Feelings of loneliness, but not social isolation, predict dementia onset: results from the Amsterdam Study of the Elderly (AMSTEL)

Fear of Positive Evaluation and Loneliness: Mediating Role of Social Anxiety and Suppression

Loneliness is a commonly observed problem that is associated with several mental and physical health outcomes. Although research shows that fear of negative evaluation is related to loneliness, no study has examined the role of fear of positive evaluation (FPE) on loneliness. This study investigated the mediator role of social anxiety and suppression in the relationship between FPE and loneliness using an undergraduate sample (N = 467). The results show that FPE is positively associated with loneliness and that this relationship is mediated by social anxiety and suppression. This study highlights the importance of the FPE in understanding loneliness and can guide intervention programs for loneliness.

Prolonged loneliness and risk of incident cognitive decline and dementia: A two-cohort study

BACKGROUND

Loneliness is prevalent currently and could result in increased dementia risks, whereas the associations of prolonged loneliness and its changes with cognitive decline and dementia remain less investigated.

METHODS

Data were from the English Longitudinal Study of Ageing (ELSA) and Health and Retirement Study (HRS). Loneliness was assessed using the Revised UCLA Loneliness Scale. Health risk factors for dementia included unhealthy lifestyles, depressive symptoms, chronic diseases, and functional limitations. Cognitive function was assessed using validated tests in both cohorts, with cognitive decline defined as cognitive z-scores < -1.5. Dementia was identified through self- or proxy-reported physician diagnoses. The Cox proportional hazard regression and Aalen's additive hazard regression were performed to calculate the relative and absolute risk for cognitive decline and dementia, respectively. Covariates including socio-demographic characteristics, social networks, and polygenic scores were adjusted.

RESULTS

Of 6721 ELSA and 10,195 HRS participants aged ≥50y, 2129 (13.7 %) and 612 (3.6 %) developed incident cognitive decline and dementia in about 10 years, respectively. Participants with severe (versus no) cumulative loneliness had 42 % and 98 % higher cognitive decline and dementia risks after pooling, corresponding to 791.6 (477.4-1105.8) and 372.8 (223.6-522.0) excess incidence densities (/105 person-years). Additionally, those who recovered from frequent loneliness (versus persistent frequent) were 9 %-31 % less likely to develop unhealthy lifestyles, depressive symptoms, chronic diseases, and functional limitations, and were at 33 % lower risks of dementia, corresponding to -248.6 (-446.0 ~ -51.2) excess incidence density.

CONCLUSIONS

Prolonged loneliness could increase the risks of incident cognitive decline and ADRD, while alleviating loneliness may help.

Community-level determinants of loneliness and social isolation: a population-based cohort study across younger and older adults

Introduction

Loneliness and social isolation (SI) are critical public health issues with well-documented effects on health and well-being. However, much of existing observational and intervention research has focused predominantly on individual-and interpersonal-level factors. This longitudinal study addresses significant knowledge gaps by comprehensively examining the independent influence of multiple community-level determinants on loneliness and SI and uniquely comparing these effects across younger (18-30 year) and older (60 + years) adults within an Australian population cohort over a 12-year period.

Methods

Using longitudinal data from the Household, Income and Labour Dynamics in Australia (HILDA) survey, we analysed data from four wave pairs (2006/07, 2010/11, 2014/15, 2018/19) to investigate associations between loneliness and SI and nine community and neighbourhood-level variables. We employed lagged mixed-effects Poisson regression models to calculate risk ratios (RR) adjusted for individual-and interpersonal-level factors.

Results

Our findings reveal that low community engagement is the strongest risk factor for loneliness and SI in both younger (Loneliness, RR = 1.34; SI, RR = 1.58) and older populations (Loneliness, RR = 1.35; SI = 2.02). Low neighbourhood social cohesion was found to significantly increase loneliness and SI in older adults (Loneliness, RR = 1.15; SI, RR = 1.36) and to increase SI in younger adults (RR = 1.54). We also observed distinct age-specific effects, with cultural practices, altruism, and perceived neighbourhood safety having differential impacts across age groups.

Discussion

Our findings highlight the critical need for community-level interventions to address loneliness and SI, suggesting that focusing solely on individual-related factors is insufficient. Tailoring public health strategies to enhance community dynamics may be essential in reducing loneliness and SI among vulnerable populations, particularly in areas with low social cohesion and community engagement offerings.

Association Between Socioeconomic Status and Neuropsychiatric Symptoms in the UK Biobank: The Moderating Role of Sociability

Introduction: Neuropsychiatric symptoms are signs of cognitive decline and associated disorders. The effects of socioeconomic status and social interaction on cognitive decline have already been well documented. Accordingly, the present study aimed to build on the work investigating those factors and cognitive health by examining the relationships between socioeconomic status, sociability, and neuropsychiatric symptoms. Methods: Data from the UK Biobank (N = 301,848) were subjected to logistic regressions to examine the relationship between socioeconomic status, sociability, and neuropsychiatric symptoms and sociability to identify any potential moderator in the socioeconomic status-neuropsychiatric symptoms relationship. Specifically, socioeconomic status was defined by the Townsend deprivation index, while sociability was constructed using a cumulative score of four aspects. Meanwhile, neuropsychiatric symptoms were represented by depression, anxiety, and irritability, each of which had a genetic risk score calculated. Results: Individuals who reported lower socioeconomic status also reported more depression and anxiety, while those with higher sociability reported fewer depression and anxiety. Further, it was found that sociability moderated the relationship between socioeconomic status and two symptoms: depression and anxiety. No significant moderating effects were found regarding irritability. Conclusion: The study results indicate the need for interventions aimed at neuropsychiatric symptoms to reduce possible cognitive disorders. They also demonstrate the need to eliminate economic and social disparities and the importance of improving sociability.

Homophily and social influence as mechanisms of loneliness clustering in social networks

Loneliness, a pervasive mental health concern, is often misconstrued as an individual pathology, limiting our understanding of social effects via peer-to-peer interactions. This study investigates how homophily (similarity-based connectivity) and induction (interacting mental states) contribute to loneliness clustering. Using a computational model, we simulate social network interactions via established induction frameworks: emotional, behavioral, and cognitive contagion. We map these pathways to fundamental processes of simple contagion, complex contagion, and self-activation, explaining how ideas and behaviors spread. Results show that high homophily is necessary for loneliness clustering, and the model recovers empirical findings of network clustering (a positive correlation of individuals' mental states beyond direct neighbors) with extended "degrees of influence" across networks and setups. This universality of clustering across pathways renders the metric uninformative in screening causal mechanisms behind loneliness clustering. Fortunately, each inductive pathway displays distinct out-of-equilibrium dynamics, aiding in identifying real-world mechanisms. The study emphasizes the significant role of individuals' social contexts in loneliness and calls for a shift from static to dynamic measurements in loneliness research. This shift will enhance the relevance of future research on evolutionary patterns in real-world social network data, leading to a more robust understanding of the mechanisms of loneliness.

Lost in Thought or Just Lonely? Everyday Cognitive Competence in Middle Adulthood

Everyday cognitive competence refers to the ability to manage cognitively demanding tasks essential for maintaining functional independence. While cognitive abilities are well explored in explaining individual differences in everyday cognitive competence, growing attention has been directed toward the impact of non-cognitive factors like loneliness. This study aims to investigate how executive function (EF) components-updating, inhibition, and task shifting-predict everyday cognitive competence and whether loneliness explains the additional variance beyond EF processes. To account for the multifaceted nature of everyday cognitive competence, both performance-based (Everyday Problems Test-EPT) and self-reported measures (Cognitive Failures Questionnaire-CFQ) were administrated. The sample included 176 middle-aged adults (ages 43-65), a group suitable for investigating predictors of everyday cognitive competence in the early stages of cognitive aging. The findings reveal that updating is a significant predictor of the performance on the EPT, while loneliness is not. When self-reported cognitive lapses are considered, loneliness emerges as a significant predictor. The lack of a relationship between the EPT and CFQ, along with their differing associations with EF, loneliness, and sociodemographic factors, suggests they assess distinct aspects of everyday cognitive competence. This highlights the need for a multidimensional assessment framework to gain a comprehensive understanding of everyday cognitive competence in middle-aged adults.

Combined effects of social isolation and loneliness on disability incidence in older adults

OBJECTIVES

Relationships among social isolation, loneliness, and disability onset remain unclear. We investigated the distinct patterns of disability development among Japanese older adults who experience social isolation and loneliness.

DESIGN

This study applied a prospective observational approach.

PARTICIPANTS

Data from 4,716 community-dwelling independent older adults were analyzed.

MEASUREMENTS

The Japanese version of the University of California, Los Angeles Loneliness Scale Version 3 and the Social Isolation Scale were used to measure loneliness and social isolation, respectively. The long-term care insurer conducted monthly follow-ups with participants over two years to determine their care needs. Disability onset was defined as the point at which participants were certified by a care manager as requiring long-term care.

