Loneliness in old age

A Lonely Life by Hugh Cameron depicting an old Highland woman returning to her cottage at the end of the day, seemingly having no one to welcome her on her return.

Loneliness in old age is the subjective feeling of being isolated or disconnected at an old age. It may be caused due to various social, physical and psychological factors. While loneliness can affect all human beings, older people are more exposed to risks resulting from life changes such as retirement, widowhood and health declines.

Loneliness is especially associated with various demographics, health and social factors, including widowhood, chronic illness, social isolation and limited socio-economic resources. Older adults, particularly those over the age of 80, are at increased risk of loneliness, which is exacerbated by the loss of close relationships and physical impairments. Gender differences also play a significant role, with women generally reporting higher levels of loneliness, influenced by factors such as widowhood, caregiving roles and socialization patterns.

Older adults can take proactive steps to alleviate loneliness and foster social connections. Simple actions such as building intergenerational friendships, practicing gratitude and engaging in regular social activities can improve emotional well-being. Furthermore, numerous interventions have been developed to specifically target loneliness and social isolation, including psychological therapies, animal-assisted interventions and social support programs. These strategies aim to enhance social interactions, improve mental health and promote a sense of belonging, thereby improving the overall quality of life for older adults.

Prevalence

Loneliness follows a U-shaped distribution across the life course, peaking in adolescence and late adulthood while being less common in middle adulthood. ^[1] Unlike the transient nature of loneliness during younger ages—often associated with life transitions like entering adulthood or starting a career—loneliness in older adulthood tends to persist. It is often driven by life circumstances such as the loss of loved ones, residence in assisted living or nursing homes, financial hardships, and lower socioeconomic status, all of which can reduce opportunities for meaningful social connections. ^[2] Additionally, risk factors such as chronic illness, limited mobility, and economic constraints become more prevalent with age, further exacerbating loneliness. ^[3]

In some countries and regions, including China, Europe, Latin America and the United States, up to one-third of older adults experience loneliness. ^[4] Meta-analyses of studies in high-income countries estimate that 25.9% of older adults experience moderate loneliness, while 7.9% experience severe loneliness. ^[5]

Certain groups in the United States, including immigrants and individuals identifying as gay, lesbian, bisexual, or transgender, are considered at higher risk for loneliness in later life. Older immigrants, particularly those who are first-generation, face unique challenges that contribute to social isolation. These challenges include language barriers, cultural differences and shifts in family or intergenerational dynamics. Their social networks in new communities may lack depth and history, exacerbating feelings of isolation. Women, unmarried individuals and those without a close confidant are especially vulnerable. Research in England and the Netherlands has highlighted higher loneliness levels among older immigrants, further illustrating the global nature of this issue. For LGBTQ+ older adults, sexual orientation has been linked to loneliness, although research findings are mixed. In general, studies suggest that gay, lesbian and bisexual individuals report greater loneliness compared to their heterosexual peers. ^[6]

Special context: COVID-19

A 2020 National Poll on Healthy Aging conducted by the University of Michigan found that the prevalence of loneliness among U.S. adults aged 50–80 doubled during the early months of the COVID-19 pandemic. ^[7] Older adults faced heightened health risks due to weakened immune systems and a greater prevalence of chronic conditions such as heart disease, diabetes, lung disease and cancer. ^{[8] [9]}

Lockdowns and social distancing measures, while necessary to protect public health, further isolated older adults, intensifying feelings of loneliness. Those in long-term care facilities were particularly affected, with these restrictions contributing to increased rates of depression, anxiety and irritability. The pandemic underscored the profound impact of social isolation on the mental health and well-being of older populations. ^[10]

Social challenge

Loneliness in old age has become a pressing social challenge, driven by demographic shifts, evolving family structures and changing cultural values. ^[11]

The global increase in life expectancy, often termed the "longevity revolution", has led to a rapidly growing population of older adults. By 2050, the number of people aged 60 and above is projected to reach 2 billion, yet this achievement in longevity has highlighted new social issues. ^[12] Many older adults face social isolation as traditional support systems struggle to meet the needs of this expanding demographic.

Modern family dynamics have undergone significant changes, with nuclear and diverse family structures replacing extended family networks. ^[13] This shift has weakened intergenerational ties and caregiving roles, leaving many older individuals to navigate the "empty nest" phase with limited familial support. Additionally, societal emphasis on individualism and youth has diminished the cultural status of older adults, further marginalizing them from social and community activities. ^[14]

The COVID-19 pandemic starkly exposed the vulnerabilities of older populations, emphasizing their isolation and lack of adequate care. Despite contributing significantly to their families and communities, older adults often remain invisible in societal priorities, their needs overshadowed by a focus on younger generations. ^[15]

Causes

Loneliness in later life is a multifaceted phenomenon shaped by various psychological, environmental and social factors. The following are theoretical frameworks of understanding loneliness in old age. ^[16]

According to cognitive behavioral theories, loneliness arises when there is a discrepancy between the desired and actual quality and quantity of social relationships. Factors such as retirement, living alone, the loss of loved ones and chronic health conditions can reduce social connections, heightening the risk of loneliness. However, social isolation and loneliness are not synonymous; individuals may feel lonely despite regular social contact, while others who are socially isolated may not experience loneliness. This discrepancy can be influenced by cognitive processes, such as social comparison and cultural expectations, which shape subjective appraisals of loneliness. The stress process model adds that health problems, financial difficulties and other stressors contribute to loneliness, but supportive resources, including family and community connections, can mitigate these effects.

The interaction between cognitive processes and environmental factors is further emphasized in models linking loneliness to life events and social contexts. For instance, changes such as retirement or bereavement may disrupt social networks, leading to increased feelings of isolation. Environmental gerontology highlights how older adults' resources, including socioeconomic status and living conditions, interact with their surroundings to influence loneliness. Poor living conditions and limited access to social opportunities can exacerbate loneliness, particularly for individuals with fewer financial or educational resources.

Socioemotional selectivity theory proposes that older adults prioritize meaningful relationships over expanding their social networks as they age. This shift in focus often results in maintaining close ties with loved ones while reducing interactions with acquaintances or less significant connections. Consequently, the quality of relationships, rather than their quantity, becomes a key determinant of loneliness. Disruptions to these close relationships, such as those caused by pandemic restrictions, can significantly impact emotional well-being.

