Which factors contribute to loneliness among older Europeans? Findings from the Survey of Health, Ageing and Retirement in Europe: Determinants of loneliness

Contributors to age inequalities in loneliness among older adults: a decomposition analysis of 29 countries

OBJECTIVES

Loneliness is highly prevalent and can have severe health consequences. While generally assumed to increase with age, some evidence suggests the relationship between age and loneliness may vary across country. In this study, we investigate the contribution of demographic and health factors to age-related inequalities in loneliness both within and across countries.

METHOD

We used population-based cross-sectional data from 64,324 older adults (age range: 50-90 years) across 29 countries. Loneliness was measured with the 3 item UCLA loneliness scale. We quantified the magnitude of age inequalities in loneliness using concentration indices, and we estimated the contribution of demographic and health factors to age inequalities in loneliness using a decomposition approach.

RESULTS

Loneliness was generally more concentrated among the oldest adults in the sample, although in the US and the Netherlands it was more concentrated among younger adults. Top contributors to age inequalities in loneliness were being unmarried and not working; however, the amount that factors contributed to inequalities differed markedly by country.

CONCLUSION

Age inequalities in loneliness, and contributors to these inequalities, vary substantially across countries, suggesting that loneliness is not an inevitable consequence of age but may instead be shaped by environments within countries (e.g. social cohesion).

Reversed loneliness development after age 65 for men and women: Modeling of the age trajectories of loneliness using national cohorts in Taiwan and Japan

AIM

This study depicts the age trajectories of loneliness and gender differences among older adults in Taiwan and Japan.

METHODS

Two nationally representative data sets for older adults in Taiwan and Japan were obtained from the Taiwan Longitudinal Study on Aging (TLSA, 1996-2011) and the National Survey of the Japanese Elderly (NSJE, 1996-2012), respectively. The analytic sample included 3037 and 1974 older adults aged 65 and over at baseline in Taiwan and Japan, respectively.

RESULTS

The prevalence rate of loneliness for adults aged 65+ living in the community was 23.64% in Taiwan and 17.03% in Japan. Higher average levels (βTaiwan = 0.1508, P < 0.001) and rates of increment (βTaiwan*age = 0.0068, P < 0.05) in loneliness development were found in Taiwan as compared with Japan. In addition, although women reported higher levels of loneliness compared with men at age 65 (29.0% vs. 19.4% in Taiwan, and 19.3% vs. 13.9% in Japan), a soaring development of loneliness with accelerated rates of increment after age 65 was observed in men in both countries.

CONCLUSIONS

Lonliness in old age is very different between men and women. Women's loneliness curve shows an inverted U state: Although they feel more lonely than men during midlife, it has a downward trend as they get older. On the contrary, men's loneliness curve shows an upward U-shaped curve: After retirement, both Japanese and Taiwanese men continue to rise. Geriatr Gerontol Int 2025; 25: 620-627.

The association of loneliness and social isolation with multimorbidity over 14 years in older adults in England: A population-based cohort study

BACKGROUND

Previous longitudinal studies have linked multimorbidity to loneliness (feeling alienated) and social isolation (having reduced social contact). However, the nature of these associations over time is unclear.

OBJECTIVE

To examine bidirectional associations of multimorbidity with loneliness and social isolation over a 14-year follow-up in a nationally representative cohort of adults aged ≥ 50 years.

METHODS

This retrospective cohort study used seven waves of data (collected between 2004/2005 and 2018/2019) from adults in the English Longitudinal Study of Ageing. Multimorbidity was defined as the presence of ≥2 long-term conditions. Loneliness was measured using the 3-item University of California Los Angeles (UCLA) scale. Social isolation was derived based on cohabitation status, frequency of contact with children, relatives, and friends, and social organisation membership. We used Cox proportional hazards models adjusted for social isolation or loneliness, demographic and health behaviour variables.

RESULTS

The cohort consisted of 6031 adults with baseline and follow-up data on loneliness, social isolation, multimorbidity, and other covariates. Loneliness was associated with increased risk of incident multimorbidity [aHR (95 % CI): 1.38 (1.15-1.65)], whereas social isolation was not [aHR (95 % CI): 0.97 (0.81-1.16)]. Multimorbidity was associated with increased risk of incident loneliness [aHR (95 % CI): 1.55 (1.30-1.84)], but not significantly associated with subsequent risk of incident social isolation [aHR (95 % CI): 1.09 (0.92-1.28)].

CONCLUSIONS

An independent bidirectional association exists between loneliness and multimorbidity. Interventions targeting loneliness may prevent or delay multimorbidity and also improve wellbeing for people with multimorbidity.

Themes of togetherness. Examining space sharing sociality among older people

Extensive research demonstrates a positive relationship between social participation and health and well-being in older adults. Yet, knowledge is scarce regarding the diverse practices older individuals employ when engaging with others in everyday life settings. For the purpose, we elaborate on the concept of togetherness to encapsulate the full spectrum of co-located activities. Togetherness embodies a spatiotemporal understanding of sociality, involving "being with" others in shared spaces, times, and projects. We empirically investigate how various forms of togetherness manifest in everyday life and explore the motivation behind immediate and more overarching projects and goals. Drawing on time-space diaries that inform in-depth interviews with 22 older adults (aged 68-85) in Gothenburg, Sweden, our findings reveal that practising everyday togetherness seldom is a standalone project with the explicit purpose of socializing. More often, sociality is integrated into projects with other primary, sometimes overlapping, goals such as maintaining everyday routines, providing structure and rhythm to daily life, breaking away from routines, thriving and feeling safe in a place, and seeking inspiration and creativity in life.

What Is Social Connection in the Context of Human Need: An Interdisciplinary Literature Review

The U.S. Surgeon General made an impactful declaration in the 2023 advisory on America's loneliness and social isolation epidemic that social connection, or human relationships, is a human need equivalent to water, food, and shelter. After witnessing the impact of social isolation measures during the COVID-19 pandemic, there is a global urgency to better understand social connection in public health responses. However, meaningfully effective interventions for social isolation or loneliness have yet to be identified, and the consensus that social connection is an equivalent human need is unclear. To understand what social connection, oxygen, water, food, and shelter have in common regarding population health, we conducted an interdisciplinary literature review between September 2021 and October 2024, seeking to find commonalities between research literature advocating social connection as a human need critical to survival and key concepts across population health disciplines that explain how oxygen, water, food, and shelter function as human needs. We integrated the concepts of evolution, resource, environment, ecosystem, exposure science, embodiment, homeostasis, allostatic load theory, and interdisciplinary from 44 core publications to develop a unified conceptual model and definition for social connection as a human need. We believe a holistic understanding of social connection within the shared context of oxygen, water, food, and shelter can better support health researchers across a variety of disciplines to find common ground in developing evidence-based interventions within public health.

