Loneliness as a risk factor for time to care home entry for older adults receiving community care

Rickman, Samuel ORCID: 0000-0003-1921-5258, Fernández, José-Luis ORCID: 0000-0002-4190-7341 and Malley, Juliette ORCID: 0000-0001-5759-1647 (2025) Loneliness as a risk factor for time to care home entry for older adults receiving community care. Innovation in Aging. ISSN 2399-5300 (In Press)

Text (loneliness-social-isolation-care-home-entry-final-no-track-changes) - Accepted Version Pending embargo until 1 January 2100. Download (1MB)

Abstract

Background and Objectives: International efforts to contain long-term care costs have prioritised personal care provision. However, reductions in services aimed at addressing loneliness or promoting social participation may affect demand for long-term care facilities. Research on the impact of loneliness on entry to residential or nursing care facilities is based on survey data, which under-represents those with the highest needs. Administrative records include such individuals and, unlike surveys, contain continuous data on service receipt, enabling accurate modelling of time to care home entry. Research Design and Methods: We use administrative data for 1,101 individuals receiving care in a London local authority. We extract loneliness from free text notes using a large language model and model its impact on care home entry five years after assessment, controlling for needs and demographics. We use logistic regression and a competing risks survival model to measure time until care home entry. Results: The odds ratio for care home entry associated with loneliness is 1.45 with logistic regression (95% CI 1.04 – 2.01). The hazard ratio is 1.32 (95% CI 1.01 – 1.72) with a cause-specific model, and 1.39 (95% CI 1.08 - 1.79) using the Fine & Gray method. Among those most likely to enter a care home, the median time to entry is around 9 months (95% CI 228 - 328 days) earlier for those who are lonely. Discussion and Implications: The hazard ratio of loneliness on care home entry is around the magnitude associated with gender, ethnicity or living alone. However, loneliness is modifiable. Reductions to services which reduce loneliness, such as day centres, are likely to cause an increase in loneliness. We demonstrate that for those with the highest needs, loneliness is a significant risk factor for time until care home entry. Policymakers seeking to delay care home entry should consider the impact on services for loneliness.

Item Type:	Article
Additional Information:	© 2025 The Author(s)
Divisions:	Care Policy and Evaluation Centre
Subjects:	H Social Sciences
Date Deposited:	14 Jan 2025 09:57
Last Modified:	14 Jan 2025 10:15
URI:	http://eprints.lse.ac.uk/id/eprint/126868

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