From an evolutionary perspective, loneliness and social isolation are thought to reinforce one another. Reduced social networks and negative appraisals of interactions can lead to maladaptive social behaviors, further isolating individuals. Lonely older adults may dwell on negative experiences, creating a cycle of poor social engagement and increasing their sense of disconnection.

Life course theories provide additional context by exploring how early-life experiences shape loneliness in older age. Adverse events, such as socioeconomic hardships during childhood, can have cumulative effects on well-being, influencing loneliness later in life. However, later-life conditions, such as health, income and social resources, often have a stronger impact, suggesting that interventions in older adulthood can help mitigate the effects of earlier disadvantages.

Factors

The factors related to loneliness in old age include: being female, widowed, divorced or never married; having limited or low-quality social ties; poor physical health, such as chronic illnesses or mobility impairments; and constrained socioeconomic resources, such as low income or education levels. ^{[17] [18] [19]}

Demographics

Age

The U-shaped pattern of loneliness across the lifespan underscores the role of age in shaping loneliness among older adults, with advanced age—particularly beyond 80—emerging as a significant risk factor. ^[20] For younger older adults, factors such as being married and maintaining good health often help protect against loneliness. In contrast, advanced age is commonly linked to heightened loneliness due to sensory and physical impairments, loss of a spouse, and shrinking social networks. ^{[21] [22]}

Despite these risks, some theories suggest that older adults may experience less loneliness under certain circumstances. According to socioemotional selectivity theory, older individuals tend to prioritize emotionally fulfilling relationships, which can help alleviate loneliness. ^[23] Compared to younger counterparts, among the oldest-old, relationships that foster self-esteem are often maintained, while those less beneficial for psychological well-being are allowed to fade.

Gender

Older women generally report higher levels of loneliness than older men. ^[6]

Theoretical perspectives suggest that early life socialization processes shape how individuals experience loneliness in later life. Chodorow proposed that women, due to their socialization, develop a personality that places greater emphasis on relationships and connections with others, particularly within the family, where they often assume roles like kin keepers. This relational focus may make them more vulnerable to loneliness when these bonds are disrupted. In contrast, men's traditional roles tend to emphasize instrumental activities, with less emphasis placed on interpersonal relationships, which could contribute to different patterns of loneliness in older adulthood. ^[24]

Women are generally more prone to loneliness in old age due to factors like widowhood and caregiving responsibilities. Women tend to live longer, often marry older partners and are more likely to experience widowhood, which can lead to significant loneliness, particularly if they relied heavily on their spouse for companionship. Caregiving roles, such as caring for a disabled spouse, can further restrict women's opportunities for social engagement outside the family. Socialization also influences reported loneliness, as women are more open about expressing emotions and seeking help, while men are less likely to disclose loneliness. However, gender differences in loneliness often stem from situational factors, like widowhood or caregiving, rather than intrinsic gender traits. Women's larger social networks and greater tendency to seek support may help mitigate loneliness, providing them with confidants and higher satisfaction with social connections. ^{[18] [25]}

Marriage and widowhood

Marriage is widely regarded as protective against loneliness in old age, offering emotional, psychological, financial and physical benefits. ^{[26] [27] [28]} However, the quality of the marital relationship is critical; dissatisfaction with a spouse can exacerbate feelings of loneliness, while emotionally fulfilling and supportive marital relationships can mitigate it. ^[29]

The loss of a spouse brings higher risks of loneliness. Among widowed older adults, men tend to experience greater loneliness after the loss of a spouse, but women often benefit from stronger social networks with family and friends, which provide more opportunities for emotional support. Furthermore, older women are more likely to share the experience of widowhood with others due to the typical age gap between spouses and their higher involvement in social activities. In contrast, older men often have fewer social connections and may face greater challenges with loneliness after losing a spouse. ^[30] However, men tend to have better prospects for remarrying in later life, which could reduce their loneliness. ^[31]

Socioeconomic status

Higher socioeconomic status (SES) is generally associated with lower levels of loneliness. Higher SES is generally associated with reduced loneliness, as it often enables the development of broader social networks that include not only family members but also friends and acquaintances. These expanded networks provide greater opportunities for social interaction and support, decreasing the likelihood of loneliness. In contrast, lower SES can intensify loneliness by limiting access to social engagement opportunities. Financial constraints may restrict older adults' ability to participate in social activities or access caregiving resources. Additionally, lower SES is often linked to reduced self-esteem, which can hinder the formation or maintenance of meaningful social relationships. ^[18] Key indicators of lower SES, such as limited income and low education levels, are frequently associated with increased loneliness in older age. ^[32]

Health

Having low levels of physical health is a major contributor to loneliness in older adults. ^[33] Chronic conditions such as heart disease, stroke, and cancer are strongly associated with increased risks of both social isolation and loneliness. These relationships are often bi-directional; poor health can lead to isolation and isolation can exacerbate health issues. Functional impairments, including difficulties with daily activities or reduced mobility, are similarly linked to loneliness and isolation in reciprocal ways. ^[6]

Sensory impairments, particularly hearing loss, increase risks of loneliness in old age. Hearing loss can hinder communication, reduce social participation and increase feelings of isolation and loneliness. Evidence suggests that addressing hearing loss can improve social functioning and alleviate loneliness. ^[6]

Mental health challenges further compound these issues. Depression, for instance, can both result from prolonged loneliness and contribute to its development, creating a cyclical relationship. Loneliness has also been associated with cognitive decline, including an increased risk of dementia and with mental health symptoms such as paranoia and psychosis. ^{[2] [34]} Chronic medical conditions, when present, are often linked to loneliness, highlighting the interconnected nature of physical and psychological health in later life. ^[35]

Social network

Social networks, particularly confidant networks, play a significant role in mitigating loneliness among older adults. Both family and non-family relationships contribute to alleviating loneliness, but their effects vary. Family ties, especially with children, are often a key source of emotional support for older adults. However, these relationships can sometimes involve caregiving responsibilities or obligations that create emotional strain. Friendships, by contrast, are usually voluntary and reciprocal, offering emotional support without the complexities of familial obligations. Research suggests that friendships formed by choice may be particularly effective in reducing loneliness. ^[36]

