loneliness in elderly essay

Should the Elderly Receive Free Bus Rides Persuasive

This essay will address the issue of loneliness among the elderly. It will discuss its causes, impact on mental and physical health, and potential interventions to alleviate loneliness in this demographic. On PapersOwl, there’s also a selection of free essay templates associated with Loneliness.

How it works

• 1 Introduction
• 2 Figures and Statistics
• 3 Impacts of Loneliness
• 6 Interventions
• 7 Conclusion

Introduction

Loneliness is an increasingly prominent issue, especially among older people, and its impact is profound and multifaceted. For this report, I am focusing on the effects of loneliness on older adults, a demographic that is particularly vulnerable to this emotional state. Numerous studies, such as those by Victor (2011), suggest that between 6-13 percent of the older population experience loneliness frequently or continuously. This statistic highlights the global nature of the issue, indicating a growing concern that requires comprehensive exploration and intervention. Need a custom essay on the same topic? Give us your paper requirements, choose a writer and we’ll deliver the highest-quality essay! Order now

My objective is to delve into the various dimensions of loneliness, its causes, and its significant impacts on the lives of older adults, while also exploring potential solutions to mitigate its effects.

Figures and Statistics

The prevalence of loneliness among older adults is alarming, and various studies have highlighted its association with health and well-being. According to Beaumont (2013), 59% of adults over the age of 52 who report poor health feel lonely some of the time or frequently, compared to only 21% who consider themselves in excellent health. This stark contrast suggests that loneliness is not merely an emotional experience but is intricately linked to one's physical health and quality of life. Davidson and Rossall (2014) emphasize that loneliness can lead to a decline in the quality of life, as factors such as poor health, living alone, and a lack of a support network contribute significantly to feelings of isolation.

Impacts of Loneliness

As individuals age, they often experience changes that can lead to diminished social networks. Retirement, the death of loved ones, relocation, and communication barriers can all contribute to a sense of isolation (Havens et al., 2004). The loss of social connections can exacerbate feelings of loneliness, which, in turn, can have dire consequences on health. Some studies suggest that the impact of loneliness on health and mortality is comparable to risk factors such as high blood pressure, obesity, and smoking. Indeed, loneliness is recognized as a significant risk factor for depression (Green et al., 1992), and it is closely linked to suicide and suicide attempts. A study by Hansson et al. (1987) revealed that loneliness correlates with poor psychological adjustment and dissatisfaction with familial and social relationships.

Interventions

Loneliness among older adults is a complex and pressing issue that warrants significant attention. While it can affect individuals at any stage of life, the impact is particularly pronounced among the elderly, leading to a range of health problems and diminished quality of life. Factors such as limited access to resources, social stigma, and weakened social networks contribute to this growing concern. To address loneliness effectively, it is essential to implement targeted interventions that foster social connections and provide support to those in need. By recognizing loneliness as a public health issue and addressing its root causes, we can improve the well-being and quality of life for older adults worldwide.

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The Effects of Chronic Loneliness on the Elderly

How social isolation affects health and longevity in older individuals..

Posted July 24, 2023 | Reviewed by Devon Frye

• Understanding Loneliness
• Take our Social Anxiety Test
• Find a therapist near me
• Loneliness is synonymous with perceived social isolation, not with objective social isolation.
• Loneliness increases morbidity and mortality.
• Loneliness is usually characterized by mental anguish; in reality, it is a whole-body affliction.
• Aging is not an option. Healthy aging is.

According to a recent paper by the National Academies of Sciences, Engineering, and Medicine (NASEM), more than one-third of adults aged 45 and older feel lonely, and nearly one-fourth of adults aged 65 and older are considered to be socially isolated. Among older adults, social isolation has been linked to various adverse physical and psychological effects, including increased risk of dementia and heart disease.

Loneliness is the subjective and distressing feeling of being alone, regardless of the amount of social contact. Social isolation is a lack of social connections.

Social isolation can lead to loneliness in some people, while others can feel lonely without being socially isolated. For as many as 15 to 30 percent of the general population, loneliness is a chronic state.

Social isolation due to COVID or bullying has affected large numbers of youth. On the opposite end of the spectrum, older adults are at increased risk for loneliness and social isolation due to loss, often of their partner, family, or friends.

Many have realistic financial concerns. Others may be unfamiliar with banking, budgeting, investments, taxes, and the like, especially if they recently lost a partner and were not the primary breadwinner.

Lonely people, even when in the company of others, may have difficulties relating because of hearing loss or visual and mobility impairments. All these factors aggravated by chronic illness may force a person to relinquish their home and familiar neighborhood for unfamiliar quarters surrounded by strangers with similar, or even worse difficulties in communicating.

Current Research Findings

Social isolation was associated with about a 50 percent increased risk of dementia in older people. Poor social relationships (characterized by social isolation or loneliness) were associated with a 29 percent increased risk of heart disease and a 32 percent increased risk of stroke.

Social isolation, particularly among vulnerable populations such as low-income, immigrant, and LGBT people, substantially increased the risk for premature death, comparable to other risk factors such as high blood pressure, smoking , or obesity. Loneliness was associated with higher rates of depression , anxiety , and suicide . The high medical comorbidity and mortality associated with loneliness result in accelerated biological aging.

People living on their own tend to prepare meals that are quick and simple, low in nutrition and variety. This is likely to be reflected in lack of diversity in their gut flora. Interestingly, research from the University of California, San Diego, found that loneliness was associated with a lack of diversity in the gut microbiome . It is also likely that loneliness may result in decreased stability of the gut microbiome and, consequently, reduced resistance and resilience to stress -related disruptions, increasing the risk of systemic inflammation.

In the brains of lonely persons, all the channels serving the stress response are in overdrive. A study from Kyushu University in Japan found that older people with few social contacts have a loss of overall brain volume in areas of the brain affected by dementia.