RESULTS

During the follow-up period, 265 participants (5.6 %) required long-term care insurance certification due to disability onset. The incidence of disability in the lonely and not lonely groups was 8.0 % and 4.5 %, respectively. In the socially isolated and not socially isolated groups, it was 7.1 % and 4.4 %, respectively. The Cox proportional hazards regression model revealed a significantly higher risk of disability incidence in the lonely and socially isolated groups. The high-risk group experiencing both loneliness and social isolation exhibited significantly higher hazard ratios than the low-risk group without these symptoms.

CONCLUSIONS

The results indicated that older adults experiencing both social isolation and loneliness were at high-risk for future disability incidence. This finding provides insight into the complex interplay between social factors and disability, which can contribute to the development of effective interventions to promote healthy aging and prevent disability.

Influence of Living Arrangements on Perioperative Cognitive Dysfunction Among Elderly Patients

OBJECTIVE

The authors' aim in this study was to investigate the impact of various living arrangements on the occurrence of perioperative cognitive dysfunction (POCD) (now known as perioperative neurocognitive dysfunction, or PND) among elderly patients.

METHODS

The authors' study cohort consisted of 162 elderly patients who underwent laparoscopic radical surgery for gastrointestinal cancer under general anesthesia. The authors categorized them into the following 5 groups based on their preoperative living arrangements: living with the spouse and children (group A); living with the spouse (group B); living with children (group C); living alone (group D); and living in a nursing home (group E). The authors observed and compared the preoperative and postoperative cognitive functions of the patients in the 5 groups.

RESULTS

There was no statistically significant difference in age, sex, years of education, duration of surgery, duration of anesthesia, or postoperative visual Analog Scale (VAS) scores among the 5 groups of patients. However, the 5 groups of patients differed significantly with respect to preoperative mini-mental state examination (MMSE) scores, the difference between preoperative and postoperative scores, the preoperative rate of cognitive impairment, and the prevalence of postoperative POCD. When the authors examined the Montreal cognitive assessment (MoCA) scale scores, there were statistically significant differences in the preoperative scores, the difference between preoperative and postoperative scores, and the prevalence of postoperative POCD among the 5 groups. The prevalence of preoperative cognitive impairment, as diagnosed by the MMSE and MoCA scales, and the occurrence of POCD at 3 and 5 days post-surgery were similar. Logistic regression analysis of risk factors for POCD prevalence revealed that the living arrangement of elderly patients was a risk factor for the prevalence of POCD on day 3 post-surgery, whereas the living arrangement and the presence of preoperative cognitive impairment were risk factors for POCD on day 5 post-surgery.

CONCLUSION

The authors' study results highlighted the type of living arrangements of elderly patients as one of the factors that influence the prevalence of POCD in the immediate postoperative period. Elderly patients who preoperatively resided in a nursing home or those who lived alone were more likely to be associated with developing POCD.

Virtual avatar communication task eliciting pseudo-social isolation and detecting social isolation using non-verbal signal monitoring in older adults

Social isolation and loneliness are two of the main causes of mental health problems or suicide, not only in younger adults but also in older adults. Thus, identifying an effective method to detect social isolation is important in the field of human-machine interaction. However, to the best of our knowledge, no effective method has been developed to elicit pseudosocial isolation tasks to evaluate social isolation detection systems for older adults. This study has two research aims: 1. To develop a virtual avatar conversation cyberball task to evoke pseudosocial isolation in older adults and, 2. to identify non-verbal indicators that replace social isolation in older adults. To achieve these objectives, 22 older men were recruited as participants. They were asked to communicate with two virtual avatars on a monitor and then to rate the follow-up questions provided to evaluate the level of social isolation and emotions; meanwhile, facial expressions and gaze patterns were recorded by a camera and an eye tracker. In the results, the developed virtual avatar conversation cyberball task successfully induced pseudosocial isolation in older adults, and this social isolation was detected by the intensity of inner/outer eyebrow and eyelid movements and the blink frequency.

Association between social networks and cognitive impairment among older Chinese adults: the mediating effect of depression

Objectives

This study aimed to explore the rationality of the social networks-depression-cognitive impairment pathway and to provide recommendations for the development of mild cognitive impairment intervention strategies.

Methods

A cross-sectional survey was conducted in 2021. Sixteen urban communities in Xi 'an, Shaanxi China were selected as sample sites. The cognitive function, social networks and depression were measured by the Montreal Cognitive Assessment (MoCA), the Lubben Social Network Scale-6 (LSNS-6) and the Geriatric Depression Scale-15 (GDS-15), respectively. The generalized linear model was used to analysis the impact of social networks on cognitive impairment, and further analysis the mediating effect of depression.

Results

A total of 745 elderly people aged 60 and above was included in this survey, with an average age of 68.90 ± 6.00 years. The prevalence of cognitive impairment was 18.52%, and the prevalence of cognitive impairment increased with age. According to the generalized linear model, poor social networks (relative network, friend network) was associated with higher risk of cognitive impairment (OR = 2.08, 95% CI: 1.27-3.41), and this association was more significant in women and older adults <70 years of age. Mediation analysis results showed that depression was the mediating path between social networks and cognitive impairment, with the indirect effects accounting for 34.44%.

Conclusion

Social isolation increases the risk of cognitive impairment and depression has a significant mediating effect on the relationship between social isolation and cognitive impairment.

Psychological Mediators of Reduced Distress: Preregistered Analyses from a Randomized Controlled Trial of a Smartphone-Based Well-Being Training

Understanding why interventions work is essential to optimizing them. Although mechanistic theories of meditation-based interventions (MBIs) exist, empirical evidence is limited. We randomly assigned 662 adults (79.9% reported clinical levels of anxiety or depressive symptoms) to a four-week smartphone-based MBI or wait-list control condition early in the COVID-19 pandemic. Psychological distress and four theory driven preregistered psychological mediators of well-being (mindful action, loneliness, cognitive defusion and purpose) were assessed five times during the intervention period and at three-month follow-up. In preregistered analyses, assignment to the intervention predicted significant gains on all mediators which in turn significantly mediated follow-up distress (21.9%-62.5% of intervention effect on distress). No significant mediation pathway was observed in an exploratory multiple mediator analysis, but reduced loneliness accounted for 61.7% of the combined indirect effect. Multiple psychological pathways may mediate reduced distress in a digital MBI.

Negative Social Exchanges During the Pandemic, Loneliness, and the Mediating Role of Stress and Feeling Misunderstood Among People at High-Risk for COVID-19 Related Complications

The goal of this study was to investigate the links between social interactions and mental health for people who are high-risk for COVID-19 complications. Specifically, we tested the relationships between negative social exchanges during the pandemic and loneliness through two mediators: stress and feeling misunderstood about one's health status. Data were collected via Amazon's MTurk from participants (N = 271) who self-identified as being high-risk for COVID-19. The results from our model showed both a direct association between negative social interactions and loneliness, and an indirect link between these variables through stress. Overall, these results highlight the importance of understanding social interactions for people who are at high-risk for COVID-19 and their mental well-being. The results and implications are discussed.

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.

Relationship between cognitive function and sleep quality in middle-aged and older adults for minimizing disparities and achieving equity in health: Evidence from multiple nationwide cohorts

BACKGROUND

Cognitive decline, a heavy burden on middle-aged and older adults as global aging is aggravated, was found to be associated with sleep quality. However, the country-between heterogeneity of the association prevented us from quantifying underlying relationship and identifying potential effect modifiers for vulnerable populations and targeted interventions.

METHODS

We collected data from 79,922 eligible adults in five nationwide cohorts, examined the respective relationships between cognitive function and sleep quality, synthesized underlying average relationships by meta-analysis, and explored effect modifiers by meta-regressions. Additionally, we conducted subgroup and interaction analyses to identify vulnerable populations and to determine their disparities in vulnerability.

RESULTS

Although country-between disparities exist, cognitive function is robustly associated with sleep quality in middle-aged and older adults worldwide, with an effect (β) of 0.015 [0.003, 0.027]. Executive function is the subdomain most relevant to sleep quality. Disparities in the effects of sleep quality on subdomains exist in populations with different sexes (orientation: βfemale/βmale = 1.615, P = 0.020), marital statuses (orientation: βunmarried/βmarried = 2.074, P < 0.001), education levels (orientation:βuneducated/βeducated = 2.074, P < 0.001) and chronic disease statuses (memory: βunhealthy/βhealthy = 1.560, P = 0.005).

CONCLUSIONS

Cognitive function decreases with worsening sleep quality in middle-aged and older adults. Vulnerability to poor sleep generally persists in singles, females, the uneducated and people with chronic diseases. To minimize disparities and achieve health equity, we advocate for targeted interventions, i.e., encouraging socialization in singles, confirming effectiveness of hormone replacement therapy in females, employing compulsory education in middle-aged and older adults.

