Skip to main content

A Review of Social Isolation: An Important but Underassessed Condition in Older Adults

Abstract

Social isolation is a major and prevalent health problem among community-dwelling older adults, leading to numerous detrimental health conditions. With a high prevalence, and an increasing number of older persons, social isolation will impact the health, well-being, and quality of life of numerous older adults now and in the foreseeable future. For this review, a series of literature searches of the CINAHL, PsycINFO, and Medline databases were conducted, using the key words “social isolation,” “social networks,” “older adults,” “elderly,” “belonging,” “perceived isolation,” “social engagement,” “social contacts,” and “social integration,” for the period of 1995–2010. The results show that there is an overabundance of evidence demonstrating numerous negative health outcomes and potential risk factors related to social isolation. However, there is scarce evidence that public health professionals are assessing social isolation in older persons, despite their unique access to very socially isolated, homebound older adults. Additionally, few viable interventions were found; therefore, it is advisable to focus on the prevention of social isolation in older adults. Public health professionals can take steps toward increasing the early assessment of social isolation and referring at-risk individuals to available community resources in order to prevent social isolation or further isolation, which would serve to reduce the numerous negative health outcomes associated with this condition.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  • Ackley, B., & Ladwig, G. (2010). Nursing diagnosis handbook: An evidence-based guide to planning care (9th Edn.). Maryland Heights, Mo.: Mosby.

  • Ajrouch, K. J., Antonucci, T. C., & Janevic, M. R. (2001). Social networks among blacks and whites: The interaction between race and age. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 56, S112–S118. Retrieved from http://psychsoc.gerontologyjournals.org/cgi/content/full/56/2/S112.

  • Antonucci, T. C., Akiyama, H., & Lansford, J. (1998). Negative effects of close social relations. Family Relations, 47(4), 379–384. doi:10.2307/585268.

    Article  Google Scholar 

  • Bassuk, S. S., Glass, T. A., & Berkman, L. F. (1999). Social disengagement and incident cognitive decline in community-dwelling elderly persons. Annals of Internal Medicine, 131, 165–173. doi:10.1037/0033-2909.104.1.97.

    PubMed  CAS  Google Scholar 

  • Beland, F., Zunzunegui, M. V., Alvarado, B., Otero, A., & Del Ser, T. (2005). Trajectories of cognitive decline and social relations. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 60, P320–P330. Retrieved from http://psychsoc.gerontologyjournals.org/cgi/reprint/60/6/P320.

  • Berkman, L. (1984). Assessing the physical health effects of social networks and social support. Annual Review of Public Health, 5, 413–432. Retrieved from http://arjournals.annualreviews.org/doi/pdf/10.1146/annurev.pu.05.050184.002213?cookieSet=1.

  • Berkman, L. F. (2000). Which influences cognitive function: Living alone or being alone?. Lancet, 355, 1291–1292. doi:10.1016/S0140-6736(00)02107-3.

    PubMed  Article  CAS  Google Scholar 

  • Berkman, L. F., Glass, T., Brissette, I., & Seeman, T. E. (2000). From social integration to health: Durkheim in the new millennium. Social Science and Medicine, 51, 843–857. doi:10.1016/S0277-9536(00)00065-4.

    PubMed  Article  CAS  Google Scholar 

  • Berkman, L., & Syme, L. (1979). Social networks, host resistance, and mortality: A nine-year follow-up study of alameda county residents. American Journal of Epidemiology, 109, 186–204. Retrieved from http://aje.oxfordjournals.org/cgi/reprint/109/2/186.

    Google Scholar 

  • Blazer, D. (2005). Depression and social support in late life: A clear but not obvious relationship. Aging & Mental Health, 9, 497–499. doi:10.1080/13607860500294266.

    Article  CAS  Google Scholar 

  • Boden-Albala, B., Litwak, E., Elkind, M. S., Rundek, T., & Sacco, R. L. (2005). Social isolation and outcomes post stroke. Neurology, 64, 1888–1892. doi:10.1212/01.WNL.0000163510.79351.AF.

