We aim to examine multimorbidity as a risk factor for feeling of loneliness among older adults in India. Further, we investigate the interactive effects of sex and living arrangements in the association of multimorbidity and feeling alone in old age. The study involved a cross-sectional design of baseline data from the Longitudinal Ageing Study in India (LASI, 2017–18). A single-item measure was used from the 10-item Centre for Epidemiological Studies Depression Scale (CES-D-10) to capture the feeling of loneliness among older adults. Model 1 in the multivariable analysis (Wald χ2 = 6.50, p < 0.05, Pseudo R2 = 0.0011) produced a significant association between multimorbidity and feeling alone (UOR = 1.20, CI: 1.04–1.38). In models 2 and 3, socio-demographic variables, as well as health and behavioral factors were added and it is found that model fit has been increased significantly (Wald χ2 = 524.82, p < 0.0001, Pseudo R2 = 0.0430), showing a positive association of multimorbidity with the feeling of loneliness. These findings highlight the importance of knowledge about multimorbidity to determine individuals at risk for higher loneliness scores in order to promote healthy aging.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Agarwal, A., Lubet, A., Mitgang, E., Mohanty, S., & Bloom, D. E. (2020). Population Aging in India: Facts, Issues, and Options. In Population change and impacts in Asia and the Pacific (pp. 289–311). https://doi.org/10.1007/978-981-10-0230-4_13
Arensberg, M. (2018). Population aging: Opportunity for business expansion, an invitational paper presented at the Asia-Pacific Economic Cooperation (APEC) International Workshop on Adaptation to Population Aging Issues, July 17, 2017, Ha Noi, Viet Nam. Journal of Health, Population, and Nutrition, 37, 7. https://doi.org/10.1186/s41043-018-0138-0
Arokiasamy, P., & Uttamacharya, & Jain, K. . (2015). Multi-morbidity, functional limitations, and self-rated health among older adults in India: Cross-sectional analysis of LASI pilot survey, 2010. SAGE Open. https://doi.org/10.1177/2158244015571640
Arokiasamy, P., Uttamacharya, U., Jain, K., Biritwum, R. B., Yawson, A. E., Wu, F., … Kowal, P. (2015). The impact of multimorbidity on adult physical and mental health in low- and middle-income countries: What does the study on global ageing and adult health (SAGE) reveal? BMC Medicine, 13(1), 1–16. https://doi.org/10.1186/s12916-015-0402-8
Bandari, R., Khankeh, H. R., Shahboulaghi, F. M., Ebadi, A., Keshtkar, A. A., & Montazeri, A. (2019). Defining loneliness in older adults: Protocol for a systematic review. Systematic Reviews, 8(1), 4–9. https://doi.org/10.1186/s13643-018-0935-y
Benyamini, Y. (2011). Why does self-rated health predict mortality? An update on current knowledge and a research agenda for psychologists. Psychology and Health, 26(11), 1407–1413. https://doi.org/10.1080/08870446.2011.621703
Carmel, S. (2019). Health and Well-Being in Late Life: Gender Differences Worldwide. Frontiers in Medicine, 6(October), 3–6. https://doi.org/10.3389/fmed.2019.00218
Carmona-Torres, J. M., Rodríguez-Borrego, M. A., Laredo-Aguilera, J. A., López-Soto, P. J., Santacruz-Salas, E., & Cobo-Cuenca, A. I. (2019). Disability for basic and instrumental activities of daily living in older individuals. PLoS ONE, 14(7), 1–13. https://doi.org/10.1371/journal.pone.0220157
Chou, K. L., Ho, A. H. Y., & Chi, I. (2006). Living alone and depression in Chinese older adults. Aging and Mental Health, 10(6), 583–591. https://doi.org/10.1080/13607860600641150
Christensen, K., Doblhammer, G., Rau, R., & Vaupel, J. W. (2009). Ageing populations: The challenges ahead. Lancet (london, England), 374(9696), 1196–1208. https://doi.org/10.1016/S0140-6736(09)61460-4
Chrostek, A., Grygiel, P., Anczewska, M., Wciórka, J., & Świtaj, P. (2016). The intensity and correlates of the feelings of loneliness in people with psychosis. Comprehensive Psychiatry, 70, 190–199. https://doi.org/10.1016/j.comppsych.2016.07.015
Cohen-Mansfield, J., Hazan, H., Lerman, Y., & Shalom, V. (2016). Correlates and predictors of loneliness in older-adults: A review of quantitative results informed by qualitative insights. International Psychogeriatrics, 28, 557–576. https://doi.org/10.1017/S1041610215001532
Ćwirlej-Sozańska, A., Wiśniowska-Szurlej, A., Wilmowska-Pietruszyńska, A., & Sozański, B. (2019). Determinants of ADL and IADL disability in older adults in southeastern Poland. BMC Geriatrics, 19(1), 1–13. https://doi.org/10.1186/s12877-019-1319-4
Dahlberg, L., Andersson, L., McKee, K. J., & Lennartsson, C. (2015). Predictors of loneliness among older women and men in Sweden: A national longitudinal study. Aging & Mental Health, 19(5), 409–417. https://doi.org/10.1080/13607863.2014.944091
DarooghegiMofrad, M., Siassi, F., Guilani, B., Bellissimo, N., Suitor, K., & Azadbakht, L. (2020). The association of food quality index with mental health in women: A cross-sectional study. BMC Research Notes, 13(1), 1–7. https://doi.org/10.1186/s13104-020-05401-x
De Jong Gierveld, J. (1998 ). A review of loneliness: Concept and definitions, determinants and consequences. In Reviews in Clinical Gerontology (Vol. 8, Issue 1, pp. 73–80). https://doi.org/10.1017/S0959259898008090
Dhak, B., & Mutharayappa, R. (2009). Gender Differential in Disease Burden: Its Role To Explain Gender Differential in Mortality. ISEC Working Paper Series -221, ISEC Worki, 1–17.