Associations between recorded loneliness and adverse mental health outcomes among patients receiving mental healthcare in South London: a retrospective cohort study

PURPOSE

Loneliness disproportionately affects people with mental disorders, but associations with mental health outcomes in groups affected remain less well understood.

METHOD

A cohort of patients receiving mental healthcare on 30th June 2012 was assembled from a large mental health records database covering a south London catchment area. Recorded loneliness within the preceding 2 years was extracted using natural language processing and outcomes were measured between 30th June 2012 until 30th December 2019, except for survival which applied a censoring point of 6th December 2020 according to data available at the time of extraction. The following mental healthcare outcomes: (i) time to first crisis episode; (ii) time to first emergency presentation; (iii) all-cause mortality; (iv) days active to service per year; and (v) face-to-face contacts per year.

RESULTS

Loneliness was recorded in 4,483 (16.7%) patients in the study population and fully adjusted models showed associations with subsequent crisis episode (HR 1.17, 95% CI 1.07-1.29), emergency presentation (HR 1.30, 1.21-1.40), days active per year (IRR 1.04, 1.03-1.05), and face-to-face contacts per year (IRR 1.28, 1.27-1.30). Recorded loneliness in patients with substance misuse problems was particularly strongly associated with adverse outcomes, including risk of emergency presentation (HR 1.68, 1.29-2.18) and mortality (HR 1.29, 1.01-1.65).

CONCLUSION

Patients receiving mental healthcare who are recorded as lonely have a higher risk of several adverse outcomes which may require a need for higher service input.

The closure of Wyoming's Program of All-Inclusive Care for the Elderly (PACE): Qualitative analysis of the impact on social isolation and loneliness

Introduction

Social isolation and loneliness are global public health concerns experienced among older adults which are commonly associated with negative physical, psychological, and social outcomes. The healthcare system has an opportunity to identify and address social isolation and loneliness in older adults. The Program of All-Inclusive Care for the Elderly (PACE) was developed to serve comprehensive social needs along with medical and behavioral needs of older adults who qualify for long-term care while still living in the community. In 2021, due to state budget reductions, Wyoming's only PACE program (WY PACE) closed, resulting in the discharge of all participants and loss of social engagement opportunities provided by this program. The objectives of this evaluation were to (1) examine the impact of the WY PACE closure on isolation and loneliness, (2) identify how older adults adapted to the loss of services addressing isolation and loneliness, and (3) identify needs for future interventions to address isolation among clients who experienced loss of supportive programs.

Methods

A mixed-methods design was used to facilitate understanding of qualitative findings while also conducting quantitative analyses to provide context for qualitative responses. Participants included 17 individuals who were either former PACE participants or their caregivers. Participants (n = 12; M = 74 years old) were predominantly non-Hispanic White (n = 8, 66%) and cisgender female (n = 7, 58%). Caregivers of participants (n = 5; M = 63 years old) were predominantly Hispanic, Latino, or of Spanish origin (n = 3, 60%) and cisgender female (n = 4, 80%).

Results

A mixed-methods design was used to facilitate understanding of qualitative findings while also conducting quantitative analyses to provide context for qualitative responses. Participants included 17 individuals who were either former PACE participants or their caregivers. Participants (n = 12; M = 74 years old) were predominantly non-Hispanic White (n = 8, 66%) and cisgender female (n = 7, 58%). Caregivers of participants (n = 5; M = 63 years old) were predominantly Hispanic, Latino, or of Spanish origin (n = 3, 60%) and cisgender female (n = 4, 80%).

Discussion

This evaluation provided preliminary insight into the impacts of the loss of programs like WY PACE on social isolation and loneliness. Creative solutions to maintain social engagement of this vulnerable population are needed.

Prevalence of Loneliness in Older Adults in Rural Population and Its Association with Depression and Caregiver Abuse

Background

Loneliness in the elderly is of public health importance as it is a risk factor for adverse consequences. There is lack of data on loneliness among the elderly population of India, especially those residing in a rural community.

Aim

To estimate loneliness and its association with depression and caregiver abuse.

Materials and Methodology

A cross-sectional study was conducted in a rural health clinic in North India. 125 elderly persons were evaluated on the UCLA Loneliness Scale, Patient Health Questionnaire-15, Geriatric Depression Rating Scale‑30 (GDS), and Caregiver Abuse Screening (CASE) scale.

Results

67.6 years was the mean age of the study's subjects, with a mean number of years of education of 2.9. Most were female, married, and from lower socioeconomic status and belonged to a non-nuclear family. The prevalence of loneliness was 66.4%. Regarding specific features, subjects reported a lack of companionship (64.8%), being left out in life (45.2%), and being isolated from others (52.8%). The severity of depression, somatization, psychological and physical abuse, neglect abuse, and caregiver abuse had a significant positive association with loneliness. Those with a presence of loneliness scored higher on GDS and CASE than those without. Those who were single at the time of the study reported significantly more loneliness than married ones. Those from nuclear families and middle socioeconomic status reported a significantly higher level of loneliness.

Conclusion

Loneliness among the elderly rural population is significantly high. The severity of loneliness is associated with higher severity of depression, somatization, and caregiver abuse.

Meta-analysis of the association between gratitude and loneliness

Gratitude is a positive social emotion that involves recognizing that others have brought benefits into one's life. Loneliness, on the other hand, is an unpleasant emotion resulting from a perceived lack of social connectedness. Although previous studies have reported an inverse association between gratitude and loneliness, these studies have not been systematically examined in a single review. To address this gap in the literature, we conducted a random-effects meta-analysis to examine the association between gratitude and loneliness. Analysis of 26 studies revealed a moderate sized effect (mean Fisher's z transformed correlation, zr = -.406, 95% confidence interval [CI] = -.463, -.349; mean back-transformed correlation, r = -.385, 95% CI = -.433, -.335). To complement these effect sizes, we calculated a probability-based common language effect size for correlations. Random-effects homogeneity testing suggested the presence of effect size heterogeneity. Analyses of both continuous and categorical moderators were non-significant, indicating that these variables did not influence effect size magnitude. Furthermore, publication bias tests suggested that our results were not influenced by unpublished studies. Finally, we proposed several statistical and clinical recommendations for future research. Regarding the latter, we offered suggestions for modifying gratitude enhancement programs with the aim of reducing loneliness.

A Meta-analysis of Loneliness and Risk of Dementia using Longitudinal Data from >600,000 Individuals

Loneliness is one critical risk factor for cognitive health. Combining data from ongoing aging studies and the published literature, we provided the largest meta-analysis on the association between loneliness and dementia (k = 21 samples, N = 608,561) and cognitive impairment (k = 16, N = 103,387). Loneliness increased risk for all-cause dementia (HR = 1.306, 95% CI [1.197,1.426]), Alzheimer's disease (HR = 1.393, 95% CI [1.290,1.504]; k = 5), vascular dementia (HR = 1.735, 95% CI [1.483,2.029]; k = 3), and cognitive impairment (HR = 1.150, 95% CI [1.113,1.189]). The associations persisted when models controlled for depression, social isolation, and/or other modifiable risk factors for dementia. The large heterogeneity across studies was partly due to differences in loneliness measures and ascertainment of cognitive status. Results underscored the importance to further examine type/sources of loneliness and cognitive symptoms to develop effective interventions that reduce the risk of dementia.

Longitudinal associations between loneliness, social isolation, and healthcare utilisation trajectories: a latent growth curve analysis

PURPOSE

To explore the longitudinal associations between eight-year trajectories of loneliness, social isolation and healthcare utilisation (i.e. inpatient, outpatient, and nursing home care) in US older adults.

METHODS

The study used data from the Health and Retirement Study in 2006-2018, which included a nationally representative sample of American adults aged 50 and above (N = 6,832). We conducted latent growth curve models to assess the associations between trajectories of loneliness and isolation and healthcare utilisation over 8 years.

RESULTS

Independent of sociodemographic and health-related confounders, social deficits were associated with a lower likelihood of baseline physician visits (loneliness β= -0.15, SE = 0.08; social isolation β= -0.19, SE = 0.08), but there was a positive association between loneliness and number of physician visits (β = 0.06, SE = 0.03), while social isolation was associated with extended hospital (β = 0.07, SE = 0.04) and nursing home stays (β = 0.05, SE = 0.02). Longer nursing home stays also predicted better trajectories of loneliness and isolation over time.

CONCLUSION

Loneliness and social isolation are cross-sectionally related to complex patterns of different types of healthcare. There was no clear evidence that social deficits led to specific trajectories of healthcare utilisation, but nursing home stays may over time help provide social contact, supporting trajectories of isolation and potentially loneliness. Non-clinical services such as social prescribing could have the potential to address unmet social needs and further promote patients' health-seeking profiles for improving healthcare equity.