Many lonely people not only feel sad; they also feel scared. Social situations may be perceived as a threat, not an invitation. They worry about falling or getting lost. They worry about spending money even when they are financially secure.

Boosting Social Connections

If you are a friend or family member of a lonely person, you need to keep in mind that well-meaning advice like "join a club," "call a friend," or "make small talk with a stranger" rarely works. If you feel lonely yourself, perhaps the realization that loneliness is highly detrimental to your health and markedly shortens your lifespan will move you to adopt some of the advice that follows.

What is crucial is to make a decision and then stick to it. Thinking about what measures to take can lead to delays and paralysis. Stop ruminating. Start acting.

Here are some tips to help you foster social connections and reduce feelings of loneliness. The more of these you adopt, the faster you will feel whole again.

• Step out of your comfort zone: Meeting new people and engaging in social activities may be intimidating at first, but it's essential to push yourself beyond your comfort zone. Start with small steps, like attending social events or gatherings related to your interests.
• Pursue your passions : Join clubs, groups, or organizations that focus on activities you enjoy. Engaging in hobbies and interests can help you connect with like-minded individuals and provide natural conversation starters.
• Exercising or eating in the company of other people.
• Social media can be a great tool to form connections as long as you use them prudently.
• Join workshops to learn a new skill such as painting, pottery making, or playing bridge.
• In-person shopping or trips to the library, museums, and art galleries get you among people.
• Helping people is one of the most powerful antidotes to loneliness. A great way of accomplishing this is by volunteering. Volunteering has many benefits for the volunteer and the recipient. The satisfaction also multiplies if you volunteer in a field you love.
• Regular doctor’s appointments or visits from a home health nurse are opportunities for face-to-face encounters.
• It is important, to also educate health care workers . They need to understand that addressing loneliness in their patients does not detract from patient care—it is patient care. (As an aside: Healthcare providers often neglect taking care of themselves. Unless we prioritize social connections, how can we do so for others?)
• If, in spite of all your good intentions, you find it challenging to socialize due to anxiety or shyness , seek professional therapy or counselling.

Final Thoughts

Remember that developing social connections is a gradual process, and it's okay to take small steps at your own pace. Be patient with yourself and celebrate the progress you make along the way.

Helpful Resources AARP Area Agencies on Aging Eldercare Locator. National Council on Aging National Institute on Aging (NIA) https://www.canadianseniorsdirectory.ca/senior-service-canada/older-wom… Ontario Society of Senior Citizens Organizations (OCSCO)

Holt-Lunstad, J., & Perissinotto, C. (2023). Social isolation and loneliness as medical issues. New England Journal of Medicine, 388(3), 193-195.

Blázquez-Fernández, C., & Cantarero-Prieto, D. (2023). The associations between suicides, economic conditions

Walter, Alexa E, Sandsmark, Danielle (2023). The Importance of Social Contact on Brain Atrophy among Older Individuals, DOI: https://doi.org/10.1212/WNL.0000000000207720

National Academies of Sciences, Engineering, and Medicine. (2020). Social isolation and loneliness in older adults: Opportunities for the health care system. National Academies Press.

Blázquez-Fernández, C., & Cantarero-Prieto, D. (2023). The associations between suicides, economic conditions and social isolation: Insights from Spain. PLoS one, 18(7), e0288234.

Jeste, D. V., Lee, E. E., & Cacioppo, S. (2020). Battling the modern behavioral epidemic of loneliness: suggestions for research and interventions. JAMA psychiatry, 77(6), 553-554.

Hawkley, L. C., & Cacioppo, J. T. (2010). Loneliness matters: A theoretical and empirical review of consequences and mechanisms. Annals of behavioral medicine, 40(2), 218-227.

Thomas R. Verny, M.D. , the author of eight books, including The Embodied Mind , has taught at Harvard University, University of Toronto, York University, and St. Mary’s University of Minnesota. His podcast, Pushing Boundaries , may be viewed on Youtube or listened to on Spotify and many other platforms.

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Band 9: A lot of old people are suffering from loneliness these days. They also lack physical fitness. What are the reasons for these? Can you think of possible solutions?

In the contemporary era, there has been a notable surge in the number of elderly individuals grappling with feelings of isolation and loneliness. This essay seeks to examine the underlying reasons contributing to this troubling trend and to propose effective solutions aimed at alleviating the plight of the aging population.

One of the principal factors exacerbating loneliness among senior citizens is their declining health. Chronic conditions, particularly neurodegenerative diseases such as Alzheimer’s, necessitate continuous caregiving to prevent potential emergencies, such as wandering or accidental injuries. This situation often imposes significant burdens on family caregivers, particularly offspring whose work commitments become strained. Consequently, some children may adopt a mindset that fosters the notion that allowing their elderly parents to reside independently is preferable for their professional advancement. Moreover, there is a demographic of older adults who consciously opt for solitary living, driven by the desire to avoid being perceived as a burden on their families. This self-imposed isolation can contribute to heightened feelings of loneliness. A pertinent example is observed in Japan, where a substantial number of seniors choose to lead solitary lives, thereby enabling their children to focus on their careers without the added concern of caregiving responsibilities. The intersection of these factors has greatly intensified the prevalence of loneliness among the elderly.

To address this pressing issue, a multi-faceted approach must be adopted. Firstly, it is imperative for governmental bodies to advocate for adjustments in workplace structures, such as reducing workloads and implementing flexible working hours. Such measures would provide family members with the opportunity to dedicate more time to the care of their elderly parents, subsequently diminishing their feelings of isolation. Additionally, the establishment of community centers specifically designed for the elderly can foster social engagement through organized activities such as dance, music, and fitness classes. These initiatives not only promote physical health but also significantly enhance mental well-being by enabling social interactions. A relevant example can be found in Vietnam, where the introduction of communal living spaces has encouraged seniors to participate in health-oriented programs, facilitating connections with peers and combating loneliness.

