Loneliness amongst older people in Europe: a comparative study of welfare regimes

Material, Health, and Social Vulnerability and Loneliness Among Older Adults: From the Welfare Regime Perspective

Loneliness in later life is a significant global public health issue that negatively impacts well-being, life satisfaction, and mental health. This study investigates how material, health, and social vulnerabilities contribute to loneliness among older adults using a welfare regime framework. It examines the link between vulnerability and loneliness in the United States, Korea, Sweden, Spain, and Germany using the Health and Retirement Study (HRS) alongside its international sister studies, encompassing both Western and East Asian welfare states. Findings indicate that older adults in less generous welfare regimes experience higher levels of loneliness and material vulnerability. A multidimensional approach reveals that the most urgently vulnerable population is the multiply vulnerable group. Vulnerable groups are more likely to experience loneliness, with divergent associations emerging across countries. Cross-national variations demonstrate how institutional arrangements can either mitigate or exacerbate the relationship between vulnerability and loneliness.

Urban-rural disparities in the prevalence and trends of loneliness among Chinese older adults and their associated factors: Evidence from machine learning analysis

In the context of rapid aging development, exploring the predictive factors of older adults' loneliness and its urban-rural differences is of great significance for promoting the psychological health of older adults. This study selected 30 variables from the three waves of China Family Panel Studies (CFPS) data in 2016, 2018, and 2020, using a random forest classifier to explore the predictive factors of loneliness. The sense of loneliness among rural older adults is significantly higher than that of urban older adults. Among the top 10 predictors of loneliness, there are seven common factors in urban and rural, including sleep quality, marital status, confidence in the future, weekly family dinners, life satisfaction, physical discomfort in the past 2 weeks, and relationship with children. The other three different predictive factors for urban older adults are weekly movie and TV duration, family size, and family net worth, while self-rated health, health change, and per capita family income set the rural older adults apart. In addition, the urban-rural differences in the predictive factors of older adults' loneliness show different development trends in the time dimension. Paying attention to the predictive factors that contribute to the high ranking of older adults' loneliness and the widening trend of urban-rural differences is highly required.

Intensity and changes in grandparental caregiving: Exploring the link to loneliness in Europe

This study investigates the impact of the overall intensity and changes in grandparental caregiving on loneliness in grandparents in European countries. Data from waves 5 to 8 of the Survey on Health, Ageing, and Retirement in Europe (SHARE) were used (Nindividuals = 30,896 and Nobservations = 48,562). We included grandparents (aged 50 years and over) with at least one grandchild at the beginning of the study. The analyses reveal that any intensity of grandparental care decreases the risk of loneliness. When looking at changes in grandparental care the results show that stable caregiving roles appeared to reduce loneliness, while starting to provide grandparental care makes grandparents more vulnerable to loneliness. In conclusion, our findings underscore that consistent grandparental care is important for grandparents in mitigating loneliness, highlighting the importance of sustained caregiving roles over fluctuations in caregiving intensity.

The unique and synergistic effects of social isolation and loneliness on 20-years mortality risks in older men and women

Introduction

This study investigates the individual and combined impacts of loneliness and social isolation on 20-year mortality risks among older men and women.

Methods

Utilizing data from the Norwegian Life Course, Ageing, and Generation study (NorLAG) carried out in 2002, 2007 and 2017, we assessed loneliness via direct and indirect questions, and social isolation through factors like partnership status and contact frequency with family and friends. Yearly information on mortality was derived from the national registries and was available until November 2022. Gender-stratified Cox regression models adjusted for age and other risk factors were employed.

Results

Of the 11,028 unique respondents, 9,952 participants were included in the study sample, 1,008 (19.8%) women and 1,295 (26.6%) men died. In the fully adjusted models including indirectly assessed loneliness, social isolation increased the 20-year mortality risk by 16% (HR = 1.16, 95% CI 1.09-1.24) for women and 15% (HR = 1.15, 95% CI 1.09-1.21) for men. This effect was primarily driven by the absence of a partner and little contact with children for both genders. Loneliness measured with indirect questions lost its significant association with mortality after adjusting for social isolation and other factors in both genders. However, for men, reporting loneliness via a direct question was associated with a higher mortality risk, even in the fully controlled models (HR = 1.20, 96% CI 1.06-1.36). Interactions between loneliness and social isolation were not, or only borderline significantly, associated with mortality risks in the fully controlled models.

Discussion

Social isolation, but not loneliness measured with indirect questions are associated with a 15-16% higher mortality risk in both men and women. However, loneliness assessed with a direct question is associated with increased mortality in men, even after controlling for social isolation and other relevant factors, which might suggest that men may deny loneliness, unless it is (very) severe. These findings emphasize the importance of methodological precision in the measurement of loneliness and social isolation.

[Strategies against loneliness-examples from an international comparative perspective]

The extent of loneliness differs internationally. Especially in the developed welfare states of Northern Europe, loneliness levels in the population are comparatively low. However, the increase in loneliness in many countries shows that existing concepts are not sufficient to provide effective protection against loneliness. Younger people also need to be strengthened so that they do not withdraw when they experience social exclusion and loneliness. This requires qualified specialists in kindergartens, schools, sports clubs, and other leisure facilities who help children and young people to establish social contacts. Friendship and neighborhood models have proven to be successful when it comes to strategies to combat loneliness. Greater identification with the neighborhood and a feeling of security help build social networks and reduce loneliness. For older people it is important to be able to stay in their usual social environment and maintain their social contacts. To this end, accessible public spaces must be combined with home care and support services that are tailored to the needs and wishes of older people.

