Living Alone and Loneliness in Predicting Health-Related Quality of Life: Results from the Healthy Aging Longitudinal Study in Taiwan (HALST)

Abstract

Abstract Purpose. This study examined two related but distinct features of social isolation – living alone and loneliness – concerning their unique and joint effects on predicting health-related quality of life (HRQoL). In addition, we examined the moderating and mediating role of loneliness in the associations between living alone and HRQoL. Method. Analyses were with a nationally representative sample of 5,012 community-residing adults aged 55 and older (Mage = 59.3, SD = 8.1) and with their follow-up data 3.2 years later. Results. At baseline, 9% (n = 508) reported living alone, and 10.3% (n = 586) reported feeling lonely. 2.5% (n = 130) reported both living alone and feeling lonely. A series of regression showed that loneliness was consistently associated with lower physical (PCS) and mental (MCS) components of HRQoL, concurrently and longitudinally, whereas living alone was only associated with lower PCS 3.2 years later. Moderation analysis showed compounded effects of loneliness and living alone in predicting lower MCS. Mediation analyses revealed a cascading effect where living alone was associated with concurrent and subsequent loneliness, which, in turn, was associated with lower PCS and MCS 3.2 years later. Conclusion. Loneliness appeared to be a more potent predictor of lower HRQoL in later life. Nevertheless, living alone could indirectly worsen adults’ HRQoL by either exacerbating the negative impacts of loneliness or triggering a sense of prolonged loneliness predicting lower HRQoL. For practice, programs and policies to improve adults’ HRQoL should pay special attention to older adults who report loneliness, especially those who live alone.