In conclusion, the rising incidence of loneliness among the elderly can be directly linked to their declining health and the choices they make regarding their living arrangements. Sustainable solutions lie in proactive government measures that prioritize the reduction of caregiver burdens and the development of community support infrastructures.

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Open Access

Peer-reviewed

Research Article

Reducing loneliness and depressive symptoms in older adults during the COVID-19 pandemic: A pre-post evaluation of a psychosocial online intervention

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Writing – original draft

* E-mail: [email protected]

Affiliations Epidemiology of Mental Health Disorders and Ageing Research Group, Sant Joan de Déu Research Institute, Barcelona, Esplugues de Llobregat, Spain, Research, Teaching, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain, Department of Medicine, Universitat de Barcelona, Barcelona, Spain

Roles Investigation, Methodology, Project administration, Supervision, Writing – review & editing

Affiliations Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain, Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain

Roles Conceptualization, Investigation, Methodology, Writing – review & editing

Affiliation Fundació Salut i Envelliment UAB, Universitat Autònoma de Barcelona, Barcelona, Spain

Affiliation Epidemiology of Mental Health Disorders and Ageing Research Group, Sant Joan de Déu Research Institute, Barcelona, Esplugues de Llobregat, Spain

Roles Funding acquisition, Project administration, Supervision, Writing – review & editing

Affiliations Epidemiology of Mental Health Disorders and Ageing Research Group, Sant Joan de Déu Research Institute, Barcelona, Esplugues de Llobregat, Spain, Research, Teaching, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain

Roles Conceptualization, Formal analysis, Investigation, Methodology, Project administration, Supervision, Writing – review & editing

• Aina Gabarrell-Pascuet, 
• Laura Coll-Planas, 
• Sergi Blancafort Alias, 
• Regina Martínez Pascual, 
• Josep Maria Haro, 
• Joan Domènech-Abella

• Published: December 13, 2024
• https://doi.org/10.1371/journal.pone.0311883
• Reader Comments

Loneliness is related to worse mental health, particularly in people with poor social support. The COVID-19 pandemic altered our lives and ways of social interaction, especially among vulnerable populations such as older adults.

We designed a group-based psychosocial online intervention for older adults (≥ 65 years) facilitated by gerontologists addressing loneliness consisting of: (i) sharing experiences and promoting peer support to overcome feelings of loneliness and (ii) increasing the chances of establishing successful social relationships. This was a feasibility non-controlled prospective pilot study carried out during the COVID-19 pandemic with a pre-post evaluation. Interviews before and after the intervention assessed loneliness (emotional and social), social support, depressive and anxiety symptoms, quality of life, and perceived health. Groups of 6–8 participants and 2 facilitators met once a week for 8 weeks through videoconferencing. The intervention effectiveness was assessed with multilevel models for repeated measures.

The study sample (N = 27) was mainly composed of females (74%) and the mean age was 74.26 years. 21 participants completed the intervention (22% drop-out rate). Statistically significant ( p <0.01) decreases in emotional loneliness and depressive symptoms were observed following the intervention. Qualitatively, participants positively evaluated the intervention and found in the group a space for personal growth where they could meet new people and express themselves with confidence and security.

Conclusions

Interventions overcoming social distancing restrictions through online tools and targeting vulnerable population sectors (e.g., older adults) can become essential to lessen the collateral consequences of the COVID-19 pandemic on social behaviour and mental health.

Citation: Gabarrell-Pascuet A, Coll-Planas L, Alias SB, Pascual RM, Haro JM, Domènech-Abella J (2024) Reducing loneliness and depressive symptoms in older adults during the COVID-19 pandemic: A pre-post evaluation of a psychosocial online intervention. PLoS ONE 19(12): e0311883. https://doi.org/10.1371/journal.pone.0311883

Editor: Hatime Kamilcelebi, Kırklareli University: Kirklareli Universitesi, TÜRKIYE

Received: May 10, 2024; Accepted: September 26, 2024; Published: December 13, 2024

Copyright: © 2024 Gabarrell-Pascuet et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Following what was approved by the Ethics Comitee, data from the BLOC project are available for use for specific research questions, provided that an agreement is made up. Research proposals should be sent to the "Impact and prevention of mental disorders" Research Group ( https://www.irsjd.org/en/research/35/impact-and-prevention-of-mental-disorders ), through the following institutional email: [email protected] . Files with data published in this publication are freely available for replication purposes and can be obtained using the same analysis proposal form. The "Impact and prevention of mental disorders" Research Group will review all requests for data to ensure that proposals do not violate privacy regulations and are in keeping with informed consent that is provided by all participants.

Funding: This study was supported by “Fundació CMJ Godó”. Aina Gabarrell‐Pascuet's work is supported by the Secretariat of Universities and Research of the Generalitat de Catalunya and the European Social Fund (2023 FI-3 00187). Joan Domènech‐Abella has a “Juan de la Cierva” research contract awarded by the Spanish Ministry of Science and Innovation (MCIU: FJC2019‐038955‐I). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

List of abbreviations: COVID-19, Coronavirus Disease 2019; MDD, major depressive disorder; BLOC, Breaking Loneliness, Opening Community; OSSS, Oslo Social Support Scale; PHQ, Patient Health Questionnaire Depression; GAD, Generalized Anxiety Disorder Scale; EQ-5D-5L, health-related quality of life questionnaire; T1, assessment before the intervention; T2, assessment after the intervention

Introduction

Loneliness is a feeling experienced when the quantity and quality of our social relationships do not meet our expectations [ 1 ]. It is a subjective feeling that does not necessarily relate to the number of people surrounding us. According to Weiss [ 2 ], loneliness can be considered a multifaceted construct comprised of a social and an emotional dimension. Social loneliness emerges from the absence of an available and satisfying social network that can provide a sense of belonging and is connected to social factors such as having close friendships, companionship, and the size of one’s social network. Emotional loneliness refers to the absence of one or more attachment figures with whom one could establish a close connection, and the desired level of intimacy or confidence is not achieved.