Can Social Policy Alleviate Loneliness Among Older Adults? A Comparative Analysis of OECD Countries

Loneliness in old age is a multifaceted issue influenced by personal, social, and environmental factors, necessitating a holistic approach. However, most research has predominantly focused on individual-level risk factors, with limited attention given to institutional factors such as social policy. This study investigated how social policies impact loneliness among older adults. Multi-level analysis was conducted using data from the 2017 wave of International Social Survey Programme, involving 6,337 older adults from 23 OECD countries. The analysis revealed that higher public spending on welfare and old-age pensions significantly reduces the likelihood of loneliness among older adults. These findings confirm the protective role of generous social policies in addressing old-age loneliness. They underscore the need for long-term changes in welfare systems to enhance the public response to the significant social risk posed by old-age loneliness.

Loneliness Trajectories and Chronic Loneliness Around the World

OBJECTIVES

We examine cross-national variation in (a) loneliness trajectories and (b) the association between common social risk factors and chronic loneliness in middle and older adulthood.

METHODS

Using longitudinal data, we assess the country-level prevalence of loneliness trajectories (chronic, transitory, and no loneliness) and the extent of common social risk factors for loneliness (living alone, widowhood, divorce, no grandchildren, having chronic conditions, and never working) among adults 50 and older in 20 countries covering 47% of the global population in this age bracket. Additionally, we compare how the associations between social risk factors and chronic loneliness vary across countries.

RESULTS

We find considerable variation in the prevalence of chronic loneliness cross-nationally, ranging between 4% (Denmark) and 15% (Greece) of adults 50 and older. Living arrangements have the most consistent association with the likelihood of chronic loneliness across countries, with those ever living alone having an 8% higher likelihood of chronic loneliness on average across countries, with a range of 2%-25%. Additionally, those who never report working and those with chronic conditions have a higher likelihood of chronic loneliness across more than a third of the countries.

DISCUSSION

These results suggest that policies and interventions targeted to middle age and older adults living alone and with limited work histories or with chronic conditions are critical in reducing the public health challenges of chronic loneliness.

Perceived Loneliness, Social Isolation, and Social Support Resources of Frail Older People Ageing in Place Alone in Italy

This paper presents some findings from the IN-AGE ("Inclusive ageing in place") study, which the authors carried out in 2019 in Italy. It explores the available social support resources for frail older people with functional limitations ageing in place alone, and possible links between their social isolation and perceived loneliness. The authors conducted qualitative/semi-structured interviews involving 120 participants aged 65 years and over, and used a mixed-methods analysis (quantitative/qualitative). The main results show the family as the main help resource for daily activities, but also for intimate confidences against social isolation, especially when said relatives live close. Family confidants are less present when seniors are supported by friends/neighbours or/and public services. Moreover, the family is valuable for decreasing loneliness, although not always. However, some older people feel particularly alone when they are supported by public services. Such a complex context draws attention on the need of support for frail seniors living alone and could provide insights for policymakers on adequate policies for preventing and managing loneliness and social isolation in later life. This is especially relevant when family (and other) resources are not available or scarce, also considering the opportunities offered by technology, which can help seniors remain socially connected to relatives, friends and their overall community.

Unraveling the dynamics of loneliness in the Baltic-Nordic region: a comparative analysis in the wake of COVID-19

Introduction

The primary aim of this study is to thoroughly investigate the prevalence and determinants of loneliness among older adults in the Baltic-Nordic region. Utilizing high-quality data sources and employing a methodologically rigorous approach, the study endeavors to enhance our understanding of how loneliness manifests and varies across different cultural and socio-economic contexts within these regions. By identifying key factors influencing loneliness, including demographic, social, and economic variables, the research seeks to contribute significantly to the existing body of knowledge on loneliness and inform targeted public health strategies and interventions tailored to the unique needs of older adults in the Baltic and Nordic countries.

Material and methods

This research, centered on older adults aged 67 and above within the Baltic-Nordic region, draws upon data from the Survey of Health, Ageing and Retirement in Europe (SHARE), specifically its eighth wave conducted between June and August 2020. The demographic analysis of this study covers a diverse sample of 5,313 participants from the Baltic and Nordic regions. Specifically, the sample includes 2,377 participants from Nordic countries, namely Sweden, Denmark, and Finland, and 2,936 from the Baltic countries of Estonia, Latvia, and Lithuania. The investigation extends to the financial well-being of households, involving an analysis of 3,925 individuals, with 1,748 from Nordic countries and 2,177 from Baltic countries. Although Iceland is categorized as a Nordic country, the analysis within this study is conducted separately due to the unavailability of SHARE data for this region. Instead, the HL20 study, focusing on the health and well-being of the older adult population in Iceland, contributes data for 1,033 respondents. This methodological distinction allows for a comprehensive understanding of regional differences, highlighting the importance of specialized approaches to examine the intricate dynamics of loneliness and well-being across the Baltic-Nordic region.

