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Chapter 8 - Loneliness and Psychological Health in Late Life

from Part II - Society Interacting with Brain, Cognition, and Health in Late Life

Published online by Cambridge University Press:  28 September 2023

By
Hairin Kim  and
Jeanyung Chey
Edited by
Jeanyung Chey
Jeanyung Chey
Affiliation:
Seoul National University
Get access

Summary

While social disconnection has been consistently perceived as a threat to human beings, objective and subjective social disconnectedness have been associated with poor physical well-being and a higher mortality rate. These factors are equivalent to or more significant than other well-known risk factors, such as smoking. Although mild to severe loneliness persists across the lifespan, correlates of loneliness show age differences, and loneliness affects late-life depression and accelerates the rate of physiological decline with age. In many societies, older adults undergo a transition in social life after retirement or bereavement, leading in many cases to social isolation, which may result in loneliness. This chapter reviews the effects of social isolation on late-life psychological health, focusing on the role of perceived isolation, also known as loneliness. It also discusses multiple risk factors contributing to loneliness, which can be described in terms of trait and state loneliness. Lastly, it notes that not all social connections are beneficial for all when discussing gender differences in social networks.

Keywords

lonelinessmental healthsocial isolationlate-life social relationshipssocio-emotional selectivity theorysense of belongingHPA axisdepressionfunctional impairment
Type
Chapter
Information
Society within the Brain
How Social Networks Interact with Our Brain, Behavior and Health as We Age
 , pp. 175 - 192
Publisher: Cambridge University Press
Print publication year: 2023

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References

Abdellaoui, A., Sanchez-Roige, S., Sealock, J., Treur, J. L., Dennis, J., Fontanillas, P., Elson, S., Nivard, M. G., Ip, H. F., Van Der Zee, M., Baselmans, B. M. L., Hottenga, J. J., Willemsen, G., Mosing, M., Lu, Y., Pedersen, N. L., Denys, D., Amin, N., M Van Duijn, C., Szilagyi, I., … Boomsma, D. I. (2019). Phenome-wide investigation of health outcomes associated with genetic predisposition to loneliness. Human Molecular Genetics, 28(22), 3853–3865. https://doi.org/10.1093/hmg/ddz219Google Scholar
Adam, E. K., Hawkley, L. C., Kudielka, B. M., & Cacioppo, J. T. (2006). Day-to-day dynamics of experience-cortisol associations in a population-based sample of older adults. Proceedings of the National Academy of Sciences, 103(45), 17058–17063. https://doi.org/10.1073/pnas.0605053103Google Scholar
Aisa, B., Tordera, R., Lasheras, B., Del Río, J., & Ramírez, M. J. (2007). Cognitive impairment associated to HPA axis hyperactivity after maternal separation in rats. Psychoneuroendocrinology, 32(3), 256–266. https://doi.org/10.1016/j.psyneuen.2006.12.013Google Scholar
Antonucci, T. C., Ajrouch, K. J., & Birditt, K. S. (2014). The convoy model: Explaining social relations from a multidisciplinary perspective. Gerontologist, 54(1), 82–92. https://doi.org/10.1093/geront/gnt118CrossRefGoogle ScholarPubMed
Beal, C. (2006). Loneliness in older women: A review of the literature. Issues in Mental Health Nursing, 27(7), 795–813. https://doi.org/10.1080/01612840600781196Google Scholar
Birditt, K. S., & Fingerman, K. L. (2005). Do we get better at picking our battles? Age group differences in descriptions of behavioral reactions to interpersonal tensions. Journals of Gerontology: Series B, Psychological Sciences and Social Sciences, 60(3), P121–P128. https://doi.org/10.1093/geronb/60.3.P121CrossRefGoogle ScholarPubMed
