The discrepancy between social isolation and loneliness as a clinically meaningful metric: findings from the Irish and English longitudinal studies of ageing (TILDA and ELSA)

The association between mental status, personality traits, and discrepancy in social isolation and perceived loneliness among community dwellers

BACKGROUND

Social isolation and loneliness can co-occur; however, they are distinct concepts. There is discrepancy as some people feel lonely in social isolation, while others do not. This study sought to enhance our understanding of this discrepancy between social isolation and loneliness by investigating its related factors, with a specific focus on mental status and personality traits.

METHODS

This study adopted a cross-sectional study design and utilized data from the 2016 and 2018 waves of the University of Michigan Health and Retirement Study. The participants were community dwellers aged 50 years and older. The outcome measurement was defined as the discrepancy between social isolation, based on six criteria, and loneliness, assessed using the three-item version of the Revised UCLA Loneliness Scale. Multinomial logistic regression models were conducted to examine the factors associated with the discrepancy.

RESULTS

Participants with fewer depressive symptoms and higher extraversion were associated with the only social isolation group and the only loneliness group rather than the group consisting of those who felt lonely with social isolation. In addition, lower neuroticism was associated with the only social isolation group. Participants with fewer depressive symptoms, lower neuroticism, and higher extraversion were more likely not to feel lonely even with social isolation, compared to feeling lonely even in the absence of isolation.

CONCLUSIONS

Mental status and personality traits may be closely related to the discrepancy between social isolation and loneliness. This study suggests that incorporating social, mental, and psychological factors may be essential for interventions in social isolation and loneliness.

How Do Discrepancies between Subjective and Objective Health Predict the Risk of Injurious Falls? A Study of Community-Dwelling Swedish Older Adults

OBJECTIVES

Previous studies demonstrated that discrepancies between subjective and objective health measures are associated with physical and mental health-related outcomes in older adults. We investigate whether such discrepancies are also associated with risk of injurious falls in community-dwelling Swedish older adults.

DESIGN

A prospective, observational cohort study.

SETTING AND PARTICIPANTS

Using data from the Swedish National Study on Aging and Care in Kungsholmen, we followed 2222 community-dwelling older adults aged ≥60 years at baseline, across a 10-year period of data collection (2001-2011).

METHODS

A "health asymmetry" metric classified older adults into 4 categories, based on the level of agreement between their subjective and objective health scores ("health pessimist", "health optimist", "poor health realist", and "good health realist"). Time-varying Cox proportional hazard and Laplace regressions were employed to investigate if these categories were associated with the risk of injurious falls.

RESULTS

Over a 10-year follow-up, 23.5% of the sample experienced an injurious fall. Health optimists had the greatest risk of experiencing an injurious fall [hazard ratio (HR) 2.16, 95% confidence interval (CI) 1.66, 2.80], compared with good health realists. Poor health realists (HR 1.77, 95% CI 1.50, 2.11) and health pessimists (HR 1.66, 95% CI 1.21, 2.29) also had an increased risk of experiencing injurious falls, compared with good health realists. Being a health pessimist was only associated with the risk of injurious falls within the younger-old (HR 2.43, 95% CI 1.63, 3.64) and among males (HR 1.95, 95% CI 1.14, 3.33).

CONCLUSIONS AND IMPLICATIONS

Older adults with similar objective health levels may differ in terms of their injurious fall risk, depending on their subjective health. Interpreting subjective health alongside objective health is clinically pertinent when assessing injurious fall risk.

Social Isolation, Loneliness, and Depressive Symptoms Among Older Adults: The Moderating Effect of Resilience

BACKGROUND AND OBJECTIVES

Social isolation has been recognized as a social problem with negative health consequences. Using data from 3 waves of the Health and Retirement Study, this study aimed to examine the long-term impact of social isolation on loneliness and depressive symptoms and to explore the moderating effect of resilience.

RESEARCH DESIGN AND METHODS

This study comprised 3,681 U.S. adults aged 60 and older at the baseline wave. Social isolation index was constructed using 5 indicators, including not married or cohabitating with a partner, no social participation, and less than monthly contacts with children, family members, or friends. Loneliness was measured by the University of California Los Angeles (UCLA) Loneliness Scale and depressive symptoms were measured by the Center for Epidemiological Studies-Depression scale. The moderator of resilience was assessed by the simplified resilience score. Latent growth curve models with robust standard errors were estimated.

RESULTS

The results of latent growth curve models showed that social isolation was significantly associated with more initial loneliness and depressive symptoms. However, social isolation was associated with a slower increasing rate of loneliness, but no significant relationship with the change rate of depressive symptoms. Furthermore, resilience significantly buffered the negative effect of social isolation on the initial level of depressive symptoms.

DISCUSSION AND IMPLICATIONS

The findings underscore the importance of enacting strategies and interventions targeting resilience to address social isolation and its negative consequences among older adults.

Narrating Loneliness: Isolation, Disaffection, and the Contemporary Novel

This article focuses on the ways in which narrative accounts of loneliness in literature problematize current definitions of this important and yet underexplored determinant of health. I argue that the prevailing conceptualization of loneliness in health research, with a general emphasis on social prescribing, obscures other dimensions of loneliness beyond social connectedness that also need to be accounted for in its definition. Drawing on narrative approaches to health and care and taking as a case study Santiago Lorenzo's Spanish novel Los asquerosos (2018), the article gestures toward a more political-rather than exclusively subjective and relational-reading of loneliness. It shows how the novel's exploration of loneliness as an ambivalent experience of tranquility and disaffection questions whether there is any direct causation between loneliness and aloneness or social isolation, presenting loneliness not so much as a problem or a social pain in need of curing, but as a symptom of a larger structural crisis. The article also reflects on the ability of literary narratives to illuminate, discuss, and ultimately challenge the underlying dynamics of loneliness, raising questions about how we understand these narratives and the type of agency we attribute to them.

Association between loneliness and mild cognitive impairment in older adults: a meta-analysis of longitudinal studies

OBJECTIVES

Prior studies reporting the effects of loneliness on mild impairment cognitive (MCI) have generated inconsistent results. This meta-analysis aimed to investigate the longitudinal association between loneliness and risk of MCI among community-dwelling middle-aged and older adults.

METHOD

Five electronic databases were searched from inception to 9 May 2023. Eligible studies examined the longitudinal association between loneliness and cognitive outcomes, including incident MCI, cognitive impairment, and cognitive decline. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated using random-effects or fixed-effects meta-analysis. Sensitivity analysis and subgroup analysis were conducted. Publication bias was examined using Egger's and Begg tests.

RESULTS

Eight studies were included. Among the 45,032 participants, 10,570 were diagnosed with MCI/cognitive decline. Loneliness was positively associated with an increased risk of MCI (overall OR = 1.14; 95% CI = 1.05, 1.23), with moderate heterogeneity (I2 = 44.2%). Sensitivity analysis have minimal influence on the aforementioned pooled effect. Subgroup analyses indicated stronger associations in studies which employed incident MCI as cognitive outcome (OR = 2.55, 95%CI = 1.31, 1.83), were conducted in non-Asia countries (OR = 1.52, 95%CI = 0.95, 1.20), and reported no depression adjustment (OR = 1.51, 95%CI = 1.04, 1.25). The association between loneliness and MCI was stronger among males compare to females. The Egger test and Begg test showed no evidence of significant publication bias (p = .493; p = .474).

CONCLUSION

The findings indicated that loneliness was associated with an increased risk of MCI. Future longitudinal studies should evaluate potential cases of MCI through comprehensive clinical assessments by practitioners to draw robust findings on the association of loneliness with MCI.

Social isolation and cognitive function in patients with schizophrenia: A two years follow-up study

Cognitive impairment is a core characteristic of schizophrenia. Social isolation has been linked to impaired cognitive function among the general population. In this longitudinal study, we examined the association between social isolation and cognitive function among inpatients with schizophrenia. Two waves of data (2019 and 2021) were collected from chronic psychiatric wards. A total of 166 inpatients completed all measurements at baseline and follow-up. Social isolation was measured by incorporating the frequency of social contact and participation, while cognitive functions were assessed by the Taiwan version of the Montreal Cognitive Assessment (MoCA-T). We used multiple linear regression to evaluate the link between baseline social isolation and cognitive function. For the total sample, social isolation was significantly related to poor language abilities (β = -0.17, p = 0.013) and delayed recall (β = -0.15, p = 0.023). Sex-stratified analysis showed that social isolation was significantly related to poor global cognitive function (β = -0.14, p = 0.021) and domain-specific cognitive functions including language abilities (β = -0.26, p = 0.003) and delayed recall (β = -0.19, p = 0.045) in male inpatients. No significant association was found between social isolation and global cognitive function or any cognitive domain (all ps > 0.05) for females. All associations were independent of loneliness and other covariates. These findings suggested that social isolation could predict poor subsequent cognitive function in inpatients with schizophrenia, especially in males. Interventions aimed at enhancing social connections could potentially improve cognitive function in this population.

