Loneliness and social isolation interventions for older adults: a scoping review of reviews

Background: Loneliness and social isolation are growing public health concerns in the context of our ageing society. Research has identified loneliness and social isolation as risk factors for all-cause morbidity and mortality with outcomes comparable to smoking, lack of exercise, obesity and high blood pressure. It is estimated that 50% of individuals aged over 60 are at risk of social isolation and approximately one-third of older people will experience some degree of loneliness later in life with figures predicted to rise due to, for example, increasing family dispersal and an ageing population. Loneliness and/or social isolation reduction and prevention interventions have been developed in response to these public health concerns. We scoped the large and diverse body of research publications on this broad topic with the aim of providing an overview of reviews of interventions designed to reduce loneliness and/or social isolation. Particular attention was paid to the ways in which interventions were described and categorised in order to try to derive a clear overall classification and grouping of different types of interventions.

Methods: Three electronic databases (CINAHL, Embase and Medline) were searched for published reviews of any type and Google was used to identify unpublished reviews. Citations were screened for inclusion based on the eligibility criteria: reviews, published in English, a target population of people aged 65 and over and reported data on the categorisation of loneliness and/or social isolation interventions. The review followed the PRISMA reporting guidelines. Full texts of papers were retrieved if they passed initial screening and the following data was extracted and charted in tables: categories of interventions, rationale for the typology used and the theoretical basis underpinning the categorisations.

Results: The searches identified 915 records of which 485 full-text papers remained after duplicates were removed. Full text papers were retrieved and 22 papers were deemed to meet the eligibility criteria. An additional 15 papers that were found by hand-searching the reference lists met the eligibility criteria. There was no time frame in which the papers were to be disseminated however 70% were published from 2010. So many papers focused on the general population of older people however some papers focused on interventions for older people living in care homes (n=4) and a few reviews (n=2) were mixed population which included children, young, middle and older aged adults.
Most reviews focused on interventions that addressed either loneliness (n=18) or social isolation (n=9) however there were some reviews that addressed both domains (n=10). A range of methods used to categorise loneliness and/or social isolation interventions were identified however, the most common methods of characterisations were: one-to-one, group and community. The main aims across most categories included: to improve social skills, enhance social support, create/increase opportunities for social interaction or to address maladaptive social cognition. The underlying theoretical basis for the categorisation was poorly explained in most reviews.

Conclusion: This review of reviews highlighted that interventions for loneliness and/or social isolation are commonly grouped on the basis of whether they were delivered on a one-to-one basis, in groups or to a wider community. Although there is some hint across some reviews to suggest that interventions delivered in group settings might potentially be the most effective at reducing loneliness and/or social isolation, the overall quality of the evidence of successful interventions was generally weak as stated in most reviews. Thus, there is a need for high quality experimental studies in order to identify and evaluate effective interventions for loneliness and social isolation.