Loneliness is a common, distressing feeling that results when one perceives his/her social relationships and supports as inadequate. Social connectedness refers to the relationships between the individual and his or her family, friends, community, and other supports. Neither loneliness nor social connectedness has received enough research attention, in particular with regard to older adults’ physical and mental health.
China is a rapidly aging society, where the older population aged 60 years and above stood at over 200 million in 2013. By 2030 this number is expected to rise to over 360 million. Traditionally, many older adults in China seek social support from their family members. However, with the dramatic economic and socio-cultural change China has undergone, it is increasingly difficult for older adults to get the social support they require from their families. A recent study in China indicated that about 28% of older Chinese adults reported feeling lonely (Luo and Waite, Reference Luo and Waite2014). Adding to our understanding of this emerging problem is the contribution by Yan et al. (Reference Yan, Yang, Wang, Zhao and Yu2014) in this issue of International Psychogeriatrics. Using cross-temporal meta-analysis, Yan et al. (Reference Yan, Yang, Wang, Zhao and Yu2014) found that levels of loneliness in Chinese older adults have increased by 1.02 standard deviations from 1995 to 2011, and these increased levels were predicted by social indicators such as increased level of urbanization, personal medical expenditure, divorce rate, the Gini coefficient, and rate of unemployment.
Why are these constructs important for the health and well-being of older adults? Many older persons are at risk for loneliness because of declining health and other age-related losses that prevent them from remaining engaged in meaningful relationships. Loneliness and low social supports are associated with poor mental and physical health. Perceptions of social isolation, or loneliness, may increase vigilance for threat and heighten feelings of vulnerability, and these psychological processes may in turn influence physiological functioning, diminish sleep quality, and increase in morbidity and mortality. A meta-analytic review done by Holt-Lunstad and colleagues (Reference Holt-Lunstad, Smith and Layton2010) found strong links of social connectedness to mortality, comparable with the strength of association between mortality and a range of other health behaviors with which people are much more familiar, such as smoking and obesity. Another study on 14,072 Chinese older adults indicated that loneliness affected their self-rated health, and lonely adults faced increased risks of dying over the subsequent years (Luo and Waite, Reference Luo and Waite2014). Many longitudinal studies show an association between loneliness, diabetes, and hypertension in middle-aged and older adults, increased cardiovascular risk in young adults, with incident coronary heart disease (Hawkley and Cacioppo, Reference Hawkley and Cacioppo2010).
Loneliness predicts increase in depressive symptoms, and also perceived stress, fear of negative evaluation, anxiety, and anger (Hawkley and Cacioppo, Reference Hawkley and Cacioppo2010). The importance of social disconnectedness in late-life suicide has been highlighted (Van Orden et al., Reference Van Orden, Stone, Rowe, McIntosh, Podgorski and Conwell2013), and there is a preliminary evidence that loneliness increases the risk of developing dementia. A cohort study of 2,173 non-demented community-living older adults in the Netherlands found, for example, that after controlling for other risk factors, such as socio-demographic factors, medical conditions, depression, cognitive functioning, and functional status, older persons with feelings of loneliness were more likely to develop dementia (OR: 1.64, 95% CI: 1.05 to 2.56) than people without such feelings (Holwerda et al., Reference Holwerda2014).
How then are we to address the problem of social disconnectedness and the loneliness that results in the older adult population? Modifying macro factors such as the rate of urbanization, divorce rate, or rate of unemployment would be a very difficult task; however, benefits may be obtained by developing approaches at the local level to improve support for older adults, including innovative interventions to decrease loneliness in older adults. There is much more to be done in research on the neurobiology of loneliness and mechanisms by which it causes adverse health outcomes, and in the study of systematic screening for social connectedness in those settings in which older adults get care, so that interventions to reduce loneliness and social disconnectedness can be implemented for them. Psychosocial interventions such as problem solving therapy (PST), interpersonal therapy (IPT), and family therapies may be useful means to improve the capacity of older adults to engage with others. Interventions that take full advantage of community-based resources to reduce social isolation in later life would be very useful as well. Such resources are often available in China. Most villages and neighborhoods have community centers that provide social services for older adults. In more than 80% of villages in rural areas and 90% of neighborhoods in urban areas, the community center and primary care clinic are located close to one another, often in the same building. This arrangement ensures that older adults can get social and primary medical services easily in their community, and offers the opportunity for their activities to be coordinated. In the United States, Area Agencies on Aging administer friendly visitor programs, the health impact of which has yet to be studied (Van Orden et al., Reference Van Orden, Stone, Rowe, McIntosh, Podgorski and Conwell2013). They sponsor senior volunteer programs as well, although little research has been conducted on how best to engage older adults who are lonely or socially disconnected or the health benefits that may result (Morrow-Howell, Reference Morrow-Howell2010).
Older adults represent a valuable resource for society because of the experience, knowledge, and skills they possess. We must take full advantage of those assets. Loneliness is damaging for the older person. It also is a sign of the need to better engage the older adult in the family life and their communities for the good of all.
