Interventions Associated With Reduced Loneliness and Social Isolation in Older Adults

Abstract

ImportanceLoneliness and social isolation are public health concerns faced by older adults due to physical, cognitive, and psychosocial changes that develop with aging. Loneliness and social isolation are associated with increased morbidity and mortality.ObjectiveTo evaluate interventions, targeting older adults, associated with a reduction in loneliness and social isolation.Data SourcesOVID, CINAHL, CENTRAL, Embase, PsychINFO, Web of Science, and Scopus were searched from inception to March 2020.Study SelectionPeer-reviewed randomized clinical trials measuring loneliness and social isolation or support in adults aged 65 years or older. Only English language articles were included.Data Extraction and SynthesisTwo independent reviewers screened studies, extracted data, and assessed risk of bias. Random-effects models were performed to pool the overall effect size by intervention. Statistical heterogeneity was evaluated with the I2 statistic and by estimating prediction intervals. Data were analyzed from November 2021 to September 2022.Main Outcomes and MeasuresQuantitative measures of loneliness, social isolation, or social support based on an effect size of standardized mean differences.ResultsSeventy studies were included in the systematic review (8259 participants); 44 studies were included in the loneliness meta-analysis (33 in the community with 3535 participants; 11 in long-term care with 1057 participants), with participants’ ages ranging from 55 to 100 years. Study sizes ranged from 8 to 741 participants. Interventions included animal therapy, psychotherapy or cognitive behavioral therapy, multicomponent, counseling, exercise, music therapy, occupational therapy, reminiscence therapy, social interventions, and technological interventions. Most interventions had a small effect size. Animal therapy in long-term care, when accounting for studies with no active controls, had the largest effect size on loneliness reduction (−1.86; 95% CI, −3.14 to −0.59; I2 = 86%) followed by technological interventions (videoconferencing) in long-term care (−1.40; 95% CI, −2.37 to −0.44; I2 = 70%).Conclusions and RelevanceIn this study, animal therapy and technology in long-term care had large effect sizes, but also high heterogeneity, so the effect size’s magnitude should be interpreted with caution. The small number of studies per intervention limits conclusions on sources of heterogeneity. Overall quality of evidence was very low. Future studies should consider measures of social isolation in long-term care and identify the contextual components that are associated with a reduction in loneliness.

Online acceptance and commitment therapy as treatment for loneliness among older adults: Report of a pilot study

“…Recent meta-analyses modeling CBT interventions for loneliness found average effect sizes of 0.47 and 0.52. 6,24 Although this study employed a quasi-experimental design, the use of a propensity-matched comparison group to adjust for regression to the mean helped to strengthen the final conclusions. Ideal experimental designs are often not achievable in process improvement environments.…”

“…The current intervention's adjusted effect size of 0.49 compares favorably with a variety of other psychological interventions and other direct attempts to mitigate loneliness. Recent meta‐analyses modeling CBT interventions for loneliness found average effect sizes of 0.47 and 0.52 6,24 …”

Retrospective cross-sectional study examining the association between loneliness and unmet healthcare needs among middle-aged and older adults using the Canadian Longitudinal Study of Aging (CLSA)

“…Our finding that lonely individuals report more unmet healthcare needs, irrespective of sociodemographic and health factors, could also indicate that loneliness contributes to a persistent feeling of dissatisfaction, reinforcing the feeling that a need is not being met. Interventions aimed at reducing loneliness have been described in numerous reviews, ranging from personal contact interventions (eg, friendly visitor programmes) to animal/pet therapy and various technological interventions51 52; however, these reviews found small to medium effect sizes and note significant limitations of the included studies such as variable study quality, small sample sizes, distinct populations (eg, community vs nursing homes) and incomparable loneliness measures. Efforts to address loneliness will remain stalled until findings from robust interventions are available.…”

Breaking the vicious cycle: The interplay between loneliness, metabolic illness, and mental health

“…Examples of interventions found to increase oxytocin signaling include skin-to-skin stimulation like massages, gustatory stimulation, positive human interactions like cohabitation and safe, consensual sexual interactions, and interaction with pets ( 48 ). Notably, a systematic review and meta-analysis of 44 studies found that animal therapy is more effective than psychotherapy and occupational therapy, among other types of interventions, in reducing loneliness among older adults ( 94 ).…”