Predictive factors and risk and protection groups for loneliness in older adults: a population-based study

BACKGROUND

Loneliness is considered a public health problem, particularly among older adults. Although risk factors for loneliness have been studied extensively, fewer studies have focused on the protected and risk groups that these factors configure. Our objective is to analyze the variables and latent factors that predict loneliness in older adults and that enable risk and protected groups to be configured.

METHODS

We employed an epidemiological, cross-sectional survey that was carried out on a random sample of 2060 people over 65 years extracted from the census. A structured telephone interview was used to assess mental and physical health, habits, quality of life, and loneliness, applying the COOP-Wonca, Goldberg General Health (GHQ-12), and Barber Questionnaires.

RESULTS

Predictors of loneliness were: mental health, living alone, quality of life, depressive symptoms, low educational level, and some deficiency situations such as having no one to turn to for help. The factors extracted (Factorial Analysis) were: a subjective experience of poor health, objective isolation, and psychological isolation. We established at risk and protected groups ("Decision Tree" procedure), and loneliness was referred to by 73.2% of the people living alone and with poor mental health and quality of life (risk group). By contrast, only 0.8% of people living with others, with good mental health and good quality of life felt loneliness (protected group).

CONCLUSION

In a well-developed city, subjective and objective factors are associated with loneliness. These factors, especially those associated with at risk or protected groups, must be considered to develop strategies that address loneliness.

General self-efficacy, not musculoskeletal health, was associated with social isolation and loneliness in older adults during the COVID-19 pandemic: findings from the Hertfordshire Cohort Study

BACKGROUND

Social isolation and loneliness are prevalent among older adults. This study investigated factors influencing worsening social isolation and loneliness in community-dwelling older adults during the COVID-19 pandemic, focusing on musculoskeletal conditions, falls, and fractures.

METHODS

We studied 153 participants from the Hertfordshire Cohort Study. Baseline assessments (2019-20) included osteoporosis, clinical osteoarthritis, fractures after age 45 years, falls in previous year, and lifestyle factors. Self-efficacy was assessed using a shortened General Self-Efficacy Scale. Social isolation was assessed using the 6-item Lubben Social Network Scale. Follow-up (2020-21) assessments included social isolation and loneliness using the 6-item De Jong-Gierveld scale for emotional, social, and overall loneliness.

RESULTS

Baseline median age was 83.1 years. A history of smoking predicted worsening social isolation (p = 0.046). Being married (p = 0.026) and higher self-efficacy scores (p = 0.03) predicted reduced social isolation at follow-up. Greater alcohol consumption was associated with higher overall loneliness (p = 0.026). Being married was related to a 36% (95% CI: 3%, 58%) reduction in emotional loneliness (p = 0.037). No musculoskeletal condition was associated with social isolation or loneliness. However, we observed a 22% (14%, 30%; p < 0.001) reduction in emotional loneliness and a 12% (4%, 20%; p = 0.003) reduction in overall loneliness per unit increase in self-efficacy score.

CONCLUSIONS

No musculoskeletal condition was associated with increased social isolation or loneliness, but longitudinal studies in larger samples are required. Greater self-efficacy was associated with reduced social isolation and reduced loneliness. Interventions promoting self-efficacy in older adults may reduce isolation and loneliness in this age group.

Attitudes toward COVID-19 restrictions and COVID-19-related stress and fear among college students across three waves

Background and Aims

The COVID-19 pandemic has significantly impacted the mental health of college students, leading to increased psychological distress. This study explored potenital predictors to better understand the factors that influence and mitigate student COVID-19 stress in the evolving landscape of residential colleges. Specifically, we investigated the roles of COVID-19 fear, loneliness, and attitudes toward COVID-19 restrictions.

Methods

Employing a longitudinal online survey design, we collected data over the fall 2020 semester from 122 first-year college students enrolled in a small mid-west liberal arts college. Participants completed the same survey three times: Wave 1 in August, Wave 2 in October, and Wave 3 in November.

Results

Fear of COVID-19 (Time 1) was a significant predictor of increased COVID-19 related stress at both Time 2 and Time 3. Interestingly, loneliness (Time 1) moderated the effect of fear of COVID-19 (Time 1) on attitudes toward COVID-19 restrictions at Time 2. Moreover, students' negative attitudes toward COVID-19 restrictions and feelings of loneliness increased over the course of the semester.

Conclusions

These findings suggest that college students' wellbeing in the context of COVID-19 stress is influenced by a complex interplay of perceptions of COVID-19 (stress, fear, attitudes) and feelings of social isolation (loneliness). Further research in this area is crucial to provide targeted support and interventions to promote students' mental health.

Later-life depressive symptoms during the Covid-19 pandemic: Investigations of individual, cumulative, and synergistic effects of social isolation

OBJECTIVES

This study examines associations between social isolation and depressive symptoms among Hong Kong Chinese adults aged 65 and older by investigating the distinct effects of individual indicators, cumulative index, and typologies of social isolation during the Covid-19 pandemic.

METHODS

We used a sample of 260 older adults from a cross-sectional, city-wide online survey targeting 1,109 aged 45+ adults through purposive sampling. Seven indicators of social isolation (not married; living alone; not engaging in social/organizational activities; no social contact with friends or families; lack of family and friends networks; loneliness) using Cornwell & Waite's framework were selected to construct three unique types of social isolation measures. We used latent class analysis (LCA) and regression models to examine the effects of varied typologies of social isolation on depressive symptoms.

RESULTS

Individual model of social isolation showed that lack of social contact and feeling lonely were significant predictors of depressive symptoms. A strong linear-trend gradient effect of cumulative social isolation on depressive symptoms was also observed. The LCA model identified four typologies of social isolation (socially isolated; living alone but socially engaged; married but lacking social ties, and not socially isolated); those in the 'socially isolated' and 'married but lacking social ties' groups had the most depressive symptoms.

CONCLUSION

Three operationalizations of social isolation demonstrated different utilities and implications in assessing the impacts of social isolation on depressive symptoms. Social contacts and loneliness, rather than living status or other characteristics of isolation, were the factors most strongly associated with depressive symptoms. Support programs should target lonely older adults who lack social engagement opportunities, as they are at increased risk of depression.

The role of loneliness in the association between chronic physical illness and depressive symptoms among older adults: A prospective cohort study

BACKGROUND

Chronic physical illness increases the risk of subsequent depressive symptoms, but we know little about the mechanisms underlying this association that interventions can target. We investigated whether loneliness might explain associations between chronic illness and subsequent depressive symptoms.

METHODS

We used English Longitudinal Study of Ageing data, a prospective cohort of adults over 50. Our exposure was chronic illnesses (wave two) including arthritis, cancer, diabetes, cardiovascular disease, stroke, and chronic obstructive pulmonary disease. Loneliness scores were a mediator on the short University of California, Los Angeles Loneliness Scale at wave three. Depressive symptom scores (outcome) were measured using the Centre for Epidemiologic Studies Depression Scale (wave four). We examined associations of chronic physical illness with loneliness and depressive symptoms in univariable and multivariable regression models.

RESULTS

Fully-adjusted models included 2436 participants with the depression outcome and 2052 participants with the loneliness outcome. Chronic physical illness was associated with 21 % (incident rate ratio = 1.21, 95%CI = 1.03-1.42) higher depression scores at follow-up. We found no evidence of an association between chronic physical illness and loneliness and therefore did not proceed to analyses of mediation.

LIMITATIONS

More prevalent chronic illnesses could have driven our results, such as cardiovascular disease.

CONCLUSIONS

Chronic physical illnesses increase the risk of depressive symptoms in older adults. However, we did not find any that chronic physical illnesses were associated with an increased risk of subsequent loneliness. Therefore, interventions targeting loneliness to reduce depression in older adults with chronic physical illness may be insufficient.

Social Isolation, Loneliness, and Cognitive Performance in Older Adults: Evidence From the ELSI-Brazil Study

BACKGROUND

The association between social isolation and cognitive performance has been less investigated in low-to-middle-income countries (LMIC) and the presence of depression as a moderator on this association has not been examined. The authors examined the associations of social isolation and perceived loneliness with cognitive performance in the Brazilian Longitudinal Study of Aging.

METHODS

In this cross-sectional analysis, social isolation was evaluated by a composite score including marital status, social contact, and social support. The dependent variable was global cognitive performance, which considered memory, verbal fluency, and temporal orientation tests. Linear and logistic regressions were adjusted for sociodemographic and clinical variables. The authors added interaction terms of depressive symptoms with social isolation and loneliness to examine whether depression, measured through the Center for Epidemiologic Studies-Depression Scale, modified these associations.