Early Recognition of Loneliness and Frailty in Relation to Chronic Disease Self-Management: A Quantitative Cross-Sectional Study

BACKGROUND

Chronic disease significantly influences mental health, identity, and self-esteem. It is deeply interconnected with loneliness, frailty, stress, mental health, and the ageing process, forming a complex and interrelated dynamic. The aim was to find an association between loneliness, frailty, mental health, and the patient's self-management.

METHODS

A cross-sectional study was conducted between October 2023 and May 2024. A total of 605 patients with chronic disease took part in the research, of whom 67% were female and 33% were male. In total, 71% of participating patients lived in a home environment, and 19% lived in retirement homes.

RESULTS

605 respondents with chronic disease participated in the study and were recruited using a purposive sampling method. Participants were drawn from healthcare settings, including primary care centres, outpatient clinics, and nursing homes, to increase representativeness. The study achieved a response rate of 55% after distributing 1100 questionnaires. Data were analysed with SPSS Statistics 25.0 using descriptive and inferential statistical methods, including non-parametric tests (Kruskal-Wallis test, Mann-Whitney U test) and Spearman's correlation. The main results showed that patients who self-rated their chronic disease as well- or very well-managed (81%) were less frail (p < 0.001), less lonely (p < 0.001), and had better mental health (p = 0.015). Significant associations were found between frailty, loneliness (rs = 0.428, p < 0.001), and lower mental health (rs = 0.185, p < 0.001). In addition, frequent social contact was associated with lower frailty and loneliness (p < 0.001).

CONCLUSIONS

Without adequate assessment and support from the healthcare system, patients may face challenges in meeting their needs, which can contribute to loneliness, frailty, and mental health decline. It is crucial to acknowledge that every individual with a chronic disease, regardless of age, education level, or condition, must actively participate in managing their chronic disease. Recognising the importance of self-management and its impact on mental health is essential to mitigating the negative effects of chronic disease on a patient's quality of life.

Loneliness and social anxiety in the general population over time - results of a cross-lagged panel analysis

BACKGROUND

Loneliness has become a major public health issue of the recent decades due to its severe impact on health and mortality. Little is known about the relation between loneliness and social anxiety. This study aimed (1) to explore levels of loneliness and social anxiety in the general population, and (2) to assess whether and how loneliness affects symptoms of social anxiety and vice versa over a period of five years.

METHODS

The study combined data from the baseline assessment and the five-year follow-up of the population-based Gutenberg Health Study. Data of N = 15 010 participants at baseline (Mage = 55.01, s.d.age = 11.10) were analyzed. Multiple regression analyses with loneliness and symptoms of social anxiety at follow-up including sociodemographic, physical illnesses, and mental health indicators at baseline were used to test relevant covariates. Effects of loneliness on symptoms of social anxiety over five years and vice versa were analyzed by autoregressive cross-lagged structural equation models.

RESULTS

At baseline, 1076 participants (7.41%) showed symptoms of social anxiety and 1537 (10.48%) participants reported feelings of loneliness. Controlling for relevant covariates, symptoms of social anxiety had a small significant effect on loneliness five years later (standardized estimate of 0.164, p < 0.001). Vice versa, there was no significant effect of loneliness on symptoms of social anxiety taking relevant covariates into account.

CONCLUSIONS

Findings provided evidence that symptoms of social anxiety are predictive for loneliness. Thus, prevention and intervention efforts for loneliness need to address symptoms of social anxiety.

Short-Term Coupling Associations Between State Loneliness and Cognitive Performance in Daily Life Among Older Adults

OBJECTIVES

Despite extensive efforts to study individual differences in loneliness and neurocognitive health, little is known about how within-person changes in state loneliness relate to cognitive performance. This study addressed this gap by examining the association between within-person variation in state loneliness and cognitive performance assessed objectively in daily life.

METHODS

Participants were 313 community-dwelling older adults (70-90 years) who reported momentary feelings of loneliness and completed smartphone-based cognitive tests 5 times daily for 14 consecutive days. Mobile cognitive tests assess visual associative memory, processing speed, and spatial memory.

RESULTS

At the day level, average state loneliness levels were negatively related to cognitive performance on the same day and subsequent day. Consistent with the day-level analysis, momentary assessments of increased loneliness were consistently linked to worse cognitive performance on concurrent assessments. However, moments characterized by lower cognitive performance predicted higher levels of loneliness 3-4 hr later (next occasion), but not vice versa.

DISCUSSION

The findings suggest a prospective association between loneliness and cognitive performance, with higher daily loneliness negatively associated with cognitive performance on the same day and predicting worse performance the following day. Notably, within a single day, lower cognitive performance at a given moment predicted elevated loneliness later in the day. This highlights a complex, reciprocal relationship-loneliness predicting and being predicted by cognitive performance depending on timescale.

Perception of one's social environment and loneliness: results of the nationally representative "Old age in Germany (D80+)" study

OBJECTIVES

To examine the association between perception of one's social environment (in terms of residential attachment and neighborhood trust) and loneliness among the oldest old and whether these associations differ by living arrangement.

METHODS

We used data from the nationally representative "Old Age in Germany (D80+)" study that included individuals residing in private households and institutionalized settings. The analytic sample was 9,621 individuals (average age: 85.5 years, SD: 4.1 years; 62% female). Data collection took place from November 2020 to April 2021. Multiple linear regressions were conducted with adjustment for relevant covariates.

RESULTS

Higher residential attachment (β=-0.02, p < .05) and higher neighborhood trust (β=-0.12, p < .001) were associated with less loneliness. The latter association was moderated by living arrangement (β=-0.09, p = .04) such that the association between neighborhood trust and loneliness was stronger among individuals living in institutionalized settings compared to individuals in private households.

CONCLUSION

Greater residential attachment and neighborhood trust, particularly among individuals living in institutionalized settings, are associated with less loneliness among the oldest old. Finding ways to improve perceived attachment and trust may assist in avoiding loneliness among older individuals.

[Migration background and loneliness among middle-aged and older adults in Germany]

BACKGROUND

Currently, there is limited knowledge about the association between a migration background and loneliness among middle-aged and older individuals in Germany. The aim was therefore to examine the association between migration background and loneliness in this group.

METHODS

Data were taken from the German Ageing Survey (Wave 7, November 2020 to March 2021), a representative sample of middle-aged and older individuals. The sample comprised 4145 individuals, and the mean age was 63.8 years. Of the respondents, 93.2% had no migration background, approximately 5.9% had a migration background with personal migration experience, and 0.9% had a migration background but no personal migration experience. The De Jong Gierveld tool was used to quantify loneliness.

RESULTS

Multiple linear regressions showed that individuals with a migration background and their own migration experience have significantly higher levels of loneliness (β = 0.15, 95% confidence interval (CI): 0.004 to 0.30, p < 0.05) compared to individuals without a migration background, whereas individuals with a migration background without their own migration experience have significantly lower levels of loneliness (β = -0.27, 95% CI: -0.52 to -0.02 p < 0.05).