Results

The study reveals significant regional variations in loneliness among older adults during the COVID-19 outbreak, with the Baltic countries (Estonia, Latvia, Lithuania) reporting a lower prevalence of loneliness compared to the Nordic countries (Sweden, Denmark, Finland). Iceland, while grouped with the Nordic countries, was analysed separately. Employment emerges as a key factor in reducing loneliness across all regions, suggesting the benefits of social interactions and structured routines. Gender and marital status significantly influence loneliness, with notable disparities in the Baltic region and smaller gaps in the Nordic countries, reflecting the impact of societal and cultural norms. Additionally, educational attainment and health status show varied associations with loneliness, highlighting the complex interplay of individual and societal factors in these regions.

Risk factors for loneliness: A literature review

RATIONALE

Increasingly, loneliness is being recognised as a serious problem with detrimental effects on health, as well as on social cohesion and community trust. To effectively tackle this complex issue, a clear understanding of the phenomenon and its main drivers is needed. Over years of scientific research on loneliness, many potential risk factors have emerged and been tested empirically.

OBJECTIVE

This narrative review of 109 studies provides a concise summary of empirical evidence on the main potential risk factors for loneliness and presents an additional section dedicated to the COVID-19 pandemic.

METHOD

Given the very large number of existing studies, emphasis is placed on recent meta-analyses and systematic literature reviews as well as longitudinal studies. Similarly, given the large number of possible risk factors for loneliness, which may differ based on the geographical and cultural context, this review focuses on studies from Europe and North America.

RESULTS

The results show that demographic factors often correlate with loneliness, but in many cases the link becomes negligible when controlling for other factors. Often, physical and mental health problems are found to be associated with loneliness, and so are some psychological factors, such as neuroticism or extroversion. Loneliness also depends on the environment in which one lives, and possibly the broader socio-economic and socio-cultural contexts. Nevertheless, the review shows that ultimately everything comes down to the quantity and quality of social relationships. In particular, marital status, living arrangements and the characteristics of one's personal social network are quite consistently found to be among the strongest predictors of loneliness. These main findings about the risk factors for loneliness remained valid also during the COVID-19 pandemic.

POLICY IMPLICATIONS

The findings of this review have implications for policy, as understanding who the most vulnerable groups are is key for designing targeted policy solutions that tackle loneliness.

COVID-19 experiences of social isolation and loneliness among older adults in Africa: a scoping review

Objective

Social isolation and loneliness (SI/L) are considered critical public health issues. The primary objective of this scoping review is to document the experience of SI/L among older adults in Africa during the COVID-19 pandemic, given research gaps in this area. We identified the reasons for SI/L, the effects of SI/L, SI/L coping strategies, and research and policy gaps in SI/L experiences among older adults in Africa during COVID-19.

Methods

Six databases (PubMed, Scopus, CINAHL, APA PsycINFO, Web of Science, and Ageline) were used to identify studies reporting the experiences of SI/L among older adults in Africa during the COVID-19 lockdown. We adopted the Joanna Briggs Institute (JBI) methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).

Results

Social isolation and loneliness due to COVID-19 in Africa affected older adults' mental, communal, spiritual, financial, and physical health. The use of technology was vital, as was the role of social networks within the family, community, religious groups, and government. Methodological challenges include the risk of selective survival bias, sampling biases, and limited inductive value due to context. Also, lack of large-scale mixed methods longitudinal studies to capture the experiences of older adults during COVID-19. There were essential policy gaps for African mental health support services, media programs, and community care service integration targeting older adults in the era of the COVID-19 lockdown.

Discussion

Like in other countries, COVID-19 lockdown policies and the lockdown restrictions primarily caused the experience of SI/L among older adults in Africa. In African countries, they resulted in a severance of older adults from the cultural structure of care for older adults and their familial support systems. Weak government intervention, personal situations, challenges regarding technology, and detachment from daily activities, disproportionately affected older adults in Africa.

Complex association of self-rated health, depression, functional ability with loneliness in rural community-dwelling older people

BACKGROUND

This study aimed to explore whether and how self-rated health, depression and functional ability interactively associated with loneliness using a sample group of older adults residing in China rural communities.

METHODS

Data on socio-demographic information, self-rated health, depressive symptoms, functional ability and loneliness (quantified via a single question) were collected from 1009 participants. Cross-tabulations with chi-square test, bivariate correlations, and Classification and Regression Tree (CART) models were employed for analysis.

RESULTS

We found that 45.1% of the participants were classified as lonely. Our results gain insight into the hierarchical order of predictors for the presence of loneliness, suggesting that there was a significant interaction between functional ability and depressive symptoms while self-rated health was not a significant factor. The probability of loneliness increased with the combination of limited functional ability and depression, and varied with different interaction of functional ability, depressive symptoms, and marital status, respectively. Notably, while there were some differences, similar associations were observed among older male and female respondents.

CONCLUSION

To delay or reduce loneliness, early detection which focuses on older people who report limitations in functional ability, depression, and being female, offers opportunities to start early interventions. Our findings might be helpful not only in designing and implementing loneliness prevention programs but also in improving healthcare for older rural community-dwelling people.

