The Impact of Physical Functional Impairments on Social Isolation in Older Adults: A Systematic Review

Background and Purpose:

Loneliness and social isolation are significant barriers to healthy aging among older adults. Extensive research has identified various predictors of social isolation, with physical decline and reduced mobility emerging as key risk factors. However, despite existing evidence, there remains a critical gap in understanding how functional impairments, such as difficulties in performing activities of daily living (ADLs), directly influence social relationships in aging populations. Without a systematic examination of this relationship, valuable insights into mitigating social isolation remain unexplored. This review seeks to address this gap by analyzing the nature of physical functional impairments (PFIs) that contribute to social isolation in older adults, providing a foundation for targeted interventions.

Methods:

A systematic review was conducted across nine online databases, yielding 1,128 unique articles. After applying predefined inclusion criteria, 21 studies were selected for final analysis. The review focused on peer-reviewed research examining the relationship between PFIs (e.g., mobility limitations, ADL dependencies) and social isolation in adults aged 60 and above. The risk of bias assessment (RoB) of the final sample was done using the Quality in Prognostic Studies (QUIPS) tool. Data extraction and thematic analysis were performed to identify recurring patterns and key dimensions through which functional impairments affect social connectedness.

Results:

Thematic analysis revealed that physical functional impairments contribute to social isolation across four primary dimensions: Perceived Isolation (Subjective feelings of loneliness and exclusion, often stemming from reduced social engagement due to physical limitations); Communication Barriers (Challenges such as hearing loss, difficulty using telephones, or impaired comprehension, which hinder meaningful interactions); Daily Living Capacities (Dependence on others for basic ADL and instrumental ADL activities, leading to decreased autonomy and social participation); and, Structural Barriers (External obstacles like lack of accessible transportation or technology, further isolating older adults with functional impairments). Notably, the review identified a bi-directional relationship between PFIs and social isolation where physical decline exacerbates isolation, and isolation, in turn, may accelerate functional deterioration. This cyclical association has been underemphasized in prior research.

Conclusions and Implications:

This systematic review highlights the profound impact of physical functional impairments (PFI) on social isolation among older adults. The measures of PFI identified in this systematic review will aid routine assessment of PFI in aging populations for early identification of individuals vulnerable to being socially isolated. Furthermore, interventions should adopt a multi-dimensional approach, addressing not only physical health but also communication aids, social support systems, and accessibility improvements. By recognizing the bi-directional nature of this relationship, policymakers and healthcare providers can develop more effective strategies to enhance social connectedness and overall well-being in older adults. Future research should explore longitudinal studies to understand causality better and evaluate the efficacy of targeted interventions.