Burt, R. S., Kilduff, M., & Tasselli, S. (2013). Social network analysis: Foundations and frontiers on advantage. Annual Review of Psychology, 64(January 2013), 527–547. https://doi.org/10.1146/annurev-psych-113011-143828CrossRefGoogle ScholarPubMed
Cacioppo, J. T., Hawkley, L. C., & Thisted, R. A. (2010). Perceived social isolation makes me sad: 5-year cross-lagged analyses of loneliness and depressive symptomatology in the Chicago Health, Aging, and Social Relations Study. Psychology and Aging, 25(2), 453–463. https://doi.org/10.1037/a0017216Google Scholar
Cacioppo, S., Grippo, A. J., London, S., Goossens, L., & Cacioppo, J. T. (2015). Loneliness: Clinical Import and Interventions. Perspectives on Psychological Science, 10(2), 238–249. https://doi.org/10.1177/1745691615570616Google Scholar
Cairns, R. B., Leung, M.-C., Buchanan, L., & Cairns, B. D. (1995). Friendships and social networks in childhood and adolescence: Fluidity, reliability, and interrelations. Child Development, 66(5), 1330–1345. https://doi.org/10.2307/1131650Google Scholar
Carstensen, L. L., & Mikels, J. A. (2005). At the intersection of emotion and cognition: Aging and the positivity effect. Current Directions in Psychological Science, 14(3), 117–121.CrossRefGoogle Scholar
Charles, S. T., & Carstensen, L. L. (2010). Social and emotional aging. Annual Review of Psychology, 61, 383–409. https://doi.org/10.1146/annurev.psych.093008.100448Google Scholar
Charles, S. T., Mather, M., & Carstensen, L. L. (2003). Aging and emotional memory: The forgettable nature of negative images for older adults. Journal of Experimental Psychology: General, 132(2), 310–324. https://doi.org/10.1037/0096-3445.132.2.310Google Scholar
Chen, Y., & Feeley, T. H. (2014). Social support, social strain, loneliness, and well-being among older adults: An analysis of the Health and Retirement Study. Journal of Social and Personal Relationships, 31(2), 141–161.CrossRefGoogle Scholar
Clyde, D. (2018). The genetics of loneliness. Nature Reviews Genetics, 19(9), 532–533. https://doi.org/10.1038/s41576-018-0036-8Google Scholar
Cohen-Mansfield, J., Hazan, H., Lerman, Y., & Shalom, V. (2016). Correlates and predictors of loneliness in older-adults: A review of quantitative results informed by qualitative insights. International Psychogeriatrics, 28(4), 557–576. https://doi.org/10.1017/S1041610215001532Google Scholar
Cohen-Mansfield, J., & Parpura-Gill, A. (2007). Loneliness in older persons: A theoretical model and empirical findings. International Psychogeriatrics, 19(2), 279–294. https://doi.org/10.1017/S1041610206004200Google Scholar
Cohen-Mansfield, J., Shmotkin, D., & Goldberg, S. (2009). Loneliness in old age: Longitudinal changes and their determinants in an Israeli sample. International Psychogeriatrics, 21(6), 1160–1170. https://doi.org/10.1017/S1041610209990974Google Scholar
d’Oleire Uquillas, F., Jacobs, H. I. L., Biddle, K. D., Properzi, M., Hanseeuw, B., Schultz, A. P., Rentz, D. M., Johnson, K. A., Sperling, R. A., & Donovan, N. J. (2018). Regional tau pathology and loneliness in cognitively normal older adults. Translational Psychiatry, 8(1), 282. https://doi.org/10.1038/s41398-018-0345-xGoogle Scholar
Day, F. R., Ong, K. K., & Perry, J. R. B. (2018). Elucidating the genetic basis of social interaction and isolation. Nature Communications, 9(1), 2457. https://doi.org/10.1038/s41467-018-04930-1Google Scholar
Deniro, D. A. (1995). Perceived alienation in individuals with residual-type schizophrenia. Issues in Mental Health Nursing, 16(3), 185–200.Google Scholar