CONCLUSIONS

Individuals with a migration background and their own migration experience appear to represent a risk group for high loneliness among middle-aged and older adults in Germany. In this respect, this group should be given special consideration in corresponding measures. Against the background of current (and potential future) migration movements, the results are of great importance as these groups in particular could be affected by loneliness.

Factors associated with loneliness among individuals aged 80 years and over: Findings derived from the nationally representative "Old Age in Germany (D80+)" study

OBJECTIVES

To clarify the factors associated with loneliness in individuals aged 80 years and older in Germany (also stratified by sex).

METHODS

Data from the nationally representative "Old Age in Germany (D80+)" were employed. The analytic sample equaled 10,031 individuals. The D80+ study included community-dwelling and institutionalized individuals ≥ 80 years in Germany. Multiple linear regressions were used (with sociodemographic and health-related explanatory factors). The collection of data occurred between November 2020 and April 2021 (written questionnaire).

RESULTS

Higher loneliness was significantly associated with not being married (e.g., widowed compared to being married, β=0.37, p<.001), being institutionalized (β=0.33, p<.001), low education (high education compared to low education, β=-0.07, p<.01), a higher number of chronic conditions (β=0.02, p<.001), poor self-rated health (β=-0.19, p<.001) and greater functional impairment (β=0.15, p<.001). Sex-stratified regressions produced comparable results. However, low education was only associated with higher loneliness among men, but not women (with significant interaction: education x sex).

CONCLUSION

Several sociodemographic and health-related factors can contribute to loneliness among the oldest old in Germany, with sex-specific associations between education and loneliness. Overall, such knowledge can aid to address individuals with higher loneliness levels.

Determinants of social loneliness among older adults in job retirement and the role of emotional expressivity

OBJECTIVES

The study examined the possibility that a mediating role of positive and negative emotional expressivity may contribute to understanding the associations between social loneliness and its previously identified predictors (i.e. health, age, sex, and social living situation).

METHOD

Self-reported assessments were collected from community-dwelling Swedish residents (aged 65 and above) in job retirement. Structural equation modeling with manifest variables was applied to cross-sectional data (N = 601) to analyze two competing models; one main-effect regression model, examining the predictive effect of emotional expressivity (along with health and sociodemographics) on social loneliness, and one mediation model, examining the mediating effect of emotional expressivity (using the bootstrapping technique provided in Mplus).

RESULTS

The results indicated that the mediation model fit the data considerably better than the main-effect regression model (Δχ2 [Δdf = 8] = 72.69, p < 0.00001), and demonstrated a good fit on its own, with CFI = 0.986 and RMSEA = 0.030. This suggests that emotional expressivity contributes to the understanding of the connection between social loneliness and its previously identified predictors.

CONCLUSION

Recognizing the significance of emotional expressivity has the potential to enhance our understanding of loneliness in older adults, both in theory and in practice.

Oral health-related quality of life and loneliness: results based on a cross-sectional survey

BACKGROUND

The aim of this study was to clarify the link between oral health-related quality of life (independent variable) and loneliness (outcome) among the general adult population (also stratified by sex).

METHODS

Data were taken from a quota-based survey of the German general adult population (representative in terms of state, sex and age group), with n = 5,000 individuals (mean age was 46.9 years, SD: 15.3 years, ranging from 18 to 74 years). Oral health-related quality of life was quantified using the OHIP-G5. Loneliness was quantified using the De Jong Gierveld tool. Multiple linear regressions were conducted.

RESULTS

After adjusting for several covariates, multiple linear regressions revealed that poor oral health-related quality of life is associated with higher loneliness levels in the total sample (β = 0.12, p < 0.001). Such associations were also found in both sexes (men: β = 0.12, p < 0.001, women: β = 0.12, p < 0.001).

CONCLUSION

Study findings showed an association between oral health-related quality of life and loneliness. Such knowledge is important for addressing individuals at risk for higher loneliness levels. Future research is required to clarify the underlying mechanisms.

Relationship between social participation and depressive symptoms in patients with multimorbidity: the chained mediating role of cognitive function and activities of daily living

OBJECTIVE

The potential mechanisms linking social participation and depressive symptoms in Chinese individuals with multimorbidity are not yet fully understood. This study aims to explore how cognitive function and activities of daily living (ADLs) mediate the relationship between social participation and depressive symptoms in individuals with multimorbidity.

METHODS

We selected 3782 participants with multimorbidity from the 2018 China Health and Retirement Longitudinal Study. Data related to social participation, cognitive function, ADLs, and depressive symptoms were extracted. Regression and Bootstrap analyses were used to explore the sequential mediating effects of social participation, cognitive function, ADLs, and depressive symptoms.

RESULTS

(1) There was a significant correlation between social participation, cognitive function, activities of daily living, and depressive symptoms (p < 0.01). (2) Social participation directly affected depressive symptoms (β = -0.205, p < 0.05). (3) Cognitive function (β = -0.070, p < 0.01) and activities of daily living (β = -0.058, p < 0.01) played separate mediating roles in the effect of social participation on depressive symptoms. (4) Cognitive function and activities of daily living had a chain-mediated role in the relationship between social participation and depressive symptoms in patients with multimorbidity (β = -0.020, p < 0.01).

CONCLUSION

A chained mediating effect was found between cognitive function, ADLs, social participation, and depressive symptoms in patients with multimorbidity. Social participation was found to improve the cognitive function of patients with multimorbidity, which in turn enhanced their daily life activities and ultimately alleviated their depressive symptoms.

Multiple long-term conditions, loneliness and social isolation: A scoping review of recent quantitative studies

BACKGROUND

Multiple long-term conditions (MLTC), loneliness and social isolation are common in older adults. Recent studies have explored the association of MLTC with loneliness and social isolation. This scoping review aimed to map this current evidence and identify gaps in the literature.

METHODS

A scoping review was conducted following the PRISMA guidelines for scoping reviews. Ovid Medline, Embase, CINAHL, The Cochrane Library, PsycInfo, and Bielefeld Academic Search Engine were searched for studies published between January 2020-April 2023. Quantitative studies, published in any language, that assessed the association of MLTC with loneliness and/or social isolation were included.

RESULTS

1827 records were identified and screened. Of these, 17 met inclusion criteria. Most studies were cross-sectional and based on older adults. Studies were conducted in Europe, the US, Canada, and low- and middle-income countries. Ten studies focused on the association between MLTC and loneliness, six assessed the association between MLTC and social isolation and one examined associations with both loneliness and social isolation. Most studies reported a significant cross-sectional association of MLTC with loneliness, but there was weaker evidence for a longitudinal association between MLTC and loneliness and an association between MLTC and social isolation. Studies were heterogenous in terms of measures and definitions of loneliness/social isolation and MLTC, confounders adjusted for, and analytical models used, making comparisons difficult.