    PubMed  Article  CAS  Google Scholar 

  • Brock, A. M., & O’Sullivan, P. (1985). A study to determine what variables predict institutionalization of elderly people. Journal of Advanced Nursing, 10, 533–537. doi:10.1111/j.1365-2648.1985.tb00544.x.

    PubMed  Article  CAS  Google Scholar 

  • Cattan, M., White, M., Bond, J., & Learmouth, A. (2005). Preventing social isolation and loneliness among older adults: A systematic review of health promotion interventions. Aging & Society, 25, 41.

    Article  Google Scholar 

  • Centers for Disease Control and Prevention, & Merck Company Foundation. (2007). The state of aging and health in America 2007. Whitehouse Station, NJ: The Merck Company Foundation. Retrieved from http://www.cdc.gov/Aging/pdf/saha_2007.pdf.

  • Chipperfield, J. G., & Havens, B. (2001). Gender differences in the relationship between marital status transitions and life satisfaction in later life. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 56, P176–P186. Retrieved from http://psychsoc.gerontologyjournals.org/cgi/content/full/56/3/P176.

  • Christakis, N. A., & Fowler, J. H. (2007). The spread of obesity in a large social network over 32 years. The New England Journal of Medicine, 357, 370–379. doi:10.1056/NEJMsa066082.

    PubMed  Article  CAS  Google Scholar 

  • Cohen, S., Doyle, W. J., Skoner, D. P., Rabin, B. S., & Gwaltney, J. M., Jr. (1997). Social ties and susceptibility to the common cold. JAMA, 277, 1940–1944. doi:10.1001/jama.277.24.1940.

    PubMed  Article  CAS  Google Scholar 

  • Colantonio, A., Kasl, S. V., Ostfeld, A. M., & Berkman, L. F. (1993). Psychosocial predictors of stroke outcomes in an elderly population. Journal of Gerontology, 48, S261–S268. Retrieved from http://geronj.oxfordjournals.org/cgi/reprint/48/5/S261.

  • De Vogli, R., Chandola, T., & Marmot, M. G. (2007). Negative aspects of close relationships and heart disease. Archives of Internal Medicine, 167(18), 1951–1957. doi:10.1001/archinte.167.18.1951.

    PubMed  Article  Google Scholar 

  • Dorfman, R. A., Lubben, J. E., Mayer-Oakes, A., Atchison, K., Schweitzer, S. O., De Jong, F. J., et al. (1995). Screening for depression among a well elderly population. Social Work, 40, 295–304. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/7761915.

  • Driscoll, H. C., Serody, L., Patrick, S., Maurer, J., Bensasi, S., Houck, P. R., et al. (2008). Sleeping well, aging well: A descriptive and cross-sectional study of sleep in “successful agers” 75 and older. The American Journal of Geriatric Psychiatry, 16, 74–82. doi:10.1097/JGP.0b013e3181557b69.

    PubMed  Article  Google Scholar 

  • Elovainio, M., Kivimaki, M., Vahtera, J., Ojanlatva, A., Korkeila, K., Suominen, S., et al. (2003). Social support, early retirement, and a retirement preference: A study of 10,489 Finnish adults. Journal of Occupational and Environmental Medicine, 45, 433–439. doi:10.1097/01.jom.0000058334.05741.7a.

    PubMed  Article  Google Scholar 

  • Eng, P. M., Rimm, E. B., Fitzmaurice, G., & Kawachi, I. (2002). Social ties and change in social ties in relation to subsequent total and cause-specific mortality and coronary heart disease incidence in men. American Journal of Epidemiology, 155, 700–709. doi:10.1093/aje/155.8.700.

    PubMed  Article  Google Scholar 

  • Faulkner, K. A., Cauley, J. A., Zmuda, J. M., Griffin, J. M., & Nevitt, M. C. (2003). Is social integration associated with the risk of falling in older community-dwelling women? The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 58, M954–M959. Retrieved from http://biomed.gerontologyjournals.org/cgi/content/full/58/10/M954.

