Facing the Next "Geriatric Giant"-A Systematic Literature Review and Meta-Analysis of Interventions Tackling Loneliness and Social Isolation Among Older Adults.
Interventions; loneliness; meta-analysis; older people; social isolation; systematic review; Nursing (all); Health Policy; Geriatrics and Gerontology
Abstract :
[en] [en] OBJECTIVES: Loneliness and social isolation are associated with adverse health outcomes, especially within the older adult population, underlining the need for effective interventions. This systematic review and meta-analysis aims to summarize all available evidence regarding the effectiveness of interventions for loneliness and social isolation, to map out their working mechanisms, and to give implications for policy and practice.
DESIGN: Systematic literature review and meta-analysis.
SETTING AND PARTICIPANTS: Older adults (≥65 years).
METHODS: A systematic search was conducted in MEDLINE, PsycINFO, and CINAHL for studies quantitively or qualitatively assessing effects of interventions for loneliness and social isolation in older adults, following predefined selection criteria. Risk of bias as well as small study effects were assessed and, wherever appropriate, information about effect sizes of individual studies pooled using random-effects meta-analyses. Sources for between-study heterogeneity were explored using meta-regression.
RESULTS: Of n = 2223 identified articles, n = 67 were eventually included for narrative synthesis. Significant intervention effects were reported for a proportion of studies (55.9% and 50.0% for loneliness and social isolation, respectively) and 57.6% of studies including a follow-up measure (n = 29) reported sustained intervention effects. Meta-analysis of n = 27 studies, representing n = 1756 participants, suggested a medium overall effect of loneliness interventions (d = -0.47; 95% CI, -0.62 to -0.32). Between-study heterogeneity was substantial and could not be explained by differences in study design, year of publication, outcome measures, intervention length, participant demographics, setting, baseline level of loneliness, or geographic location. However, non-technology-based interventions reported larger effect sizes on average (Δd = -0.35; 95% CI, -0.66 to -0.04; P = .029) and were more often significant. Qualitative assessment of potential intervention mechanisms resulted in 3 clusters of effective components: "promoting social contact," "transferring knowledge and skills," and "addressing social cognition".
CONCLUSIONS AND IMPLICATIONS: Interventions for loneliness and social isolation can generally be effective, although some unexplained between-study heterogeneity remains. Further research is needed regarding the applicability of interventions across different settings and countries, also considering their cost-effectiveness.
Disciplines :
Social & behavioral sciences, psychology: Multidisciplinary, general & others
Author, co-author :
Duffner, Lukas A ; Alzheimer Centrum Limburg, Mental Health and Neuroscience Research Institute, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
Janssen, Niels ; Alzheimer Centrum Limburg, Mental Health and Neuroscience Research Institute, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. Electronic address: niels.janssen@maastrichtuniversity.nl
Deckers, Kay; Alzheimer Centrum Limburg, Mental Health and Neuroscience Research Institute, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
Schroyen, Sarah ; Université de Liège - ULiège > Département des sciences de la santé publique > Epidémiologie nutritionnelle
de Vugt, Marjolein E; Alzheimer Centrum Limburg, Mental Health and Neuroscience Research Institute, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
Köhler, Sebastian; Alzheimer Centrum Limburg, Mental Health and Neuroscience Research Institute, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
Adam, Stéphane ; Université de Liège - ULiège > Département de Psychologie > Psychologie de la sénescence et du vieillissement
Verhey, Frans R J; Alzheimer Centrum Limburg, Mental Health and Neuroscience Research Institute, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
Veenstra, Marja Y; Alzheimer Centrum Limburg, Mental Health and Neuroscience Research Institute, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
Language :
English
Title :
Facing the Next "Geriatric Giant"-A Systematic Literature Review and Meta-Analysis of Interventions Tackling Loneliness and Social Isolation Among Older Adults.
Publication date :
28 June 2024
Journal title :
Journal of the American Medical Directors Association
This project was conducted within the scope of euPrevent PROFILE. L.A.D. was additionally supported by Stichting Adriana van Rinsum-Ponsen and the Health Foundation Limburg.
Mushtaq, A., Khan, M.A., Social isolation, loneliness, and mental health among older adults during COVID-19: a scoping review. J Gerontol Soc Work 67 (2024), 143–156.
