Community-based responses to loneliness in older people: A systematic review of qualitative studies

[A panel model of the relationships between loneliness and depression in older adults]

ANTECEDENTS AND OBJECTIVE

The declining birth rate and increasing life expectancy have led to an aging population, causing challenges at the economic, social and healthcare levels. Ensuring and maintaining high levels of well-being and mental health in older adults is crucial for successful aging. Given that previous literature indicates that perceived loneliness and depressive symptoms constitute significant obstacles to their quality of life, the aim of this study is to examine how perceived loneliness and depression intertwined in community-dwelling older adults over time.

METHODOLOGY

For this purpose, we conducted a longitudinal research study with a total of 46,317 European older adults (57.40% women), using the SHARE database (Survey of Health, Ageing and Retirement in Europe), at waves 6, 7, and 8, spanning a recent four-year period from 2016 to 2020. Several cross-lagged panel models were estimated using the structural equation modeling package Mplus.

RESULTS

The results show that loneliness and depression are bidirectionally related, which is difficult to combat because of their feedback and stability over time.

CONCLUSIONS

We discuss the practical implications of these findings concerning the potential double-edged sword of these reciprocal relationships on treatment and preventive interventions, as well as the study's limitations and future research directions.

Mobilizing community health assets through intersectoral collaboration for social connection: Associations with social support and well-being in a nationwide population-based study in Catalonia

BACKGROUND

Limited social connection among older adults poses a global public health challenge, reducing sources of support and affecting health and well-being. National public health strategies that leverage local intersectoral collaboration between key sectors such as primary and social care, community organizations, and society, have been advocated, yet their impact remains underexplored.

OBJECTIVE

This study examines the regional variability in the uptake of a public health strategy in Catalonia that mobilizes community health assets, such as social clubs and leisure activities, through intersectoral collaboration and its associations with social support and mental well-being in older adults.

METHODS

We conducted a population-based cross-sectional study using the Catalan Health Survey (2017-2021) with 6011 adults aged ≥ 60 years across 31 Health Sectors. Survey data were linked with area-level uptake metrics, generated using data analytic techniques. Individuals were categorized into three uptake groups based on the number and territorial distribution of asset-based initiatives within their area of residence. Multilevel regressions tested associations with social support (OSSS-3) and mental well-being (SWEMWBS), controlling for individual, contextual, and temporal factors.

RESULTS

Participants' average age was 74.1 years ±  10.0 with 53.3% women. From 2017 to 2021, 2312 asset-based initiatives were registered across Health Sectors, ranging from 0 to 342 per sector. Residing in sectors with the highest uptake of initiatives (>15 initiatives per 10,000 population) was associated with higher social support (β = .34, p < .01) and mental well-being scores (β =  1.11, p < .01).

CONCLUSION

Residing in areas with greater health assets mobilized through intersectoral collaboration was associated with higher social support and well-being among older adults. This study represents one of the first national evaluations of an intersectoral strategy aimed at mitigating the mental health impacts of limited social networks. Future public health strategies should prioritize equitable access for inclusive benefits.

'Keeps me young at heart': Exploring the influence of volunteering on social connection, health and well-being in rural Australia

OBJECTIVE

The negative consequences of social disconnection, including loneliness and social isolation, is receiving considerable attention from researchers and policymakers, and growing as a global public health priority. Volunteering has emerged as a promising strategy to promote social connection and combat loneliness, calling for a closer examination of its potential benefits to individual social health and community cohesion. This study explores the experiences and impact of volunteering on individuals' social health, providing insights into both the positive impacts and possible limitations of volunteering in rural communities.

DESIGN/SETTING/PARTICIPANTS

Twenty-two volunteers (6 males; 16 females) in one rural Northern Victoria community participated in semi-structured interviews via telephone, online or face-to-face. Thematic analysis was used to develop descriptive themes from the qualitative data.

RESULTS

Four themes were identified: (1) creating social and community bonds, (2) giving back to the community, (3) building identity through volunteering and (4) social identity and belonging. Findings suggest that volunteering helps individuals to meet new people, increase opportunities for social interactions with others and within social groups, positively influencing their social identity and the identity of the community. Volunteers, who felt connected through their volunteering, experienced a sense of belonging. However, when feeling overburdened or undervalued, volunteers disengaged and sought new volunteering opportunities.

CONCLUSIONS

This study demonstrates the influence of rural volunteering on volunteer's social connections, identity and social health. Creating flexible, accessible and inclusive volunteering opportunities acts as a valuable community resource for building and maintaining social health and connection and reduces social disconnection in rural populations.

