Interventions to reduce loneliness in older adults

Loneliness is associated with a number of negative health outcomes, and old age is a risk factor for feelings of loneliness and of social isolation. This short appraisal has included systematic reviews of interventions targeting loneliness in older adults, and concludes limited positive effects in group-based psychosocial activities and dog- or robopet-based activities, and no evidence of effect in technological interventions.

Reading time approx. 17 minutes Published: January 24, 2022 Publication type:

SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: January 24, 2022 Report no: ut202202 Registration no: SBU 2021/545

Question

What systematic reviews are there on interventions to reduce loneliness in older adults?

Identified literature

Table 1. Systematic reviews with low/medium risk of bias
AAT = Animal-assisted therapy; ADL =Assisted daily living; CI = Confidence interval; DAI = Dog-assisted interventions; MD = Mean difference; n = number; RCT = Randomised controlled trial; RLTCF = Residential long-term care facilities; SMD = Standardised mean difference; SNS = Social networking sites; TAU = Treatment as usual
Included studies	Population/Intervention	Outcome and Results
Animal-assisted interventions
Jain et al, 2019 [1] Dog-assisted interventions and outcomes for older adults in residential long-term care facilities: A systematic review and meta-analysis
43 included studies 5 studies reporting on loneliness Study designs: The review included RCTs (n=16), pre-post designs (n=14), quasi-experimental (n=9) and qualitative cross-sectional studies (n=4) Setting: Residential living	Population: Older people in residential long-term care facilities Intervention: Dog-assisted interventions (DAI). Group session (n=16), individual sessions (n=23) Outcome measure scale: UCLA loneliness scale (n=1), Geriatric Depression Scale (n=2), Cornell Scale for Depression in Dementia (n=1), Beck depression index (n=1)	Depressive or loneliness symptoms (5 trials, 190 participants): SMD 0.66 (95% CI, 0.21 to 1.11)
Authors' conclusion: “Almost half (n=18, 46%) of the 39 quantitative studies did not find any significant changes over time, or differences between experimental and control groups, among residents exposed to DAI[…] The findings of this review indicate that while DAI has value for older people in RLTCF [residential long-term care facilities], challenges remain in accurately measuring its impact to provide a stronger evidence-base.”
Virués-Ortega et al, 2012 [2] Effect of animal-assisted therapy on the psychological and functional status of elderly populations and patients with psychiatric disorders: A meta-analysis
21 included studies 4 studies reporting on loneliness Study designs: The review included multiple study designs. Included a total of 21 studies whereof 11 had a control group (7 of which were an RCT) Setting: Mixed	Population: Elderly, with dementia or cognitively unimpaired, or psychiatric patients Intervention: Animal-assisted therapy. Group sessions (n=15), individual (n=5), both group and individual (n=1). Dogs (n=8), birds (n=3), cats (n=1), aquarium (n=1), dolphins (n=1), multiple animals (n=6, dogs, cats, rabbits, ferrets, robotic dog) Outcome measure scale: UCLA loneliness scale (n=4)	Cognitively unimpaired elderly Loneliness, 4 trials SMD –0.27 (95% CI, –0.97 to 0.43) Social functioning, 3 trials SMD 0.66 (95% CI, –0.81 to 2.12) Elderly with dementia Social functioning, 2 trials SMD 1.01 (–0.83 to 2.85) ADL, 2 trials SMD 0.03 (–0.49 to 0.56)
Authors' conclusion: “In conclusion, this meta-analysis suggests that AAT might be effective in improving social functioning among elderly and psychiatric patients. These findings are in line with the stress-buffering and social-enhancement hypotheses, which suggest that specific aspects of social functioning may be related to the health effects of human animal interaction reported in the epidemiological literature. Nevertheless, the evidence is still inconclusive due to the limited methodological quality of available studies and large-scale randomised controlled trials should be conducted to obtain more precise estimates of effect, as well as to determine the most effective AAT interventions”
General interventions targeting loneliness or social isolation
Dickens et al, 2011 [3] Interventions targeting social isolation in older people: a systematic review
32 included studies 19 studies reporting on loneliness or social isolation Study design: The review included all controlled trials, both randomized (n=16) and non-randomized (n=16). Settings: Community and institutional/nursing homes included	Population: Older people (n=4 061, range 23–741) either identified as lonely or socially isolated (12 studies) or part of a group at risk for loneliness or social isolation (20 studies) Intervention: Interventions aimed at reducing loneliness: activity-based (n=7), support or education (n=15), home visiting (n=5), internet training (n=4), service provision (n=1) Participatory interventions (n=23), non-participatory (study population received service or training, n=9). Group interventions or mixed (n=21), one-to-one (n=11) Outcome measure scale: Included both validated and non-validated outcome measures for loneliness	Loneliness (16 studies) All studies 4 studies reporting statistically significant decrease in loneliness 12 studies reporting statistically non-significant results Participatory support interventions in group (8 studies) 3 of 8 studies reporting statistically significant decrease in loneliness Non-participatory internet training, group and one-to-one (4 studies) 1 of 4 studies reporting statistically significant decrease in loneliness All four social sub-domains: loneliness, social isolation, structural social support, functional social support (n=32) Studies with statistically significant positive effect on at least one sub-domain Group interventions 13 out of 19 (68%) One-to-one interventions 5 out of 11 (45%) Participatory interventions 15 out of 23 (65%) Non-participatory interventions 4 out of 9 (44%)
