Skip to main content

Prospective associations of social isolation and loneliness with poor sleep quality in older adults

Quality of Life Research volume 27, pages 683–691 (2018)Cite this article

Abstract

Purpose

There is evidence for negative associations between social isolation and loneliness and sleep quality in older adults. However, it is unclear to what extent these two factors independently affect sleep quality. This study examined the simultaneous associations of social isolation and loneliness with sleep quality in a longitudinal study of older adults.

Methods

Data were analyzed from the Social Environment and Biomarkers of Aging Study in Taiwan collected in 2000 and 2006, involving a cohort of 639 participants (mean age = 66.14, SD 7.26). Poisson regression models were conducted to examine the association of social isolation and/or loneliness with sleep quality at follow-up after adjusting for multiple confounding variables.

Results

Univariate analysis showed that sleep quality was inversely associated with both social isolation and loneliness. After demographic, health, cognitive factors, and depressive symptoms were controlled in multivariable analysis, social isolation at the baseline still predicted poor sleep quality 6 years later (incident rate ratio, IRR 1.14; 95% CI 1.04–1.24; p < 0.01), while the association between loneliness and sleep quality was no longer significant (IRR 1.08; 95% CI 0.94–1.23; p = 0.27). The results were unchanged when participants who had poor sleep quality at the baseline were excluded from the analysis.

Conclusions

These findings confirm an adverse effect of social isolation on the sleep quality of older adults, but indicate that this effect is independent of loneliness. Social isolation and loneliness seem to have distinct pathways in affecting the sleep quality of older adults.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Ancoli-Israel, S., & Ayalon, L. (2006). Diagnosis and treatment of sleep disorders in older adults. American Journal of Geriatric Psychiatry, 14(2), 95–103.

    Article  PubMed  Google Scholar 

  2. Crowley, K. (2011). Sleep and sleep disorders in older adults. Neuropsychology Review, 21(1), 41–53.

    Article  PubMed  Google Scholar 

  3. Roth, T. (2007). Insomnia: Definition, prevalence, etiology, and consequences. Journal of Clinical Sleep Medicine, 3(5 Suppl), S7–S10.

    PubMed  PubMed Central  Google Scholar 

  4. Leng, Y., Cappuccio, F. P., Wainwright, N. W., Surtees, P. G., Luben, R., Brayne, C., & Khaw, K. T. (2015). Sleep duration and risk of fatal and nonfatal stroke: A prospective study and meta-analysis. Neurology, 84(11), 1072–1079.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Cappuccio, F. P., Cooper, D., D’Elia, L., Strazzullo, P., & Miller, M. A. (2011). Sleep duration predicts cardiovascular outcomes: A systematic review and meta-analysis of prospective studies. European Heart Journal, 32(12), 1484–1492.

    Article  PubMed  Google Scholar 

  6. Chen, J. H., Waite, L. J., & Lauderdale, D. S. (2015). Marriage, relationship quality, and sleep among U.S. older adults. Journal of Health and Social Behavior, 56(3), 356–377.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Chen, J. H., Lauderdale, D. S., & Waite, L. J. (2016). Social participation and older adults’ sleep. Social Science & Medicine, 149, 164–173.

    Article  Google Scholar 

  8. Gu, D., Sautter, J., Pipkin, R., & Zeng, Y. (2010). Sociodemographic and health correlates of sleep quality and duration among very old Chinese. Sleep, 33(5), 601–610.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Cacioppo, J. T., & Patrick, W. (2008). Loneliness : Human nature and the need for social connection 1. New York: Norton.

    Google Scholar 

  10. Jacobs, J. M., Cohen, A., Hammerman-Rozenberg, R., & Stessman, J. (2006). Global sleep satisfaction of older people: The Jerusalem Cohort Study. Journal of the American Geriatrics Society, 54(2), 325–329.

    Article  PubMed  Google Scholar 

  11. McHugh, J. E., & Lawlor, B. A. (2013). Perceived stress mediates the relationship between emotional loneliness and sleep quality over time in older adults. British Journal of Health Psychology, 18(3), 546–555.

    Article  PubMed  Google Scholar 

  12. Hawkley, L. C., Preacher, K. J., & Cacioppo, J. T. (2010). Loneliness impairs daytime functioning but not sleep duration. Health Psychology, 29(2), 124–129.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Shankar, A., Hamer, M., McMunn, A., & Steptoe, A. (2013). Social isolation and loneliness: Relationships with cognitive function during 4 years of follow-up in the English Longitudinal Study of Ageing. Psychosomatic Medicine, 75(2), 161–170.

    Article  PubMed  Google Scholar 

  14. Holwerda, T. J., Deeg, D. J., Beekman, A. T., van Tilburg, T. G., Stek, M. L., Jonker, C., & Schoevers, R. A. (2014). Feelings of loneliness, but not social isolation, predict dementia onset: Results from the Amsterdam Study of the Elderly (AMSTEL). Journal of Neurology, Neurosurgery, and Psychiatry, 85(2), 135–142.