Perlman, D., Peplau, L., Toward a social Psychology of loneliness. Personal relationships in disorder, Vol:3, 1981, Academic Press, 31–56.
van Tilburg, T.G., Social, emotional, and existential loneliness: a test of the multidimensional concept. Gerontologist 61 (2021), e335–e344.
Wolfers, M.E.G., Stam, B.E., Machielse, A., Correlates of emotional and social loneliness among community dwelling older adults in Rotterdam, The Netherlands. Aging Ment Health 26 (2022), 355–367.
Berg, R., Cassells, J., Social Isolation Among Older Individuals: The Relationship to Mortality and Morbidity. 1992, Institute of Medicine (US) Division of Health Promotion and Disease Prevention.
Luhmann, M., Hawkley, L.C., Age differences in loneliness from late adolescence to oldest old age. Dev Pychol 52 (2016), 943–959.
Lim, M.H., Eres, R., Vasan, S., Understanding loneliness in the twenty-first century: an update on correlates, risk factors, and potential solutions. Soc Psychiatry Psychiatr Epidemiol 55 (2020), 793–810.
National Academies of Sciences. Engineering, and medicine; division of behavioral and social sciences and education; health and medicine division; board on behavioral, cognitive and SSB on HSPC on the H and MD of SI and L in OA. 2020, Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System.
Schroyen, S., Janssen, N., Duffner, L.A., et al. Prevalence of loneliness in older adults: a scoping review. Chen, Q.W., (eds.) Health Soc Care Community, 2023, 2023, 7726692.
Beridze, G., Ayala, A., Ribeiro, O., et al. Are loneliness and social isolation associated with quality of life in older adults? Insights from Northern and Southern Europe. Int J Environ Res Public Health, 17, 2020.
Heisel, M.J., Loneliness and suicide ideation in older adults: a longitudinal investigation. Innov Aging, 3, 2019, S594.
Kuiper, J.S., Zuidersma, M., Zuidema, S.U., et al. Social relationships and cognitive decline: a systematic review and meta-analysis of longitudinal cohort studies. Int J Epidemiol 45 (2016), 1169–1206.
Kuiper, J.S., Zuidersma, M., Oude Voshaar, R.C., et al. Social relationships and risk of dementia: a systematic review and meta-analysis of longitudinal cohort studies. Ageing Res Rev 22 (2015), 39–57.
Matthews, G.A., Nieh, E.H., Vander Weele, C.M., et al. Dorsal raphe dopamine neurons represent the experience of social isolation. Cell 164 (2016), 617–631.
Valtorta, N.K., Kanaan, M., Gilbody, S., et al. Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart 102 (2016), 1009–1016.
Mihalopoulos, C., Le, L.K.D., Chatterton, M.L., et al. The economic costs of loneliness: a review of cost-of-illness and economic evaluation studies. Soc Psychiatry Psychiatr Epidemiol 55 (2020), 823–836.
Masi, C.M., Chen, H.Y., Hawkley, L.C., et al. A meta-analysis of interventions to reduce loneliness. Pers Soc Psychol Rev 15 (2011), 219–266.
Quan, N.G., Lohman, M.C., Resciniti, N.V., et al. A systematic review of interventions for loneliness among older adults living in long-term care facilities. Aging Ment Health 24 (2020), 1945–1955.
Poscia, A., Stojanovic, J., La Milia, D.I., et al. Interventions targeting loneliness and social isolation among the older people: an update systematic review. Exp Gerontol 102 (2018), 133–144.
Page, M.J., McKenzie, J.E., Bossuyt, P.M., et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 372, 2021, n71.
National institutes of health. NIH style guide: age. Retrieved from: https://www.nih.gov/nih-style-guide/age#older-adults. (Accessed 16 April 2024)
European Commission (Eurostat). Ageing Europe – looking at the lives of older people in the EU. Retrieved from: https://ec.europa.eu/eurostat/web/products-statistical-books/-/ks-02-20-655. (Accessed 16 April 2024)
Hughes, M.E., Waite, L.J., Hawkley, L.C., et al. A short scale for measuring loneliness in large surveys: results from two population-based studies. Res Aging 26 (2004), 655–672.