Authors' conclusion: “Our systematic review has identified a need for well conducted studies to improve the evidence base regarding the effectiveness of social interventions for alleviating social isolation. However, it appeared that common characteristics of effective interventions may include having a theoretical basis and offering social activity and/or support within a group format. Interventions in which older people are active participants also appeared more likely to be effective”
Medical Advisory Secretariat, 2008 [4] Social isolation in community-dwelling seniors: an evidence-based analysis
11 included studies 7 studies reporting on loneliness Study design: The review included all controlled trials, both randomized (n=6) and non-randomized (n=5) Setting: Community	Population: Community-dwelling elderly (n=1 951, range 60–448). Intervention: Single-focused interventions directed to or evaluating social isolation or loneliness; social support group interventions (n=6), technology supported interventions (n=5). Outcome measure scale: UCLA Loneliness Scale, OARS, SF-36, other validated and un-validated outcome measures	Loneliness: 4 of 7 studies found a statistically significant decrease in loneliness Social isolation: 5 of 10 studies found a statistically significant effect on loneliness The review also reported results on depression and cost-effectiveness.
Authors' conclusion: “Both classes (in-person group support activities and technology-assisted interventions) of interventions were found to reduce social isolation and loneliness in seniors. Social support groups were found to effectively decrease social isolation for seniors on wait lists for senior apartments and those living in senior citizen apartments. Community-based exercise programs featuring health and wellness for physically inactive community-dwelling seniors also effectively reduced loneliness. Rehabilitation for mild/moderate hearing loss was effective in improving communication disabilities and reducing loneliness in seniors. Interventions evaluated for informal caregivers of seniors with dementia, however, had limited effectiveness for social isolation or loneliness.”
Technology-based interventions
Abbott et al, 2019 [5] How do "robopets" impact the health and well-being of residents in care homes? A systematic review of qualitative and quantitative evidence
19 included studies (in 27 papers) Study designs: RCTs (n=7) and qualitative study designs (n=10). The review also included 2 studies with a mixed design (both RCT and qualitative). 2 quantitative and 5 qualitative studies reporting on loneliness Setting: Nursing home residents	Population: Older people resident in care homes, mainly with dementia. Intervention: Robotic pets: baby seal Paro (n=15), cat NeCoRO (n=1), cat JustoCat (n=1), dog Aibo (n=1), teddy bear CuDDler (n=1) Outcome measure scale: UCLA loneliness scale	Loneliness, 2 trials, 59 participants SMD –0.51 (95% CI, –1.24 to 0.22) Outcome measures also included meta-analysis of agitation, quality of life and depression. Qualitative studies, 5 trials Staff, relatives, and residents concluded that intervention decreased loneliness in some residents, particularly those that [11] did not engage in other social activities.
Authors' conclusion: “Together the findings indicate that robopets, for those that engage and interact with them, appear to have the potential to impact favourably on outcomes such as loneliness and agitation. The evidence to date, however, comes from studies of low to moderate quality and is both diverse and complex.”
Noone et al, (2020) [6] Video calls for reducing social isolation and loneliness in older people: a rapid review
3 included studies All reporting on loneliness Study design: Cluster quasi-randomized trials (n=3). RCTs searched but none identified. Setting: Nursing home residents (n=3), Taiwan (n=3)	Population: Elderly adults ≥65 years (n=201), without major neurocognitive disorders or sight and hearing impairments. Intervention: Outcome measure scale: UCLA loneliness scale	Loneliness 3 months (3 studies, 201 participants) MD –0.44 (95% CI, –3.28 to 2.41) 6 months (2 studies, 152 participants) MD –0.34 (95% CI, –3.42 to 2.72) 12 months (1 study, 90 participants) MD –2.40 (95% CI, –7.20 to 2.40)
Authors' conclusion: “The evidence was very uncertain and suggests that video calls may result in little to no difference in loneliness compared to usual care at three months, at six months and at 12 months. […] This rapid review found very-low certainty evidence to support the effectiveness of video calls for reducing loneliness in older people. The included studies also produced imprecise evidence regarding the effectiveness of video calls for outcomes of symptoms of depression and quality of life. None of the studies were of high quality and none reported measures of social isolation. Therefore, the evidence available for addressing the objectives of this review is limited.”
Shah et al, (2021) [7] Evaluation of the effectiveness of Digital Technology Interventions to Reduce Loneliness in Older Adults: Systematic Review and Meta-analysis