    Article  PubMed  Google Scholar 

  15. Steptoe, A., Shankar, A., Demakakos, P., & Wardle, J. (2013). Social isolation, loneliness, and all-cause mortality in older men and women. Proceedings of the National Academy of Sciences of the United States of America, 110(15), 5797–5801.

    Article  Google Scholar 

  16. Cornman, J. C., Glei, D. A., Goldman, N., Chang, M. C., Lin, H. S., Chuang, Y. L., Hurng, B. S., Lin, Y. H., Lin, S. H., Liu, I. W., Liu, H. Y., & Weinstein, M. (2014). Cohort profile: The Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan. International Journal of Epidemiology. https://doi.org/10.1093/ije/dyu1179.

    PubMed  PubMed Central  Google Scholar 

  17. Vasunilashorn, S., Glei, D. A., Lin, Y.-H., & Goldman, N. (2013). Apolipoprotein E and measured physical and pulmonary function in older Taiwanese adults. Biodemography and Social Biology, 59(1), 57–67.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Carney, C. E., & Edinger, J. D. (2010). Insomnia and anxiety. New York: Springer.

    Book  Google Scholar 

  19. Smith, M. T., & Wegener, S. T. (2003). Measures of sleep. Rheumatoid Arthritis, 49(5S), S184–S196.

    Article  Google Scholar 

  20. Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193–213.

    CAS  Article  PubMed  Google Scholar 

  21. Lin, C.-L., Su, T.-P., & Chang, M. (2003). Quality of sleep and its associated factors in the institutionalized elderly. Journal of the Formosan Medical Association, 7(2), 174–184.

    Google Scholar 

  22. Wu, C.-Y., Su, T.-P., Fang, C.-L., & Chang, M. Y. (2012). Sleep quality among community-dwelling elderly people and its demographic, mental, and physical correlates. Journal of the Chinese Medical Association, 75(2), 75–80.

    Article  PubMed  Google Scholar 

  23. Dowd, J. B., Goldman, N., & Weinstein, M. (2011). Sleep duration, sleep quality, and biomarkers of inflammation in a Taiwanese population. Ann Epidemiol, 21(11), 799–806.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Cornwell, E. Y., & Waite, L. J. (2009). Social disconnectedness, perceived isolation, and health among older adults. Journal of Health and Social Behavior, 50(1), 31–48.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Gersten, O. (2008). Neuroendocrine biomarkers, social relations, and the cumulative costs of stress in Taiwan. Social Science & Medicine, 66(3), 507–519.

    Article  Google Scholar 

  26. Glei, D. A., Goldman, N., Ryff, C. D., Lin, Y. H., & Weinstein, M. (2012). Social relationships and inflammatory markers: An analysis of Taiwan and the U.S. Social Science & Medicine, 74(12), 1891–1899.

    Article  Google Scholar 

  27. Luo, Y., & Waite, L. J. (2014). Loneliness and mortality among older adults in China. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 69(4), 633–645.

    Article  PubMed Central  Google Scholar 

  28. Nummela, O., Seppanen, M., & Uutela, A. (2011). The effect of loneliness and change in loneliness on self-rated health (SRH): A longitudinal study among aging people. Archives of Gerontology and Geriatrics, 53(2), 163–167.

    Article  PubMed  Google Scholar 

  29. Tilvis, R. S., Pitkala, K. H., Jolkkonen, J., & Strandberg, T. E. (2000). Social networks and dementia. Lancet, 356(9223), 77–78.

    CAS  Article  PubMed  Google Scholar 

  30. Hu, W., & Lu, J. (2015). Associations of chronic conditions, APOE4 allele, stress factors, and health behaviors with self-rated health. BMC Geriatrics, 15, 137. https://doi.org/10.1186/s12877-12015-10132-y.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Department of Health. (2003). Identification, evaluation, and treatment of overweight and obesity in adults in Taiwan. Taiwan: Department of Health.

    Google Scholar 

  32. Chien, K. L., Chen, P. C., Hsu, H. C., Su, T. C., Sung, F. C., Chen, M. F., & Lee, Y. T. (2010). Habitual sleep duration and insomnia and the risk of cardiovascular events and all-cause death: Report from a community-based cohort. Sleep, 33(2), 177–184.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Grandner, M. A., Patel, N. P., Perlis, M. L., Gehrman, P. R., Xie, D., Sha, D., Pigeon, W. R., Teff, K., Weaver, T., & Gooneratne, N. S. (2011). Obesity, diabetes, and exercise associated with sleep-related complaints in the American population. Z Gesundh Wiss, 19(5), 463–474.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Leng, Y., Wainwright, N. W., Cappuccio, F. P., Surtees, P. G., Hayat, S., Luben, R., Brayne, C., & Khaw, K. T. (2016). Daytime napping and increased risk of incident respiratory diseases: Symptom, marker, or risk factor? Sleep Med, 23, 12–15.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Katz, S., & Akpom, C. A. (1976). A measure of primary sociobiological functions. International Journal of Health Services, 6(3), 493–508.

    CAS  Article  PubMed  Google Scholar 

  36. Spector, W. D., & Fleishman, J. A. (1998). Combining activities of daily living with instrumental activities of daily living to measure functional disability. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 53(1), S46–S57.

