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.

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

Older individuals are at increased risk of a severe and lethal course of COVID-19. They have typically been advised to practice particularly restrictive social distancing (‘cocooning’), which has sparked much debate on the consequences for their mental wellbeing. We aimed to provide evidence by conducting a representative survey among the German old population during COVID-19 lockdown. A computer-assisted standardized telephone interview was conducted in a randomly selected and representative sample of the German old age population (n = 1005; age ≥ 65 years) during the first lockdown in April 2020. Assessments included sociodemographic factors, aspects of the personal life situation during lockdown, attitudes towards COVID-19, and standardized screening measures on depression, anxiety, somatization, overall psychological distress (Brief Symptom Inventory/BSI-18) and loneliness (UCLA 3-item loneliness scale). Sampling-weighted descriptive statistics and multiple multivariable regression analyses were conducted. Participants were M = 75.5 (SD = 7.1) years old; 56.3% were women. At data collection, COVID-19 lockdown had been in force for M = 28.0 (SD = 4.8) days. Overall, older individuals were worried about COVID-19, but supportive of the lockdown. Mean BSI-18 scores were 1.4 for depression, 1.6 for anxiety and 2.2 for somatization as well as 5.1 for global psychological distress. These figures did not indicate worse mental wellbeing, given normative values established by studies before the pandemic (2.0, 1.6, 2.4, 6.0, respectively). The prevalence of loneliness was 13.1%, which also fell within a range of estimates reported by studies before the pandemic. There were only few significant associations of aspects of the personal life situation during lockdown and attitudes towards COVID-19 with mental wellbeing. Resilience explained a large amount of variance. In the short-term, the mental wellbeing of the German old age population was largely unaltered during COVID-19 lockdown, suggesting resilience against the challenging pandemic situation. Our results refute common ageist stereotypes of “the weak and vulnerable older adults” that were present during the pandemic. Long-term observations are needed to provide robust evidence.

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Mental wellbeing in the German old age population largely unaltered during COVID-19 lockdown: results of a representative survey.

The extension of the life span has led to an increase in the number of older people and an increase in the prevalence of disability in people over 60 years of age. The aim of this study was to assess the prevalence of ADL and IADL disability and to analyze its determinants among people aged 60 and older living in southeastern Poland. This cross-sectional study was carried out among a randomly selected, representative population of people aged 60 and older living in southeastern Poland. Disability was assessed using the Katz Index of Independence in Basic Activities of Daily Living and Instrumental Activities of Daily Living. Logistic regression models were used to identify the factors related to ADLs and IADLs. For the variables that were included in the above models, their clustered influence on the increase in the odds ratio for the occurrence of an ADL or IADL limitation was also examined. The research results show that 35.75% of the participants reported at least one problem with IADLs. At least one problem with ADLs was reported by 17.13% of the participants. The most significant modifiable factors influencing the occurrence of disability were the presence of barriers in the participant’s environment, poor relations with relatives, a lack of social contacts, multimorbidity and pain. A multiple increase in the odds ratio of disability was found with the presence of pairs of analyzed factors. The highest odds ratio of at least one ADL limitation was observed for the combination of barriers in the participant’s environment with multimorbidity (OR 74.07). With regard to IADL disability, the highest odds ratio was observed for the combination of pain on the VAS scale ≥3 points with older age (OR 19.47). The study showed a high prevalence of ADL and IADL disability in older people living in southeastern Poland. It also indicated the extent to which modifiable factors influenced the occurrence of disability and the extent to which the risk of disability increased with the presence of pairs of factors, especially those that included environmental barriers in the participant’s environment.

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Determinants of ADL and IADL disability in older adults in southeastern Poland

Effects of social isolation, loneliness and frailty on health outcomes and their possible mediators and moderators in community-dwelling older adults: A scoping review.

Previous research has suggested that individuals are mostly prone to loneliness in their later years of life because of exposure to several risk factors typical of old age. The current study aims to examine possible demographic, health and social determinants of loneliness among older adults in Europe. Data on a nationally representative sample of 5074 Europeans aged ≥ 65 years were drawn from the first wave of the Survey of Health, Aging and Retirement in Europe (SHARE, 2004/2005). Frequency of feelings of loneliness was examined according to adverse health conditions, stressful life events and social isolation indicators. Female gender, older age, lower socioeconomic status, living unpartnered, being childless and having no activity involvement were significantly associated with frequent feelings of loneliness (p < 0.001). The proportion of the respondents who declared enduring loneliness most of the time compared with none of the time was significantly higher among Southern Europeans relative to their Northern counterparts (p < 0.001). Recent departure of offspring from the parental nest was a significant predictor of loneliness in both the second (ORs = 2.08; 95% CI 1.24–3.48) and the third (ORs = 1.75; 95% CI 1.03–2.96) multiple regression models. In this sample of older Europeans, several demographic characteristics, specific adverse health conditions, stressful life events and social isolation indicators were associated with feelings of loneliness. Policy initiatives for the alleviation of loneliness in older age should therefore aim at improving psychosocial and health-related difficulties faced by this population.