De Jong Gierveld, J., Van Tilburg, T., A 6-item scale for overall, emotional, and social loneliness: confirmatory tests on survey data. Res Aging 28 (2006), 582–598.
De Jong Gierveld, J., Van Tilburg, T., The De Jong Gierveld short scales for emotional and social loneliness: tested on data from 7 countries in the UN generations and gender surveys. Eur J Ageing 7 (2010), 121–130.
Pluye, P., Hong, Q.N., Combining the power of Stories and the power of numbers: mixed methods research and mixed studies reviews. Annu Rev Public Health 35 (2014), 29–45.
Cohen, J., Statistical Power Analysis for the Behavioral Sciences. 1988, L. Erlbaum Associates.
Campbell, D.T., Stanley, J.C., Gage, N.L., Experimental and Quasi-Experimental Designs for Research. 1963, Houghton, Mifflin and Company.
Cacioppo, J.T., Hughes, M.E., Waite, L.J., et al. Loneliness as a specific risk factor for depressive symptoms: cross-sectional and longitudinal analyses. Psychol Aging 21 (2006), 140–151.
Cochran, W.G., The combination of estimates from different experiments. Biometrics 10 (1954), 101–129.
Higgins, J.P.T., Thompson, S.G., Deeks, J.J., et al. Measuring inconsistency in meta-analyses. BMJ 327 (2003), 557–560.
Egger, M., Smith, G.D., Schneider, M., et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 315 (1997), 629–634.
Anderson, L., Intervention against loneliness in a group of elderly women: an impact evaluation. Soc Sci Med 20 (1985), 355–364.
McKay, H.A., Nettlefold, L., Sims-Gould, J., et al. Status Quo or drop-off: do older adults maintain benefits from choose to move-a scaled-up physical activity program-12 months after withdrawing the intervention?. J Phys Act Health 18 (2021), 1236–1244.
Bruce, M.L., Pepin, R., Marti, C.N., et al. One year impact on social connectedness for homebound older adults: randomized controlled trial of tele-delivered behavioral activation versus tele-delivered friendly visits. Am J Geriatr Psychiatry 29 (2021), 771–776.
Barbosa, M.R., Campinho, A., Silva, G., “Give and receive”: the impact of an intergenerational program on institutionalized children and older adults. J Intergener Relatsh 19 (2021), 283–304.
Borji, M., Tarjoman, A., Investigating the effect of religious intervention on mental vitality and sense of loneliness among the elderly referring to community healthcare centers. J Relig Health 59 (2020), 163–172.
Cattan, M., Kime, N., Bagnall, A.M., The use of telephone befriending in low level support for socially isolated older people - an evaluation. Health Soc Care Community 19 (2011), 198–206.
Chan, A.W.K., Yu, D.S.F., Choi, K.C., Effects of tai chi qigong on psychosocial well-being among hidden elderly, using elderly neighborhood volunteer approach: a pilot randomized controlled trial. Clin Interv Aging 12 (2017), 85–96.
Chen, Y.M., Ji, J.Y., Effects of horticultural therapy on psychosocial health in older nursing home residents: a preliminary study. J Nurs Res 23 (2015), 167–171.
Chen, S.C., Moyle, W., Jones, C., et al. A social robot intervention on depression, loneliness, and quality of life for Taiwanese older adults in long-term care. Int Psychogeriatr 32 (2020), 981–991.
Choi, N.G., Pepin, R., Marti, C.N., et al. Improving social connectedness for homebound older adults: randomized controlled trial of tele-delivered behavioral activation versus tele-delivered friendly visits. Am J Geriatr Psychiatry 28 (2020), 698–708.
Chu, H.Y., Chen, M.F., Tsai, C.C., et al. Efficacy of a horticultural activity program for reducing depression and loneliness in older residents of nursing homes in Taiwan. Geriatr Nurs 40 (2019), 386–391.
Cohen-Mansfield, J., Hazan, H., Lerman, Y., et al. Efficacy of the I-SOCIAL intervention for loneliness in old age: lessons from a randomized controlled trial. J Psychiatr Res 99 (2018), 69–75.
Coll-Planas, L., del Valle Gómez, G., Bonilla, P., et al. Promoting social capital to alleviate loneliness and improve health among older people in Spain. Health Soc Care Community 25 (2017), 145–157.