Donovan, N. J., Okereke, O. I., Vannini, P., Amariglio, R. E., Rentz, D. M., Marshall, G. A., Johnson, K. A., & Sperling, R. A. (2016). Association of higher cortical amyloid burden with loneliness in cognitively normal older adults. JAMA Psychiatry, 73(12), 1230–1237. https://doi.org/10.1001/jamapsychiatry.2016.2657Google Scholar
Donovan, N. J., Wu, Q., Rentz, D. M., Sperling, R. A., Marshall, G. A., & Glymour, M. M. (2017). Loneliness, depression and cognitive function in older US adults. International Journal of Geriatric Psychiatry, 32(5), 564–573. https://doi.org/10.1002/gps.4495Google Scholar
Dykstra, P. A. (2009). Older adult loneliness: Myths and realities. European Journal of Ageing, 6(2), 91–100. https://doi.org/10.1007/s10433-009-0110-3CrossRefGoogle ScholarPubMed
Dykstra, P. A., Van Tilburg, T. G., & Gierveld, J. D. J. (2005). Changes in older adult loneliness: Results from a seven-year longitudinal study. Research on Aging, 27(6), 725–747. https://doi.org/10.1177/0164027505279712Google Scholar
Ferraro, K. F. (1984). Widowhood and Social Participation in Later Life: Isolation or Compensation? Research on Aging, 6(4), 451–468. https://doi.org/10.1177/0164027584006004001Google Scholar
Gao, J., Davis, L. K., Hart, A. B., Sanchez-Roige, S., Han, L., Cacioppo, J. T., & Palmer, A. A. (2017). Genome-wide association study of loneliness demonstrates a role for common variation. Neuropsychopharmacology, 42, 811–821. https://doi.org/10.1038/npp.2016.197CrossRefGoogle ScholarPubMed
Hänsel, A., Hong, S., Cámara, R. J. A., & von Känel, R. (2010). Inflammation as a psychophysiological biomarker in chronic psychosocial stress. Neuroscience and Biobehavioral Reviews, 35(1), 115–121. https://doi.org/10.1016/j.neubiorev.2009.12.012Google Scholar
Hawkley, L. C. (2007). Aging and loneliness: Downhill quickly? Current Directions in Psychological Science, 16(4), 187–191. https://doi.org/10.1111/j.1467-8721.2007.00501.xGoogle Scholar
Hawkley, L. C., Browne, M. W., & Cacioppo, J. T. (2005). How can I connect with thee? Let me count the ways. Psychological Science, 16(10), 798–804.Google Scholar
Hawkley, L. C., & Cacioppo, J. T. (2010). Loneliness matters: A theoretical and empirical review of consequences and mechanisms. Annals of Behavioral Medicine, 40(2), 218–227. https://doi.org/10.1007/s12160-010-9210-8Google Scholar
Hawkley, L. C., Hughes, M. E., Waite, L. J., Masi, C. M., Thisted, R. A., & Cacioppo, J. T. (2008). From social structural factors to perceptions of relationship quality and loneliness: The Chicago Health, Aging, and Social Relations Study. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 63(6), S375–S384. https://doi.org/10.1093/geronb/63.6.S375Google Scholar
Hector-Taylor, L., & Adams, P. (1996). State versus trait loneliness in elderly New Zealanders. Psychological Reports, 78(3_suppl), 1329–1330. https://doi.org/10.2466/pr0.1996.78.3c.1329Google Scholar
Hollenhorst, S. J., & Jones, C. D. (2001). Wilderness solitude: Beyond the social-spatial perspective. In Freimund, W. A., Cole, D. N., comps. Visitor Use Density and Wilderness Experience: Proceedings 13 June 2000, Missoula, MT. Proceedings RMRS-P-20, Ogden, UT. US Department of Agriculture, Forest Service, Rocky Mountain Research Station, 20, 56–61.Google Scholar
Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality. Perspectives on Psychological Science, 10(2), 227–237. https://doi.org/10.1177/1745691614568352Google Scholar
Hostinar, C. E. (2015). Recent developments in the study of social relationships, stress responses, and physical health. Current Opinion in Psychology, 5, 90–95. https://doi.org/10.1016/j.copsyc.2015.05.004CrossRefGoogle Scholar