Social Infrastructure and the Alleviation of Loneliness in Europe

In Europe, individualist societies, in which people more highly value independence, have fewer people who are lonely. Yet these societies also have more people who live alone, a strong determinant of loneliness. Evidence suggests that some unrecognized societal-level resources or characteristics can explain this. We uncover multiple pathways toward a lower degree of loneliness among European societies using an ideal method for this purpose, fuzzy-set qualitative comparative analysis. Using data from the 2014 wave of the European Social Survey and other sources, we analyzed loneliness outcomes among 26 European societies. Our findings suggest two necessary conditions for a low degree of loneliness: high internet access and high association participation. Further, three pathways are sufficient for achieving less loneliness at the societal level. Most societies that have less loneliness follow both the welfare support and cultural support pathways. The third path, commercial provision, is mutually exclusive with welfare support because the former requires a weak welfare state. The surest policy for building societies that have lower rates of loneliness includes the expansion of internet accessibility, the fostering of civil society through association participation and volunteering, and a welfare state that protects potentially vulnerable populations while funding opportunities for social interaction. This article further contributes methodologically by demonstrating "configurational robustness testing," a more comprehensive means to implement current best practices for fuzzy-set qualitative comparative analysis robustness testing.

[Studying loneliness and social support networks among older people: a systematic review in Europe.]

OBJECTIVE

During the ageing process the loss of family and social relationships is frequent which conditions loneliness, similarly the current COVID-19 pandemic has generated more social limitations in this age group and has increased the risk factors to trigger feelings of loneliness. This paper aimed to examine how loneliness among older people had been studied in Europe over the last ten years. Specific objectives were: i) to describe the methodological aspects; ii) to identify the scales or questions for the assessment of loneliness; iii) what were the main variables or dimensions that were related to loneliness in old age.

METHODS

A total of 1,591 articles were found in WoS and Scopus digital platforms. After initial assessment of titles and abstracts, full text reading and review of the established criteria, 42 scientific articles were finally included in the systematic review.

RESULTS

The countries that had carried out the most studies were the Netherlands and Spain. Most of the research was quantitative and uses the De Jong Gierveld Loneliness Scale (DJGLS) and the University of California at Los Angeles (UCLA) Loneliness Scale. The most analysed variables were: marital status, household structure, social support networks, social participation, depression, health problems, co-morbidity and physical functioning.

CONCLUSIONS

The scientific interest in studying loneliness, with a focus on social support networks, in older people in Europe and strategically addressing loneliness as a public health problem is confirmed.

Loneliness before and during the COVID-19 pandemic-are unpartnered and childless older adults at higher risk?

COVID-19 mitigation efforts had the potential to exacerbate loneliness among older adults, particularly for the unpartnered or childless, yet specific studies on loneliness among these groups during the COVID-19 pandemic are lacking. Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE) collected before (October 2019-March 2020) and during the pandemic (June-August 2020), we examine two loneliness outcomes: (1) "have you felt lonely recently?" (both datasets) and (2) "have you felt lonelier than before the pandemic?" (2020), and examine differences by partnership and parenthood status. Before COVID-19, those who lacked one tie but had the other (unpartnered parents or partnered childless) were at highest loneliness risk. During COVID-19, unpartnered and childless-especially unpartnered-remain at higher risk for loneliness, entering loneliness, and not "exiting" loneliness. We discuss these findings in light of family norms and needs in pandemic and non-pandemic times and provide recommendations for future research.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10433-022-00718-x.

Effects of Physical Activity Interventions in the Elderly with Anxiety, Depression, and Low Social Support: A Clinical Multicentre Randomised Trial

The percentage of older people is increasing worldwide. Loneliness and anxious−depressive states are emerging health conditions in this population group, and these conditions give rise to higher morbidity and mortality. Physical activity (PA) and social relationships have been linked to physical and mental health. The objective of this study was to evaluate whether a 4-month programme of moderate PA in a group would improve the emotional state, levels of social support, and quality of life in a sample of individuals >64 years of age. A multicentre randomised clinical trial was designed in primary care. Ninety (90) participants were selected. After the intervention, there were positive differences between the groups, with significant improvements in the intervention group (IG) in depression, anxiety, health status perception, and social support. Walking in a group two days per week for 4 months reduced clinical depression and anxiety by 59% and 45%, respectively. The level of satisfaction was very high, and adherence was high. In conclusion, the moderate group PA programme improved clinical anxiety, depression, social support, and perceptions of health status in the patients studied.

The micro-macro interplay of economic factors in late-life loneliness: Evidence from Europe and China

Individual socioeconomic status has a significant impact on whether older adults can initiate and maintain social relationships and participate in society, hence it affects loneliness. At the macro level, income inequality is expected to increase the risk of loneliness by eroding social cohesion and trust, while welfare generosity might protect people from loneliness. The aim of the study is to explore whether income inequality and welfare generosity at the country level moderate the effect of socioeconomic status at the individual level on late-life loneliness. Data were obtained from the HRS family of surveys - the Survey of Health, Aging and Retirement in Europe (SHARE) (wave 5, 2011/12) and China Health and Retirement Longitudinal Study (CHARLS) (wave 2, 2012/13). Respondents aged 50 years and older from twelve European countries and China were included in the study. Logistic country fixed effect models were used in the analysis. The findings show a stronger effect of individual socioeconomic status on late-life loneliness in more income-unequal societies and a weaker effect in more welfare-generous societies. There is a need to consider the impact of income distribution and welfare spending on the risk of loneliness among those older adults with low socioeconomic status when tailoring preventive programs and interventions to reduce loneliness among this vulnerable group.

