Social Isolation In Older Adults Research Articles

The effect of sociodemographic characteristics and polypharmacy on loneliness and social isolation in community-dwelling older adults

The aim of this study was to assess the impact of sociodemographic factors and polypharmacy on loneliness and social isolation in older adults. This cross-sectional study included 370 older adults with and without polypharmacy. The data were gathered via the Personal Information Form, Loneliness Scale for Elderly, and Lubben Social Network Scale-Revised. A multivariate ANOVA (MANOVA) was conducted to assess the impact of independent variables on the combined dependent variables. Loneliness and social isolation were found higher in older adults with polypharmacy. In addition, loneliness and social isolation are more common in women, individuals with low educational attainment, single individuals, individuals with low income, individuals living in rural areas, individuals with poor family relationships, individuals not living with their families and individuals with chronic diseases. It is thought that the findings of this study will be guiding for all health professionals working in the field of elderly health in interventions to be planned for the elderly population.

Loneliness and Social Isolation in Older Adults in Latvia and Iceland During COVID-19

Abstract Background The COVID-19 pandemic has significantly impacted the mental health and wellbeing of older populations across Europe, exacerbating feelings of loneliness and social isolation, known risk factors for poor physical and mental health outcomes. This study aims to understand the extent and implications of these changes in Latvia and Iceland, providing essential insights for targeted public health interventions. Methods This comparative study utilized data from two key sources: the Survey of Health, Ageing, and Retirement in Europe (SHARE) for Latvia and the HL20 study for Iceland, focusing on individuals aged 67 and above. Both quantitative surveys were conducted during the pandemic, offering data on health status, loneliness, and social isolation. A novel approach was applied in analyzing older populations to standardize comparisons between the two distinct datasets. This methodological innovation is part of a bilateral EEA initiative FM2021/23 aimed at strengthening research collaboration between Latvia and Iceland. Descriptive statistics and the Pearson Chi-square test were used to compare outcomes between the two countries and within demographic subgroups. Results The study revealed stark differences between the two countries: 80% of Latvian older adults reported social isolation compared to 42.7% in Iceland. Similarly, 45% of Latvians experienced loneliness versus 30% of Icelanders. Significant associations were found between social isolation, loneliness, and deteriorating mental and physical health, with worse outcomes noted in socially isolated individuals. Conclusions Our findings demonstrate a clear link between social isolation and adverse health outcomes among the older adults, exacerbated by the COVID-19 pandemic. The study supports the need for proactive public health measures in Latvia and Iceland, including the development of community engagement programs and mental health support services tailored to the needs of older adults. Key messages • Study shows significant health impact of social isolation among older adults in Latvia and Iceland, highlighting urgent need for targeted public health interventions. • Effective public health strategies and innovative digital outreach can mitigate adverse effects of loneliness and isolation observed in older populations.

Relationship between objectively measured conversation time and social behavior in community-dwelling older adults.

Social isolation is a significant public health concern in aging societies. The association between conversation time and social behavior remains unclear. This study examines whether objective conversation time is associated with social activity frequency in older adults. This prospective cohort study enrolled 855 older adults (538 women; mean age, 73.8 years) aged 65 and older, who were followed from 2015 to 2019. All participants wore a wristband sensor to measure conversation time for at least 9 days and an average of 31.3 days per year. Social behaviors were assessed through interviews, and the frequency of engagement in community activities, outings, lessons, or classes and contact frequency were assessed using a self-report questionnaire. The association between conversation time and social behavior was evaluated using multi-linear regression analysis. Conversation time was significantly associated with the frequency of engagement in community activities and lessons or classes after adjusting for several covariates (β = 0.181, 95% confidence interval: 0.107-0.254, p < 0.001; β = 0.11, 95% confidence interval: 0.04-0.179, p = 0.002). Objectively measured conversation time using a wearable sensor is associated with social behavior and may be a valuable parameter for social isolation in older adults.

