Loneliness and health in older adults: a mini-review and synthesis

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These factors have also been previously identified as major risk factors for social isolation among older individuals.

“Moreover, these factors have also been previously identified as major risk factors for social isolation among older individuals [5].”

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In the English Longitudinal Study of Ageing, both social isolation and loneliness were associated with increased mortality; however, after adjustments for demographic, socioeconomic and health factors, only social isolation continued to significantly predict survival.

“Findings revealed that both isolation and loneliness were associated with increased mortality; however, following adjustments for demographic, socioeconomic and health factors, only social isolation continued to significantly predict survival.”

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Available evidence supports the conclusion that prevalence estimates of loneliness at older ages are high enough to justify intervention, though estimates vary across studies due to different measurement approaches and populations.

“In sum, the available evidence supports the conclusion that prevalence estimates of loneliness at older ages are high enough to justify intervention; however, estimates vary across studies, reflecting the different measurement approaches and populations sampled.”

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Independent of objective features of social relationships, loneliness is associated with impaired daytime functioning, reduced physical activity, lower subjective well-being, and poorer physical health.

“independent of objective features of social relationships (e.g., living arrangement, number and frequency of contacts, presence and propinquity of caregivers), loneliness has been associated with impaired daytime functioning, reduced physical activity, lower subjective well-being, and poorer physical health.”

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Living alone is not necessarily indicative of loneliness; many older adults who live alone report frequent social contact and active social involvement in community organizations.

“research with older adults demonstrates that living alone is not necessarily indicative of loneliness, with many who live alone reporting frequent social contact and active social involvement in community organizations [8].”

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Beyond cross-sectional associations, loneliness prospectively predicts increased depressive symptomatology, impaired cognitive performance, dementia progression, significant likelihood of nursing home admission, and multiple disease outcomes including hypertension, heart disease, and stroke in older persons.

“beyond cross-sectional associations, loneliness has been shown to prospectively predict increased depressive symptomatology, impaired cognitive performance, dementia progression, significant likelihood of nursing home admission, and multiple disease outcomes (e.g., hypertension, heart disease, and stroke in older persons) [22].”

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Stessman et al. estimated that among Israeli residents in Jerusalem aged 70 years and older, the prevalence of loneliness was 27.9% at age 70, 23.9% at age 78, and 24% at age 85.

“Stessman et al. [20] investigated feelings of loneliness among a representtative sample of Israeli residents in Jerusalem aged 70 years and older. Using a single global measure of subjecttive loneliness (i.e., ‘How often do you feel lonely?’), the authors estimated that at the age of 70, 78, and 85 years, the prevalence of loneliness was 27.9% (n = 95), 23.9% (n = 124), and 24% (n = 169),”

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Prevalence of loneliness in US older adults is high enough to warrant concern, with estimates ranging between 25 and 29% of American adults aged 70 years and older reporting being lonely.

“Overall, despite the heterogeneous nature of the measures, sample sizes, and ages considered in the HRS and AARP surveys, prevalence of loneliness in US older adults are high enough to warrant concern, with estimates ranging between 25 and 29% of American adults aged 70 years and older reporting being lonely.”

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Factor analyses of the 20-item UCLA Loneliness Scale have revealed two to five dimensions, with second-order factor analyses yielding a single hierarchical loneliness construct.

“factor analyses of the 20-item UCLA Loneliness Scale have revealed anywhere from two to five dimensions, with second-order factor analyses yielding a single hierarchical loneliness construct.”

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A meta-analytic synthesis of 218 studies concluded that loneliness is associated with sociodemographic, psychosocial, and health-related risk factors including being female, widowed, divorced, never married; having little contact with significant friends or low-quality friendship ties; worsening physical health; and lacking socioeconomic resources.

“A meta-analytic synthesis of 218 studies by Pinquart and Sörensen [21] concluded that loneliness was associated with a constellation of sociodemographic, psychosocial, and health-related risk factors that include being female, widowed, divorced, never married; having little contact with significant friends or low-quality friendship ties; worsening physical health (e.g., increased chronic illness”

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Severe and persistent feelings of loneliness impair executive functioning, heighten sensitivity to negative social stimuli, and erode interpersonal trust.

“severe and persistent feelings of loneliness have been shown to impair executive functioning, heighten sensitivity to negative social stimuli, and erode interpersonal trust [for a review, see 29].”

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Full understanding of loneliness in later life is far from complete.

