Loneliness and social isolation in the elderly: positive effects for some interventions

In the “ThemenCheck Medizin” procedure offered by the German Institute for Quality and Efficiency in Health Care (IQWiG), interested members of the public can submit proposals for the assessment of medical procedures and technologies. On behalf of IQWiG, a research team led by the University Medical Center Hamburg-Eppendorf (UKE) investigated which interventions could prevent or reduce social isolation and loneliness in the elderly.

The conclusion of their report: The large inconsistencies and methodological weaknesses of the available studies do not allow clear statements to be made about which interventions help. However, the available evidence suggests positive effects for some approaches.

An English translation of the report is now available.

A request from a member of the public was the starting point of the “ThemenCheck” report

Around 10 per cent of adults say they often feel lonely. Loneliness, especially if it is long-term, can be a risk factor for poor health and low quality of life. This is why the German government has taken up the issue and announced that it will develop a strategy to combat loneliness, especially among the elderly, by the end of the legislative period. Although older people do not feel lonely more often than younger people, they are more often exposed to changes that increase the risk of social isolation and distressing feelings of loneliness – such as a small pension, the loss of professional contacts with retirement age, the departure of relatives, illnesses, limited mobility, as well as declining hearing and vision.

Older people who are socially isolated or lonely are more likely to suffer from high blood pressure, anxiety, depression and sleep problems. They also tend to die earlier.

Against this background, in the ThemenCheck procedure a member of the public asked whether there are effective interventions to prevent and reduce social isolation in the elderly.

No overall conclusion possible, but positive results for four interventions

The commissioned research team led by the UKE identified a total of 14 studies on the research question: six on prevention for people at risk of social isolation and eight on the treatment of people who were already socially isolated. These studies looked at different services: Volunteer visits or phone calls, exercise classes, leisure activities, tablet training, psychotherapeutic support, and support by a health guide.

However, the available studies have weaknesses and are not very conclusive, so it is difficult to assess how helpful the services examined are. But four studies suggest positive effects – three of them on treatment and one on prevention:

• In the USA, a programme showed that face-to-face or telephone contact with volunteers of the same age could reduce anxiety symptoms in older people, who were on average 71 years old. The programme ran for a year and contact was made once a week.
• In Canada, a programme showed that visits by student volunteers could increase life satisfaction. The students visited participants, who were on average around 79 years old, once a week for three hours over a six-week period. For example, they went for walks, read stories or helped around the house.
• In Finland, a three-month programme was tested in which the participants, who were on average 80 years old, could choose between different activities: therapeutic writing and psychotherapy, sports and discussion of health issues, or art, music, theatre and painting activities. The services were offered in groups and were professionally supervised. Participants in the programme felt healthier and there were even fewer deaths within two years after the programme than among people who had not participated.
• In China, a prevention programme was developed for older people whose adult children had moved out of the common household. Group meetings led by professionals aimed to increase interest in social interaction and promote mutual help. The programme lasted seven months and increased the social support of participants.

It is not clear whether the interventions have further benefits. In addition, none of the studies investigated whether the interventions also had negative effects.

The “ThemenCheck Medizin” procedure

In a two-stage selection process, which also involves members of the public, up to five new topics are selected each year from all the proposals submitted. According to the legal mandate, these should be topics of particular importance for patient care.

The ThemenCheck reports are not written by IQWiG itself, but by external experts. Their assessment is published together with an easily understandable summary and a publisher’s comment by IQWiG.