“Zoom pals:” a pilot evaluation of a virtual service-learning program to address social isolation in long-term care residents living with dementia

ABSTRACT A mixed-methods, embedded case study design was used to triangulate the effects of a virtual service-learning paradigm, “Zoom Pals,” on participants and community partners including Communicative Disorders students, adults with dementia, and long-term care facility (LTCF) staff. Zoom Pals was designed to provide an experiential learning opportunity for students while addressing social isolation for older adults during the COVID-19 pandemic. A convenience sample of 18 adults with dementia residing in an LTCF, eight student volunteers, and three LTCF staff members participated. Results of this exploratory study showed active engagement and consistent communication across sessions for older adults, although individuals with mild dementia were more responsive than those in moderate stages. Themes from resident interviews included positive emotions, a sense of novelty, and decreased loneliness. Students endorsed significantly increased communication skills and comfort and a trend toward improved dementia knowledge. Students’ post-experience surveys emphasized learning communication strategies, making a difference, empathy, reciprocal benefits, and realizing the complexity of a dementia diagnosis. This pilot study demonstrates the feasibility of delivering remote service learning and social interventions for adults with dementia and provides a useful road map for others interested in increasing their reach by adapting in-person group behavioral interventions for remote delivery.

Neighborhood social cohesion and physical disorder in relation to social isolation in older adults: racial and ethnic differences

BackgroundNeighborhood factors of social isolation have been understudied, hindering efforts to reduce social isolation at the neighborhood level. This study aims to investigate the longitudinal effects of neighborhood social cohesion and physical disorder on social isolation in community-dwelling older adults, as well as to examine whether race/ethnicity moderates the neighborhood-isolation relationship.MethodsWe used 11-year data from the National Health and Aging Trend Study, a longitudinal national study of Medicare beneficiaries aged 65 and older. Social isolation was measured through a summary score across four domains: marital/partner status, family and friend contact, religious attendance, and club participation. A series of weighted mixed-effects logistic regression models were performed to test the study aims. Sample sizes ranged from 7,303 to 7,291 across individual domains of social isolation.ResultsApproximately 20% of participants reported social isolation. Findings indicated a negative association between neighborhood social cohesion and social isolation. Higher levels of neighborhood social cohesion were longitudinally associated with lower odds of social isolation (odds ratio [OR] = 0.52, 95% CI: 0.47–0.58). Yet, the presence of neighborhood physical disorder was associated with an increased risk of overall social isolation ([OR] = 1.2, 95% CI: 1.00, 1.44). Race/ethnicity significantly moderated the effects of neighborhood social cohesion and physical disorder on social isolation. The odds of no in-person visits associated with neighborhood social cohesion are smaller among Black adults compared to White adults. Black adults had constantly lower odds of isolation from religious attendance compared to White adults regardless of the level of neighborhood social cohesion. Hispanic adults had decreased odds of having no friends associated with signs of physical disorder, while no associations were found among older White adults. White adults had higher odds of isolation from in-person visits when living in neighborhoods with signs of physical disorder, whereas no association was observed among older Black and Hispanic adults.ConclusionsThis study elucidates the role of neighborhood characteristics in shaping social isolation dynamics among older adults. Furthermore, the observed moderation effects of race/ethnicity suggest the need for culturally sensitive interventions tailored to address social isolation within specific neighborhood and racial contexts.

Comparison of the Effects of Mobile Learning and Traditional Self-care Education on Loneliness and Social Isolation in Community-dwelling Older Adults: Study Protocol of a Three-Arm Randomized Controlled Trial

Introduction: Loneliness and social isolation are common problems in older adults, which has negative effects on health. Increasing self-care ability seems to help. Therefore, the present study will be conducted with the aim of comparing the effects of mobile learning and traditional self-care education on loneliness and social isolation in community-dwelling older adults. Methods: This three-arm randomized controlled trial will be conducted in Tehran-Iran 2024. The qualified older adults from health centers in Tehran city will be consecutively selected and randomly allocated into three groups: mobile learning (n = 40), traditional education (n = 40), and control (n = 40). The loneliness inventory for older adults, Lubben social network scale, and demographic characteristics will be used to collect information, and completed before, immediately, and 12 weeks after the intervention. The data will be analyzed using descriptive and inferential statistics by SPSS software version 16 at a significance level of p &lt; 0.05. Conclusion: This clinical trial will determine the most successful and cost-effective approach in reducing loneliness and social isolation in older adults. The results are expected to improve the self-care skills of the older adults, thereby reducing the negative consequences of loneliness and social isolation, including various health issues and mortality rates, in the long run.

