title: Effects of psychosocial group rehabilitation on health, use of health care services, and mortality of older persons suffering from loneliness: a randomized, controlled trial.
abstract: BACKGROUND
  Loneliness is a distressing feeling of a lack of satisfying human relationships. It is associated with poor quality of life, impaired health, and increased mortality among older individuals. The study aim was to determine the effects of new psychosocial group rehabilitation on the subjective health, use and costs of health services, and mortality of lonely older individuals.
  
  
  METHODS
  This randomized, controlled trial was performed in seven day care centers. A total of 235 older people (>74 years) suffering from loneliness participated. Intervention was implemented in 15 groups (each with 7-8 participants and 2 professional group leaders) meeting for 3 months altogether 12 times. Group intervention aimed to empower elderly people, and to promote their peer support and social integration. Intervention was based on the effects of closed-group dynamics. The groups had the following activities according to the participants' interests: (a) therapeutic writing and group psychotherapy, (b) group exercise and discussions, and (c) art activities. Group leaders received thorough training and tutoring. Subjective health, use and costs of health services, and mortality were measured.
  
  
  RESULTS
  At 2 years, survival was 97% in the intervention group (95% confidence interval [CI], 91-99) and 90% in the control group (95% CI, 85-95) (p = .047). The intervention group showed a significant improvement in subjective health, thus resulting in significantly lower health care costs during the follow-up: the difference between the groups was -943 euro/person per y (95% CI -1955 to -127; p = .039).
  
  
  CONCLUSIONS
  Psychosocial group rehabilitation was associated with lower mortality and less use of health services.
authors.affiliation: Department of Primary Health Care and General Practice, University of Helsinki, Finland. kaisu.pitkala@helsinki.fi
authors.forename: Kaisu H
authors.initials: KH
authors.lastname: Pitkala
authors.forename: Pirkko
authors.initials: P
authors.lastname: Routasalo
authors.forename: Hannu
authors.initials: H
authors.lastname: Kautiainen
authors.forename: Reijo S
authors.initials: RS
authors.lastname: Tilvis
mesh_terms: D000368:Aged; D000375:Aging; D005260:Female; D005387:Finland; D017048:Health Care Costs; D006299:Health Services for the Aged / Q000191:economics / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D007398:Interpersonal Relations; D008132:Loneliness / Q000523:psychology*; D008297:Male; D011615:Psychotherapy, Group / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis