Examining the relationship between loneliness and doctor’s visits for influenza-like symptoms in Canadian older adults

Abstract

Loneliness is the subjective experience of the lack of one’s social belonging in their community which plays an important role in healthy aging. It is a complex phenomenon associated not only with psychological distress, but also negative physiological outcomes. Few studies have examined the association between loneliness and infectious diseases. Infectious respiratory diseases such as influenza disproportionately affect older adults due to the natural weakening of the immune system as we age, as well as the high level of comorbidities in this age group. The purpose of this study is to understand the association between loneliness in older adults and the odds of seeking medical care for flu-related symptoms, after adjusting for demographic variables, social connection, behavioural factors, chronic health conditions and diagnosis of mental health disorders. We also assess whether loneliness is associated with severity of influenza symptoms, and whether there is evidence of the COVID-19 pandemic impacting the association between loneliness and doctor visits for influenza symptoms. We used data from follow-up 1 (FUP1) and follow-up 2 (FUP2) surveys of the CLSA comprehensive and tracking cohorts to understand the association between loneliness and going to the doctor with influenza symptoms in older adults aged 65 and above. FUP1 surveys were administered from 2014 to 2018, while FUP2 surveys were administered from 2018 to 2021. Cross-sectional analyses were conducted separately at FUP1 and FUP2 using a logistic regression model with the binary variable ‘doctor’s visit for influenza symptoms’ as the main outcome, and the categorical variable ‘loneliness status’ as the main explanatory variable. Since follow-up 2 coincided with the COVID-19 pandemic, we used a GEE model to investigate whether the association between loneliness and doctor visits for influenza differed across the two timepoints. In order to investigate the association between loneliness and influenza severity, we used the CLSA COVID-19 exit questionnaire, which was administered in December 2020. We ran a negative binomial regression with ‘number of influenza symptoms’ and ‘loneliness status’ as the primary outcome and explanatory variables respectively. A cumulative log-link GEE was conducted for the association between loneliness and influenza symptom severity. In the cross-sectional analyses, loneliness was associated with higher odds of going to the doctor with influenza symptoms at follow-up 2, but not follow-up 1. Loneliness was also positively associated with experiencing more influenza symptoms, as well as higher levels of symptom severity. While participants who took the CLSA main survey prior to COVID-19 had higher odds of going to the doctor with influenza symptoms compared to participants who took the survey after the commencement of COVID-19, we found no evidence that the relationship between loneliness and healthcare utilization for influenza symptoms was impacted by the COVID-19 pandemic. The number of chronic health conditions, diagnosis of mental health disorders, and social connection were identified as possible confounders of the relationship between loneliness and doctor visits for flu. This study addresses the gap in current scientific evidence around the association between loneliness and seeking healthcare for influenza outcomes, as well as severity of influenza symptoms. Our results highlight the complex interactions between loneliness, social connection, chronic health conditions, mental health, and influenza outcomes as well as health-seeking behaviours. Understanding the association between social connection and health outcome, as well as the factors that impact influenza severity in older adults is instrumental to informing more targeted models of care for this vulnerable age group and preparing for future public health crises.