A Scoping Review of Risk and Protective Factors of Social Isolation and Loneliness Among Older Adults

Background and Purpose: Social Isolation and loneliness diminishes individuals’ physical health, psychological wellbeing and quality of life. Current evidences illustrating the risk and protective factors for social isolation and loneliness are segmented, which has not been assessed carefully across diverse social-cultural contexts and specific definitions of social isolation and loneliness. Scoping review has been increasingly employed to synthesize existing knowledge to inform policy and practice because of its inclusiveness of diverse research evidence around a specific research topic. The objective of this paper is to conduct a scoping review to synthesize existing knowledge and to scrutinize the risk/protective factors of social isolation and loneliness for older adults within specific social context and cultural diverse populations.

Methods: To identify relevant studies, literature search was conducted in PubMed, PsycINFO, CINAHL, AgeLine and MEDLINE. These databases are selected because of their comprehensiveness regarding primary peer-reviewed sources around health, mental health and social well-being issue for older people. The search focused on paper published between 1990 and 2018. In addition, we hand-searched key journals, including Journal of Marriage and Family, Journal of Social Work, Population and Development Review etc. The authors searched the reference list of the literature identified, aiming to achieve saturation of relevant papers. The inclusion criteria for review consisted of: 1) participants aged 65 years old and over; 2) study focused on or having a section addressing the risk/protective factors of social isolation or loneliness; 3) empirical studies or review of empirical studies; and 4) written in English or Chinese to cover significant portion of older adults studied globally. Two reviewers independently screened papers for eligibility and extracted information.

Results: For the physical health aspect, the current scoping review found that deterioration of health and hearing impairment are correlated with increased social isolation and loneliness. In terms of psychological factors, unsecure style of attachment, lack confidence, self-centeredness and expectation and stereotype towards loneliness in later life predict higher level of experienced loneliness.  Social risk factors for social isolation and loneliness include financial hardship, loss of social roles, language barriers and migration. Having higher education and frequent religious attendance act as protective factors for older adults from social isolation. Socio-cultural expectations of social interactions may affect individuals’ loneliness more than researchers anticipated.  In addition, mixed effects of general health conditions, increased age, gender difference and technology use were identified for the loneliness and social isolation status among older adults.

Conclusions and Implications: The risk and protective factors of social isolation and loneliness are complicated, involving physical, psychological, social, and spiritual aspects of an older person. Results of the review shed lights on a number of areas that call for future research, including understanding the interaction of well-stablished risk factors, scrutinizing the factors with mixed effects, comparing the performance of different measurements and more culturally sensitive studies with minority groups.