Another kind of lonely death: the effects of changes in loneliness on the end-of-life self-care ability of elderly people from the perspective of the distance to death

Abstract Objective Lonely death, in the general sense, refers to the phenomenon in which the elderly pass away unattended and not unnoticed for some time thereafter. The objective of this paper is to examine whether a distinct form of lonely death exists, separate from the conventional understanding of lonely death, through an analysis of the impact of trends in loneliness on the end-of-life self-care ability of elderly individuals. Methods This study utilized data from a sample of 1,423 older adults aged 65 and over who participated in three waves of the Chinese Longitudinal Healthy Longevity Survey 2008–2014. Loneliness trends were characterised using the group-based growth model. Logistic and linear regressions were used to test the effect of changing loneliness trends on the self-care abilities of older adults nearing the end of life. Finally, path analyses were conducted to explore the specific mechanisms underlying the relationship between loneliness trends and end-of-life self-care. Results Among the older participants, people who were not lonely (61.9%) had greater health gains and, therefore, exhibited lower rates of chronic bedriddenness and higher levels of end-of-life self-care ability. In contrast, increased loneliness (30.8%) is associated with reduced health gains for the elderly population, resulting in a higher likelihood of chronic bedriddenness and decreased self-care abilities in their final days. The remaining older adults (7.3%) report reduced loneliness as a result of the 'attention' they receive as their health deteriorates. Reduced loneliness significantly impaired their end-of-life self-care ability. Conclusion 30.8% of older people experienced increased loneliness during their lifetimes with a significant negative impact on their end-of-life self-care ability, i.e. "a different kind of lonely death". 7.3% of older people did not benefit from reduced loneliness, which was a "death by attention".