House, J. S., Landis, K. R., & Umberson, D. (1988). Social relationships and health. Science, 241(4865), 540–545.Google Scholar
Jylhä, M. (2004). Old age and loneliness: Cross-sectional and longitudinal analyses in the Tampere longitudinal study on aging. Canadian Journal on Aging/La Revue Canadienne Du Vieillissement, 23(2), 157–168. https://doi.org/10.1353/cja.2004.0023Google Scholar
Kawachi, I., & Berkman, L. F. (2001). Social ties and mental health. Journal of Urban Health, 78(3), 458–467. https://doi.org/10.1093/jurban/78.3.458Google Scholar
Kim, H., Kwak, S., Kim, J., Youm, Y., & Chey, J. (2019). Social network position moderates the relationship between late-life depressive symptoms and memory differently in men and women. Scientific Reports, 9(1), 1–10. https://doi.org/10.1038/s41598-019-42388-3Google Scholar
Kim, H., Kwak, S., Youm, Y., & Chey, J. (2021). Social network characteristics predict loneliness in older adults. Gerontology, 68(3), 309–320. https://doi.org/10.1159/000516226Google Scholar
Kinney, J. W., Bemiller, S. M., Murtishaw, A. S., Leisgang, A. M., Salazar, A. M., & Lamb, B. T. (2018). Inflammation as a central mechanism in Alzheimer’s disease. Alzheimer’s and Dementia: Translational Research and Clinical Interventions, 4(1), 575–590. https://doi.org/10.1016/j.trci.2018.06.014Google Scholar
Li, Y., & Ferraro, K. F. (2006). Volunteering in middle and later life: Is health a benefit, barrier or both? Social Forces, 85(1), 497–519. https://doi.org/10.1353/sof.2006.0132Google Scholar
Long, C. R., & Averill, J. R. (2003). Solitude: An exploration of benefits of being alone. Journal for the Theory of Social Behaviour, 33(1), 21–44. https://doi.org/10.1111/1468-5914.00204Google Scholar
Luanaigh, C. Ó., & Lawlor, B. A. (2008). Loneliness and the health of older people. International Journal of Geriatric Psychiatry, 23(12), 1213–1221. https://doi.org/10.1002/gps.2054Google Scholar
Luhmann, M., & Hawkley, L. C. (2016). Age differences in loneliness from late adolescence to oldest old age. Developmental Psychology, 52(6), 943–959. https://doi.org/10.1037/dev0000117Google Scholar
Macdonald, S. J., Nixon, J., & Deacon, L. (2018). “Loneliness in the city”: Examining socio-economics, loneliness and poor health in the North East of England. Public Health, 165, 88–94. https://doi.org/10.1016/j.puhe.2018.09.003CrossRefGoogle ScholarPubMed
Martín-María, N., Caballero, F. F., Lara, E., Domènech-Abella, J., Haro, J. M., Olaya, B., Ayuso-Mateos, J. L., & Miret, M. (2021). Effects of transient and chronic loneliness on major depression in older adults: A longitudinal study. International Journal of Geriatric Psychiatry, 36(1), 76–85. https://doi.org/10.1002/gps.5397Google Scholar
Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370.Google Scholar
McEwen, B. S., & Gianaros, P. J. (2011). Stress- and allostasis-induced brain plasticity. Annual Review of Medicine, 62(1), 431–445. https://doi.org/10.1146/annurev-med-052209-100430Google Scholar
Neeleman, J., & Power, M. J. (1994). Social support and depression in three groups of psychiatric patients and a group of medical controls. Social Psychiatry and Psychiatric Epidemiology, 29(1), 46–51. https://doi.org/10.1007/BF00796448Google Scholar
Newmyer, L., Verdery, A. M., Margolis, R., & Pessin, L. (2020). Measuring older adult loneliness across countries. The Journals of Gerontology: Series B, 76(7), 1408–1414. https://doi.org/10.1093/geronb/gbaa109Google Scholar
OECD (2020), Social Connections. In How’s Life? 2020: Measuring Well-Being, Paris: OECD Publishing. https://doi.org/10.1787/b2090ea8-enGoogle Scholar