Exploring the differential impacts of social isolation, loneliness, and their combination on the memory of an aging population: A 6-year longitudinal study of the CLSA

Memory plays a crucial role in cognitive health. Social isolation (SI) and loneliness (LON) are recognized risk factors for global cognition, although their combined effects on memory have been understudied in the literature. This study used three waves of data over six years from the Canadian Longitudinal Study on Aging to examine whether SI and LON are individually and jointly associated with memory in community-dwelling middle-aged and older adults (n = 14,208). LON was assessed with the question: "In the last week, how often did you feel lonely?". SI was measured using an index based on marital/cohabiting status, retirement status, social activity participation, and social network contacts. Memory was evaluated with combined z-scores from two administrations of the Rey Auditory Verbal Learning Test (immediate-recall, delayed-recall). We conducted our analyses using all available data across the three timepoints and retained participants with missing covariate data. Linear mixed models were used to regress combined memory scores onto SI and LON, adjusting for sociodemographic, health, functional ability, and lifestyle variables. Experiencing both SI and LON had the greatest inverse effect on memory (least-squares mean: -0.80 [95 % confidence-interval: -1.22, -0.39]), followed by LON alone (-0.73 [-1.13, -0.34]), then SI alone (-0.69 [-1.09, -0.29]), and lastly by being neither lonely nor isolated (-0.65 [-1.05, -0.25]). Sensitivity analyses confirmed this hierarchy of effects. Policies developed to enhance memory in middle-aged and older adults might achieve greater benefits when targeting the alleviation of both SI and LON rather than one or the other individually.

Risk factors and prognostic impact of unwanted loneliness in heart failure

Heart failure (HF) is associated with a high prevalence of unwanted loneliness. This study aimed to assess whether unwanted loneliness was associated with adverse clinical endpoints in HF patients. Additionally, we also aimed to examine the risk factors associated with unwanted loneliness in HF. We included 298 patients diagnosed with stable HF. Clinical, biochemical, echocardiographic parameters and loneliness using ESTE II scale were assessed. We analyzed the association between the exposure and adverse clinical endpoints by Cox (death or any hospitalization), and negative binomial regressions (recurrent hospitalizations or visits to the emergency room). Risk factors associated with loneliness were analyzed using logistic regression. The mean age was 75.8 ± 9.4 years, with 111 (37.2%) being women, 53 (17.8%) widowed, and 154 (51.7%) patients having preserved ejection fraction. The median (p25-p75%) ESTE II score was 9.0 (6.0-12.0), and 36.9% fulfilled the loneliness criteria (> 10). Both women (OR = 2.09; 95% CI 1.11-3.98, p = 0.023) and widowhood (OR = 3.25; 95% CI 1.51-7.01, p = 0.003) were associated with a higher risk of loneliness. During a median follow-up of follow-up of 362 days (323-384), 93 patients (31.3%) presented the combined episode of death or all-cause admissions. Loneliness was significantly related to the risk of time to the composite of death or any readmission during the composite (HR = 1.83; 95% CI 1.18-2.84, p = 0.007). Women and widowhood emerge as risk factors for unwanted loneliness in HF patients. Unwanted loneliness is associated with higher morbidity during follow-up.

Prevalence of Unwanted Loneliness and Associated Factors in People over 65 Years of Age in a Health Area of the Region of Murcia, Spain: HELPeN Project

Background/Objectives: Population aging poses many challenges to public health, highlighting loneliness and social isolation as severe problems that affect the physical and mental health of older adults. During the COVID-19 pandemic, these became aggravated. The objective of the present study was to assess the prevalence of loneliness and its relationship with social isolation, depression, cognitive deterioration, sleep quality, and the level of physical mobility and functioning of older adults in Health Area 3 of the Region of Murcia. Methods: A descriptive, observational, and cross-sectional study was performed. The inclusion criteria were age ≥ 65, living in Health Area 3 of the Region of Murcia, and not being institutionalized. The following variables were evaluated: sociodemographic variables, loneliness (UCLA scale), social isolation (DUFSS), depression (GDS), cognitive deterioration (Pfeiffer), sleep quality (PSQI), and mobility (Barthel index). A univariate and multivariate regression model was created to examine how the dependent variable was related to the independent variables. Results: A total of 102 older adults participated in the study. Of these, 31.4% perceived unwanted loneliness and 14.7% low social support. The multivariate regression analysis showed that social isolation, geriatric depression, and cognitive deterioration were significant predictors of loneliness. Conclusions: The findings highlight the importance of developing multifaceted interventions that address not only social isolation but also other interrelated factors such as depression, cognitive deterioration, and sleep quality. The strategies should be centered on community programs and support networks. It is fundamental to perform longitudinal studies to better understand the causal relationships between these variables.

The link between social and emotional isolation and dementia in older black and white Brazilians

OBJECTIVE

To examine the link between social and emotional isolation and likelihood of dementia among older black and white Brazilians.

DESIGN

Cross-sectional clinical-pathological cohort study.

SETTING

Medical center in Sao Paulo, Brazil.

PARTICIPANTS

As part of the Pathology, Alzheimer's and Related Dementias Study, we conducted uniform structured interviews with knowledgeable informants (72% children) of 1,493 older (age > 65) Brazilian decedents.

MEASUREMENTS

The interview included measures of social isolation (number of family and friends in at least monthly contact with decedent), emotional isolation (short form of UCLA Loneliness Scale), and major depression plus the informant portion of the Clinical Dementia Rating Scale to diagnose dementia and its precursor, mild cognitive impairment (MCI).

RESULTS

Decedents had a median social network size of 8.0 (interquartile range = 9.0) and a median loneliness score of 0.0 (interquartile range = 1.0). On the Clinical Dementia Rating Scale, 947 persons had no cognitive impairment, 122 had MCI, and 424 had dementia. In a logistic regression model adjusted for age, education, sex, and race, both smaller network size (odds ratio [OR] = 0.975; 95% confidence interval [CI]: 0.962, 0.989) and higher loneliness (OR = 1.145; 95% CI: 1.060, 1.237) were associated with higher likelihood of dementia. These associations persisted after controlling for depression (present in 10.4%) and did not vary by race. After controlling for depression, neither network size nor loneliness was related to MCI.

CONCLUSION

Social and emotional isolation are associated with higher likelihood of dementia in older black and white Brazilians.

Thermoneutral Housing has Limited Effects on Social Isolation-Induced Bone Loss in Male C57BL/6J Mice

Social isolation stress has numerous known negative health effects, including increased risk for cardiovascular disease, dementia, as well as overall mortality. The impacts of social isolation on skeletal health, however, have not been thoroughly investigated. We previously found that four weeks of social isolation through single housing led to a significant reduction in trabecular and cortical bone in male, but not female, mice. One possible explanation for these changes in male mice is thermal stress due to sub-thermoneutral housing. Single housing at room temperature (~20-25°C)-below the thermoneutral range of mice (~26-34°C)-may lead to cold stress, which has known negative effects on bone. Therefore, the aim of this study was to test the hypothesis that housing mice near thermoneutrality, thereby ameliorating cold-stress, will prevent social isolation-induced bone loss in male C57BL/6J mice. 16-week-old mice were randomized into social isolation (1 mouse/cage) or grouped housing (4 mice/cage) at either room temperature (~23°C) or in a warm temperature incubator (~28°C) for four weeks (N=8/group). As seen in our previous studies, isolated mice at room temperature had significantly reduced bone parameters, including femoral bone volume fraction (BV/TV), bone mineral density (BMD), and cortical thickness. Contrary to our hypothesis, these negative effects on bone were not ameliorated by thermoneutral housing. Social isolation increased glucocorticoid-related gene expression in bone and Ucp1 and Pdk4 expression in BAT across temperatures, while thermoneutral housing increased percent lipid area and decreased Ucp1 and Pdk4 expression in BAT across housing conditions. Overall, our data suggest social isolation-induced bone loss is not a result of thermal stress from single housing and provides a key insight into the mechanism mediating the effects of isolation on skeletal health.

A prospective association between social isolation and cognitive performance among older adults in Europe: the role of loneliness and poor oral health

OBJECTIVES

The relationship between social isolation, loneliness, and tooth loss and cognition in older people is poorly understood. We examine how social isolation and cognitive performance are associated prospectively among older adults, as well as how tooth loss and loneliness are related to this association.

METHODS

Using data from 26,168 participants aged ≥50 from the Survey of Health, Ageing and Retirement in Europe (SHARE), we explored the association between social isolation, loneliness, tooth loss and cognition. We used bootstrapping with resampling strategies for testing a moderated mediating model.

RESULTS

Higher social isolation was associated with poorer cognitive performance (B = -0.20, 95% CI = -0.03, -0.01; R2 =0.60), an association mediated by the respondent's number of missing teeth (B = -0.001, 95% CI = -0.002, -0.001). Higher levels of social isolation were associated with a greater number of missing teeth, and a higher number of missing teeth was linked with poorer cognition. We also found that loneliness moderated the relationship between social isolation and both the number of missing teeth (B = -0.11, p  = 0.047) and cognitive performance.

