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Cited by 767Health disparities and outcomesAging, Health, and DisabilityAging, Elder Care, and Social Issues

Interventions targeting social isolation in older people: a systematic review

Open access
Dickens, Andy P, Richards, Suzanne H, Greaves, Colin J, Campbell, John L·2011·BMC Public Health
DOI 10.1186/1471-2458-11-647PMC PMC3170621
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Abstract

BACKGROUND: Targeting social isolation in older people is a growing public health concern. The proportion of older people in society has increased in recent decades, and it is estimated that approximately 25% of the population will be aged 60 or above within the next 20 to 40 years. Social isolation is prevalent amongst older people and evidence indicates the detrimental effect that it can have on health and wellbeing. The aim of this review was to assess the effectiveness of interventions designed to alleviate social isolation and loneliness in older people. METHODS: Relevant electronic databases (MEDLINE, EMBASE, ASSIA, IBSS, PsycINFO, PubMed, DARE, Social Care Online, the Cochrane Library and CINAHL) were systematically searched using an extensive search strategy, for randomised controlled trials and quasi-experimental studies published in English before May 2009. Additional articles were identified through citation tracking. Studies were included if they related to older people, if the intervention aimed to alleviate social isolation and loneliness, if intervention participants were compared against inactive controls and, if treatment effects were reported. Two independent reviewers extracted data using a standardised form. Narrative synthesis and vote-counting methods were used to summarise and interpret study data. RESULTS: Thirty two studies were included in the review. There was evidence of substantial heterogeneity in the interventions delivered and the overall quality of included studies indicated a medium to high risk of bias. Across the three domains of social, mental and physical health, 79% of group-based interventions and 55% of one-to-one interventions reported at least one improved participant outcome. Over 80% of participatory interventions produced beneficial effects across the same domains, compared with 44% of those categorised as non-participatory. Of interventions categorised as having a theoretical basis, 87% reported beneficial effects across the three domains compared with 59% of interventions with no evident theoretical foundation. Regarding intervention type, 86% of those providing activities and 80% of those providing support resulted in improved participant outcomes, compared with 60% of home visiting and 25% of internet training interventions. Fifty eight percent of interventions that explicitly targeted socially isolated or lonely older people reported positive outcomes, compared with 80% of studies with no explicit targeting. CONCLUSIONS: More, well-conducted studies of the effectiveness of social interventions for alleviating social isolation are needed to improve the evidence base. However, it appeared that common characteristics of effective interventions were those developed within the context of a theoretical basis, and those offering social activity and/or support within a group format. Interventions in which older people are active participants also appeared more likely to be effective. Future interventions incorporating all of these characteristics may therefore be more successful in targeting social isolation in older people.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review of 32 studies found that interventions to alleviate social isolation and loneliness in older people were highly heterogeneous, but group-based, participatory, theoretically based, and activity/support interventions more often reported beneficial outcomes. The evidence base was limited by medium-to-high risk of bias and poor reporting, so firmer conclusions require better-conducted studies.

Key findings

  • Across social, mental, and physical health domains, 79% of group-based interventions and 55% of one-to-one interventions reported at least one improved participant outcome; 83% of participatory interventions versus 44% of non-participatory interventions, and 87% of theory-based versus 59% of non-theory-based interventions, reported beneficial effects.
  • By intervention type, 86% of activity interventions, 80% of support interventions, 60% of home visiting interventions, and 25% of internet training interventions reported beneficial effects.
  • Interventions explicitly targeting socially isolated or lonely older people were less likely to report positive outcomes: 58% versus 80% of studies with no explicit targeting.
  • Of 32 included studies (16 RCTs, 16 quasi-experimental; 4061 participants), 10/16 RCTs and 1/16 quasi-experimental studies were judged at moderate risk of bias; the rest were high risk. Only 12/32 (38%) explicitly targeted people identified as socially isolated or lonely.

Methods

  • Systematic searches of MEDLINE, EMBASE, ASSIA, IBSS, PsycINFO, PubMed, DARE, Social Care Online, the Cochrane Library, and CINAHL for English-language studies published before May 2009, plus citation tracking.
  • Included RCTs and quasi-experimental studies with inactive controls, older people, interventions aiming to alleviate social isolation/loneliness, and reported treatment effects.
  • Two independent reviewers extracted data; narrative synthesis and vote-counting were used because heterogeneity made meta-analysis inappropriate. Outcomes covered social health (loneliness, social isolation, structural/functional social support), mental health (depression, wellbeing), and physical health; quality was assessed with the Cochrane risk of bias tool and a modified Newcastle-Ottawa Scale.

Limitations

  • Stated in the paper: heterogeneity of interventions, participants, and outcomes limited comparability; poor reporting and poor quality of many studies were major limitations; limiting inclusion to English-language studies may have introduced bias; jointly presenting randomised and non-randomised studies may be considered a limitation; most studies were conducted in Scandinavia (n = 4), the Netherlands (n = 6), or the United States (n = 17), limiting generalisability; lack of consensus on the definition of social isolation may have affected study identification and interpretation.
  • Evident from the text: many studies had small samples, high attrition, no sample size calculation, baseline imbalances, selective follow-up, and incomplete outcome reporting; vote-counting is a crude summary method that does not pool effect sizes or account for study precision.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/1471-2458-11-647

Cites

78 of 78 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 200 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Over 80% of participatory interventions produced beneficial effects across social, mental and physical health domains.

    “Over 80% of participatory interventions produced beneficial effects across the same domains”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Vote-counting is a valid method for summarising and interpreting the effectiveness data in this review.
    • Rests on an assumption: The outcome measures across included studies are sufficiently comparable to be combined in vote-counting across the three domains.
  • Findingcitation

    In the volunteer reading study, significant between-group differences favouring the intervention were observed for self-rated health and frequency of communication with children at 21 months.

    “Significant between-group differences favouring the intervention were observed for both outcomes, but these must be interpreted with caution due to the selective nature of participants followed up.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [74] Fujiwara Y, Sakuma N, Ohba H, Nishi M, Lee S, Watanabe N, Kousa Y, Yoshida H, Fukaya T, Yajima S, et al: REPRINTS: effects of an intergenerational health promotion program for older adults in Japan. Journal of Intergenerational Relationships. 2009, 7: 17-39. 10.1080/15350770802628901. source

      Not checked in the free run.

  • Findingcitation

    Community-dwelling older people who volunteered to read books to school children reported increased frequency of communication with children contacted through volunteer activities at nine months.

    “Community-dwelling older people who volunteered to read books to school children [74] unsurprisingly reported increased frequency of communication with children contacted through volunteer activities at nine months.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [74] Fujiwara Y, Sakuma N, Ohba H, Nishi M, Lee S, Watanabe N, Kousa Y, Yoshida H, Fukaya T, Yajima S, et al: REPRINTS: effects of an intergenerational health promotion program for older adults in Japan. Journal of Intergenerational Relationships. 2009, 7: 17-39. 10.1080/15350770802628901. source

      Not checked in the free run.

  • Findingown data

    After application of the study inclusion criteria, 32 studies were deemed eligible for inclusion.

    “After application of the study inclusion criteria, 32 studies were deemed eligible for inclusion (Figure 1).”
    Quote in the paperSubstantial claim
  • Findingown data

    87% of interventions categorised as having a theoretical basis reported beneficial effects across the three domains.

    “Of interventions categorised as having a theoretical basis, 87% reported beneficial effects across the three domains”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Vote-counting is a valid method for summarising and interpreting the effectiveness data in this review.
    • Rests on an assumption: The outcome measures across included studies are sufficiently comparable to be combined in vote-counting across the three domains.
  • Classified as probably not a substantial claim. 31
  • May combine two claims. 72
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Twenty-three studies were participatory and the remaining nine were non-participatory.