Being lonely has been associated with all-cause mortality [ 3 ], higher rates of morbidity, worse physical health [ 4 ], a faster rate of cognitive decline [ 5 ], and impaired functional status and quality of life [ 6 ]. Loneliness is related to increases in anxiety and depressive symptomatology (and their comorbidities), particularly in people with poor social support [ 7 , 8 ]. In recent years, we have witnessed an increasing prevalence of loneliness, with nearly a third of individuals in developed countries experiencing its impact [ 9 ]. According to a recent meta-analysis including data from 2000 to 2019, loneliness prevalence in Europe ranges from 5.3% in young adults to 11.9% in older adults [ 10 ].

A previous longitudinal study with a 7-year follow-up performed by our research team, identified social support and loneliness as potential targets in people with major depressive disorder (MDD). We reported that lower social support predicted higher subsequent levels of loneliness, which in turn predicted higher probabilities of MDD in a sample of older adults (50 years or older) with MDD at baseline [ 11 ]. Moreover, having a small social network has a negative impact on depression in lonely people [ 12 ], so increasing social support by creating opportunities for successful social interactions may reduce depressive symptomatology [ 13 , 14 ].

The effect of socially disruptive measures on social relationships in the context of the COVID-19 pandemic increased feelings of loneliness [ 15 , 16 ] and the prevalence of mental health problems among older adults [ 17 , 18 ]. In addition, aging can be accompanied by events that can limit social participation, such as the loss of people from our social environment, retirement, and health problems. This vital transition implies a personal and social adaptation of the individual to a new social role or personal situation, being a stressful moment that can lead to non-desired loneliness [ 19 ].

The highly prevalent late-life loneliness [ 20 ], accompanied by its adverse health effects, calls for a heightened focus on the development of effective interventions to address this escalating public health issue. It is important that interventions offer new social opportunities while also prompting a shift in how individuals approach and perceive social relationships on a broader scale. Moreover, such interventions must be adapted to the social restrictions needed to contain the spread of COVID-19 pandemic, which highlighted the need to explore remote delivery methods. The adaptation of these interventions is not only relevant in the pandemic context but can also be employed in future similar situations or for individuals unable to physically travel to the intervention site (e.g., due to distance or mobility issues). Additionally, online interactions enable better reconciliation with daily activities and can also help facilitate initial contacts for individuals who have difficulties establishing social relationships, especially in face-to-face settings.

Considering the different targets we can address to reduce loneliness, there are mainly four types of interventions. We can target the community or social support level by (1) enhancing social skills, (2) providing social support, or (3) increasing opportunities for social interaction. Additionally, interventions can target the individual or psychological level by (4) addressing maladaptative social cognition (e.g., cognitive behavioural therapy to identify and reframe negative perceptions and thoughts of loneliness) [ 21 ]. Cohen-Mansfield & Perach [ 22 ] concluded in their review that combining multiple approaches seems to be the most promising strategy to reduce loneliness.

The most effective tools to deliver interventions targeting social support and aimed at alleviating loneliness are group-based interventions with educational inputs or support activities for specific groups of older people and with the presence of facilitators who encourage the participation of participants in decision-making [ 23 – 25 ]. However, the studies that applied it used heterogeneous health measures, obtaining both positive and negative results [ 26 , 27 ]. Thus, the health effects of loneliness interventions are promising but inconclusive to date.

Likewise, systematic reviews on interventions to reduce loneliness that include online interventions [ 28 , 29 ] suggest that new technologies can be considered a promising tool, but although most interventions report some effectiveness in reducing social isolation and loneliness, the quality of the evidence is generally weak. According to a recent scoping review of reviews [ 30 ], it is crucial to acknowledge that there is no universal approach to addressing loneliness and, as a result, interventions should be tailored to meet the unique needs of each participant. In this regard, modular interventions offer greater flexibility to adapt to the specific needs of each participant.

In the pandemic context, studies based on previous research and using a rigorous methodology were needed, so we designed a psychosocial online intervention following the assumption that interventions addressing loneliness to improve mental health should follow a modular structure and have a dual focus: (i) sharing experiences and promoting peer support to overcome feelings of loneliness and (ii) increasing the chances of establishing successful social relationships.

The design of the intervention took into account previous programs with similar aims that showed promising results in psychosocial well-being (including mental health, social support, and loneliness), such as the "Circle of Friends" [ 31 , 32 ], conducted in Finland, and in the Spanish context "Paths: from loneliness to participation" [ 27 , 33 ] and "Feeling good" [ 34 ]. These programs were conducted through face-to-face group sessions. In the present project, its main components were adapted to an online format.

Therefore, we aim to assess the feasibility of an online psychosocial group-based pilot intervention named “Breaking Loneliness, Opening Community” (BLOC). The intervention followed a pre-post evaluation design aimed at testing the following hypotheses: 1) the intervention has a positive effect on participants’ feelings of loneliness, and 2) it contributes to improving social support, symptoms of depression and anxiety, quality of life, and self-reported health of the participants.

Study design and setting

We conducted a non-controlled prospective pilot study with a pre-post evaluation. The study was performed from October 2021 to January 2022 in Barcelona (Spain), during the COVID-19 pandemic. During the study, face masks were mandatory, more than 95% of the older population had all their scheduled vaccines, and the entrance to restaurants or other indoor public spaces was limited to vaccinated people [ 35 ].

The intervention’s feasibility was based on the impact of the intervention on the participants’ well-being and the acceptability of the intervention by the participants in order to determine if the intervention was suitable for implementation on a larger scale or in different contexts. Therefore, to assess the impact of the BLOC project on the well-being of older individuals, changes in feelings of loneliness (including emotional and social loneliness), social support, anxiety and depressive symptoms, self-perceived health, and health-related quality of life were evaluated through telephone interviews before and after the intervention. The telephone interviews were conducted by two members of the research team, who had previously received training in administering item-based questionnaires. Intervention acceptability was assessed based on participants’ attendance and on a feedback survey.

