Social isolation and loneliness as risk factors for the progression of frailty: the English Longitudinal Study of Ageing
Open accessAbstract
Background: loneliness and social isolation have been associated with mortality and with functional decline in older people. We investigated whether loneliness or social isolation are associated with progression of frailty. Methods: participants were 2,817 people aged ≥60 from the English Longitudinal Study of Ageing. Loneliness was assessed at Wave 2 using the Revised UCLA scale (short version). A social isolation score at Wave 2 was derived from data on living alone, frequency of contact with friends, family and children, and participation in social organisations. Frailty was assessed by the Fried phenotype of physical frailty at Waves 2 and 4, and by a frailty index at Waves 2-5. Results: high levels of loneliness were associated with an increased risk of becoming physically frail or pre-frail around 4 years later: relative risk ratios (95% CI), adjusted for age, sex, level of frailty and other potential confounding factors at baseline were 1.74 (1.29, 2.34) for pre-frailty, and 1.85 (1.14, 2.99) for frailty. High levels of loneliness were not associated with change in the frailty index-a broadly based measure of general condition-over a mean period of 6 years. In the sample as a whole, there was no association between social isolation and risk of becoming physically frail or pre-frail, but high social isolation was associated with increased risk of becoming physically frail in men. Social isolation was not associated with change in the frailty index. Conclusion: older people who experience high levels of loneliness are at increased risk of becoming physically frail.
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“15,20 Although some of these issues may naturally resolve upon future lifting of social distancing measures end at the conclusion of the COVID-19 pandemic, this issue will remain important in the future as it is likely that many workplaces will adopt a hybrid model of in-person and…”
Factors associated with social isolation in community-dwelling older adults: a cross-sectional study
Merchant, R. A., Liu, G., Lim, J. Y., Fu, X., & Chan, Y. H. (2020) · Quality of Life Research · doi:10.1007/s11136-020-02493-7 · Cited by 75 · see citing works
Factors Associated With Social Isolation in Older Adults: A Systematic Review and Meta-Analysis
Wen, Z., Peng, S., Yang, L., Wang, H., Liao, X., Liang, Q., & Zhang, X. (2022) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2022.11.008 · Cited by 78 · see citing works
Jung, H., Kim, M., Lee, Y., & Won, C. W. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17217883 · Cited by 72 · see citing works
“Poor social participation can lead to social isolation and loneliness as well as frailty among older adults [59].”
BackgroundXie, B., Ma, C., Chen, Y., & Wang, J. (2020) · Health & Social Care in the Community · doi:10.1111/hsc.13092 · Cited by 72 · see citing works
Xie, B., & Ma, C. (2021) · Maturitas · doi:10.1016/j.maturitas.2021.06.015 · Cited by 71 · see citing works
Tcymbal, A., Abu‐Omar, K., Hartung, V., Bußkamp, A., Comito, C., Roßmann, C., Meinzinger, D., & Reimers, A. K. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.1048496 · Cited by 71 · see citing works
Frailty and depression: Reciprocal influences or common causes?
Mayerl, H., Stolz, E., & Freidl, W. (2020) · Social Science & Medicine (1967) · doi:10.1016/j.socscimed.2020.113273 · Cited by 60 · see citing works
Early identification of frailty: Developing an international delphi consensus on pre-frailty
Sezgin, D., O’Donovan, M. R., Woo, J., Bandeen‐Roche, K., Liotta, G., Fairhall, N., Rodríguez‐Laso, Á., Apóstolo, J., Clarnette, R., Holland, C., et al. (2021) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2021.104586 · Cited by 68 · see citing works
Chen, W. L., Shuxian, W., Ling, L., & Renzaho, A. M. N. (2019) · Australian and New Zealand Journal of Public Health · doi:10.1111/1753-6405.12856 · Cited by 67 · see citing works
Takashima, R., Onishi, R., Saeki, K., & Hirano, M. (2020) · Healthcare · doi:10.3390/healthcare8040450 · Cited by 66 · see citing works
“More specifically, living alone is an indicator of social isolation [32], and previous studies have repeatedly pointed out that living alone is a risk factor for loneliness in older adults [33,34].”
