title: Impact of living alone on institutionalization and mortality: a population-based longitudinal study.
abstract: BACKGROUND
  Living alone is common among elderly people in Western countries, and studies on its relationship with institutionalization and all-cause mortality have shown inconsistent results. We investigated that the impact of living alone on institutionalization and mortality in a population-based cohort of elderly people.
  
  
  METHODS
  Data originate from the Swedish National study on Aging and Care-Kungsholmen. Participants aged ≥66 years and living at home (n = 2404) at baseline underwent interviews and clinical examination. Data on living arrangements were collected in interviews. All participants were followed for 6 years; survival status and admission into institutions were tracked continuously through administrative registers from 2001 to 2007. Data were analysed using Cox proportional hazard models, competing risk regressions and Laplace regressions with adjustment for potential confounders.
  
  
  RESULTS
  Of the 2404 participants, 1464 (60.9%) lived alone at baseline. During the follow-up, 711 (29.6%) participants died, and 185 (15.0%) were institutionalized. In the multi-adjusted Cox model, the hazard ratio (HR) of mortality in those living alone was 1.35 (95% confidence interval [CI] 1.18 to 1.54), especially among men (HR = 1.44, 95% CI 1.18 to 1.76). Living alone shortened survival by 0.6 years and was associated with the risk of institutionalization (HR = 1.74, 95% CI 1.10 to 2.77) after taking death into account as a competing risk.
  
  
  CONCLUSIONS
  Living alone is associated with elevated mortality, especially among men and an increased risk of institutionalization. Over a 6-year period, living alone was related to a half year reduction in survival among elderly people in Sweden.
authors: 1 Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden 2 INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France 3 University of Bordeaux, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France clement.pimouguet@isped.u-bordeaux2.fr.
authors: Clément
authors: C
authors: Pimouguet
authors: 1 Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
authors: Debora
authors: D
authors: Rizzuto
authors: 1 Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden 4 Stockholm Gerontology Research Center, Stockholm, Sweden.
authors: Pär
authors: P
authors: Schön
authors: 1 Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
authors: Behnaz
authors: B
authors: Shakersain
authors: 1 Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
authors: Sara
authors: S
authors: Angleman
authors: 1 Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden 4 Stockholm Gerontology Research Center, Stockholm, Sweden.
authors: Marten
authors: M
authors: Lagergren
authors: 1 Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden 4 Stockholm Gerontology Research Center, Stockholm, Sweden.
authors: Laura
authors: L
authors: Fratiglioni
authors: 1 Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
authors: Weili
authors: W
authors: Xu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D005191:Family Characteristics; D005260:Female; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data*; D008017:Life Expectancy; D008137:Longitudinal Studies; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D012737:Sex Factors; D013548:Sweden