Ethics approval and consent to participate

This study was conducted in accordance with the ethical standards set forth in the Helsinki Declaration (1983). The protocol received Fundació Sant Joan de Déu (Barcelona, Spain) Research Ethics Committee approval (PIC-128-21). Individuals were included in the study only after giving their written informed consent.

Participants

The research team contacted various primary care health centres and centres for the elderly in Barcelona to disseminate the study through informative posters, pamphlets, and calls. All the contacted centres were geographically close to encourage participants to stay in touch beyond the intervention. The dissemination material to attract participants called for people who wanted to connect more and better with others. Among the calls made from primary care centres and community centres, the attendees at senior centre presentations, and those who saw the advertisements, approximately 500 individuals with the appropriate profile were given the option to participate in the study. Out of these, 63 expressed interest and were screened starting in October 2021. The research team performed telephone screenings based on the inclusion/exclusion criteria for interested participants and those included in the study signed the informed consent form (n = 27) (see S1 Fig ).

The inclusion criteria were as follows: (i) being ≥ 65 years, (ii) expressing the need to connect more and better with other people, (iii) wishing to participate, and (iv) having internet and computer/smartphone access. The exclusion criteria were: (i) being blind or deaf, and (ii) reporting cognitive impairment.

Intervention

Participants were divided into groups of 6–8 participants and 2 facilitators. The facilitators of the intervention were all gerontologists with experience in psychosocial interventions with older adults. In each intervention, one facilitator was a psychologist, while the other was either a medical doctor or a sociologist. Groups met once a week for 8 weeks through the ‘Zoom’ videoconferencing online platform. Each session lasted between 90 and 120 minutes. The distribution between groups was based on participants’ schedule availability. Technological assistance by telephone and WhatsApp was provided to those participants who needed support to participate in the intervention.

Sessions were divided into two parts, each facilitated by one of the facilitators: (1) community approach to loneliness (i.e., activities to improve the relationship with others, learning about neighbourhood activities, and looking for socially significant activities); and (2) individual approach to loneliness through peer support (i.e., activities based on cognitive-behavioural techniques, enhancement of positive coping strategies, sharing experiences oriented towards the sense of purpose in life, and use of reminiscence for the recognition of coping resources used throughout the life cycle). At the end of all sessions, facilitators proposed activities to participants to be done amid sessions, which were linked to the next sessions’ topic. The last sessions dedicated some time to give continuity to the group once the intervention was over ( Fig 1 and S1 Table ). The modular structure of the intervention allowed group facilitators to adapt the different sessions to the group needs and to the individuals who comprised it.

• PPT PowerPoint slide
• PNG larger image
• TIFF original image

https://doi.org/10.1371/journal.pone.0311883.g001

Instruments

Outcome measures were assessed before and after the intervention through an interview, while sociodemographic data (i.e., age, gender, partner status, and educational attainment) were just asked before.

The primary outcome measure was loneliness, assessed through the 11-item De Jong Gierveld Loneliness Scale, obtaining a global score of 0–11, where higher scores indicate higher levels of loneliness [ 36 ]. This scale contains the social and emotional subscales. Responses in each subscale are summed to produce a score from 0 to 5 for social loneliness, and from 0 to 6 for emotional loneliness [ 37 ].

Secondary outcomes were social support, depressive and anxiety symptoms, quality of life, and health status. Social support was measured using the Oslo Social Support Scale (OSSS-3), which ranges from 3 to 14, with higher values representing stronger social support [ 38 ]. Depressive symptoms were measured on a scale of 3 to 24 using the 8-item Patient Health Questionnaire Depression Scale (PHQ-8) [ 39 ]. Anxiety symptoms were evaluated using the Generalized Anxiety Disorder Scale (GAD-7) [ 40 ], a 7-item measure with a total score ranging from 0 to 21. In both scales, higher values represent greater emotional disorder symptoms. We used the health-related quality of life questionnaire (EQ-5D-5L) [ 41 , 42 ], which has two sections. First, the EQ-5D descriptive system was used to measure quality of life in terms of 5 dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Second, the EQ visual analogue scale (EQ VAS) was used to evaluate one’s general health, ranging from 0 (i.e., the worst health you can imagine) to 100 (i.e., the best health you can imagine).

Finally, at the end of the study, during the post-evaluation quantitative interview, we included an additional open qualitative question. Participants were invited to provide any comments or feedback regarding the project with the prompt: "Please feel free to leave any comments or feedback about the project". This approach enabled participants to assess their satisfaction with the study and offer valuable insights.

Data analysis

Sample size calculation..

Based on a previous study [ 27 ] with a similar sociodemographic profile and outcome measurements, accepting an alpha risk of 0.05, a beta risk below 0.20 in a two-tailed test, assuming a standard deviation of 2.33, and considering a drop-out rate of 25%, using ANOVA, a minimum of 20 subjects were needed to detect a significant difference greater than or equal to 1.7 units in loneliness between pre- and post-measurements.

Statistical analyses.

The characteristics of the study sample before (T1) and after (T2) the intervention were assessed using frequencies and proportions for categorical variables and medians and standard deviations for continuous variables. Differences between T1 and T2 were evaluated by applying the χ2-test for categorical data, and the Student’s t-test for continuous variables. Effect sizes (Cohen’s d ) were calculated for the outcome variables based on the guidelines proposed by Cohen (1988) [ 43 ]: small effect size (d = 0.2), medium effect size (d = 0.5), and large effect size (d = 0.8). Cronbach’s alpha values were calculated to assesses the internal consistency of the main measurement tools (see S2 Table ).

