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Loneliness, Aging, and Polypharmacy

Older people who scored high on a loneliness questionnaire were more likely to take multiple medications, mostly psychotropics, than those reporting no social support deficits, researchers said.

Use of antidepressants, benzodiazepines, and other anxiolytic/sedative drugs were all significantly more common in individuals older than 65 with substantial loneliness indicators versus those with none, with differences in prevalence of 6 to 13 percentage points after adjustments, according to Ashwin Kotwal, MD, MS, of University of California San Francisco, and colleagues writing in JAMA Internal Medicine.

The loneliest people also were more likely to use nonsteroidal anti-inflammatory drugs (NSAIDs) and had higher rates of overall polypharmacy as well, the investigators reported in a research letter.

Data for the analysis came from the National Social Life, Health, and Aging Project, an in-home survey of older people conducted periodically from 2005 to 2015. Among other things, it contained questions from the three-item UCLA Loneliness Scale. Participants also showed the interviewer all the medications they took regularly. A total of 6,107 were included in the current analysis, of which 3,233 showed no substantial loneliness on the UCLA scale, 2,388 were classed as low/moderate, and 396 scored high.

“[C]linicians should consider initiating social interventions for lonely older adults or ‘social prescribing’ to local community-based support programs” rather than piling on medications to relieve symptoms, Kotwal’s group suggested. They noted that loneliness may contribute to somatic and psychiatric problems; and in those cases in which loneliness results from such symptoms, it may exacerbate them. And, the researchers pointed out, medications are unlikely to relieve loneliness.

Mean participant age in the study was about 74. Just over half were women, and about 85% of participants were white.

Half of the sample reported pain, about one-third said they had insomnia, 11% reported depression, and 6% had anxiety.

Rates of medication use for participants with zero versus high scores on the loneliness scale, adjusted for sociodemographic variables and multimorbidity, were as follows (all P<0.001):

  • NSAIDs: 14% vs 22%
  • Benzodiazepines: 5% vs 11%
  • Other anxiolytics/sedatives: 9% vs 20%
  • Antidepressants: 14% vs 27%
  • Polypharmacy: 41% vs 50%

A nonsignificant trend toward higher rates of opioid use among the loneliest participants was seen as well (7% vs 10%).

All of those drug classes come with substantial risks for older people, the researchers noted, including “opioid dependence, gastrointestinal bleeds, falls, fractures, delirium or cognitive impairment, new functional disability, and death.”

To what extent loneliness may lead to overmedication through actual causation is unclear, Kotwal’s group cautioned. They said the study’s most important limitation is the cross-sectional survey method, which precludes “conclusions on the directionality of our findings.”

  • John Gever was Managing Editor from 2014 to 2021; he is now a regular contributor.

Disclosures

The study was funded from National Institutes of Health grants.

Authors reported no financial relationships with commercial entities.

Source: MedicalNewsToday.com