The physical proximity of friends and family can influence social connectedness, as frequent and close interactions provide emotional support to counter loneliness. However, excessive proximity or overly frequent interactions can sometimes lead to emotional fatigue, potentially fostering negative emotions. Confidant networks—close, supportive relationships with individuals who provide understanding and reassurance—are also critical in addressing loneliness. Older adults who lack a confidant or have strained relationships within their confidant network are more likely to report loneliness. Conversely, having a strong and supportive confidant network characterized by frequent, emotionally close interactions can significantly reduce feelings of isolation. However, overly strained or dependent relationships within a confidant network may contribute to emotional stress, highlighting the complex dynamics of social connections in later life. ^[18]

Living arrangement

Aging in place

Different living arrangements lead to different loneliness outcomes in old age. Research shows that living alone is often linked to higher levels of loneliness compared to other living situations. Having a partner in the household tends to reduce loneliness, while living with children does not seem to have the same effect. Some studies suggest that older adults living with one other person may feel the least lonely. Although research on changes in living arrangements over time is limited, findings suggest that loneliness might influence living arrangements, with lonelier individuals being more likely to live alone. ^[37]

Institutionalization

Approximately one in three older adults will spend time living in a nursing home due to the need for physical care or safety during their lifetime. ^[38] Loneliness is highly prevalent in institutional settings, such as nursing homes. Studies have shown that loneliness in residential care facilities estimated roughly 61% of residents may be moderately lonely and approximately 35% severely lonely, at least twice as high as among those living in the community. ^[39] Residents in long-term care facilities often experience loneliness due to loss of autonomy, limited familial contact, reduced social networks and declines in physical and cognitive capacities. ^{[40] [41]} Additionally, the institutional environment may lack opportunities for meaningful social engagement and emotional support, which are crucial for mitigating loneliness. These challenges are compounded by superficial social interactions and limited opportunities for forming deep connections with peers, particularly when cognitive abilities differ among residents. ^[42]

Disruptive life events

Disruptive life events can affect interpersonal relationships and influence perceptions of life, isolation and loneliness at any age. While such experiences are not exclusive to older adults, certain events—such as bereavement, illness or declining health, and retirement—are more common or occur with greater frequency after the age of 50. These events often reshape social networks and emotional well-being, highlighting the vulnerabilities associated with aging. ^[43]

Societal factors

Societal changes

Societal changes have played a significant role in increasing loneliness among older adults. The shift from traditional, tight-knit communities to more mobile and fragmented societies has contributed to heightened isolation. Factors such as the decline in intergenerational living, increased geographic mobility and weaker community ties have all exacerbated loneliness. Furthermore, while life expectancy has risen globally, many older adults face extended lives without sufficient social support, leading to more individuals living alone and without the familial or social connections that once helped alleviate feelings of isolation. ^[44]

Culture

Cultural factors further shape the experience of loneliness in old age. In collectivist cultures, where the needs of the family or community are prioritized over individual desires, social cohesion is maintained through cultural norms and social control. These societies often provide stronger support systems, reducing the likelihood of physical isolation for older adults. In contrast, individualistic cultures emphasize personal independence, which can lead to greater freedom in forming and maintaining social relationships but may also contribute to higher levels of loneliness, as the focus on individual needs can sometimes result in weaker social ties. ^[45]

For example, older adults in eastern, southern and central European countries, where familism is more prominent, often report higher levels of loneliness compared to their counterparts in northern and western Europe. In these collectivist societies, strong family involvement is expected, so when familial ties weaken or are lost, loneliness is frequently amplified. This suggests that while strong family connections can provide support, societal expectations surrounding them may also increase loneliness when those connections are not met. ^[36]

Ageism

Ageism is another significant factor contributing to loneliness in old age, as it involves discriminatory attitudes and stereotypes based on age, such as viewing older adults as "out of touch" or "unproductive." These biases can lead to social exclusion in various areas, including social activities, workplaces and even within families, fostering feelings of isolation. Additionally, internalized ageism can lead older adults to self-impose isolation, believing they have little to contribute or fearing rejection, which further exacerbates loneliness. The combination of ageism and loneliness can intensify psychological distress, making it essential to address both issues to improve the well-being of older adults. ^[46]

Longitudinal Factors

Some conditions affect older adults' loneliness over a period of time, rather than just at a single point. The loss of a spouse or partner, a limited social network and low levels of social activity, often have lasting effects, gradually shaping or worsening loneliness as people age. Poor health or depression may start as minor issues but can lead to increased isolation and loneliness over the years if not addressed. Similarly, the loss of a spouse or reduced social activity might initially cause loneliness, but their impact can grow as time passes, making older adults more vulnerable to chronic loneliness. ^[47]

Effects

Loneliness has wide-ranging effects on older adults, influencing their health behaviors, physical health, mental well-being and cognitive abilities. While this section focuses on these specific impacts in later life, see "Loneliness" for a comprehensive overview of loneliness and its effects across all age groups.

Health behaviors

Loneliness in older adults may lead to various negative health behaviors, including substance use and sleep disturbances. An estimated 1 million older adults in the United States face substance use challenges, with loneliness acting as a significant risk factor. Despite being as likely to benefit from treatment as other age groups, older adults are less likely to seek help for substance use. ^[48] Loneliness can also lead to sleep problems, such as difficulty falling asleep, maintaining sleep, early-morning awakenings, and feeling unrefreshed after sleep. ^[49] Studies have shown that lonely individuals experience more insomnia symptoms and shorter sleep durations, further impacting their overall health and well-being. ^[50]

Physical health

Loneliness poses serious risks to the physical health of older adults, contributing to conditions such as high blood pressure, heart disease, and obesity. ^[10] Studies have linked loneliness to cardiovascular problems, including elevated systolic blood pressure and peripheral vascular disease. Additionally, it is associated with immune system dysregulation, marked by increased systemic inflammation and reduced immune function. Although research specific to older populations remains limited, these findings highlight potential mechanisms through which loneliness undermines physical health. ^[51]

Loneliness may contribute to higher mortality risks among older adults. A study by the University of California, San Francisco, involving 1,600 participants with an average age of 71, found that loneliness significantly increased mortality risk among older adults. Over six years, 23% of those who reported feeling lonely died, compared to 14% of their non-lonely counterparts, even after accounting for socioeconomic and health factors. ^[52]

Mental health

Loneliness is a well-documented independent risk factor for depression in old age. ^[20] It has been linked to heightened anxiety, psychological distress and lower overall emotional well-being, often exacerbating depression and anxiety in a bidirectional relationship. ^[53] Perceived social support, a key predictor of loneliness, has been linked to mental health conditions such as schizophrenia, bipolar disorder and anxiety disorders in older adults. ^[54]