BackgroundElliQ, an AI-Driven Social Robot to Alleviate Loneliness: Progress and Lessons Learned
Broadbent, E., Loveys, K., Ilan, G., Chen, G., Chilukuri, M. M., Boardman, S. G., Doraiswamy, P. M., & Skuler, D. (2024) · Journal of Aging Research and Lifestyle · doi:10.14283/jarlife.2024.2 · Cited by 66 · see citing works
“Loneliness significantly increases the risk of physical and mental morbidity (9) and has been associated with declines in cognitive capacity and increased frailty (9, 10) as well as mortality (11).”
BackgroundLoneliness as a risk factor for frailty transition among older Chinese people
Sha, S., Xu, Y., & Chen, L. (2020) · BMC Geriatrics · doi:10.1186/s12877-020-01714-5 · Cited by 65 · see citing works
Cudjoe, T., Prichett, L. M., Szanton, S. L., Roberts, L., & Thorpe, R. J. (2022) · Journal of the American Geriatrics Society · doi:10.1111/jgs.17795 · Cited by 64 · see citing works
Zhao, M., Gao, J., Li, M., & Wang, K. (2019) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2018.11.007 · Cited by 61 · see citing works
Malicka, B., Skośkiewicz−Malinowska, K., & Kaczmarek, U. (2022) · BMC Geriatrics · doi:10.1186/s12877-021-02716-7 · Cited by 60 · see citing works
“It was found that high levels of loneliness, but not of social isolation, increased the risk of becoming physically frail [41].”
BackgroundGrover, S., Avasthi, A., Sahoo, S., Lakdawala, B. M., Dan, A., Nebhinani, N., Dutt, A., Tiwari, S., Gania, A., Subramanyam, A. A., et al. (2018) · Journal of Geriatric Mental Health · doi:10.4103/jgmh.jgmh_26_18 · Cited by 63 · see citing works
Follmann, A., Schollemann, F., Arnolds, A., Weismann, P., Laurentius, T., Rossaint, R., & Czaplik, M. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18094846 · Cited by 60 · see citing works
“In addition, social isolation and loneliness were associated as higher risk factors for progression of frailty [14] and mortality [15].”
BackgroundCoelho‐Júnior, H. J., Uchida, M. C., Picca, A., Bernabei, R., Landi, F., Calvani, R., Cesari, M., & Marzetti, E. (2021) · Aging Clinical and Experimental Research · doi:10.1007/s40520-021-01802-5 · Cited by 58 · see citing works
Li, L. (2024) · Globalization and Health · doi:10.1186/s12992-024-01056-6 · Cited by 60 · see citing works
“At the same time, loneliness and social isolation would be confirmed to accelerate the progression of frailty based on the population from ELSA [47].”
BackgroundMaltby, J., Hunt, S., Ohinata, A., Palmer, E. J., & Conroy, S. (2020) · Journal of Aging and Health · doi:10.1177/0898264320923245 · Cited by 59 · see citing works
“Loneliness, as an indicator of isolation in the ageing literature, has been linked to a number of health states: heart attacks, strokes, dementia, hospital admissions, and premature deaths (Dreyer et al., 2018; Gale et al., 2018; Hanratty et al., 2018; Kuiper et al., 2015; Shiovitz-Ezra & Ayalon, 2010).”
BackgroundMethodInfluentialSaito, M., Aida, J., Cable, N., Zaninotto, P., Ikeda, T., Tsuji, T., Koyama, S., Noguchi, T., Osaka, K., & Kondo, K. (2020) · Geriatrics and gerontology international/Geriatrics & gerontology international · doi:10.1111/ggi.14118 · Cited by 57 · see citing works
Social Isolation, Loneliness and Their Relationships with Mental Health Status in South Korea
Kim, M. H., An, J. H., Lee, H., Jeong, S., Hwang, S. J., & Hong, J. P. (2021) · Psychiatry Investigation · doi:10.30773/pi.2021.0067 · Cited by 55 · see citing works
Kojima, G., Aoyama, R., & Tanabe, M. K. G. (2022) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2022.06.012 · Cited by 54 · see citing works
Interventions aimed at loneliness and fall prevention reduce frailty in elderly urban population
Ožić, S., Vasiljev, V., Ivković, V., Bilajac, L., & Rukavina, T. (2020) · Medicine · doi:10.1097/md.0000000000019145 · Cited by 53 · see citing works
Yu, B., Steptoe, A., Niu, K., & Jia, X. (2020) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2020.06.029 · Cited by 57 · see citing works
Hsu, H. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17249181 · Cited by 56 · see citing works
“[15] found that those who are socially isolated (no social contact and no social group participation) were more likely to be lonely.”