    “Twenty three studies were participatory [13,51-56,58,60,61,63,65-70,73-77,81] and the remaining nine were non-participatory [57,59,62,64,71,72,78-80].”
    Quote in the paperNot a substantial claim

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    Findingcitation

    Participants in the volunteer reading study also reported increased contact with grandchildren and distant friends, and improved self-rated health compared with controls.

    “Participants also reported increased contact with grandchildren and distant friends, and improved self-rated health compared with controls.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [74] Fujiwara Y, Sakuma N, Ohba H, Nishi M, Lee S, Watanabe N, Kousa Y, Yoshida H, Fukaya T, Yajima S, et al: REPRINTS: effects of an intergenerational health promotion program for older adults in Japan. Journal of Intergenerational Relationships. 2009, 7: 17-39. 10.1080/15350770802628901. source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Seven studies evaluated activity interventions, fifteen evaluated support interventions, five evaluated home visiting, four evaluated internet training interventions, and one evaluated a service provision intervention.

    “Seven studies evaluated activity interventions [13,60,61,67,70,74,81], fifteen evaluated support interventions [51-56,58,63,66,68,69,73,75-77], five evaluated home visiting [57,59,71,78,80], four evaluated internet training interventions [62,64,72,79], and one evaluated a service provision intervention [65].”
    Quote in the paperNot a substantial claim

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    Findingcitation

    Participants in a physical activity programme within an inpatient geriatric rehabilitation setting reported reduced depression at 12 month follow-up, while no effect was observed on loneliness or the number of friends and relatives.

    “Participants in a physical activity programme within an inpatient geriatric rehabilitation setting [70] reported reduced depression at 12 month follow-up, while no effect was observed on loneliness or the number of friends and relatives.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [70] Ollonqvist K, Palkeinen H, Aaltonen T, Pohjolainen T, Puuka P, Hinkka K, Pontinen S: Alleviating loneliness among frail older people - findings from a randomised controlled trial. International Journal of Mental Health Promotion. 2008, 10: 26-34. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    A total of 4061 participants contributed to the 32 studies, with between 23 and 741 participants per study.

    “A total of 4061 participants contributed to the 32 studies, with between 23 and 741 participants per study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The remaining 14 studies had multiple follow-up points, of which 13 had between two and four follow-up points covering periods of between six months and two years, while the final study involved 11 assessments over a five year period.

    “The remaining 14 studies consisted of multiple follow-up points, of which 13 had between two and four follow-up points covering periods of between six months and two years [13,55-58,60,66,68,69,72,75,80,81], while the final study [52] involved 11 assessments over a five year period.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    The frequency of contact varied, from individually tailored interventions to the majority delivered weekly or fortnightly, with one intervention entailing participant contact three times per week.

    “The frequency of contact varied, from those delivered as individually tailored [52] interventions, to the majority that were delivered on a weekly or fortnightly basis (one intervention entailed participant contact three times per week [63]).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Thirty-two studies were included in the review.

    “Thirty two studies were included in the review.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Full papers were obtained for 137 studies.

    “Full papers were obtained for 137 studies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Participants included caregivers, disease sufferers, housing residents, residents in institutional settings, and community-dwelling older people.

    “Participants (Table 2) included caregivers [51-54], disease sufferers [55-57], housing residents [58-63], residents in institutional settings [64,65] and community-dwelling older people [13,66-81].”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Eighteen studies had only one follow-up, conducted between six weeks and three years after the baseline assessment.

    “Eighteen studies had only one follow-up, conducted between six weeks and three years after the baseline assessment [51,53,54,59,61-65,67,70,71,73,74,76-79].”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Studies reported comparators including no intervention, usual care, waiting list, and attentional control groups; five studies used multiple comparators.

    “Studies reported a range of comparators including: no intervention [13,54,58,60-62,66,68,70,73,75,77-80], usual care [52,63-65,67,69,71,74], waiting list [55,57], and attentional [51,53] control groups. Five studies used multiple comparators [56,59,72,76,81].”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    An activity programme for senior citizen apartment residents reportedly increased the number of participants' activities at six months, although no reduction was observed in level of depression or suicidal thoughts.

    “An activity programme for senior citizen apartment residents [60] reportedly increased the number of participants' activities at six months, although no reduction was observed in level of depression or suicidal thoughts.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [60] Arnetz B, Theorell T: Psychological, sociological and health behaviour aspects of a long term activation programme for institutionalized elderly people. Soc Sci Med. 1983, 17: 449-456. 10.1016/0277-9536(83)90050-3. source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Most interventions lasted between six weeks and one year, with several lasting up to three and five years.

    “Most interventions lasted between six weeks and one year, with several lasting up to three [79] and five [52] years.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Nineteen interventions were delivered in groups, 11 were delivered one-to-one, one used a combination of group and one-to-one formats, and one was concerned with the provision of an alternative form of nursing home care.

    “Nineteen interventions were delivered in groups [13,53,55,56,60-64,66-70,73-77], 11 were delivered one-to-one [51,54,57-59,71,72,78-81], one used a combination of group and one-to-one formats [52] and one was concerned with the provision of an alternative form of nursing home care [65].”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In the volunteer reading study, the quantity of and amount of contact with friends or neighbours did not change, but the level of social support received from them reduced and the level of social support provided by participants increased.

    “While the quantity of and amount of contact with friends or neighbours did not change, the level of social support received from them reduced and the level of social support provided by participants increased.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [74] Fujiwara Y, Sakuma N, Ohba H, Nishi M, Lee S, Watanabe N, Kousa Y, Yoshida H, Fukaya T, Yajima S, et al: REPRINTS: effects of an intergenerational health promotion program for older adults in Japan. Journal of Intergenerational Relationships. 2009, 7: 17-39. 10.1080/15350770802628901. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Of the 7067 studies identified, 6930 did not meet the selection criteria.

    “Of the 7067 studies identified, 6930 did not meet the selection criteria.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Some studies omitted details of the frequency or duration of the intervention.

    “Some studies omitted details of the frequency [58,75,77] or duration [57,75,77,81] of the intervention.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Interventions were delivered by health or social care professionals, instructors, students, counsellors, and unspecified professionals; four studies did not report who delivered the interventions.

    “Interventions were delivered by health or social care professionals [13,51,52,56,60,61,65,69,70,76,81], instructors [62,64,72,79], students [59,66,71,78], counsellors [53,54,73] and unspecified professionals [55,57,58,68,74,80]. Four studies [63,67,75,77] did not report who delivered the interventions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Sixteen RCTs and 16 quasi-experimental studies were included.

    “Sixteen RCTs and 16 quasi-experimental studies were included (Table 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In the mental health counselling group study, the authors reported no reduction in social isolation and non-significant trends suggesting a protective effect on perceived health and morale compared with controls at follow-up.

    “The authors reported no reduction in social isolation and non-significant trends suggesting a protective effect on perceived health and morale compared with controls at follow-up.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [76] Rosen C, Rosen S: Evaluating an intervention program for the elderly. Community Mental Health Journal. 1982, 18: 21-33. 10.1007/BF00757109. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In the self-management group study, participants reported improved social loneliness and psychological wellbeing at six weeks, although the effects disappeared at six months.

    “Participants did however report improved social loneliness and psychological wellbeing at six weeks, although the effects disappeared at six months.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [68] Kremers I, Steverink N, Albersnagel F, Slaets J: Improved self-management ability and well-being in older women after a short group intervention. Aging & Mental Health. 2006, 10: 476-484. 10.1080/13607860600841206. source

      Not checked in the free run.

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    Findingcitation

    In the individual counselling study, at eight weeks compared with the control group, participants receiving professional counselling reported improved wellbeing and reduced psychiatric symptoms according to an overall score and the three subscales of depression, anxiety, and hostility.