Impact of an intergenerational program to improve loneliness and social isolation in older adults initiated at the time of emergency department discharge: study protocol for a three-arm randomized clinical trial

BackgroundSocial isolation and loneliness (SIL) worsens mortality and other outcomes among older adults as much as smoking. We previously tested the impact of the HOW R U? intervention using peer support from similar-aged volunteers and demonstrated reduced SIL among older adults discharged from the emergency department (ED). Generativity, defined as “the interest in establishing and guiding the next generation,” can provide an alternative theoretical basis for reducing SIL via intergenerational programs between members of younger and older generations. The current protocol will examine the impact of younger intergenerational volunteers providing the HOW RU? intervention.MethodsIn this randomized clinical trial, we will compare the following three arms: (1) the standard same-generation peer support HOW R U? intervention, (2) HOW R U? intervention delivered by intergenerational volunteers, and (3) a common wait-list control group. Outcome assessors will be blinded to the intervention. Trained volunteers will deliver 12 weekly telephone support calls. We will recruit participants ≥ 70 years of age with baseline loneliness (six-item De Jong loneliness score of 2 or greater) from two EDs. Research staff will assess SIL, depression, quality of life, functional status, generativity, and perceived benefit at baseline, at 12 weeks, and 24 weeks post-intervention.DiscussionWe hypothesize participants receiving the intergenerational intervention will show improved outcomes compared to the control group and peer support HOW R U? intervention. We also hypothesize that participants with higher perceptions of generativity will have greater reductions in SIL than their lower generativity counterparts. Aging is experienced diversely, and social interventions combatting associated SIL should reflect that diversity. As part of a program of research following the Obesity-Related Behavioral Intervention Trials (ORBIT) model, the findings of this RCT will be used to define which intervention characteristics are most effective in reducing SIL.Trial registrationClinicalTrials.gov NCT05998343 Protocol ID:21-0074E. Registered on 24 July 2023.

Addressing loneliness and social isolation through the involvement of primary and secondary informal caregivers in nursing homes: a scoping review

ObjectivesTo clarify the mechanisms of interventions addressing loneliness and social isolation in older adults living in nursing homes through the involvement of primary and secondary informal caregivers.MethodsThis scoping review was performed by two independent reviewers, covering the period between 2011 and 2022 and the databases MEDLINE, CINAHL, PsycINFO and Scopus. It included terms related to (A) informal caregivers, (B) nursing homes, (C) psychosocial interventions, (D) involvement and (E) social isolation or loneliness.ResultsThirty-three studies met the inclusion criteria. Although there were various definitions and assessment tools related to social isolation and loneliness, the studies referred to three dimensions of these concepts in nursing home residents: the quantity of social interactions, the perception of these encounters and biographical changes in social relationships. Most studies did not explicate the mechanisms of these interventions. The review uncovered the following aspects of intervention mechanisms: increasing opportunities for social contact, creating meaningful encounters, maintaining existing relationships with primary informal caregivers and establishing new ones with secondary informal caregivers.ConclusionStudies reporting on interventions addressing loneliness and social isolation in nursing home residents need to clarify and detail their intervention mechanisms in order to foster more targeted interventions. In addition, there is a need for further research on large-scale programs or care philosophies in this field and the development of intervention designs, which allow for tailored intervention formats in order to respond to the individual perception of social relationships.

The Grip Strength Loss Rate and the Subsequent Cognitive Decline Rate in Older Adults: The Moderating Role of Social Isolation.