  • Foley, D. J., Monjan, A. A., Brown, S. L., Simonsick, E. M., Wallace, R. B., & Blazer, D. G. (1995). Sleep complaints among elderly persons: An epidemiologic study of three communities. Sleep, 18, 425–432. Retrieved from http://www.journalsleep.org/ViewAbstract.aspx?pid=24560.

  • Fowles, D., & Greenberg, S. (2009). A profile of older Americans: 2008. Retrieved October 10, 2009, from http://www.aoa.gov/AoAroot/Aging_Statistics/Profile/2008/index.aspx.

  • Fratiglioni, L., Paillard-Borg, S., & Winblad, B. (2004). An active and socially integrated lifestyle in late life might protect against dementia. Lancet Neurology, 3, 343–353. doi:10.1016/S1474-4422(04)00767-7.

    PubMed  Article  Google Scholar 

  • Fratiglioni, L., Wang, H. X., Ericsson, K., Maytan, M., & Winblad, B. (2000). Influence of social network on occurrence of dementia: A community-based longitudinal study. Lancet, 355, 1315–1319. doi:10.1016/S0140-6736(00)02113-9.

    PubMed  Article  CAS  Google Scholar 

  • Fultz, N. H., & Herzog, A. R. (2001). Self-reported social and emotional impact of urinary incontinence. Journal of the American Geriatrics Society, 49, 892–899. doi:10.1046/j.1532-5415.2001.49179.x.

    PubMed  Article  CAS  Google Scholar 

  • Gallicchio, L., Hoffman, S. C., & Helzlsouer, K. J. (2007). The relationship between gender, social support, and health-related quality of life in a community-based study in Washington County, Maryland. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 16, 777–786. doi:10.1007/s11136-006-9162-4.

    Article  Google Scholar 

  • Gavira Iglesias, F. J., Caridad y Ocerin, J. M., Perez del Molino Martin, J., Valderrama Gama, E., Lopez Perez, M., Romero Lopez, M., et al. (2000). Prevalence and psychosocial impact of urinary incontinence in older people of a Spanish rural population. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 55, M207–M214. Retrieved from http://biomed.gerontologyjournals.org/cgi/content/full/55/4/M207.

  • Giles, L. C., Glonek, G. F., Luszcz, M. A., & Andrews, G. R. (2005). Effect of social networks on 10 year survival in very old Australians: The Australian longitudinal study of aging. Journal of Epidemiology and Community Health, 59, 574–579.

    PubMed  Article  Google Scholar 

  • Gordis, L. (2009). Epidemiology (4th Edn.). Philadelphia, Pa.: Saunders Elsevier.

  • Hanson, B. S. (1994). Social network, social support and heavy drinking in elderly men-a population study of men born in 1914, Malmo, Sweden. Addiction, 89, 725–732. doi:10.1111/j.1360-0443.1994.tb00958.x.

    PubMed  Article  CAS  Google Scholar 

  • Hanson, B. S., Isacsson, S. O., Janzon, L., & Lindell, S. E. (1990). Social support and quitting smoking for good is there an association? Results from the population study, “men born in 1914,” Malmo, Sweden. Addictive Behaviors, 15, 221–233. doi:10.1016/0306-4603(90)90065-6.

    PubMed  Article  CAS  Google Scholar 

  • Havens, B., & Hall, M. (2001). Social isolation, loneliness, and the health of older adults in Manitoba, Canada. Indian Journal of Gerontology, 1, 126–144.

    Google Scholar 

  • Havens, B., Hall, M., Sylvestre, G., & Jivan, T. (2004). Social isolation and loneliness: Differences between older rural and urban Manitobans. Canadian Journal on Aging, 23, 129–140. doi:10.1353/cja.2004.0022.