Olsen, R. B., Olsen, J., Gunner-Svensson, F., & Waldstrøm, B. (1991). Social networks and longevity. A 14 year follow-up study among elderly in Denmark. Social Science & Medicine, 33(10), 1189–1195.Google Scholar
Penninx, B. W. J. H., Van Tilburg, T., Kriegsman, D. M. W., Deeg, D. J. H., Boeke, A. J. P., & Van Eijk, J. T. M. (1997). Effects of social support and personal coping resources on mortality in older age: The Longitudinal Aging Study Amsterdam. American Journal of Epidemiology, 146(6), 510–519.Google Scholar
Peplau, L. A., & Perlman, D. (1982). Perspectives on Loneliness. In Loneliness: A Sourcebook of Current Theory, Research and Therapy. John Wiley & Sons.Google Scholar
Perissinotto, C. M., Stijacic Cenzer, I., & Covinsky, K. E. (2012). Loneliness in older persons: A predictor of functional decline and death. Archives of Internal Medicine, 172(14):1078–1084. https://doi.org/10.1001/archinternmed.2012.1993Google Scholar
Pinquart, M., & Sörensen, S. (2000). Influences of socioeconomic status, social network, and competence on subjective well-being in later life: A meta-analysis. Psychology and Aging, 15(2), 187–224. https://doi.org/10.1037/0882-7974.15.2.187Google Scholar
Pressman, S. D., Cohen, S., Miller, G. E., Barkin, A., Rabin, B. S., & Treanor, J. J. (2005). Loneliness, social network size, and immune response to influenza vaccination in college freshmen. Health Psychology, 24(3), 297–306. https://doi.org/10.1037/0278-6133.24.3.297Google Scholar
Rafnsson, S. B., Orrell, M., D’Orsi, E., Hogervorst, E., & Steptoe, A. (2020). Loneliness, social integration, and incident dementia over 6 years: Prospective findings from the English Longitudinal Study of Ageing. Journals of Gerontology: Series B, Psychological Sciences and Social Sciences, 75(1), 114–124. https://doi.org/10.1093/geronb/gbx087Google Scholar
Richman, N. E., & Sokolove, R. L. (1992). The experience of aloneness, object representation, and evocative memory in borderline and neurotic patients. Psychoanalytic Psychology, 9(1), 77.Google Scholar
Prieto-Flores, M. E., Fernandez-Mayoralas, G., Forjaz, M. J., Rojo-Perez, F., & Martinez-Martin, P. (2011). Residential satisfaction, sense of belonging and loneliness among older adults living in the community and in care facilities. Health & Place, 17(6), 1183–1190.Google Scholar
Russell, D., Peplau, L. A., & Cutrona, C. E. (1980). The revised UCLA Loneliness Scale: Concurrent and Discriminant validity evidence. Journal of Personality and Social Psychology, 39(3), 472–480. https://doi.org/10.1037//0022-3514.39.3.472Google Scholar
Seeman, T. E. (2000). Health promoting effects of friends and family on health outcomes in older adults. American Journal of Health Promotion, 14(6), 362–370.Google Scholar
Shiovitz-Ezra, S., & Ayalon, L. (2010). Situational versus chronic loneliness as risk factors for all-cause mortality. International Psychogeriatrics, 22(3), 455–462. https://doi.org/10.1017/S1041610209991426Google Scholar
Shumaker, S. A., & Hill, D. R. (1991). Gender differences in social support and physical health. Health Psychology, 10(2), 102–111. https://doi.org/10.1037/0278-6133.10.2.102Google Scholar
Silverman, M. N., & Sternberg, E. M. (2012). Glucocorticoid regulation of inflammation and its functional correlates: From HPA axis to glucocorticoid receptor dysfunction. Annals of the New York Academy of Sciences, 1261(1), 55–63. https://doi.org/10.1111/j.1749-6632.2012.06633.xGoogle Scholar
Simone, M. J., & Tan, Z. S. (2011). The role of inflammation in the pathogenesis of delirium and dementia in older adults: A review. CNS Neuroscience and Therapeutics, 17(5), 506–513. https://doi.org/10.1111/j.1755-5949.2010.00173.xGoogle Scholar
