Aging and social isolation: an integrative review

This was an integrative literature review with basis on the theoretical perspective of ageism. The data were collected from March to May 2019, in LILACS, MEDLINE, EBSCO and Web of Science databases. The crossing of keywords “Older adult” and “Elderly” were used, with the controlled descriptors “Aged,” “Social Isolation,” and “Loneliness” registered in the Medical Subject Headings (MeSH), using the Boolean operator AND. The final sample consisted of 18 articles.

Results:

The social isolation of older person is related to absence or inadequacy of family, friends and general social networks; isolation does not necessarily mean loneliness; operationalization of the social isolation concept needs standardization for a better measurement; risk factors was already identified with possible consequences; interventions are available, but there is insufficient information whether they are based on evidence; the relationship between isolation and loneliness is described and protective factors are presented, but with a low level of evidence.

Conclusion:

Instruments to operationalize the concept of social isolation need to be created, as the studies present heterogeneity of concepts and theoretical bases.

Keywords
Aging; Aged; Ageism; Social isolation; Loneliness; Social behavior

Year and Country	Study design	Social isolation concept	Main findings
(2018) Taiwan ⁽¹¹11. Yu B, Steptoe A, Niu K, Ku PW, Chen LJ. Prospective associations of social isolation and loneliness with poor sleep quality in older adults. Qual Life Res. 2018;27(3):683–91.⁾	A prospective study based on the longitudinal study “Social Environment and Aging Biomarkers in Taiwan”	Objective aspect of social relationships, network size, diversity and frequency of contact.	Social isolation is associated with worse quality of sleep in older adults and indicates that this effect is not related to the subjective feeling of loneliness.
(2009) USA ⁽¹²12.Cornwell EY, Waite LJ. Measuring social isolation among older adults using multiple indicators from the NSHAP study. J Gerontol B Psychol Sci Soc Sci. 2009;64 Suppl 1:i38–46.⁾	A study on the psychometric properties of scales of Social Disconnection and Isolation Social, based on data from research National Social Life, Health and Aging Project (NSHAP)	Social disconnection (physical separation from others) and perceived social isolation (feelings of loneliness and lack of social support). Individuals with no social connection tend to feel isolated.	Individuals with a small social network or rarely participate in social activities do not necessarily feel lonely. The person may be surrounded by friends and family, but realizes the lack of social support and feels excluded. Inconclusive on whether social isolation increases with age.
(2013) USA ⁽¹³13. Cotten SR, Anderson WA, McCullough BM. Impact of internet use on loneliness and contact with others among older adults: cross-sectional analysis. J Med Internet Res. 2013;15(2):e39.⁾	A cross-sectional study performed in Institutions for the elderly in Alabama	Objective experience of absence of contact with other persons, especially people who provide the necessary social support. Social isolation is the lack of a meaningful social interaction.	The frequency of Internet use affects loneliness, but not the perceptions of isolation, indicating a higher frequency associated with lower levels of loneliness, but not with lower levels of social isolation.
(2012) USA ⁽¹⁴14. Coyle CE, Dugan E. Social isolation, loneliness and health among older adults. J Aging Health. 2012;24(8):1346–63.⁾	A study of indicators of social isolation based on data from a longitudinal research “Health and Retirement Study” developed by University of Michigan.	Objective lack of relationships and social interaction.	Isolation and loneliness are not highly correlated, which implies that two constructs are distinct. The impacts on physical and mental health can have different repercussions. Distinguishing them is necessary to intervene
(2017) USA ⁽¹⁵15. Drum JL, Medvene LJ. The social convoys of affordable senior housing residents: Fellow residents and “Time Left”. Educ Gerontol. 2017;43(11):540–51.⁾	A cross-sectional study conducted with older adults living in government-subsidized residences	Social isolation is associated with lack of social resources (friends, family and trustful relationships), which results in worse outcomes in terms of physical and mental health.	The average score for older residents of housing affordable to lower economic people revealed that almost half of residents were socially isolated or had “high risk”.
