Loneliness as a Risk Factor for Time to Care Home Entry for Older Adults Receiving Community Care.

Background and objectives: International efforts to contain long-term care costs have prioritized personal care. 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 is based on survey data, which under-represents those with highest needs. Administrative records include such individuals and, unlike surveys, contain continuous data on service receipt, enabling accurate modeling 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 5 years after assessment, controlling for needs and demographics. We use logistic regression and a competing risks survival model to measure the 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 and Gray method. Among those most likely to enter a care home, the median time to entry is 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 for social participation, such as day centers, 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 of services for loneliness.