Social relations and health in older people in Spain using SHARE survey data

INTRODUCTION

Social relationships (SR) are an important aspect in the healthy ageing process. The study aimed to describe SR in over-50s in Spain and analyse their association with physical/emotional, functional and cognitive/sensory health variables.

METHODS

The study sample was formed by 5583 people representing the Spanish population aged 50 and over, who participated in the sixth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE). The variables were divided into socio-demographic aspects and economic, health and SR aspects represented by the number of friends, family members and satisfaction with social network and the Revised UCLA loneliness scale. The health variables were grouped using a main component analysis. Multiple linear regressions were performed between the health components with socio-demographic and SR variables.

RESULTS

67.26% of respondents said they did not feel lonely. The feeling of loneliness was the variable most closely related to the physical and emotional, functional and cognitive and sensory health components. The main SR variable associated to health components was the Revised UCLA Loneliness Scale (standardised beta, p < 0.001; p < 0.001; and p < 0.001, respectively). The number of family members in social network SR variable was also associated with the physical/emotional health (β = 0.09, p < 0.001) and cognitive/sensory ability (β = 0.10, p = 0.001) components.

CONCLUSIONS

The main SR aspect that impacts health status was loneliness. The results of this study suggest the importance of developing public health policies oriented to promoting action on the SR characteristics that enhance older people's health.

A social exclusion perspective on loneliness in older adults in the Nordic countries

Several factors associated with loneliness are also considered indicators of social exclusion. While loneliness has been proposed as an outcome of social exclusion, there is limited empirical evidence of a link. This study examines the associations between social exclusion indicators and loneliness in older adults (60+ years) in four Nordic countries. Data from four waves of the European Social Survey were pooled, providing a total of 7755 respondents (Denmark n = 1647; Finland n = 2501, Norway n = 1540; Sweden n = 2067). Measures of loneliness, demographic characteristics, health, and eight indicators of social exclusion were selected from the survey for analysis. Country-specific and total sample hierarchical logistic regression models of loneliness were developed. Significant model improvement occurred for all models after social exclusion indicators were added to models containing only demographic and health variables. Country models explained between 15.1 (Finland) and 21.5% (Sweden) of the variance in loneliness. Lower frequency of social contacts and living alone compared to in a two-person household was associated with a higher probability of loneliness in all countries, while other indicators were associated with loneliness in specific countries: lower neighbourhood safety (Sweden and Denmark); income concern (Sweden and Finland); and no emotional support (Denmark, Finland, and Sweden). A robust relationship was apparent between indicators of social exclusion and loneliness with the direction of associations being highly consistent across countries, even if their strength and statistical significance varied. Social exclusion has considerable potential for understanding and addressing risk factors for loneliness.

Subjective psychological impacts during COVID-19 lockdown on older people, risk profiles and coping strategies: Results of an online survey in Spain

This study explores the psychological impacts of lockdown among older people during the coronavirus disease 2019 pandemic in Spain, and identifies risk profiles and adaptative behaviors. A cross-sectional online survey was disseminated by social networks through snowball sampling (April-June 2020). The survey included ad-hoc questions about psychological impacts on subjective cognitive functioning, emotional distress, and loneliness. Open end-questions were coded according to Lazarus and Folkman's coping strategies framework. Of the 2010 respondents, 76% experienced impact in at least one cognitive function (11% reporting severe effects), 78% frequent sadness and 13% frequent loneliness. Age 80+, women and low education increased the risk of loneliness and severe impact in memory and processing speed. Living alone was an additional risk factor for loneliness and sadness. Lockdown is associated with cognitive impacts, emotional distress, and loneliness being risk profiles related to inequality axes. Coping strategies should inform aging policies to prevent psychological impacts during the lockdown.

A systematic review of longitudinal risk factors for loneliness in older adults

OBJECTIVES

To effectively reduce loneliness in older adults, interventions should be based on firm evidence regarding risk factors for loneliness in that population. This systematic review aimed to identify, appraise and synthesise longitudinal studies of risk factors for loneliness in older adults.

METHODS

Searches were performed in June 2018 in PsycINFO, Scopus, Sociology Collection and Web of Science. Inclusion criteria were: population of older adults (M = 60+ years at outcome); longitudinal design; study conducted in an OECD country; article published in English in a peer-review journal. Article relevance and quality assessments were made by at least two independent reviewers.

RESULTS

The search found 967 unique articles, of which 34 met relevance and quality criteria. The Netherlands and the United States together contributed 19 articles; 17 analysed national samples while 7 studies provided the data for 19 articles. One of two validated scales was used to measure loneliness in 24 articles, although 10 used a single item. A total of 120 unique risk factors for loneliness were examined. Risk factors with relatively consistent associations with loneliness were: not being married/partnered and partner loss; a limited social network; a low level of social activity; poor self-perceived health; and depression/depressed mood and an increase in depression.

CONCLUSION

Despite the range of factors examined in the reviewed articles, strong evidence for a longitudinal association with loneliness was found for relatively few, while there were surprising omissions from the factors investigated. Future research should explore longitudinal risk factors for emotional and social loneliness.

Older Adults' Loneliness, Social Isolation, and Physical Information and Communication Technology in the Era of Ambient Assisted Living: A Systematic Literature Review

BACKGROUND

Loneliness and social isolation can have severe effects on human health and well-being. Partial solutions to combat these circumstances in demographically aging societies have been sought from the field of information and communication technology (ICT).