(2012) Italy ⁽¹⁶16. Giuli C, Spazzafumo L, Sirolla C, Abbatecola AM, Lattanzio F, Postacchini D. Social isolation risk factors in older hospitalized individuals. Arch Gerontol Geriatr. 2012;55(3):580–5.⁾	Longitudinal study with older people hospitalized, using the “Global survey on geriatrics.”	Defined as absence or reduction of more closed social networks and/or informal social support.	For hospitalized individuals, the quality of life was an independent predictor of isolation; woman had a 2-fold higher risk of hospitalization; the isolation meant greater chance of re-hospitalizing.
(2013) Malaysia ⁽¹⁷17. Ibrahim R, Abolfathi Momtaz Y, Hamid TA. Social isolation in older Malaysians: prevalence and risk factors. Psychogeriatrics. 2013;13(2):71–9.⁾	A study based on data from the national research “Patterns of Social Relationships and Psychological well being social relationships among elderly adults of Malaysia”.	Defined social isolation objectively as absence of contact or interaction with others individuals, and subjectively as feeling of loneliness or lack of genuine company or communication with other people.	Number of children, brothers, aggregate size, and health self-evaluation, local of residence, property, sex and ethnicity were closely related to social isolation.
(2018) India ⁽¹⁸18. Kotian DB, Mathews M, Parsekar SS, Nair S, Binu VS, Subba SH. Factors associated with social isolation among the older people in India. J Geriatr Psychiatry Neurol. 2018;31(5):271–8.⁾	A study based on data from the Research “Building Knowledge on population ageing in India” (BKPAI).	Social isolation occurs when, in the previous12 months, the older adult does not attend a public meeting; meeting of a group/club/organization; religious program, nor received visit from a friend or family.	Absence of social security benefits, Alzheimer’s and having a dependency for activities of daily living. increase the risk to isolation. Being an active Christian or having three to five children diminishes the risk. Association with cancer was not significant.
(2015) The Netherlands ⁽¹⁹19. Machielse A. The heterogeneity of socially isolated older adults: a social isolation typology. J Gerontol Soc Work. 2015;58(4):338–56.⁾	A study with qualitative approach by means of in-depth interviews.	The definition of social isolation begins with the context of state policies of social well-being assumed by western European countries, which emphasizes the importance of independence and self-confidence of citizens and presents a theoretical background typology of interventions that extend the older people’s self-confidence considered socially isolated.	The social isolation was perceived from two classifications: after a recent life event - situational - and the individuals who are long isolated - structural. Motivations for change and support are more required in the structural case
(2019) Canada ⁽²⁰20. Menec VH, Newall NE, Mackenzie CS, Shooshtari S, Nowicki S. Examining individual and geographic factors associated with social isolation and loneliness using Canadian Longitudinal Study on Aging (CLSA) data. PLoS One. 2019;14(2):e0211143.⁾	A cross-sectional study based on the Canadian Longitudinal Study on Aging (CLSA) and the Census 2016, with inferential statistics of multilevel logistic regression.	Contact and bonds that individuals have on social networks, from the closest to the least close, based on the “ Social Relationship Train Model “.	Age, sex, education, income, commitment functional, chronic diseases were related to social isolation and loneliness. Being aged 65 and older with a. low income can increase the relationship with isolation.
(2016) Canada ⁽²¹21. Ramage-Morin PL. Hearing difficulties and feelings of social isolation among Canadians aged 45 or older. Health Rep. 2016;27(11):3–12.⁾	A quantitative, population study, involving people 45 years or older from the “Canadian Community Health Survey - Healthy Aging (CCHS-HA)”.	Social isolation mixed variable that measures loneliness and sense of community involvement using two scales. The participant is considered socially isolated if he/she feels lonely and has a weak sense of community affiliation.	The isolation increases with hearing disability in women, not in men. Age, education, coexistence, regularity physical motor, job, incontinence, fear of falling and functional limitations increased the chances.
