Risk factors for social isolation in older people

Social isolation is defined as having objectively few social relationships, social roles, and infrequent social interaction. [1] Being socially isolated  is a common occurance in older people.[ 2, 3]  Some people prefer being solitary with fewer social relationships but for some, being socially isolated can lead to undesirable outcomes such as developing cardiovascular disease and stroke,[4] dementia,[5] and depression. [6] It can also lead to loneliness which is the subjective or distressing feeling of a lack of connection to other people, along with a desire for more, or more satisfying, social relationships. [1] Social isolation and loneliness can lead to poor wellbeing, including increased risk of depression, anxiety, and suicidal behaviour. [1] 

Given the seriousness of undesirable impacts on health and wellbeing of people who are socially isolated, lonely and needing social connections, research has been undertaken to identify what the risk factors are for social isolation in older individuals. [7] Most often, these factors also have a bidirectional relationship with social isolation. This means that they can either lead to social isolation and/or could occur as a further consequence of being socially isolated. [7] Therefore, it is important to identify such factors to determine the most effective strategies for preventing, reducing, and addressing social isolation among older people.

This evidence theme is a summary of one of the key topics identified by a scoping review of social isolation research. If you need more specific or comprehensive information on this topic, try the PubMed search below.   

We found four reviews that focused on factors that may lead to social isolation in older people in the community. [3,8-10] Most of these factors relate to the individual, rather than the system or structural factors (i.e. aged care facilities and systems in place). These factors include socio- demographic, physical, psychological and cognitive, and socio-cultural factors. The findings of the reviews were: 

• A socio-demographic factor that may increase the possibility of being socially isolated include not owning a house such as older individuals who do not have their own homes. [3]  
• Socio-demographic factors that demonstrated limited evidence regarding older people’s risk of being socially isolated include age, [3,8] education, [3,8] income, [3,8], living in urban or rural areas, [3,8] gender and living arrangements or marital status. [3] This was due to conflicting findings in both the reviews and the included studies within the reviews.  
• Physical factors that may increase the possibility of being socially isolated include visual problems, physical and health concerns (i.e. incontinence, osteoporosis, bone fractures) and chronic conditions. [3,8]  
• Hearing problems, more specifically age-related hearing loss, increased social isolation in older people. [3,9,10] For a more in-depth summary about hearing loss, please refer to the evidence theme on age-related hearing loss.  
• Psychological factors such as self-rated health [3,8] and cognitive factors such as cognitive decline [3] were related to being socially isolated.  
• Social and cultural factors such as engaging in leisure activities (i.e. hobbies and sports but not watching television) and participation in community or religious events reduced and/or prevented isolation. [3,8]

The evidence on factors that may lead to social isolation had some limitations noted. First, the evidence was based on a scoping review of systematic reviews intended to map the current high level research published in this area and does not include primary studies that may be reporting on emerging research findings. Second, different tools were used to measure objective social isolation which make it difficult to standardise findings. Third, the research studies in the reviews were mostly cross sectional which did not consider long-term outcomes. Lastly, current findings are based on reviews that considered individual factors leading to social isolation, however societal and community factors are also important. Further research is needed to consider these broader factors.

• Be aware of the factors that may lead to social isolation.  
• Take time to get to know an older person to develop meaningful and nurturing relationships. 
• Engage with older people from various backgrounds and experiences.  
• Refer an older person for assessment and management if you think the person is socially isolated and maybe experiencing undesirable outcomes. 
• Refer to the Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community for practical guidance on what individuals can do.

• Provide staff training/strategies on recognising the signs of social isolation.  
• Contact any family and friends of an older person who appears to be socially isolated to ensure they are aware of the situation. Suggest that they arrange for the person to have a source of contact such as physical visits or through digital devices (if physical visits are not feasible).  
• Ensure strategies such as social activities encouraging participation are in place to prevent older people from being socially isolated.  

1. Badcock JC, Holt-Lunstad J, Garcia E, Bombaci P, Lim MH. Position statement: Addressing social isolation and loneliness and the power of human connection. Global Initiative on Loneliness and Connection (GILC). 2022 [cited 2023 Jun 30]. Available from https://www.gilc.global/general-6 
2. Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community. [Internet] 2023 [cited 2023 Nov 15]. Available from: https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf 
3. Ejiri M, Kawai H, Ishii K, Oka K, Obuchi S. Predictors of older adults' objectively measured social isolation: A systematic review of observational studies. Arch Gerontol Geriatr. 2021 May-Jun;94:104357. 
4. Valtorta NK, Kanaan M, Gilbody S, Ronzi S, Hanratty B. Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart. 2016 Jul 1;102(13):1009-16. 
5. Kuiper JS, Zuidersma M, Oude Voshaar RC, Zuidema SU, van den Heuvel ER, Stolk RP, Smidt N. Social relationships and risk of dementia: A systematic review and meta-analysis of longitudinal cohort studies. Ageing Res Rev. 2015 Jul;22:39-57. 
6. Choi H, Irwin MR, Cho HJ. Impact of social isolation on behavioral health in elderly: Systematic review. World J Psychiatry. 2015 Dec 22;5(4):432-8. 
7. National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Health and Medicine Division; Board on Behavioral, Cognitive, and Sensory Sciences; Board on Health Sciences Policy; Committee on the Health and Medical Dimensions of Social Isolation and Loneliness in Older Adults. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Washington (DC): National Academies Press (US); 2020 Feb 27. PMID: 32510896. 
8. Townsend BG, Chen JT, Wuthrich VM. Barriers and Facilitators to Social Participation in Older Adults: A Systematic Literature Review. Clin Gerontol. 2021 Jul-Sep;44(4):359-380. 
9. Ludlow K, Mumford V, Makeham M, Braithwaite J, Greenfield D. The effects of hearing loss on person-centred care in residential aged care: a narrative review. Geriatr Nurs. 2018 May-Jun;39(3):296-302.  
10. Shukla A, Harper M, Pedersen E, Goman A, Suen JJ, Price C, Applebaum J, Hoyer M, Lin FR, Reed NS. Hearing Loss, Loneliness, and Social Isolation: A Systematic Review. Otolaryngol Head Neck Surg. 2020 May;162(5):622-633.