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Addressing Social Isolation To Improve the Health of Older Adults: A Rapid Review

Rapid Evidence Product
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Purpose of Review

To rapidly evaluate the effect of interventions targeting social isolation/loneliness in community-dwelling older adults (60 years and older) on outcomes of social isolation/loneliness, health and health care utilization.

Key Messages

  • Physical activity interventions to reduce social isolation showed the most promise at improving the health of older adults; however, effects were inconsistent and short-term. Three of the four interventions that found a positive effect on health or social isolation met more than once per week and involved a health care professional in the delivery of the intervention.
  • Among interventions that improved social isolation or health/health care utilization outcomes, there was no clear relationship between effects on social isolation and effects on health or health care utilization.
  • Looking across studies, we found several methodological issues: lack of consistency on whether and how social isolation and/or loneliness are measured; follow-up not being long enough to see health benefits, and lack of measurement of health care utilization or potential harms.
  • Interventions that connect socially isolated older adults to health services are conceptually promising and need good-quality studies.

Structured Abstract

Background. Social isolation and loneliness in older adults are substantial public health problems. Interventions have been examined for their effect on reducing social isolation and loneliness; however, it is unclear which are effective at improving health outcomes and avoiding unnecessary health care utilization.

Purpose. To review recent literature evaluating the effectiveness of interventions that target social isolation and loneliness to improve health and/or health care utilization.

Methods. We used rapid review methods to evaluate recent research. We systematically searched Ovid/Medline®, PsycInfo®, and CINAHL® from 2013 to 2018 for systematic reviews and from 2016 to 2018 for primary studies. We used predetermined criteria to select primary studies from systematic reviews published in 2018, in addition to the primary study search. We extracted study-level data, conducted quality assessments, and synthesized results.

Findings. Sixteen studies were included: one good-quality randomized controlled trial [RCT], seven fair-quality studies (6 RCTs and 1 pre-post), and eight poor-quality studies (7 pre-post and 1 cross-sectional with post-test survey). Of the eight good- or fair-quality studies, five examined physical activity, two examined social interventions, and one examined an arts and recreation intervention. Two were associated with a positive effect on health outcomes: a resistance training, nutrition, and psychosocial support intervention improved functionality, depression, diet, and social capital, and a physical/leisure activity intervention improved quality of life but not social support. Two interventions (group tai chi and facilitated group discussion) improved loneliness but not health outcomes (e.g. quality of life or depression). Of the four fair- or good-quality studies reporting a positive impact on social isolation or health outcomes, three involved a health care professional in delivery, and three met more than once/week. Most poor-quality studies showed improvement in health but not social isolation; however, study design issues limited the reliability of these results. Five of 16 studies reported on harms and none were clinically significant. Three reported on health care utilization, with conflicting results.

Implications. Of interventions to reduce social isolation, physical activity interventions show the most promise at improving the health of older adults; however, effects were inconsistent and studies short term. Information on the effect of interventions on health care utilization is sparse and inconsistent. Health systems should target interventions to the needs of their population while keeping in mind that the documented impact of such interventions specific to social isolation, health, and health care utilization outcomes is limited. Health systems should rigorously evaluate their efforts to increase the evidence base and share results with other health care systems.

Citation

Suggested citation: Veazie S, Gilbert J, Winchell K, Paynter R, Guise J-M. Addressing Social Isolation To Improve the Health of Older Adults: A Rapid Review. Rapid Evidence Product. (Prepared by Scientific Resource Center under Contract No. 290-2017-00003-C.) AHRQ Publication No. 19-EHC009-EF. Rockville, MD: Agency for Healthcare Research and Quality; February 2019. Posted final reports are located on the Effective Health Care Program search page. DOI: https://doi.org/10.23970/AHRQEPC-RAPIDISOLATION.