Loneliness, Social Isolation, and Living Alone: a Comprehensive Systematic Review, Meta-analysis, and Meta-regression of Mortality Risks in Older Adults

Overview

Journal Aging Clin Exp Res

Publisher Springer

Date 2025 Jan 21

PMID 39836319

Authors

Agni Nakou

Elena Dragioti

Nikolaos-Stefanos Bastas

Nektaria Zagorianakou

Varvara Kakaidi

Dimitrios Tsartsalis

Stefanos Mantzoukas

Fotios Tatsis

Nicola Veronese

Marco Solmi

Mary Gouva

Affiliations

Soon will be listed here.

Abstract

Loneliness, social isolation, and living alone are significant risk factors for mortality, particularly in older adults. This systematic review and meta-analysis aimed to quantify their associations with all-cause and cause-specific mortality in older adults, broadening previous research by including more social factors. Comprehensive searches were conducted in PubMed, APA PsycINFO, and CINAHL until December 31, 2023, following PRISMA 2020 and MOOSE guidelines. Studies included were prospective cohort or longitudinal studies examining the relationship between loneliness, social isolation, living alone, and mortality. Quality was assessed using the Newcastle-Ottawa Scale. Meta-analyses used random-effects models with the Restricted Maximum Likelihood method. Subgroup and meta-regression analyses explored the relationships further. Of 11,964 identified studies, 86 met the inclusion criteria. Loneliness was associated with increased all-cause mortality (HR 1.14, 95% CI 1.10-1.18), with substantial heterogeneity (I² = 84.0%). Similar associations were found for social isolation (HR 1.35, 95% CI 1.27-1.43) and living alone (HR 1.21, 95% CI 1.13-1.30). Subgroup analyses revealed variations based on factors like sex, age, region, chronic diseases, and study quality. Meta-regression identified longer follow-up, female sex, validated social network indices, adjustments for cognitive function, and study quality as significant predictors of mortality risks. These findings highlight the need for public health interventions to address these social factors and improve health outcomes in older adults. However, further research is needed due to variability and heterogeneity across studies. Also studying the cumulative effect of these factors on mortality risks will be of considerable interest.

References

Blakoe M, Christensen A, Palm P, Hojskov I, Thrysoee L, Thorup C . Prognostic value of a brief loneliness questionnaire for patients with coronary heart disease: Proposal for a prediction model. J Clin Nurs. 2021; 31(11-12):1686-1696. DOI: 10.1111/jocn.16023. View

Wang J, Zhang W, Jiang C, Zhu F, Jin Y, Cheng K . Associations of face-to-face and non-face-to-face social isolation with all-cause and cause-specific mortality: 13-year follow-up of the Guangzhou Biobank Cohort study. BMC Med. 2022; 20(1):178. PMC: 9059436. DOI: 10.1186/s12916-022-02368-3. View

Fakoya O, McCorry N, Donnelly M . How do befriending interventions alleviate loneliness and social isolation among older people? A realist evaluation study. PLoS One. 2021; 16(9):e0256900. PMC: 8428774. DOI: 10.1371/journal.pone.0256900. View

Saito M, Aida J, Cable N, Zaninotto P, Ikeda T, Tsuji T . Cross-national comparison of social isolation and mortality among older adults: A 10-year follow-up study in Japan and England. Geriatr Gerontol Int. 2020; 21(2):209-214. PMC: 7898799. DOI: 10.1111/ggi.14118. View

OSuilleabhain P, Gallagher S, Steptoe A . Loneliness, Living Alone, and All-Cause Mortality: The Role of Emotional and Social Loneliness in the Elderly During 19 Years of Follow-Up. Psychosom Med. 2019; 81(6):521-526. PMC: 6615929. DOI: 10.1097/PSY.0000000000000710. View

Penninx B, van Tilburg T, Kriegsman D, Deeg D, Boeke A, van Eijk J . Effects of social support and personal coping resources on mortality in older age: the Longitudinal Aging Study Amsterdam. Am J Epidemiol. 1997; 146(6):510-9. DOI: 10.1093/oxfordjournals.aje.a009305. View

