Loneliness of Older Adults

Loneliness of Older Adults - #98

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When there is a discrepancy between one’s desired state of social connection and one’s actual relationships, a complex set of feelings termed loneliness occurs.

Adults over the age of 65 years, especially those identified as at risk of loneliness.

Following a positive screen for loneliness, explore why the patient feels lonely. Consider a “social prescription” to local community-based programs for social connection and ongoing support. A meta-analysis of interventions to reduce loneliness suggested the following:

  • Enhancing social support
  • Increasing opportunities for social interaction
  • Improving social skills
  • Addressing maladaptive social cognition (e.g., social anxiety, lack of self-esteem)11
  1. Define loneliness and how it differs from social isolation.
  2. Describe the impact of loneliness on patient health.
  3. Identify risk factors for loneliness in older adults.
  4. Describe how to assess older patients for loneliness.
  1. National Academies of Sciences, Engineering, and Medicine. Social isolation and loneliness in older adults: Opportunities for the health care system. 2020. Washington, DC: The National Academies Press. https://doi.org/10.17226/25663
  2. Kotwal, A.A., Holt-Lunstad, J., Newmark, R.L., Cenzer, I., Smith, A.K., Covinsky, K.E., Escueta, D.P., Lee, J.M. and Perissinotto, C.M. Social Isolation and Loneliness Among San Francisco Bay Area Older Adults During the COVID-19 Shelter-in-Place Orders. J Am Geriatr Soc. 2021;69: 20-29. https://doi.org/10.1111/jgs.16865
  3. Malani P, Kullgren J, Solway E, Piette J, Singer D, Kirch M. Loneliness Among Older Adults Before and During the COVID-19 Pandemic. University of Michigan National Poll on Healthy Aging. September 2020. Available at: http://hdl.handle.net/2027.42/162549
  4. Rico-Uribe, L. A., F. F. Caballero, N. Martin-Maria, M. Cabello, J. L. Ayuso-Mateos, and M. Miret. Association of loneliness with all-cause mortality: A meta-analysis. PLoS ONE. 2018;13(1):e0190033.
  5. Holt-Lunstad, J., T. B. Smith, M. Baker, T. Harris, and D. Stephenson. Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science. 2015;10(2):227–237.
  6. Hakulinen C, Pulkki-Råback L, Virtanen M, Jokela M, Kivimäki M, Elovainio M. Social isolation and loneliness as risk factors for myocardial infarction, stroke and mortality: UK Biobank cohort study of 479 054 men and women. Heart. 2018;104(18):1536-1542. doi:10.1136/heartjnl-2017-312663
  7. Richard A, Rohrmann S, Vandeleur CL, Schmid M, Barth J, Eichholzer M. Loneliness is adversely associated with physical and mental health and lifestyle factors: Results from a Swiss national survey. PLoS ONE. 2017;12(7):e0181442.
  8. Sutin AR, Stephan Y, Luchetti M, & Terracciano A. Loneliness and risk of dementia. J Gerontol B Psychol Sci Soc Sci. 2020;75(7):1414-1422. doi.org/10.1093/geronb/gby112
  9. Goodman, A., Adams, A., & Swift H.J. Hidden citizens: How can we identify he most lonely older adults? 2015. The Campaign to End Loneliness: London. Available at: https://www.campaigntoendloneliness.org/wp-content/uploads/CEL-Hidden-People-report-final.pdf
  10. Hughes, M. E., Waite, L. J., Hawkley, L. C., & Cacioppo, J. T. A short scale for measuring loneliness in large surveys: Results from two population-based studies. Research on Aging. 2004;26(6), 655–672.
  11. Masi CM, Chen HY, Hawkley LC & Cacioppo JT. A meta-analysis of interventions to reduce loneliness. Personality and Social Psychology Review. 2010;3:219-66.
  12. Su Y, Rao W, Li M, Caron G, D’Arcy C, Meng X. Prevalence of loneliness and social isolation among older adults during the COVID-19 pandemic: A systematic review and meta-analysis. International Psychogeriatrics. 2022:1-13. doi:10.1017/S1041610222000199
  13. Kotwal AA, Cenzer IS, Waite LJ, et al. The epidemiology of social isolation and loneliness among older adults during the last years of life. J Am Geriatr Soc. 2021;69(11):3081-3091. doi:10.1111/jgs.17366
This GFF ___ my competence in geriatrics.

Stacy Barnes, PhD, Director, Wisconsin Geriatric Education Center and Associate Professor of Practice, College of Nursing, Marquette University