Cognitive health

Loneliness is linked to declines in several areas of cognitive functioning, including overall cognitive ability, intelligence quotient (IQ), processing speed and both immediate and delayed memory recall. ^[55]

Research suggests that loneliness can contribute to inflammation and immune system dysregulation, both of which negatively impact cognitive function. At the same time, cognitive impairments can exacerbate feelings of loneliness by hindering social interactions. The a bidirectional relationship between loneliness and cognitive decline highlights how loneliness and cognitive health are closely interconnected, with each influencing the other over time. ^[56]

Relief

Older adults can take practical steps to relieve the feeling of loneliness and foster social connections. Building intergenerational friendships can provide meaningful relationships and promote a positive outlook on aging. Practicing gratitude daily and staying present during interactions, such as by putting away phones during conversations, can enhance emotional connections. Volunteering offers both social engagement and personal fulfillment, with activities like delivering meals or participating in community projects benefiting both physical and mental health. Caring for pets can provide valuable companionship for older adults. Integrating enjoyable and practical social activities into daily routines can help foster healthier social habits. Grief support programs, such as support groups, offer emotional assistance and social connection during periods of loss. Addressing health issues, such as untreated hearing loss, can prevent isolation by improving communication and social participation. Joining senior activity centers or community programs provides opportunities for education, exercise and shared hobbies, fostering a sense of belonging. Pursuing hobbies, especially those shared with others, like pottery or gardening, can also help older adults connect with like-minded individuals and strengthen their social networks. ^{[57] [58]}

Interventions

A wide variety of interventions have been developed to reduce social isolation and loneliness among older people. The interventions generally focus on four areas: improving social skills, strengthening social support, fostering more social interaction and dealing with maladaptive social cognition. ^[59]

Among these, addressing distorted social cognition stands out as the most successful, particularly with the use of cognitive-behavioral therapy (CBT). More recently, integrated interventions that combine CBT with medication have emerged as a promising avenue for reducing loneliness. ^[60]

Interventions to address loneliness in older adults fall into the following six main categories: ^[61]

• Social facilitation interventions: These interventions primarily aim to increase social interaction and often involve group-based activities. Examples include charity-funded friendship clubs, shared interest groups, day care centers and friendship enrichment programs. Social facilitation encourages reciprocal relationships, where both participants benefit from mutual companionship. Group-based activities can help older adults form connections, alleviate feelings of loneliness and promote a sense of belonging. ^[61]
• Psychological therapies: Interventions based on therapeutic approaches, such as reminiscence therapy, mindfulness, exercise-talk discussions, social engagement-directed discussions, coaching and stress reduction techniques, aim to address emotional and psychological aspects of loneliness. These therapies have been found to significantly reduce loneliness and improve social support, happiness and life satisfaction. ^{[62] [61]}
• Health and social care provision: For older adults who are homebound or frail, formal health and social care interventions can help reduce isolation and improve well-being. These interventions often involve health professionals and may be delivered through nursing homes, community settings, or geriatric rehabilitation programs. ^[61]
• Animal-assisted interventions: The interactions with living dogs or robotic animals help older adults relieve loneliness by offering companionship and emotional support. ^[63] These interventions are thought to work by fostering a bond between the individual and the animal, creating opportunities for social interaction with others. Research suggests that pet attachment can alleviate loneliness by providing both emotional comfort and social connections. Companion robots like Paro, a robotic seal, have been developed to simulate the emotional benefits of animal companionship, providing a viable alternative for older adults who may not be able to care for live animals. ^[64]
• Befriending interventions: These interventions focus on forming new social connections, usually through one-on-one interactions facilitated by trained volunteers. Unlike social facilitation programs, befriending interventions are specifically designed to support the lonely individual, helping them establish friendships that can reduce feelings of isolation. For example, the AmeriCorps Senior Companion Program pairs volunteers, who are typically older adults themselves (age 55 and older), with older adults who may be isolated or have special needs. ^[65] Volunteers, known as Senior Companions, provide friendly visits, assist with basic activities of daily living and offer companionship to reduce loneliness and promote well-being among older adults. ^[66]
• Leisure and skill development interventions: Activities that encourage personal growth and social engagement can help reduce loneliness among older adults by offering meaningful opportunities for connection. Programs centered around hobbies such as gardening, computer use, or volunteering, as well as those focused on skill development, have been shown to engage older adults in social networks and alleviate feelings of isolation. These interventions not only facilitate the formation of new relationships but also promote a sense of purpose and fulfillment. ^[62]

Technology-based interventions

In recent years, technological advancements have provided new ways to address loneliness among older adults. Technology-based interventions, including video calls, online communities and virtual reality, are increasingly used to enhance communication and social connection. ^[67] These tools enable individuals to stay connected with family, friends and healthcare providers, helping to overcome barriers such as geographical distance and physical limitations that contribute to isolation. Several reviews have highlighted the effectiveness of these technologies in improving communication and offering new social interaction opportunities for older adults. ^[68] Additionally, innovations in artificial intelligence (AI) and robotics, such as virtual companions and digital assistants, offer further support by providing social engagement and emotional care. These technologies have the potential to supplement social support, especially for older adults with mobility challenges or limited local connections. As technology continues to evolve, its role in combating loneliness among older adults is expected to grow. ^[69]

The use of technology to combat loneliness among older adults raises ethical concerns despite its potential benefits. For instance, ElliQ, an AI-powered robotic companion distributed to hundreds of older residents in New York State, has been praised for reducing boredom, maintaining social skills and assisting with grief. However, critics highlight significant issues, including data privacy, the protection of sensitive user information and the potential for such technology to diminish human relationships. Some experts warn that overreliance on robotic companions could discourage older adults from engaging in meaningful, reciprocal interactions with friends and family, undermining the very social connections these tools aim to enhance. ^[70]

Long-term care settings

Loneliness in long-term care settings presents distinct challenges, as interventions effective in community settings may not always be practical in institutional environments. These settings often restrict the feasibility of certain interventions due to factors like limited physical space, institutional routines and residents' varied physical and cognitive abilities. ^[71] One intervention that has shown promise is implementing The Eden Alternative (TEA) model, proposed by Dr. Bill Thomas in 1991. This model emphasizes social rather than medical care and encourages family and community involvement, aiming to transform institutional environments into more homelike settings. ^[72] The Eden Alternative has been adopted by the Texas Department of Aging and Disability Services to assist Texas nursing homes in promoting residents' quality of life. ^[73]