    “At eight weeks, compared with the control group, participants receiving professional counselling reported improved wellbeing and reduced psychiatric symptoms, according to an overall score and the three subscales of depression, anxiety and hostility.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54] Toseland R, Smith G: Effectiveness of individual counseling by professional and peer helpers for family care-givers of the elderly. Psychology and Aging. 1990, 5: 256-263. source

      Not checked in the free run.

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    Findingcitation

    In the discussion group study, participants reported decreased depression at 24 weeks and reduced feelings of hopelessness at all time points compared with the control group.

    “Participants reported decreased depression at 24 weeks, and reduced feelings of hopelessness at all time points in comparison with the control group.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [69] Lokk J: Emotional and social effects of a controlled intervention study in a day-care unit for elderly patients. Scand J Prim Health. 1990, 8: 165-172. 10.3109/02813439008994951. source

      Not checked in the free run.

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    Findingcitation

    A coping group intervention for people with chronic rheumatic disorders reported improved functional health status compared with a waiting list control group, and improved action-directed coping compared with a mutual support control group at 13 weeks.

    “A coping group intervention [56] for people with chronic rheumatic disorders reported improved functional health status in comparison with a waiting list control group, and improved action-directed coping in comparison with a mutual support control group at 13 weeks.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [56] Savelkoul M, de Witte LP: Mutual support groups in rheumatic diseases: Effects and participants' perceptions. Arthritis & Rheumatism. 2004, 51: 605-608. 10.1002/art.20538. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In the mental health counselling group study, participants enjoyed more new activities and rediscovered old activities compared with an untreated comparison group at post-intervention.

    “Participants enjoyed more new activities and rediscovered old activities when compared with an untreated comparison group at post-intervention.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [76] Rosen C, Rosen S: Evaluating an intervention program for the elderly. Community Mental Health Journal. 1982, 18: 21-33. 10.1007/BF00757109. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In the widows study, the effect on socialisation and depression was most notable at six weeks and subsequently reduced over time, although bereavement support group scores remained better than those of both other groups.

    “The effect on both outcomes was most notable at six weeks and subsequently reduced over time, although bereavement support group scores remained better than those of both other groups.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [66] Constantino RE: Comparison of two group interventions for the bereaved. IMAGE: Journal of Nursing Scholarship. 1988, 20: 83-88. 10.1111/j.1547-5069.1988.tb00036.x. source

      Not checked in the free run.

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    Findingcitation

    An educational friendship programme for older women reported that, at six months, participants developed more new friendships compared with a control group and demonstrated improved positive and negative affect.

    “An evaluation of an educational friendship programme for older women [75] reported that, at six months, participants developed more new friendships in comparison with a control group and demonstrated improved positive and negative affect.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [75] Martina CM, Stevens NL: Breaking the cycle of loneliness? Psychological effects of a friendship enrichment program for older women. Aging & Mental Health. 2006, 10: 467-475. 10.1080/13607860600637893. source

      Not checked in the free run.

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    Findingcitation

    In the foster grandparent programme study, despite beneficial effects on structural social support, there were no significant between-group differences regarding loneliness, depression, or self-esteem at either time point.

    “Despite the observed beneficial effects on structural social support, there were no significant between-group differences regarding loneliness, depression or self-esteem at either time point.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [81] Rook KS, Sorkin DH: Fostering social ties through a volunteer role: implications for older-adults' psychological health. International Journal of Aging & Human Development. 2003, 57: 313-337. 10.2190/NBBN-EU3H-4Q1N-UXHR. source

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    Findingcitation

    Two studies reported internet training interventions delivered within group settings; one was at moderate risk of bias and one was judged to be at high risk of bias.

    “Two studies reported internet training interventions delivered within group settings; one of which was at moderate risk of bias [64] and one was judged to be at high risk of bias [62].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [64] White H, McConnell E, Clipp E, Branch L, Sloane R, Pieper C, Box T: A randomized controlled trial of the psychosocial impact of providing internet training and access to older adults. Aging & Mental Health. 2002, 6: 213-221. 10.1080/13607860220142422. source

      Not checked in the free run.

    • cites [62] White H, McConnell E, Clipp E, Bynum L, Teague C, Navas L, Craven S, Halbrecht H: Surfing the net in later life. Journal of Applied Gerontology. 1999, 18: 358-378. 10.1177/073346489901800306. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In the widows study, the bereavement support group reported enhanced socialisation and reduced depression compared with the other groups.

    “The bereavement support group reported enhanced socialisation and reduced depression compared with the other groups.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [66] Constantino RE: Comparison of two group interventions for the bereaved. IMAGE: Journal of Nursing Scholarship. 1988, 20: 83-88. 10.1111/j.1547-5069.1988.tb00036.x. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In the caregiver support study, at eight weeks support group participants reported an increased support network size compared with controls, though no effect was observed on the extent of support, on wellbeing, or on the numbers of anxiety and depression symptoms.

    “At eight weeks, support group participants reported an increased support network size in comparison with controls, though no effect was observed on the extent of support, on wellbeing or on the numbers of anxiety and depression symptoms.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [53] Toseland R, Rossiter C, Peak T, Smith G: Comparative effectiveness of individual and group interventions to support family caregivers. Social Work. 1990, 35: 209-217.

      Not checked in the free run.

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    Findingcitation

    A telephone-based group therapy that taught older people how to cope with their blindness was reported to increase numbers of social activities and reduce levels of loneliness among participants compared with controls at eight weeks.

    “A telephone-based group therapy that taught older people how to cope with their blindness [73] was reported to increase numbers of social activities and reduce levels of loneliness amongst participants in comparison with controls at eight weeks.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [73] Evans RL, Jaureguy BM: Phone therapy outreach for blind elderly. Gerontologist. 1982, 22: 32-35. 10.1093/geront/22.1.32. source

      Not checked in the free run.

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    Findingcitation

    In the discussion group study, participants reported increased social network size at six weeks and increased availability of contacts at 24 weeks, although more participants reported feeling often lonely compared with controls at six weeks.

    “Participants reported increased social network size at six weeks and increased availability of contacts at 24 weeks, although more participants reported feeling 'often lonely' compared with controls at six weeks.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [69] Lokk J: Emotional and social effects of a controlled intervention study in a day-care unit for elderly patients. Scand J Prim Health. 1990, 8: 165-172. 10.3109/02813439008994951. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In the cognitive behavioural therapy study for nursing home residents, at three months participants' perception of their social support remained constant compared with deterioration in the control group, while no effect was observed on loneliness.

    “At three months, participants' perception of their social support remained constant compared with deterioration in the control group, while no effect was observed on loneliness.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [63] Winningham RG, Pike NL: A cognitive intervention to enhance institutionalized older adults' social support networks and decrease loneliness. Aging & Mental Health. 2007, 11: 716-721. 10.1080/13607860701366228. source

      Not checked in the free run.

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    Findingcitation

    Women with breast cancer who participated in a psychosocial group intervention reported having more confidants available to them, better satisfaction with social support, and reduced loneliness compared with the control group at six weeks and six months.

    “Women with breast cancer who participated in a psychosocial group intervention [55] reported having more confidants available to them, better satisfaction with social support and reduced loneliness in comparison with the control group at six weeks and six months.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [55] Fukui S, Koike M, Ooba A, Uchitomi Y: The effect of a psychosocial group intervention on loneliness and social support for Japanese women with primary breast cancer. Oncology Nursing Forum. 2003, 30: 823-831. 10.1188/03.ONF.823-830. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In the educational friendship programme study, there was no observed reduction in participants' loneliness, no improvement in assertiveness, and a non-significant trend towards improved self-esteem.

    “There was no observed reduction in participants' loneliness, no improvement in assertiveness and a non-significant trend towards improved self-esteem.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [75] Martina CM, Stevens NL: Breaking the cycle of loneliness? Psychological effects of a friendship enrichment program for older women. Aging & Mental Health. 2006, 10: 467-475. 10.1080/13607860600637893. source

      Not checked in the free run.

