Loneliness in Community-Dwelling, Older Adults: An Integrative Review


      • Loneliness has implications for poor health outcomes in an older adult population.
      • Social networks, physical and mental conditions, and loneliness are interconnected.
      • Nurse practitioners integrating screening tools can promote interventions to reduce loneliness.
      • Individualized care plans may prevent poor health outcomes caused by loneliness.


      Loneliness is a major public health concern impacting the well-being of older adults. Loneliness increases older adults’ risk of adverse health outcomes. Approximately 35% of adults over age 65 report frequent feelings of loneliness. A comprehensive search was performed of the literature published from 2011 to 2021. Primary studies that examined or described loneliness in the community-dwelling, older adult US population were included. The evidence was synthesized, and common themes were identified. Twenty-two studies were included. The University of California Los Angeles Loneliness Scale was the most frequently used measurement tool. Older adults experienced physical and psychological changes associated with loneliness. Common approaches to reduce loneliness included community-based, person-centered, and socialization approaches. Loneliness increases older adults’ risk of adverse health outcomes. Future studies should consider the impact of loneliness on older adults across diverse backgrounds. The integration of loneliness screening tools may help promote targeted interventions and improve quality of care.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal for Nurse Practitioners
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ortman J.M.
        • Velkoff V.A.
        • Hogan H.
        An aging nation: the older population in the United States, Current Population Reports, P25-1140. U.S. Census Bureau, Washington, D.C.
        • Hawkley L.C.
        • Capitanio J.P.
        Perceived social isolation, evolutionary fitness and health outcomes: a lifespan approach.
        Philos Trans R Soc Lond B Biol Sci. 2015; 37020140114
        • Novotney A.
        The risks of social isolation.
        Monit Psychol. 2020; 50: 5
        • Henning-Smith C.
        Meeting the social needs of older adults in rural areas.
        JAMA Health Forum. 2020; 1 (e201411-e201411)
        • Theeke L.A.
        • Mallow J.
        Loneliness and quality of life in chronically ill rural older adults.
        Am J Nurs. 2013; 113: 28-38
        • United States Census Bureau
        American community survey: ACS demographic and housing estimates.
      1. National Academies of Sciences, Engineering, & Medicine. Social isolation and loneliness in older adults. Accessed May 28, 2022. https://doi:10.17226/25663