CONCLUSIONS

Further population-based longitudinal studies using consistent measures and methodological approaches are needed to improve understanding of the association of MLTC with both loneliness and social isolation.

There but not really involved: The meanings of loneliness for people with chronic illness

Loneliness is one of the most pressing and rapidly growing contemporary social challenges around the world. Yet we still lack a good understanding of how loneliness is constituted and experienced by those most affected. We conducted semi-structured interviews with 40 people with chronic illness who were experiencing loneliness to explore what loneliness means to them and how it impacts in their daily lives. Drawing on ideas around liquidity and performativity, we identified the relational, temporal and social layers of loneliness. Our analysis revealed the interconnectedness of chronic illness and loneliness in participants' daily lives, as well as how chronic illness shifts temporal orientation, and transforms interpersonal relationships and relationship with self, contributing to the experiences of loneliness. Though participants described the many social conditions that restricted their opportunities for social participation, giving them a sense of being left behind and spectating the social life of others, a rhetoric of loneliness as a problem and responsibility of the individual was still prominent. A narrative of the need to perform social connection emerged in the absence of meaningful social bonds with others. We argue that normative ideals of wellness and positivity circulating in chronic illness communities and society more broadly are implicated in the experience of loneliness for people with chronic conditions. We conclude by considering how more expansive representations of how to live well with chronic illness may be important in reducing personal and collective loneliness.

Wishing for an end? Longitudinal analysis of suicidal ideation among informal caregivers inside and outside their household in different welfare systems of Europe

OBJECTIVE

This study examines whether transition to caregiving within or outside the household is associated with changes in suicidal ideation and whether this depends on the type of caregiver relationship, the age or gender of the caregiver, or the welfare system.

DESIGN

Longitudinal study.

SETTING

Ten European countries.

PARTICIPANTS

Data from the Survey of Health, Ageing, and Retirement in Europe were used (waves 1, 2, 4, 5, and 6) including participants aged ≥40 years (pooled Observations = 171,848).

MEASUREMENTS

Suicidal ideation was measured using the Euro-D scale. Caregiving was measured as care inside and outside the household, and for different recipients. Fixed effects logistic regression analyses, adjusted for health and sociodemographic factors, were used.

RESULTS

Transitioning into caregiving inside the household was associated with higher odds of suicidal ideation, in particular if they transitioned into care for partners or parents and within Southern and Bismarckian welfare systems. Transitioning into caregiving outside the household was not associated with suicidal ideation, except among those transitioning into caregiving for non-relatives (higher odds of suicidal ideation), and among male and older caregivers (lower odds of suicidal ideation). Suicide ideation was higher among caregivers in Southern compared to Bismarckian or Scandinavian welfare systems.

CONCLUSION

Informal caregiving is associated with suicidal ideation among caregivers inside but not among all caregivers outside the household. The caregiver's characteristics, the care relationship, and the welfare system play an important role. Preventing suicidal ideation requires interventions that focus on informal caregivers and consider their individual and contextual factors.

Loneliness in the Norwegian adolescent population: prevalence trends and relations to mental and self-rated health

BACKGROUND

Loneliness has become a significant public health problem and should be addressed with more research over a broader period. This study investigates the variations in the prevalence of loneliness among a nationally representative study population of Norwegian adolescents over the last three decades and whether age, gender, self-rated health, and mental distress are associated with these changes.

METHODS

Adolescents aged 13-19 years completed the structured and validated questionnaires from the three waves of the Young-HUNT Study: 1995-1997, 2006-2008, and 2017-2019. Loneliness was measured with one item asking, 'Are you lonely?'. Hopkins Symptom Checklist-5 was used to measure mental distress (cut-off ≥ 2). Self-rated health was assessed by a single question 'How is your health at the moment?' Measures were provided by self-report. Descriptive analyses were stratified by age, gender, self-rated health, and mental distress. Linear-by-Linear association test across survey years was performed to test time trends of loneliness. Logistic regression was used to analyze the cross-sectional associations of self-rated health and mental distress with loneliness, adjusting for sociodemographic factors in all three waves of Young-HUNT.

RESULTS

Loneliness prevalence doubled from 5.9% in 1995/97 to 10.2% in 2017/19 in the total population sample. The highest loneliness prevalence and an increase from 8.9% in 1995/97 to 16.7% in 2017/19 was observed in girls of 16-19 years. Among mentally distressed adolescents, loneliness increased from 22.3% in 1995/97 to 32.8% in 2006/08 and lowered to 27% in 2017/19. Increasing loneliness prevalence was seen in those with poor self-rated health, i.e., 14.6% in 1995-97 and 26.6% in 2017-19. Mental distress and poor self-rated health were associated with higher odds of loneliness in each wave (p < 0.001).

CONCLUSION

The results highlight the increasing burden of loneliness in the Norwegian adolescent population, especially girls. Those with mental distress and poor self-rated health have a higher risk of experiencing loneliness. Thus, health-promoting upbringing environments for children and adolescents that support mutual affinity, social support, integration, and belongingness in adolescents' daily arenas are essential.

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.

Neighbourhood cohesion, loneliness and perceived social isolation prior and during the COVID-19 pandemic. Longitudinal evidence from the German Ageing Survey

PURPOSE

To investigate the longitudinal association between neighbourhood cohesion and loneliness as well as perceived social isolation prior and during the COVID-19 pandemic (stratified by sex).

METHODS

Longitudinal data were taken from a nationally representative sample (German Ageing Survey) of inhabitants aged 40 years and over in Germany prior (wave 6: year 2017) and during the COVID-19 pandemic (wave 8: November 2020 until February 2021; n = 6688 observations, mean age was 67.4 years). The De Jong Gierveld tool was used to measure loneliness and the Bude and Lantermann tool was used to measure perceived social isolation. Neighbourhood cohesion was assessed based on different items.

RESULTS

FE regressions showed that decreases in closeness of contact with neighbours were associated with increases in loneliness and perceived social isolation levels among men, but not women. In contrast, decreases in different indicators of involvement in neighbourhood activities were associated with increases in loneliness and perceived social isolation levels among women, but not men.

CONCLUSION

Changes in neighbourhood factors are differently associated with loneliness and perceived social isolation among middle-aged and older women and men. Gender-specific efforts to avoid loneliness and social isolation are, therefore, needed.