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    Findingcitation

    With the addition of two studies, the proportion of effective group interventions rose to 79% (15 out of 19), and with the addition of one study, the proportion of effective one-to-one interventions rose to 55% (6 out of 11).

    “The proportion of effective group interventions rose to 79% (15 out of 19) with the addition of two studies [56,70], and the proportion of effective one-to-one interventions rose to 55% (6 out of 11) with the addition of one study [54].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [56] Savelkoul M, de Witte LP: Mutual support groups in rheumatic diseases: Effects and participants' perceptions. Arthritis & Rheumatism. 2004, 51: 605-608. 10.1002/art.20538. source

      Not checked in the free run.

    • cites [70] Ollonqvist K, Palkeinen H, Aaltonen T, Pohjolainen T, Puuka P, Hinkka K, Pontinen S: Alleviating loneliness among frail older people - findings from a randomised controlled trial. International Journal of Mental Health Promotion. 2008, 10: 26-34. source

      Not checked in the free run.

    • cites [54] Toseland R, Smith G: Effectiveness of individual counseling by professional and peer helpers for family care-givers of the elderly. Psychology and Aging. 1990, 5: 256-263. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In the same friendly visiting programme, the desire for larger social networks did not lead to larger current social networks, or a greater number of visits or visitors, or phone calls per week.

    “though this did not lead to larger current social networks, or a greater number of visits or visitors, or phone calls per week.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [78] Bogat G, Jason L: An evaluation of two visiting programs for elderly community residents. International Journal of Aging and Human Development. 1983, 17: 267-280. 10.2190/6AQX-1TDM-DEL4-3T6L. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    A volunteer home visiting intervention for community-dwelling older people in receipt of home nursing who were considered by their nurses to be socially isolated or lonely showed some evidence of improved social support at six weeks, with participants reporting increased social integration and feelings of worth.

    “There was some evidence of improved social support at six weeks, as participants reported increased social integration and feelings of worth.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [71] MacIntyre I, Corradetti P, Roberts J, Browne G, Watt S, Lane A: Pilot study of a visitor volunteer programme for community elderly people receiving home health care. Health and Social Care in the Community. 1999, 7: 225-232. 10.1046/j.1365-2524.1999.00178.x. source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Nineteen out of 23 (83%) participatory interventions were observed to have beneficial effects on at least one outcome compared with only four out of nine (44%) non-participatory interventions.

    “Nineteen out of the 23 (83%) participatory interventions were observed to have beneficial effects on at least one outcome [13,52-56,60,63,65-70,73-76,81] compared with only four out of nine (44%) non-participatory interventions [59,71,78,79].”
    Quote in the paperSubstantial claim0 of 10 sources checked
    • cites [13] Routasalo PE, Tilvis RS, Kautiainen H, Pitkala KH: Effects of psychosocial group rehabilitation on social functioning, loneliness and well-being of lonely, older people: randomized controlled trial. Journal of Advanced Nursing. 2009, 65: 297-306. 10.1111/j.1365-2648.2008.04837.x. source

      Not checked in the free run.

    • cites [52] Drentea P, Clay OJ, Roth DL, Mittelman MS: Predictors of improvement in social support: Five-year effects of a structured intervention for caregivers of spouses with Alzheimer's disease. Soc Sci Med. 2006, 63: 957-967. 10.1016/j.socscimed.2006.02.020. source

      Not checked in the free run.

    • cites [53] Toseland R, Rossiter C, Peak T, Smith G: Comparative effectiveness of individual and group interventions to support family caregivers. Social Work. 1990, 35: 209-217.

      Not checked in the free run.

    • cites [54] Toseland R, Smith G: Effectiveness of individual counseling by professional and peer helpers for family care-givers of the elderly. Psychology and Aging. 1990, 5: 256-263. source

      Not checked in the free run.

    • cites [55] Fukui S, Koike M, Ooba A, Uchitomi Y: The effect of a psychosocial group intervention on loneliness and social support for Japanese women with primary breast cancer. Oncology Nursing Forum. 2003, 30: 823-831. 10.1188/03.ONF.823-830. source

      Not checked in the free run.

    • cites [56] Savelkoul M, de Witte LP: Mutual support groups in rheumatic diseases: Effects and participants' perceptions. Arthritis & Rheumatism. 2004, 51: 605-608. 10.1002/art.20538. source

      Not checked in the free run.

    • cites [60] Arnetz B, Theorell T: Psychological, sociological and health behaviour aspects of a long term activation programme for institutionalized elderly people. Soc Sci Med. 1983, 17: 449-456. 10.1016/0277-9536(83)90050-3. source

      Not checked in the free run.

    • cites [63] Winningham RG, Pike NL: A cognitive intervention to enhance institutionalized older adults' social support networks and decrease loneliness. Aging & Mental Health. 2007, 11: 716-721. 10.1080/13607860701366228. source

      Not checked in the free run.

    • cites [65] Bergman-Evans B: Beyond the basics. Effects of the Eden Alternative model on quality of life issues. Journal of Gerontological Nursing. 2004, 30: 27-34. source

      Not checked in the free run.

    • cites [66] Constantino RE: Comparison of two group interventions for the bereaved. IMAGE: Journal of Nursing Scholarship. 1988, 20: 83-88. 10.1111/j.1547-5069.1988.tb00036.x. source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Thirteen out of 15 (87%) interventions categorised as having a theoretical basis reported beneficial effects on at least one outcome domain compared with 10 out of 17 (59%) studies categorised as having no theoretical basis.

    “Thirteen out of 15 (87%) interventions categorised as having a theoretical basis reported beneficial effects on at least one outcome domain [13,53-55,59,65,67-69,73-75,81] compared with 10/17 (59%) studies categorised as having no theoretical basis [52,56,60,63,66,70,71,76,78,79].”
    Quote in the paperSubstantial claim0 of 10 sources checked
    • cites [13] Routasalo PE, Tilvis RS, Kautiainen H, Pitkala KH: Effects of psychosocial group rehabilitation on social functioning, loneliness and well-being of lonely, older people: randomized controlled trial. Journal of Advanced Nursing. 2009, 65: 297-306. 10.1111/j.1365-2648.2008.04837.x. source

      Not checked in the free run.

    • cites [53] Toseland R, Rossiter C, Peak T, Smith G: Comparative effectiveness of individual and group interventions to support family caregivers. Social Work. 1990, 35: 209-217.

      Not checked in the free run.

    • cites [54] Toseland R, Smith G: Effectiveness of individual counseling by professional and peer helpers for family care-givers of the elderly. Psychology and Aging. 1990, 5: 256-263. source

      Not checked in the free run.

    • cites [55] Fukui S, Koike M, Ooba A, Uchitomi Y: The effect of a psychosocial group intervention on loneliness and social support for Japanese women with primary breast cancer. Oncology Nursing Forum. 2003, 30: 823-831. 10.1188/03.ONF.823-830. source

      Not checked in the free run.

    • cites [59] Schulz R: Effects of control and predictability on the physical and psychological well-being of the institutionalized aged. Journal of Personality and Social Psychology. 1976, 33: 563-573. source

      Not checked in the free run.

    • cites [65] Bergman-Evans B: Beyond the basics. Effects of the Eden Alternative model on quality of life issues. Journal of Gerontological Nursing. 2004, 30: 27-34. source

      Not checked in the free run.

    • cites [67] Harris JE, Bodden JL: An activity group experience for disengaged elderly persons. Journal of Counseling Psychology. 1978, 25: 325-330. source

      Not checked in the free run.

    • cites [68] Kremers I, Steverink N, Albersnagel F, Slaets J: Improved self-management ability and well-being in older women after a short group intervention. Aging & Mental Health. 2006, 10: 476-484. 10.1080/13607860600841206. source

      Not checked in the free run.