Individual, social and area level factors associated with older people's walking: Analysis of an UK household panel study (Understanding Society)

BACKGROUND

Among older people, walking is a popular and prevalent activity. Walking is key to increasing physical activity levels and resulting physical and mental health. In the context of rapidly ageing populations, it is important to better understand what factors are associated with walking among older people, based on the socioecological model of health.

METHODS

We used data from Understanding Society (n:6450), a national panel survey of UK adults aged 65 years and over living in Great Britain. Slope Indices of Inequality (SII) were calculated for weekly walking hours for older people according to individual, social and area characteristics. These include health, loneliness and social isolation, previous walking and sporting activity, residential self-selection, contact with neighbours, number of close friends and social activity. Spatial area-level data described local area crime, walkability, and proximity to retail, greenspace, and public transport amenities.

RESULTS

Multivariable models indicated that poor health, particularly requiring help with walking, was the strongest predictor of weekly walking hours (SII (95% CI) comparing those needing help vs. no help: -3.58 (-4.30, -2.87)). However, both prior sporting activity (most vs. least active: 2.30 (1.75, 2.88)) and walking for pleasure (yes vs. no: 1.92 (1.32, 2.53)) were strongly associated with increased walking several years later. Similarly having close friends (most vs. fewest, 1.18 (0.72, 1.77)) and local retail destinations (any vs. none: 0.93 (0.00, 1.86)) were associated with more weekly walking.

CONCLUSIONS

Past engagement in physical activity and walking for pleasure are strong predictors of walking behaviour in older people, underscoring the importance of implementing and sustaining walking interventions across the lifespan to ensure continued engagement in later years and the associated health benefits. However, poor health significantly impedes walking in this demographic, emphasising the need for interventions that offer both physical assistance and social support to promote this activity.

National trends in loneliness and social isolation in older adults: an examination of subgroup trends over three decades in Sweden

Introduction

Loneliness and social isolation are public health concerns. This study aimed to examine levels and trends in loneliness and social isolation among older adults (77+ years) in Sweden, assess subgroup variations, and determine associations between loneliness and social isolation.

Methods

The 1992, 2002, 2004, 2011, 2014 and 2021 waves of the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) were analysed through ordered logistic and linear regressions.

Results

On average, 12.5 percent of the participants experienced loneliness often/nearly always, while 6 percent were categorised as severely isolated. Loneliness and social isolation were more common in women, those aged 85+, and persons with basic education, in psychological distress or with mobility limitations. Loneliness was also associated with living alone. No increases in loneliness or isolation were identified; instead, loneliness tended to decrease in groups already experiencing lower levels of loneliness. Loneliness and social isolation were moderately associated each survey year.

Discussion

This study challenges perceptions of high and increasing levels of loneliness and social isolation. Given the impact on health and wellbeing and the ageing of populations, policy and practice should still address these issues and target vulnerable groups. Subgroup analyses in trends are scarce and should be explored further in future research.

Understanding and using experiences of social care to guide service improvements: translating a co-design approach from health to social care

Background

Local authorities need to find new ways of collecting and using data on social care users' experiences to improve service design and quality. Here we draw on and adapt an approach used in the healthcare improvement field, accelerated experience-based co-design, to see if it can be translated to social care. We use loneliness support as our exemplar.

Objectives

To understand how loneliness is understood and experienced by members of the public and characterised by social care and voluntary sector staff; to identify service improvements around loneliness support; to explore whether accelerated experience-based co-design is effective in social care; and to produce new resources for publication on Socialcaretalk.org.

Design and methods

Discovery phase: in-depth interviews with a diverse sample of people in terms of demographic characteristics with experience of loneliness, and 20 social care and voluntary staff who provided loneliness support. Production of a catalyst film from the public interview data set. Co-design phase: exploring whether the accelerated experience-based co-design approach is effective in one local authority area via a series of three workshops to agree shared priorities for improving loneliness support (one workshop for staff, another for people with experience of local loneliness support, and a third, joint workshop), followed by 7-monthly meetings by two co-design groups to work on priority improvements. A process evaluation of the co-design phase was conducted using interviews, ethnographic observation, questionnaires and other written material.

Results

Accelerated experience-based co-design demonstrated strong potential for use in social care. Diverse experiences of participants and fuzzy boundaries around social care compared to health care widened the scope of what could be considered a service improvement priority. Co-design groups focused on supporting people to return to pre-pandemic activities and developing a vulnerable passenger 'gold standard' award for taxi drivers. This work generated short-term 'wins' and longer-term legacies. Participants felt empowered by the process and prospect of change, and local lead organisations committed to take the work forward.