RESULTS

Among 6,986 participants (mean age = 62.1 ± 9.2 years), higher levels of social connections were associated with better global cognitive performance (B = 0.02, 95%CI: 0.02; 0.04). Perceived loneliness was associated with worse cognition (B = -0.26, 95%CI = -0.34; -0.18). Interactions of depressive symptoms with social connections scores were found on memory z-score and with loneliness on global and memory z-scores, suggesting a weaker association between social isolation or loneliness and cognition among those with depressive symptoms.

CONCLUSION

In a large sample from an LMIC, social isolation and loneliness were associated with worse cognitive performance. Surprisingly, depressive symptoms decrease the strength of these associations. Future longitudinal studies are important to assess the direction of the association between social isolation and cognitive performance.

Associations of social isolation and loneliness with the onset of insomnia symptoms among middle-aged and older adults in the United States: A population-based cohort study

There is an inconsistent conclusion regarding the relationship of social isolation and loneliness with poor sleep. We investigated the associations of social isolation and loneliness with new-onset insomnia symptoms in a nationally-representative sample of 9,430 adults aged ≥50 who were free of any insomnia symptoms/sleep disorders at baseline (wave 12/13) and followed up to 4 years from the Health and Retirement Study. Social isolation was measured by Steptoe's Social Isolation Index. Loneliness was measured by the revised 3-item UCLA-Loneliness Scale. Insomnia symptoms were quantified using the modified Jenkins Sleep Questionnaire. During a mean follow-up of 3.52 years, 1,522 (16.1%) participants developed at least one insomnia symptom. Cox models showed that loneliness was associated with the onset of difficulties initiating or maintaining sleep, early-morning awakening, nonrestorative sleep, and at least one of these symptoms after adjusting for potential covariates; while social isolation was not associated with the onset of difficulties maintaining sleep, early-morning awakening, or at least one insomnia symptom after adjusting for health indicators. These results are consistent in sensitivity analyses and stratified analyses by age, sex, race/ethnicity, and obesity. Public health interventions aimed at fostering close emotional relationships may reduce the burden of poor sleep among middle-aged and older adults.

Social Isolation/Loneliness and Tooth Loss in Community-Dwelling Older Adults: The Sukagawa Study

Background and Objectives

The relationship between social isolation/loneliness and oral health is unclear. This study investigated the association between social isolation/loneliness and tooth loss in older Japanese adults.

Research Design and Methods

This was a cross-sectional study of a population-based cohort (the Sukagawa Study); 5,490 cohort study participants aged ≥75 years and who were independent answered a self-administered questionnaire in 2018. Social isolation was defined based on the 6-item Japanese version of the Lubben Social Network Scale. Loneliness was measured by the 3-item Japanese version of the University of California, Los Angeles (UCLA) Loneliness Scale version 3. The primary outcome was tooth loss, defined as having fewer than 20 teeth. The secondary outcomes were decreased toothbrushing frequency and diminished ability to chew food. Prevalence ratios (PRs) were estimated using a modified Poisson regression analysis in 2 models-Model 1, which adjusted for age, gender, smoking status, alcohol consumption, low annual income, and short education period, and Model 2, which added history of depression, history of diabetes mellitus, history of stroke, and cognitive impairment to Model 1.

Results

The primary analysis included 4,645 participants. Adjusted PRs of social isolation and loneliness for tooth loss (Model 1) were 0.97 (95% confidence interval [CI] 0.92-1.01) and 1.06 (95% CI 1.01-1.12), respectively; those for decreased toothbrushing frequency were 1.13 (95% CI 0.95-1.36) and 1.56 (95% CI 1.26-1.92), respectively; and those for chewing difficulty were 1.61 (95% CI 1.06-2.43) and 2.94 (95% CI 1.91-4.53), respectively. The adjusted PRs in Model 2 demonstrated results similar to that of Model 1.

Discussion and Implications

Loneliness is associated with tooth loss among older adults, whereas social isolation is not. Our findings can inform plans for policymakers, professionals, and organizations to identify lonely older adults and provide social prescriptions to improve their access to oral health care services.

The Mediating Role of Social Participation in Motoric Cognitive Risk and its Relation to Depression and Loneliness in Older Adults

BACKGROUND

Motoric cognitive risk syndrome (MCR) reduces the quality of life, independence, and social interaction in older adults. Social participation is a potentially modifiable factor that benefits cognitive and mental health. This study explored the mediating roles of social participation between MCR and depression and between MCR and loneliness.

METHODS

We performed a secondary analysis of data from the 2015-2016 National Social Life, Health, and Aging Project. Slow gait speed and cognitive decline were used to assess MCR. Mediation analysis was applied to two models, both of which used MCR as an exposure and social participation as a mediator. The outcomes were depression and loneliness for each model, respectively.

RESULTS

Among 1,697 older adults, 196 (11.6%) had MCR. The mediating role of social participation was statistically significant in both models. The indirect effect (β=0.267, p=0.001) of MCR on depression through social participation comprised 11.97% of the total effect (β=2.231, p&lt;0.001). The indirect effect (β=0.098, p=0.001) of MCR on loneliness through social participation was 19.48% of the total effect (β=0.503, p&lt;0.001).

CONCLUSION

Interventions to increase social participation may reduce depression and loneliness of older adults with MCR.

Effects of non-pharmacological interventions on loneliness among community-dwelling older adults: A systematic review, network meta-analysis, and meta-regression

BACKGROUND

The highly prevalent late-life loneliness, together with its deleterious health impacts, calls for increasing attention to the need for effective interventions targeting on this growing public health problem. With the increasing evidence on interventions for combating loneliness, it is timely to identify their comparative effectiveness.

OBJECTIVE

This systematic review, meta-analysis and network meta-analysis was to identify and compare the effects of various non-pharmacological interventions on loneliness in community-dwelling older adults.

METHODS

Systematic search was conducted in nine electronic databases from inception to 30th March 2023 for studies investigating the effects of non-pharmacological interventions on loneliness among community-dwelling older adults. The interventions were categorized according to the nature and purpose of use. Pairwise meta-analysis and network meta-analyses were sequentially performed to identify the effects of each category of interventions and their comparative intervention effectiveness, respectively. Meta-regression was performed to examine any influence of study design and participants' characteristics on the intervention effectiveness. The study protocol was registered at PROSPERO (CRD42022307621).

RESULTS

A total of 60 studies with 13,295 participants were included. The interventions were categorized as psychological interventions, social support interventions (by digital and non-digital means), behavioral activation, exercise intervention with and without social engagement, multi-component intervention and health promotion. Pairwise meta-analysis identified the positive effect of psychological interventions (Hedges' g = -2.33; 95%CI [-4.40, -0.25]; Z = -2.20, p = 0.003), non-digital social support interventions (Hedges' g = -0.63; 95%CI [-1.16, -0.10]; Z = 2.33, p = 0.02) and multi-component interventions (Hedges' g = -0.28 95%CI [-0.54, -0.03]; Z = -2.15, p = 0.03) on reducing loneliness. Subgroup analysis provided additional insights: i) social support and exercise interventions which integrated active strategies to optimize the social engagement demonstrated more promising intervention effects; ii) behavioral activation and multicomponent interventions worked better for older adults who were male or reported loneliness, respectively, and iii) counseling-based psychological interventions was more effective than mind-body practice. Network meta-analysis consistently pointed to the greatest therapeutic benefits of psychological interventions, and this was followed by exercise-based interventions, non-digital social support interventions and behavioral activation. Meta-regression further suggested that the therapeutic effects of the tested interventions were independent of the various factors relating to study design and participants' characteristics.

CONCLUSIONS

This review highlights the more superior effects of psychological interventions in improving loneliness among older adults. Interventions which have an attribute to optimize social dynamic and connectivity may also be effective.

TWEETABLE ABSTRACT

Psychological intervention is the best to beat late-life loneliness, but increasing social dynamic and connectivity may add an impact.

Social isolation, loneliness and accelerated tooth loss among Chinese older adults: A longitudinal study

OBJECTIVE

Social isolation and loneliness have been linked to numerous determinants of health and well-being. However, the effects of social isolation and loneliness on oral health remain unclear. The purpose of this study was to examine the effects of social isolation and loneliness on the number of remaining teeth and the rate of tooth loss over time among Chinese older adults.

METHODS

We used three waves of data (2011/2012, 2014 and 2018) from the Chinese Longitudinal Healthy Longevity Survey with 4268 older adults aged 65 and older who were interviewed in at least two waves. The number of remaining teeth was first evaluated at baseline and then subsequently at follow-up visits. Mixed-effects Poisson regression was used to examine the associations between social isolation, loneliness, and both the number of remaining teeth and the rate of tooth loss.