Donovan, N. J., Wu, Q., Rentz, D. M., Sperling, R. A., Marshall, G. A., & Glymour, M. M. (2017). Loneliness, depression and cognitive function in older U.S. adults. International Journal of Geriatric Psychiatry, 32(5), 564–573. https://doi.org/10.1002/gps.4495
Elovainio, M., Hakulinen, C., Pulkki-Råback, L., Virtanen, M., Josefsson, K., Jokela, M., … Kivimäki, M. (2017). Contribution of risk factors to excess mortality in isolated and lonely individuals: an analysis of data from the UK Biobank cohort study. The Lancet Public Health, 2(6), e260–e266. https://doi.org/10.1016/S2468-2667(17)30075-0
Fiske, A., Wetherell, J. L., & Gatz, M. (2009). Depression in older adults. Annual Review of Clinical Psychology. https://doi.org/10.1146/annurev.clinpsy.032408.153621
Forman, D., Maurer, M., Boyd, C., Brindis, R., Salive, M., Horne, F., … Rich, M. (2018). Multimorbidity in Older Adults With Cardiovascular Disease. Journal of the American College of Cardiology, 71, 2149–2161. https://doi.org/10.1016/j.jacc.2018.03.022
Garin, N., Koyanagi, A., Chatterji, S., Tyrovolas, S., Olaya, B., Leonardi, M., … Haro, J. M. (2016). Global Multimorbidity Patterns: A Cross-Sectional, Population-Based, Multi-Country Study. Journals of Gerontology - Series A Biological Sciences and Medical Sciences, 71(2), 205–214. https://doi.org/10.1093/gerona/glv128
Garin, N., Olaya, B., Moneta, M. V., Miret, M., Lobo, A., Ayuso-Mateos, J. L., & Haro, J. M. (2014). Impact of multimorbidity on disability and quality of life in the Spanish older population. PLoS ONE, 9(11). https://doi.org/10.1371/journal.pone.0111498
Grover, S., Verma, M., Singh, T., Dahiya, N., & Nehra, R. (2019). Loneliness and its correlates amongst elderly attending non-communicable disease rural clinic attached to a tertiary care centre of North India. Asian Journal of Psychiatry, 43(May), 189–196. https://doi.org/10.1016/j.ajp.2019.06.001
Hajek, A., Kretzler, B., & König, H. H. (2020). Multimorbidity, loneliness, and social isolation. A systematic review. International Journal of Environmental Research and Public Health, 17(22), 1–12. https://doi.org/10.3390/ijerph17228688
Hakulinen, C., Pulkki-Råback, L., Virtanen, M., Jokela, M., Kivimäki, M., & Elovainio, M. (2018). Social isolation and loneliness as risk factors for myocardial infarction, stroke and mortality: UK Biobank cohort study of 479 054 men and women. Heart (british Cardiac Society), 104(18), 1536–1542. https://doi.org/10.1136/heartjnl-2017-312663
He, W., Muenchrath, M. N., & Kowal, P. R. (2012). Shades of gray: a cross-country study of health and well-being of the older populations in SAGE countries, 2007–2010. U.S. Census Bureau, (July 2015), 2007–2010. https://doi.org/10.13140/RG.2.1.3427.5682
Himanshu, & Talukdar, B. (2017). Prevalence of Multimorbidity (Chronic NCDS) and Associated Determinants Among Elderly in India. Demography India, Table 1, Page 74.
