Loneliness in Older Adults: A Comparative Analysis of Characteristics Based on Rural and Urban Living

Background and Purpose: Loneliness in older adults presents a significant societal challenge, raising social work policy considerations regarding the impact of the built environment on its prevalence and severity. While some existing studies examine loneliness in relation to geographic factors, the majority focus on either rural or urban areas without comparing the findings. As older adults disproportionately reside in rural areas, understanding how the environment impacts loneliness is necessary. This scoping review aims to synthesize findings that describe loneliness in older adults in rural and urban areas, exploring similarities and differences to provide insight into how the environment may impact loneliness within the older adult population. Additionally, differences between pre-pandemic and during/post-COVID-19 pandemic studies were examined.

Methods: A scoping review was conducted in March 2025 following PRISMA-ScR guidelines using academic databases (e.g., ProQuest, Web of Science). Keywords were input at the abstract level in the following categories: environment (e.g., urban, rural, environment), loneliness (e.g., lonely, loneliness), and older adults (e.g., older adults, aging). Articles were included if they were: 1) peer-reviewed, 2) written in English, 3) participants were 60+ years, 4) loneliness was the focus of the study, 5) rural/urban was either a variable in the study or the study’s location, 6) data were collected in 2007 or later. Articles were examined at the title, abstract, and full text levels independently by both authors. A consensus was reached before continuing to each stage. Results were synthesized using a table to chart details, including loneliness measures, rural/urban measures, sociodemographic variables, and other relevant factors.

Results: The initial search uncovered 525 articles. After removing 135 duplicates, 390 records were screened by title. Based on the inclusion and exclusion criteria, 119 abstracts and 38 full-text articles were assessed, resulting in 17 studies included in the review. Nine focused on rural areas, three on urban areas, and five on mixed locations. Differences in the prevalence and severity of loneliness were reported. Although some mixed articles found higher levels of loneliness among older adults in rural areas, the rural-only and urban-only articles did not confirm this. Sociodemographic relationships in both settings generally aligned with existing loneliness literature, though some articles reported conflicting results. Articles examining the COVID-19 pandemic indicated increased loneliness across locations due to heightened social isolation among older adults.

Conclusions and Implications: Loneliness in older adults varied depending on the measures used and the authors' interpretations of the results. Additionally, the prevalence of loneliness was emphasized more strongly than the severity of loneliness. Future studies should focus on a broader range of environmental factors to provide a more nuanced understanding of their impact on loneliness in older adults. This scoping review synthesizes the literature in this area, offering social work policymakers insight when considering the allocation of resources.