Coll-Planas, L., Rodríguez-Arjona, D., Pons-Vigués, M., et al. Not alone in loneliness: a qualitative evaluation of a program promoting social capital among lonely older people in primary health care. Int J Environ Res Public Health, 18, 2021, 5580.
Collins, C.C., Benedict, J., Evaluation of a community-based health promotion program for the elderly: Lessons from Seniors CAN. Am J Health Promot 21 (2006), 45–48.
Creswell, J.D., Irwin, M.R., Burklund, L.J., et al. Mindfulness-based stress reduction training reduces loneliness and pro-inflammatory gene expression in older adults: a small randomized controlled trial. Brain Behav Immun 26 (2012), 1095–1101.
Damnée, S., Djabelkhir-Jemmi, L., Ware, C., et al. Impact d'un programme de formation de groupe à l'utilisation de la tablette numérique chez des personnes âgées. Geriatr Psychol Neuropsychiatr Vieil 17 (2019), 336–342.
Ehsan, A., Bolano, D., Guillaume-Boeckle, S., et al. Reducing loneliness in older adults: looking at locals and migrants in a Swiss case study. Eur J Ageing 18 (2021), 333–344.
Ekwonye, A.U., Gerdes, S., Exploring the effectiveness of virtual compassionate presence sessions in reducing loneliness and isolation among assisted-living older adults: a pilot study. J Relig Spiritual Aging 34 (2022), 174–193.
Elsherbiny, M.M.K., Al Maamari, R.H., The effectiveness of Logotherapy in mitigating the social isolation of neglected institutionalised older people. Br J Soc Work 48 (2018), 1090–1108.
Esmaeilzadeh, S., Oz, F., Effect of psychosocial care model applied in an “elderly day care center” on loneliness, depression, quality of life, and elderly attitude. Niger J Clin Pract 23 (2020), 189–197.
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 40 (2021), 489–499.
Fields, N., Xu, L., Greer, J., et al. Shall I compare thee…to a robot? An exploratory pilot study using participatory arts and social robotics to improve psychological well-being in later life. Aging Ment Health 25 (2021), 575–584.
Fokkema, T., Knipscheer, K., Escape loneliness by going digital: a quantitative and qualitative evaluation of a Dutch experiment in using ECT to overcome loneliness among older adults. Aging Ment Health 11 (2007), 496–504.
Follmann, A., Schollemann, F., Arnolds, A., et al. Reducing loneliness in stationary geriatric care with robots and virtual encounters—a contribution to the covid-19 pandemic. Int J Environ Res Public Health, 18, 2021, 4846.
Franke, T., Sims-Gould, J., Nettlefold, L., et al. It makes me feel not so alone”: features of the choose to move physical activity intervention that reduce loneliness in older adults. BMC Public Health 21 (2021), 1–15.
Gaggioli, A., Morganti, L., Bonfiglio, S., et al. Intergenerational group reminiscence: a potentially effective intervention to enhance elderly psychosocial wellbeing and to improve Children's perception of aging. Educ Gerontol 40 (2014), 486–498.
Galinha, I.C., García-Martín, M.Á., Lima, M.L., Sing4Health: randomised controlled trial of the effects of a singing group program on the subjective and social well-being of older adults. Appl Psychol Health Well Being 14 (2022), 176–195.
Gonyea, J.G., Burnes, K., Aging well at home: evaluation of a neighborhood-based pilot project to “put connection back into community.”. J Hous Elderly 27 (2013), 333–347.
Gustafsson, S., Berglund, H., Faronbi, J., et al. Minor positive effects of health-promoting senior meetings for older community-dwelling persons on loneliness, social network, and social support. Clin Interv Aging 12 (2017), 1867–1877.
Heller, K., Thompson, M.G., Trueba, P.E., et al. Peer support telephone dyads for elderly women: was this the wrong intervention?. Am J Commun Psychol 19 (1991), 53–74.
Hernández-Ascanio, J., Perula-de Torres, L.Á., Rich-Ruiz, M., et al. Effectiveness of a multicomponent intervention to reduce social isolation and loneliness in community-dwelling elders: a randomized clinical trial. Nurs Open 10 (2023), 48–60.