Hossain, M. M., Purohit, N., Khan, N., McKyer, E. L. J., Ma, P., Bhattacharya, S., & Pawar, P. (2019). Prevalence and correlates of loneliness in India: A systematic review. ISSN 2502–3632 (Online), 7(1), 1689–1699.
International Institute for Population Sciences (IIPS), NPHCE, MoHFW, H. T. H. C. S. of P. H. (HSPH) and the U. of S. C. (USC). (2020). Longitudinal Ageing Study in India (LASI) Wave 1, 2017-18. India Report.
Jing, Z., Li, J., Fu, P. P., Wang, Y., Yuan, Y., Zhao, D., … Zhou, C. (2021). Catastrophic health expenditure among single empty-nest elderly with multimorbidity in rural Shandong, China: the effect of co-occurrence of frailty. International Journal for Equity in Health, 20(1), 1–9. https://doi.org/10.1186/s12939-020-01362-6
Jones, S. M. W., Amtmann, D., & Gell, N. M. (2016). A psychometric examination of multimorbidity and mental health in older adults. Aging and Mental Health, 20(3), 309–317. https://doi.org/10.1080/13607863.2015.1008988
Kondo, N., Kazama, M., Suzuki, K., & Yamagata, Z. (2008). Impact of mental health on daily living activities of Japanese elderly. Preventive Medicine, 46(5), 457–462. https://doi.org/10.1016/j.ypmed.2007.12.007
Kristensen, K., König, H. H., & Hajek, A. (2019). The association of multimorbidity, loneliness, social exclusion and network size: Findings from the population-based German Ageing Survey. BMC Public Health, 19(1), 1–10. https://doi.org/10.1186/s12889-019-7741-x
Lee, E. E., Depp, C., Palmer, B. W., Glorioso, D., Daly, R., Liu, J., … Jeste, D. V. (2019). High prevalence and adverse health effects of loneliness in community-dwelling adults across the lifespan: role of wisdom as a protective factor. International Psychogeriatrics, 31(10), 1447–1462. https://doi.org/10.1017/S1041610218002120
Lee, I. F. K., Lee, D. T. F., & MacKenzie, A. E. (2006). Correlates of functional limitations in older Chinese patients with chronic obstructive pulmonary disease in Hong Kong. Heart & Lung: The Journal of Cardiopulmonary and Acute Care, 35(5), 324–333. https://doi.org/10.1016/j.hrtlng.2006.05.004
Lett, H. S., Blumenthal, J. A., Babyak, M. A., Strauman, T. J., Robins, C., & Sherwood, A. (2005). Social support and coronary heart disease: Epidemiologic evidence and implications for treatment. Psychosomatic Medicine, 67(6), 869–878. https://doi.org/10.1097/01.psy.0000188393.73571.0a
Lim, L. L., & Kua, E. H. (2011). Living alone, loneliness, and psychological well-being of older persons in Singapore. Current Gerontology and Geriatrics Research, 2011. https://doi.org/10.1155/2011/673181
Lindgren, B. (2016). The rise in life expectancy, health trends among the elderly, and the demand for care - a selected literature review (vol. 22521, p. 30). Working Paper Series - National Bureau of Economic Research.