6 included studies All reporting on loneliness or social isolation Study design: The review included all trials. 4 RCTs, 1 nonrandomized controlled trial, 1 study without control group Setting: Residential care, nursing home or community	Population: Older adults (n=646). Mean age between 71.2–80.7 Intervention: Digital technology interventions lasting at least 3 months. Interventions included videoconferencing, social activities via social websites, customized and simplified computers with personal and social features, WhatsApp-group. Outcome measure scale: UCLA loneliness scale (n=4) De Jong-Gierveld loneliness scale (n=2)	Loneliness At 3 months (3 studies) SMD 0.02 (95% CI, –0.36 to 0.40) At 4 months (2 studies) SMD –1.11 (95%CI, –2.60 to 0.38) At 6 months (2 studies) SMD –0.11 (–0.54 to 0.32)
Authors' conclusion: “The narrative summary of 6 studies included in our review showed a reduction in loneliness in the intervention groups at follow-up compared with baseline. However, our meta-analysis of 5 clinical trials with follow-up measurements at 3, 4, and 6 months showed no statistically significant pooled effect estimates as SMDs.”
Wiwatkunupakarn et al, (2021) [8] Social networking site usage: A systematic review of its relationship with social isolation, loneliness, and depression among older adults
15 included studies 10 reporting on loneliness or social isolation Study design (relevant studies): Observational studies (n=6), Experimental studies with control group (n=4) Setting: Community	Population: Older adults ≥60 years (n=34 542, range 32 to 12 300), without any cognitive impairment or severe mental disease. Mean age between 61.5 to 80.7. Intervention: Social networking sites. Observational studies: usage and frequency; RCTs: training on SNS usage, or training friendship/networking.	Loneliness Experimental studies with control group; 4 studies, 551 participants Decreased loneliness (n=1) Statistically non-significant (n=3) Observational studies (n=5; 6 outcome measures) Decreased loneliness (n=3) Statistically non-significant (n=3) Social isolation Observational studies; 2 studies with 4 outcome measures, 33 991 participants) Statistically non-significant (n=3) Increased social isolation (n=1)
Authors' conclusion: “This review found very limited evidence, especially from experimental studies, to support associations between SNS use with depression, loneliness, and social isolation among older adults.”
Forsman et al, (2018) [9] Promoting mental wellbeing among older people: technology-based interventions
19 included studies (21 articles) 9 studies (10 articles) reporting on loneliness Study design (relevant studies): RCTs (n=5), quasi-experimental (n=2), pre-post without control (n=2) Setting: Community, nursing homes, day-care centres	Population: Older adults ≥65, or ≥55 and retired (total n=1569, relevant n=641). Mean age between 66 and 82 Intervention: Technology-based interventions designed to promote mental wellbeing or independence. Outcome measure scale: UCLA loneliness scale (n=4) De Jong-Gierveld loneliness scale (n=2) Other/unstandardized (n=3)	Loneliness RCTs; 5 studies, 511 participants Decreased loneliness (n=1) Statistically non-significant (n=4) Quasi-experimental; 2 studies, 67 participants Decreased loneliness (n=1) Statistically non-significant (n=1) Uncontrolled pre-post; 2 studies, 63 participants Decreased loneliness (n=1) Clinically not relevant (n=1)
Authors' conclusion: “When considering studies with a sound methodological rigour, limited evidence favourable to interventions can be identified. […] The review suggests that there is a lack of methodologically rigorous evaluations within this area. This fact, coupled with a lack of comparable outcomes between studies, results in the strength of the evidence being moderate and inconsistent. Further, many outcomes of interest included in the studies reported no statistically significant or clinically significant intervention effects[.]”
Physical activity interventions
Robins et al, (2016) [10] The Impact of Physical Activity Interventions on Social Isolation Among Community-Dwelling Older Adults: A Systematic Review
17 included studies (16 articles) All reporting on social isolation Study design: RCTs (n=9), prospective randomized longitudinal study (n=1), non-randomized trials (n=2), trials without control group (n=2), qualitative (n=2), mixed methods (n=1). Setting: Community	Population: Older adults (n=1930) Intervention: Physical activity. Group-based (n=15), individual (n=2). Water exercise (n=4), gym (n=2), gardening (n=1), Wii (n=1), walking (n=1), mixed community/home-based activities (n=4), unknown (n=4). Outcome measure scale: SF-36: social functioning (n=6), UCLA Loneliness Scale (n=2), other named scales (n=4), unstandardized scales or measurements (n=2).	Social isolation, metaanalysis 4 studies, 194 participants SMD 0.41 (95% CI, 0.08 to 0.75) Social isolation, narrative synthesis Intervention studies; 14 studies, 1847 participants Decrease in social isolation (n=10) No significant effect (n=4) Qualitative studies; 3 studies, 83 participants Participants believed taking part in group physical activity interventions helped them expand social networks, avoiding social isolation
Authors' conclusion: “The results of this review suggests that group physical activity interventions are associated with decreases in social isolation among community-dwelling older adults. […] The findings suggest that physical activity interventions combined with social interaction may have a greater impact on social isolation than social activity alone. However, changes in social isolation were not maintained over the longer term.”