OBJECTIVE

This systematic literature review investigates the research conducted on older adults' loneliness and social isolation, and physical ICTs, namely robots, wearables, and smart homes, in the era of ambient assisted living (AAL). The aim is to gain insight into how technology can help overcome loneliness and social isolation other than by fostering social communication with people and what the main open-ended challenges according to the reviewed studies are.

METHODS

The data were collected from 7 bibliographic databases. A preliminary search resulted in 1271 entries that were screened based on predefined inclusion criteria. The characteristics of the selected studies were coded, and the results were summarized to answer our research questions.

RESULTS

The final data set consisted of 23 empirical studies. We found out that ICT solutions such as smart homes can help detect and predict loneliness and social isolation, and technologies such as robotic pets and some other social robots can help alleviate loneliness to some extent. The main open-ended challenges across studies relate to the need for more robust study samples and study designs. Further, the reviewed studies report technology- and topic-specific open-ended challenges.

CONCLUSIONS

Technology can help assess older adults' loneliness and social isolation, and alleviate loneliness without direct interaction with other people. The results are highly relevant in the COVID-19 era, where various social restrictions have been introduced all over the world, and the amount of research literature in this regard has increased recently.

Risk factors for loneliness among older people in a Nordic regional context – a longitudinal study

The aim of this study was to examine the prevalence of loneliness among older people and to identify risk factors for loneliness in a Nordic regional context over a six-year period. Longitudinal data from the Gerontological Regional Database (GERDA) study of 4,269 older adults living in northern Sweden and western Finland, aged 65, 70, 75 and 80 at baseline in 2010, were analysed. Logistic regressions were used to analyse socio-demographic, social and health-related risk factors at baseline and changes in these for experiences of loneliness at follow-up. The results showed that most older adults (85%) did not experience loneliness at baseline or at follow-up in our study region. However, 3 per cent of the sample reported loneliness in both study years, indicating enduring and chronic loneliness. Analyses revealed that being widowed and becoming a widow/er as well as poor self-rated health at baseline and the onset of depression were risk factors for loneliness. Finally, the risk of loneliness was higher in older people living in Sweden. Further work is needed to explore changes and stability in loneliness as well as to increase our understanding of between-country differences in loneliness.

A Mixed-Methods Analysis of Care Arrangements of Older People with Limited Physical Abilities Living Alone in Italy

Older people with limited physical abilities, who live alone without cohabiting family members, need support ageing in place and to perform daily living activities. In this respect, both the available informal and formal care seem crucial. The present study aimed to explore the current role of the care arrangements of older people, especially if they have functional limitations. Qualitative interviews were carried out in 2019 within the “Inclusive ageing in place” (IN-AGE) research project, involving 120 older people who lived at home, alone, or with a private personal care assistant (PCA) in three Italian regions (Lombardy, Marche, and Calabria). A mixed-methods analysis was conducted. Results showed that support networks are still mainly made up of family members, but also of domestic home help (DHH) and PCAs, friends/neighbours, and public services, albeit the latter provide support in a residual way, while the former is not as intensive as it was in the past. Frequency and geographical/living proximity of help play a role, emerging also as a territorial differentiation. The paucity or absence of support, especially from the family, risks compromising the ability of ageing in place. It seems, thus, necessary to innovate and improve, in particular, home services, also through real formal and informal care integration.

Soledad y envejecimiento

El objetivo del estudio es conocer la prevalencia de soledad y aislamiento social en mayores de 65 años en Ourense y sus factores asociados. Métodos: estudio descriptivo trasversal, muestra aleatoria de personas mayores de 65 años a las que se realizó una entrevista entre junio de 2010 y junio de 2011. Tamaño muestral: 486 pacientes (soledad estimada del 35%). Se administró la escala OARS-MFAQ (Olders American Resource and Services Multidimensional Functional Assessment Questionnaire), que recoge variables sociodemográficas, recursos sociales, económicos, salud física, mental y la capacidad para llevar a cabo actividades básicas de la vida diaria (ABVD) y actividades instrumentales de la vida diaria (AIVD). Se les hizo la pregunta «¿Se encuentra usted sola/solo?», con cuatro posibles respuestas: siempre, a menudo, casi nunca, nunca. Resultados: se entrevistó a 572 personas de una edad media de 79 años (desviación estándar [DE]: 6,79). Soledad: 32,7%; vive sola/solo: 17%; sin contacto semanal: 18,9%; aislamiento social: 1,4%. Fueron factores asociados a la percepción de soledad: ser mujer, tener pensión y nivel educativo bajos, depresión, deterioro cognitivo, pérdida de visión, dependencia para las AVBD, tomar psicofármacos en los 6 meses previos y la necesidad de mejoras en la vivienda. La práctica de ejercicio regular constituyó un factor protector. Conclusiones: la soledad en nuestra población es similar a la descrita en otros ámbitos, se asocia a desigualdad de género, factores sociales y demográficos, depresión y deterioro cognitivo. Los profesionales de Atención Primaria deben identificarla y abordarla. Palabras clave: soledad, personas mayores, aislamiento social, promoción de la salud, condicionantes sociales de la salud.

Social Exclusion and Subjective Well-being Among Older Adults in Europe: Findings From the European Social Survey

Objectives

The current study aims to examine how social exclusion is related to subjective well-being in older adults across different European regions.