    CAS  Article  Google Scholar 

  37. Ku, P. W., Fox, K. R., Gardiner, P. A., & Chen, L. J. (2016). Late-life exercise and difficulty with activities of daily living: An 8-year nationwide follow-up study in Taiwan. Annals of Behavioral Medicine, 50(2), 237–246.

    Article  PubMed  Google Scholar 

  38. Chu, D.-C., Fox, K. R., Chen, L.-J., & Ku, P.-W. (2015). Components of late-life exercise and cognitive function: An 8-year longitudinal study. Prevention Science, 16(4), 568–577.

    Article  PubMed  Google Scholar 

  39. Boey, K. W. (1999). Cross-validation of a short form of the CES-D in Chinese elderly. International Journal of Geriatric Psychiatry, 14(8), 608–617.

    CAS  Article  PubMed  Google Scholar 

  40. Chen, L.-J., Stevinson, C., Ku, P. W., Chang, Y.-K., & Chu, D.-C. (2012). Relationships of leisure-time and non-leisure-time physical activity with depressive symptoms: A population-based study of Taiwanese older adults. International Journal of Behavioral Nutrition and Physical Activity, 9, 28. https://doi.org/10.1186/1479-5868-1189-1128.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Chou, K. L. (2010). Moderating effect of apolipoprotein genotype on loneliness leading to depressive symptoms in Chinese older adults. American Journal of Geriatric Psychiatry, 18(4), 313–322.

    Article  PubMed  Google Scholar 

  42. Hosmer, D. W., & Lemeshow, S. (2000). Applied logistic regression (2). New York: Wiley.

    Book  Google Scholar 

  43. Locher, J. L., Ritchie, C. S., Roth, D. L., Baker, P. S., Bodner, E. V., & Allman, R. M. (2005). Social isolation, support, and capital and nutritional risk in an older sample: Ethnic and gender differences. Social Science & Medicine, 60(4), 747–761.

    Article  Google Scholar 

  44. Vandervoort, D. (2000). Social isolation and gender. Current Psychology, 19(3), 229–236.

    Article  Google Scholar 

  45. Tanskanen, J., & Anttila, T. (2016). A prospective study of social isolation, loneliness, and mortality in Finland. American Journal of Public Health, 106, e1–e7.

    Article  Google Scholar 

  46. Kent, R. G., Uchino, B. N., Cribbet, M. R., Bowen, K., & Smith, T. W. (2015). Social relationships and sleep quality. Annals of Behavioral Medicine, 49(6), 912–917.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Worthman, C. M., & Melby, M. K. (2002). Toward a comparative developmental ecology of human sleep. Cambridge: Cambridge University Press

    Book  Google Scholar 

  48. Kurina, L. M., Knutson, K. L., Hawkley, L. C., Cacioppo, J. T., Lauderdale, D. S., & Ober, C. (2011). Loneliness is associated with sleep fragmentation in a communal society. Sleep, 34(11), 1519–1526.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Petersen, J., Kaye, J., Jacobs, P. G., Quinones, A., Dodge, H., Arnold, A., & Thielke, S. (2016). Longitudinal relationship between loneliness and social isolation in older adults: Results from the cardiovascular health study. Journal of Aging and Health, 28(5), 775–795.

    Article  PubMed  Google Scholar 

  50. Victor, C., Grenade, L., & Boldy, D. (2005). Measuring loneliness in later life: A comparison of differing measures. Reviews in Clinical Gerontology, 15(01), 63–70.

    Article  Google Scholar 

  51. Dickens, A. P., Richards, S. H., Greaves, C. J., & Campbell, J. L. (2011). Interventions targeting social isolation in older people: A systematic review. BMC Public Health, 11, 647.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors thank the SEBAS research group for collecting the data and making it available to researchers.

Author information

Authors and Affiliations

  1. Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China

    Bin Yu & Kaijun Niu

  2. Department of Epidemiology and Public Health, University College London, London, UK

    Bin Yu, Andrew Steptoe, Po-Wen Ku & Li-Jung Chen

  3. Institute of Psychology, Tianjin Medical University, Tianjin, China

    Bin Yu

  4. Graduate Institute of Sports and Health, National Changhua University of Education, No. 1 Jin-De Rd., Changhua City, 500, Taiwan

    Po-Wen Ku

  5. Department of Exercise Health Science, National Taiwan University of Sport, No. 16, Section 1, Shuang-Shih Rd, Taichung, 404, Taiwan

    Li-Jung Chen

Authors
  1. Bin Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew Steptoe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kaijun Niu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Po-Wen Ku
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Li-Jung Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Po-Wen Ku or Li-Jung Chen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Yu, B., Steptoe, A., Niu, K. et al. Prospective associations of social isolation and loneliness with poor sleep quality in older adults. Qual Life Res 27, 683–691 (2018). https://doi.org/10.1007/s11136-017-1752-9

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-017-1752-9

Keywords

  • Sleep quality
  • Social isolation
  • Loneliness
  • Older adults