Accumulating evidence suggests that low grip strength (GS) is associated with a faster cognitive decline, but most previous studies have measured GS at a single time point, ignoring changes in GS. We aimed to explore the association of the GS loss rate with the sequent cognitive decline, as well as the moderating role of social isolation in older adults. Data were from the English Longitudinal Study of Ageing. Absolute and relative GS loss rates were calculated as the annual losses from Wave 2 (2004-05) to Wave 4 (2008-09). Participants were divided into 3 groups according to the tertiles of GS loss rates. Linear mixed models were used to assess the association of the GS loss rate during Waves 2-4 with the cognitive decline rate during Waves 4-9 (Wave 9,2018-19). Of the 4356 participants included in analyses, 1938 (44.5%) were men, with a mean age of 68.4 (SD: 8.4) years. Compared with Tertile 1 of the absolute GS loss rate, Tertile 2 (β = -0.009 [95% CI: -0.018 to -0.001] SD/year) and Tertile 3 (β = -0.018 [95% CI: -0.027 to -0.010] SD/year) were associated with a faster cognitive decline rate. The results of relative GS were similar to those of absolute GS. Social isolation was a significant modifier in the associations of the absolute GS loss rate with decline rates in global cognition and episodic memory, but not in temporal orientation. We did not observe that social isolation moderated the association of the relative GS loss rate with the cognitive decline rate. Both absolute and relative GS loss rates were positively associated with the cognitive decline rate in older adults. Low social isolation scores attenuated the association of the absolute GS loss rate with the cognitive decline rate.

Feasibility of a Telephone-Delivered Group Meditation Intervention for Chronically Ill Socially Isolated Older Adults

ABSTRACT Objectives This pilot study assessed the feasibility of a group-based telephone-delivered meditation intervention to reduce social isolation in older adults. It included weekly training sessions and daily practices of loving-kindness meditation in small groups via telephone conferences for six weeks and an extended group meditation practice for another six weeks. Methods Community-living older adults (age 60+) with multiple chronic conditions and experiencing social isolation were recruited. Each participant was assessed at the pretest, posttest, and follow-up (6 and 12 weeks after pretest). Outcome measures included social interaction, loneliness, and depressive symptoms. Open-ended questions were asked in the posttest and follow-up. Results Sixteen individuals enrolled, and fourteen completed the program (87.5% retention). Completers showed high levels of adherence (95% attendance to training) and acceptability and a statistically significant increase in social interaction at follow-up. Qualitative data suggest that participants experienced changes in emotion regulation, motivation and confidence, and sense of belonging. Conclusions A group-based telephone-delivered meditation intervention targeting chronically ill older adults who experience social isolation is technically feasible, very acceptable, and potentially beneficial to them. Clinical Implications Older adults enjoy learning meditation. Telephone conferencing is a low-cost tool for engaging socially isolated older adults in social interactions and group meditation.

Chronic loneliness and chronic social isolation among older adults: a study protocol for a systematic review, meta-analysis and meta-regression

IntroductionThere are around 20 studies identifying the prevalence of chronic loneliness and chronic social isolation in older adults. However, there is an absence of a systematic review, meta-analysis and meta-regression...

Comparing Social Isolation in Older Adults With and Without Physical Health Challenges During COVID-19: Church and Church Friends Matter.

Older adults were disproportionately affected by COVID-19. The purpose of this study was to explore experiences of sudden-onset social isolation and factors that influenced it among social isolation in two groups of older adults. A qualitative thematic study with a survey component was conducted comparing 18 older adults in two groups: 12 reporting physical health challenges and 6 reporting no physical health challenges. Three qualitative themes describe experiences of (a) avoiding risk to personal health as the reason to postpone healthcare, (b) grieving church and church friends as a lost social connection, and (c) compound stress due to converging factors related to personal health, public health, racial justice movement and critical national events. Those with physical health challenges were less able to postpone seeking healthcare, suffered from compound stress, and were more likely to feel isolated when unable to participate in church activities. Religious, faith, or spiritual supports may be important buffers against social isolation during public health emergencies, especially for older adults with physical health challenges and when there is concurrent social unrest.

Examining the Effect of Contactless Intergenerational Befriending Intervention on Social Isolation Among Older Adults and Students' Attitude Toward Companionship: Content Analysis.