RESULTS

Social isolation was associated with fewer remaining teeth (β = -.06, 95% CI = -0.13 to 0.00, p < .05) and accelerated tooth loss (β = -.02, 95% CI = -0.02 to -0.01, p < .01) after adjusting for sociodemographic covariates, lifestyle and oral hygiene behaviours, physical and cognitive health, and loneliness. Loneliness was neither associated with the number of remaining teeth (β = .15, 95% CI = -0.01 to 0.30, p = .06) nor with the rate of tooth loss (β = -.01, 95% CI = -0.02 to 0.00, p = .16) after adjusting for all other factors.

CONCLUSIONS

This study provides strong evidence that social isolation was associated with fewer remaining teeth and accelerated tooth loss among Chinese older adults. These findings expand our knowledge about the impact of social disconnection on tooth loss. More future studies are needed to further examine the associations between social connections and oral conditions using longitudinal cohort studies and intervention studies.

The relationship between social isolation, social support, and loneliness with cardiovascular disease and shared risk factors: A narrative review

BACKGROUND

Cardiovascular disease (CVD) is the greatest contributor to global morbidity and mortality. Poor social health plays a critical role in CVD incidence. Additionally, the relationship between social health and CVD may be mediated through CVD risk factors. However, the underlying mechanisms between social health and CVD are poorly understood. Certain social health constructs (social isolation, low social support and loneliness) have complicated the characterisation of a causal relationship between social health and CVD.

AIM

To provide an overview of the relationship between social health and CVD (and its shared risk factors).

METHOD

In this narrative review, we examined published literature on the relationship between three social health constructs (social isolation, social support, and loneliness) and CVD. Evidence was synthesised in a narrative format, focusing on the potential ways in which social health affects CVD, including shared risk factors.

RESULTS

The current literature highlights an established relationship between social health and CVD with a likelihood for bi-directionality. However, there is speculation and varied evidence regarding how these relationships may be mediated through CVD risk factors.

CONCLUSIONS

Social health can be considered an established risk factor for CVD. However, the potential bi-directional pathways of social health with CVD risk factors are less established. Further research is needed to understand whether targeting certain constructs of social health may directly improve the management of CVD risk factors. Given the health and economic burdens of poor social health and CVD, improvements to addressing or preventing these interrelated health conditions would have societal benefits.

Within-Person Dynamics of Objective and Subjective Social Isolation in Midlife and Later Life

ObjectivesTo investigate the within-person dynamics of objective and subjective social isolation among U.S. middle-aged and older adults and to explore gender differences in this relationship. Methods: Four waves of data from the Health and Retirement Study (HRS, 2006-2018, N = 5437) and the multiple group random intercept cross-lagged panel model were used. Results: Within-person deviation in expected subjective isolation predicted deviation in expected objective isolation years later. No corresponding cross-lagged effect of objective isolation on subjective isolation was found. Gender differences were detected: the within-person cross-lagged positive effect of subjective isolation on objective isolation was significant for men but not for women. Discussion: This study provides evidence for a unidirectional relationship between subjective and objective isolation at the within-person level: higher than expected increase in subjective isolation predicts higher than expected increase in subsequent objective isolation. This within-person process is more salient in men than in women.

Health asymmetry as a predictor of depressive symptomatology over time among older European adults: A growth curve analysis

OBJECTIVE

Subjective (SH) and objective health (OH) measures are associated with depressive symptomatology in older adults. We explored whether the discrepancy between SH and OH (operationalised as 'health asymmetry' with four categories: 'health optimistic', 'health pessimistic' and 'good health realistic' and 'poor health realistic') may also relate to depressive symptomatology 1) cross-sectionally, and 2) longitudinally, among older European adults.

METHODS

Adults (n = 26,520), aged 50+, from 11 European countries, were assessed over six waves of data collection (2006-2020) in the SHARE study. A hierarchical multi-level growth curve model explored whether health asymmetry was associated with depressive symptomology at baseline, and with depressive symptom trajectories across time, accounting for country of origin.

RESULTS

At baseline, 11.8% of older adults were classified as health pessimistic, with 15.5% being health optimistic, 42.9% being poor health realistic and 29.8% being good health realistic. A positive linear trend in depressive symptomatology was noted across 14 years of SHARE data (β = 0.11, p < .001). Health pessimists displayed higher levels of depressive symptoms than both health realistic groups and health optimists. However, health pessimists experienced a less steep increase in depressive symptoms across time (β = -0.10, p < .001), relative to good health realists.

CONCLUSION

Health pessimists experience elevated levels of depressive symptoms, but show less growth in depressive symptomatology than expected. Further research is required to understand the underlying causes of the varying depressive symptom trajectories among these groups.

Association of loneliness and social isolation with all-cause mortality among older Mexican adults in the Mexican health and aging study: a retrospective observational study

BACKGROUND

Plenty of evidence shows how social isolation and loneliness are associated with increased risk for numerous diseases and mortality. But findings about their interactive or combined effects on health outcomes and mortality remains inconclusive.

OBJECTIVE

Analyze the longitudinal association of loneliness, social isolation and their interactions, with the all-cause mortality among older adults in Mexico.

METHODS

A retrospective observational study was conducted. Mexican adults older than 50 years were included. Data from the Mexican Health and Aging Study (MHAS) in the 2015 and 2018 waves were used. The subjects were classified according to their level of loneliness and the presence of social isolation. Multivariate logistic regression analyzes were performed to determine the degree of association between loneliness and social isolation with all-cause mortality at a 3-year follow-up.

RESULTS

From the total sample of 11,713 adults aged 50 years or over, 707 (6%) did not survive, 42% presented loneliness, and 53% were classified as socially isolated. After multivariate adjustment only social isolation (OR = 1.30, 95%CI:1.03-1.64) was associated with all-cause mortality, loneliness (Mild: OR = 0.83, 95%CI:0.59-1.16; Severe: OR = 1.03, 95%CI:0.71-1.64), and the interaction between loneliness and social isolation were not associated with all-cause mortality.

CONCLUSION

Social isolation, but not loneliness or their interaction, was associated with all-cause mortality in Mexican adults older than 50 years. This finding may help direct possible future interventions that help improve mental health in older adults from a highly collectivistic country.

Loneliness, Social Isolation, and Living Alone Associations With Mortality Risk in Individuals Living With Cardiovascular Disease: A Systematic Review, Meta-Analysis, and Meta-Regression

OBJECTIVE

This study aimed to conduct a systematic review and meta-analysis of associations between loneliness, social isolation, and living alone and risk of mortality among individuals with established cardiovascular disease.

METHODS

Five electronic databases were searched (MEDLINE [Ovid], PsycINFO, EMBASE, PubMed, and SCOPUS) from inception to November 25, 2021. In all, 35 studies were included in a narrative synthesis and, where appropriate, a meta-analytic evaluation using a random-effects model.

RESULTS

Living alone was associated with increased risk of all-cause mortality ( k = 15, n = 80,243, hazard ratio [HR] = 1.48, 95% confidence interval [CI] = 1.20-1.83, I2 = 83%), and meta-regressions found that the effects were stronger in studies from Europe and with longer follow-up. However, there was evidence of publication bias. Social isolation was associated with increased risk of all-cause mortality, measured both as a dichotomous variable ( k = 3, n = 2648, HR = 1.46, 95% CI = 1.08-2.04, I2 = 31%) and as a continuous variable ( k = 5, n = 2388, HR = 1.11, 95% CI = 1.02-1.24, I2 = 51%). Meta-analysis was not feasible for loneliness as exposure, but narrative synthesis of four studies suggested a tentative association between loneliness and increased risk of all-cause mortality.

CONCLUSIONS

Supporting public health concerns, our review finds that loneliness, social isolation, and living alone are associated with premature mortality among individuals with established cardiovascular disease. However, evidence of publication bias and large methodological differences across studies point to the need for more rigorous research.

Are social isolation and loneliness associated with cognitive decline in ageing?

Objective

Social isolation and loneliness are associated with poor health (immunity, inflammation, etc.) in ageing. The purpose of this scoping review was to investigate the link between social isolation, loneliness (as distinct constructs, in contrast to previous published work) and cognition in cognitively healthy older adults.

Method

We followed PRISMA-ScR guidelines. Our search, conducted between January 2017 and April 2021, yielded 2,673 articles, of which, twelve longitudinal studies were finally identified as meeting the inclusion criteria. Multiple cognitive functions (short-term and episodic memory, attention, and global cognitive functioning) were measured.

Results

The results showed that both social isolation and loneliness were associated with poor cognition in ageing, with depression as a possible mediator between loneliness and poor cognition. Some studies also suggested that the link between social isolation, loneliness and cognitive decline may be bidirectional.

Conclusion

We conclude that both social isolation and loneliness may have a different impact on cognition. While depression may be an important mediator between loneliness and cognitive decline, the lack of cognitive stimulation may be a greater mediator between social isolation and cognitive health.