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Loneliness among older European adults: results from the survey of health, aging and retirement in Europe

Increasing evidence suggests that different patterns of activity participation confer several positive well-being outcomes through the later years of life. The aim of the present study is to examine the likelihood of higher well-being linked with a socially engaged lifestyle with a view to extending prior research. Data on a nationally representative sample of adults aged 65 and older from eleven European countries (n = 7025) was drawn from the first Wave of the Survey of Health, Aging and Retirement in Europe (SHARE, 2004/5). Socially and productively oriented activities were administered as salient aspects of activity participation and were rated on frequency of involvement. Well-being was defined by the clustering of six indicators including life satisfaction, quality of life, self-rated health, psychological distress, chronic diseases and Body Mass Index (BMI). The effect of activity participation on the clustering of well-being indicators was estimated according to complex samples ordinal regression models. The overall pattern was that of a significantly increased likelihood for frequently active participants to present multiple presence of positive well-being outcomes (p < 0.05). This held true not only at the individual level but also across most SHARE countries. Although the findings of the current analysis cannot identify the direction of causality of the observed effects, they still lend some support to the reasonable conjecture that old-age activity engagement matters for individuals’ wellbeing and testify to the suggestion that public health and social care interventions should consider the respective potential well-being gains and therefore foster the facilitation of activities and attachments.

Activity Participation and Well-Being Among European Adults Aged 65 years and Older

Introduction Noncommunicable diseases are the leading cause of illness and death worldwide; behavioral risk factors (BRFs) contribute to these diseases. We assessed the presence of multiple BRFs among European adults according to their physical and mental health status. Methods We used data from 26,026 adults aged 50 years or older from 11 countries that participated in the Survey of Health, Ageing and Retirement in Europe (2004-2005). BRFs (overweight or obesity, smoking, physical inactivity, and risky alcohol consumption) were assessed according to physical health (ie, presence of chronic diseases, disease symptoms, or limitations in activities of daily living) and mental health (depression) through multiple regression estimations. Results Overweight or obesity in men and physical inactivity in women were the most prevalent BRFs. Compared with physically active adults, physically inactive adults had a higher mean number of chronic diseases (1.33 vs 1.26) and chronic disease symptoms (1.55 vs 1.47). Risky alcohol consumption (≥4 servings of an alcohol beverage ≥3 times a week) was associated with a higher mean depression score (2.84 vs 2.47). Compared with adults with 0 or 1 BRF, adults with 2 or more BRFs had significantly higher odds of having 1 or more chronic diseases (men: 1.52; women: 1.73) and functional limitations (men: 1.65; women: 1.79) and higher prevalence of high blood pressure (37.8% vs 28.2). Belgian adults with BRFs had the highest mean number of chronic diseases or functional limitations among those who were overweight or obese and the highest mean number of chronic diseases and disease symptoms among those who smoked and were physically inactive. Conclusion We found revealed significant positive associations between BRFs and poor health among middle-aged and older European adults. Primary health care intervention programs should focus on developing ways to reduce BRF prevalence in this population.

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Association of Behavioral Risk Factors for Chronic Diseases With Physical and Mental Health in European Adults Aged 50 Years or Older, 2004–2005

Are religiosity and prayer use related with multiple behavioural risk factors for chronic diseases in European adults aged 50+ years?

The current study aims to examine the utilization of preventive health services in relation to social isolation among older Europeans adults. Data on 5,129 adults 65 years of age and older was obtained from the first wave of the Survey of Health, Ageing and Retirement in Europe (SHARE, 2004/05). Prevalence of social isolation indicators (living arrangements, marital status, number of children, contact with children, proximity to children, activity participation, social exchange) was assessed in relation to preventive health services utilization, which was ascertained by a 12-item composite score (PHSUs). Estimations were based on the complex study design. Diverse facets of social isolation were differently associated to preventive care. Significantly lower mean PHSUs were found for adults living unpartnered, who were unmarried, had no children and were socially disengaged. A similar pattern was thus drawn regarding the clustering of social isolation indicators (4+). Considerable variations were detected across SHARE countries in the distribution of PHSUs among socially isolated adults. Socially isolated individuals were found to receive fewer preventive services. This finding confers important evidence on the potential factors that affect the use of preventive health services among older adults. It is also suggestive of the need to develop public health and social policies with the aim to alleviate social isolation and as a means to enhance preventive care uptake in later life.

Maria Vozikaki

Papers

Loneliness among older European adults: results from the survey of health, aging and retirement in Europe

Activity Participation and Well-Being Among European Adults Aged 65 years and Older

Association of Behavioral Risk Factors for Chronic Diseases With Physical and Mental Health in European Adults Aged 50 Years or Older, 2004–2005

Are religiosity and prayer use related with multiple behavioural risk factors for chronic diseases in European adults aged 50+ years?

Preventive health services utilization in relation to social isolation in older adults