(2012) Japan ⁽²²22. Saito T, Kai I, Takizawa A. Effects of a program to prevent social isolation on loneliness, depression, and subjective well-being of older adults: a randomized trial among older migrants in Japan. Arch Gerontol Geriatr. 2012;55(3):539–47.⁾	A quasi-Experimental study to test a social isolation coping program for Japanese older adults with an intervention group and a control group, pre-test before intervention, random sampling, and data collection in the first and sixth month after intervention	Qualitative e quantitative imperfections in social interactions associated with poor relationships. It’s correlated with the concept of emotional, instrumental and social support	Programs designed to prevent social isolation are effective when using the resources available in the community; they are made considering the individual needs and target people who may share similar experiences.
(2019) England ⁽²³23. Schrempft S, Jackowska M, Hamer M, Steptoe A. Associations between social isolation, loneliness, and objective physical activity in older men and women. BMC Public Health. 2019;19(1):74.⁾	A quantitative study based on data from the English Longitudinal Study of Ageing (ELSA) with English people aged 50 or older, from the sixth phase of data collection (2012-2013).	Social isolation defined as no regular monthly contact with family and friends, as well as lack of involvement in activities of social organizations.	Isolation is related to the decrease in physical activity objective and the largest sedentary time. That can contribute to increase the risk of health problems and welfare associated with isolation.
(2011) England ⁽²⁴24. Shankar A, McMunn A, Banks J, Steptoe A. Loneliness, social isolation, and behavioral and biological health indicators in older adults. Health Psychol. 2011;30(4):377–85.⁾	A quantitative study based on data from the English Longitudinal Study of Ageing (ELSA)	Absence of regular contact with family and friends and lack of organizational social involvement.	Social isolation and loneliness can affect health, independently. Isolation can increase the blood pressure and inflammatory processes associated with cardiovascular disease development.
(2013) England ⁽²⁵25. Shankar A, Hamer M, McMunn A, Steptoe A. Social isolation and loneliness: relationships with cognitive function during 4 years of follow-up in the English Longitudinal Study of Ageing. Psychosom Med. 2013;75(2):161–70.⁾	A quantitative study based on data from English Longitudinal Study of Ageing (ELSA)	Absence of regular contact with family and friends and lack of organizational social involvement.	Isolation was associated with reductions in verbal fluency, immediate memory and delay in memory during a four-year period. Isolation and loneliness were closely related with worse cognitive function.
(2015) England ⁽²⁶26. Shankar A, Rafnsson SB, Steptoe A. Longitudinal associations between social connections and subjective wellbeing in the English Longitudinal Study of Ageing. Psychol Health. 2015;30(6):686–98.⁾	A quantitative study based on data from the English Longitudinal Study of Ageing (ELSA), with inferential analysis along four years.	Absence of regular contact with family and friends and lack of organizational social involvement.	The isolation and loneliness were associated, by means of different forms, to changes on the course of cognitive and affective (evaluative) (hedonic) well-being over time.
(2018) England ⁽²⁷27. Smith SG, Jackson SE, Kobayashi LC, Steptoe A. Social isolation, health literacy, and mortality risk: Findings from the English Longitudinal Study of Ageing. Health Psychol. 2018;37(2):160–9.⁾	A quantitative study based on data from the English Longitudinal Study of Ageing (ELSA), second data collection step (2004-2005), with inferential analysis over six years.	Social isolation defined according with the marital situation, cohabitation, and contact with children, relatives, friends and participation in social organizations.	Low level of health literacy and isolation were independently associated with increased mortality risk from different causes. Separately, low literacy represented higher chance of die in 22% and isolation, 28%.
(2013) Holland ⁽²⁸28. Toepoel V. Ageing, leisure, and social connectedness: how could leisure help reduce social isolation of older people? Soc Indic Res. 2013;113(1):355–72.⁾	A quantitative study based on data from a web platform of Longitudinal Internet Studies for the Social Sciences (LISS Panel), with a representative sample of the Dutch population.	Defined as social loneliness due to the absence of a more extensive contact group and disengagement. Subjective measures involve social connection, feeling of isolation or disconnection.	Volunteer work, cultural activities, vacation, sports, reading, hobbies and shopping are predictors of success for social connection of old people. Watching TV, listening to the radio and using the computer were not associated with social connection.

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[1] Corresponding author Patricia Araújo Bezerra, E-mail: pat.araujobezerra@gmail.com