TEA principles include:

• Loneliness, helplessness and boredom are harmful and can negatively impact our overall health and quality of life.
• A compassionate and inclusive community, where individuals of all ages and abilities are supported, fosters well-being for everyone.
• We flourish when we can easily connect with others, as this helps alleviate feelings of loneliness.
• A sense of purpose and the chance to both give and receive are essential for overcoming helplessness and promoting well-being.
• Our well-being is enhanced when we experience variety, spontaneity and the unexpected in our daily lives, which combats boredom.
• Activities without meaning can diminish our spirit and personal meaning is crucial for maintaining health and well-being.
• We are more than our diagnoses and medical care should empower us to lead a fulfilling and meaningful life.
• Decision-making should actively involve those who are most affected by the decisions, as empowerment fosters autonomy and influence.
• Cultivating a resilient and collaborative culture is an ongoing process that requires continuous learning, growth and adaptability.
• Effective leadership is vital for creating lasting and impactful change and no alternative can replace it. ^[74]

Another innovative approach in facilities involves the use of animals, which has been demonstrated to alleviate loneliness. ^[75] Dog-assisted interventions (DAI) are among the most widely used forms of animal-assisted interventions, largely because of dogs' strong emotional bonds with humans and their ability to be trained for specific behaviors. Research has shown that DAI can lead to various positive outcomes for residents, including enhanced social functioning, reduced depression and decreased feelings of loneliness. Notably, the greatest impact of DAI appears to be on improving social interactions and engagement. ^[76] Moreover, interactive robotic animals, like the AIBO robotic dog, also have been used as a source of companionship and emotional support. ^[77]

Studies suggest that both living animals, such as dogs and interactive robotic animals, like the AIBO robotic dog, have a positive impact on reducing loneliness. ^[76] Residents develop attachments to these animals, which can serve as a source of companionship and emotional support. Some research even suggests that robotic animals may offer advantages over live pets in terms of engagement, with residents interacting more frequently with robotic dogs and expressing greater emotional attachment, though the underlying mechanisms for loneliness reduction remain complex. ^[78]

Common characteristics of effective interventions

Effective interventions to reduce loneliness among older adults share a few key features. ^[61] First, they must be adaptable, allowing for adjustments based on the specific needs of the local population. This flexibility ensures that programs resonate with the target group's demographic and cultural context, making them more engaging. ^[8] In long-term care settings, this means considering factors like age, mobility and cognitive abilities to ensure activities are accessible and relevant.

Second, a community development approach, where older adults participate in designing and delivering interventions, has proven effective. This involvement fosters a sense of ownership, increases participation and strengthens long-term engagement. It also helps ensure that interventions remain responsive to residents' evolving needs. ^[79]

Lastly, interventions promoting productive engagement—activities that encourage active participation—are more effective than passive ones. These activities, whether group-based or individual, provide opportunities for meaningful connections and a sense of achievement. ^[71] In residential care facilities, where autonomy and social interaction may be limited, productive engagement can significantly improve residents' social well-being.

