Loneliness and Health Services Utilisation in Older Adults: A Narrative Review of Portuguese Evidence

Abstract

Loneliness is an increasing problem in Portugal. We aim to characterise the impact of loneliness on health services utilisation among older adults in Portugal, exploring how loneliness functions as a hidden determinant of healthcare demand.

This narrative review synthesises evidence from original observational studies conducted in Portugal that investigated the association between loneliness or social isolation and healthcare utilisation in individuals aged 65 and older. Studies were identified through national and international databases and included if they reported loneliness and healthcare outcomes (primary care visits, emergency department use, hospital admissions, or medication consumption). Findings were analysed to identify patterns and implications for clinical practice and health system organisation.

Four cross-sectional studies were included, totalling 1272 participants. Loneliness was consistently associated with increased healthcare services utilisation, including frequent primary care consultations, emergency department visits, medication consumption, and functional decline. Institutionalised older adults and those with greater functional dependence reported higher levels of loneliness. The evidence suggests health services often act as social surrogates, absorbing unmet relational needs, with risk of diagnostic inflation and overtreatment.

Loneliness is measurable, prevalent, and linked to increased healthcare demand in Portugal. Recognising it as a social diagnosis supports proactive, person-centred strategies, such as brief routine screening, stronger relational continuity in primary care, and linkage to community resources (e.g., social prescribing, intergenerational programs). Such approaches align with healthy-ageing frameworks and may reduce avoidable utilisation while improving well-being.