CONCLUSION

In later life, social isolation and loneliness are associated with shoddy oral health and poor cognitive status. Clinicians and policymakers should be aware of both the association between social isolation and feelings of loneliness on dentition and oral health and their relationship to the cognitive status of older adults.

The Paradox in Positive and Negative Aspects of Emotional Functioning Among Older Adults with Early Stages of Cognitive Impairment

Introduction: Emotional functioning in older adults is influenced by normal aging and cognitive impairment, likely heterogeneous across positive versus negative aspects of emotional functioning. Little is known about positive emotional experiences at the early stages of cognitive impairment. Methods: We assessed different aspects of emotional functioning among 448 participants aged 65+ (Normal Control (NC) = 276, Mild Cognitive Impairment (MCI) = 103, and mild dementia of the Alzheimer type (mild DAT) = 69) and tested moderators. Results: Compared to NC, older adults with MCI and mild DAT have maintained many positive aspects of emotional functioning, despite higher levels of negative affect, sadness, and loneliness. Among the oldest-old, the mild DAT group experienced higher fear and lower self-efficacy. Discussion: Older adults at early stages of cognitive impairment can experience positive aspects of emotional functioning, such as positive affect, purpose, and life satisfaction, all of which are important buildable psychological resources for coping.

Effectiveness of a Virtual Reality Open-Air Bath Program in Reducing Loneliness and Improving Brain Function for Dementia Prevention in Older Adults: Protocol for a Prospective Randomized Crossover Study

BACKGROUND

Older adults often face loneliness due to chronic illness or loss of close ones, a situation worsened by the COVID-19 pandemic. Increased loneliness heightens the risk of diseases, especially dementia, necessitating urgent action.

OBJECTIVE

This study aims to assess the impact of a virtual reality (VR)-based open-air bath program on depression and loneliness in older individuals with subjective cognitive decline/mild cognitive impairment attending the Dementia Medical Center in Kyoto, Japan. We further aim to evaluate the feasibility of the program (participant recruitment and adherence) and to measure program enjoyment and satisfaction.

METHODS

The study design is a crossover trial with a 1:1 ratio, wherein 12 participants will be randomly assigned to groups 1 and 2, with group 2 serving as a waitlist control and group 1 receiving the VR program from the onset for 6 months; the VR program will be conducted 6 times (monthly). Program completion for group 1 will be followed by an observation period from months 7 to 12. Group 2 will participate in the VR program from months 7 to 12, with an observation period from months 1 to 6. Cognitive tests, psychiatric assessments, and the University of California, Los Angeles Loneliness Scale will be conducted before the study, at 6 months, and at 12 months. Results will be analyzed using repeated-measures ANOVA. Head magnetic resonance imaging and single-photon emission computed tomography scans will be performed before and after the VR program to evaluate changes and effects on brain regions.

RESULTS

Recruitment began in September 2023 and data collection is expected to be completed by March 2025. Complete study results will be published by September 2025.

CONCLUSIONS

This study examines the preliminary effects of VR on loneliness in older adults with predementia through open-air bath simulations. VR experiences could benefit this population, particularly those with limited outdoor activities. Quantifying VR's impact will aid in determining the size for a larger clinical trial. Qualitative results will inform participation mechanisms and guide the implementation and design of future trials.

TRIAL REGISTRATION

University hospital Medical Information Network UMIN000052667; https://tinyurl.com/3yaccay5.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/57101.

A translational neuroscience perspective on loneliness: Narrative review focusing on social interaction, illness and oxytocin

This review addresses key findings on loneliness from the social, neurobiological and clinical fields. From a translational perspective, results from studies in humans and animals are included, with a focus on social interaction, mental and physical illness and the role of oxytocin in loneliness. In terms of social interactions, lonely individuals tend to exhibit a range of abnormal behaviors based on dysfunctional social cognitions that make it difficult for them to form meaningful relationships. Neurobiologically, a link has been established between loneliness and the hypothalamic peptide hormone oxytocin. Since social interactions and especially social touch regulate oxytocin signaling, lonely individuals may have an oxytocin imbalance, which in turn affects their health and well-being. Clinically, loneliness is a predictor of physical and mental illness and leads to increased morbidity and mortality. There is evidence that psychopathology is both a cause and a consequence of loneliness. The final section of this review summarizes the findings from social, neurobiological and clinical perspectives to present a new model of the complex construct of loneliness.

A brief but comprehensive three-item social connectedness screener for use in social risk assessment tools

BACKGROUND

The 2014 IOM report "Capturing Social and Behavioral Domains and Measures in Electronic Health Records" described three subdomains of social relationships that affect patient health and well-being. However, most social risk screeners currently assess only one subdomain, frequency of social connections. We are proposing a three-item Brief Social Connectedness (SC) screener that additionally assesses risks in social/emotional support and loneliness/social isolation subdomains.

METHODS

For this cross-sectional study, we used data from a 2021 Kaiser Permanente Northern California (KPNC) social risk survey for 2244 members ages 35-85 years. The survey included three validated questions that covered the SC subdomains (frequencies of social contacts with people they care about, feeling lonely/socially isolated, and getting enough social/emotional support). Variables representing moderate/high versus low risk were created for each subdomain. We used weighted data for bivariate analyses and modified log-Poisson regression models that adjusted for age, sex, race, and ethnicity to examine cross-sectional associations among the three subdomain risks, as well as with two structural SC risks, living alone and not being in a committed relationship. We then used modified log-Poisson regression models to study cross-sectional associations of these five SC variables with three single-item self-report measures of emotional health.

RESULTS

In regression models that included all five SC variables, loneliness/social isolation and social/emotional support risks were significantly associated with all three emotional health measures, while frequency of social contacts, living alone, and no committed relationship were not. However, low frequency of social contacts and no committed relationship significantly increased risk of often feeling lonely/socially isolated and lacking in social/emotional support.

CONCLUSIONS

A three-item social connectedness screener that assessed risks of loneliness/social isolation, inadequate social/emotional support, and low frequency of social contacts provided more comprehensive information about emotional health risks than social connection frequency alone.

Temporal dynamics of depressive symptoms and cognitive decline in the oldest old: dynamic time warp analysis of the Leiden 85-plus study

BACKGROUND

The prevalence of depressive symptoms and cognitive decline increases with age. We investigated their temporal dynamics in individuals aged 85 and older across a 5-year follow-up period.

METHODS

Participants were selected from the Leiden 85-plus study and were eligible if at least three follow-up measurements were available (325 of 599 participants). Depressive symptoms were assessed at baseline and at yearly assessments during a follow-up period of up to 5 years, using the 15-item Geriatric Depression Scale (GDS-15). Cognitive decline was measured through various tests, including the Mini Mental State Exam, Stroop test, Letter Digit Coding test and immediate and delayed recall. A novel method, dynamic time warping analysis, was employed to model their temporal dynamics within individuals, in undirected and directed time-lag analyses, to ascertain whether depressive symptoms precede cognitive decline in group-level aggregated results or vice versa.

RESULTS

The 325 participants were all 85 years of age at baseline; 68% were female, and 45% received intermediate to higher education. Depressive symptoms and cognitive functioning significantly covaried in time, and directed analyses showed that depressive symptoms preceded most of the constituents of cognitive impairment in the oldest old. Of the GDS-15 symptoms, those with the strongest outstrength, indicating changes in these symptoms preceded subsequent changes in other symptoms, were worthlessness, hopelessness, low happiness, dropping activities/interests, and low satisfaction with life (all P's < 0.01).

CONCLUSION

Depressive symptoms preceded cognitive impairment in a population based sample of the oldest old.

Dyadic loneliness, age, and cognitive functioning among midlife and older Black couples

Objectives: Within marriages, loneliness has been linked with individuals' own and their partners' cognitive health. Yet little research has situated Black older adults within a relational, dyadic context.

Method: This study analyzed longitudinal dyadic data from the Health and Retirement Study (2010-2016; n = 1270 participants from 635 couples) from both partners in opposite-sex midlife and older couples where at least one partner reported being Black or African American.

Results: Results indicated (1) husbands' loneliness was associated with worse cognitive functioning 4 years later for wives who had high baseline cognitive functioning themselves; (2) wives' loneliness was associated with worse cognitive functioning 4 years later only for oldest-old husbands; and (3) wives' cognitive functioning was associated with slower increases to husbands' loneliness 4 years later.

Conclusion: Findings indicate that loneliness has dyadic consequences for cognitive functioning among older Black couples, but that context is crucial for determining who is at greatest risk of harmful repercussions from a partner's loneliness.

