AMSTEL study finds that loneliness increases the risk of death in older men, but social isolation does not


Some of the older elves in the woodland don’t join in with our social activities as much as they used to. The younger elves call them ‘cranky’ and laugh at them sitting alone in their tree houses. Personally I worry that they might be feeling lonely and I doubt that shutting themselves away from the rest of us is doing much for their health.

I was intrigued to see the findings of the AMSTEL study published in Psychological Medicine recently. It’s not a lager-tasting placebo controlled trial as some of you might presume, but a prospective cohort study of over 4,000 people from Amsterdam aged 65-84 years old. Older Amsterdammers aren’t so very different from older elves, so I read the paper with interest.

The authors were concerned about the impact that social isolation and loneliness can have on people, particularly if it can increase the risk of mortality. They randomly selected people from different age categories and ended up with a sample that was representative of Amsterdam’s elderly population.

They carried out structured interviews in people’s homes to find out how lonely and isolated they were. Loneliness was measured subjectively by asking them if they felt lonely and social isolation was assessed by finding out if they had help from their family, neighbours or any other form of home support.

Potential confounders were controlled for in the analysis. These confounders included mental health and medical conditions, substance misuse, cognitive function, functional status and education.

Participants were followed up for nearly 10 years and associations between social isolation, feelings of loneliness and mortality were calculated using Cox proportional hazard regression models.

Here’s what they found:

  • At baseline, fewer men (12%) than women (27%) reported feeling lonely
  • Self-reported feelings of loneliness were associated with a significantly increased risk of death:
    • In men (HR 1.30, 95% CI 1.04 to 1.63)
    • But not women (HR 1.04, 95% CI 0.90 to 1.24)
  • Social isolation was not associated with a higher risk of death
The authors concluded:
Feelings of loneliness rather than social isolation factors were found to be a major risk factor for increasing mortality in older men. Developing a better understanding of the nature of this association may help us to improve quality of life and longevity, especially in older men.

The limitations of this study include that:

  • Loneliness was measured at baseline but the severity was not assessed
  • Other changes in personal status (e.g. the death of a partner, moving into care) were not accounted for during the study

Of course, these findings don’t mean that individuals can’t live independently and happily on their own. I’m going to keep inviting my local elf elders out for a regular game of boules and a walk around the woods.


Holwerda TJ, Beekman AT, Deeg DJ, et al. Increased risk of mortality associated with social isolation in older men: only when feeling lonely? Results from the Amsterdam Study of the Elderly (AMSTEL). Psychol Med 2012;42:843–53. [PubMed abstract]

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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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