Sha, S., Pan, Y., Xu, Y., & Chen, L. (2022) · BMC Geriatrics · doi:10.1186/s12877-022-03044-0 · Cited by 49 · see citing works
“They found that higher loneliness was significantly associated with an increased risk of becoming frail or prefrail in follow-up [16]; (2) two other longitudinal studies assessed frailty in the PFP scale and the FRAIL scale, and measured loneliness using the Revised UCLA Loneliness Scale and one-single question, respe…”
MethodYang, Y., Zeng, D., & Yang, F. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191912087 · Cited by 49 · see citing works
“At the same time, the individual characteristics of the elderly group, such as the reduction of personal economic resources, deteriorating physical health, cognitive decline, and other factors, will reduce the elderly’s social participation and increase their risk of social isolation [8,9].”
BackgroundEllwood, A., Quinn, C., & Mountain, G. A. (2021) · Research on Aging · doi:10.1177/01640275211045603 · Cited by 47 · see citing works
“, 2017), while positive attitudes to ageing appear to decrease the risk of frailty associated decline (Gale et al., 2018).”
BackgroundFreer, K., & Wallington, S. L. (2019) · British Journal of Community Nursing · doi:10.12968/bjcn.2019.24.10.486 · Cited by 47 · see citing works
Long, R. M., Terracciano, A., Sutin, A. R., Creaven, A., Gerstorf, D., D’Arcy-Bewick, S., & O’Súilleabháin, P. S. (2022) · Psychosomatic Medicine · doi:10.1097/psy.0000000000001151 · Cited by 45 · see citing works
“All three aspects of social health are associated with a number of adverse health outcomes such as depression (21,22), frailty (23,24), poorer cognitive”
BackgroundElderly caregivers of the elderly: frailty, loneliness and depressive symptoms
dos Santos‐Orlandi, A. A., Brígola, A. G., Ottaviani, A. C., Luchesi, B. M., Souza, É. N., de Moura, F. G., Cardoso, J. D. F. Z., Terassi, M., de Oliveira, N. A., & Pavarini, S. C. I. (2019) · Revista Brasileira de Enfermagem · doi:10.1590/0034-7167-2018-0137 · Cited by 43 · see citing works
“The authors concluded that older people experiencing loneliness are at greater risk of becoming frail(13).”
BackgroundResultInfluentialLenze, E. J., Nicol, G. E., Barbour, D. L., Kannampallil, T., Wong, A. W. K., Piccirillo, J., Drysdale, A. T., Sylvester, C. M., Haddad, R., Miller, J. P., et al. (2021) · Journal of Psychiatry and Neuroscience · doi:10.1503/jpn.200042 · Cited by 43 · see citing works
The prevalence of social frailty among older adults: A systematic review and meta-analysis
Yu, S., Wang, J., Zeng, L., Yang, P., Tang, P., & Su, S. (2022) · Geriatric Nursing · doi:10.1016/j.gerinurse.2022.11.009 · Cited by 44 · see citing works
Ségaux, L., Broussier, A., Oubaya, N., Leissing-Desprez, C., Laurent, M., Naga, H., Fromentin, I., David, J., & Bastuji‐Garin, S. (2021) · Scientific Reports · doi:10.1038/s41598-021-88410-5 · Cited by 41 · see citing works
Yoshida, Y., Iwasa, H., Ishioka, Y., & Suzukamo, Y. (2021) · Geriatrics and gerontology international/Geriatrics & gerontology international · doi:10.1111/ggi.14151 · Cited by 40 · see citing works
Social frailty in community-dwelling older adults: a scoping review
Huang, C., Sirikul, W., & Buawangpong, N. (2025) · BMC Geriatrics · doi:10.1186/s12877-025-05971-0 · Cited by 39 · see citing works
“Social frailty is associated with other related concepts, such as loneliness, social isolation, social vulnerability (SV), and resilience, highlighting the need for a holistic approach to understanding it [9–11].”