References

Jain B, Syed S, Hafford-Letchfield T, O'Farrell-Pearce S. Dog-assisted interventions and outcomes for older adults in residential long-term care facilities: A systematic review and meta-analysis. Int J Older People Nurs. 2020;15(3):e12320. Available from: https://doi.org/10.1111/opn.12320.
Virués-Ortega J, Pastor-Barriuso R, Castellote JM, Población A, de Pedro-Cuesta J. Effect of animal-assisted therapy on the psychological and functional status of elderly populations and patients with psychiatric disorders: A meta-analysis. Health Psychol Rev. 2012;6(2):197-221.
Dickens AP, Richards SH, Greaves CJ, Campbell JL. Interventions targeting social isolation in older people: a systematic review. BMC Public Health. 2011;11:647. Available from: https://doi.org/10.1186/1471-2458-11-647.
Medical Advisory S. Social isolation in community-dwelling seniors: an evidence-based analysis. Ont Health Technol Assess Ser. 2008;8(5):1-49.
Abbott R, Orr N, McGill P, Whear R, Bethel A, Garside R, et al. How do "robopets" impact the health and well-being of residents in care homes? A systematic review of qualitative and quantitative evidence. Int J Older People Nurs. 2019;14(3):e12239. Available from: https://doi.org/10.1111/opn.12239.
Noone C, McSharry J, Smalle M, Burns A, Dwan K, Devane D, et al. Video calls for reducing social isolation and loneliness in older people: a rapid review. Cochrane Database Syst Rev. 2020;5:CD013632. Available from: https://doi.org/10.1002/14651858.CD013632.
Shah SGS, Nogueras D, van Woerden HC, Kiparoglou V. Evaluation of the Effectiveness of Digital Technology Interventions to Reduce Loneliness in Older Adults: Systematic Review and Meta-analysis. J Med Internet Res. 2021;23(6):e24712. Available from: https://doi.org/10.2196/24712.
Wiwatkunupakarn N, Pateekhum C, Aramrat C, Jirapornchaoren W, Pinyopornpanish K, Angkurawaranon C. Social networking site usage: A systematic review of its relationship with social isolation, loneliness, and depression among older adults. Aging Ment Health. 2021:1-9. Available from: https://doi.org/10.1080/13607863.2021.1966745.
Forsman AK, Nordmyr J, Matosevic T, Park AL, Wahlbeck K, McDaid D. Promoting mental wellbeing among older people: Technology-based interventions. Health Promot Int. 2018;33(6):1042-54. Available from: https://doi.org/10.1093/heapro/dax047.
Robins LM, Jansons P, Haines T. The impact of physical activity interventions on social isolation among community-dwelling older adults: A systematic review. Research & Reviews: Journal of Nursing and Health Sciences. 2016;2(1):62-71.

