Loneliness in the Elderly During the COVID-19 Pandemic: A Literature Review in Preparation for a Future Study

Abstract

<h3>Introduction</h3> Loneliness, defined as "the subjective feeling of isolation, not belonging, or lacking companionship" has been found to have increasing prevalence in the United States. Elderly populations have a unique susceptibility to loneliness since aging is associated with many losses that can both provoke and amplify such feelings. Loneliness has been found to have detrimental effects on physical and mental health in the elderly, including increased rates of depression, cognitive impairment, and mortality. The COVID-19 pandemic has been associated with several factors that may contribute to feelings of isolation and loneliness. These include quarantine, social distancing, family and other significant relationship disruptions, interruption of regular vocation and avocational roles, illness, and death with associated grief. On the other hand, reports have also emerged about how older people have demonstrated greater resilience during the pandemic, with a sense of enhanced community emerging. As such, examining the pandemic's impact on loneliness in the elderly, especially in those older people with psychiatric illness, may illuminate new strategies to improve quality of life and clinical symptomatology. <h3>Methods</h3> PubMed searches were completed using the terms "loneliness," "COVID-19," and "elderly" up until December 6 2020. Media reports about loneliness during the COVID-19 pandemic were reviewed for any references to studies. Published, peer-reviewed studies were selected based upon their examination and measurement of loneliness prior to and during the COVID-19 pandemic in populations aged 65 and older. Additional eligible studies were obtained through reviewing the references of selected studies. <h3>Results</h3> Nine published studies were found that measured levels of loneliness in older adults at both any time point before the COVID-19 pandemic and during the COVID-19 pandemic. All studies examined a general older adult population without cognitive impairment. Loneliness was typically measured using the UCLA Loneliness Scale or the DeJong Gierveld Loneliness Scale. The majority of studies (seven out of nine) found increased levels of loneliness during the pandemic compared to after the pandemic. However, two of these studies found the increases to only be slight, although still significant. Two studies found the levels of loneliness pre-pandemic to remain stable during the pandemic. <h3>Conclusions</h3> Thus far, limited studies have looked at changes in loneliness in older adults during the COVID-19 pandemic. The results are mixed, although a majority of studies have found loneliness levels increase. The COVID-19 pandemic has led to associated stay-at-home orders, decreased in-person socialization, and increased death and loss, especially in older adults. All of these factors have the potential to exacerbate loneliness. On the other hand, some media reports have suggested that collective interest in and focus on the pandemic have been associated with a higher frequency of social interactions and greater engagement in current events. Hence, despite COVID-related isolation, quarantine and social distancing, a paradoxical enhanced sense of community may emerge for some that is not dissimilar to observed phenomena during other recent crises, leading to static levels of loneliness seen in two of the selected studies. As loneliness has many negative consequences for older adults it should continue to be studied within the context of COVID-19. Further research is needed to assess changes in loneliness during the pandemic and its aftermath within the subgroup of older, depressed adults living in the community as the relationship between loneliness and depression is well-established. This review has provided key background information for such a future study. <h3>Funding</h3> Not Applicable