Luck-Sikorski, C., Riedel-Heller, S. G., & Phelan, J. C. (2017). Changing attitudes towards obesity- results from a survey experiment. BMC Public Health, 17(1), 1–13. https://doi.org/10.1186/s12889-017-4275-y
Masi, C. M., Chen, H. Y., Hawkley, L. C., & Cacioppo, J. T. (2011). A meta-analysis of interventions to reduce loneliness. Personality and Social Psychology Review, 15(3), 219–266. https://doi.org/10.1177/1088868310377394
Maynard, M., Andrade, L., Packull-McCormick, S., Perlman, C. M., Leos-Toro, C., & Kirkpatrick, S. I. (2018). Food insecurity and mental health among females in high-income countries. International Journal of Environmental Research and Public Health, 15(7), 9–13. https://doi.org/10.3390/ijerph15071424
Melo, L. A. de, Braga, L. de C., Leite, F. P. P., Bittar, B. F., Oséas, J. M. de F., & Lima, K. C. de. (2019). Factors associated with multimorbidity in the elderly: an integrative literature review. Revista Brasileira de Geriatria e Gerontologia, 22(1). https://doi.org/10.1590/1981-22562019022.180154
Menec, V. H., Newall, N. E., Mackenzie, C. S., Shooshtari, S., & Nowicki, S. (2019). Examining individual and geographic factors associated with social isolation and loneliness using Canadian Longitudinal Study on Aging (CLSA) data. PLoS ONE, 14(2), 1–18. https://doi.org/10.1371/journal.pone.0211143
Mofrad, M. D., Siassi, F., Gilani, B., Bellissimo, N., Azadbakht, L., Sciences, N., … Science, F. (2019). The association of dietary phytochemical index and mental health in women: A cross-sectional study. The British Journal of Nutrition, 121(9), 1049–1056
Muhammad, T., Balachandran, A., & Srivastava, S. (2021). Socio-economic and health determinants of preference for separate living among older adults: A cross-sectional study in India. PLoS ONE, 16(4 April), 1–14. https://doi.org/10.1371/journal.pone.0249828
Muhammad, T., Govindu, M., & Srivastava, S. (2021b). Relationship between chewing tobacco, smoking, consuming alcohol and cognitive impairment among older adults in India: A cross-sectional study. BMC Geriatrics, 21(1), 85. https://doi.org/10.1186/s12888-021-03257-4
Muhammad, T., & Meher, T. (2021). Association of late-life depression with cognitive impairment: Evidence from a cross-sectional study among older adults in India. BMC Geriatrics, 21(1), 1–13. https://doi.org/10.1186/s12877-021-02314-7
Muhammad, T., & Srivastava, S. (2020). Why Rotational Living Is Bad for Older Adults? Evidence from a Cross-Sectional Study in India. Journal of Population Ageing, 1. https://doi.org/10.1007/s12062-020-09312-4
Müller, F., Hagedoorn, M., & Tuinman, M. A. (2017). Chronic multimorbidity impairs role functioning in middle-Aged and older individuals mostly when non-partnered or living alone. PLoS ONE, 12(2), 1–14. https://doi.org/10.1371/journal.pone.0170525
Muszalik, M., Kedziora-Kornatowska, K., & Kornatowski, T. (2009). Functional assessment and health-related quality of life (HRQOL) of elderly patients on the basis of the functional assessment of chronic illness therapy (FACIT)-F questionnaire. Archives of Gerontology and Geriatrics, 49(3), 404–408. https://doi.org/10.1016/j.archger.2008.12.007
Oh, D. H., Park, J. H., Lee, H. Y., Kim, S. A., Choi, B. Y., & Nam, J. H. (2015). Association between living arrangements and depressive symptoms among older women and men in South Korea. Social Psychiatry and Psychiatric Epidemiology, 50(1), 133–141. https://doi.org/10.1007/s00127-014-0904-2
Palinkas, L. A., Wingard, D. L., & Barrett-Connor, E. (1996). Depressive symptoms in overweight and obese older adults: A test of the “Jolly Fat” Hypothesis. Journal of Psychosomatic Research, 40(1), 59–66. https://doi.org/10.1016/0022-3999(95)00542-0
Peltzer, K., & Pengpid, S. (2017). Loneliness: Its correlates and associations with health risk behaviours among university students in 25 countries. Journal of Psychology in Africa, 27(3), 247–255. https://doi.org/10.1080/14330237.2017.1321851
Pikhartova, J., Bowling, A., & Victor, C. (2014). Does owning a pet protect older people against loneliness? BMC Geriatrics, 14, 106. https://doi.org/10.1186/1471-2318-14-106
Ryan, A., Murphy, C., Boland, F., Galvin, R., & Smith, S. M. (2018). What is the impact of physical activity and physical function on the development of multimorbidity in older adults over time? A population-based cohort study. Journals of Gerontology - Series A Biological Sciences and Medical Sciences, 73(11), 1538–1544. https://doi.org/10.1093/gerona/glx251
Sekher, T. V. (2011). Catastrophic Health Expenditure and Poor in India : Health Insurance is the Answer ? SAGE-India, 494, 1–4.
Shah, A. A. M. (2016). Changes in the Family and the Elderly Changes in the Family and the Elderly., 34(20), 1179–1182.