“Although there is growing interest in studying the prevalence and detrimental effects of loneliness in later life, full understanding of the phenomenon is far from complete.”

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These interventions have attempted to improve social skills, enhance social support, increase opportunities for social interaction, and address maladaptive social cognition.

“With variable success, these interventions have attempted to improve social skills (e.g., through social recreation), enhance social support (e.g., via mentoring, home visits), increase opportunities for social interaction (e.g., telephone outreach, nonverbal communication), and address maladaptive social cognition (e.g., psychological reframing or cognitive behavioral therapy).”

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Accumulating evidence suggests that adverse health behaviors, impaired sleep, biological dysregulation, negative social cognition, and regional brain activation to social versus nonsocial stimuli may be among the key mechanisms underlying the effects of loneliness on broad-based morbidity and mortality.

“In sum, accumulating evidence suggests that adverse health behaviors, impaired sleep, biological dysregulation, negative social cognition, and regional brain activation to social in contrast to nonsocial stimuli may be among the key mechanisms underlying the effects of loneliness on broad-based morbidity and mortality.”

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The UCLA Loneliness Scale and the dJG Loneliness Scale have demonstrated reliability and validity, although further measurement research is needed to address their multidimensionality in older adult samples.

“The two most frequently used loneliness assessment tools – the UCLA Loneliness Scale and the dJG Loneliness Scale – have demonstrated reliability and validity, although as noted, there is a need for further measurement research that addresses the multidimensionality of the UCLA and dJG scales in older adult samples.”

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Loneliness is linked to changes in depression over time that may in turn result in health-relevant biological changes.

“For instance, loneliness is linked to changes in depression over time that may in turn result in health-relevant biological changes [40].”

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Loneliness is associated with adverse health behaviors, including poorer health practices such as alcohol use and smoking, and fewer health-promoting behaviors such as less physical activity and poor nutrition, among older persons.

“loneliness has been found to be associated with adverse health behaviors – poorer health practices (e.g., alcohol use and smoking) and fewer health-promoting behaviors (e.g., less physical activity, poor nutrition) among older persons.”

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Follow-up analysis including potential moderators (gender, age, type of loneliness measure) revealed that only gender had a moderating influence on the effect size; studies with more women in the sample showed a smaller reduction in loneliness.

“Furthermore, follow-up analysis that included potential moderators (gender, age, type of loneliness measure) revealed that only gender had a moderating influence on the effect size. Studies with more women in the sample showed a smaller reduction in loneliness.”

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Little work to date has examined age differences in the relative potency of theoretical pathways through which loneliness impacts health.

“Moreover, little work to date has examined age differences in the relative potency of theoretical pathways (e.g., health behaviors, sleep salubrity, biological systems, social cognition, and regional brain processes) through which loneliness impacts health.”

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Findlay reviewed 17 relevant interventions targeting social isolation and/or loneliness in older individuals and concluded that although numerous such interventions have been implemented worldwide, there is very little evidence to show that they work.

“Findlay [34] reviewed 17 relevant interventions that targeted social isolation and/or loneliness in older individuals and concluded that ‘although numerous such interventions have been implemented worldwide, there is very little evidence to show that they work’.”

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Among titi monkeys and adult baboons, social isolation from a preferred companion (i.e., loneliness) is associated with a range of behavioral and neural effects that are dissociable from isolation per se, including increased vigilance for predatory threats and elevated cardiovascular activity.

“Cacioppo et al. [39] reviewed evidence suggesting that among titi monkeys and adult baboons, social isolation from a preferred companion (i.e., loneliness) is associated with a range of behavioral and neural effects that are dissociable from isolation per se, including increased vigilance for predatory threats and elevated cardiovascular activity.”

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There is a dearth of studies that distinguish older adults who experience transient versus prolonged loneliness.

“Finally, there is a dearth of studies that distinguish older adults who experience transient versus prolonged loneliness.”

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There is a relative paucity of research examining the health effects of loneliness in non-Western countries.

“Fourth, there is a relative paucity of research examining the health effects of loneliness in non-Western countries [23].”

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Efforts to combat loneliness, particularly among older persons, may play an important role in improving well-being, minimizing chronic illness, and prolonging life.

“To the extent that progress can be made on these issues, efforts to combat loneliness, particularly among older persons, may play an important role in improving well-being, minimizing chronic illness, and prolonging life.”

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A meta-analytic review of 70 independent prospective studies conducted between 1980 and 2014, with 3,407,134 participants, found that after accounting for multiple covariates, the increased likelihood of premature mortality was 26% for reported loneliness, 29% for social isolation, and 32% for living alone.