Marital Status Differences in Loneliness Among Older Americans During the COVID-19 Pandemic

Guided by the social integration perspective, we conducted one of the first population-based studies on marital status differences in loneliness during the COVID-19 pandemic among older Americans. Analysis of data from the 2020 National Health and Aging Trends Study COVID-19 supplement (n = 2861) suggested that, compared to their married counterparts, divorced and widowed older adults reported higher levels of loneliness during the pandemic, and divorced older adults also felt lonely more often when compared to before the pandemic. These marital status differences in pandemic loneliness cannot be explained by changes in social participation (e.g., working for pay, volunteering, attending religious services, or attending clubs, classes, or other organized activities) or changes in contact frequency with family and friends (via phone calls, emails/texts/social media messages, video calls, or in-person visits). No gender difference was found in the association between marital status and loneliness during the pandemic. These results, coupled with the growth of the unmarried older population, highlight that policymakers, health care providers, and researchers should think creatively about ways to reduce the loneliness gap between married and unmarried groups to promote healthy aging for all older adults, particularly in the face of emerging pandemics that may complicate strategies to improve population health in the future.

Use and Acceptance of Digital Communication Technology by Older Adults for Social Connectedness During the COVID-19 Pandemic: Mixed Methods Study

BACKGROUND

Older adults are at higher risk for health issues, including mental health problems. This was especially apparent during the COVID-19 pandemic, where older adults were simultaneously more vulnerable to the disease and the mental health concerns created by social distancing. Subsequently, the use of digital communication technology (DCT) became a critical option for maintaining social connectedness in older adults. Prior to the pandemic, the low uptake and use of technology by older adults was an established problem, known as the digital divide. However, not much is known about how this may have changed as a result of the pandemic.

OBJECTIVE

This study aims to explore how older adults maintained social connectedness through DCT during the pandemic and to understand factors influencing the use and acceptance of DCT.

METHODS

A mixed methods explorative field study was set up, involving surveys and interviews of 25 community-dwelling older adults (65-88 years old) living in the United Kingdom. The surveys included the internet acceptance questionnaire (based on the Technology Acceptance Model [TAM]); COVID-19 dysfunctional anxiety was captured using the COVID-19 Anxiety Scale (CAS). Background information (demographics, use of technology) was gathered before conducting semistructured interviews. We hypothesized that CAS would affect constructs of TAM and that predictive constructs of TAM would have remained valid during the pandemic. We also posited that there would be unidentified themes outside TAM that impacted the acceptance and use of DCT. We used the quantitative data to guide the semistructured interviews, which were then analyzed through thematic analysis to identify additional themes.

RESULTS

Correlational analysis showed that CAS influences all constructs of TAM. We also saw that the predictive constructs of TAM, especially the perceived ease of use (PEU) and perceived usefulness (PU), remained valid during the pandemic. Common acceptance-influencing themes were encountered in both quantitative and qualitative analyses, with 3 matching the known constructs of TAM (PU, PEU, and behavioral intention). We identified 2 additional themes affecting acceptance, namely influence of the pandemic (situational context) and privacy and security concerns. DCT use (especially email and videoconferencing use) increased during the pandemic, but the results related to social networking sites were mixed.

CONCLUSIONS

The COVID-19 pandemic impacted technology acceptance and use by older adults, encouraging their use of certain DCT apps (email and videoconferencing apps, such as WhatsApp). These apps helped insulate them from adverse effects (social isolation and loneliness). Other social networking apps, however, exerted a negative influence, increasing anxiety and a general feeling of negativity. Future studies should maximize older adult agency related to design, privacy, security, and user requirements for development. We also recommend that when studying DCT acceptance for older adults, our additional identified themes should be considered alongside the existing TAM constructs.

Early life adversities and discrimination, social activity, and loneliness among older adults in Europe: a moderated mediation analysis

OBJECTIVE

The present study explores how and when lifetime discriminatory experience moderates the mediation effect of early life adversities and social activity on loneliness among older European adults over eight years.

METHOD

The study analyzed 13,699 respondents aged 50 years and over who were interviewed in 2009 and re-interviewed in 2017 in the European Survey of Health, Ageing, Retirement. Conditional process analysis using the PROCESS model 15 was applied to examine the moderated mediation effect of lifetime discriminatory experience in 2009 (W) on early life adversities in 2009 (X) and social activity at 2017 (M) to loneliness in 2017 (Y).

RESULTS

Our moderated mediation models found that early life adversities (X) are associated with loneliness (Y) (Coeff X→Y=-0.0501, p<.001), but social activity (M) reduces its effect on loneliness (Y) (Coeff X→M→Y=-1.6391, p<.001). However, lifetime discriminatory experience (W) hampers social activity (Coeff M*W→Y = 0.0955, p<.05) and increases loneliness (Coeff X*M→Y = 0.6069, p<.05).

CONCLUSION

Older adults experiencing early life adversities may not necessarily develop later life loneliness. However, lifetime discriminatory experience due to political beliefs, religion, ethnicity, sexual orientation/background etc. may reverse the positive effect of social engagement on the relationship between early life adversities and loneliness. Early interventions should address discrimination and social inequalities and increase social participation across the life course to prevent the development of later-life loneliness among older adults.

Longitudinal analyses indicate bidirectional associations between loneliness and health

OBJECTIVES

To evaluate temporal dynamics between loneliness and both objective and subjective health (i.e. functional impairment and self-rated health) in mid- to late-adulthood.

METHOD

We applied bivariate dual-change-score models to longitudinal data from 3 Swedish twin studies (N = 1,939) to explore dynamic associations between loneliness and health across 3 age ranges (50-69, 70-81, and 82+ years) to investigate whether associations between loneliness and health change with age due to increasing incidence of chronic health conditions and bereavement.

RESULTS

Results showed bidirectional associations between loneliness and both objective and subjective health, with adverse impacts of loneliness observed on subsequent subjective and objective health beginning at age 70. Associations between health and subsequent loneliness were observed after age 82 and varied for subjective and objective health, with subjective health associated with less loneliness and objective health associated with greater loneliness.

CONCLUSIONS

Our results indicate dynamic associations between loneliness and health with age in mid- to late-adulthood, with earlier impacts of loneliness on health and later impacts of health on loneliness that vary for objective and subjective measures of health. These findings suggest impacts of health on loneliness may arise later in life when worsening health or mobility interfere with social interaction.

Loneliness and Social Isolation among Transgender and Gender Diverse People

Here, we report the prevalence of loneliness and social isolation and investigate the levels of loneliness and social isolation among transgender and gender diverse people using cross-sectional data from the HH-TPCHIGV study. Using the De Jong Gierveld tool, we assess loneliness, using the Bude and Lantermann tool, we assess perceived social isolation and using the Lubben Social Network Scale, we assess objective social isolation. The prevalence rate of loneliness was 83.3% (perceived social isolation: 77.7%; objective social isolation: 34.4%). Regressions revealed that favorable outcomes (i.e., lower loneliness levels, lower perceived social isolation, and lower objective social isolation) were consistently associated with higher school education. Beyond that, we identify an association between particularly poor health-related factors and higher loneliness and objective social isolation levels. We also report that unemployment was significantly associated with higher levels of perceived social isolation. In conclusion, we show high prevalence rates of loneliness and social isolation among transgender and gender diverse people. Additionally, important correlates (e.g., education, health-related factors, or unemployment) were identified. Such knowledge may provide help to address transgender and gender diverse people at risk for loneliness and social isolation.