    PubMed  Article  Google Scholar 

  • He, W., Sengupta, M., Velkoff, V., DeBarros, K., U.S. Department of Health and Human Services, & U.S. Department of Commerce. (2005). Current population reports: United States Census Bureau: 65+ in the United States 2005 No. P23-209). Washington, DC: United States Census Bureau. Retrieved from http://www.census.gov/prod/2006pubs/p23-209.pdf.

  • Heine, C., Erber, N. P., Osborn, R., & Browning, C. J. (2002). Communication perceptions of older adults with sensory loss and their communication partners: Implications for intervention. Disability and Rehabilitation, 24, 356–363. doi:10.1080/09638280110096250.

    PubMed  Article  CAS  Google Scholar 

  • House, J. S., Landis, K. R., & Umberson, D. (1988). Social relationships and health. Science, 241, 540–545. Retrieved from http://www.jstor.org/sici?origin=sfx%3Asfx&sici=0036-8075%28198807%29241%3A4865%3C540%3ASRAH%3E2.0.CO%3B2-2.

  • Howat, P., Iredell, H., Grenade, L., Nedwetzky, A., & Collins, J. (2004). Reducing social isolation amongst older people implications for health professionals. Geriatrician, 22, 13–20.

    Google Scholar 

  • Iliffe, S., Kharicha, K., Harari, D., Swift, C., Gillmann, G., & Stuck, A. E. (2007). Health risk appraisal in older people 2: The implications for clinicians and commissioners of social isolation risk in older people. The British Journal of General Practice, 57, 277–282. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2043334/?tool=pubmed.

  • Jang, Y., Mortimer, J., Haley, W., Small, B., Chisolm, T., & Graves, A. (2003). The role of vision and hearing in physical, social, and emotional functioning among older adults. Research on Aging, 25, 172–191. doi:10.1177/0164027502250019.

    Article  Google Scholar 

  • Kinney, A. Y., Bloor, L. E., Martin, C., & Sandler, R. S. (2005). Social ties and colorectal cancer screening among blacks and whites in North Carolina. Cancer Epidemiology, Biomarkers & Prevention, 14, 182–189. Retrieved from http://cebp.aacrjournals.org/content/14/1/182.long.

  • Lewis, D., & Salem, G. (1986). Fear of crime: Incivility and the production of a social problem. New Brunswick, NJ: Transaction Books.

    Google Scholar 

  • Lim, J. W., & Zebrack, B. (2006). Social networks and quality of life for long-term survivors of leukemia and lymphoma. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 14, 185–192. doi:10.1007/s00520-005-0856-x.

  • Locher, J. L., Ritchie, C. S., Roth, D. L., Baker, P. S., Bodner, E. V., & Allman, R. M. (2005). Social isolation, support, and capital and nutritional risk in an older sample: Ethnic and gender differences. Social Science and Medicine, 60, 747–761. doi:10.1016/j.socscimed.2004.06.023.

    PubMed  Article  Google Scholar 

  • Lubben, J., Blozik, E., Gillmann, G., Iliffe, S., von Renteln Kruse, W., Beck, J. C., et al. (2006). Performance of an abbreviated version of the lubben social network scale among three European community-dwelling older adult populations. The Gerontologist, 46, 503–513.

    PubMed  Article  Google Scholar 

  • Lubben, J., & Gironda, M. (2000). Social support networks. In D. Osterweil, K. Brummel-Smith & J. C. Beck (Eds.), Comprehensive geriatric assessment (pp. 121). New York: McGraw-Hill, Medical Publishing Division.

  • Lubben, J., & Gironda, M. (2003). Centrality of social ties to the health and well being of older adults. In B. Berkman & L. Harooytan (Eds.), Social work and health care in an aging world: Informing education, policy, practice, and research (pp. 319–350). New York: Springer.

    Google Scholar 

  • Luggen, A. S., & Rini, A. G. (1995). Assessment of social networks and isolation in community-based elderly men and women. Geriatric Nursing, 16, 179–181. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/7628744.