Adaptation and Implementation of a Volunteer-Delivered, Telephone-Based, Social Support Program HOW-R-U? During the COVID-19 Pandemic: A Pragmatic Study

BACKGROUND AND OBJECTIVES

Public health concerns surrounding social isolation and loneliness heightened during the coronavirus disease 2019 (COVID-19) pandemic, as infection prevention measures led to increased feelings of loneliness and depression. Our objective was to evaluate the implementation of the HOW-R-U? program, during the pandemic (March 2020-December 2021). HOW-R-U? is a weekly volunteer-delivered telephone program designed to facilitate social connection and ease feelings of social isolation, loneliness, and depression in older people.

RESEARCH DESIGN AND METHODS

This pragmatic study used the Implementation Framework for Aged Care to adapt and implement HOW-R-U? in an Australian aged and community care organization and a tertiary health service in Melbourne. The evaluation involved analysis of program data, semistructured interviews, and surveys with program recipients, volunteers, and referrers. A process evaluation was conducted alongside an assessment of outcomes including pre- and post-symptoms of isolation, depression, and loneliness.

RESULTS

The implementation evaluation indicated that codesigned systems and processes effectively supported the ongoing implementation of HOW-R-U? with transition into business as usual across both organizations. Recipients reported that telephone calls had a positive impact on their lives, whereas volunteers reported enjoyment of supporting others. Several challenges were identified, namely in program reach and fidelity.

DISCUSSION AND IMPLICATIONS

HOW-R-U? was well regarded by all involved, and evaluation learnings have informed implementation into business as usual by both organizations.

Contributions of loneliness to cognitive impairment and dementia in older adults are independent of other risk factors and Alzheimer's pathology: a narrative review

Loneliness significantly contributes to cognitive impairment and dementia in older adults. Loneliness is a distressing feeling resulting from a perceived lack of social connection (i.e., a discrepancy between desired and actual social relationships), while social isolation is a related term that can be defined by number and type of social relationships. Importantly, loneliness is distinct from social isolation in that it is associated with a distressing self-perception. The primary focus of this narrative review is the impact of chronic loneliness on cognitive impairment and dementia among older adults. Loneliness has a significant association with many factors that are related to worse cognition, and therefore we include discussion on health, mental health, as well as the physiological effects of loneliness, neuropathology, and potential treatments. Loneliness has been shown to be related to development of dementia with a hazard ratio (HR) risk comparable to having a single APOE4 gene. The relationship of dementia to loneliness appears to be at least partially independent of other known dementia risk factors that are possibly associated with loneliness, such as depression, educational status, social isolation, and physical activity. Episodic memory is not consistently impacted by loneliness, which would be more typically impaired if the mild cognitive impairment (MCI) or dementia was due to Alzheimer's disease (AD) pathology. In addition, the several longitudinal studies that included neuropathology showed no evidence for a relationship between loneliness and AD neuropathology. Loneliness may decrease resilience, or produce greater cognitive change associated with the same level of AD neuropathology. Intervention strategies to decrease loneliness in older adults have been developed but need to consider key treatment targets beyond social isolation. Loneliness needs to be assessed in all studies of cognitive decline in elders, since it significantly contributes to the variance of cognitive function. It will be useful to better define the underlying mechanism of loneliness effects on cognition to determine if it is similar to other psychological factors related to excessive stress reactivity, such as neuroticism or even depression, which are also associated with cognitive decline. It is important from a health perspective to develop better strategies to decrease loneliness in older adults.

Leisure activities as reserve mediators of the relationship between loneliness and cognition in aging

Previous studies have found that loneliness affects cognitive functions in older persons. However, the influence of loneliness on different cognitive fields and the internal mechanism of the relationship are unclear. A total of 4772 older persons aged above 50 years (Mean = 65.31, SD = 6.96, 57.7% female) were included in this study. All the participants completed the characteristics scale, as well as the loneliness scale, leisure activity scale, and cognitive function tests in six domains. The results showed that 17.6% of participants had high loneliness, while 16.7% of participants had low loneliness. Associations were observed between higher levels of loneliness and lower scores in general cognitive ability, memory, and executive functions. Mediation analysis suggested that leisure activities, encompassing mental, physical, and social activities, were associated with cognitive functions in the context of loneliness. These results indicate that leisure activities may play a significant role in the relationship between loneliness and cognitive functions in older adults. The study highlights the importance of considering leisure activities in this demographic to potentially mitigate the adverse cognitive effects associated with loneliness.

Introduction to Large Language Models (LLMs) for dementia care and research

Introduction

Dementia is a progressive neurodegenerative disorder that affects cognitive abilities including memory, reasoning, and communication skills, leading to gradual decline in daily activities and social engagement. In light of the recent advent of Large Language Models (LLMs) such as ChatGPT, this paper aims to thoroughly analyse their potential applications and usefulness in dementia care and research.

Method

To this end, we offer an introduction into LLMs, outlining the key features, capabilities, limitations, potential risks, and practical considerations for deployment as easy-to-use software (e.g., smartphone apps). We then explore various domains related to dementia, identifying opportunities for LLMs to enhance understanding, diagnostics, and treatment, with a broader emphasis on improving patient care. For each domain, the specific contributions of LLMs are examined, such as their ability to engage users in meaningful conversations, deliver personalized support, and offer cognitive enrichment. Potential benefits encompass improved social interaction, enhanced cognitive functioning, increased emotional well-being, and reduced caregiver burden. The deployment of LLMs in caregiving frameworks also raises a number of concerns and considerations. These include privacy and safety concerns, the need for empirical validation, user-centered design, adaptation to the user's unique needs, and the integration of multimodal inputs to create more immersive and personalized experiences. Additionally, ethical guidelines and privacy protocols must be established to ensure responsible and ethical deployment of LLMs.

Results

We report the results on a questionnaire filled in by people with dementia (PwD) and their supporters wherein we surveyed the usefulness of different application scenarios of LLMs as well as the features that LLM-powered apps should have. Both PwD and supporters were largely positive regarding the prospect of LLMs in care, although concerns were raised regarding bias, data privacy and transparency.

Discussion

Overall, this review corroborates the promising utilization of LLMs to positively impact dementia care by boosting cognitive abilities, enriching social interaction, and supporting caregivers. The findings underscore the importance of further research and development in this field to fully harness the benefits of LLMs and maximize their potential for improving the lives of individuals living with dementia.

Association between loneliness and cognitive function, and brain volume in community-dwelling elderly

Introduction

We investigated the relationship between loneliness, cognitive impairment, and regional brain volume among elderly individuals residing in the Korean community.

Methods

Data from the ARIRANG aging-cognition sub-cohort, collected between 2020 and 2022, were utilized for the present study. Loneliness was assessed using the UCLA-Loneliness Scale (UCLA-LS) questionnaire and the relevant item from Center for Epidemiologic Studies Depression Scale Korean version (CES-D-K). Cognitive impairment was measured through Mini-Mental State Examination (K-MMSE-2) and Seoul Neuropsychological Screening Battery (SNSB-C), with five sub-categories: attention, memory, visuospatial function, language, and executive function. Logistic regression was employed for prevalence ratios related to cognitive impairment, while linear regression was used for regional brain volume including white matter hyperintensity (WMH) and cortical thickness.

Results

Our analysis involved 785 participants (292 men and 493 women). We observed increased cognitive impairment assessed by K-MMSE-2 [UCLA-LS: odds ratio (OR) 3.133, 95% confidence interval (CI) 1.536-6.393; loneliness from CES-D: OR 2.823, 95% CI 1.426-5.590] and SNSB-C total score (UCLA-LS: OR 2.145, 95% CI 1.304-3.529) in the lonely group compared to the non-lonely group. Specifically, the lonely group identified by UCLA-LS showed an association with declined visuospatial (OR 1.591, 95% CI 1.029-2.460) and executive function (OR 1.971, 95% CI 1.036-3.750). The lonely group identified by CES-D-K was associated with impaired memory (OR 1.577, 95% CI 1.009-2.466) and executive function (OR 1.863, 95% CI 1.036-3.350). In the regional brain volume analysis, loneliness was linked to reduced brain volume in frontal white matter (left: -1.24, 95% CI -2.37 ∼-0.12; right: -1.16, 95% CI -2.31 ∼ -0.00), putamen (left: -0.07, 95% CI -0.12 ∼-0.02; right: -0.06, 95% CI -0.11 ∼-0.01), and globus pallidus (-15.53, 95% CI -30.13 ∼-0.93). There was no observed association in WMH and cortical thickness.

Conclusion

Loneliness is associated with cognitive decline and volumetric reduction in the frontal white matter, putamen, and globus pallidus.

Loneliness status transitions and risk of cardiovascular disease among middle-aged and older adults

BACKGROUND AND AIMS

Loneliness is a risk factor for cardiovascular disease (CVD), and the levels at which individuals experience it can transition over time. However, the impact of increased loneliness or decreased loneliness on later CVD risk remains unexplored. We aimed to identify the age-specific association between loneliness status transitions and subsequent CVD incidences in middle-aged and older adults.

