Implications for practice and research

• National screening recommendations are needed for loneliness.

• Assessments for loneliness should be a component of primary care for older adults.

• Interventions focused on the poorly adapted cognitive processes associated with loneliness warrant further study.

Context

Prevalence rates of loneliness have been reported to be as high as 17% in samples of older adults in the USA.1 Historically, scientists viewed loneliness as a social phenomenon. Recently, loneliness has been reconceptualised as a biopsychosocial stressor that contributes to poor health. Loneliness reflects a person's perception of the self and where they fit in the world. It stems from a person's inability to meet their ‘human belonging’ needs.2 Chronically, lonely persons have higher blood pressure and elevated C reactive protein and fibrinogen, all of which contribute to cardiovascular disease.3 ,4 In chronic loneliness, physiological stress-response impacts homeostasis and negatively influences health. Loneliness contributes to poor sleep habits, limiting human physiological restorative capacity.5 Loneliness not only predicts depression, but is also linked to higher self-perceived stress, anger, sadness and anxiety. In addition, lonely persons more frequently use emergency services,6 primary care clinics7 and long-term care facilities,1 making loneliness a costly healthcare problem.

Findings

Loneliness predicted functional decline and death, even when controlling for sociodemographics and comorbid conditions.

Commentary

The findings of this study are congruent with recent studies reporting negative outcomes associated with loneliness. Similar studies of HRS data have also concluded that loneliness contributes to morbidity and mortality.9 Separate analyses of HRS data have reported that loneliness is linked to less exercise, more tobacco use and higher numbers of chronic illnesses, depression scores and nursing-home stays.1

These study-findings emphasise that loneliness is a significant health problem. There are no screening guidelines for loneliness, though nurses could use the same three-item assessment8 which has been reported as a reliable assessment of loneliness.9 There is an absence of effective well-described interventions for loneliness that could be translated to clinical settings. Interventions that rely on social programmes can ultimately fail the older lonely person as they experience functional decline. A recent model designed to predict the impact of loneliness interventions suggests that diminishing loneliness could have a significant impact on the occurrence of depression.10 A recent meta-analysis of interventions delivered for all age groups concluded that interventions that targeted the maladaptive cognitive processes associated with loneliness would be most likely effective.11 Nurses possess a holistic view of a person, coupled with an understanding of mind–body interaction which makes them uniquely positioned to assess for loneliness, design and evaluate innovative interventions for loneliness and link with other disciplines to translate findings into practice protocols.