Methods

European population-based cross-sectional study design was employed using data sampled from the eighth round of the European Social Survey (ESS). Multiple items for social exclusion were used in this round, including household income, civic participation, frequent meetings with friends and relatives, basic health services, and neighborhood cohesion. Life satisfaction, happiness, and self-rated general health were also assessed. An ANOVA was performed to examine the regional differences related to social exclusion and subjective well-being, while a regression analysis was used to examine the relationship between the social exclusion and subjective well-being.

Results

There were significant regional differences in the social exclusion and subjective well-being of older Europeans. In addition, older adults in the Nordic nations are more likely to indicate higher levels of subjective well-being and lower levels of social exclusion, while older adults from Central and Eastern European nations tend to report lower levels of subjective well-being and higher levels of social exclusion. Material resources and basic services are highlighted as the most important domains pertaining to life satisfaction, happiness, and general health.

Discussion

The study findings reinforce the inequality in subjective well-being linked to social exclusion across different societies. Both global and country-specific exclusion models in later life should be implemented in order to enhance comparable research and provide insight into EU and national guidelines for interventions to diminish social exclusion.

Gendered experiences of widowhood and depression across Europe: The role of loneliness and financial resources from a longitudinal perspective

OBJECTIVE

This study analyses the gendered experiences of widowhood and its relation to depressive symptoms in four European regions. A special focus lies on the question whether loneliness and reduced financial contribute to the detrimental effect of widowhood on mental health.

METHODS

Using waves 5,6 and 7 of the Survey of Health. Ageing and Retirement in Europe (SHARE), this study estimates fixed-effects linear regression models for the effect of widowhood on depressive symptoms with and without adjustment for potential mediating factors.

RESULTS

There were no gender differences in the mental health consequences of widowhood irrespective of the regional context. Whereas loneliness was a major pathway through which widowhood exerts its negative consequences on mental health, reduced financial resources did not play a substiantial role. Moreover, the magnitude of the widowhood effect on depressive symptoms differed between European regions with stronger increases in Southern Europe. These regional differences were attenuated when accounting for inequalities in financial resources and loneliness.

DISCUSSION

The findings support Attachment Theory, which postulates that it's mainly the loss of such an emotionally strong tie as one's spouse that leads to psychological distress following widowhood. Moreover, one can conclude that some contexts in Europe provide conditions that buffer the negative effect of widowhood on mental health at least to some extent.

Metabolic dysregulation in older adults with depression and loneliness: The ATHLOS study

This study aimed to examine how loneliness contributes to metabolic dysregulation among older adults with depression and determine the relative contribution of loneliness to the development of chronic diseases in late adulthood. Harmonised data from the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project were used. Concretely, the sample comprised 6195 participants (53.95% women; M = 61.30 years, SD = 7.11) from three European cohorts. Three groups were considered: control group (CG); depressive symptom episode group (DEP); and a group with depression and loneliness (DEP + LONE). A metabolic score was estimated using anthropometric and blood indicators, by means of multi-indicator multi-causes (MIMIC) modelling and after controlling for sociodemographic and health-related covariates. Group-comparison was based on measurement-invariance procedures. Multimorbidity development was predicted at follow-up considering the study group and relevant covariates. All the analyses were sex-specific. As a result, measurement invariance revealed the influence of group (ΔCFI = -0.017 for male participants and ΔCFI = -0.009 for female ones) on metabolic scores in both sexes. Metabolic scores were significantly lower (i.e., they had more metabolic risk) in DEP + LONE women in comparison to women from the other groups. DEP men showed the lowest metabolic scores but those from the DEP + LONE group showed meaningfully lower scores than CG men (d = 1.35). In terms of multimorbidity prediction, DEP + LONE group membership significantly predicted the outcome in both sexes; DEP group membership significantly predicted multimorbidity at follow-up in women. In summary, these results highlight the relevant contribution of loneliness in depression-related metabolic dysregulation in the short- (concurrent metabolic risk) and long-term (chronic condition development). Moreover, sex-specific mechanisms seem to be involved in metabolic alterations of depressed people showing loneliness feelings. This study calls for action to reduce the impact of loneliness in old age and to promote healthy ageing.

Social Network and Risk of Poor Sleep Outcomes in Older Adults: Results from a Spanish Prospective Cohort Study

BACKGROUND

Not having social support has been associated with poor sleep, but most prospective studies were based on social support in the workplace, did not account for baseline sleep characteristics or did not assess sleep duration. Moreover, no previous research has evaluated the relationship between social network and sleep outcomes in an older Spanish population.

METHODS

1444 individuals aged ≥60 years were followed between 2012 and 2015. At baseline (2012), a poor social network index (SNI) was computed by summing the following dichotomous indicators: not being married; living alone; not having daily contact with family, friends or neighbors; being alone ≥8h/day; lacking someone to go for a walk with; not having emotional support; lacking instrumental support. Higher values in SNI indicate less social support. In 2012 and 2015, information was collected on sleep duration (hours/day) and on symptoms of sleep disturbance: bad overall sleep; difficulty falling asleep, awakening during nighttime, early awakening with difficulty getting back to sleep, use of sleeping pills, feeling restless in the morning, being asleep at daytime, and having an Epworth Sleepiness Scale>10. Poor sleep duration was defined as short (<6 h) or long (>9 h) nighttime sleep, and poor sleep quality as having ≥4 indicators of sleep disturbance. Linear or logistic regression models were used to assess the relationship of SNI with changes in sleep duration and in number of sleep disturbance indicators, or with the risk of developing poor nighttime sleep or poor sleep quality.

