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Social isolation in the elderly

Updated May 21, 2025

Background

Overview

Definition

Social isolation and loneliness in older adults is a growing concern, characterized by limited social contacts and interactions, leading to reduced meaningful engagement with others and significantly impacting physical and mental health. Loneliness is defined as a distressing subjective feeling arising from the perception that social needs are not met by the quantity or quality of social relationships. Social isolation is defined as having few social relationships or infrequent social contact with others.

Pathophysiology

Risk factors for social isolation and loneliness include advanced age, female sex, vulnerable ethnic, cultural, or minority groups, living alone, widowhood, low income, poverty, or lack of education, lack of affordable housing and shelter, poor neighborhood conditions, loss of community, urban, and home care options, small or decreasing social network, and lifelong physical health issues, especially dementias, frailty such as loss of mobility or sensory loss, and multimorbidity. Other contributing factors include mental health issues, such as depression, anxiety, and psychosis, poor health behaviors, including smoking, heavy drinking, sedentary lifestyle, obesity/poor nutrition, and challenges with technology use.

Epidemiology

In 2023 in the US, 34% of adults aged 50-80 years reported social isolation, 37% reported a lack of companionship, and 33% reported infrequent contact with people outside their home in the past year. In 2022 in Canada, 58% of adults aged > 50 years were found to have experienced some degree of loneliness, and 41% were at risk of social isolation.

Prognosis and risk of recurrence

Social isolation is associated with an increased risk of depression, anxiety, poor health outcomes, suicide, and mortality.

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of social isolation in the elderly are prepared by our editorial team based on guidelines from the Canadian Coalition for Seniors' Mental Health (CCSMH 2024) and the National Academies of Sciences, Engineering, and Medicine (NASEM 2020).

Screening and diagnosis

Indications for screening

As per CCSMH 2024 guidelines:

Obtain targeted screening in older adults having risk factors for social isolation and loneliness.

Use evidence-based screening tools (such as the Single-Item Loneliness, UCLA 3-item Loneliness Scale, UK Campaign to end Loneliness Scale, de Jong Gierveld 6-item Loneliness Scale, CARED Social Isolation and Loneliness Referral Tool, Lubben Social Isolation Scale, or Structural Social Isolation Scale) to identify and assess the severiy of social isolation and/or lonelines.

UCLA Loneliness Scale

Calculator

When to use

How often do you feel that you lack companionship?

Hardly ever

Some of the time

Often

How often do you feel left out?

Hardly ever

Some of the time

Often

How often do you feel isolated from others?

Hardly ever

Some of the time

Often

Calculation

Please enter all the required inputs.

The UCLA Loneliness Scale is a clinical calculator used to assess subjective feelings of loneliness or social isolation. This tool is applicable to a wide range of patient populations, including both adults and adolescents, and can be used in various settings such as mental health clinics, schools, and community health centers. The clinical utility of the UCLA Loneliness Scale lies in its ability to identify individuals who may be experiencing significant loneliness, which can be a risk factor for various mental and physical health conditions, including depression, anxiety, and cardiovascular disease. There are no specific exclusion criteria for its use, but it should be noted that this scale is subjective and relies on self-report, so it may not be as accurate in populations with cognitive impairment or difficulty with introspection.

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Diagnostic investigations

Initial assessment

As per CCSMH 2024 guidelines:

Obtain a thorough clinical assessment (including medical history, social history, cultural background, previous social exclusion, supports, and interests, mental health, cognition, screening for substance use, environment, and finances, recent life events, lifestyle factors, insight and motivation for change) in patients with social isolation and/or loneliness to explore the possible causes and identify any contributing underlying health conditions. Use a biopsychosocial approach to identify other contributing causes.

Document the identified social isolation and loneliness in the health record. Aim to collect data on social isolation and loneliness as important social determinants of health.

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Medical management

Pharmacotherapy: as per CCSMH 2024 guidelines, do not use pharmacological agents as a treatment for social isolation and loneliness in older adults unless for an underlying mental disorder or physical illness.

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Nonpharmacologic interventions

General principles: as per CCSMH 2024 guidelines, consider offering social prescribing, social activity, physical activity, psychological therapies, animal-assisted therapies and animal ownership, leisure skill development and leisure activities, and technology in older adults.

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Patient education

General counseling: as per CCSMH 2024 guidelines, inform and educate patients and the general public about the association between social isolation and loneliness and poor mental and physical health and to promote social connection.

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Follow-up and surveillance

Follow-up: as per CCSMH 2024 guidelines, use an individualized approach to the follow-up of social isolation and loneliness. Reassess intervention efficacy and adherence with a preference towards short-term follow-up.

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