Honigh-De Vlaming, R., Haveman-Nies, A., Heinrich, J., et al. Effect evaluation of a two-year complex intervention to reduce loneliness in non-institutionalised elderly Dutch people. BMC Publ Health, 13, 2013.
Hudson, J., Ungar, R., Albright, L., et al. Robotic pet use among community-dwelling older adults. J Gerontol B Psychol Sci Soc Sci 75 (2020), 2018–2028.
Hwang, J., Wang, L., Siever, J., et al. Loneliness and social isolation among older adults in a community exercise program: a qualitative study. Aging Ment Health 23 (2019), 736–742.
Jeste, D.V., Glorioso, D.K., Depp, C.A., et al. Remotely administered resilience- and wisdom-focused intervention to reduce perceived stress and loneliness: pilot controlled clinical trial in older adults. Am J Geriatr Psychiatry 31 (2023), 58–64.
Jones, C.A., Siever, J., Knuff, K., et al. Walk, Talk and Listen: a pilot randomised controlled trial targeting functional fitness and loneliness in older adults with hearing loss. BMJ Open 9 (2019), 1–10.
Kahlon, M.K., Aksan, N., Aubrey, R., et al. Effect of layperson-delivered, empathy-focused program of telephone calls on loneliness, depression, and anxiety among adults during the COVID-19 pandemic: a randomized clinical trial. JAMA Psychiatr 78 (2021), 616–622.
Knowles, L.M., Stelzer, E.M., Jovel, K.S., et al. A pilot study of virtual support for grief: Feasibility, acceptability, and preliminary outcomes. Comput Human Behav 73 (2017), 650–658.
Lai, D.W.L., Li, J., Ou, X., et al. Effectiveness of a peer-based intervention on loneliness and social isolation of older Chinese immigrants in Canada: a randomized controlled trial. BMC Geriatr 20 (2020), 1–12.
Larsson, E., Padyab, M., Larsson-Lund, M., et al. Effects of a social internet-based intervention programme for older adults: an explorative randomised crossover study. Br J Occup Ther 79 (2016), 629–636.
Lee, O.E.K., Kim, D.H., Bridging the digital divide for older adults via intergenerational mentor-up. Res Soc Work Pract 29 (2019), 786–795.
Lin, T.Y., Huang, C.M., Hsu, H.P., et al. Effects of a combination of three-dimensional virtual reality and hands-on horticultural therapy on institutionalized older adults’ physical and mental health: quasi-experimental design. J Med Internet Res, 22, 2020, e19002.
Lorente, R., Sitges, E., Brotons, P., Benefits of a psychosocial intervention programme using volunteers for the prevention of loneliness among older women living alone in Spain. Health Soc Care Community 30 (2022), 2000–2012.
Mays, A.M., Kim, S., Rosales, K., et al. The leveraging exercise to age in place (leap) study: engaging older adults in community-based exercise classes to impact loneliness and social isolation. Am J Geriatr Psychiatry 29 (2021), 777–788.
Ollonqvist, K., Palkeinen, H., Aaltonen, T., et al. Alleviating loneliness among Frail older people – findings from a randomised controlled trial. Int J Ment Health Promot 10 (2008), 26–34.
Pandya, S.P., Meditation program mitigates loneliness and promotes wellbeing, life satisfaction and contentment among retired older adults: a two-year follow-up study in four South Asian cities. Aging Ment Health 25 (2021), 286–298.
Quinn, K., Social media and social wellbeing in later life. Ageing Soc 41 (2021), 1349–1370.
Roberts, J.R., Windle, G., Evaluation of an intervention targeting loneliness and isolation for older people in North Wales. Perspect Public Health 140 (2020), 153–161.
Robinson, H., MacDonald, B., Kerse, N., et al. The psychosocial effects of a companion robot: a randomized controlled trial. J Am Med Dir Assoc 14 (2013), 661–667.
Rodríguez-Romero, R., Herranz-Rodríguez, C., Kostov, B., et al. Intervention to reduce perceived loneliness in community-dwelling older people. Scand J Caring Sci 35 (2021), 366–374.
Routasalo, P.E., Tilvis, R.S., Kautiainen, H., et al. Effects of psychosocial group rehabilitation on social functioning, loneliness and well-being of lonely, older people: randomized controlled trial. J Adv Nurs 65 (2009), 297–305.
