Authored by Sarah Lim
For the first time in history, the number of people aged 60 years or older outnumbered children under five. The world’s population is aging rapidly, owing to increased life expectancy and decreased fertility rates, particularly in developed nations [1]. In 2021, the proportion of individuals aged 65 or older across 38 OECD countries surpassed 17% and is projected to reach nearly 30% by 2050 [2]. Population aging stands out as one of the most formidable challenges for the coming decades. As older adults increasingly shape the demographic makeup of societies worldwide, it is vital to foster a deeper understanding of the aging process and its associated challenges. By recognizing and responding to seniors’ unique needs and experiences, we can help develop strategies to provide adequate old age support, promote healthy aging, and build a more inclusive and age-friendly society.
Aging is a complex and multifaceted process that affects people physically, mentally, and emotionally. Loneliness, or the feeling associated with the absence of a companion or a limited social network, is one of the most prevalent emotional challenges that older adults face [3]. In fact, research indicates that half of individuals over 60 are at risk of social isolation, and one-third will experience loneliness later in life [4]. As people grow old, their social circles diminish due to various factors, such as retirement, changes in living situations, the loss of close friends or family members, chronic illness, and decreased physical mobility. While loneliness in general does not constitute a psychiatric disorder, its impact on the health and well-being of older adults is substantial. Meta-analyses have found that loneliness is associated with a 50% increased risk of developing dementia and a 30% increased risk of developing coronary artery disease and stroke, independent of traditional risk factors for cardiovascular disease [5]. Other studies have found that loneliness relates to various physical and psychiatric problems in older adults, such as depression, anxiety, higher blood pressure, weakened immunity, cognitive decline and impairment, suicidal thoughts, and even premature mortality [6].
Social isolation is another pervasive problem affecting older adults, closely related to loneliness. While many mistakenly use loneliness and social isolation interchangeably, there is a clear distinction between the two concepts, and addressing them requires different approaches. Whereas loneliness is the perceived lack of companionship or intimacy, social isolation is the objective lack of contact with others, resulting from physical separation [4]. While not all socially isolated individuals experience loneliness (and those who frequently interact with others can still feel lonely), studies found that social isolation increases the risk of loneliness in older adults, making them more susceptible to adverse health consequences. For instance, social isolation in older adults is linked to increased risk of depression, decreased life satisfaction and happiness, and decreased health-related quality of life. Isolated seniors are also more likely to develop unhealthy behaviors (i.e., smoking, excessive drinking, and low physical activity) and less likely to benefit from social resources (i.e., social support, caregiving, and healthcare access), ultimately contributing to the development of these adverse health outcomes.
The onset of the COVID-19 pandemic only further highlighted the impact of social isolation and loneliness on the mental well-being of seniors. While social distancing guidelines and restrictions on mass gatherings have played an undeniably critical role in preventing the spread of the virus, they have also taken a significant toll on older adults’ physical and mental health. The psychological consequences of prolonged social isolation and loneliness during the pandemic were especially detrimental for those in long-term facilities and nursing homes when the government issued a lockdown shortly after the outbreak [7]. Residents reported feeling isolated from their loved ones, in addition to experiencing feelings of loneliness, abandonment, social exclusion, stress, depression, and anxiety. Similar effects were observed among older adults in general. According to a national poll conducted by the University of Michigan, 46% of individuals aged 50 to 80 reported infrequent social contact, and 56% reported feeling isolated from others in June 2020, compared to 28% and 27% in 2018, respectively [8]. Additionally, infrequent social contact was more common among individuals who reported fair or poor physical health (compared to those with better physical health) and those with more depressive symptoms.
Despite the growing body of evidence that social isolation and loneliness lead to adverse health outcomes and a poor quality of life for older adults, these issues are often overlooked. However, as the world’s population ages at an unprecedented rate, it is absolutely imperative that societies recognize the pressing need to address these challenges and bolster social connections among older adults. While there are many interventions aimed at reducing loneliness and social isolation among seniors, their effectiveness varies substantially due to the individuality of these experiences [4]. Future research should focus on developing a more robust framework for categorizing interventions based on their components (e.g. delivery mode, setting, personnel, activities, resources) and for understanding how these components interact with individual characteristics (e.g. age, health status, access to transport, degree of isolation, cultural characteristics). Such framework will be useful for discerning what programs work for whom and in which contexts, and the mechanisms by which they operate. These insights will be highly valuable in the design and implementation of programmes to combat loneliness and social isolation in older adults.
Works Cited
Olshansky, S. J. & Carnes, B. A. (2019). Inconvenient truths about human longevity. The Journals of Gerontology, 74, S7-S12. https://doi.org/10.1093/gerona/glz098
OECD. (2021). Health at a Glance 2021. OECD Publishing. https://doi.org/10.1787/ae3016b9-en
Singh, A. & Misra, N. (2009). Loneliness, depression and sociability in old age. Industrial Psychiatry Journal, 18(1), 51-55. https://doi.org/10.4103/0972-6748.57861
Fakoya, O. A., McCorry, N. K., & Donnelly, M. (2020). Loneliness and social isolation interventions for older adults: A scoping review of reviews. BMC Public Health, 20(129). https://doi.org/10.1186/s12889-020-8251-6
Donovan, N. J. & Blazer, D. (2020). Social isolation and loneliness in older adults: Review and commentary of a national academies report. The American Journal of Geriatric Psychiatry, 28(12), 1233-1244. https://doi.org/10.1016/j.jagp.2020.08.005
Cacioppo, S., Grippo, A. J., London, S., Goossens, L., & Cacioppo, J. T. (2015). Loneliness: Clinical import and interventions. Perspectives on Psychological Science, 10(2), 238-249. https://doi.org/10.1177/1745691615570616
Tappenden, I. & Tomar, R. (2020). Mental health impacts of social isolation in older people during COVID pandemic. Progress in Neurology and Psychiatry, 24(4), 25-29. https://doi.org/10.1002/pnp.684
Piette, J., Solway, E., Singer, D., Kirch, M., Kullgren, J., & Malani, P. (2020). Loneliness among older adults before and during the COVID-19 pandemic. University of Michigan National Poll on Healthy Aging. http://hdl.handle.net/2027.42/162549