Shvedko, A. V., Thompson, J. L., Greig, C. A., & Whittaker, A. C. (2020). Physical Activity Intervention for Loneliness (PAIL) in community-dwelling older adults: A randomised feasibility study. Pilot and Feasibility Studies, 6(1), 1–10. https://doi.org/10.1186/s40814-020-00587-0
Smith, K. J., & Victor, C. (2019). Typologies of loneliness, living alone and social isolation, and their associations with physical and mental health. Ageing and Society, 39(8), 1709–1730. https://doi.org/10.1017/S0144686X18000132
Snell, K. D. M. (2017). The rise of living alone and loneliness in history. Social History, 42(1), 2–28. https://doi.org/10.1080/03071022.2017.1256093
Srivastava, S., Joseph, V. K. J., Dristhi, D., & Muhammad, T. (2021a). Interaction of physical activity on the association of obesity-related measures with multimorbidity among older adults: A population-based cross-sectional study in India. British Medical Journal Open, 11(5), e050245. https://doi.org/10.1136/bmjopen-2021-050245
Srivastava, S., & Muhammad, T. (2020). Violence and associated health outcomes among older adults in India: A gendered perspective. SSM - Population Health, 12. https://doi.org/10.1016/j.ssmph.2020.100702
Srivastava, S., & Muhammad, T. (2021). In Pursuit of Happiness: Changes in Living Arrangement and Subjective Well-Being among Older Adults in India. Journal of Population Ageing. https://doi.org/10.1007/s12062-021-09327-5
Srivastava, S., Purkayastha, N., Chaurasia, H., & Muhammad, T. (2021b). Socioeconomic inequality in psychological distress among older adults in India : A decomposition analysis. BMC Psychiatry, 21(179), 1–15. https://doi.org/10.1186/s12888-021-03192-4
Stata Statistical Software: Release 14. (2015). https://doi.org/10.1186/s12970-017-0182-y
Stickley, A., & Koyanagi, A. (2018). Physical multimorbidity and loneliness: A population-based study. PLoS ONE, 13(1), 1–13. https://doi.org/10.1371/journal.pone.0191651
Theeke, L. A. (2009). Predictors of Loneliness in U.S. Adults Over Age Sixty-Five. Archives of Psychiatric Nursing, 23(5), 387–396. https://doi.org/10.1016/j.apnu.2008.11.002
Tijhuis, M. A. R., De Jong-Gierveld, J., Feskens, E. J. M., & Kromhout, D. (1999). Changes in and factors related to loneliness in older men. The Zutphen Elderly Study. Age and Ageing, 28(5), 491–495. https://doi.org/10.1093/ageing/28.5.491
United Nations. Department of Economic and Social Affairs Population Division. (2017). World population ageing 2017 report. World Population Ageing 2017.
van den Akker, M., Buntinx, F., & Knottnerus, J. A. (1996). Comorbidity or multimorbidity. European Journal of General Practice, 2(2), 65–70. https://doi.org/10.3109/13814789609162146
Varì, R., Scazzocchio, B., D’Amore, A., Giovannini, C., Gessani, S., & Masella, R. (2016). Gender-related differences in lifestyle may affect health status. Annali Dell’istituto Superiore Di Sanita, 52(2), 158–166. https://doi.org/10.4415/ANN_16_02_06
Victor, C., Scambler, S., Bond, J., & Bowling, A. (2000). Being alone in later life: Loneliness, social isolation and living alone. Reviews in Clinical Gerontology, 10, 407–417.
Walker, A. E. (2007). Multiple chronic diseases and quality of life: Patterns emerging from a large national sample. Australia. Chronic Illness, 3(3), 202–218. https://doi.org/10.1177/1742395307081504
Wang, X., Yao, S., Wang, M., Cao, G., Chen, Z., Huang, Z., … Hu, Y. (2020). Multimorbidity among two million adults in China. International Journal of Environmental Research and Public Health, 17(10). https://doi.org/10.3390/ijerph17103395
World Health Organization. (2010). Global status report on noncommunicable diseases. World Health Organization, 53(9), 1689–1699. https://doi.org/10.1017/CBO9781107415324.004
Yang, R., Wang, H., Edelman, L. S., Tracy, E. L., Demiris, G., Sward, K. A., & Donaldson, G. W. (2020). Loneliness as a mediator of the impact of social isolation on cognitive functioning of Chinese older adults. Age and Ageing, 49(4), 599–604. https://doi.org/10.1093/ageing/afaa020
Yeung, W. J. J., & Cheung, A. K. L. (2015). Living alone: One-person households in Asia. Demographic Research, 32(1), 1099–1112. https://doi.org/10.4054/DemRes.2015.32.40
Zhang, Z., Li, L. W., Xu, H., & Liu, J. (2019). Does widowhood affect cognitive function among Chinese older adults? SSM - Population Health, 7(November 2018), 100329. https://doi.org/10.1016/j.ssmph.2018.100329
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Ansari, S., Muhammad, T. & Dhar, M. How Does Multi-Morbidity Relate to Feeling of Loneliness among Older Adults? Evidence from a Population-Based Survey in India. Population Ageing 16, 45–66 (2023). https://doi.org/10.1007/s12062-021-09343-5