Saito, T., Kai, I., Takizawa, A., Effects of a program to prevent social isolation on loneliness, depression, and subjective well-being of older adults: a randomized trial among older migrants in Japan. Arch Gerontol Geriatr 55 (2012), 539–547.
Sen, K., Prybutok, G., A quality mobility program reduces elderly social isolation. Act Adapt Aging 45 (2021), 14–26.
Shapira, S., Cohn-Schwartz, E., Yeshua-Katz, D., et al. Teaching and practicing cognitive-behavioral and mindfulness skills in a web-based platform among older adults through the covid-19 pandemic: a pilot randomized controlled trial. Int J Environ Res Public Health, 18, 2021, 10563.
Slegers, K., van Boxtel, M., Jolles, J., Effects of computer training and internet usage on cognitive abilities in older adults: a randomized controlled study. Aging Clin Exp Res 21 (2009), 43–54.
Stewart, M., Craig, D., MacPherson, K., et al. Promoting positive affect and diminishing loneliness of widowed seniors through a support intervention. Public Health Nurs 18 (2001), 54–63.
Taube, E., Kristensson, J., Midlöv, P., et al. The use of case management for community-dwelling older people: the effects on loneliness, symptoms of depression and life satisfaction in a randomised controlled trial. Scand J Caring Sci 32 (2018), 889–901.
Teater, B., Baldwin, M., Singing for successful ageing: the perceived benefits of participating in the golden oldies community-arts programme. Br J Soc Work 44 (2014), 81–99.
Tkatch, R., Wu, L., MacLeod, S., et al. Reducing loneliness and improving well-being among older adults with animatronic pets. Aging Ment Health 25 (2021), 1239–1245.
Travers, C., Bartlett, H.P., Silver memories: implementation and evaluation of a unique radio program for older people. Aging Ment Health 15 (2011), 169–177.
Tsai, H.H., Tsai, Y.F., Changes in depressive symptoms, social support, and loneliness over 1 year after a minimum 3-month videoconference program for older nursing home residents. J Med Internet Res 13 (2011), 1–23.
Tsai, H.H., Cheng, C.Y., Shieh, W.Y., et al. Effects of a smartphone-based videoconferencing program for older nursing home residents on depression, loneliness, and quality of life: a quasi-experimental study. BMC Geriatr 20 (2020), 1–11.
Tse, M.M.Y., Therapeutic effects of an indoor gardening programme for older people living in nursing homes. J Clin Nurs 19 (2010), 949–958.
Vrbanac, Z., Zecević, I., Ljubić, M., et al. Animal assisted therapy and perception of loneliness in geriatric nursing home residents. Coll Antropol 37 (2013), 973–976 http://www.ncbi.nlm.nih.gov/pubmed/24308245.
White, H., McConnell, E., Clipp, E., et al. A randomized controlled trial of the psychosocial impact of providing internet training and access to older adults. Aging Ment Health 6 (2002), 213–221.
Winningham, R.G., Pike, N.L., A cognitive intervention to enhance institutionalized older adults’ social support networks and decrease loneliness. Aging Ment Health 11 (2007), 716–721.
Xu, X., Li, J., Pham, T.P., et al. Improving psychosocial well-being of older adults through exergaming: the moderation effects of intergenerational communication and age cohorts. Games Health J 5 (2016), 389–397.
Yang, S.Y., Yang, C.C., Lee, Y.C., et al. Investigating the effectiveness of online interactive courses on loneliness and quality of life of older adults in the community during the COVID-19 pandemic: a pilot study and a randomized controlled trial. Geriatr Gerontol Int 23 (2023), 91–97.
Russell, D., Peplau, L.A., Ferguson, M.L., Developing a measure of loneliness. J Pers Assess 42 (1978), 290–294.
Leung, G.T.Y., de Jong Gierveld, J., Lam, L.C.W., Validation of the Chinese translation of the 6-item de Jong Gierveld loneliness scale in elderly Chinese. Int Psychogeriatr 20 (2008), 1262–1272.
Lubben, J.E., Assessing social networks among elderly populations. Fam Community Health, 11, 1988.