        • Page M.J.
        • McKenzie J.E.
        • Bossuyt P.M.
        • et al.
        The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
        BMJ. 2021; 372: n71
        • Russell D.
        • Peplau L.A.
        • Ferguson M.L.
        Developing a measure of loneliness.
        J Pers Assess. 1978; 42: 290-294
        • Gierveld J.D.J.
        • van Tilburg T.G.
        A 6-Item scale for overall, emotional, and social loneliness.
        Res Aging. 2006; 28: 582-598
        • Gierveld J.D.J.
        • Kamphuis F.
        The development of a Rasch-type loneliness scale.
        Appl Psychol Meas. 1985; 9: 289-299
        • Gierveld J.D.J.
        • van Tilburg T.G.
        Manual of the loneliness scale.
        • Van Orden K.A.
        • Cukrowicz K.C.
        • Witte T.K.
        • Joiner T.E.
        Thwarted belongingness and perceived burdensomeness: construct validity and psychometric properties of the Interpersonal Needs Questionnaire.
        Psychol Assess. 2012; 24: 197-215
        • Austin J.
        • Dodge H.H.
        • Riley T.
        • Jacobs P.G.
        • Thielke S.
        • Kaye J.
        A smart-home system to unobtrusively and continuously assess loneliness in older adults.
        IEEE J Transl Eng Health Med. 2016; 42800311
        • Boss L.
        • Branson S.
        • Cron S.
        • Kang D.H.
        Spiritual pain in meals on wheels' clients.
        Healthcare (Basel). 2015; 3: 917-932
        • Canham S.L.
        • Mauro P.M.
        • Kaufmann C.N.
        • Sixsmith A.
        Association of alcohol use and loneliness frequency among middle-aged and older adult drinkers.
        J Aging Health. 2016; 28: 267-284
        • Cimarolli V.R.
        • Jopp D.S.
        • Boerner K.
        • Minahan J.
        Depressive symptoms in the oldest-old: the role of sensory impairments.
        Arch Gerontol Geriatr. 2018; 78: 249-254
        • d'Oleire Uquillas F.
        • Jacobs H.I.L.
        • Biddle K.D.
        • et al.
        Regional tau pathology and loneliness in cognitively normal older adults.
        Transl Psychiatry. 2018; 8: 282
        • Donovan N.J.
        • Okereke O.I.
        • Vannini P.
        • et al.
        Association of higher cortical amyloid burden with loneliness in cognitively normal older adults.
        JAMA Psychiatry. 2016; 73: 1230-1237
        • Fields J.
        • Cemballi A.G.
        • Michalec C.
        • et al.
        In-home technology training among socially isolated older adults: findings from the Tech Allies program.
        J Appl Gerontol. 2021; 40: 489-499
        • Jeste D.V.
        • Glorioso D.
        • Lee E.E.
        • et al.
        Study of independent living residents of a continuing care senior housing community: sociodemographic and clinical associations of cognitive, physical, and mental health.
        Am J Geriatr Psychiatry. 2019; 27: 895-907
        • John M.D.
        • Greene M.
        • Hessol N.A.
        • et al.
        Geriatric assessments and association with VACS index among HIV-infected older adults in San Francisco.
        J Acquir Immune Defic Syndr. 2016; 72: 534-541
        • Kotwal A.A.
        • Holt-Lunstad J.
        • Newmark R.L.
        • et al.
        Social isolation and loneliness among San Francisco Bay area older adults during the COVID-19 shelter-in-place orders.
        J Am Geriatr Soc. 2021; 69: 20-29
        • Medvene L.J.
        • Nilsen K.M.
        • Smith R.
        • et al.
        Social networks and links to isolation and loneliness among elderly HCBS clients.
        Aging Ment Health. 2016; 20: 485-493
        • Petersen J.
        • Thielke S.
        • Austin D.
        • Kaye J.
        Phone behaviour and its relationship to loneliness in older adults.
        Aging Ment Health. 2016; 20: 1084-1091
        • Bonsaksen T.
        • Thygesen H.
        • Leung J.
        • et al.
        Video-based communication and its association with loneliness, mental health and quality of life among older people during the COVID-19 outbreak.
        Int J Environ Res Public Health. 2021; 18: 6284
        • Conwell Y.
        • Van Orden K.A.
        • Stone D.M.
        • et al.
        Peer companionship for mental health of older adults in primary care: a pragmatic, nonblinded, parallel-group, randomized controlled trial.
        Am J Geriatr Psychiatry. 2021; 29: 748-757
        • Emerson K.G.
        Coping with being cooped up: social distancing during COVID-19 among 60+ in the United States.
        Rev Panam Salud Publica. 2020; 44: e81
        • Stanley I.H.
        • Conwell Y.
        • Bowen C.
        • Van Orden K.A.
        Pet ownership may attenuate loneliness among older adult primary care patients who live alone.
        Aging Ment Health. 2014; 18: 394-399
        • Stevens T.B.
        • Richmond N.L.
        • Pereira G.F.
        • Shenvi C.L.
        • Platts-Mills T.F.
        Prevalence of nonmedical problems among older adults presenting to the emergency department.
        Acad Emerg Med. 2014; 21 ( 651-658
        • Tanner E.K.
        • Martinez I.L.
        • Harris M.
        Examining functional and social determinants of depression in community-dwelling older adults: implications for practice.
        Geriatr Nurs. 2014; 35: 236-240
        • Teater B.
        • Chonody J.M.
        • Davis N.
        Risk and protective factors of loneliness among older adults: the significance of social isolation and quality and type of contact.
        Soc Work Public Health. 2021; 36: 128-141
        • Howard E.P.
        • Schreiber R.
        • Morris J.N.
        • Russotto A.
        • Flashner-Fineman S.
        COLLAGE 360: a model of person-centered care to promote health among older adults.
        J Ageing Res Healthc. 2016; 1: 21-30
        • Sadarangani T.
        • Missaelides L.
        • Eilertsen E.
        • Jaganathan H.
        • Wu B.
        A mixed-methods evaluation of a nurse-led community-based health home for ethnically diverse older adults with multimorbidity in the adult day health setting.
        Policy Polit Nurs Pract. 2019; 20: 131-144
      2. Centers for Medicare and Medicaid Services, 2022.
        • Sterns A.A.
        • Sterns H.L.
        • Walter A.
        Prioritizing age-friendly domains for transforming a mid-sized American city.
        Int J Environ Res Public Health. 2020; 17: 9103
        • Goyal P.
        • Gorodeski E.Z.
        • Flint K.M.
        • et al.
        Perspectives on implementing a multidomain approach to caring for older adults with heart failure.
        J Am Geriatr Soc. 2019; 67: 2593-2599
        • Abedini N.C.
        • Choi H.
        • Wei M.Y.
        • Langa K.M.
        • Chopra V.
        The relationship of loneliness to end-of-life experience in older Americans: a cohort study.
        J Am Geriatr Soc. 2020; 68: 1064-1071
        • Perissinotto C.M.
        • Stijacic Cenzer I.
        • Covinsky K.E.
        Loneliness in older persons: a predictor of functional decline and death.
        Arch Intern Med. 2012; 172: 1078-1083
        • Ali S.H.
        • Islam T.
        • Pillai S.
        • et al.
        Loneliness and mental health outcomes among South Asian older adult immigrants in the United States: a cross-sectional study.
        Int J Geriatr Psychiatry. 2021; 36: 1423-1435
        • Drageset J.
        • Haugan G.
        Associations between nurse-patient interaction and loneliness among cognitively intact nursing home residents – a questionnaire survey.
        Geriatr Nurs. 2021; 42: 828-832
        • Glass A.P.
        • Vander Plaats R.S.
        A conceptual model for aging better together intentionally.
        J Aging Stud. 2013; 27: 428-442


      Kala K. Blakely, DNP, NP-C, CNE, is an assistant professor at the School of Nursing, University of Alabama in Birmingham and can be contacted at [email protected] .


      Natalie R. Baker is an Associate Professor at the University of Alabama at Birmingham.