Conclusions

Using an exemplar, loneliness support, that does not correspond to a single pathway allowed us to comprehensively explore the use of accelerated experience-based co-design, and we found it can be adapted for use in social care. We produced recommendations for the future use of the approach in social care which include identifying people or organisations who could have responsibility for implementing improvements, and allowing time for coalition-building, developing trusted relationships and understanding different perspectives.

Limitations

COVID-19 temporarily affected the capacity of the local authority Project Lead to set up the intervention. Pandemic work pressures led to smaller numbers of participating staff and had a knock-on effect on recruitment. Staff turnover within Doncaster Council created further challenges.

Future work

Exploring the approach using a single pathway, such as assessing eligibility for care and support, could add additional insights into its transferability to social care.

Trial registration

This trial is registered as Current Controlled Trials ISRCTN98646409.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128616) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 27. See the NIHR Funding and Awards website for further award information.

Community Health Dialogue Implementation for the Solution of Loneliness in Rural Communities: Autoethnography

INTRODUCTION

Isolation and loneliness among older adults in rural communities pose significant risks to physical and mental health, leading to higher rates of morbidity and mortality. This study investigates the impact of continual rural health dialogues facilitated by family physicians on reducing loneliness and enhancing community health in Unnan City, Shimane Prefecture, Japan.

METHOD

Using a constructivist grounded theory approach, we conducted a qualitative study involving 165 participants over 65 from five rural communities between April 2022 and March 2024. Monthly health dialogues covered chronic diseases, exercise, and polypharmacy. Data were collected through ethnographic observations, focus group interviews, and field notes, with iterative coding and analysis to identify themes and concepts.

RESULTS

Three primary themes emerged: the existence of loneliness and its impact on health, motivation to address loneliness through a sense of security, and recognition of the importance of community engagement in reducing loneliness. Participants reported increased health awareness, enhanced community interaction, and recognition of loneliness's prevalence and health impacts. Regular dialogues fostered trust with healthcare professionals, encouraged proactive health management, and facilitated supportive community connections. These interactions significantly reduced feelings of loneliness and improved health outcomes.

CONCLUSION

Continual rural health dialogues effectively mitigate loneliness and enhance health outcomes in rural communities by fostering regular interactions and building supportive networks. These findings underscore the importance of community engagement and continuous relationships with healthcare professionals in addressing loneliness. Policymakers and healthcare providers should consider integrating such dialogues into rural health strategies to promote healthier, more connected communities. Future research should explore these interventions' long-term sustainability and broader applicability across diverse rural settings.

Associations of history of alcohol use disorder with loneliness, social support, and mental health during the COVID-19 pandemic

This study examined the effects of alcohol use disorder (AUD) and treatment history on changes in loneliness, social support, and mental health symptoms from before to during the pandemic, and tested loneliness and social support as mediators of the AUD-mental health associations. Participants (n = 427) enrolled in the NIAAA COVID-19 Pandemic Impact on Alcohol Study were categorized into three groups: healthy control (62.3%), nontreatment AUD (14.1%), and treatment AUD (23.7%). Multilevel generalized linear models were conducted to examine changes in loneliness, social support, and mental health symptoms by group. Path analyses tested the mediating roles of loneliness and social support. Loneliness increased during the pandemic, especially in the nontreatment AUD group. Social support decreased in the healthy control and AUD treatment group. Anxiety and depressive symptoms increased in the nontreatment AUD group. Individuals with a history of AUD regardless of treatment history reported greater loneliness, which was linked to higher anxiety and depressive symptoms. Loneliness, but not social support, mediated the AUD-mental health associations. Psychosocial interventions aimed at increasing positive social engagement among individuals with AUD may help alleviate feelings of loneliness and mitigate mental health symptoms. Study findings can also help improve preparedness for future public health crises.

Social Contact and Belonging Among Older People Receiving Home Care Nursing

Purpose

Support of social contact and a sense of belonging may be essential for older persons who need help, to take care of their wellbeing and reduce the feeling of loneliness. The aim of this qualitative study was to explore the features that influence social contact and belonging among older persons who received home care nursing.

Patients and Methods

The study involved nine individual in-depth interviews with older persons residing in Norway. The interviews were analyzed in accordance with a model of content analysis.

Findings

Social contact and belonging among the older persons depended on the availability of necessary resources that foster social activity, contact with family and friends, and housing quality. Interaction with helpers and accommodation of their needs as necessary were important for these persons. Reflecting on the past and considering life in context may be essential as a basis for their present and future life.