    • cites [69] Lokk J: Emotional and social effects of a controlled intervention study in a day-care unit for elderly patients. Scand J Prim Health. 1990, 8: 165-172. 10.3109/02813439008994951. source

      Not checked in the free run.

    • cites [73] Evans RL, Jaureguy BM: Phone therapy outreach for blind elderly. Gerontologist. 1982, 22: 32-35. 10.1093/geront/22.1.32. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In a home visiting intervention for retirement home residents testing predictability and control, at two months, intervention participants who controlled frequency/duration of visits and had advance notice reported more activity, a greater amount of time spent in active pursuits, and planned more activities for the coming week compared with control groups receiving random visits and no visits.

    “At two months, in comparison with the control groups (receiving random visits and no visits), intervention participants (controlling frequency/duration of visits, and advance notice of visits) reported more activity, a greater amount of time spent in active pursuits and planned more activities for the coming week.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [59] Schulz R: Effects of control and predictability on the physical and psychological well-being of the institutionalized aged. Journal of Personality and Social Psychology. 1976, 33: 563-573. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In the same home visiting intervention, intervention groups reported improved hope and happiness, and a smaller increase in the quantity of medication taken per day compared with control participants.

    “The intervention groups also reported improved hope and happiness, and reported a smaller increase in the quantity of medication taken per day in comparison with control participants.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [59] Schulz R: Effects of control and predictability on the physical and psychological well-being of the institutionalized aged. Journal of Personality and Social Psychology. 1976, 33: 563-573. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In the same home visiting intervention, no significant differences were observed between the two intervention groups, or between the two control groups.

    “No significant differences were observed between the two intervention groups, or between the two control groups.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [59] Schulz R: Effects of control and predictability on the physical and psychological well-being of the institutionalized aged. Journal of Personality and Social Psychology. 1976, 33: 563-573. source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Six studies provided limited information about the background of personnel delivering the intervention, three of which (75%) reported positive treatment effects.

    “Six studies provided limited information about the background of personnel delivering the intervention (e.g. female leader, professional, trained interviewer), three of which (75%) reported positive treatment effects [55,68,74].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [55] Fukui S, Koike M, Ooba A, Uchitomi Y: The effect of a psychosocial group intervention on loneliness and social support for Japanese women with primary breast cancer. Oncology Nursing Forum. 2003, 30: 823-831. 10.1188/03.ONF.823-830. source

      Not checked in the free run.

    • cites [68] Kremers I, Steverink N, Albersnagel F, Slaets J: Improved self-management ability and well-being in older women after a short group intervention. Aging & Mental Health. 2006, 10: 476-484. 10.1080/13607860600841206. source

      Not checked in the free run.

    • cites [74] Fujiwara Y, Sakuma N, Ohba H, Nishi M, Lee S, Watanabe N, Kousa Y, Yoshida H, Fukaya T, Yajima S, et al: REPRINTS: effects of an intergenerational health promotion program for older adults in Japan. Journal of Intergenerational Relationships. 2009, 7: 17-39. 10.1080/15350770802628901. source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Four studies provided no information about the person providing the intervention, three of which (75%) reported beneficial outcomes.

    “Four studies provided no information about the person providing the intervention, three of which (75%) reported beneficial outcomes [63,67,75].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [63] Winningham RG, Pike NL: A cognitive intervention to enhance institutionalized older adults' social support networks and decrease loneliness. Aging & Mental Health. 2007, 11: 716-721. 10.1080/13607860701366228. source

      Not checked in the free run.

    • cites [67] Harris JE, Bodden JL: An activity group experience for disengaged elderly persons. Journal of Counseling Psychology. 1978, 25: 325-330. source

      Not checked in the free run.

    • cites [75] Martina CM, Stevens NL: Breaking the cycle of loneliness? Psychological effects of a friendship enrichment program for older women. Aging & Mental Health. 2006, 10: 467-475. 10.1080/13607860600637893. source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    All interventions delivered by counsellors and by students reported at least one beneficial effect.

    “All interventions delivered by counsellors [53,54,73] and by students [59,66,71,78] reported at least one beneficial effect”
    Quote in the paperNot a substantial claim0 of 7 sources checked
    • cites [53] Toseland R, Rossiter C, Peak T, Smith G: Comparative effectiveness of individual and group interventions to support family caregivers. Social Work. 1990, 35: 209-217.

      Not checked in the free run.

    • cites [54] Toseland R, Smith G: Effectiveness of individual counseling by professional and peer helpers for family care-givers of the elderly. Psychology and Aging. 1990, 5: 256-263. source

      Not checked in the free run.

    • cites [73] Evans RL, Jaureguy BM: Phone therapy outreach for blind elderly. Gerontologist. 1982, 22: 32-35. 10.1093/geront/22.1.32. source

      Not checked in the free run.

    • cites [59] Schulz R: Effects of control and predictability on the physical and psychological well-being of the institutionalized aged. Journal of Personality and Social Psychology. 1976, 33: 563-573. source

      Not checked in the free run.

    • cites [66] Constantino RE: Comparison of two group interventions for the bereaved. IMAGE: Journal of Nursing Scholarship. 1988, 20: 83-88. 10.1111/j.1547-5069.1988.tb00036.x. source

      Not checked in the free run.

    • cites [71] MacIntyre I, Corradetti P, Roberts J, Browne G, Watt S, Lane A: Pilot study of a visitor volunteer programme for community elderly people receiving home health care. Health and Social Care in the Community. 1999, 7: 225-232. 10.1046/j.1365-2524.1999.00178.x. source

      Not checked in the free run.

    • cites [78] Bogat G, Jason L: An evaluation of two visiting programs for elderly community residents. International Journal of Aging and Human Development. 1983, 17: 267-280. 10.2190/6AQX-1TDM-DEL4-3T6L. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    The remaining intervention concerned service provision, which reported beneficial effects.

    “The remaining intervention concerned service provision [65], which reported beneficial effects.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [65] Bergman-Evans B: Beyond the basics. Effects of the Eden Alternative model on quality of life issues. Journal of Gerontological Nursing. 2004, 30: 27-34. source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Seven out of 12 studies (58%) that recruited explicitly targeted participants reported positive effects on outcomes compared with 16 out of 20 (80%) studies with no explicit targeting.

    “Seven out of 12 studies (58%) that recruited explicitly targeted participants reported positive effects on outcomes [13,56,67,71,75,78,79], compared with 16/20 (80%) studies with no explicit targeting [52-55,59,60,63,65,66,68-70,73,74,76,81].”
    Quote in the paperSubstantial claim0 of 10 sources checked
    • cites [13] Routasalo PE, Tilvis RS, Kautiainen H, Pitkala KH: Effects of psychosocial group rehabilitation on social functioning, loneliness and well-being of lonely, older people: randomized controlled trial. Journal of Advanced Nursing. 2009, 65: 297-306. 10.1111/j.1365-2648.2008.04837.x. source

      Not checked in the free run.

    • cites [56] Savelkoul M, de Witte LP: Mutual support groups in rheumatic diseases: Effects and participants' perceptions. Arthritis & Rheumatism. 2004, 51: 605-608. 10.1002/art.20538. source

      Not checked in the free run.

    • cites [67] Harris JE, Bodden JL: An activity group experience for disengaged elderly persons. Journal of Counseling Psychology. 1978, 25: 325-330. source

      Not checked in the free run.

    • cites [71] MacIntyre I, Corradetti P, Roberts J, Browne G, Watt S, Lane A: Pilot study of a visitor volunteer programme for community elderly people receiving home health care. Health and Social Care in the Community. 1999, 7: 225-232. 10.1046/j.1365-2524.1999.00178.x. source

      Not checked in the free run.

