{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T11:57:13Z","timestamp":1784894233887,"version":"3.55.0"},"reference-count":68,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,2,8]],"date-time":"2025-02-08T00:00:00Z","timestamp":1738972800000},"content-version":"vor","delay-in-days":38,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute of Health and Care Research"},{"name":"Policy Research Unit in Adult Social Care","award":["PR-PRU-1217-21101"],"award-info":[{"award-number":["PR-PRU-1217-21101"]}]},{"name":"NIHR Applied Research Collaboration","award":["NIHR200163"],"award-info":[{"award-number":["NIHR200163"]}]},{"name":"National Health Service"},{"name":"Digital Social Care Pathfinders Initiative","award":["8717"],"award-info":[{"award-number":["8717"]}]},{"DOI":"10.13039\/501100000276","name":"Department of Health and Social Care","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000276","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background and Objectives<\/jats:title>\n                  <jats:p>International efforts to contain long-term care costs have prioritized personal care. However, reductions in services aimed at addressing loneliness or promoting social participation may affect demand for long-term care facilities. Research on the impact of loneliness on entry to residential or nursing care is based on survey data, which under-represents those with highest needs. Administrative records include such individuals and, unlike surveys, contain continuous data on service receipt, enabling accurate modeling of time to care home entry.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Research Design and Methods<\/jats:title>\n                  <jats:p>We use administrative data for 1\u00a0101 individuals receiving care in a London local authority. We extract loneliness from free text notes using a large language model and model its impact on care home entry 5 years after assessment, controlling for needs and demographics. We use logistic regression and a competing risks survival model to measure the time until care home entry.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The odds ratio for care home entry associated with loneliness is 1.45 with logistic regression (95% CI 1.04\u20132.01). The hazard ratio is 1.32 (95% CI 1.01\u20131.72) with a cause-specific model, and 1.39 (95% CI 1.08\u20131.79) using the Fine and Gray method. Among those most likely to enter a care home, the median time to entry is 9 months (95% CI 228\u2013328 days) earlier for those who are lonely.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion and Implications<\/jats:title>\n                  <jats:p>The hazard ratio of loneliness on care home entry is around the magnitude associated with gender, ethnicity, or living alone. However, loneliness is modifiable. Reductions to services for social participation, such as day centers, are likely to cause an increase in loneliness. We demonstrate that for those with the highest needs, loneliness is a significant risk factor for time until care home entry. Policymakers seeking to delay care home entry should consider the impact of services for loneliness.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/geroni\/igaf010","type":"journal-article","created":{"date-parts":[[2025,2,8]],"date-time":"2025-02-08T16:08:26Z","timestamp":1739030906000},"source":"Crossref","is-referenced-by-count":3,"title":["Loneliness as a Risk Factor for Time to Care Home Entry for Older Adults Receiving Community Care"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1921-5258","authenticated-orcid":false,"given":"Sam","family":"Rickman","sequence":"first","affiliation":[{"name":"Care Policy and Evaluation Centre (CPEC), London School of Economics , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose-Luis","family":"Fernandez","sequence":"additional","affiliation":[{"name":"Care Policy and Evaluation Centre (CPEC), London School of Economics , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliette","family":"Malley","sequence":"additional","affiliation":[{"name":"Care Policy and Evaluation Centre (CPEC), London School of Economics , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,2,8]]},"reference":[{"key":"2025061003015014600_CIT0001","author":"Wittenberg","year":"2018"},{"issue":"1","key":"2025061003015014600_CIT0002","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1017\/S1744133118000221","article-title":"Projecting future demand for informal care among older people in China: the road towards a sustainable long-term care system","volume":"14","author":"Hu","year":"2019","journal-title":"Health Econ Policy Law"},{"issue":"4","key":"2025061003015014600_CIT0003","first-page":"541","article-title":"Japan\u2019s long-term care cost projections: comparison with the European Commission ageing report","volume":"14","author":"Akemura","year":"2018","journal-title":"Public Policy Rev Policy Res Inst Ministry Finance Japan"},{"key":"2025061003015014600_CIT0004","doi-asserted-by":"publisher","first-page":"231","DOI":"10.18261\/9788215057880-24-10","article-title":"Conceptualizing needs when allocating public long-term care services in the welfare state","volume-title":"The Political Economy of Care: Welfare State Capitalism, Universalism, and Social Reproduction","author":"F\u00f8rland","year":"2024"},{"issue":"2","key":"2025061003015014600_CIT0005","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1007\/s10433-022-00703-4","article-title":"Revisiting the Nordic long-term care model for older people\u2014still equal","volume":"19","author":"Rostgaard","year":"2022","journal-title":"Eur J Ageing."},{"issue":"1","key":"2025061003015014600_CIT0006","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1017\/s0144686x18000843","article-title":"Day centres for older people: a systematically conducted scoping review of literature about their benefits, purposes and how they are perceived","volume":"40","author":"Orellana","year":"2020","journal-title":"Ageing Soc"},{"key":"2025061003015014600_CIT0007","volume-title":"The Changing Role of the Day Centre for Older People in Addressing Loneliness: A Participatory Action Research Study [PhD thesis]","author":"Noone","year":"2023"},{"issue":"4","key":"2025061003015014600_CIT0008","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1017\/s0047279412000311","article-title":"The return of the family? 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