Smith, K. P., & Christakis, N. A. (2008). Social networks and health. Annual Review of Sociology, 34, 405–429. http://dx.doi.org/10.1146/annurev.soc.34.040507.134601Google Scholar
Smith, S. M., & Vale, W. W. (2006). The role of the hypothalamic-pituitary-adrenal axis in neuroendocrine responses to stress. Dialogues in Clinical Neuroscience, 8(4), 383–395. https://doi.org/10.31887/dcns.2006.8.4/ssmithGoogle Scholar
Steptoe, A., Owen, N., Kunz-Ebrecht, S. R., & Brydon, L. (2004). Loneliness and neuroendocrine, cardiovascular, and inflammatory stress responses in middle-aged men and women. Psychoneuroendocrinology, 29(5), 593–611. https://doi.org/10.1016/S0306-4530(03)00086-6Google Scholar
Szabo, A., Allen, J., Alpass, F., & Stephens, C. (2019). Loneliness, socioeconomic status and quality of life in old age: The moderating role of housing tenure. Ageing and Society, 39(5), 998–1021. https://doi.org/10.1017/S0144686X17001362Google Scholar
Thoits, P. A., & Hewitt, L. N. (2001). Volunteer work and well-being. Journal of Health and Social Behavior, 42(2), 115–131. https://doi.org/10.2307/3090173Google Scholar
Thurston, R. C., & Kubzansky, L. D. (2009). Women, loneliness, and incident coronary heart disease. Psychosomatic Medicine, 71(8), 836–842. https://doi.org/10.1097/PSY.0b013e3181b40efcGoogle Scholar
Tilvis, R. S., Ka, M. H., Jolkkonen, J., Valvanne, J., Pitkala, K. H., & Strandberg, T. E. (2004). Predictors of cognitive decline and mortality of aged people over a 10-year period. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 59(3), 268–274.Google Scholar
Umberson, D. (1992). Gender, marital status and the social control of health behavior. Social Science and Medicine, 34(8), 907–917. https://doi.org/10.1016/0277-9536(92)90259-SGoogle Scholar
Victor, C., Mansfield, L., Kay, T., Daykim, N., Lane, J., Duffy, L. G., Tomlinsom, A., & Meads, C. (2018). An Overview of Reviews: The Effectiveness of Interventions to Address Loneliness at All Stages of the Life-Course. What Works Centre for Wellbeing.Google Scholar
Victor, C. R., Rippon, I., Nelis, S. M., Martyr, A., Litherland, R., Pickett, J., Hart, N., Henley, J., Matthews, F., & Clare, L. (2020). Prevalence and determinants of loneliness in people living with dementia: Findings from the IDEAL programme. International Journal of Geriatric Psychiatry, 35(8), 851–858. https://doi.org/10.1002/gps.5305Google Scholar
Wrzus, C., Hänel, M., Wagner, J., & Neyer, F. J. (2013). Social network changes and life events across the life span: A meta-analysis. Psychological Bulletin, 139(1), 53–80. https://doi.org/10.1037/a0028601Google Scholar
Yang, Y. C., McClintock, M. K., Kozloski, M., & Li, T. (2013). Social Isolation and adult mortality: The role of chronic inflammation and sex differences. Journal of Health and Social Behavior, 54(2), 183–203. https://doi.org/10.1177/0022146513485244Google Scholar
Youm, Y., Laumann, E. O., Ferraro, K. F., Waite, L. J., Kim, H. C., Park, Y.-R., Chu, S. H., Joo, W.-T., & Lee, J. A. (2014). Social network properties and self-rated health in later life: Comparisons from the Korean social life, health, and aging project and the national social life, health and aging project. BMC Geriatrics, 14(102), 1–15. https://doi.org/10.1186/1471-2318-14-102Google Scholar
Zebhauser, A., Baumert, J., Häfner, S., Lacruz, M. E., Emeny, R. T., Döring, A., & Grill, E. (2014). How much does it hurt to be lonely? Mental and physical differences between older men and women in the KORA-Age Study. Geriatric Psychiatry, 29(3), 245–252. https://doi.org/10.1002/gps.3998Google Scholar

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