Conclusion

The results of the present study indicated that a sense of being cared for and supported are important for social contact and belonging. Social activity, engagement in family and contact with friends and neighbors are valued. However, a proportion of older persons are not engaged in such activities. Volunteer help may be a key factor for improving social contact. Moreover, contact and communication with home care nurses are important for recognition as valued persons and as a link to the community.

Social-ecological factors influencing loneliness and social isolation in older people: a scoping review

There are growing calls from researchers and policy makers to redefine loneliness and social isolation (SI) as public health issues, and to move towards a transdisciplinary, systems-based approach, due to their association with significant health risks, particularly in older people. Research about loneliness and SI in older people has typically adopted a narrow focus, evaluating effects of individual and inter-personal factors on these experiences. Less is known about the community and societal influences that may be used to inform public health interventions. We conducted a scoping review applying Joanna Briggs Institute methodology and the social-ecological model framework in order to: i) identify the available evidence for the influence of the community and societal factors on loneliness and SI as experienced by older people; ii) examine how quantitative research about community- and societal-level factors of loneliness and SI in the older population is conducted; and iii) identify current knowledge gaps in relation to the use of the social-ecological model in this area. A total of 52 articles from 30 countries met the inclusion criteria, including 33 observational studies, primarily cross-sectional (88%), and 19 interventions, mostly (89%) pre-post evaluations. The majority of included articles measured loneliness only (n = 34, 65%), while 11 measured both loneliness and SI (21%). To measure these outcomes validated scales were frequently used. Eighteen community/societal factors were investigated in relation to loneliness and/or SI, most commonly neighbourhood safety, access to public third-places and cultural practices. Three societal-level interventions were found: two campaigns to reduce ageism and one which explored the impact of free public transport. Community-based interventions were either educational or enlisted volunteers to foster connections. There is a need for longitudinal studies to better understand the mechanisms through which community- and societal- level factors affect loneliness and SI, which in turn will guide interventions that utilise the social-ecological framework for these issues.

Voluntary male mentors' lived experience of social engagement with men in their community

Men volunteering to mentor other men is a growing form of social engagement in Australia. Masculine norms associated with not disclosing emotional distress or discussing loneliness are often set aside by participating in these one-to-one relationships. Mentors have reported improvement in their well-being and a desire to contribute more. In this phenomenological study, which draws on hermeneutic methodology, 12 men who voluntarily met and mentored another adult man for a minimum of 6 months participated in a semi-structured interview. Findings showed non-judgement and deep listening facilitated a rewarding and personally developmental relationship. Most voluntary mentors experienced substantial changes in their masculine views, particularly with the regard to trust and openness with others. This experience has implications for men realising their ability to engage others and for community well-being.

Managing Perceived Loneliness and Social-Isolation Levels for Older Adults: A Survey with Focus on Wearables-Based Solutions

As an inevitable process, the number of older adults is increasing in many countries worldwide. Two of the main problems that society is being confronted with more and more, in this respect, are the inter-related aspects of feelings of loneliness and social isolation among older adults. In particular, the ongoing COVID-19 crisis and its associated restrictions have exacerbated the loneliness and social-isolation problems. This paper is first and foremost a comprehensive survey of loneliness monitoring and management solutions, from the multidisciplinary perspective of technology, gerontology, socio-psychology, and urban built environment. In addition, our paper also investigates machine learning-based technological solutions with wearable-sensor data, suitable to measure, monitor, manage, and/or diminish the levels of loneliness and social isolation, when one also considers the constraints and characteristics coming from social science, gerontology, and architecture/urban built environments points of view. Compared to the existing state of the art, our work is unique from the cross-disciplinary point of view, because our authors' team combines the expertise from four distinct domains, i.e., gerontology, social psychology, architecture, and wireless technology in addressing the two inter-related problems of loneliness and social isolation in older adults. This work combines a cross-disciplinary survey of the literature in the four aforementioned domains with a proposed wearable-based technological solution, introduced first as a generic framework and, then, exemplified through a simple proof of concept with dummy data. As the main findings, we provide a comprehensive view on challenges and solutions in utilizing various technologies, particularly those carried by users, also known as wearables, to measure, manage, and/or diminish the social isolation and the perceived loneliness among older adults. In addition, we also summarize the identified solutions which can be used for measuring and monitoring various loneliness- and social isolation-related metrics, and we present and validate, through a simple proof-of-concept mechanism, an approach based on machine learning for predicting and estimating loneliness levels. Open research issues in this field are also discussed.