Community asset participation and social medicine increases qualities of life
Munford, L. A., Panagioti, M., Bower, P., & Skevington, S. M. (2020) · Social Science & Medicine · doi:10.1016/j.socscimed.2020.113149 · Cited by 39 · see citing works
Yuan, Y., Lapane, K. L., Tjia, J., Baek, J., Liu, S., & Ulbricht, C. M. (2022) · BMC Geriatrics · doi:10.1186/s12877-022-03012-8 · Cited by 39 · see citing works
Social anxiety and loneliness among older adults: a moderated mediation model
Sun, S., Wang, Y., Wang, L., Lu, J., Li, H., Zhu, J., Qian, S., Zhu, L., & Xu, H. (2024) · BMC Public Health · doi:10.1186/s12889-024-17795-5 · Cited by 45 · see citing works
“Previous research has shown that higher levels of loneliness may predict frailty, depression, cognitive decline, an increased risk of cardiovascular disease, suicide, and mortality [6–8].”
BackgroundDamme, J. V., Neiterman, E., Oremus, M., Lemmon, K., & Stolee, P. (2020) · BMC Geriatrics · doi:10.1186/s12877-020-1459-6 · Cited by 37 · see citing works
A gradual separation from the world: a qualitative exploration of existential loneliness in old age
Carr, S., & Fang, C. (2021) · Ageing and Society · doi:10.1017/s0144686x21001252 · Cited by 37 · see citing works
Ensuring Sustainable Digital Inclusion among the Elderly: A Comprehensive Analysis
Mohan, R., Saleem, F., Voderhobli, K., & Sheikh-Akbari, A. (2024) · Sustainability · doi:10.3390/su16177485 · Cited by 37 · see citing works
Frailty measurement in research and clinical practice: An updated review
Dent, E., Hanlon, P., Kowal, P. R., & Hoogendijk, E. O. (2025) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2025.106595 · Cited by 42 · see citing works
Combined Impact of Physical Frailty and Social Isolation on Rate of Falls in Older Adults
Hayashi, T., Umegaki, H., Makino, T., Huang, C., Inoue, A., Shimada, H., & Kuzuya, M. (2020) · The journal of nutrition health & aging · doi:10.1007/s12603-020-1316-5 · Cited by 37 · see citing works
“Moreover, high levels of social isolation are associated with an increased risk of becoming physically frail (23), possibly increasing the severity of physical frailty in those who have a combination of physical frailty and social isolation.”
Zhang, Y., Xu, X.-J., Lian, T., Huang, L., Zeng, J., Liang, D., Yin, M., Huang, J., Xiu, L., Yu, Z., et al. (2020) · Aging · doi:10.18632/aging.102671 · Cited by 37 · see citing works
“found that a high level of loneliness was associated with an increased risk of becoming physically frail [21].”
BackgroundVlachantoni, A., Evandrou, M., Falkingham, J., & Qin, M. (2022) · The Gerontologist · doi:10.1093/geront/gnac033 · Cited by 53 · see citing works
“This concept relates to human health and wellbeing, which can affect psychological processes influencing physiological functioning, resulting in increased morbidity and mortality (Hawkley & Cacioppo, 2010; Steptoe et al., 2013; Gale et al., 2018; Jarach et al., 2021; Wenger et al., 1996).”
Ward, M. D., Briggs, R., McGarrigle, C. A., Looze, C. D., O’Halloran, A. M., & Kenny, R. A. (2022) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5856 · Cited by 35 · see citing works
Li, Z., Gu, J., Li, P., Hu, J., Wang, S., Wang, P., Zhou, L., Yun, Y., Shi, Y. X., & Wang, P. (2024) · BMC Geriatrics · doi:10.1186/s12877-024-04666-2 · Cited by 35 · see citing works
“Social frailty is an important dimension of frailty, which means that individuals continue to lose one or more important resources to meet their basic social needs [1, 2].”