Kroenke C, Michael Y, Poole E, Kwan M, Nechuta S, Leas E . Postdiagnosis social networks and breast cancer mortality in the After Breast Cancer Pooling Project. Cancer. 2016; 123(7):1228-1237. PMC: 5360517. DOI: 10.1002/cncr.30440. View

Khalatbari-Soltani S, Stanaway F, Cvejic E, Blyth F, Naganathan V, Handelsman D . Contribution of psychosocial factors to socioeconomic inequalities in mortality among older Australian men: a population-based cohort study. Int J Equity Health. 2020; 19(1):177. PMC: 7539396. DOI: 10.1186/s12939-020-01277-2. View

House J, Landis K, Umberson D . Social relationships and health. Science. 1988; 241(4865):540-5. DOI: 10.1126/science.3399889. View

10.

Jeong H, Yim H, Nam B . Independent predictors of depressive symptoms and social isolation on 2-year all-cause mortality among the Korean elderly in a population-based cohort study: gender differences. Epidemiol Health. 2022; 44:e2022012. PMC: 9117106. DOI: 10.4178/epih.e2022012. View

11.

Olaya B, Domenech-Abella J, Moneta M, Lara E, Caballero F, Rico-Uribe L . All-cause mortality and multimorbidity in older adults: The role of social support and loneliness. Exp Gerontol. 2017; 99:120-126. DOI: 10.1016/j.exger.2017.10.001. View

12.

Tilvis R, Laitala V, Routasalo P, Strandberg T, Pitkala K . Positive life orientation predicts good survival prognosis in old age. Arch Gerontol Geriatr. 2011; 55(1):133-7. DOI: 10.1016/j.archger.2011.06.030. View

13.

Naito R, Leong D, Bangdiwala S, Mckee M, Subramanian S, Rangarajan S . Impact of social isolation on mortality and morbidity in 20 high-income, middle-income and low-income countries in five continents. BMJ Glob Health. 2021; 6(3). PMC: 7986654. DOI: 10.1136/bmjgh-2020-004124. View

14.

Akerlind I, Hornquist J . Loneliness and alcohol abuse: a review of evidences of an interplay. Soc Sci Med. 1992; 34(4):405-14. DOI: 10.1016/0277-9536(92)90300-f. View

15.

Steptoe A, Shankar A, Demakakos P, Wardle J . Social isolation, loneliness, and all-cause mortality in older men and women. Proc Natl Acad Sci U S A. 2013; 110(15):5797-801. PMC: 3625264. DOI: 10.1073/pnas.1219686110. View

16.

Dragioti E, Radua J, Solmi M, Gosling C, Oliver D, Lascialfari F . Impact of mental disorders on clinical outcomes of physical diseases: an umbrella review assessing population attributable fraction and generalized impact fraction. World Psychiatry. 2023; 22(1):86-104. PMC: 9840513. DOI: 10.1002/wps.21068. View

17.

Long R, Terracciano A, Sutin A, Creaven A, Gerstorf D, DArcy-Bewick S . Loneliness, Social Isolation, and Living Alone Associations With Mortality Risk in Individuals Living With Cardiovascular Disease: A Systematic Review, Meta-Analysis, and Meta-Regression. Psychosom Med. 2022; 85(1):8-17. DOI: 10.1097/PSY.0000000000001151. View

18.

Ng T, Jin A, Feng L, Nyunt M, Chow K, Feng L . Mortality of older persons living alone: Singapore Longitudinal Ageing Studies. BMC Geriatr. 2015; 15:126. PMC: 4608301. DOI: 10.1186/s12877-015-0128-7. View

19.

Manemann S, Chamberlain A, Roger V, Griffin J, Boyd C, Cudjoe T . Perceived Social Isolation and Outcomes in Patients With Heart Failure. J Am Heart Assoc. 2018; 7(11). PMC: 6015354. DOI: 10.1161/JAHA.117.008069. View

20.

Yu B, Steptoe A, Chen L, Chen Y, Lin C, Ku P . Social Isolation, Loneliness, and All-Cause Mortality in Patients With Cardiovascular Disease: A 10-Year Follow-up Study. Psychosom Med. 2019; 82(2):208-214. DOI: 10.1097/PSY.0000000000000777. View