Loneliness and Pain Interference Among Older Adults Living in Puerto Rico during COVID-19

Background: Loneliness and pain are associated with negative health outcomes. Previous studies document a relationship between these constructs, mostly among White adults and clinical samples. The COVID-19 pandemic has led to increased loneliness. Yet, little is known about how this experience has affected the interference of pain in older adults’ daily activities. This study draws on the Diathesis Biopsychosocial Model of Chronic Pain to examine the association of loneliness and pain interference among older adults in Puerto Rico during the COVID-19 pandemic.

Methods: We used data from a Knowledge, Attitudes and Practices COVID-19 study of older adults in Puerto Rico. We examined data collected in December 2021 via face-to-face interviews with a nonprobability sample of adults aged 60+ (N = 146) who completed measures of objective and subjective isolation and pain interference. Participants ranged in age from 60-98 (M = 71.9, SD = 8.71); 55% were female. We assessed loneliness with the Three-item Loneliness Scale (TILS) (Range 3 - 9) and pain interference over the previous four weeks with a single item from the 12-item Short Form Survey (SF-12) (Range 1 - 5). We used multiple linear regression to explore the effects of loneliness on pain interference. Missing data were treated with Multiple Imputation using Fully Conditional Specification, Chained Equation methods, with 20 imputations, using Predictive Mean Matching for models for scale variables. Our adjusted model included included salient demographics, health (e.g., diabetes, arthritis, cardiovascular), mental health (Self-Reporting Questionnaire-20), and social factors (e.g., Lubben Social Network Scale) and COVID-19 stressors (i.e., COVID-19 infection, delays in treatment, loss of loved ones).

Results: Approximately 39% of participants met the threshold (score ≥ 6) for loneliness . Mean pain interference score was 2.51 (SD = 1.37) with 26% reporting “quite a bit” or “extreme”. Approximately 26% reported treatment delays and 32.5% experienced the loss of a loved one during the COVID pandemic. In our final fully adjusted pooled model, loneliness was associated with higher pain interference (β = .140, p = .042). Sensitivity analyses using complete case analysis indicated similar results.

Discussion: Our results indicated high rates of loneliness and clinically significant pain interference and underscore the importance of these two public health problems among older Puerto Ricans. Consistent with our guiding theory, after controlling for the direct effects of demographic factors, objective social isolation, health and COVID-19 stressors, loneliness was significantly associated with pain interference in our sample of older adults. We consider that multiple cultural (e.g., familism) and contextual (e.g., emigration, under-resourced healthcare system, natural disasters) may shape perceptions and impact of loneliness on pain outcomes. Given the limited examination of loneliness among older Puerto Ricans, our results suggest that further work is needed to understand lived experience of loneliness, and how it may enhance stress and influence diverse pain outcomes. Researchers and practitioners should also collaborate on examining if and how addressing loneliness may improve pain outcomes via adaptation and implementation of culturally appropriate and contextually feasible interventions in Puerto Rico.