    • cites [75] Martina CM, Stevens NL: Breaking the cycle of loneliness? Psychological effects of a friendship enrichment program for older women. Aging & Mental Health. 2006, 10: 467-475. 10.1080/13607860600637893. source

      Not checked in the free run.

    • cites [78] Bogat G, Jason L: An evaluation of two visiting programs for elderly community residents. International Journal of Aging and Human Development. 1983, 17: 267-280. 10.2190/6AQX-1TDM-DEL4-3T6L. source

      Not checked in the free run.

    • cites [79] Fokkema T, Knipscheer K: Escape loneliness by going digital: a quantitative and qualitative evaluation of a Dutch experiment in using ECT to overcome loneliness among older adults. Aging & Mental Health. 2007, 11: 496-504. 10.1080/13607860701366129. source

      Not checked in the free run.

    • cites [52] Drentea P, Clay OJ, Roth DL, Mittelman MS: Predictors of improvement in social support: Five-year effects of a structured intervention for caregivers of spouses with Alzheimer's disease. Soc Sci Med. 2006, 63: 957-967. 10.1016/j.socscimed.2006.02.020. source

      Not checked in the free run.

    • cites [53] Toseland R, Rossiter C, Peak T, Smith G: Comparative effectiveness of individual and group interventions to support family caregivers. Social Work. 1990, 35: 209-217.

      Not checked in the free run.

    • cites [54] Toseland R, Smith G: Effectiveness of individual counseling by professional and peer helpers for family care-givers of the elderly. Psychology and Aging. 1990, 5: 256-263. source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    The majority of studies were conducted in either Scandinavia (n = 4), the Netherlands (n = 6) or the United States (n = 17), which limits generalisability to other countries.

    “In addition, the majority of studies were conducted in either Scandinavia (n = 4), the Netherlands (n = 6) or the United States (n = 17), which limits generalisability to other countries.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    While interventions targeting social isolation include some of the beneficial characteristics identified in this and previous systematic reviews, none appear to include all of them.

    “While interventions targeting social isolation include some of the beneficial characteristics identified in this and previous systematic reviews [5,40], none appear to include all of them.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [5] Cattan M, White M, Bond J, Learmouth A: Preventing social isolation and loneliness among older people: a systematic review of health promotion interventions. Ageing Soc. 2005, 25: 41-67. 10.1017/S0144686X04002594. source

      Not checked in the free run.

    • cites [40] Findlay R: Interventions to reduce social isolation amongst older people: where is the evidence?. Ageing Soc. 2003, 23: 647-658. 10.1017/S0144686X03001296. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Since the end of the search period (May 2009), new analysis of data derived from a study already included in the review has provided additional evidence suggesting beneficial effects for a psychosocial group intervention.

    “since the end of our search period (May 2009), new analysis [87] of data derived from a study already included in our review [13] has provided additional evidence suggesting beneficial effects for a psychosocial group intervention.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [87] Pitkala KH, Routasalo P, Kautiainen H, Tilvis RS: Effects of psychosocial group rehabilitation on health, use of health care services, and mortality of older persons suffering from loneliness: a randomized, controlled trial. J Gerontol A Biol Sci Med Sci. 2009, 64: 792-800. source

      Not checked in the free run.

    • cites [13] Routasalo PE, Tilvis RS, Kautiainen H, Pitkala KH: Effects of psychosocial group rehabilitation on social functioning, loneliness and well-being of lonely, older people: randomized controlled trial. Journal of Advanced Nursing. 2009, 65: 297-306. 10.1111/j.1365-2648.2008.04837.x. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The impact of social relationships on mortality risk is comparable with major risk factors such as smoking and alcohol consumption and exceeds that of physical inactivity and obesity.

    “the authors observed that the impact of social relationships on the risk of mortality is comparable with major, well-established risk factors such as smoking and alcohol consumption, and exceeds that of physical inactivity and obesity.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Holt-Lunstad J, Smith TB, Layton JB: Social relationships and mortality risk: a meta-analytic review. Public Library of Science Medicine. 2010, 7: e1000316-

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Loneliness is experienced by approximately 40% of older people.

    “The related, but distinct concept of loneliness is reported to be experienced by approximately 40% of this age group [32-34].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [32] Savikko N, Routasalo P, Tilvis RS, Strandberg TE, Pitkala KH: Predictors and subjective causes of loneliness in an aged population. Archives of Gerontology & Geriatrics. 2005, 41: 223-233. 10.1016/j.archger.2005.03.002. source

      Not checked in the free run.

    • cites [33] Steed L, Boldy D, Grenade L, Iredell H: The demographics of loneliness among older people in Perth, Western Australia. Australasian Journal on Ageing. 2007, 26: 81-86. 10.1111/j.1741-6612.2007.00221.x. source

      Not checked in the free run.

    • cites [34] Victor C, Scambler S, Bond J: The prevalence of, and risk factors for, loneliness in later life: a survey of older people in Great Britain. Ageing Soc. 2005, 25: 357-375. 10.1017/S0144686X04003332. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Risk factors for social isolation in older people include lack of access to private transport, minimal or no contact with friends and family, low morale, and living alone.

    “Risk factors for social isolation in older people include a lack of access to private transport, minimal or no contact with friends and family, low morale and living alone [26-28].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [26] Victor C, Scambler S, Bond J: Social exclusion and social isolation. The Social World of Older People: understanding loneliness and social isolation in later life. 2009, Maidenhead: Open University Press, 168-200.

      Not checked in the free run.

    • cites [27] Iliffe S, Kharicha K, Harari D, Swift C, Gillmann G, Stuck A: Health risk appraisal in older people 2: the implications for clinicians and commissioners of social isolation risk in older people. British Journal of General Practice. 2007, 57: 277-282. source

      Not checked in the free run.

    • cites [28] Barnes M, Blom A, Cox K, Lessof C, Walker A: The Social Exclusion of Older People: evidence from the first wave of the English Longitudinal Study of Ageing (ELSA). Final report. 2006, London

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Only two studies identified a primary outcome measure and only one study reported a sample size calculation.

    “Only two studies [62,70] identified a primary outcome measure and only one study [70] reported a sample size calculation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Study eligibility was assessed by two reviewers, with disagreements resolved by consensus.

    “Study eligibility for inclusion in the review was assessed by two reviewers (AD and SR or CG), with disagreements being resolved by consensus.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    The need to consider a broader range of participant outcomes, combined with the substantial body of research relating to social isolation published since 2002, supports the need for an updated review.

    “The need to consider a broader range of participant outcomes, combined with the substantial body of research relating to social isolation published since 2002, supports the need for an updated review.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Premisereasoning

    Given the lack of consensus regarding the definition of social isolation, previous reviews may not have identified all relevant intervention effects.

    “Given the lack of consensus regarding the definition of social isolation, previous reviews may not have identified all relevant intervention effects.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Ten of the 16 RCT studies were judged to be at moderate risk of bias, compared with only one of the 16 quasi-experimental studies.

    “Ten out of the 16 RCT studies included in this review were judged to be at moderate risk of bias [13,51,55-57,64,66,70-72] (Table 3), compared with only one of the 16 quasi-experimental studies [61] (Table 4).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductcitation

    In the volunteer reading study, follow-up assessments at 21 months were restricted to volunteers (37/67) participating in more than a few sessions every month, and to two outcomes of self-rated health and frequency of communication with children contacted through volunteer activities.

    “Follow-up assessments at 21 months were restricted to volunteers (37/67) participating in “more than a few sessions every month”, and to two outcomes of self-rated health and frequency of communication with children contacted through volunteer activities.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [74] Fujiwara Y, Sakuma N, Ohba H, Nishi M, Lee S, Watanabe N, Kousa Y, Yoshida H, Fukaya T, Yajima S, et al: REPRINTS: effects of an intergenerational health promotion program for older adults in Japan. Journal of Intergenerational Relationships. 2009, 7: 17-39. 10.1080/15350770802628901. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Additional articles were identified through citation tracking.