Intergenerational friendship, a mechanism of social support, is an effective intervention to reduce the increasing risk of social isolation (SI) and develop companionship in the older adult population. The COVID-19 pandemic provided a unique opportunity to examine the psychosocial intervention of befriending via technology use as a primary form of contactless socialization. The study aims to explore the effectiveness of the befriending intervention through a contactless, intergenerational service-learning project on older adult emotions, especially boredom and loneliness as the key attributes of SI, and on students' attitude toward companionship. During the months of January to April 2022 , undergraduate students enrolled in a health administration course with a special focus on culture were asked to be involved in a contactless, intergenerational service-learning project (n=46). In this study, contactless intervention meant communication using the telephone and apps such as FaceTime and Zoom. Students were paired with older adults to have at least a 30-minute weekly conversation, for 8 weeks, via telephone or an internet-based app such as FaceTime. Students were asked to write a half-page diary after each interaction and a 1-page reflection at the end of the fourth week and at the end of the service-learning project. At the completion of the project, the researchers also surveyed the older adults to assess the impact of the project using a 5-item open-ended questionnaire. Following a heuristic approach and content analysis, student artifacts (110,970 words; 118-page, single-spaced Microsoft Word document) and the older adult surveys were analyzed using MAXQDA, (VERBI GmbH). Qualitative data were extracted to assess the impact of service learning on SI by measuring the attributes of boredom and loneliness among 46 older adults. Students' attitudes toward companionship were also assessed using data from their diaries and reflections. Overall, three major constructs were identified: (1) meaningful engagement, defined as feeling safe, having increased confidence, and having reduced boredom; (2) internal motivation to participate in the weekly interaction, defined as discussion about daily life experience, level of happiness, and ability to exert personal control over the situation; and (3) intergenerational befriending, defined as perceived benefits from the friendly nature of the interaction, ability to comfortably connect with students, and positive feeling and attitude toward the student. The contactless, intergenerational befriending intervention reduced boredom and loneliness among older adults and enhanced positive attitude and confidence among university students. Students helped older adults to develop digital skills for the use of apps and social media. Older adults showed interest in the intervention and shared their daily life experiences with the students, which helped to reduce the gap between generations. Findings indicate the effectiveness of an intergenerational service-learning intervention on SI reduction and increased positive attitude among college students.

Racial and ethnic differences in predictors of participation in an intergenerational social connectedness intervention for older adults

BackgroundSocial connectedness is a key determinant of health and interventions have been developed to prevent social isolation in older adults. However, these interventions have historically had a low participation rate amongst minority populations. Given the sustained isolation caused by the COVID-19 pandemic, it is even more important to understand what factors are associated with an individual’s decision to participate in a social intervention. To achieve this, we used machine learning techniques to model the racial and ethnic differences in participation in social connectedness interventions.MethodsData were obtained from a social connectedness intervention that paired college students with Houston-area community-dwelling older adults (> 65 yo) enrolled in Medicare Advantage plans. Eligible participants were contacted telephonically and asked to complete the 3-item UCLA Loneliness Scale. We used the following machine-learning methods to identify significant predictors of participation in the program: k-nearest neighbors, logistic regression, decision tree, gradient-boosted decision tree, and random forest.ResultsThe gradient-boosted decision tree models yielded the best parameters for all race/ethnicity groups (96.1% test accuracy, 0.739 AUROC). Among non-Hispanic White older adults, key features of the predictive model included Functional Comorbidity Index (FCI) score, Medicare prescription risk score, Medicare risk score, and depression and anxiety indicators within the FCI. Among non-Hispanic Black older adults, key features included disability, Medicare prescription risk score, FCI and Medicare risk scores. Among Hispanic older adults, key features included depression, FCI and Medicare risk scores.ConclusionsThese findings offer a substantial opportunity for the design of interventions that maximize engagement among minority groups at greater risk for adverse health outcomes.

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

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. 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. 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. 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.