  • McCrae, N., Murray, J., Banerjee, S., Huxley, P., Bhugra, D., Tylee, A., et al. (2005). ‘They’re all depressed, aren’t they?’ A qualitative study of social care workers and depression in older adults. Aging & Mental Health, 9, 508–516. doi:10.1080/13607860500193765.

    Article  CAS  Google Scholar 

  • Mendes de Leon, C. F., Glass, T. A., Beckett, L. A., Seeman, T. E., Evans, D. A., & Berkman, L. F. (1999). Social networks and disability transitions across eight intervals of yearly data in the new haven EPESE. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 54, S162S172. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10363047.

  • Mendes de Leon, C. F., Glass, T. A., & Berkman, L. F. (2003). Social engagement and disability in a community population of older adults: The new haven EPESE. American Journal of Epidemiology, 157, 633–642. doi:10.1093/aje/kwg028.

    PubMed  Article  Google Scholar 

  • Mendes de Leon, C. F., Gold, D., Glass, T., Kaplan, L., & George, L. (2001). Disability as a function of social networks and support in elderly African Americans and whites: The duke EPESE 1986-1992. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 56B, S179–S190. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11316843.

  • Michael, Y. L., Berkman, L. F., Colditz, G. A., Holmes, M. D., & Kawachi, I. (2002). Social networks and health-related quality of life in breast cancer survivors: A prospective study. Journal of Psychosomatic Research, 52, 285–293. doi:10.1016/S0022-3999(01)00270-7.

    PubMed  Article  Google Scholar 

  • Mistry, R., Rosansky, J., McGuire, J., McDermott, C., Jarvik, L., & UPBEAT Collaborative Group. (2001). Social isolation predicts re-hospitalization in a group of older American veterans enrolled in the UPBEAT program: Unified psychogeriatric biopsychosocial evaluation and treatment. International Journal of Geriatric Psychiatry, 16, 950–959. doi:10.1002/gps.447.

    Google Scholar 

  • Nicholson, N. (2009). Social isolation in older adults: An evolutionary concept analysis. Journal of Advanced Nursing, 65, 1342–1352. doi:10.1111/j.1365-2648.2008.04959.x.

    PubMed  Article  Google Scholar 

  • Nicholson, N., Molony, S., Fennie, K., Shellman, J., & McCorkle, R. (2010). Predictors of social isolation in community living older persons. Unpublished PhD, Yale University, New Haven, CT.

  • Pagel, M. D., Erdly, W. W., & Becker, J. (1987). Social networks: We get by with (and in spite of) a little help from our friends. Journal of Personality and Social Psychology, 53(4), 793–804. doi:10.1037/0022-3514.53.4.793.

    PubMed  Article  CAS  Google Scholar 

  • Peek, M. K., & O’Neill, G. S. (2001). Networks in later life: An examination of race differences in social support networks. International Journal of Aging and Human Development, 52, 207–229. doi:10.2190/F1Q1-JV7D-VN77-L6WX.

    PubMed  Article  CAS  Google Scholar 

  • Ross, C. E., & Jang, S. J. (2000). Neighborhood disorder, fear, and mistrust: The buffering role of social ties with neighbors. American Journal of Community Psychology, 28, 401–420. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10965384.

    Google Scholar 

  • Routasalo, P. E., Tilvis, R. S., Kautiainen, H., & Pitkala, K. H. (2009). Effects of psychosocial group rehabilitation on social functioning, loneliness and well-being of lonely, older people: Randomized controlled trial. Journal of Advanced Nursing, 65, 297–305. doi:10.1111/j.1365-2648.2008.04837.x.

    PubMed  Article  Google Scholar 

  • Schoevers, R. A., Beekman, A. T., Deeg, D. J., Geerlings, M. I., Jonker, C., & Van Tilburg, W. (2000). Risk factors for depression in later life; results of a prospective community based study (AMSTEL). Journal of Affective Disorders, 59, 127–137. doi:10.1016/S0165-0327(99)00124-X.