“a recent meta-analytic review of 70 independent prospective studies conducted between 1980 and 2014 – featuring a total of 3,407,134 participants – found that after accounting for multiple covariates (e.g., age, gender, socioeconomic status, health status, physical activity, smoking), the increased likelihood of premature mortality was 26% for reported loneliness, 29% for social isolation, and 32%”

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The health effects of each of these pathways may be most apparent in later life, although more research on age differences is needed.

“Research also suggests that the health effects of each of these pathways may be most apparent in later life, although more research on age differences in the associations between loneliness and health-related processes is clearly needed.”

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Transient feelings of loneliness may motivate individuals to reconnect with others, whereas prolonged loneliness increases withdrawal and cognitive vigilance to social threat.

“Whereas transient feelings of loneliness may motivate individuals to reconnect with other individuals, prolonged loneliness increases withdrawal and cognitive vigilance to social threat [29].”

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Several forms of social isolation may exist (objective and perceived) that have distinct effects on health, but empirical work does not permit drawing strong inferences regarding their relative importance for adult mortality.

“In sum, several forms of social isolation may exist (e.g., objective and perceived) that have distinct effects on health, but, to date, empirical work does not permit drawing strong inferences regarding their relative importance for adult mortality.”

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Candidate neurobiological mechanisms linking loneliness to health include age-related changes in neuroendocrine, cardiovascular, and inflammatory stress responses; elevated vascular resistance, blood pressure, and hypothalamic pituitary adrenocortical activity; leukocyte glucocorticoid resistance; and lower inflammatory control and diminished immunity.

“candidate neurobiological mechanisms include age-related changes in neuroendocrine, cardiovascular, and inflammatory stress responses; elevated vascular resistance, blood pressure, and hypothalamic pituitary adrenocortical activity; leukocyte glucocorticoid resistance reflecting aberrant ratios of circulating white blood cells, and lower inflammatory control and diminished immunity.”

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Findings from two longitudinal health surveys suggest that loneliness predicts decrements in subjective sleep quality, which in turn feed forward to further exacerbate subsequent loneliness, suggesting a bidirectional causal relationship.

“findings from two longitudinal health surveys of older adults [27, 28] suggest that loneliness predicts decrements in subjective sleep quality, which, in turn, feed forward to further exacerbate subsequent loneliness, suggesting a bidirectional causal relationship.”

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More limited empirical data exists on the impact of loneliness on mortality as well as mechanisms through which successful loneliness interventions enhance health and well-being in older individuals.

“More limited empirical data exists on the impact of loneliness on mortality as well as mechanisms through which successful loneliness interventions enhance health and well-being in older individuals.”

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Specific groups of older adults who might benefit from targeted loneliness interventions include those suffering from cognitive impairment and dementia, as well as the 'oldest-old' who are at heightened risk for loneliness due to decreasing opportunities for social connection.

“Specific groups of older adults who might benefit from such interventions might include those suffering from cognitive impairment and dementia, as well as the ‘oldest-old’ who are at heightened risk for loneliness due to decreasing opportunities for social connection [35].”

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It remains unclear which mechanisms might accelerate the rate of morbidity and mortality in lonely older adults.

“Thus, it remains unclear which mechanisms might accelerate the rate of morbidity and mortality in lonely older adults.”

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Experiences of physical warmth/coldness and feelings of social warmth/coldness share similar sensorimotor representations.

“Cacioppo and Cacioppo [30] reviewed data suggesting that experiences of physical warmth/coldness and feelings of social warmth/coldness share similar sensorimotor representations.”

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Several authors have suggested that there is a bidirectional relationship between loneliness and various risk factors such as initial health status, health behaviors, and depression.

“Second, several authors have suggested that there is a bidirectional relationship between loneliness and various risk factors (e.g., initial health status, health behaviors, depression).”

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Important methodological issues identified in previous qualitative reviews of loneliness reduction include differences in duration and frequency of interventions, potential for regression toward the mean and selection bias in nonrandomized controlled trials, the need to match interventions to specific therapies and population characteristics, and the relative paucity of randomized control trials.

“The important methodological issues identified in previous qualitative reviews of loneliness reduction include differences in the duration of interventions and frequency of the interventions sessions, potential for regression toward the mean and selection bias in nonrandomized controlled trials, the need to match interventions to specific therapies and population characteristics, and the relative”