References

1. Caron, Christina (2024-05-21). "The Loneliness Curve". The New York Times. Retrieved 2024-11-29.
2. Hawkley, Louise C.; Cacioppo, John T. (2010-07-22). "Loneliness Matters: A Theoretical and Empirical Review of Consequences and Mechanisms". Annals of Behavioral Medicine. 40 (2): 218–227. doi:10.1007/s12160-010-9210-8. ISSN   0883-6612. PMC   3874845 . PMID   20652462.
3. Holt-Lunstad, Julianne; Smith, Timothy B.; Baker, Mark; Harris, Tyler; Stephenson, David (2015-03-11). "Loneliness and Social Isolation as Risk Factors for Mortality". Perspectives on Psychological Science. 10 (2): 227–237. doi:10.1177/1745691614568352. ISSN   1745-6916. PMID   25910392.
4. "Reducing Social Isolation and Loneliness among Older People". World Health Organization. Retrieved 2024-12-04.
5. Chawla, Kavita; Kunonga, Tafadzwa Patience; Stow, Daniel; Barker, Robert; Craig, Dawn; Hanratty, Barbara (2021-07-26). "Prevalence of loneliness amongst older people in high-income countries: A systematic review and meta-analysis". PLOS ONE. 16 (7): e0255088. Bibcode:2021PLoSO..1655088C. doi: 10.1371/journal.pone.0255088 . ISSN   1932-6203. PMC   8312979 . PMID   34310643.
6. National Academies of Sciences Engineering and Medicine, 2020. Risk and protective factors for social isolation and loneliness. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System, pp.63-91.
7. "Loneliness Among Older Adults Before and During the COVID-19 Pandemic | National Poll on Healthy Aging". www.healthyagingpoll.org. 2020-09-14. Retrieved 2024-12-04.
8. Schroyen, S.; Janssen, N.; Duffner, L. A.; Veenstra, M.; Pyrovolaki, E.; Salmon, E.; Adam, S. (2023-09-14). "Prevalence of Loneliness in Older Adults: A Scoping Review". Health & Social Care in the Community. 2023: 1–12. doi: 10.1155/2023/7726692 . ISSN   1365-2524.
9. Ruiz-Callado, Raúl; Jareño-Ruiz, Diana; Fabregat-Cabrera, María Elena; Penalva-Lorca, María Manuela (2023-03-30). "Ageing and Loneliness in Times of Pandemic: A Scoping Review". International Journal of Environmental Research and Public Health. 20 (7): 5337. doi: 10.3390/ijerph20075337 . ISSN   1660-4601. PMC   10093808 . PMID   37047952.
10. "How to Navigate Social Isolation and Loneliness as an Older Adult". National Council on Aging. 2022-05-03. Retrieved 2024-12-04.
11. Rondón García, Luis Miguel (2022), "Loneliness in aging: concept, typology and characteristics", Loneliness in Older Adults, Elsevier, pp. 1–23, doi:10.1016/b978-0-323-91659-2.00005-3, ISBN   978-0-323-91659-2 , retrieved 2024-12-05
12. "Ageing and Health". World Health Organization. 2024-10-01. Retrieved 2024-12-05.
13. Popenoe, David (2020). Disturbing the Nest: Family Change and Decline in Modern Societies (1st ed.). New York: Routledge (published 2020-10-13). ISBN   9781003058786.
14. Sokolovsky, Jay (2020). The Cultural Context of Aging: Worldwide Perspectives (4th ed.). Bloomsbury Academic (published 2020-06-09). ISBN   9781440852015.
15. "UNSDG | Policy Brief: The Impact of COVID-19 on older persons". unsdg.un.org. Retrieved 2024-12-05.
16. LU, Nan (2022), "How to Understand Loneliness in Later Life?", Loneliness Among Older Adults During the COVID-19 Pandemic, Singapore: Springer Singapore, pp. 17–26, doi:10.1007/978-981-19-0611-4_2, ISBN   978-981-19-0610-7 , retrieved 2024-12-05
17. Ong, Anthony D.; Uchino, Bert N.; Wethington, Elaine (2015-11-06). "Loneliness and Health in Older Adults: A Mini-Review and Synthesis". Gerontology. 62 (4): 443–449. doi:10.1159/000441651. ISSN   0304-324X. PMC   6162046 . PMID   26539997.
18. Pinquart, Martin; Sorensen, Silvia (2001-06-07). "Influences on Loneliness in Older Adults: A Meta-Analysis". Basic and Applied Social Psychology. 23 (4): 245–266. doi:10.1207/s15324834basp2304_2. ISSN   0197-3533.
19. Perissinotto, Carla M.; Stijacic Cenzer, Irena; Covinsky, Kenneth E. (2012-07-23). "Loneliness in Older Persons". Archives of Internal Medicine. 172 (14): 1078–1083. doi:10.1001/archinternmed.2012.1993. ISSN   0003-9926. PMC   4383762 . PMID   22710744.
20. Luanaigh, Conor Ó; Lawlor, Brian A. (2008-06-09). "Loneliness and the health of older people". International Journal of Geriatric Psychiatry. 23 (12): 1213–1221. doi:10.1002/gps.2054. ISSN   0885-6230. PMID   18537197.
21. Hobbs, Frank B.; Damon, Bonnie L. (1996). "65 in the United States". PsycEXTRA Dataset. doi:10.1037/e401512005-001 . Retrieved 2024-11-25.
22. MCKEE, KEVIN (1997-05-01). "James E. Birren and K. Warner Schaie (eds), Handbook of the Psychology of Aging, Academic, San Diego, California, 4th edn, 1996, 416 pp., hbk no price, ISBN 0 121 01260 3, pbk £12.99, ISBN 121 01261 1". Ageing and Society. 17 (3): 353–371. doi:10.1017/s0144686x97226413. ISSN   0144-686X.
23. Ferrucci, Luigi; Guralnik, Jack M. (2013-02-01). "Mobility in Human Aging: A Multidisciplinary Life Span Conceptual Framework". Annual Review of Gerontology and Geriatrics. 33 (1): 171–192. doi:10.1891/0198-8794.33.171. ISSN   0198-8794.
24. Chodorow, N. (2018). Family structure and feminine personality. In Feminism and philosophy (pp. 199-216). Routledge.
25. KONDRATOWITZ, HANS-JOACHIM (2009-12-11). "K. Warner Schaie and Ronald P. Abeles (eds), Social Structures and Aging Individuals: Continuing Challenges, Springer Publishing Company, New York, 2008, 412 pp., hbk US $85.00, ISBN 13: 978 0 8261 2408 1". Ageing and Society. 30 (1): 183–184. doi:10.1017/s0144686x09990419. ISSN   0144-686X.
26. Carr, Deborah; Springer, Kristen W. (2010-06-18). "Advances in Families and Health Research in the 21st Century". Journal of Marriage and Family. 72 (3): 743–761. doi:10.1111/j.1741-3737.2010.00728.x. ISSN   0022-2445.
27. Proulx, Christine M.; Helms, Heather M.; Buehler, Cheryl (2007-07-05). "Marital Quality and Personal Well-Being: A Meta-Analysis". Journal of Marriage and Family. 69 (3): 576–593. doi:10.1111/j.1741-3737.2007.00393.x. ISSN   0022-2445.
28. England, Paula; Waite, Linda J.; Gallagher, Maggie (2001-11-01). "The Case for Marriage: Why Married People Are Happier, Healthier, and Better off Financially". Contemporary Sociology. 30 (6): 564. doi:10.2307/3088984. ISSN   0094-3061. JSTOR   3088984.