Literature search

Medline via OvidSP 2 November 2021

Title: Socially isolated elders
Search terms		Items found
The final search result, usually found at the end of the documentation, forms the list of abstracts. .ab. = Abstract; .ab,ti. = Abstract or title; .af. = All fields; Exp = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; .sh. = Term from the Medline controlled vocabulary; .ti. = Title; / = Term from the Medline controlled vocabulary, but does not include terms found below this term in the MeSH hierarchy; * = Focus (if found in front of a MeSH-term); * or $ = Truncation (if found at the end of a free text term); .mp = Text, heading word, subject area node, title; “ “ = Citation Marks; searches for an exact phrase; ADJn = Positional operator that lets you retrieve records that contain your terms (in any order) within a specified number (n) of words of each other.
Population: Elderly
1.	Aged/ or Aging/ or “Aged, 80 and over”/	3 473 668
2.	(elder* or old* or aging or age?).ab,kf,ti	4 169 879
3.	1 or 2	6 339 927
Intervention/Outcome: Social isolation
4.	Loneliness/ or Social Isolation/ or Social Participation/	21 740
5.	(lonel* or social* isolat* or social prescri* or social participation).ab,kf.ti	22 627
6.	4 or 5	36 107
Study types: Systematic reviews
7.	(Systematic Review or Meta-Analysis).pt. or Cochrane Database Syst Rev.ja. or ((systematic adj3 review) or "meta analys" or metaanalys).ti,ab.
Combined sets
8.	3 and 6	16 683
9.	8 and 7	372
Final result
10.		372

Scopus via Elsevier 2 November 2021

Title: Socially isolated elders
Search terms		Items found
The final search result, usually found at the end of the documentation, forms the list of abstracts. TITLE-ABS-KEY = Title or abstract or keywords ALL = All fields; PRE/n = "precedes by". The first term in the search must precede the second by a specified number of terms (n).; W/n = "Within". The terms in the search must be within a specified number of terms (n) in any order.; * = Truncation; ? = Wildcard, used to replace any single character either inside or at the right end of a word; “ “ = Citation Marks; searches for an exact phrase; LIMIT-TO (SRCTYPE, "j" = Limit to source type journal; LIMIT-TO (DOCTYPE, "ar" = Limit to document type article; LIMIT-TO (DOCTYPE, "re" = Limit to document type review
Population: Elderly
1.	TITLE-ABS-KEY(elder* OR old* OR aging OR age? OR age)	10 525 888
Intervention/Outcome: Social isolation
2.	TITLE-ABS-KEY(lonel* OR “social* isolat” OR “social prescri” OR “social participation”	70 225
Study types: Systematic reviews
3.	TITLE-ABS-KEY ( ( systematic W/2 review ) OR "meta analys" OR metaanalys ) OR ( SRCTITLE ( cochrane ) AND DOCTYPE ( re ) )
Limits: Age groups and document types
4.	EXCLUDE(EXACTKEYWORD, “Child”, “Preschool child”, “Child, preschool”, “Adolescent”, “Young adult”, “Middle aged”)
5.	EXCLUDE(DOCTYPE, “Conference paper”, “Editorial”, “Note”, “Short survey”, “Letter”, “Book chapter”)
Combined sets
6.	1 AND 2	31 578
7.	6 AND 3	762
8.	7 AND 4	503
9.	8 AND 5	469
Final result
10.		469

Page published January 24, 2022

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