Mixed-effects linear regression models for repeated measures were constructed to study changes in the outcome measures (social and emotional loneliness, social support, depressive and anxiety symptoms, quality of life, and perceived health) between T1 and T2. Two-level random intercept models (“mixed” command in Stata) were fitted through maximum likelihood. The models used time point (T1 or T2) as a within-participant repeated factor and participant ID as a random factor. We assessed unconditional models to justify the use of hierarchical linear modelling (HLM) or mixed-effects regression. These models were constructed without any predictors to effectively partition the data into level 2 units. The results consistently showed significant random effects for the ID variable, which supports the adoption of mixed-effects models. By employing these approaches, we can properly accommodate the data’s multilevel structure and address temporal dependencies, thereby enhancing the robustness of our estimates regarding the effects of independent variables on the outcomes.

As statistically significant differences were found in the proportions of males and females between T1 and T2, the models were adjusted for sex. From these models, estimated means for the outcome variables were calculated through the margins command in Stata 13 [ 44 ]. All reported p-values were based on a two-sided test, where the level of statistical significance was set at p<0.05.

Stata version SE 13 [ 45 ] was used to analyse the data.

The study sample (N = 27) was mainly composed of females (74%) and the mean age was 74.26 years (66–88 years) ( Table 1 ). Most participants had achieved a secondary education level (48%) and were married or in a relationship (33%). Significantly more women dropped out at post-intervention ( p <0.05), while no significant differences were observed in the remaining sociodemographic variables. The means of the outcome variables improved from T1 to T2: quality of life, perceived health, and social support increased, while loneliness, and depressive and anxiety symptoms decreased. In the case of depressive symptoms and emotional loneliness, this improvement was statistically significant ( p <0.05) with medium to large effect sizes ( Table 1 ).

https://doi.org/10.1371/journal.pone.0311883.t001

The estimated means presented in Table 2 show statistically significant decreases in depressive symptoms and emotional loneliness ( p <0.01). Emotional loneliness decreased by 0.84 points on a scale of 0 to 6, and depressive symptoms decreased by 2.30 points on a scale of 0 to 24.

https://doi.org/10.1371/journal.pone.0311883.t002

Most of the participants used their own computer (59.3%) or their mobile phone (29.6%) to carry out the sessions. The link to the Zoom session was mainly sent by e-mail (66.7%) or WhatsApp (29.6%). The drop-out rate was 22%. The post-intervention interview was done to the 21 participants who had at least completed one session (81% assistance to ≥5 sessions).

Qualitatively, participants positively evaluated the intervention and found in the group a space for personal growth, where they could meet new people and express themselves with confidence and security. Most participants gave their group peers their phone number to keep in touch and some even met face-to-face to do social activities.

The ‘Breaking Loneliness, Opening Community’ (BLOC) pilot intervention aimed to promote the participants’ development of coping strategies to cope with feelings of loneliness while reflecting on the social meaning of loneliness in late life and, conversely, to increase social support by being a group-based intervention. Our study sample, on average, presented moderate levels of loneliness and mild depressive symptoms at baseline, which agrees with previous literature reporting their frequent co-occurrence [ 46 – 48 ]. Following the intervention, participants exhibited a decrease in loneliness, notably showing a substantial reduction in emotional loneliness ( p <0.01). Furthermore, the statistically significant ( p <0.01) decrease in participants’ depressive symptoms highlights the importance of an intervention that can reduce depressive symptomatology, especially given the increase in the prevalence of depression during the COVID-19 pandemic [ 49 ], which already placed a substantial burden prior to the pandemic.

The intervention had a high assistance rate for the majority of the sessions and a low drop-out rate, indicators that, together with the positive qualitative evaluation of the participants, reflect the acceptability and participants’ motivation to participate in the intervention. Females were more prone to participate in the study, which aligns with previous studies that have reported that among older adults, the digital gender gap has been compensated in recent years, and now females use more internet for social contact [ 50 , 51 ].

However, contrary to what we expected, we did not obtain significant changes in the outcomes related to social relationships in an objective sense (i.e., increase in social support or a reduction in social loneliness). In the present study, to recruit participants, a call was made to those individuals who “wanted to connect more and better with others”, reflecting a desire to improve their social support at that time. Almost 60% of the sample reported loneliness, having a 44% of the sample moderate loneliness (de Jong score between 3–8) and 15% severe loneliness (de Jong: 9–11), reflecting a need to enhance their social relationships and highlighting a deficiency in either the individual or community dimensions of social interactions. Nevertheless, most participants (67%) had a moderate level of social support (OSSS-3: 9–11). This could suggest that participants likely have access to social support, and that difficulties in connection might more commonly stem from the qualitative or individual aspects of their social relationships. Our sample scored higher in the dimension of emotional loneliness compared to social loneliness at baseline, which aligns with previous studies showing a peak in emotional loneliness in older adulthood, while social loneliness is more stable across adulthood and drops at later stages of life [ 52 , 53 ]. The significant decrease in emotional loneliness after the intervention could be due to the participants finding a confidence and intimate environment in the intervention group, where they gave each other support and understanding when sharing their thoughts and feelings. In this way, even though perhaps their social network was already satisfactory, they did not have the necessary closeness and emotional support that the group provided them.

The content of the intervention relied on the idea that we need to address the new needs derived from the pandemic and, at the same time, attend to pre-existing unmet mental health needs from before the pandemic. A significant reduction in depressive symptomatology was identified after the intervention, with the study sample going from having mild depressive symptoms before the intervention to minimal symptomatology afterward. Therefore, interventions providing peer support groups to combat loneliness and, at the same time, increasing the likelihood of establishing satisfying social relationships might help to reduce the burden of depression among older adults and reduce the significant economic costs associated with it [ 54 ].