29. LU, Nan (2022), "The Moderating Role of Marital Status and Living Alone in the Relationship Between Social Capital and Loneliness", Loneliness Among Older Adults During the COVID-19 Pandemic, Singapore: Springer Singapore, pp. 59–69, doi:10.1007/978-981-19-0611-4_5, ISBN   978-981-19-0610-7 , retrieved 2024-12-05
30. Garcia, Luis Miguel Rondon. Loneliness in Older Adults: Effects, Prevention and Treatment. Academic Press, 2022
31. Carr, Deborah; Utz, Rebecca L. (2020-01-05). "Families in Later Life: A Decade in Review". Journal of Marriage and Family. 82 (1): 346–363. doi:10.1111/jomf.12609. ISSN   0022-2445. PMC   7904069 . PMID   33633412.
32. Routasalo, Pirkko; Pitkala, Kaisu H (2004-08-11). "Loneliness among older people". Reviews in Clinical Gerontology. 13 (4): 303–311. doi:10.1017/S095925980400111X. ISSN   0959-2598.
33. Pinquart, Martin; Sörensen, Silvia (March 2003). "Associations of Stressors and Uplifts of Caregiving With Caregiver Burden and Depressive Mood: A Meta-Analysis". The Journals of Gerontology: Series B. 58 (2): P112 –P128. doi:10.1093/geronb/58.2.p112. ISSN   1758-5368. PMID   12646594.
34. Jylhä, Marja; Saarenheimo, Marja (2010), "Loneliness and Ageing: Comparative Perspectives", The SAGE Handbook of Social Gerontology, London: SAGE Publications Ltd, pp. 317–328, doi:10.4135/9781446200933.n24, ISBN   978-1-4129-3464-0 , retrieved 2024-11-25
35. Solmi, Marco; Veronese, Nicola; Galvano, Daiana; Favaro, Angela; Ostinelli, Edoardo G; Noventa, Vania; Favaretto, Elisa; Tudor, Florina; Finessi, Matilde; Shin, Jae Il; Smith, Lee; Koyanagi, Ai; Cester, Alberto; Bolzetta, Francesco; Cotroneo, Antonino (2020-04-15). "Factors Associated With Loneliness: An Umbrella Review Of Observational Studies". Journal of Affective Disorders. 271: 131–138. doi:10.1016/j.jad.2020.03.075. hdl: 10072/398187 . ISSN   0165-0327. PMID   32479308.
36. Shiovitz-Ezra, Sharon (2013-06-14), "30 Confidant networks and loneliness", Active ageing and solidarity between generations in Europe, DE GRUYTER, pp. 349–358, doi:10.1515/9783110295467.349, ISBN   978-3-11-029545-0 , retrieved 2024-11-25
37. Barjaková, Martina; Garnero, Andrea; d'Hombres, Béatrice (2023-08-09). "Risk Factors for Loneliness: A Literature Review". Social Science and Medicine. 334: 116163. doi:10.1016/j.socscimed.2023.116163. ISSN   0277-9536. PMC   10523154 . PMID   37625251.
38. "Most Older Adults Are Likely to Need and Use Long-Term Services and Supports Issue Brief". Office of The Assistant Secretary for Planning and Evaluation. 2021-01-31. Retrieved 2024-12-04.
39. Gardiner, Clare; Laud, Pete; Heaton, Tim; Gott, Merryn (2020-05-12). "What is the prevalence of loneliness amongst older people living in residential and nursing care homes? A systematic review and meta-analysis". Age and Ageing. 49 (5): 748–757. doi:10.1093/ageing/afaa049. ISSN   0002-0729. PMID   32396600.
40. Sedlackova, Katerina Beji; Bartova, Alzbeta; Holmerova, Iva (2024-09-23). "Feeling Lonely, Isolated and Depressed. Older Adults' Feelings in Long-term Term Facilities: A Scoping Review". Journal of Population Ageing. 17 (4): 861–914. doi:10.1007/s12062-024-09463-8. ISSN   1874-7884.
41. Quan, Nicolas G.; Lohman, Matthew C.; Resciniti, Nicholas V.; Friedman, Daniela B. (2019-10-11). "A systematic review of interventions for loneliness among older adults living in long-term care facilities". Aging & Mental Health. 24 (12): 1945–1955. doi:10.1080/13607863.2019.1673311. ISSN   1360-7863. PMID   31602993.
42. Boamah, Sheila A.; Weldrick, Rachel; Lee, Tin-Suet Joan; Taylor, Nicole (2021-03-27). "Social Isolation Among Older Adults in Long-Term Care: A Scoping Review". Journal of Aging and Health. 33 (7–8): 618–632. doi:10.1177/08982643211004174. ISSN   0898-2643. PMC   8236667 . PMID   33779366.
43. National Academies of Sciences, Engineering, and Medicine; Institute of Medicine; National Academies of Sciences, Engineering, and Medicine; National Research Council; National Research Council; National Academies of Sciences, Engineering, and Medicine, eds. (2020). Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. A consensus study report of the National Academies of Sciences, Engineering, Medicine. Washington, D.C: National Academies Press. ISBN   978-0-309-67100-2.
44. Bongaarts, John; Greenhalgh, Susan; Hewett, Paul; McNicoll, Geoffrey; Todaro, Michael P.; Zimmer, Zachary (2004-01-27). "SHORT REVIEWS". Population and Development Review. 28 (4): 809–816. doi:10.1111/j.1728-4457.2002.00809.x. ISSN   0098-7921.
45. Burholt, Vanessa (2023-08-07), "Culture, social isolation and loneliness in later life", Loneliness and Social Isolation in Old Age, London: Routledge, pp. 50–60, doi:10.4324/9781003289012-8, hdl: 2292/65804 , ISBN   978-1-003-28901-2 , retrieved 2024-12-04
46. "The Impact of Ageism on Elders' Mental Health". American Society on Aging. 2024-04-24. Retrieved 2024-12-04.
47. Dahlberg, Lena; McKee, Kevin J.; Frank, Amanda; Naseer, Mahwish (2021-02-10). "A systematic review of longitudinal risk factors for loneliness in older adults". Aging & Mental Health. 26 (2): 225–249. doi:10.1080/13607863.2021.1876638. ISSN   1360-7863. PMID   33563024.
48. Russell, Ray (2022-07-21). "Substance Use Challenges in Older Adults". National Council for Mental Wellbeing. Retrieved 2024-12-04.
49. Hedrih, Vladimir (2023-07-25). "Lonely individuals tend to develop sleep problems, study finds". PsyPost - Psychology News. Retrieved 2024-12-04.
50. "Loneliness and Social Isolation Linked to Poor Sleep Quality in Older Adults". Psychiatry Advisor. 2020-09-21. Retrieved 2024-12-04.
51. James Alexander Crewdson (2016). "The Effect of Loneliness in the Elderly Population: A Review". Healthy Aging & Clinical Care in the Elderly. 8: 1–8. doi:10.4137/hacce.s35890. ISSN   1179-0601.
52. Span, Paula (2016-12-30). "Loneliness Can Be Deadly for Elders; Friends Are the Antidote". New York Times. Retrieved 2024-12-04.
53. Courtin, Emilie; Knapp, Martin (2015-12-28). "Social isolation, loneliness and health in old age: a scoping review". Health & Social Care in the Community. 25 (3): 799–812. doi:10.1111/hsc.12311. ISSN   0966-0410. PMID   26712585.