'Those whom I have to talk to, I can't talk to': Perceived social isolation in the context of anxiety symptoms among pregnant women in Pakistan

Anxiety during pregnancy is highly prevalent in low- and middle-income countries. The relative importance of different sources and types of perceived support in the Pakistani context is unknown. We explored social support during pregnancy and the role of social isolation in Pakistani women's experiences of antenatal anxiety. We conducted semi-structured interviews with 19 pregnant women with symptoms of anxiety and 10 female healthcare providers at a public urban hospital. We used inductive and deductive thematic coding to analyse the data. Many pregnant women reported feelings of physical and social isolation, even when living in joint families with larger social networks. Often fearing censure by their in-laws and peers for sharing or seeking help with pregnancy-related anxieties, women reported relying on husbands or natal family members. Normative expectations around pregnancy such as male gender preference, perceived immutability of wives' domestic responsibilities and expectations of accompanied travel by women may serve as sources of disconnectedness in the antenatal period. Providers viewed social isolation and deficits in social support during pregnancy as contributing to worse anxiety symptoms, reduced access to care and poorer health behaviours. One limitation is that the hospital setting for this study may have resulted in underreporting of abuse or neglect and limited inclusion of pregnant women who do not utilise facility-based antenatal care. In conclusion, husbands and natal families were key in reducing social isolation in pregnancy and mitigating anxiety, while in-laws did not always confer support. Targeted strategies should enhance existing support and strengthen in-law family relationships in pregnancy.

Loneliness is associated with maladaptive schema modes in patients with persistent depressive disorder

OBJECTIVES

Though loneliness represents a public health concern, this complex unpleasant feeling is commonly neglected in psychiatric care and may constitute a new treatment target in clinical groups particularly prone to feeling lonely and socially isolated, e.g., persistent depressive disorder (PDD). Schema modes encompass a set of distinct cognitive-affective patterns that may contribute to loneliness and social isolation. Aim of this study was to examine the interplay between subjective loneliness and objective social network size with schema modes in patients with PDD as well as healthy controls (HC).

METHOD

Sixty-two PDD patients (DSM-5; 35 female, M_age = 40.5, SD = 12.4) and 71 HC (60 female, M_age = 28.1, SD = 10.1) were assessed cross-sectionally using the following self-report measures: UCLA Loneliness Scale, Social Network Index (SNI), and Schema-Mode-Inventory, revised version (SMI-r). Correlational and multiple linear regression analyses were performed.

RESULTS

PDD patients reported significantly higher scores of loneliness and maladaptive schema modes and a smaller social network than HC. Loneliness was significantly positively associated with the modes Vulnerable Child, Detached Protector, Bully and Attack, and Punitive Parent, and negatively with Contented Child and Healthy Adult in both groups. In contrast, social network size was only positively associated with the Contented Child mode.

CONCLUSION

Loneliness is highly prevalent in PDD and in contrast to social network size associated with maladaptive schema modes. Therapeutically addressing these schema modes with specific techniques may represent a mechanism-based intervention for patients suffering from loneliness and should be investigated in clinical trials.

Social network subtypes among socially disconnected older adults at risk for suicide: A latent class analysis

OBJECTIVES

We sought to characterize the social networks of older adults who report feeling lonely or like a burden on others, psychological states that are associated with risk for suicide according to the Interpersonal Theory of Suicide.

METHODS

We used a latent class analysis to identify distinct groups of older adults based on social network characteristics and perceptions of their networks within a sample of older adults endorsing loneliness and/or feeling like a burden. We examined associations between class membership and mental health outcomes.

RESULTS

Four network types were identified: small, cohabitating networks with daily contact; moderate-sized family-oriented networks with multiple contacts weekly; moderate-sized friend-oriented networks with weekly contact; and average-sized mixed networks with weekly contact. The friend-oriented class reported the greatest loneliness, perceived burden, and lifetime prevalence of suicidal ideation and attempts.

CONCLUSIONS

Social network composition may be more explanatory of loneliness and perceived burden than number of members alone. Profile differences in outcomes suggest utilizing tailored social connectedness interventions. Individuals with small-to-moderate networks may benefit most from interventions designed to build friendships. Individuals with many close confidants may benefit most from psychotherapy. Individuals reporting moderately frequent contact with moderately-sized networks may benefit from both intervention types.

Expecting the best or fearing the worst: Discrepancies between self-rated health and frailty in an ageing Irish population

OBJECTIVES

Ageing populations have the propensity to rate their health status more inaccurately than their younger counterparts. As a result, we (1) devised a metric which categorized older adults into groups based on the discrepancy between their self-rated health (SRH) and Frailty Index (FI) scores, and (2) investigated which factors predict group membership.

DESIGN

A cross-sectional design was employed using data from The Irish Longitudinal Study of Ageing (TILDA).

METHODS

A health asymmetry metric was derived: this categorized 6907 participants (aged 50+ years) into three groups: 'health pessimistic' where participants underestimated their healthiness, 'health realistic' where participants accurately assessed their health, and 'health optimistic' where participants overestimated their healthiness. A multinomial logistic regression modelled the ability of a set of sociodemographic, psychosocial, and health behaviour variables in predicting membership of these categories.

RESULTS

A significant proportion of the study population were categorized as 'health realistic' (~69%). The prevalence rates of health optimistic individuals increased in older age groups, and conversely, health pessimistic rates decreased in older age groups. Most notably, psychosocial factors significantly predicted being health pessimistic: such as anxiety (OR = 1.03), loneliness (OR = 1.04), and decreased social connectedness (OR = 0.87). However, less clear sociodemographic, psychosocial, and health behaviour associations were found for being health optimistic.

CONCLUSION

Health asymmetry is a useful method of identifying at-risk individuals for inaccurate SRH. The ability of this metric to predict clinical mental health outcomes should be investigated.

Social isolation, social support and loneliness as independent concepts, and their relationship with health-related quality of life among older women

Objectives: To assess whether social isolation, social support, and loneliness are independently associated with health-related quality of life (HRQoL).Method: Retrospective analysis including 10,517 women aged 70-75 years from the Australian Longitudinal Study on Women's Health (ALSWH). Social isolation, social support (Duke Social Support Index), and loneliness (single item) were investigated for their association with standardised HRQoL (physical [PCS] and mental [MCS] components of the SF-36® questionnaire). Analyses were adjusted for sociodemographic variables and number of medical conditions.Results: Only 3% reported being socially isolated, having low social support and being lonely, and 34% reported being not socially isolated, high social support and not being lonely. Each construct was independently associated with HRQoL, with loneliness having the strongest inverse association (PCS: isolation -0.98, low support -2.01, loneliness -2.03; MCS: isolation -1.97, low support -4.79, loneliness -10.20; p-value < 0.001 for each). Women who were not isolated or lonely and with high social support had the greatest HRQoL (compared to isolated, low social support and lonely; MCS: 17 to 18 points higher, PCS: 5 to 8 points higher). Other combinations of social isolation, social support and loneliness varied in their associations with HRQoL.Conclusion: Ageing populations face the challenge of supporting older people to maintain longer, healthy, meaningful and community-dwelling lives. Among older women, social isolation, low social support and loneliness are distinct, partially overlapping yet interconnected concepts that coexist and are each adversely associated with HRQoL. Findings should be replicated in other cohorts to ensure generalisability across other age groups and men.

Social isolation trajectories in midlife and later-life: patterns and associations with health

OBJECTIVES

Social isolation has objective and subjective dimensions. Few studies have simultaneously examined trajectories of both dimensions. We integrated multiple indicators of both dimensions to identify social isolation trajectory patterns and investigated how different patterns were related to adults' physical, mental, cognitive, and self-rated health.

METHODS

We used latent class growth modeling to examine social isolation trajectory patterns, based on data from the 2008-2016 waves of the Health and Retirement Study (N = 6457). Mixed-effect linear models were used to examine how trajectory patterns were associated with functional limitations, depressive symptoms, memory deficits, and self-rated health over the 8-year study period.

RESULTS

Four social isolation trajectory patterns were identified: severe isolation (15.4%), moderate isolation (37.6%), some objective and rare subjective isolation (35.4%), and rare objective and low subjective isolation (11.6%). Social isolation trajectory patterns showed a gradient in all health domains. The rare objective and low subjective isolation group had the best health (i.e., the fewest functional limitations, depressive symptoms, and memory deficits and the best self-rated health); the some objective and rare subjective isolation group had the next best health; the moderate isolation group had the second worst health; and the severe isolation group had the worst health.

CONCLUSIONS

The prevalence and stability of severe and moderate social isolation suggest it may be necessary to address social isolation at the national level. The most favorable health outcomes associated with the rare objective and low subjective isolation group supports interventions to strengthen social networks and engagement midlife and later-life.