Loneliness and social networks of older adults in rural communities: a narrative synthesis systematic review

Introduction

Loneliness has significant impacts on the health of older adults. Social networks help to improve psychosocial and quality of life outcomes among older adults. A fifth of older adults live in rural communities, where geographic isolation poses challenges to health. The dynamics of social networks of older adults in rural communities has not been explored.

Objective

To synthesize the literature related to loneliness and social networks of older adults in rural settings.

Methods

A mixed-methods systematic review was conducted through searching six bibliographic databases to retrieve peer-reviewed literature with no time limits. We performed a methodological assessment of each study using a mixed method quality assessment tool. Findings are synthesized thematically.

Results

A total of 50 studies (32 quantitative, 15 qualitative, and 3 mixed methods) were included in this review. Studies were conducted in 17 different countries, the majority from China (n = 12), the UK (n = 9), and USA (n = 9). Findings revealed that social networks of older adults consist of family, friends and neighbors and continue to be developed through participation in various physical and social activities such as walking groups and participation in religious events. Social networks offer informational, functional, psychological and social support to older adults. Through their social networks, older adults feel socially connected and cared for. Successful interventions to improve social networks and address loneliness were those developed in groups or one-on-one with the older adults. The key ingredient to the positive impact of these interventions on reducing social isolation and loneliness was the formation of a social connection and regular engagement with the older adults. However, the review did not find any explicitly reported theory or model on which these interventions are based.

Conclusion

The prevalence of loneliness among older adults in rural areas needs urgent attention. Social network theory and methods can help in developing interventions to address social isolation and loneliness among older adults in rural communities.

The impact of COVID-19 restrictions on older adults' loneliness: Evidence from high-frequency panel data in Austria (2020-2022)

BACKGROUND

It is unclear how strong and long lasting the effects of recurring COVID-19 pandemic restrictions are on older adults' loneliness.

METHODS

457 retired older Austrians (60+) provided 9,489 repeated observations of loneliness across 30 survey waves of the Austrian Corona Panel Project between March 2020 and March 2022. Ordinal mixed regression models were used to estimate the effect of time-varying country-level strictness of COVID-19 restrictions (stringency index, range=0-100) on older adult's loneliness.

RESULTS

The proportion of older adults who reported to be often lonely correlated (r = 0.45) with the stringency index over time: both peaked during lock-downs (stringency index = 82, often lonely = 10%-13%) and were lowest during the summer of 2020 (stringency index = 36, often lonely = 4%-6%). Results from regression models adjusted for the number of new COVID-19 cases and deaths indicate, that when the stringency index increased by one point, the odds for loneliness increased by 2%. Older adults who lived alone were more likely lonely during the pandemic and were more affected by COVID-19 restriction measures compared to those living with others.

CONCLUSIONS

More stringent COVID-19 restrictions were associated with an increase in (situational) loneliness among older adults in Austria, and this effect was stronger among those who lived alone. Efforts should be made to enable older adults, in particular those who live alone, to allow for save in-person contact in case of (future) periods of strict pandemic restriction measures.

Screening for loneliness in representative population samples: Validation of a single-item measure

BACKGROUND

Loneliness is a highly relevant public mental health issue. This work presents the validation of a single-item measure of loneliness and its subjective experience: "I am frequently alone/have few contacts". It can be used in large-scale population surveys where an economical assessment is of key importance.

METHODS

Data was drawn from two representative German population surveys conducted in early and late 2020 (combined N = 4,984; 52.9% women; age: M = 48.39 years (SD = 17.88)). We determined the prevalence of loneliness in men and women across different age groups. In order to test concurrent validity, bivariate correlation analyses and Chi-square tests were performed. Convergent and discriminant validity were tested by investigating intercorrelations of the single-item measure of loneliness with another loneliness measure, other mental health outcomes, and associations with sociodemographic characteristics.

RESULTS

Based on the single-item measure, 23.4% of participants reported some degree of loneliness, 3.4% among them severe loneliness. Comparisons with the LS-S showed similar prevalence rates of loneliness. A moderately positive relationship between the two loneliness measures was found by bivariate correlation analysis (ρ = .57, p < .001), but results indicated only weak convergent validity. Construct validity was supported by associations with depressive symptoms, anxiety symptoms, satisfaction with life, household size, and partnership.

CONCLUSIONS

Loneliness is frequently reported in the general population. The single-item measure of loneliness is suitable as a brief screening measure in population-based assessments.

A Longitudinal Examination of the Association Between Loss of Control and Loneliness Among Older Adults Diagnosed with Cancer

Objectives: The objective of this paper is to examine whether feeling a loss of control over one's life is associated with an increased risk for loneliness among those diagnosed with cancer. Method: We draw on data from the Health and Retirement Study to identify three baseline and follow-up cohorts of cancer survivors age 50 and older. Ordinary least squared regression is used to examine predictors for future loneliness. Results: Upon adjusting for other known predictors of loneliness, feelings of loss of control was significantly predictive of loneliness among 4-year cancer survivors. Discussion: Social workers and other health care practitioners should seek to provide evidence-based interventions to reduce the risk for loneliness for cancer survivors feeling a loss of control.

Active ageing profiles among older adults in Spain: A Multivariate analysis based on SHARE study

BACKGROUND

Following the active ageing model based on the Health, Lifelong Learning, Participation and Security pillars, this research has a twofold objective: i) to classify older adults according to active ageing profiles, taking into account the four pillars, and ii) to ascertain the relationship between the profiles and personal and contextual factors, as well as well-being and quality of life in old age.

METHODS

A study sample of 5,566 Spanish older adults who participated in wave 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE) was included. Data were analysed in different steps applying several statistical analyses (Principal Component, Cluster, Discriminant, Multiple Correspondence and bivariate analysis with Pearson chi-square and ANOVA).

RESULTS

Five older adult profiles were obtained (I: with moderate activity; II: quasi-dependents; III: with active ageing-limiting conditions; IV: with diverse and balanced activity; V: with excellent active ageing conditions). The first three profiles were characterised by subjects with a high average age, low educational level, who were retired or housewives, and who perceived a moderate level of loneliness, satisfaction with the social network and quality of life, as well as having a larger family network, but living in small households or alone. In contrast, the latter two profiles showed better personal and contextual conditions, well-being and quality of life.

DISCUSSION AND CONCLUSIONS

The multidimensional approach to active ageing followed in this article has revealed the presence of several older adult profiles, which are confined to groups with better or worse active ageing conditions. In this context, if ageing is a process that reflects the previous way of life, intervention priorities will have to consider actions that promote better conditions during the life cycle.