LONGITUDINAL CHANGES IN WELL-BEING ASSOCIATED WITH AGING ATTITUDE, COGNITIVE STATUS, AND WIDOWHOOD TRANSITION

Abstract This symposium brings together four studies that employ national data collected from older Americans to examine longitudinal changes in older adults’ cognitive, social, and psychological health. The first study focuses on the role of self-perception of aging in memory decline and social mechanisms linking aging perception and memory. It found that negative perceptions of aging predicted memory decline 8 years later and that loneliness and social isolation were pathways. The second study is concerned with neuropsychological changes before the onset of dementia. Using latent growth modeling, it found that the trajectory of depression increased over time in a quadratic fashion before the onset of incident dementia. Further, there were racial/ethnic group differences in levels of depression. Using fixed-effect linear regression, the third study reports that changes in cognitive status were associated with changes in social isolation in older adults. Specifically, it found that transitioning from cognitive intact to cognitive impairment status was associated with increased social isolation. The fourth and final paper examines changes in psychological well-being related to the transition to widowhood. It found that during the year right after the spouse died, older adults experienced increased depressive symptoms and reduced positive well-being. But adaptation is evident—the surviving spouse returned to pre-loss levels of psychological well-being around two years after the death. Together, the four studies show that attitude, cognitive status, and life course transition shape the dynamics of cognitive, social, and psychological health in later life.

DID COVID-19 CHANGE REPORTS OF LONELINESS AND SOCIAL ISOLATION AMONG OLDER AMERICANS ACT CLIENTS?

Abstract COVID-19 raised immediate concern about the exacerbation of already high levels of loneliness and social isolation of older adults. Using the cross-sectional 2019 and 2021 National Survey of Older Americans Act Participants, we explored changes among selected populations of OAA clients – family caregivers (CGs), home-delivered meal clients (HDMs), and congregate meal clients (CMs). Descriptive statistics, t-tests, and review of 95% confidence intervals between years were conducted to understand rates of loneliness (UCLA 3-items) and social isolation (1-item). Results were not statistically significant but yield important findings. First, there were more cases of loneliness (48-70%) and social isolation (31-50%) than was known for the general older adult population before COVID-19. Second, the changes between 2019 and 2021 varied by service and gender. Among CGs, there was little difference in the cases of social isolation and loneliness from 2019 to 2021; however, male CGs reported a 20.3% increase in cases of social isolation. For HDMs there was a little difference over time in cases of social isolation and loneliness. There was a 23.3% increase in the number of CMs reporting social isolation and a small increase (9.3%) in CMs reporting loneliness; however, there was an 18.4% increase in cases of loneliness among male CMs. These results warrant further investigation to understand whether OAA services are a protective factor for social connections and further implementation of innovative approaches to lower overall rates of social isolation and loneliness among OAA clients.

ADVANCING POSITIVE SOCIAL CONNECTIONS FOR OLDER ADULTS IN SUBSIDIZED HOUSING: A HUMAN-CENTERED DESIGN APPROACH

Abstract Social isolation is a complex problem that impacts many community-dwelling older adults and has detrimental impacts on mental and physical wellbeing of older adults. This research aims to utilize Human-Centered Design (HCD) to develop and implement tools and design ideas that advance positive social connections of older adults residing in subsidized housing. HCD is a collaborative process used to understand and define social problems, identify opportunities, generate ideas, and design interventions to support positive change. We sought to capture the perspectives and insights from older adults living in two federally subsidized housing communities in Baltimore, Maryland. During a five-month period, we held listening and brainstorming sessions with over 50 residents, service coordinators and members of management. Valuable insights and ideas were recorded during each of these facilitated engagements and synthesized. Through our engagements we identified six themes that influence the social connections of older adults living in subsidized housing: feelings of exclusion, lack of community connections, burdensome transitions to communal living, changes to building policies, and concerns about the physical environment. These themes led to the creation of interventions such as providing physical materials to residents, facilitating cultural inclusion and connections, implementing effective engagement strategies for community coordinators and promoting resident leadership. HCD can be employed to develop tools and innovative opportunities that specifically target and address social isolation in older adults living in subsidized housing. HCD can be utilized to drive changes to policies that impact older adults in subsidized housing leading to social transformations to improve health.