RESULTS

Compared to individuals in the lowest (best) quartile of the SNI in 2012, those in the second, third and fourth quartiles, respectively, displayed a mean (95%confidence interval [95% CI]) change of 2.32 (-7.58-12.22), -2.70 (-13.19-7.79) and -13.04 (-23.41- -2.67) minutes in sleep duration from 2012 to 2015; p for trend=0.02. A 1-point increase in the SNI at baseline was associated with an increased risk of short nighttime sleep (Odds Ratio [OR] and 95% CI: 1.22 (1.05-1.42)), poor sleep quality (OR: 1.13; 95% CI: 1.00-1.30), and of the indicator of sleep disturbance "early awakening with difficulty getting back to sleep" (OR: 1.20; 95% CI: 1.07-1.35).

CONCLUSION

A poorer social network is associated with a higher risk of short sleep and poor sleep quality in older adults.

Examining transitions in loneliness for people without and with moderate and severe disabilities

PURPOSE

To investigate how disability affects the levels of loneliness reported by people living in Germany. In particular, we are interested in analysing the transitions into and out of loneliness but incorporating a dynamic approach of disability (i.e., disability trajectories).

METHOD

Drawing data from the German Socio-Economic Panel for the years 2013 and 2017 and using a three-item version of the UCLA Loneliness Scale, we construct a balance panel of individuals and estimate linear regression models on loneliness, and probit models to predict the likelihood to become lonely or exit from loneliness.

RESULTS

We find a positive association between disability and loneliness (especially for those people who are severely limited). The frequency of contacts with family, friends, etc., the number of close friends and the participation in volunteering, sports, cultural and religious events reduce loneliness. Furthermore, we find that those individuals making the transition into a moderate/severe disability and also those recovering totally from a severe disability are more likely to become lonely in 2017.

CONCLUSIONS

From a public health policy perspective, it is necessary to undertake the design and implementation of instrumental, emotional and social support for people with disabilities. A higher engagement in social activities (e.g., social gatherings, cultural and leisure activities) and the elimination of barriers (e.g., structural and environmental) may become key elements to preventing loneliness.IMPLICATIONS FOR REHABILITATIONLoneliness has become an important social problem in most countries with a significant impact on individuals' health status (mental and physical).Loneliness strongly affects individuals who experience important levels of discrimination and social exclusion (e.g., people with disabilities).Transitions of disabilities and loneliness must be taken into account to investigate the relative position of people with disabilities (especially those with severe disabilities).People with severe disabilities report the highest levels of loneliness, especially if this disability status remains over time.Rehabilitation professionals must promote social relations and support among people with disabilities and help them exit from permanent loneliness.

Longitudinal analysis of the impact of loneliness on cognitive function over a 20-year follow-up

Background: Loneliness and cognitive impairment are both commonly experienced by older old people, but evidence for the association between these has been inconsistent. Moreover, most evidence has been cross-sectional in nature and largely based on studies with relatively young later life age groups rather than 'the oldest old'. We aimed to test the potential impact of loneliness amongst older old people on their cognitive function over a 20-year period.Method: Data were drawn from wave 3 to wave 10 of the Cambridge City over-75s Cohort (CC75C) study. The impact of loneliness on transition between normal and impaired cognitive states was examined by multi-state modelling. The associations between loneliness changes and cognitive function decline were tested by using generalized estimating equation (GEE) with an independent working correlation structure. Missing data were imputed by using multiple imputation chained equations.Results: At wave 3, 713 participants were interviewed, of whom 657 (92%) had Mini-Mental State Examination (MMSE) assessments. Of individuals who had an MMSE score, approximately one quarter reported feeling lonely, and another 16% felt slightly lonely. The prevalence of feeling lonely or slightly lonely varied between waves. Results from multi-state modelling indicated that loneliness was not related to cognitive function transitions, and results from the GEE model showed that loneliness was not significantly associated with cognitive function decline after adjusting for cohort effects, follow-up time, sex, education, and interaction terms for sex, education and time.Conclusions: Loneliness did not exert long-term harmful effects on cognitive function in the oldest old.

Marital status, close social network and loneliness of older adults in the Czech Republic

The wellbeing of older adults is closely related to their social relationships. There is a well-documented association of widowhood with social isolation and loneliness, but less is known about the consequences of divorce. This paper focuses on the effects of divorce and widowhood on the characteristics of social networks and loneliness in the Czech Republic. Data from the Czech component of the Survey of Health, Ageing and Retirement in Europe, 2015, are used. The results show that married older adults have the lowest levels of loneliness and, together with widowed men, the largest network of confidants. However, the size of the network is not associated with loneliness (net of socio-demographic variables). The only characteristic of the close social network that has an influence on loneliness is the presence of a partner in the network. This variable explains part of the advantage of spouses. Divorce is found to have a smaller impact on loneliness than widowhood, but the size of the difference depends on the gender and timing of the event. Widowed men seem to be most vulnerable while persons who divorce at age 50 or later experience the lowest level of loneliness among the unmarried groups. The favourable effect of late divorce can be interpreted in relation to the specific nature of partnership decisions in later life.