Loneliness during COVID-19: Development and influencing factors

In early pandemic waves, when vaccination against COVID-19 was not yet an option, distancing and reduced social contact were the most effective measures to slow down the pandemic. Changes in frequency and forms of social contact have reduced the spread of the COVID-19 virus and thus saved lives, yet there is increasing evidence for negative side effects such as mental health issues. In the present study, we investigate the development of loneliness and its predictors to examine the role of changes in social networks due to social distancing and other COVID-19-related life changes. A total of 737 participants (age range = 18-81 years) completed an online survey in three waves during the last quarter of 2020 at one-month intervals. Latent growth and multilevel modeling revealed that emotional loneliness increased over time, while social loneliness remained stable. Moreover, socially lonely individuals were likely to also develop emotional loneliness over time. Increased social distancing and sanitary measures were accompanied by decreased social interactions and loss of individuals considered SOS contacts and confidants. Changes in specific social network indicators were differentially associated with changes in emotional vs social loneliness: Loss of friends considered confidants was associated with increasing emotional loneliness, whereas loss of friends considered SOS contacts and reduced overall social interactions were related to increasing social loneliness. Lastly, individuals with more family-and-friend SOS contacts, more friends as confidants and an overall higher number of social interactions were more protected from feeling socially or emotionally lonely. Study findings enhance the understanding of underlying mechanisms differentially contributing to social and emotional loneliness and offer practical suggestions to reduce mental-health side effects of social distancing.

Oral Health, Loneliness and Social Isolation. A Systematic Review and Meta-Analysis

OBJECTIVES

Thus far, some empirical studies have investigated the association between oral health and loneliness as well as social isolation. However, a systematic review and meta-analysis is lacking synthesizing this evidence. Hence, our purpose was to close this knowledge gap.

DESIGN

Systematic review and meta-analysis.

SETTING AND PARTICIPANTS

Observational studies examining the association between oral health and loneliness or social isolation were included. Disease-specific samples were excluded.

METHODS

We searched three electronic databases (PubMed, PsycINFO, CINAHL), and did an additional hand search. Data extraction covered methods, sample characteristics and main findings. To evaluate study quality/risk of bias, the NIH tool was used. Study selection, data extraction and assessment of study quality were each conducted by two reviewers.

RESULTS

Seven studies were included in our current work. Several cross-sectional studies and one longitudinal study reported an association between poorer oral health and higher loneliness as well as higher social isolation. The quality of the studies was mostly fair, with two studies of high quality. The pooled OR was 1.47 (95% CI: 1.24-1.75) among the studies with adult samples.

CONCLUSION

Most of the included studies demonstrated an association between oral health and loneliness or social isolation. There is a lack of high quality studies on these associations; in particular, future studies should use longitudinal data to clarify the directionality between oral health and loneliness or social isolation. Prospero registration number: CRD42021268116.

Frequency of contact with friends and relatives via internet and psychosocial factors in middle-aged and older adults during the COVID-19 pandemic. Findings from the German Ageing Survey

OBJECTIVES

Previous studies have examined the association between frequency of contact with friends and relatives via internet and psychosocial factors (in terms of loneliness, life satisfaction and depressive symptoms). However, far less is known about such a link during the COVID-19 pandemic, particularly based on nationally representative samples. Therefore, the aim of this study was to examine this association among middle-aged/older adults.

METHODS/DESIGN

Data were taken from the short survey of the German Ageing Survey (June/July 2020, 3134 individuals in the analytical sample). The De Jong Gierveld scale was used to quantify loneliness, the Satisfaction with Life Scale was used to quantify life satisfaction and the 10-item version of the Center for Epidemiological Studies-Depression was used to quantify depressive symptoms.

RESULTS

Regressions showed that-compared to daily users-less frequent users of the internet for contact with friends and relatives reported increased loneliness, lower life satisfaction and more depressive symptoms. With regard to covariates, better psychosocial factors were associated with medium education (compared to low education), living with partner in the same household (compared to singles), better self-rated health, and favourable COVID-19 factors (in terms of decreased feeling that the Corona crisis is a threat for oneself, not having an infection with the coronavirus and an increased feeling that you can influence an infection with the coronavirus yourself).

CONCLUSIONS

Data suggest that individuals with a high frequency of contact with friends and relatives via internet reported better psychosocial factors. Future research in other cultural settings are required.

Asymmetric effects of obesity on loneliness among older Germans. Longitudinal findings from the Survey of Health, Ageing and Retirement in Europe

OBJECTIVES

The aim of this longitudinal study was to examine whether the onset and the end of obesity was associated with loneliness.

METHOD

Nationally representative longitudinal data from Germany were taken from the Survey of Health, Ageing and Retirement in Europe (wave 5 to wave 7; n = 10,446 observations in the analytical sample). Using the three item loneliness scale (UCLA), loneliness was measured. According to the WHO thresholds, obesity was defined as BMI ≥ 30 kg/m². Asymmetric fixed effects (FE) regressions were used.

RESULTS

Conventional FE regression analysis revealed that changes in obesity status were associated with changes in loneliness (men: β = -.19, p < .05; women: β = .19, p < .05). Asymmetric FE regressions showed that in men the onset of obesity was associated with a decrease in loneliness (β = -.31, p < .05), whereas the end of obesity was not associated with loneliness. Asymmetric FE regressions showed that in women, the onset of obesity was associated with an increase in loneliness (β = .33, p < .01), whereas the end of obesity was not associated with loneliness.

CONCLUSION

Findings showed that the onset of obesity has different consequences in terms of loneliness for older women and men in Germany, whereas the end of obesity was not associated with changes in loneliness scores. We recommend that future studies should distinguish between the onset and the end of obesity - which comes along with important practical implications. When older women report transitions to obesity, efforts to prevent loneliness may be of importance.

Mental, Physical and Social Functioning in Independently Living Senior House Residents and Community-Dwelling Older Adults

Senior houses provide social interaction and support, potentially supporting older people's physical and mental functioning. Few studies have investigated functioning of senior house residents. The aim was to compare functioning between senior house residents and community-dwelling older adults in Finland. We compared senior house residents (n = 336, 69% women, mean age 83 years) to community-dwelling older adults (n = 1139, 56% women, mean age 74 years). Physical and mental functioning were assessed using the SF 36-Item Health Survey. Loneliness and frequency of social contacts were self-reported. The analyses were adjusted for age, socioeconomic factors and diseases. Physical functioning was lower among men in senior houses compared to community-dwelling men (mean 41.1 vs. 46.4, p = 0.003). Mental functioning or the frequency of social contacts did not differ between type of residence in either sex. Loneliness was higher among women in senior houses compared to community-dwelling women (OR = 1.67, p = 0.027). This was not observed in men. Results suggest that women in senior houses had similar physical and mental functioning compared to community-dwelling women. Male senior house residents had poorer physical functioning compared to community-dwelling men. Women living in senior houses were lonelier than community-dwelling women despite the social environment.