BackgroundChen, M., Cao, X. G., Wang, A., Zhu, Y., Lu, G., Li, Z., & Shen, L. (2023) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2023.105211 · Cited by 34 · see citing works
Willis, P. B., Vickery, A., & Jessiman, P. (2020) · Ageing and Society · doi:10.1017/s0144686x20000914 · Cited by 34 · see citing works
Hu, S., Jin, C., & Li, S. (2022) · BMC Geriatrics · doi:10.1186/s12877-022-02815-z · Cited by 33 · see citing works
“In addition, studies have also found that social factors such as social isolation [25], frequency of interaction with relatives and friends [26], and social support [27] were associated with frailty.”
BackgroundMehrabi, F., Pomeroy, M. L., Cudjoe, T., Jenkins, E., Dent, E., & Hoogendijk, E. O. (2024) · Age and Ageing · doi:10.1093/ageing/afae215 · Cited by 33 · see citing works
“Few longitudinal studies have yielded mixed findings [25–27], and none have explored both the reciprocal and temporal sequence of relationships among social isolation, loneliness, and frailty over an extended period.”
BackgroundMethodResultInfluentialAssociation between Social Support and Frailty among Older People with Depressive Disorders
Anantapong, K., Wiwattanaworaset, P., & Sriplung, H. (2020) · Clinical Gerontologist · doi:10.1080/07317115.2020.1728002 · Cited by 33 · see citing works
Social Isolation/loneliness and Mobility Disability Among Older Adults
Tomida, K., Shimoda, T., Nakajima, C., Kawakami, A., & Shimada, H. (2024) · Current Geriatrics Reports · doi:10.1007/s13670-024-00414-x · Cited by 32 · see citing works
“Numerous prior studies have linked social isolation and loneliness among older adults with various adverse outcomes, including cognitive impairment [19], dementia [20], frailty [21], cardiovascular disease [22], functional impairment [23], and mortality [24].”
Strategies of socially isolated older adults: Mechanisms of emergence and persistence
Machielse, A., & Duyndam, J. (2020) · Journal of Aging Studies · doi:10.1016/j.jaging.2020.100852 · Cited by 32 · see citing works
Frailty in patients with interstitial lung disease
Guler, S. A., & Ryerson, C. J. (2020) · Current Opinion in Pulmonary Medicine · doi:10.1097/mcp.0000000000000692 · Cited by 32 · see citing works
Garner, I. W., Varey, S., Navarro‐Pardo, E., Marr, C., & Holland, C. (2022) · Health & Social Care in the Community · doi:10.1111/hsc.13735 · Cited by 32 · see citing works
“…is likely to have an immediate and lasting effect on older adults’ health, with pre- pandemic evidence linking low exercise and social engagement to increased risk of frailty, cognitive decline, and dementia (Apóstolo et al., 2018; Gale et al., 2018; Livingston et al., 2020; Oliveira et al., 2020).”
BackgroundWillis, P., & Vickery, A. (2022) · Health & Social Care in the Community · doi:10.1111/hsc.13732 · Cited by 35 · see citing works
Li, J., Li, J., Chen, Y., Yang, S., Li, Z., Li, W., Gui, Z., & Zhou, C. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.04.045 · Cited by 33 · see citing works
“Social isolation scores were positively skewed, we defined social isolation as social index score ≥ 1 (Gale et al., 2018).”
- Authors
- Gale, C. R., Westbury, L., & Cooper, C.
- Affiliations
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- MRC Lifecourse Epidemiology Unit (GB)
- Venue
- Age and Ageing
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-12-22
- Volume
- 47
- Issue
- 3
- Pages
- 392-397
- ISSN
- 0002-0729 (ISSN-L)
- 1468-2834
- PMC
- PMC5920346
- OpenAlex
- W2794981433
- Cited by
- 590
- References
- 30
- Citations by year
- 2026: 67 · 2025: 91 · 2024: 107 · 2023: 77 · 2022: 83 · 2021: 74 · 2020: 57 · 2019: 24 · 2018: 10
- FWCI
- 15.04
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Age and Ageing (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
- Funders
- National Institute of Aging in the United States
- UK government
- ELSA
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Keywords
- loneliness, social isolation, frailty progression, pre-frailty, frailty index, older adults, physical frailty, sex differences, social networks, functional decline
- MeSH terms
- Frailty, Aged, England, Family Relations, Female, Humans, Loneliness, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Risk Factors, Social Isolation, Time Factors, Geriatric Assessment, Prevalence, Marital Status, Disease Progression, Risk Assessment, Friends, Social Participation
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