54. Wang, Jingyi; Mann, Farhana; Lloyd-Evans, Brynmor; Ma, Ruimin; Johnson, Sonia (2018-05-29). "Associations between loneliness and perceived social support and outcomes of mental health problems: a systematic review". BMC Psychiatry. 18 (1). doi: 10.1186/s12888-018-1736-5 . ISSN   1471-244X. PMC   5975705 .
55. Boss, Lisa; Kang, Duck-Hee; Branson, Sandy (2015-01-02). "Loneliness and cognitive function in the older adult: a systematic review". International Psychogeriatrics. 27 (4): 541–553. doi:10.1017/s1041610214002749. ISSN   1041-6102. PMID   25554219.
56. Kara-Yakoubian, Mane (2024-06-11). "Loneliness linked to cognitive decline in older adults, study finds". PsyPost - Psychology News. Retrieved 2024-12-04.
57. "Loneliness can hit older adults hard. This aging expert says there are simple ways to stay socially connected". Yahoo Life. 2024-07-31. Retrieved 2024-12-04.
58. "8 ways older adults can reduce loneliness and social isolation | Michigan Medicine". www.michiganmedicine.org. 2023-11-21. Retrieved 2024-12-04.
59. Masi, Christopher M.; Chen, Hsi-Yuan; Hawkley, Louise C.; Cacioppo, John T. (2010-08-17). "A Meta-Analysis of Interventions to Reduce Loneliness". Personality and Social Psychology Review. 15 (3): 219–266. doi:10.1177/1088868310377394. ISSN   1088-8683. PMC   3865701 . PMID   20716644.
60. Cacioppo, Stephanie; Grippo, Angela J.; London, Sarah; Goossens, Luc; Cacioppo, John T. (2015-03-11). "Loneliness". Perspectives on Psychological Science. 10 (2): 238–249. doi:10.1177/1745691615570616. ISSN   1745-6916. PMC   4391342 . PMID   25866548.
61. Gardiner, Clare; Geldenhuys, Gideon; Gott, Merryn (2016-07-13). "Interventions to reduce social isolation and loneliness among older people: an integrative review". Health & Social Care in the Community. 26 (2): 147–157. doi:10.1111/hsc.12367. hdl: 2292/43815 . ISSN   0966-0410. PMID   27413007.
62. Poscia, Andrea; Stojanovic, Jovana; La Milia, Daniele Ignazio; Duplaga, Mariusz; Grysztar, Marcin; Moscato, Umberto; Onder, Graziano; Collamati, Agnese; Ricciardi, Walter; Magnavita, Nicola (2017-12-02). "Interventions targeting loneliness and social isolation among the older people: An update systematic review". Experimental Gerontology. 102: 133–144. doi:10.1016/j.exger.2017.11.017. ISSN   0531-5565. PMID   29199121.
63. Hoang, Peter; King, James A.; Moore, Sarah; Moore, Kim; Reich, Krista; Sidhu, Harman; Tan, Chin Vern; Whaley, Colin; McMillan, Jacqueline (2022-10-17). "Interventions Associated With Reduced Loneliness and Social Isolation in Older Adults: A Systematic Review and Meta-analysis". JAMA Network Open. 5 (10): e2236676. doi:10.1001/jamanetworkopen.2022.36676. ISSN   2574-3805. PMC   9577679 . PMID   36251294.
64. Gilbert, Ben. "The adorable robotic seal from 'Master of None' is real and you can buy one". Business Insider. Retrieved 2024-12-04.
65. "AmeriCorps Seniors Senior Companion Program | AmeriCorps". americorps.gov. 2022-09-16. Retrieved 2024-12-04.
66. "Seniors Helping Seniors - The NYCHA Journal". nychajournal.nyc. 2019-12-18. Retrieved 2024-12-04.
67. Balki, Eric; Hayes, Niall; Holland, Carol (2022-10-24). "Effectiveness of Technology Interventions in Addressing Social Isolation, Connectedness, and Loneliness in Older Adults: Systematic Umbrella Review". JMIR Aging. 5 (4): e40125. doi: 10.2196/40125 . ISSN   2561-7605. PMC   9641519 . PMID   36279155.
68. Fakoya, Olujoke A.; McCorry, Noleen K.; Donnelly, Michael (2020-02-14). "Loneliness and social isolation interventions for older adults: a scoping review of reviews". BMC Public Health. 20 (1): 129. doi: 10.1186/s12889-020-8251-6 . ISSN   1471-2458. PMC   7020371 . PMID   32054474.
69. Shah, Syed Ghulam Sarwar; Nogueras, David; van Woerden, Hugo Cornelis; Kiparoglou, Vasiliki (2021-06-04). "Evaluation of the Effectiveness of Digital Technology Interventions to Reduce Loneliness in Older Adults: Systematic Review and Meta-analysis". Journal of Medical Internet Research. 23 (6): e24712. doi: 10.2196/24712 . ISSN   1438-8871. PMC   8214187 . PMID   34085942.
70. Erin, Nolan (2024-07-06). "For Older People Who Are Lonely, Is the Solution a Robot Friend?". New York Times. Retrieved 2024-12-04.
71. Dickens, Andy P; Richards, Suzanne H; Greaves, Colin J; Campbell, John L (2011-08-15). "Interventions targeting social isolation in older people: a systematic review". BMC Public Health. 11 (1): 647. doi: 10.1186/1471-2458-11-647 . ISSN   1471-2458. PMC   3170621 . PMID   21843337.
72. "The Eden Alternative Philosophy". Sherbrooke Community Centre. Retrieved 2024-12-04.
73. "Eden Alternative Grant Project Calls on Texas Nursing Homes to Leverage Leadership". Texas Health Care Association. 2016-02-10. Retrieved 2024-12-04.
74. "Intervention models for nursing homes (I): The Eden Alternative | CENIE". cenie.eu. 2020-07-12. Retrieved 2024-12-04.
75. Franklin, Mitchell; Parnell, Tracey; Versi, Natasha; Pope, Rodney (2022). "Animal Assisted Therapy for Older Adults in Aged Care Facilities: A Rapid Review". Internet Journal of Allied Health Sciences and Practice. doi: 10.46743/1540-580x/2022.2052 . ISSN   1540-580X.
76. Jain, Briony; Syed, Shabeer; Hafford-Letchfield, Trish; O'Farrell-Pearce, Sioban (2020-05-11). "Dog-assisted interventions and outcomes for older adults in residential long-term care facilities: A systematic review and meta-analysis". International Journal of Older People Nursing. 15 (3): e12320. doi:10.1111/opn.12320. ISSN   1748-3735. PMID   32394594.
77. "Sony will repair aging Aibo robot dogs to help them find their forever homes". Yahoo News. 2023-09-11. Retrieved 2024-12-04.
78. Robinson, Hayley; MacDonald, Bruce; Kerse, Ngaire; Broadbent, Elizabeth (2013-03-30). "The Psychosocial Effects of a Companion Robot: A Randomized Controlled Trial". Journal of the American Medical Directors Association. 14 (9): 661–667. doi:10.1016/j.jamda.2013.02.007. ISSN   1525-8610. PMID   23545466.
79. CATTAN, MIMA; WHITE, MARTIN; BOND, JOHN; LEARMOUTH, ALISON (2005-01-10). "Preventing social isolation and loneliness among older people: a systematic review of health promotion interventions". Ageing and Society. 25 (1): 41–67. doi:10.1017/s0144686x04002594 (inactive 5 December 2024). ISSN   0144-686X.