(© De Visu - stock.adobe.com)

In a nutshell

A study of nearly 400,000 home care recipients found that lonely older adults had an 18-23% lower risk of dying within a year compared to non-lonely peers

The findings contradict previous research on the general population, where loneliness typically predicts earlier death

Researchers suggest loneliness may be a consequence of declining health rather than a cause, and home care services may provide protective social contact

WATERLOO, Ontario — Common wisdom tells us that loneliness kills. Health officials have compared social isolation to smoking 15 cigarettes a day, and countless studies have linked feeling lonely to earlier death. But a surprising new study involving nearly 400,000 older adults across three countries has turned this assumption upside down.

Researchers tracking home care recipients in Canada, Finland, and New Zealand discovered something unexpected: lonely older adults were actually less likely to die within a year compared to their non-lonely peers. Among the most vulnerable seniors — those receiving help at home with daily activities — being lonely was associated with an 18% to 23% lower risk of death.

Why This Finding Matters More Than You Think

Dr. Bonaventure Egbujie and his research team at the University of Waterloo weren’t expecting to overturn conventional wisdom when they began analyzing mortality data from home care recipients. Previous studies had consistently shown that lonely people tend to die younger, leading to widespread public health campaigns warning about the dangers of social isolation.

Home care recipients represent a particularly vulnerable group: older adults who need assistance with daily activities like bathing, dressing, or managing medications, but still live in their own homes rather than nursing facilities. About 15% of people aged 75 and older in Finland receive home care, while 6% of Canadian households and 7.5% of New Zealanders over 65 use these services.

Among this population, loneliness was surprisingly common. Between 16% and 24% of home care recipients reported feeling lonely, with New Zealand showing the highest rates and Canada the lowest. Women were more likely to report loneliness than men, and rates increased with age across all three countries.

Scientists tracked 383,386 older adults for one year to see who died and when, linking assessment data to official death records in each country. They carefully controlled for dozens of factors known to influence mortality risk, including age, gender, living arrangements, health conditions like cancer and heart failure, cognitive function, physical abilities, and pain levels.

Is loneliness not the silent killer we’ve long believed? This study will certainly be one for debate among doctors and health experts. (© WavebreakmediaMicro – stock.adobe.com) The Numbers Don’t Lie

After accounting for all these health and social factors, researchers found consistently lower death rates among lonely participants across all three countries. In Canada, lonely home care recipients had an 18% lower risk of dying within a year. Finnish lonely participants showed a 15% reduction in death risk, while those in New Zealand had a 23% lower mortality risk.

Even more intriguingly, the survival advantage remained consistent when researchers looked at men and women separately. Graphs showing the probability of staying alive over time revealed that lonely participants consistently outlived their non-lonely counterparts throughout the entire year of follow-up.

These findings, published in the Journal of the American Medical Directors Association, directly contradict what researchers expected based on studies of the general population, where loneliness typically predicts earlier death.

Turning Loneliness Health Assumptions Upside Down

Rather than loneliness causing poor health, declining health might lead to loneliness. As people develop serious illnesses, they may withdraw from social activities or lose friends, creating isolation. In this scenario, the sickest individuals (who are most likely to die) would be less likely to report feeling lonely simply because they’re too ill to recognize or articulate their social needs.

The study found evidence supporting this theory. Lonely participants actually had better baseline physical functioning and were less impaired in daily activities compared to non-lonely participants. However, they also scored worse on measures of clinical instability and cognitive performance, revealing a complex mix of preserved abilities and emerging problems.

Another explanation focuses on healthcare-seeking behavior. Previous research has shown that lonely people tend to use medical services more frequently. Among home care recipients, this could translate into earlier detection of health problems and more intensive monitoring, potentially preventing deaths that might otherwise occur.

Home care services themselves might function as a form of social intervention. Regular visits from nurses, therapists, and care coordinators provide not just medical support but also human connection for isolated older adults. Professional contact could partially offset the health risks typically associated with loneliness.

Real-World Impact for Families and Caregivers

These findings don’t diminish the importance of addressing loneliness among older adults. Researchers emphasize that feeling lonely remains a serious quality-of-life issue that deserves attention regardless of its relationship to mortality.

However, the results do challenge blanket assumptions about loneliness and death. For the most vulnerable older adults, the traditional relationship between social isolation and mortality appears to break down.

“Loneliness is a serious threat to psychological well-being. The mental health consequences of loneliness make it an important priority for public health, even if loneliness doesn’t kill you,” said the study’s senior author, Dr. John Hirdes, a professor in Waterloo’s School of Public Health Science, in a statement. “Home and community care services must play a protective role by supporting social contact for isolated people.”

Rather than assuming all lonely older adults face immediate health risks, care teams might focus on the quality-of-life aspects of social isolation while recognizing that some of their loneliest clients may actually be more resilient than expected. Healthcare providers and policymakers could develop more targeted interventions that address emotional wellbeing without creating unnecessary alarm about mortality risks.

Paper Summary Methodology

Researchers conducted a survival analysis using standardized assessment data from home care recipients in Canada (178,611 participants), Finland (35,073), and New Zealand (85,065) between 2010-2020. All participants were 65 or older, lived in private homes, had no terminal diagnosis, and showed adequate cognitive function for reliable self-reporting. Professional health workers assessed loneliness using the interRAI Home Care assessment tool, asking whether clients “say or indicate they feel lonely.” Participants were followed for one year to track mortality, with death records linked through official government databases. Researchers used Cox proportional hazards models to calculate mortality risk while controlling for age, gender, marital status, living arrangements, cognitive function, physical abilities, pain levels, and major health conditions.

Results

Across all three countries, lonely home care recipients showed significantly lower one-year mortality rates after adjusting for health and demographic factors. Hazard ratios were 0.82 (18% lower risk) in Canada, 0.85 (15% lower risk) in Finland, and 0.77 (23% lower risk) in New Zealand. Loneliness prevalence ranged from 15.9% in Canada to 24.4% in New Zealand. Lonely participants showed better physical functioning but worse clinical instability scores compared to non-lonely peers. The survival advantage remained consistent across both men and women and persisted throughout the entire follow-up period.

Limitations

The study followed participants for only one year, potentially missing longer-term effects of loneliness on mortality. Researchers used a single-item measure of loneliness rather than more comprehensive multi-dimensional scales. The study design couldn’t establish whether loneliness preceded health changes or vice versa, making it difficult to determine causal relationships. The findings may not generalize to older adults not receiving home care services or to different cultural contexts beyond the three countries studied.

Funding and Disclosures

The research received no funding from public, commercial, or not-for-profit agencies. All authors declared no conflicts of interest. The study used existing administrative data with appropriate ethical approval from each country’s research ethics boards.

Publication Information

The study “Cross-National Evidence on Risk of Death Associated with Loneliness: A Survival Analysis of 1-Year All-Cause Mortality among Older Adult Home Care Recipients in Canada, Finland, and Aotearoa New Zealand” was published in the Journal of the American Medical Directors Association (JAMDA), Volume 26, 2025, article number 105687, by lead author Bonaventure A. Egbujie and colleagues from the University of Waterloo and partner institutions.