METHODS AND RESULTS

Data was extracted from the China Health and Retirement Longitudinal Study (CHARLS) on 8463 adults to evaluate how loneliness status transitions across two data collection points were associated with the subsequent CVD incidence at a five-year follow-up. Loneliness status transitions were divided into four categories: stable low loneliness, decreased loneliness, increased loneliness, and stable high loneliness. Data were analyzed using a Cox-proportional hazards model with age subgroups, accounting for covariates at baseline. During follow-up, the incidence rate of CVD per 1000 person-years was lower for the stable low loneliness group and decreased loneliness group compared to the increased loneliness and stable high loneliness group. Increased loneliness is associated with the highest risk of overall CVD and heart disease (HR 2.44, P < 0.001; HR 2.34, P < 0.001), while stable high loneliness is associated with the highest risk of stroke among the four loneliness categories (HR 4.29, P < 0.05). The age-specific analyses revealed no statistically significant interaction in terms of loneliness status transitions and age group.

CONCLUSION

Increased loneliness and stable high loneliness are associated with higher CVD risk. In clinical practice, it is important to monitor patients' loneliness status transitions to reduce CVD incidences.

The relationship between Internet use and loneliness of middle-aged and older adult people: the moderating effect of residence

Objectives

The proportion of middle-aged and older adult people exposed to the Internet continues to grow. Internet use may have an impact on the mental health of the older adult, especially loneliness. This study analyzed the relationship between Internet use and presence of loneliness.

Methods

A total of 550 person aged 45 years and above were randomly selected from a province in eastern China at the end of 2022. The outcome variable was presence of loneliness, as measured by self-report. Descriptive analysis, chi-square test and binary logistic analysis were used to analyze the data.

Results

58.3% of respondents use the Internet. Internet use could reduce the possible of reported loneliness in middle-aged and older adult people (OR = 0.652, 95%CI: 0.465, 0.940), and residence played a moderating role in the relationship between them. Middle-aged and older adults who used the Internet for 1-3 h (OR = 0.464, 95%CI: 0.275, 0.784) and 3-5 h (OR = 0.484, 95%CI: 0.247, 0.946) were less likely to felt lonely than those who used the Internet for less than 1 h per day. In addition, middle-aged and older adult people using the Internet to contact relatives and friends (OR = 0.488, 95%CI:0.292, 0.818), read the news (OR = 0.485, 95%CI:0.277, 0.848), assets management (OR = 0.297, 95%CI:0.109, 0.818) were less likely to report loneliness, while those who made online payment (OR = 3.101, 95%CI:1.413, 6.807) were more likely to report loneliness.

Conclusion

There is a significant negative correlation between Internet use and presence of loneliness, but different Internet duration and content have different effects on loneliness in middle-aged and older adult people. We should pay attention to the impact of Internet use on loneliness in middle-aged and older adult people.

Exploring the relationship between loneliness and volunteering amongst Australian adults: a cross-sectional study

BACKGROUND

Alleviating loneliness and fostering social connections and a sense of belonging are essential for individuals' well-being in the aftermath of the COVID-19 pandemic. Volunteering has emerged as a potential strategy to prevent or alleviate loneliness among adults. To gain insights into factors that can reduce or protect against loneliness, it is important to consider multi-dimensional measures of loneliness and motivations to volunteer. This study aimed to understand which variables predict Australian volunteers' social, family, and romantic loneliness.

METHODS

From October 2021 to January 2022, a cross-sectional online survey was administered to a sample of Australian adults with volunteering experience. The survey collected demographic information and used validated measures to assess social, family, and romantic loneliness and volunteer motivation. Bivariate and multivariate analyses were conducted to examine the association between loneliness and motivations for volunteering.

RESULTS

Of the 1723 individuals who accessed the survey link, 160 participants completed the survey. The average age of respondents was 59.87 years (SD 12.3). The majority were female (77.5%), married or partnered (70.6%), and had ten or more years of volunteering experience (62.1%). Overall, participants reported low to moderate levels of loneliness across social (M = 12.1; SD = 5.3), family (M = 11.3; SD = 6.7), and romantic (M = 14.8; SD = 8.3) dimensions. Social motivation for volunteering was negatively associated with social and romantic loneliness, while enhancement and protective motivations were positively associated with family and romantic loneliness. Age and rurality were not significantly associated with any dimension of loneliness.

CONCLUSIONS

Loneliness is a multifaceted and intricate experience that impacts individuals socially and emotionally. This study's findings confirmed that having protective and enhancement motives to volunteer was associated with increased loneliness. Social motives to volunteer were associated with a tendency to have lower levels of loneliness, possibly due to the positive impact of building and maintaining social relationships through volunteering. Understanding these associations is necessary to ensure that volunteering activities align with each person's unique needs and motivations.

Loneliness, Dementia Status, and Their Association with All-Cause Mortality Among Older US Adults

Background

Loneliness, dementia, and mortality are interconnected.

Objective

We aimed at understanding mediating pathways and interactions between loneliness and dementia in relation to mortality risk.

Methods

The study tested bi-directional relationships between dementia, loneliness, and mortality, by examining both interactions and mediating effects in a large sample of older US adults participating in the nationally representative Health and Retirement Study. Out of≤6,468 older participants selected in 2010, with mean baseline age of 78.3 years and a follow-up time up to the end of 2020, 3,298 died at a rate of 64 per 1,000 person-years (P-Y). Cox proportional hazards and four-way decomposition models were used.

Results

Algorithmically defined dementia status (yes versus no) was consistently linked with a more than two-fold increase in mortality risk. Dementia status and Ln(odds of dementia) were strongly related with mortality risk across tertiles of loneliness score. Loneliness z-score was also linked to an elevated risk of all-cause mortality regardless of age, sex, or race or ethnicity, and its total effect (TE) on mortality was partially mediated by Ln(odds of dementia), z-scored, (≤40% of the TE was a pure indirect effect). Conversely, a small proportion (<5%) of the TE of Ln(odds of dementia), z-scored, on mortality risk was explained by the loneliness z-score.

Conclusions

In sum, dementia was positively associated with all-cause mortality risk, in similar fashion across loneliness score tertiles, while loneliness was associated with mortality risk. TE of loneliness on mortality risk was partially mediated by dementia odds in reduced models.

P, Uribe FL, Felding SA, Roes M. There is no one size fits all: Elements of implementing virtual bike rides to address loneliness in people living with dementia

Objective

This study aimed to identify factors that hinder or facilitate the implementation of an exergaming technology, SilverFit Mile, which offers virtual cycling, for nursing home residents with dementia in and its potential impact on feelings of loneliness.

Methods

The study followed a descriptive qualitative approach using semi structured interviews with eight care professionals in nursing homes in the Netherlands and based on the Consolidated Framework for Implementation Research (CFIR). Thematic text analysis was used to analyze the interviews.

Results

We identified three main themes and twelve subthemes based on the CFIR. The main themes were residents' personal characteristics, implementation factors, and loneliness. SilverFit Mile was more suitable for those familiar with cycling and those who enjoyed more solitary activities. Organizational factors such as staff's low digital literacy, lack of time, and need for training were found barriers to implementation, while facilitators included fostering social interaction.

Conclusions

SilverFit Mile was considered positively by care staff based on observations of persons living with dementia. We identified loneliness as a relevant outcome of SilverFit Mile implementation. We argue that SilverFit Mile can foster social interaction between residents and staff through reminiscence or the physical aspect of cycling. However, a better understanding of the connection between loneliness and the use of SilverFit Mile is needed. Overall, our research provides initial ideas about how exergaming technology might address loneliness in dementia.

Relationship between Loneliness and Mild Behavioral Impairment: Validation of the Japanese Version of the MBI Checklist and a Cross-Sectional Study

Background

Mild behavioral impairment (MBI) and loneliness are associated with cognitive decline and an increased risk of dementia.

Objective

Our aim was to examine the validity of the Japanese version of the MBI checklist (MBI-C) and investigate the relationship between loneliness and MBI.

Methods

The participants in this cross-sectional study included 5 cognitively normal persons and 75 persons with mild cognitive impairment. MBI-C and the revised University of California at Los Angeles loneliness scale (LS) were used to assess MBI and loneliness, respectively. Diagnostic performance of MBI-C was examined using receiver operating characteristic analysis. The relationship between MBI-C and LS was examined using multiple linear regression in 67 subjects who were assessed with both scales, with MBI-C total or domain score as the dependent variable and LS as the independent variable, adjusted for age, gender, living situation, presence of visual and hearing impairment, and Mini-Mental State Examination score.

Results

Per the Youden index, in this mostly MCI sample, the optimal MBI-C cut-off score was 5.5 with sensitivity 0.917 and specificity 0.949. In multiple linear regression analysis, LS score was detected as a significant predictor of MBI-C total scores, and MBI-C decreased motivation, affective dysregulation, and abnormal thought and perception scores.