Strengths and limitations

The results of this study should be interpreted considering some limitations. First, the absence of a control group limits the possibility of attributing the results to the intervention. Second, the small sample size limits the statistical significance of our results. This was a pilot study with a pre-post design and with a short follow-up; therefore, the results should be treated as preliminary. A future study in a clinical trial format and a longer follow-up could allow its verification. Moreover, it is crucial to consider that the clinical or practical significance of these reductions may be limited by factors such as the specific characteristics of the study population. Future studies should explore interventions targeted at more specific inclusion criteria, which could offer insights into tailored approaches for achieving more substantial and meaningful outcomes in reducing loneliness and depression. Third, although technological assistance was available for those participants who needed it, this type of intervention may exclude individuals who do not feel confident in handling technologies and who do not have access to them. Finally, our data are based on self‐reported questionnaires, so reporting or recall bias could be present. Nevertheless, in our study, the recall periods were short and well-defined, which should minimize recall bias. In addition, acceptable internal consistency was found for the measures reported in our sample (see S2 Table ), suggesting reliable measurements.

Interventions overcoming social distancing restrictions through online tools and targeting vulnerable population sectors (e.g., older adults) can become essential to lessen the collateral consequences of the COVID-19 pandemic on social behaviour and mental health. The present pilot study tested a promising online psychology tool to reduce emotional loneliness and depressive symptoms, with a high rate of assistance to most of the sessions and a low drop-out rate. A future randomized controlled trial is needed to explore the impact of the present intervention on a larger sample of older adults.

Supporting information

S1 fig. consort diagram..

https://doi.org/10.1371/journal.pone.0311883.s001

S1 Table. Contents of each session of the intervention.

https://doi.org/10.1371/journal.pone.0311883.s002

S2 Table. Cronbach’s alpha for the main measurements.

Cronbach’s alpha (0–1) assesses the internal consistency of the measurement tools, with higher values indicating a higher agreement between items. A value of alpha between 0.70 and 0.95 is considered acceptable.

https://doi.org/10.1371/journal.pone.0311883.s003

Acknowledgments

The authors would like to express special gratitude to all the participants for their generous contribution, which made this study possible.

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Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System

• PMID: 32510896
• Bookshelf ID: NBK557974
• DOI: 10.17226/25663

Social isolation and loneliness are serious yet underappreciated public health risks that affect a significant portion of the older adult population. Approximately one-quarter of community-dwelling Americans aged 65 and older are considered to be socially isolated, and a significant proportion of adults in the United States report feeling lonely. People who are 50 years of age or older are more likely to experience many of the risk factors that can cause or exacerbate social isolation or loneliness, such as living alone, the loss of family or friends, chronic illness, and sensory impairments. Over a life course, social isolation and loneliness may be episodic or chronic, depending upon an individual's circumstances and perceptions. A substantial body of evidence demonstrates that social isolation presents a major risk for premature mortality, comparable to other risk factors such as high blood pressure, smoking, or obesity. As older adults are particularly high-volume and high-frequency users of the health care system, there is an opportunity for health care professionals to identify, prevent, and mitigate the adverse health impacts of social isolation and loneliness in older adults. Social Isolation and Loneliness in Older Adults summarizes the evidence base and explores how social isolation and loneliness affect health and quality of life in adults aged 50 and older, particularly among low income, underserved, and vulnerable populations. This report makes recommendations specifically for clinical settings of health care to identify those who suffer the resultant negative health impacts of social isolation and loneliness and target interventions to improve their social conditions. Social Isolation and Loneliness in Older Adults considers clinical tools and methodologies, better education and training for the health care workforce, and dissemination and implementation that will be important for translating research into practice, especially as the evidence base for effective interventions continues to flourish.

Copyright 2020 by the National Academy of Sciences. All rights reserved.

• The National Academies of SCIENCES • ENGINEERING • MEDICINE
• COMMITTEE ON THE HEALTH AND MEDICAL DIMENSIONS OF SOCIAL ISOLATION AND LONELINESS IN OLDER ADULTS
• Acknowledgments
• 1. Introduction
• 2. Evaluating the Evidence for the Impacts of Social Isolation, Loneliness, and Other Aspects of Social Connection on Mortality
• 3. Health Impacts of Social Isolation and Loneliness on Morbidity and Quality of Life
• 4. Risk and Protective Factors for Social Isolation and Loneliness
• 5. Mediators and Moderators
• 6. Assessment of Social Isolation and Loneliness in Research
• 7. Role of the Health Care System
• 8. Education and Training
• 9. Interventions
• 10. Dissemination and Implementation
• A. Public Meeting Agendas
• B. Committee and Staff Biographies

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Loneliness and Isolation in Long-term Care and the COVID-19 Pandemic

Joyce simard , msw, ladislav volicer , md, phd.

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Address correspondence to Ladislav Volicer, MD, PhD, 2337 Dekan Lane, Land O Lakes, FL 34639. [email protected]

Issue date 2020 Jul.

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Social isolation (the objective state of having few social relationships or infrequent social contact with others) and loneliness (a subjective feeling of being isolated) are serious yet underappreciated public health risks that affect a significant portion of the adult population. Social isolation is a risk factor for development of loneliness, but some persons enjoy it (eg, hermits). Conversely, having social relationships does not ensure that loneliness will not develop, because the social relationship has to be meaningful. Many people feel lonely under the best of circumstances. Approximately one-quarter (24%) of community-dwelling Americans aged 65 and older are considered to be socially isolated, and a significant proportion of adults in the United States report feeling lonely (35% of adults aged 45 and older and 43% of adults aged 60 and older). 1

Loneliness is even more common in long-term care institutions. The prevalence of severe loneliness among older people living in care homes is at least double that of community-dwelling populations: 22% to 42% for the resident population compared with 10% for the community population. 2 One study found that more than half of nursing home residents without cognitive impairment reported feeling lonely. 3 A study in Malaysian nursing homes using the UCLA loneliness scale found that all residents felt lonely: 25% moderately and 75% severely. 4 Unfulfilled need for meaningful relationships and losing their self-determination because of institutionalization play crucial roles in feelings of loneliness. 5 Several books provide information about activities that may decrease loneliness. 6 , 7 , 8 Interventions that were found to successfully decrease loneliness are laughter therapy, horticultural therapy, and reminiscence therapy. 9 However, some activities may not be feasible during the COVID-19 pandemic.

