the perceived health of older adults with MCC.

Methods: This study uses data from Wave 1 of the National Social Life, Health and Aging Project (NSHAP), which is a nationally representative survey of over 3,000 older adults between the ages of 57 and 85 years. This study includes NSHAP respondents with multiple chronic conditions (MCC), which resulted in a sample size of n=2,037. Participants completed the CES-D (a previously validated measure to assess the presence of depression), a three-item version of the UCLA loneliness scale, a 6 item measure of social support, and a 4 item measure associated with perceived health (self-rated physical and mental health, health status compared to peers, and self-rated physical activity). Structural equation modeling (SEM) assessed the underlying factor structure of loneliness, social support and perceived health. The structural model explored whether depression, loneliness and social support were associated with perceived health, controlling for age, gender, and race/ethnicity.

Results: The measurement model, examining the latent variables of loneliness, social support and perceived health, was tested using a confirmatory factor analysis. Perceived health (AGFI= 0.97 , CFI= 0.99, RMSEA= 0.07, SRMR= 0.02) and social support (AGFI= 0.99 , CFI= 0.99, RMSEA= 0.02, SRMR= 0.01) both had acceptable levels of model fit, however loneliness was just-identified and its model fit could not be assessed. The structural model with depression, loneliness, and social support predicting perceived health also showed acceptable fit (AGFI= 0.91, CFI= 0.90, RMSEA= 0.06, SRMR= 0.06). The structural model showed that both loneliness and depression significantly predicted perceived health (Loneliness Estimate= -0.29 , S.E.= .11; Depression Estimate= -0.66 , S.E.= .09). Perceived support was not a significant predictor of perceived health.

Conclusions and implications: Effectively treating individuals with MCC requires an understanding that specific factors among MCC populations can serve as important indicators for additional health-related problems. Here, we have identified depression and loneliness as distinct factors associated with diminished health among older adults with MCC. While routine screening for depression is often utilized in many health care settings, results suggest that additional screening concerning loneliness may best identify those most at-risk for poor health. The loneliness measure examined here is brief and considered to be internally valid. Thus, future research should consider the feasibility of implementing loneliness screening within medical care settings to identify those most at-risk for poor health.