Prevalence and determinants of loneliness among the oldest old living in institutionalized settings: Study findings from a representative survey
Open accessAbstract
Background: There is very limited knowledge regarding the prevalence and determinants of loneliness in oldest old residents of nursing or old age homes. Objective: To examine the prevalence and determinants of loneliness among the oldest old living in institutionalized settings in Germany. Material and methods: Data were taken from the representative survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+) including individuals ≥ 80 years living in North Rhine-Westphalia. The study focused on individuals living in institutionalized settings. Sociodemographic, lifestyle-related, and health-related determinants were included in multiple linear regression models. Results: Approximately 56.6% of the individuals were not lonely, 25.7% and 17.8% of the individuals were moderately and severely lonely, respectively. Regression analyses showed that higher loneliness was associated with being married (β = 0.48, p < 0.05), high education (compared to low education, β = 0.46, p < 0.05), having a small social network size (β = −0.02, p < 0.05), having poor self-rated health (β = −0.25, p < 0.05), and more depressive symptoms (β = 0.25, p < 0.001). Conclusion: A significant proportion of the institutionalized oldest old individuals reported moderate or severe loneliness, which underpins the relevance of this topic. Understanding the determinants of loneliness may help to address institutionalized adults aged 80 years and over at risk of loneliness.
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Correlates of loneliness in the oldest-old have not been extensively studied.
“Nevertheless, the correlations of loneliness in the oldest-old have not been extensively studied, and all of these studies were conducted in high-income countries (Germany: [10,11]; Australia: [4]; Sweden/ Finland: [18,27]) or high-income context, Shanghai, China [36]”
From Factors associated with loneliness in a national study among persons 80 years and older in India in 2017-2018 (2025) · cites this paper as [10]
The Brief introduction says that determinants of loneliness are largely unknown among the oldest-old living in nursing or old-age homes. The Discussion likewise describes limited prior evidence for that group. These passages support a research gap in institutionalized settings, but not the broader claim about the oldest-old regardless of living setting. (LLM, conf=0.82)
Experimental — accuracy not yet measuredAmong the oldest-old, health-related factors associated with loneliness include functional disability, multimorbidity, poor self-rated health, and depressive symptoms.
“Health-related factors associated with loneliness among the oldest-old included functional disability [4,11], multimorbidity [11], poor self-rated health [10,11,36], and depressive symptoms [10,18].”
From Factors associated with loneliness in a national study among persons 80 years and older in India in 2017-2018 (2025) · cites this paper as [10]
The Results (Regression analysis; page unavailable) associate poor self-rated health with higher loneliness among institutionalized adults aged 80 and over. They explicitly report no association for functional impairment, and the paper does not report multimorbidity as a loneliness determinant. Although the paper also links depressive symptoms to loneliness, the citing sentence attaches other references—not this source—to that part of the claim. (LLM, conf=0.90)
Experimental — accuracy not yet measuredThis study did not find a significant association between higher social engagement and higher loneliness.
“we did not find a significant association between higher social engagement and higher loneliness.”
From Factors associated with loneliness in a national study among persons 80 years and older in India in 2017-2018 (2025) · cites this paper as [10]
The Results (Regression analysis; page not available) state that frequency of activities was not associated with loneliness, supporting the claim if social engagement refers to that measure. But the study measured a broader activity score, not social engagement specifically, and also found that smaller social networks were significantly associated with higher loneliness. (LLM, conf=0.78)
Experimental — accuracy not yet measuredStudies of loneliness in the oldest-old have been conducted in high-income countries or high-income contexts.
“all of these studies were conducted in high-income countries (Germany: [10,11]; Australia: [4]; Sweden/ Finland: [18,27]) or high-income context, Shanghai, China [36]”
From Factors associated with loneliness in a national study among persons 80 years and older in India in 2017-2018 (2025) · cites this paper as [10]
Among four health-related factors (chronic conditions, functional disability, depression, and self-rated physical health), only functional disability was associated with higher loneliness in this study.
“While some previous studies [4,10,11,18,36] found that four healthrelated factors (chronic conditions, functional disability, depression, and self-rated physical health) were associated with higher loneliness, this study only found an association with functional disability.”
From Factors associated with loneliness in a national study among persons 80 years and older in India in 2017-2018 (2025) · cites this paper as [10]
Among the oldest-old, social factors associated with loneliness include living alone, being institutionalised, having a small social network size, lower family functioning, reduced chatting with neighbours, and not using social media on the internet.
“Social factors associated with loneliness among the oldest old included living alone [4,18,27,36], institutionalised [11,27], having a small social network size [10], lower family functioning [36], reduced chatting with neighbours [36], and not using social media on the internet [30].”
From Factors associated with loneliness in a national study among persons 80 years and older in India in 2017-2018 (2025) · cites this paper as [10]
Other studies among the oldest-old did not find significant gender differences, including in Shanghai, Germany, and Sweden/Finland.
“Similarly, other studies among the oldest-old did not find significant gender differences, including in Shanghai [36], Germany [8,10,11], and Sweden/Finland [18,27].”
From Factors associated with loneliness in a national study among persons 80 years and older in India in 2017-2018 (2025) · cites this paper as [10]
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Predictors and subjective causes of loneliness in an aged population
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Hajek, A., Gyasi, R. M., & König, H.-H. (2024) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2024.105443 · Cited by 22 · see citing works
Self-citationPengpid, S., Peltzer, K., Hajek, A., & Gyasi, R. M. (2025) · International Psychogeriatrics · doi:10.1016/j.inpsyc.2024.100019 · Cited by 8 · see citing works
Self-citation
- Authors
- Hajek, A., Zwar, L., Gyasi, R. M., Kretzler, B., & König, H.-H.
- Affiliations
- University Medical Center Hamburg-Eppendorf (DE)
- African Population and Health Research Center (KE)
- Corresponding author
- Hajek, André
- Venue
- Zeitschrift für Gerontologie und Geriatrie
- Published
- 2023-06-02
- Volume
- 57
- Issue
- 3
- Pages
- 214-219
- ISSN
- 0948-6704 (ISSN-L)
- 1435-1269
- PMC
- PMC11078814
- OpenAlex
- W4379094567
- Cited by
- 18
- References
- 4
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 7
- FWCI
- 4.86
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Zeitschrift für Gerontologie und Geriatrie (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PUBLISSO (German National Library of Medicine) (submittedVersion, cc-by)
- Funders
- Universitätsklinikum Hamburg-Eppendorf (UKE)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Keywords
- loneliness, oldest old, institutionalized elderly, nursing homes, old age homes, prevalence of loneliness, marital status, educational attainment, social network size, self-rated health, depressive symptoms, subjective well-being
- MeSH terms
- Aged, 80 and over, Female, Germany, Homes for the Aged, Humans, Institutionalization, Loneliness, Male, Nursing Homes, Quality of Life, Risk Factors, Prevalence, Sex Distribution
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