Conclusions

The caregiver-rated Japanese MBI-C has excellent diagnostic performance. Loneliness is associated with a greater MBI burden, especially in the decreased motivation, affective dysregulation, and abnormal thought and perception domains. Interventions for loneliness in older people may have the potential to improve MBI.

Exploring the relationship between perceived loneliness and subjective cognitive decline in older individuals

OBJECTIVE

Loneliness has been associated to a greater risk of cognitive decline and dementia in older individuals. However, evidence on whether this association also exists for older individuals who complain of cognitive problems is limited. We conducted a survey to examine the association between subjective cognitive decline in the working memory domain, perceived loneliness, depression, anxiety, and stress in older individuals with different profiles.

METHODS

A total of 302 healthy, old individuals completed 3 questionnaires to assess subjective cognitive problems in attention, executive functions, storage, depression, anxiety, stress, and perceived loneliness.

RESULTS

We conducted a cluster analysis and 3 clusters of individuals with different profiles emerged. Individuals with greater subjective cognitive problems (cluster 1) in the attention and storage domains, reported higher perceived loneliness and stress but not depression. In contrast, individuals with the least subjective cognitive problems (cluster 3) in the storage domain, reported lower perceived loneliness.

CONCLUSIONS

Individuals with higher subjective cognitive decline also report higher levels of perceived loneliness but not more depression than their peers. However, this correlation is present only for individuals with mild subjective cognitive decline (cluster 2). The implications for future research and interventions are discussed.

Correlations between Dementia and Loneliness

This review describes associations between dementia and loneliness on the neurobiological and epidemiological levels according to the recent body of literature. The aim of this study was to highlight major lines of research in this field. Sociocognitive skills and social interactions present complex interdependencies with dementia which may be explained by two theories. According to the first one, not sufficiently engaging in social or cognitive activities results in brain atrophy. The second one claims that brain neurogenesis and synaptic density are being increased by social connections. The relationship between loneliness and dementia could be mediated by sensory loss, including hearing and visual impairment, as well as depression and psychotic symptoms. Loneliness itself might cause a depletion in sensory and cognitive stimulation which results in a decrease in neural reserve. Certain changes in the structures of the brain caused by loneliness were found in imaging examination. Loneliness appears to be a crucial risk factor for dementia in recent times due to the modern lifestyle and consequences of the outbreak of COVID-19. Additional studies are required to understand more completely the key tenets of this topic and therefore to improve the prevention and treatment of dementia.

Psycho-social and health predictors of loneliness in older primary care patients and mediating mechanisms linking comorbidities and loneliness

BACKGROUND

Aging is associated with many personal, social, and environmental challenges that increase the risk of loneliness. Loneliness is a painful emotional experience associated with a perceived lack of connection and intimacy. Loneliness accelerates health deterioration, but the presence of chronic health conditions (comorbidities) in older individuals may potentiate the feeling of loneliness. The relationships between health status and loneliness in older individuals have not been assessed in an integrated manner, although it is necessary for planning efficient interventions. The aim of this study was to fill in this knowledge gap, by attempting to create an integrated model of loneliness in older individuals.

METHODS

The sample consisted of 189 (58% F) older individuals (> 60 years) (mean ± SD, 78.47 ± 6.65), attendees in Primary Health Care. Different factors associated with loneliness in the older population were assessed, and classified as demographic, environmental, physical (health-related), and psychological, in addition to functional abilities. A set of standard questionnaires was used to assess psychological factors and functional abilities. The hierarchical regression model assessed the effect of particular blocks of factors on status loneliness. The second aim was to analyze how psychological factors mediate associations between health status (comorbidity level) and loneliness.

RESULTS

Indicated that increasing comorbidity, anxiety, lack of positive moods, not having hobbies/activities, low perception of social support, impaired cognitive function, and suppression of emotion expression, are significant predictors of loneliness. Mediation analysis informed us of how to help patients with comorbidities feel less lonely. Interventions that were suggested were those that can reduce anxiety and depression, improve cognitive abilities and emotional regulation control, and enhance social support.

CONCLUSIONS

Results can help understand the pathophysiology loops linking poor health status (comorbidity level) of older individuals and loneliness, and have significant potentials from the translational perspectives, as a decision-support tool.

Social and Emotional Loneliness: Their Relationship to Multiple Domains of Cognition in Later Life

Despite the fact that the literature suggests loneliness to undermine cognitive functioning in later life, no work has simultaneously examined the relationships between these constructs taking a multidimensional approach to the assessment of each. The present study explored relationships among social and emotional loneliness and both general crystallized (Gc) and general fluid (Gf) ability, as well as to several indices of everyday intellectual functioning in later life. Sequential regression analyses suggested that neither social nor emotional loneliness predicted Gc. However, only when eliminating health as a covariate was more social loneliness associated with lower scores for Gf. Surprisingly, more emotional loneliness was associated with higher scores for Gf. More social loneliness also predicted more everyday cognitive failures and with less positive lifestyle attitudes. These findings support a view of loneliness-cognition relationships in later life that reflects the multidimensional nature of each construct.

Uncovering the underlying factors of ERP changes in the cyberball paradigm: A systematic review investigating the impact of ostracism and paradigm characteristics

The Cyberball is the most commonly employed paradigm for the investigation of the effects of social exclusion, also called ostracism. The analysis of event-related potentials (ERPs), short-term stimulus-induced fluctuations in the EEG signal, has been employed for the identification of time-sensitive neural responses to ostracism-related information. Changes in ERPs during the Cyberball are normally attributed to the effect of ostracism, but it has been argued that characteristics of the paradigm, not ostracism, are the driving force for these changes. To elucidate the origin of the ERP changes in the Cyberball, we systematically reviewed the Cyberball-ERP literature of healthy, adult populations, and evaluated whether the social context of ostracism or characteristics of the paradigm are better suited for the explanation of the found results. Our results show that for many components no clear origin can be identified, but that expectancy violations, not ostracism, best explains the results of the P3 complex. Future research should therefore also employ other paradigms for the research into the effects of ostracism on ERPs.

Friendly visiting by a volunteer for reducing loneliness or social isolation in older adults: A systematic review

Background

Loneliness and social isolation are currently among the most challenging social issues. Given their detrimental impact on physical and mental health, identifying feasible and sustainable interventions to alleviate them is highly important. Friendly visiting, a befriending intervention whereby older persons are matched with someone who visits them on a regular basis, seems promising. However, it is unclear if face-to-face (F2F) friendly visiting by a volunteer (FVV) is effective at reducing loneliness or social isolation, or both.

Objectives

To assess the effect of F2F FVV on feelings of loneliness, social isolation (primary outcomes) and wellbeing (i.e., life satisfaction, depressive symptom experiencing and mental health; secondary outcomes) in older adults.

Search Methods

We searched six electronic databases up until 11 August 2021. We also consulted 15 other resources, including grey literature sources and websites of organizations devoted to loneliness and ageing, between 25 October and 29 November 2021.

Selection Criteria

We included experimental and observational studies that quantitatively measured the effect of F2F FVV, compared to no friendly visiting, on at least one of following outcomes in older adults (≥60 years of age): loneliness, social isolation or wellbeing.

Data Collection and Analysis

Two reviewers independently performed study selection, data extraction and synthesis, risk of bias and GRADE assessment. If outcomes were measured multiple times, we extracted data for one short-term (≤1 month after the intervention had ended), one intermediate-term (>1 and ≤6 months), and one long-term time point (>6 months). Data from randomized controlled trials (RCTs) and non-RCTs were presented and synthesized separately. Synthesis was done using vote counting based on the direction of effect.

Main Results

Nine RCTs and four non-RCTs, conducted primarily in the United States and involving a total of 470 older adults (mean or median ages: 72-83 years), were included. All studies were limited in size (20-88 participants each). Programmes lasted 6-12 weeks and mostly involved weekly visits by undergraduate students to community-dwelling older adults. Visits consisted mainly of casual conversation, but sometimes involved gameplaying and TV-watching. All studies had major shortcomings in design and execution. The current evidence about the effect of F2F FVV on loneliness in older adults is very uncertain, both in the short (one RCT in 88, and one non-RCT in 35 participants) and intermediate term (one RCT in 86 participants) (both very low-certainty evidence). The same goes for the effects on social isolation, again both in the short (one RCT in 88, and two non-RCTs in 46 participants) and intermediate term (two non-RCTs in 99 participants) (both very low-certainty evidence). Similarly, there is a lot of uncertainty about the effect of F2F FVV on outcomes related to wellbeing (all very low-certainty evidence).

Authors’ Conclusions

Due to the very low-certainty evidence, we are unsure about the effectiveness of F2F FVV with regard to improving loneliness, social isolation, or wellbeing in older adults. Decision-makers considering implementing FVV should take into account this uncertainty. More and larger high-quality studies that are better designed and executed, and preferably conducted in various settings, are needed.