Depression trajectories among older community dwelling adults: Results from the Irish Longitudinal Study on Ageing (TILDA)

BACKGROUND

This study investigated the role of a large range psychological, attitudinal and health related variables as predictors of depression trajectories amongst older adults over a 4-year time period.

METHODS

Data from three consecutive waves of the TILDA survey of older community dwelling adults aged 50+ in Ireland were combined for analysis. Depression symptom scores were assessed using the Center for Epidemiological Studies- Depression scale (CES-D). Changes in depression scores over three time points were modelled as distinct trajectory classes using group-based trajectory modelling, whilst simultaneously controlling for demographic, attitudinal and health related predictors of these trajectory classes using multinomial regression.

RESULTS

Four distinct depression trajectories were identified as (1) a stable low symptom level group (79%), (2) a moderate but deteriorating symptoms group (7.6%), (3) a moderate but improving group (10.1%) and (4) a vulnerable group with consistently high symptoms (3.1%). Multinomial logistic regression indicated that limiting pain, mobility impairments, perceived stress and loneliness predicted membership of the moderate and higher depressive symptom classes. Retirement status and higher reported levels of worry were associated with a greater likelihood of membership of the moderate symptom classes only.

LIMITATIONS

Use of the CES-D is open to bias due to subjective nature of respondent reporting.

CONCLUSIONS

Results concur with previous studies on the development of depression among older people and highlight the key health related and psychological variables that may inform interventions aimed at mitigating risks of developing depression among older adults.

Social isolation, social support, and loneliness and their relationship with cognitive health and dementia

BACKGROUND

Poor social health is prevalent in older adults and may be associated with worse cognition, and increased dementia risk. The aim of this study was to determine whether social isolation, social support and loneliness are independently associated with cognitive function and incident dementia over 5 years in older adults, and to investigate potential gender differences.

METHODS

Participants were 11,498 community-dwelling relatively healthy Australians aged 70-94, in the ASPREE Longitudinal Study of Older Persons (ALSOP). Social isolation, social support, loneliness and cognitive function were assessed through self-report. Outcomes examined were cognitive decline (>1.5 SD decline in cognitive performance since baseline) and incident dementia (adjudicated according to DSM-IV criteria).

RESULTS

Most participants self-reported good social health (92%) with very few socially isolated (2%), with low social support (2%) or lonely (5%). Among women, social isolation and low social support were consistently associated with lower cognitive function (e.g., social support and cognition β = -1.17, p < 0.001). No consistent longitudinal associations were observed between baseline social health and cognitive decline (over median 3.1 years) or incident dementia (over median 4.4 years; social isolation: HR = 1.00, p = 0.99; low social support: HR = 1.79, p = 0.11; loneliness: HR = 0.72, p = 0.34 among women and men).

CONCLUSION

Our study provides evidence that social isolation and a low social support are associated with worse cognitive function in women, but not men. Social health did not predict incident cognitive decline or dementia, but we lacked power to stratify dementia analyses by gender.

Social isolation, rather than loneliness, is associated with cognitive decline in older adults: the China Health and Retirement Longitudinal Study

BACKGROUND

Social isolation and loneliness have each been associated with cognitive decline, but most previous research is limited to Western populations. This study examined the relationships of social isolation and loneliness on cognitive function among Chinese older adults.

METHODS

This study used two waves of data (2011 and 2015) from the China Health and Retirement Longitudinal Study (CHARLS) and analyses were restricted to those respondents aged 50 and older. Social isolation, loneliness, and cognitive function were measured at baseline. Follow-up measures on cognitive function were obtained for 7761 participants (mean age = 60.97, s.d. = 7.31; male, 50.8%). Lagged dependent variable models adjusted for confounding factors were used to evaluate the association between baseline isolation, loneliness, and cognitive function at follow-up.

RESULTS

Loneliness was significantly associated with the cognitive decline at follow-up (episodic memory: β = -0.03, p < 0.01; mental status: β = -0.03, p < 0.01) in the partially adjusted models. These associations became insignificant after additional confounding variables (chronic diseases, health behaviors, disabilities, and depressive symptoms) were taken into account (all p > 0.05). By contrast, social isolation was significantly associated with decreases in all cognitive function measures at follow-up (episodic memory: β = -0.05, p < 0.001; mental status: β = -0.03, p < 0.01) even after controlling for loneliness and all confounding variables.

CONCLUSIONS

Social isolation is associated with cognitive decline in Chinese older adults, and the relationships are independent of loneliness. These findings expand our knowledge about the links between social relationships and the cognitive function in non-Western populations.

Mortality risk associated with combinations of loneliness and social isolation. Findings from The Irish Longitudinal Study on Ageing (TILDA)

Background

Social distancing and similar measures in response to the coronavirus disease 2019 pandemic have greatly increased loneliness and social isolation among older adults. Understanding the association between loneliness and mortality is therefore critically important. We examined whether combinations of loneliness and social isolation, using a metric named social asymmetry, was associated with increased mortality risk.

Methods

The sample was derived from participants in The Irish Longitudinal Study on Ageing, a nationally representative sample of community-dwelling older adults aged ≥50. Survey data were linked to official death registration records. Cox proportional hazards regressions and competing risk survival analyses were used to examine the association between social asymmetry and all-cause and cause-specific mortality.

Results

Of four social asymmetry groups, concordant low lonely (low loneliness, low isolation) included 35.5% of participants; 26.4% were concordant high lonely (high loneliness, high isolation); 19.2% were discordant robust (low loneliness, high isolation) and 18.9% discordant susceptible (high loneliness, low isolation). The concordant high lonely (hazard ratio [HR] = 1.43, 95% confidence interval [CI]: 1.09–1.87) and discordant robust (HR = 1.37, 95% CI: 1.04–1.81) groups had an increased mortality risk compared to those in the concordant low lonely group. The concordant high lonely group had an increased risk of mortality due to diseases of the circulatory system (sub-distribution hazard ratio = 1.52, 95% CI: 1.03–2.25).

Conclusion

We found that social asymmetry predicted mortality over a 7-year follow-up period. Our results confirm that a mismatch between subjective loneliness and objective social isolation, as well as the combination of loneliness and social isolation, were associated with an increased all-cause mortality risk.

Cognitive Impairment and the Trajectory of Loneliness in Older Adulthood: Evidence from the Health and Retirement Study

Objective: To examine whether the trajectory of facets of loneliness-emotional and social-varied by cognitive impairment status in older adulthood. Methods: Data came from the Health and Retirement Study 2008-2018 waves (N = 15,352). Cognitive impairment was assessed using standard cutoffs for cognitive impairment no dementia (CIND) and dementia. The 11-item UCLA loneliness scale was used to measure emotional and social loneliness. Results: Using multilevel modeling, we found that CIND and dementia status were associated with higher overall, emotional, and social loneliness, controlling for physical health, social contact, and depressive symptoms. The trajectory of loneliness did not vary by cognitive status. There were modest variations by sociodemographic factors. Discussion: Persons with CIND and dementia experience heightened emotional and social loneliness, but cognitive impairment does not contribute to the worsening of loneliness. Older adults' social integration may be maintained early in cognitive impairment.

Loneliness, Wellbeing, and Social Activity in Scottish Older Adults Resulting from Social Distancing during the COVID-19 Pandemic

This study examined the impact of social distancing during the COVID-19 pandemic on loneliness, wellbeing, and social activity, including social support, in Scottish older adults. A mixed methods online survey was used to examine these factors during social distancing mid-lockdown, July 2020. Participants were asked to state whether loneliness, wellbeing, social activity, and social support had changed since pre-social distancing, and to provide details of strategies used to keep socially active. A total of 1429 adults (84% aged 60+ years) living in Scotland took part. The majority reported that social distancing regulations made them experience more loneliness and less social contact and support. Loneliness during lockdown was higher than reported norms for this age group before the pandemic. A larger social network, more social contact, and better perceived social support seemed to be protective against loneliness and poor wellbeing. Positive coping strategies reported included increasing online social contact with both existing social networks and reconnecting with previous networks, as well as increasing contact with neighbours and people in the community. This underlines the importance of addressing loneliness and social support in older adults but particularly during situations where risk of isolation is high.

Social Isolation, Loneliness, and All-Cause Mortality in Patients With Cardiovascular Disease: A 10-Year Follow-up Study

OBJECTIVE

Social isolation and loneliness have been associated with increased incidence of cardiovascular disease (CVD), but few studies have evaluated the impact of social isolation and loneliness on mortality in people with existing CVD, and these are limited to Western populations. We examined whether social isolation and loneliness are associated with increased risk of mortality in individuals with established CVD in Taiwan.