FUNCTIONAL LIMITATIONS, LIVING ARRANGEMENT, DAILY SOCIAL CONTACTS, AND LONELINESS IN LATE LIFE

Abstract Older adults with functional limitations are at a greater risk of social isolation and loneliness, largely due to difficulties in mobility and compromised social contacts. Lack of social contact throughout the day may contribute to loneliness among older adults with functional limitations, and these associations may differ by living arrangements. This study examined associations between functional limitations, living alone, daily social contacts, and loneliness throughout the day. Community-dwelling older adults aged 65 + (N = 310, Mage = 73.96) from the Daily Experiences and Well-being Study completed a measure of functional limitations in a baseline interview. Then, in ecological momentary assessments (EMA), they reported social contacts and loneliness every 3 hours for 5 to 6 days. Multilevel models revealed a significant interaction between functional limitations and social contacts on loneliness, such that people with higher levels of functional limitations felt less lonely if they had more social contacts in the prior 3 hours, but not for those with lower levels of functional limitations. The three-way interaction between functional limitations, living alone, and loneliness revealed that more social contacts were associated with reduced loneliness only among individuals with functional limitations and who lived with others. Individuals with functional limitations who lived alone had higher levels of loneliness than those with functional limitations who lived with others. The findings emphasize the vulnerability in social isolation of older adults with functional limitations, especially those who live alone. Yet this vulnerable group may also benefit more from adequate daily social contacts.

Friendly visiting by a volunteer for reducing loneliness or social isolation in older adults: A systematic review.

Loneliness and social isolation are currently among the most challenging social issues. Given their detrimental impact on physical and mental health, identifying feasible and sustainable interventions to alleviate them is highly important. Friendly visiting, a befriending intervention whereby older persons are matched with someone who visits them on a regular basis, seems promising. However, it is unclear if face-to-face (F2F) friendly visiting by a volunteer (FVV) is effective at reducing loneliness or social isolation, or both. To assess the effect of F2F FVV on feelings of loneliness, social isolation (primary outcomes) and wellbeing (i.e., life satisfaction, depressive symptom experiencing and mental health; secondary outcomes) in older adults. We searched six electronic databases up until 11 August 2021. We also consulted 15 other resources, including grey literature sources and websites of organizations devoted to loneliness and ageing, between 25 October and 29 November 2021. We included experimental and observational studies that quantitatively measured the effect of F2F FVV, compared to no friendly visiting, on at least one of following outcomes in older adults (≥60 years of age): loneliness, social isolation or wellbeing. Two reviewers independently performed study selection, data extraction and synthesis, risk of bias and GRADE assessment. If outcomes were measured multiple times, we extracted data for one short-term (≤1 month after the intervention had ended), one intermediate-term (>1 and ≤6 months), and one long-term time point (>6 months). Data from randomized controlled trials (RCTs) and non-RCTs were presented and synthesized separately. Synthesis was done using vote counting based on the direction of effect. Nine RCTs and four non-RCTs, conducted primarily in the United States and involving a total of 470 older adults (mean or median ages: 72-83 years), were included. All studies were limited in size (20-88 participants each). Programmes lasted 6-12 weeks and mostly involved weekly visits by undergraduate students to community-dwelling older adults. Visits consisted mainly of casual conversation, but sometimes involved gameplaying and TV-watching. All studies had major shortcomings in design and execution. The current evidence about the effect of F2F FVV on loneliness in older adults is very uncertain, both in the short (one RCT in 88, and one non-RCT in 35 participants) and intermediate term (one RCT in 86 participants) (both very low-certainty evidence). The same goes for the effects on social isolation, again both in the short (one RCT in 88, and two non-RCTs in 46 participants) and intermediate term (two non-RCTs in 99 participants) (both very low-certainty evidence). Similarly, there is a lot of uncertainty about the effect of F2F FVV on outcomes related to wellbeing (all very low-certainty evidence). Due to the very low-certainty evidence, we are unsure about the effectiveness of F2F FVV with regard to improving loneliness, social isolation, or wellbeing in older adults. Decision-makers considering implementing FVV should take into account this uncertainty. More and larger high-quality studies that are better designed and executed, and preferably conducted in various settings, are needed.