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Loneliness is a common, distressing feeling that results when one perceives his/her social relationships and supports as inadequate. Social connectedness refers to the relationships between the individual and his or her family, friends, community, and other supports. Neither loneliness nor social connectedness has received enough research attention, in particular with regard to older adults’ physical and mental health.
China is a rapidly aging society, where the older population aged 60 years and above stood at over 200 million in 2013. By 2030 this number is expected to rise to over 360 million. Traditionally, many older adults in China seek social support from their family members. However, with the dramatic economic and socio-cultural change China has undergone, it is increasingly difficult for older adults to get the social support they require from their families. A recent study in China indicated that about 28% of older Chinese adults reported feeling lonely (Luo and Waite, Reference Luo and Waite2014). Adding to our understanding of this emerging problem is the contribution by Yan et al. (Reference Yan, Yang, Wang, Zhao and Yu2014) in this issue of International Psychogeriatrics. Using cross-temporal meta-analysis, Yan et al. (Reference Yan, Yang, Wang, Zhao and Yu2014) found that levels of loneliness in Chinese older adults have increased by 1.02 standard deviations from 1995 to 2011, and these increased levels were predicted by social indicators such as increased level of urbanization, personal medical expenditure, divorce rate, the Gini coefficient, and rate of unemployment.
Why are these constructs important for the health and well-being of older adults? Many older persons are at risk for loneliness because of declining health and other age-related losses that prevent them from remaining engaged in meaningful relationships. Loneliness and low social supports are associated with poor mental and physical health. Perceptions of social isolation, or loneliness, may increase vigilance for threat and heighten feelings of vulnerability, and these psychological processes may in turn influence physiological functioning, diminish sleep quality, and increase in morbidity and mortality. A meta-analytic review done by Holt-Lunstad and colleagues (Reference Holt-Lunstad, Smith and Layton2010) found strong links of social connectedness to mortality, comparable with the strength of association between mortality and a range of other health behaviors with which people are much more familiar, such as smoking and obesity. Another study on 14,072 Chinese older adults indicated that loneliness affected their self-rated health, and lonely adults faced increased risks of dying over the subsequent years (Luo and Waite, Reference Luo and Waite2014). Many longitudinal studies show an association between loneliness, diabetes, and hypertension in middle-aged and older adults, increased cardiovascular risk in young adults, with incident coronary heart disease (Hawkley and Cacioppo, Reference Hawkley and Cacioppo2010).
Loneliness predicts increase in depressive symptoms, and also perceived stress, fear of negative evaluation, anxiety, and anger (Hawkley and Cacioppo, Reference Hawkley and Cacioppo2010). The importance of social disconnectedness in late-life suicide has been highlighted (Van Orden et al., Reference Van Orden, Stone, Rowe, McIntosh, Podgorski and Conwell2013), and there is a preliminary evidence that loneliness increases the risk of developing dementia. A cohort study of 2,173 non-demented community-living older adults in the Netherlands found, for example, that after controlling for other risk factors, such as socio-demographic factors, medical conditions, depression, cognitive functioning, and functional status, older persons with feelings of loneliness were more likely to develop dementia (OR: 1.64, 95% CI: 1.05 to 2.56) than people without such feelings (Holwerda et al., Reference Holwerda2014).
How then are we to address the problem of social disconnectedness and the loneliness that results in the older adult population? Modifying macro factors such as the rate of urbanization, divorce rate, or rate of unemployment would be a very difficult task; however, benefits may be obtained by developing approaches at the local level to improve support for older adults, including innovative interventions to decrease loneliness in older adults. There is much more to be done in research on the neurobiology of loneliness and mechanisms by which it causes adverse health outcomes, and in the study of systematic screening for social connectedness in those settings in which older adults get care, so that interventions to reduce loneliness and social disconnectedness can be implemented for them. Psychosocial interventions such as problem solving therapy (PST), interpersonal therapy (IPT), and family therapies may be useful means to improve the capacity of older adults to engage with others. Interventions that take full advantage of community-based resources to reduce social isolation in later life would be very useful as well. Such resources are often available in China. Most villages and neighborhoods have community centers that provide social services for older adults. In more than 80% of villages in rural areas and 90% of neighborhoods in urban areas, the community center and primary care clinic are located close to one another, often in the same building. This arrangement ensures that older adults can get social and primary medical services easily in their community, and offers the opportunity for their activities to be coordinated. In the United States, Area Agencies on Aging administer friendly visitor programs, the health impact of which has yet to be studied (Van Orden et al., Reference Van Orden, Stone, Rowe, McIntosh, Podgorski and Conwell2013). They sponsor senior volunteer programs as well, although little research has been conducted on how best to engage older adults who are lonely or socially disconnected or the health benefits that may result (Morrow-Howell, Reference Morrow-Howell2010).
Older adults represent a valuable resource for society because of the experience, knowledge, and skills they possess. We must take full advantage of those assets. Loneliness is damaging for the older person. It also is a sign of the need to better engage the older adult in the family life and their communities for the good of all.
Conflict of interest
None