The Moderating Role of Resilience in the Personality-Mental Health Relationship During the COVID-19 Pandemic

Background: Associations between personality traits and mental health outcomes (depression, anxiety, loneliness, and stress) have rarely been assessed in a population-representative sample of a high-income country during the COVID-19 pandemic. Additionally, as far as we know, the role of health and social behaviors as well as resilience in the personality-mental health relationship has yet to be explored. Methods: A representative sample of 1,828 residents of Luxembourg filled in validated scales to assess personality traits and resilience, depressive symptoms, generalized anxiety, loneliness, and stress, indicating mental health, in mid-April 2020. Results: Approximately 21% of the participants scored above the cut-off for moderate depression and moderate loneliness. Moderate anxiety and moderate stress were present in 6.2 and 0.3% of the participants, respectively. Higher-educated respondents and those living in higher-value housing reported better mental health. Agreeableness and conscientiousness were most consistently associated with better mental health; neuroticism was most consistently associated with worse mental health. Spending more time on social media was also associated with elevated levels of all four mental health outcomes. Social and health behaviors did not change the personality-mental health relationships. Resilience moderated some of the personality-mental health associations, most consistently in neuroticism. Conclusions: Findings suggest educational and socioeconomic inequalities in mental health in a nationally representative sample during the COVID-19 confinement measures. Personality traits, particularly agreeableness, conscientiousness, and low neuroticism were associated with mental health. The moderating role of resilience in the personality-mental health relationship suggests intervention potential to improve mental health during periods of confinement.

Loneliness and Risk for Cardiovascular Disease: Mechanisms and Future Directions

Purpose of review

In this review, we synthesise recent research on the association between loneliness and cardiovascular disease (CVD). We present evidence for mechanisms underlying this association and propose directions for future research.

Recent findings

Loneliness is related to increased risk of early mortality and CVD comparable to other well-established risk factors such as obesity or smoking.

Summary

Loneliness has been linked to higher rates of incident CVD, poorer CVD patient outcomes, and early mortality from CVD. Loneliness likely affects risk for these outcomes via health-related behaviours (e.g. physical inactivity and smoking), biological mechanisms (e.g. inflammation, stress reactivity), and psychological factors (e.g. depression) to indirectly damage health.

The impact of COVID-19 restriction measures on loneliness among older adults in Austria

BACKGROUND

To halt the spread of COVID-19, Austria implemented a 7-week 'lockdown' in March/April 2020. We assess whether the ensuing reduction in social contacts led to increased loneliness among older adults (60+).

METHODS

Three analyses were conducted: (i) a comparison between pre-pandemic (SHARE: 2013-17) and pandemic (May 2020) levels of loneliness (UCLA-3 scale), (ii) an assessment of the cross-sectional correlation between being affected by COVID-19 restriction measures and loneliness (May 2020) and (iii) a longitudinal analysis of weekly changes (March-June 2020) in loneliness (Corona panel).

RESULTS

We found (i) increased loneliness in 2020 compared with previous years, (ii) a moderate positive association between the number of restriction measures older adults were affected from and their loneliness and (iii) that loneliness was higher during 'lockdown' compared to the subsequent re-opening phase, particularly among those who live alone.

CONCLUSIONS

We found evidence that COVID-19 restriction measures in Austria have indeed resulted in increased levels of loneliness among older adults. However, these effects seem to be short-lived, and thus no strong negative consequences for older adults' mental health are expected. Nonetheless, the effects on loneliness, and subsequent mental health issues, could be both more long-lasting and severe if future restriction measures are enacted repeatedly and/or over longer time periods.

The Role of Self-Esteem in the Relationship Between Loneliness and Life Satisfaction in Late Adulthood: Evidence from Poland

Background

The life satisfaction of elderly persons has been extensively investigated and discussed. However, a literature review shows that relatively few studies have focused on the effect of loneliness on the life satisfaction of older adults. Some researchers have acknowledged that the character of the relationship between loneliness and life satisfaction is still unclear, and this association is much more complex that it appears to be. Therefore, the main purpose of the current study was to understand how loneliness is associated with satisfaction, and whether self-esteem and educational involvement in the University of the Third Age (U3A) courses can affect this relationship among elderly people.

Methods

The research was conducted on a group of 179 elderly adults (65% women). We measured loneliness, satisfaction, and self-esteem. The data were collected via the paper-and-pencil format through convenience sampling, just before the COVID-19 pandemic began.

Results

The results obtained show that loneliness correlated negatively with self-esteem and life satisfaction. Self-esteem was associated positively with life satisfaction. Self-esteem acted as a suppressor between loneliness and life satisfaction. The participation of older adults in U3A moderated the strength of the relationship between loneliness and life satisfaction (direct effect) and between loneliness and life satisfaction mediated by self-esteem (indirect effect).

Conclusion

The mediatory role of self-esteem and the moderating role of educational activities in the relationship between loneliness and life satisfaction in late adulthood have important developmental and social implications. It appears that although feelings of loneliness and social isolation have a negative association on the life satisfaction of older adults, this relationship may be altered by empowering seniors’ self-esteem through their involvement in lifelong learning. Such a solution supports the functioning of older people also at the social level.

Prevalence and Correlates of Individuals Screening Positive for Depression and Anxiety on the PHQ-4 in the German General Population: Findings from the Nationally Representative German Socio-Economic Panel (GSOEP)

Our aim was to estimate the prevalence and correlates of probable depression and anxiety in the general adult population in Germany. Repeated cross-sectional data (i.e., cross-sectional data observed at different time points: year 2012 and year 2014) were derived from the innovation sample of the German Socio-Economic Panel, a population-based study of German households. The validated Patient Health Questionnaire (PHQ-4) was used to measure probable depression and anxiety. In the analytical sample, n equaled 2952 individuals. According to the PHQ-4 cut-off values, 10.4% of the individuals had probable depression and 9.8% of the individuals had probable anxiety. Regressions revealed that the likelihood of depression was positively associated with lower age (OR: 0.98 (95% CI: 0.98-0.99)), being unmarried (and living together with spouse) (OR: 0.75 (0.58-0.98)), worse self-rated health (OR: 1.99 (1.73-2.27)), and more chronic diseases (OR: 1.18 (1.07-1.31)). Furthermore, the likelihood of anxiety was positively associated with being female (OR: 1.36 (95% CI: 1.04-1.76)), lower age (OR: 0.98 (95% CI: 0.97-0.99)), low education (medium education, OR: 0.69 (0.50-0.95)), worse self-rated health (OR: 2.00 (1.74-2.30)), and more chronic diseases (OR: 1.15 (1.03-1.27)). The magnitude of depression and anxiety was highlighted. Clinicians should be aware of the factors associated with probable depression and anxiety.