    “Additional articles were identified through citation tracking.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The quality of randomised and non-randomised studies was rated using the Cochrane risk of bias tool and the Newcastle-Ottawa Scale respectively.

    “The first reviewer (AD) rated the quality of randomised and non-randomised studies according to the Cochrane risk of bias tool and the Newcastle-Ottawa Scale respectively.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The systematic review was reported according to the PRISMA Statement.

    “The systematic review was reported according to the PRISMA Statement [50].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] Moher D, Liberati A, Tetzlaff J, Altman DG, the PRISMA Group: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009, 339: b2535-10.1136/bmj.b2535. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Twenty-two of the 32 included studies used validated outcome measures, and three studies used partially validated measures to assess the social health outcomes of loneliness, social isolation, structural social support or functional social support.

    “Twenty two out of the 32 included studies [13,51,55,56,58,59,62,63,65-68,71-77,79-81] used validated outcome measures, and three studies [52,57,64] used partially validated measures to assess the social health outcomes of loneliness, social isolation, structural social support or functional social support.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    The search strategy of the Masi et al review was relatively limited, combining six keywords on PubMed and PsycINFO, and may be insufficient to identify all relevant studies.

    “In addition, the search strategy was relatively limited (combining six keywords on PubMed and PsycINFO), and may be insufficient to identify all relevant studies.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    There is considerable academic debate regarding the appropriateness of meta-analysis in the context of clinical heterogeneity.

    “There is considerable academic debate regarding the appropriateness of meta-analysis in the context of such clinical heterogeneity [43,44].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [43] Deeks JJ, Higgins JPT, Altman DG: What is heterogeneity?. Cochrane Handbook for Systematic Reviews of Interventions. Edited by: Higgins JPT, Green S. 2009, 5.0.2

      Not checked in the free run.

    • cites [44] Petticrew M, Roberts H: Synthesizing the evidence. Systematic Reviews in the Social Sciences. 2006, Oxford: Blackwell Publishing, 164-214. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Nineteen of the 21 studies assessing mental health used validated outcome measures, and one used a partially validated measure.

    “Nineteen out of the 21 studies assessing mental health (depression or mental/psychological wellbeing) used validated outcome measures [51,53,54,56,58,59,61,62,64,66,68-70,72,73,75,76,80,81], and one [65] used a partially validated measure.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The review systematically searched relevant electronic databases for studies published before May 2009.

    “Relevant electronic databases (MEDLINE, EMBASE, ASSIA, IBSS, PsycINFO, PubMed, DARE, Social Care Online, the Cochrane Library and CINAHL) were systematically searched using an extensive search strategy, for randomised controlled trials and quasi-experimental studies published in English before May 2009.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Two independent reviewers extracted data using a standardised form or checklist.

    “Two independent reviewers extracted data using a standardised form.”
    • Also stated in: § Data extraction, analysis and synthesis · plain
      “Two reviewers (AD and SR or CG) independently extracted data from the eligible studies using a standardised checklist.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisereasoning

    The scope of the review by Masi et al differs and their results relating to loneliness do not fully address the effectiveness of interventions aimed at tackling social isolation.

    “Firstly, the scope of the review by Masi et al differs and their results - relating to the concept of loneliness - do not fully address the effectiveness of interventions aimed at tackling social isolation.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Common characteristics of effective interventions appeared to be development within the context of a theoretical basis and offering social activity and/or support within a group format.

    “However, it appeared that common characteristics of effective interventions were those developed within the context of a theoretical basis, and those offering social activity and/or support within a group format.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The intervention categories used in the review reliably distinguish meaningful differences in intervention characteristics.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    In the self-management group study, it was unclear whether the authors were reporting between-group or within-group results, so the data should be interpreted cautiously.

    “However, it was unclear whether the authors were reporting between-group or within-group results; hence the data should be interpreted cautiously.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [68] Kremers I, Steverink N, Albersnagel F, Slaets J: Improved self-management ability and well-being in older women after a short group intervention. Aging & Mental Health. 2006, 10: 476-484. 10.1080/13607860600841206. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    In the service provision study, there appeared to be large between-group differences in outcome scores at baseline, with a higher proportion of the control group being classified as lonely, helpless and bored.

    “Contrary to the authors' claims, there appeared to be large between-group differences in outcome scores at baseline, with a higher proportion of the control group being classified as lonely, helpless and bored.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [65] Bergman-Evans B: Beyond the basics. Effects of the Eden Alternative model on quality of life issues. Journal of Gerontological Nursing. 2004, 30: 27-34. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    It is not clear whether the analyses in the service provision study were adjusted for the apparent baseline differences, meaning that the results should be interpreted cautiously.

    “It is not clear whether the analyses were adjusted for the apparent baseline differences, meaning that the results should be interpreted cautiously.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [65] Bergman-Evans B: Beyond the basics. Effects of the Eden Alternative model on quality of life issues. Journal of Gerontological Nursing. 2004, 30: 27-34. source

      Not checked in the free run.

  • The quote only partly states this claim.

    Interpretationown data

    Interventions with a theoretical basis tend to be more beneficial than those without.

    “those defined as being theoretically-based tended to be more beneficial than those that were not.”
    • Also stated in: § Conclusions · hedged
      “common characteristics of effective interventions may include having a theoretical basis”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Possible explanations for the variability of effects according to intervention characteristics include the content of interventions and the methodological quality of studies.

    “Possible explanations for the variability of effects according to intervention characteristics include the content of interventions and the methodological quality of studies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The nature of the intervention provider appeared to be a factor on the basis of vote counting, but this should be interpreted cautiously due to the large number of providers identified and the small number of studies relating to each one.

    “While the nature of the intervention provider appeared to be a factor on the basis of vote counting, this should be interpreted cautiously due to the large number of providers identified and the small number of studies relating to each one.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The lack of consensus regarding the definition of social isolation had implications for both the identification of studies and the interpretation of reported findings.

    “The lack of consensus regarding the definition of social isolation had implications for both the identification of studies and the interpretation of reported findings.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    The use of a comprehensive search strategy and the inclusion of both randomised and quasi-experimental trial designs increased the number of papers reviewed, optimising the likelihood of including all relevant studies.

    “The use of a comprehensive search strategy and the inclusion of both randomised and quasi-experimental trial designs increased the number of papers reviewed, optimising our likelihood of including all relevant studies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Potentially relevant studies may not have been identified if authors did not use terms included in the search.

    “potentially relevant studies may not have been identified if authors did not use terms that we included.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Common characteristics of effective interventions may include having a theoretical basis, and offering social activity and/or support within a group format.

    “However, it appeared that common characteristics of effective interventions may include having a theoretical basis, and offering social activity and/or support within a group format.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    One explanation for the apparent lack of targeting may be the difficulty of measuring the concept of social isolation.

    “One explanation for this apparent lack of targeting may be the difficulty of measuring the concept of social isolation.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    While non-randomised studies are at increased risk of bias, there is an argument that poor quality RCTs may be lower value than well-conducted non-randomised controlled trials.

    “While we acknowledge that non-randomised studies are at increased risk of bias, there is an argument that poor quality RCTs may be lower value than well-conducted non-randomised controlled trials [88,89].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [88] Britton A, McKee M, Black N, McPherson K, Sanderson C, Bain C: Choosing between randomised and non-randomised studies: a systematic review. 1998, 13:

      Not checked in the free run.

    • cites [89] Petticrew M, Roberts H: Evidence, hierarchies, and typologies: horses for courses. J Epidemiol Community Health. 2003, 57: 527-529. 10.1136/jech.57.7.527. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    Extracting data for a greater number of outcomes than in previous reviews allowed the review to assess the wider effectiveness of interventions for reducing social isolation, as well as to look for evidence regarding their potential health benefits.