METHODS

The cohort was composed of 1267 patients with confirmed CVD 65 years or older followed up for up to 10 years. Cox proportional hazard regression models were used to examine the association between social isolation and loneliness at baseline and mortality at follow-up by adjusting for demographic variables, health-related behaviors, and health status.

RESULTS

There were 593 deaths during the follow-up period. Social isolation was associated with increased risk of mortality after accounting for established risk factors (hazard ratio [HR] = 1.16; 95% confidence interval [CI] = 1.06-1.26), whereas loneliness was not associated with increased risk of mortality (HR = 0.95; 95% CI = 0.82-1.09). When both social isolation and loneliness were included in the model, social isolation maintained an association with mortality (HR = 1.16; 95% CI =1.07-1.27).

CONCLUSIONS

Social isolation is associated with an increased risk of mortality in patients with CVD, and the effects are independent of loneliness. These findings expand our knowledge about the impact of social isolation on the outcomes of CVD in non-Western countries. Efforts to reduce isolation may have substantial benefits in terms of mortality in patients with CVD.

Social isolation, rather than loneliness, is associated with cognitive decline in older adults: the China Health and Retirement Longitudinal Study

BACKGROUND

Social isolation and loneliness have each been associated with cognitive decline, but most previous research is limited to Western populations. This study examined the relationships of social isolation and loneliness on cognitive function among Chinese older adults.

METHODS

This study used two waves of data (2011 and 2015) from the China Health and Retirement Longitudinal Study and analyses were restricted to those respondents aged 50 and older. Social isolation, loneliness, and cognitive function were measured at baseline. Follow-up measures on cognitive function were obtained for 7761 participants (mean age = 60.97, s.d. = 7.31; male, 50.8%). Lagged dependent variable models adjusted for confounding factors were used to evaluate the association between baseline isolation, loneliness, and cognitive function at follow-up.

RESULTS

Loneliness was significantly associated with the cognitive decline at follow-up (episodic memory: β = -0.03, p < 0.01; mental status: β = -0.03, p < 0.01) in the partially adjusted models. These associations became insignificant after additional confounding variables (chronic diseases, health behaviors, disabilities, and depressive symptoms) were taken into account (all p > 0.05). By contrast, social isolation was significantly associated with decreases in all cognitive function measures at follow-up (episodic memory: β = -0.05, p < 0.001; mental status: β = -0.03, p < 0.01) even after controlling for loneliness and all confounding variables.

CONCLUSIONS

Social isolation is associated with cognitive decline in Chinese older adults, and the relationships are independent of loneliness. These findings expand our knowledge about the links between social relationships and the cognitive function in non-Western populations.

Is Physical Activity Associated With Loneliness or Social Isolation in Older Adults? Results of a Longitudinal Analysis Using the Irish Longitudinal Study on Ageing

Social relationships are central to the health and well-being of older adults. Evidence exploring the association of physical activity (PA) with social isolation and loneliness is limited. This study uses a path analysis to investigate the longitudinal association between loneliness and social isolation with PA using the Irish Longitudinal Study on Ageing. Higher levels of social isolation measured using the Berkman-Syme Social Network Index were directly and indirectly associated with lower levels of walking, moderate PA, and vigorous PA over 6 years. Additionally, higher levels of walking were associated with lower levels of loneliness measured using a modified version of the University of California, Los Angeles loneliness scale over a 3-year period. Future interventions should target individuals who are more socially isolated and explore the effects of different types of PA on loneliness over time.

Associations Between Social Network Characteristics and Loneliness During Pregnancy in a Sample of Predominantly African American, Largely Publicly-Insured Women

OBJECTIVES

Most research evaluating relationships between social network attributes and loneliness have focused on older adult and adolescent networks. The present study examines the relationships between social network size (number of relationships), social network density (whether named relationships are connected to one another) and maternal loneliness during pregnancy.

METHODS

Eligible women were enrolled at the time of their dating ultrasound (between 8 and 12 weeks of gestation). Interested women provided written consent and completed demographic, social network and loneliness measures. Participants completed the same surveys in their third trimester. Mixed-regression models, adjusted for age, race, ethnicity, and insurance type, were used to assess the relationship between social network size, network density, and loneliness.

RESULTS

A total of 94 pregnant women (mean age = 23.77, 70.2% Black, 87.2% public insurance) completed baseline study measures, and 60 participants completed both assessment time points. Completers and non-completers did not differ on key characteristics. Social network density, but not social network size, predicted maternal loneliness ([Formula: see text]= - 1.27, 95% CI - 2.53, - 0.01, p = 0.0489) in the first and third trimester.

CONCLUSIONS

These findings indicate that pregnant women's social network density may be more intimately related to feelings of loneliness than the objective number of relationships. This knowledge can begin to inform the design of supportive approaches to improve women's health.

Loneliness as a mediator of the impact of social isolation on cognitive functioning of Chinese older adults

BACKGROUND AND OBJECTIVE

older adults have increased risk of social isolation, loneliness and cognitive functioning impairment, but the relationships among these factors are not conclusive. We investigated the potential mediation mechanism of loneliness on the association between social isolation and cognitive functioning among Chinese older adults within their cultural context.

DESIGN

secondary analysis of the baseline wave (2011-12) of the harmonised China Health and Retirement Longitudinal Study.

SETTING AND SUBJECTS

community-dwelling older adults in China (N = 7,410 participants aged 60-101 years).

METHODS

we applied a multiple indicator multiple cause approach to determine whether the construct of social isolation is well defined by four indicators (social activity engagement, weekly adult children contact, caregiving for grandchildren and living alone) and used structural equation modelling to examine the direct and indirect effects among variables of interest.

RESULTS

the results demonstrated that social activity engagement, weekly adult children contact and caregiving for grandchildren were significantly related to social isolation (β = -0.26 to -0.28) (Living alone was fixed to 1 for model identification.) The indirect effect of social isolation on cognitive functioning through loneliness was significant (β = -0.15), indicating loneliness was an important mediator. However, the direct effect of social isolation on cognitive functioning also remained significant (β = -0.83), suggesting a partial mediation effect.

CONCLUSIONS

our study highlights the mediation role of loneliness in the relationship between social isolation and cognitive functioning among Chinese older adults. The findings support the beneficial effects of maintaining social relations and coping with feelings of loneliness on older adults' cognitive functioning.

Cerebellar neural markers of susceptibility to social isolation and positive affective processing

Chronic loneliness predicts mood disturbances and onset of major depressive disorder. However, little research has examined the neural correlates of individual difference in susceptibility to perceiving loneliness. In addition, the role of cerebellum, which is heavily implicated in social, cognitive and affective processes, in loneliness is unclear. We studied 99 healthy individuals divided into susceptible, concordant and robust groups depending on whether the participant’s loneliness level was greater, comparable or less than her/his objective social isolation level. The cerebellar gray matter structure, functional activity and connectivity patterns during performing an emotion stroop task were examined. We found greater posterior and medial cerebellar volume in the susceptible group than the other groups. In addition, the posterior and medial cerebellar activities when processing positive versus neutral words exhibited significant interactive effects of both loneliness and social network, and susceptibility to isolation. Loneliness and social network also had positive effects on the right posterior cerebellar functional connectivity with the visual and premotor cortices. Our findings provide novel evidence on the intricate role of the cerebellum in loneliness and susceptibility to isolation, suggesting that socio-cognitive processes of the cerebellum in the hedonic domain may be a key mechanism underlying loneliness proneness.

Are loneliness and social isolation associated with cognitive decline?

OBJECTIVE

This study aimed to examine the association of loneliness and social isolation on cognition over a 3-year follow-up period in middle- and older-aged adults.

METHODS

Data from a Spanish nationally representative sample were analyzed (n = 1691; aged 50 years or older). Loneliness, social isolation, and cognition (immediate recall, delayed recall, verbal fluency, forward digit span, backward digit span, and a composite cognitive score) were assessed both at baseline and at follow-up. Adjusted generalized estimating equations models were performed.

RESULTS

Loneliness was significantly associated with lower scores in the composite cognitive score, immediate and delayed recall, verbal fluency, and backward digit span (B = -0.14 to B = -3.16; P < .05) and with a more rapid decline from baseline to follow-up in two out of six cognitive tests. Higher social isolation was associated with lower scores in the composite cognitive score, verbal fluency, and forward digit span (B = -0.06 to B = -0.85; P < .05). The effect of loneliness and social isolation on cognition remained significant after the exclusion of individuals with depression.

CONCLUSIONS

Both loneliness and social isolation are associated with decreased cognitive function over a 3-year follow-up period. The development of interventions that include the enhancement of social participation and the maintenance of emotionally supportive relationships might contribute to cognitive decline prevention and risk reduction.