Russell, D., Peplau, L.A., Cutrona, C.E., The revised UCLA Loneliness Scale: concurrent and discriminant validity evidence. J Pers Soc Psychol 39 (1980), 472–480.
Hays, R.D., DiMatteo, M.R., A short-form measure of loneliness. J Pers Assess 51 (1987), 69–81.
Cornwell, E.Y., Waite, L.J., Social disconnectedness, perceived isolation, and health among older adults. J Health Soc Behav 50 (2009), 31–48.
de Jong-Gierveld, J., Kamphuis, F., The development of a Rasch-type loneliness scale. Appl Psychol Meas 9 (1985), 289–299.
Zammuner, V.L., Italians- social and emotional loneliness: the results of five studies. World academy of science, engineering and technology, international journal of social, behavioral, educational, economic, business and industrial engineering, 2, 2008, 416–428 https://api.semanticscholar.org/CorpusID:16906387.
Pocinho, M., Farate, C., Dias, C., Validação Psicométrica da Escala UCLA-Loneliness para Idosos Portugueses. Interações Sociedade e as novas modernidades, 10, 2010 https://interacoes-ismt.com/index.php/revista/article/view/304.
Paloutzian, R.F., Ellison, C.W., Loneliness, spiritual well-being and the quality of life. Peplau, L.A., Perlman, D., (eds.) Loneliness: A Sourcebook of Current Theory, Research and Therapy, 1982, John Wiley & Sons., 224–236.
Ayala, A., Rodríguez-Blázquez, C., Frades-Payo, B., et al. Propiedades psicométricas del Cuestionario de Apoyo Social Funcional y de la Escala de Soledad en adultos mayores no institucionalizados en España. Gac Sanit 26 (2012), 317–324 http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-91112012000400005&nrm=iso.
Bellón Saameño, J.A., Delgado Sánchez, A., Luna del Castillo, J.D., et al. Validity and reliability of the Duke-UNC-11 questionnaire of functional social support. Aten Primaria 18 (1996), 153–156 158-163.
Penning, M.J., Liu, G., Chou, P.H.B., Measuring loneliness among middle-aged and older adults: the UCLA and de jong gierveld loneliness scales. Soc Indic Res 118 (2014), 1147–1166.
Boey, K.W., Cross-validation of a short form of the CES-D in Chinese elderly. Int J Geriatr Psychiatry 14 (1999), 608–617.
Zhou, L., Li, Z., Hu, M., et al. Reliability and validity of ULS-8 loneliness scale in elderly samples in a rural community. Zhong Nan Da Xue Xue Bao Yi Xue Ban 37 (2012), 1124–1128.
Velarde-Mayol, C., Fragua-Gil, S., García-de-Cecilia, J.M., [Validation of the UCLA loneliness scale in an elderly population that live alone]. Semergen 42 (2016), 177–183.
Vincenzi, H., Grabosky, F., Measuring the emotional/social aspects of loneliness and isolation. J Soc Behav Pers 2:Pt 2 (1987), 257–270.
Allen, R.L., Oshagan, H., The UCLA loneliness scale: invariance of social structural characteristics. Pers Individ Dif 19 (1995), 185–195.
Brydges, C.R., Effect size guidelines, sample size calculations, and statistical power in gerontology. Innov Aging, 3, 2019, igz036.
Leichsenring, F., Steinert, C., Rabung, S., et al. The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta-analytic evaluation of recent meta-analyses. World Psychiatr 21 (2022), 133–145.
Jacobson, N.S., Roberts, L.J., Berns, S.B., et al. Methods for defining and determining the clinical significance of treatment effects: description, application, and alternatives. J Consult Clin Psychol 67 (1999), 300–307.
Lipsey, M.W., Wilson, D.B., Practical meta-analysis. 2001, Sage Publications, Inc.
Gitlow, L., Technology use by older adults and barriers to using technology. Phys Occup Ther Geriatr 32 (2014), 271–280.
Van Beuningen, J., Coumans, M., Moonen, L., Het meten van eenzaamheid. 2018, Centraal Bureau voor de Statistiek, 24.
Tang, W.C.Y., Wong, C.S.M., Wong, T.Y., et al. Social context and loneliness in an epidemiological youth sample using the experience sampling method. J Psychiatr Res 156 (2022), 429–436.