    PubMed  Article  CAS  Google Scholar 

  • Seeman, T. E. (2000). Health promoting effects of friends and family on health outcomes in older adults. American Journal of Health Promotion: AJHP, 14(6), 362–370. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11067571.

    Google Scholar 

  • Smith, T. F., & Hirdes, J. P. (2009). Predicting social isolation among geriatric psychiatry patients. International Psychogeriatrics, 21, 50–59. doi:10.1017/S1041610208007850.

    PubMed  Article  Google Scholar 

  • Strawbridge, W. J., Cohen, R. D., Shema, S. J., & Kaplan, G. A. (1997). Frequent attendance at religious services and mortality over 28 years. American Journal of Public Health, 87, 957–961. doi:10.2105/AJPH.87.6.957.

    PubMed  Article  CAS  Google Scholar 

  • Strawbridge, W. J., Wallhagen, M. I., Shema, S. J., & Kaplan, G. A. (2000). Negative consequences of hearing impairment in old age: A longitudinal analysis. The Gerontologist, 40, 320–326. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10853526.

  • The National Council on the Aging. (1999). The consequences of untreated hearing loss in older persons No. 2008).

  • Tsai, H. H., & Tsai, Y. F. (2007). Problem-solving experiences among elders living alone in eastern Taiwan. Journal of Clinical Nursing, 16, 980–986. doi:10.1111/j.1365-2702.2006.01853.x.

    PubMed  Article  Google Scholar 

  • Wang, H. X., Karp, A., Winblad, B., & Fratiglioni, L. (2002). Late-life engagement in social and leisure activities is associated with a decreased risk of dementia: A longitudinal study from the Kungsholmen project. American Journal of Epidemiology, 155, 1081–1087. doi:10.1093/aje/155.12.1081.

    PubMed  Article  Google Scholar 

  • Weinstein, B. E., & Ventry, I. M. (1982). Hearing impairment and social isolation in the elderly. Journal of Speech and Hearing Research, 25, 593–599. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/7162161.

  • Wenger, G. C., & Burholt, V. (2004). Changes in levels of social isolation and loneliness among older people in a rural area: A twenty-year longitudinal study. Canadian Journal on Aging, 23, 115–127. doi:10.1353/cja.2004.0028.

    PubMed  Article  Google Scholar 

  • World Health Organization. (2003). Preamble to the constitution of the world health organization as adopted by the international health conference, new york, 1922 June, 1946; signed on 22 July 1946 by the representatives of 61 states (official records of the world health organization, no. 2, p. 100) and entered into force on 7 April 1948. Retrieved September 29, 2010, from http://www.who.int/about/definition/en/print.html.

  • Wyman, J. F., Harkins, S. W., & Fantl, J. A. (1990). Psychosocial impact of urinary incontinence in the community-dwelling population. Journal of the American Geriatrics Society, 38, 282–288. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/2179369.

  • Zuckerman, D. M., Kasl, S. V., & Ostfeld, A. M. (1984). Psychosocial predictors of mortality among the elderly poor. The role of religion, well-being, and social contacts. American Journal of Epidemiology, 119, 410–423. Retrieved from http://aje.oxfordjournals.org/cgi/reprint/119/3/410.

  • Zunzunegui, M. V., Alvarado, B. E., Del Ser, T., & Otero, A. (2003). Social networks, social integration, and social engagement determine cognitive decline in community-dwelling Spanish older adults. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 58, S93–S100. Retrieved from http://psychsoc.gerontologyjournals.org/cgi/content/full/58/2/S93.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nicholas R. Nicholson.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Nicholson, N.R. A Review of Social Isolation: An Important but Underassessed Condition in Older Adults. J Primary Prevent 33, 137–152 (2012). https://doi.org/10.1007/s10935-012-0271-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10935-012-0271-2

Keywords

  • Social isolation
  • Social networks
  • Older adults
  • Aging
  • Geriatrics
  • Review