Loneliness, social isolation and cardiovascular risk

Loneliness and social isolation are increasingly being acknowledged as risk factors for both physical and mental health problems. Recent statistics demonstrate that loneliness and isolation are on the rise internationally, to the point of being classed as an epidemic. In this paper, the authors outline some of the recent research linking loneliness and isolation to significant chronic diseases such as cardiovascular disease and type II diabetes; mental health disorders such as anxiety and depression; cognitive disorders and dementia. Isolation has also been shown to compromise recovery after acute cardiac events, being associated with increased hospital readmission and premature death. Indeed, isolation has now been identified as a risk factor equivalent in effect to traditional risk factors such as smoking, hypertension and obesity. While distinguishing between objective and subjective indicators of isolation, the authors highlight the complexity of this phenomenon, both in terms of definition and measurement, as well as the interplay between subjective and objective indicators. Important clinical implications for health professionals working with cardiac patients are also proposed, in terms of screening for isolation, and possible interventions to support patients at risk of isolation. The aim of the current article is to emphasise the importance of acknowledging loneliness and isolation as key risk factors requiring urgent attention, both in research and in clinical practice.

Association of Cognition and Age-Related Hearing Impairment in the English Longitudinal Study of Ageing

Importance

Evidence has linked age-related hearing impairment (ARHI) with cognitive decline; however, very few studies (none in the United Kingdom) explore this link in large well-characterized groups of community-dwelling individuals.

Objective

To investigate the link between ARHI and cognitive decline using a cohort of elderly individuals from the United Kingdom and explore untreated hearing loss and social isolation as potential explanations for the observed link.

Design, Setting, and Participants

This cross-sectional analysis of wave 7 (June 2014 through May 2015) of the English Longitudinal Study of Ageing (ELSA) sampled men and women 50 years or older and living in the United Kingdom in a community setting. Those with a diagnosis of dementia, Alzheimer disease, or Parkinson disease or with ear infections and cochlear implants were excluded. Data were analyzed from August 1, 2017, through May 25, 2018.

Main Outcomes and Measures

Memory and executive function as measures of cognitive function and hearing acuity derived from the HearCheck screener device (Siemens).

Results

Of a cohort of 9666 members in wave 7 of ELSA, 7385 were eligible for analysis after applying exclusion criteria (55.1% women; mean [SD] age, 67.4 [9.4] years). Of these, 3056 (41.4%) had mild hearing loss and 755 (10.2%) had severe hearing loss; 834 (11.3%) used a hearing aid; and 7155 (96.9%) were white. Hearing loss had a negative association with cognition; for those with moderate to severe loss, the score on memory assessment was a full 1 point less (-1.00; 95% CI, -1.24 to -0.76), ceteris paribus, relative to those with no hearing loss. However, this association was seen only in the individuals with untreated hearing loss (ie, those who did not use hearing aids) (-1.16; 95% CI, -1.45 to -0.87). Evidence suggests that social isolation acts as a mediating factor.

Conclusions and Relevance

Although hearing loss and cognition are linked, untreated hearing loss drives the association. Social isolation is a mediating factor in the link for those who have untreated hearing loss. Cognitive decline associated with ARHI is probably preventable by early rehabilitation and increased opportunistic screening for the elderly.

Comparisons of the discrepancy between loneliness and social isolation across Ireland and Sweden: findings from TILDA and SNAC-K

PURPOSE

Loneliness may have different cultural meanings in different countries. This may manifest as differing levels of Social Asymmetry-the discrepancy between loneliness and social isolation. Since loneliness is thought to be low in Sweden relative to more southerly countries, we hypothesised that more number of individuals would also fall into the "discordant robust" category of Social Asymmetry, i.e. that more individuals in Sweden would have lower loneliness levels relative to social isolation than in Ireland. We also explored the clinical relevance of Social Asymmetry in both countries, by examining its association with cognitive functioning.

METHODS

We derived Social Asymmetry metrics in two representative cohort studies: the Irish Longitudinal Study on Ageing (TILDA) and the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Data pertaining to a dementia-free sample of 4565 Irish participants and 3042 Swedish participants, all aged over 60 years, were analysed using a multilevel modelling approach, with country as a higher-order variable.

RESULTS

Contrary to the expected, more individuals in Ireland were "discordant robust" than in Sweden. We also found evidence for superior performance in global cognitive functioning among those in the "discordant robust" category relative to those in the discordant susceptible (i.e. those with higher levels of loneliness than social isolation) category, β = 0.61, p < .001, across both countries.

CONCLUSIONS

Irish older adults may be more robust to the impact of social isolation on loneliness than those in the Swedish cohort. Social Asymmetry was related to cognitive functioning in both countries, suggesting that Social Asymmetry is a clinically relevant construct.

Regional tau pathology and loneliness in cognitively normal older adults

Loneliness is a perception of social and emotional isolation that increases in prevalence among older adults during the eighth decade of life. Loneliness has been associated with higher brain amyloid-β deposition, a biologic marker of Alzheimer's disease, in cognitively normal older adults, suggesting a link with preclinical Alzheimer's disease pathophysiology. This study examined whether greater loneliness was associated with tau pathology, the other defining feature of Alzheimer's disease, in 117 cognitively normal older adults. Using flortaucipir positron emission tomography, we measured tau pathology in the entorhinal cortex, a region of initial accumulation in aging adults with or without elevated amyloid-β, and in the inferior temporal cortex, a region of early accumulation typically associated with elevated amyloid-β and memory impairment. Loneliness was measured by self-report using the 3-item UCLA-loneliness scale. We found that higher tau pathology in the right entorhinal cortex was associated with greater loneliness, controlling for age, sex, and apolipoprotein E ε4, the Alzheimer's disease genetic risk marker. This association remained significant after further adjustment for socioeconomic status, social network, depression and anxiety scores, and memory performance. There was no association of inferior temporal cortical or left entorhinal tau pathology with loneliness. Exploratory whole-brain surface maps supported these findings and identified additional clusters correlating loneliness and tau in the right fusiform gyrus. These results provide further support for loneliness as a socioemotional symptom in preclinical Alzheimer's disease.

Typologies of loneliness, living alone and social isolation, and their associations with physical and mental health

The relationship between living alone, loneliness and social isolation, and how they are associated with health remain contentious. We sought to explore typologies based on shared experiences of loneliness, social isolation and living alone using Latent Class Analysis and determine how these groups may differ in terms of their physical and mental health. We used Wave 7 of the English Longitudinal Study of Ageing (N = 7,032; mean age = 67.3) and responses to the University of California, Los Angeles (UCLA) loneliness scale, household composition, participation in social/societal activities plus frequency of contact with friends, family and relatives for the Latent Class Analysis. The optimal number of groups was identified using model-fit criteria. The socio-demographic characteristics of groups and health outcomes were explored using descriptive statistics and logistic regression. We identified a six-cluster typology: Group 1, no loneliness or isolation; Group 2, moderate loneliness; Group 3, living alone; Group 4, moderate isolation; Group 5, moderate loneliness, living alone; and Group 6, high loneliness, moderate isolation (with high likelihood of living alone). Groups experiencing loneliness and/or isolation were more likely to report poorer physical and mental health even after adjusting for socio-demographic confounders, this was particularly notable for Group 6. Our results indicate that different typologies of living alone, loneliness and isolation can be identified using data-driven techniques, and can be differentiated by the number and severity of issues they experience.

The impact of social activities, social networks, social support and social relationships on the cognitive functioning of healthy older adults: a systematic review

BACKGROUND

Social relationships, which are contingent on access to social networks, promote engagement in social activities and provide access to social support. These social factors have been shown to positively impact health outcomes. In the current systematic review, we offer a comprehensive overview of the impact of social activities, social networks and social support on the cognitive functioning of healthy older adults (50+) and examine the differential effects of aspects of social relationships on various cognitive domains.

METHODS

We followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, and collated data from randomised controlled trials (RCTs), genetic and observational studies. Independent variables of interest included subjective measures of social activities, social networks, and social support, and composite measures of social relationships (CMSR). The primary outcome of interest was cognitive function divided into domains of episodic memory, semantic memory, overall memory ability, working memory, verbal fluency, reasoning, attention, processing speed, visuospatial abilities, overall executive functioning and global cognition.

RESULTS

Thirty-nine studies were included in the review; three RCTs, 34 observational studies, and two genetic studies. Evidence suggests a relationship between (1) social activity and global cognition and overall executive functioning, working memory, visuospatial abilities and processing speed but not episodic memory, verbal fluency, reasoning or attention; (2) social networks and global cognition but not episodic memory, attention or processing speed; (3) social support and global cognition and episodic memory but not attention or processing speed; and (4) CMSR and episodic memory and verbal fluency but not global cognition.

CONCLUSIONS

The results support prior conclusions that there is an association between social relationships and cognitive function but the exact nature of this association remains unclear. Implications of the findings are discussed and suggestions for future research provided.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO 2012: CRD42012003248 .