    “Extracting data for a greater number of outcomes than in previous reviews allowed us to assess the wider effectiveness of interventions for reducing social isolation, as well as to look for evidence regarding their potential health benefits”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The organisation of statutory and voluntary services differs between countries; hence the comparability of control groups is particularly difficult as 'usual care' may be country-specific.

    “The organisation of statutory and voluntary services differs between countries; hence the comparability of control groups is particularly difficult as 'usual care' may be country-specific.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The systematic review has identified a need for well-conducted studies to improve the evidence base regarding the effectiveness of social interventions for alleviating social isolation.

    “Our systematic review has identified a need for well-conducted studies to improve the evidence base regarding the effectiveness of social interventions for alleviating social isolation.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The decision to jointly present findings of randomised and non-randomised studies may be considered a limitation.

    “Our decision to jointly present findings of randomised and non-randomised studies may also be considered a limitation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Had the review adopted a uni-dimensional definition of social isolation (e.g. a lack of social integration), it may not have extracted functional social support outcome data; the absence of which may have influenced interpretation of the count data.

    “Had we adopted a uni-dimensional definition of social isolation (e.g. a lack of social integration) we may not have extracted functional social support outcome data; the absence of which may have influenced interpretation of the count data.”
    Quote in the paperNot a substantial claim
90 of 90

  • The paper relies on this without support.

    Vote-counting is a valid method for summarising and interpreting the effectiveness data in this review.

    “Narrative synthesis and vote-counting methods were used to summarise and interpret study data.”

  • The paper relies on this without support.

    The intervention categories used in the review reliably distinguish meaningful differences in intervention characteristics.

    “The studies were categorised as having a theoretical basis if they cited a specific theory underlying their intervention design, or reported that the intervention was based on a broad theoretical approach.”

  • The paper relies on this without support.

    The outcome measures across included studies are sufficiently comparable to be combined in vote-counting across the three domains.

    “Data relating to the outcome domains of social, mental and physical health were collected using both validated and non-validated outcome measures”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Three of six studies is not 75%

    Minor

    Three of six studies is 50%, not the reported 75%.

    Reported 75 · recomputed 50

  • Toseland group sizes fall short of the reported total

    Minor

    The three listed groups total 154 participants, not the reported 175.

    Reported 175 · recomputed 154

  • Slegers risk-of-bias rating conflicts with the stated rule

    Minor

    The stated rule assigns high risk when either prioritised domain is not addressed. Slegers is marked "No" for adequate sequence generation but rated "Moderate."

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 23

  1. United Nations: Profiles of ageing by country or area. World Population Ageing 2007. 2007, New York: United Nations, 133-517. · DOI
  2. United Nations: Magnitude and speed of population ageing. World Population Ageing 2007. 2007, New York: United Nations, 13-16. · DOI
  3. Jacobzone S, Cambois E, Chaplain E, Robine JM: The health of older persons in OECD countries: is it improving fast enough to compensate for population ageing?. 1999, Paris · DOI
  4. Hall M, Havens B: The effects of social isolation and loneliness on the health of older women. Research Bulletin, Centres of Excellence for Women's Health. 2001, 2: 6-7.
  5. Victor C, Scambler S, Bond J: Loneliness and social isolation: issues of theory and method. The Social World of Older People: understanding loneliness and social isolation in later life. 2009, Maidenhead: Open University Press, 31-80.
  6. Lubben J, Gironda M: Centrality of social ties to the health and well-being of older adults. Social Work and Health Care in an Aging World. Edited by: Berkman B, Harooytan LK. 2003, New York: Springer, 319-350.
  7. Victor C, Bowling A, Bond J, Scambler S: Loneliness, social isolation and living alone in later life. ESRC Growing Old Programme, Research Findings 17. 2003
  8. Weiss RS: Loneliness: the experience of emotional and social isolation. 1973, Massachusetts: Halliday Lithograph Corporation
  9. Victor C, Scambler S, Bond J: Social exclusion and social isolation. The Social World of Older People: understanding loneliness and social isolation in later life. 2009, Maidenhead: Open University Press, 168-200.
  10. Barnes M, Blom A, Cox K, Lessof C, Walker A: The Social Exclusion of Older People: evidence from the first wave of the English Longitudinal Study of Ageing (ELSA). Final report. 2006, London
  11. Tomaszewski W, Barnes M: Investigating the dynamics of social detachment in old age. Living in the 21st century: older people in England. The 2006 English Longitudinal Study of Ageing (wave 3). Edited by: Banks J, Breeze E, Lessof C, Nazroo J. 2008, London: Institute of Fiscal Studies, 150-185.
  12. Department of Work and Pensions: Link-Age: developing networks of services for older people. 2004, London
  13. Department of Health: Confident communities, brighter future. A framework for developing well-being. 2010, London
  14. Marmot Review: Fair society, healthy lives. The Marmot Review: executive summary. 2010, London
  15. Department of Work and Pensions: Opportunity age: meeting the challenges of ageing in the 21st century. 2005, London
  16. HM Government: Building a society for all ages. 2009, London
  17. Cattan M, White M: Developing evidence based health promotion for older people: a systematic review and survey of health promotion interventions targeting social isolation and loneliness among older people. Internet Journal of Health Promotion. 1998
  18. Centre for Reviews and Dissemination: Systematic reviews: CRD's guidance for undertaking reviews in health care. 2009, York: CRD, University of York
  19. Higgins JPT, Altman DG: The Cochrane Collaboration's tool for assessing risk of bias. Cochrane Handbook for Systematic Reviews of Interventions. Edited by: Higgins JPT, Green S. 2009, 5.0.2
  20. Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M, Tugwell P: Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analysis. 2009, [ http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm ]
  21. Bushman BJ: Vote-counting procedures in meta-analysis. The Handbook of Research Synthesis. Edited by: Cooper H, Hedges LV. 1984, New York: Russell Sage Foundation, 193-213.
  22. Woodward M: Confounding and interaction. Epidemiology: study design and data analysis. 1999, Florida: Chapman & Hall/CRC, 145-190.
  23. Craig D, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M: Developing and evaluating complex interventions: new guidance. 2008

Cited by

Sorted by citations

Authors
Dickens, A. P., Richards, S. H., Greaves, C. J., & Campbell, J. L.
Affiliations
University of Exeter (GB)
Corresponding author
Dickens, Andy P
ORCID
Venue
BMC Public Health
Publisher
Springer Science and Business Media LLC
Published
2011-08-15
Volume
11
Issue
1
Pages
647-647
ISSN
1471-2458 (ISSN-L)
DOI
10.1186/1471-2458-11-647
PMC
PMC3170621
OpenAlex
W1974179382
Semantic Scholar
f39862375ae30847d3b7d05f290516310fd13c14
Cited by
767
References
78
Citations by year
2026: 36 · 2025: 45 · 2024: 63 · 2023: 52 · 2022: 82 · 2021: 90 · 2020: 76 · 2019: 65 · 2018: 57 · 2017: 58 · 2016: 50 · 2015: 31 · 2014: 24 · 2013: 27 · 2012: 11
FWCI
3.58
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Public Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Open Research Exeter (University of Exeter) (publishedVersion, cc-by)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
Funders
  • National Institute for Health and Care Research
  • University of Exeter
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 › Aging, Elder Care, and Social Issues
Keywords
people, social isolation, loneliness, social intervention, group intervention, one-to-one intervention, participatory intervention, social activity, social support, home visiting, online intervention, intervention effectiveness, mental health, physical health, social health, population aging, public health policy, health disparities
MeSH terms
Aged, Humans, Loneliness, Middle Aged, Social Isolation, Randomized Controlled Trials as Topic

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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