title: Association of loneliness and healthcare utilization among older adults in Singapore.
abstract: OBJECTIVE
  To assess the association between loneliness and physician visits among community-dwelling older adults in Singapore.
  
  
  METHODS
  We obtained data from two consecutive waves (2009 and 2011) of a nationally representative longitudinal survey of community-dwelling Singaporeans aged 60 years and older. Out of 3103 responses, we excluded proxy interviews (n = 365; 11.8 %), resulting in a final analysis cohort of 2738 respondents. Using the frequency of physician visits in the past 30 days as the dependent variable, we carried out negative binomial hurdle regression controlling for predisposing characteristics, enabling factors, needs, social capital and change in loneliness status between the two waves of the survey.
  
  
  RESULTS
  Approximately 23% of respondents suffered from chronic loneliness; a further 19% developed loneliness, whereas 33% recovered from loneliness by wave 2. Chronic (OR 0.76 ± 0.11) and recently-developed loneliness (OR 0.70 ± 0.10) were significantly associated with lower odds of physician visits, compared with being never lonely. Meanwhile, those who recovered from loneliness had the same odds of physician visits, but were associated with lower number of visits (-0.71 ± 0.27) if they did utilize their physicians.
  
  
  CONCLUSIONS
  The present study found a significant association between loneliness and lower odds of physician visits regardless of whether the loneliness was recently developed or chronic. In addition, respondents who had loneliness in the past also had a significantly lower number of visits to physicians compared with those who were never lonely. Further studies on the underlying behavior and the health consequences are warranted. Geriatr Gerontol Int 2017; 17: 1789-1798.
authors.affiliation: Duke NUS Medical School, Republic of Singapore, Singapore.
authors.forename: Ka Keat
authors.identifier: http://orcid.org/0000-0002-2340-4097
authors.initials: KK
authors.lastname: Lim
authors.affiliation: Duke NUS Medical School, Republic of Singapore, Singapore.
authors.forename: Angelique
authors.initials: A
authors.lastname: Chan
mesh_terms: D000368:Aged; D006801:Humans; D008132:Loneliness; D008137:Longitudinal Studies; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012846:Singapore
keywords: Singapore; elderly; healthcare utilization; loneliness