Feeling of loneliness has many deleterious consequences. They include increased risk of depression, alcoholism, suicidal thoughts, aggressive behaviors, anxiety, and impulsivity. 1 Some studies found that loneliness is also risk factor for cognitive decline and progression of Alzheimer's disease, recurrent stroke, obesity, elevated blood pressure, and mortality. 10 Lonely older people may be burdened by more symptoms before death and may be exposed to more intense end-of-life care compared with nonlonely people. 11

Loneliness has 3 dimensions. The first is personal loneliness, which is often related to the absence of a significant person like a spouse or partner who provides emotional support and is someone who affirms one's value as a person. The significant someone could be a pet, because pet ownership decreases loneliness. 12 The second dimension of loneliness is absence of a sympathy group, which can include 15 to 50 people who are seen regularly. This may be a card group, bridge or canasta, or another popular game, Bingo, which many retired seniors enjoy. The third dimension is a lack of an active network group, consisting of from 150 to 1500 people, who provide support just by being together in a group. Church services, rotary meetings, and the Lions Club are good examples of these larger groups.

In all countries affected by COVID-19, the message that is being sent by government officials and medical experts is “stay at home” and “isolate in place.” The isolation is especially difficult for people living in nursing homes and assisted living communities. Most facilities have asked that no one enter the facilities unless they work there because there is a high risk that COVID-19 would spread rapidly once it is introduced. Group activities have been canceled and, in many facilities, residents are eating in their rooms, as all communal dining has been stopped. Although prohibiting group activities will decrease the risk of spreading the COVID-19 infection in nursing homes, it significantly increases the isolation and resulting loneliness of residents. 13

Long-term care facilities also prohibit visits from outside, including visits by family members. This is especially burdensome for residents with cognitive impairment and dementia. Many family members of these residents visit often, sometimes every day, bring food, and help the residents with eating and drinking. 14 If they cannot visit, they may be afraid that the resident will no longer recognize them.

The following ideas are easy to implement, with little or no cost or hiring additional staff, and can decrease the loneliness of residents in nursing homes or assisted living communities:

Name tags. Ask residents and staff if they would wear a plain name tag, white with black Times New Roman lettering. The font should be at least one-half inch high. The name tag will have the name the person wants to be called on it. Our name tags would have Dr. Volicer or Joyce on them. The staff will also need to wear their “official” facility name tag, but they are very difficult for an older person with some vision impairment to read. Wearing a name tag that can easily be read helps to make a connection between the staff and residents.

Ask family members of residents who could operate a personal computer or iPad to purchase one to help them stay connected with each other. Some libraries have inexpensive laptops for sale and may have a few to give away. When the resident has a computer or iPad in his or her room, a Skype or Zoom meeting can be arranged. These meetings can be coordinated with the activity staff, so they can help set up the computer or iPad. iN2L technology may facilitate online 15 connections

Families may not be allowed to come into the facility; however, they can stay connected in several ways. Ask families to have at least 1 family member call a resident in the morning to say, “good morning,” and another to call late in the afternoon or early evening to say, “good night.” This is assuming that residents have a phone in their rooms and can answer it. If you have residents with no active family members, you may be able to recruit volunteers to call residents.

Families can come to the window in the resident's room and sing to the resident or hold signs sending love to the resident. If the resident's room is not on the ground floor, the family can arrange a time convenient for the staff to take the resident to the first floor where the resident can look out a window and see his or her family.

Urge families to send cards and letters. Residents also love to receive “art work” from their grandchildren or great grandchildren. Letters can include copies of pictures from the past that residents may enjoy seeing again.

Group religious services have been discontinued; however, many are now on the Internet or television. The activity staff will have a social history of each resident and will know the resident's religion. If it would be comforting for the resident, staff can make sure the mass or other religious service is on the resident's television or iPad.

Some residents with dementia are comforted with realistic toy dogs, cats, or life-like–looking dolls. If a resident develops a fondness for any of them, the family might agree to purchase one. It seems that men particularly like dogs. They can be purchased on amazon.com and are less than $20. Stuffed animals or dolls cannot be shared because of infection-control issues. There is also some evidence that robotic animals (robopets) may be effective in decreasing loneliness of older adults in a residential care setting. 16

Simulated Presence Therapy is another way by which families can keep in touch with a resident. It involves the family member making a recording in which questions are asked, such as, “I remember when you lived in Concord, New Hampshire, do you remember what you did with your Girl Scout troop?” Then the recording is silent, so the resident can say something. The recording could be similar to a phone call, in which the family member can ask about pleasant experiences in the past and leave a space for the resident's answers. If the resident has dementia, the recording could be played repeatedly, because the resident will forget that she or he already listened to it. A study found that Simulated Presence Therapy enhanced well-being of residents with dementia and decreased behavioral symptoms of dementia. 17

The Activity Department might be encouraged to have items that can be sorted, like buttons or small pieces of fabric. Residents can be asked to help sort items and put them into small bowls. The resident sorting buttons must be a person who would not try to eat one, as this would be quite dangerous. Take 3 packs of cards and mix them up and ask a resident to sort them. Make sure the packs are very distinctive, so it will be easy to decide what pack each card belongs in and thank the resident when the task is completed. Nursing home residents often feel hopeless, as rarely does anyone thank them for doing something. This is a great opportunity to have a resident feel as if he or she is needed.

Conclusions

Preventing loneliness in institutionalized persons is at least as important as helping them with personal hygiene. This is especially important during the COVID-19 pandemic when residents must be protected from contact with other individuals to reduce the risk of infection. Implementation of some of the strategies listed in this article requires education of staff members and supply of required items; however, this effort can significantly improve the quality of life of residents affected by pandemic restrictions.

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