Loneliness is a significant issue for older adults, often exacerbated by various life changes and social dynamics. A national survey in 2022 revealed that 54.6% of the Maltese population feels lonely, with the sentiment being notably higher among older respondents (Azzopardi, Clark, Bonnici & Cuff, 2022). This lines up with previous data signalling that loneliness increases in older age groups (Clark, Azzopardi & Bonnici, 2019). Understanding its causes, the different types, its multifaceted impacts on physical, mental and cognitive health effects, and potential solutions is crucial for improving one’s quality of life in later life.

Types and causes of loneliness

To start with, it is important to note the difference between social isolation and loneliness. While social isolation refers to the lack of relationships, minimal interaction with others and limited engagement in activities outside the home, loneliness reflects a person’s feelings of being disconnected or lacking meaningful relationships, regardless of the number of social contacts they have. A person can feel lonely even when surrounded by others, as loneliness pertains to the perceived quality and meaning of relationships.

There are different types and causes of loneliness in older adults. Loss of close relationships such as the death of a spouse, partner, family members or close friends can lead to profound feelings of emptiness, or desire for intimacy that is no longer present, leading to ‘emotional’ or ‘intimate’ loneliness. This loneliness can be particularly acute when individuals lack someone to confide in or share their experiences with.

In later life, social circles often shrink due to the loss of peers and friends, leading to diminished opportunities for social interaction. ‘Relational loneliness’ pertains to the absence of friendships and social networks.

This type of loneliness arises when individuals lack meaningful friendships or social interactions that are usually part of their routine, such as spending time with friends or engaging in social activities. Situations like the COVID-19 pandemic have intensified feelings of relational loneliness as traditional socialising opportunities diminished considerably.

‘Collective loneliness’ arises from a perceived disconnection from the broader community or lack of shared identity. Older adults may feel disconnected from societal structures, especially if they have lost their roles within family or social circles, or due to changes in one’s life, such as retirement. Indeed, a lack of meaningful social connections contributes significantly to loneliness. Factors such as retirement, mobility issues and health problems can hinder their ability to engage socially, leading to increased isolation which can increase vulnerability to loneliness.

At times, older adults may withdraw from social situations due to concerns about being perceived as burdensome or needing assistance, which can lead to increased isolation. Additionally, they may at times internalise negative stereotypes associated with ageing, such as the belief that old age equates to loneliness. This internalisation can lead to self-fulfilling prophecies where older adults withdraw socially, believing they are less capable or deserving of connection.

Changes in living situations such as transitioning to assisted living or nursing homes can disrupt established social ties and routines, contributing to feelings of loneliness. Beyond social isolation, many older adults experience ‘existential loneliness’ − a profound sense of disconnection from the world that arises from accumulated losses and a diminished sense of purpose. It often arises when individuals reflect on their existence, especially during times of illness or significant life changes, leading to feelings of being adrift without a clear direction or purpose.

Effective interventions to reduce loneliness in older persons encompass a variety of approaches

This form of loneliness is often characterised by feelings of emptiness and withdrawal from life itself. Moreover, conditions such as depression and anxiety can create a cycle where loneliness exacerbates mental health issues, further reducing the desire to engage socially. Indeed, various older adults may find it challenging to reach out for help due to stigma or pride.

Impact of loneliness

The impact of loneliness on older adults is multifaceted, affecting mental health, physical well-being and social connections. Loneliness can diminish the overall quality of life for older adults, leading to decreased participation in activities they once enjoyed and a general sense of purposelessness. Indeed, it has been closely linked to increased rates of depression and heightened anxiety levels in older adults.

Prolonged feelings of loneliness have been linked to significant emotional distress, characterised by sadness, hopelessness and low self-worth. Loneliness has also been linked with cognitive decline, with lonely older adults experiencing faster deterioration in cognitive abilities. The stress associated with loneliness can exacerbate existing mental health issues and lead to further isolation.

Furthermore, loneliness significantly raises the risk of mortality among older adults. This heightened risk is often attributed to neglect of medical care and unhealthy lifestyle choices. Health problems such as high blood pressure and heart disease have also been linked to loneliness. Besides, loneliness has been shown to impair immune responses, making older adults more susceptible to infections and chronic diseases.

Intervention

Effective interventions to reduce loneliness in older persons encompass a variety of approaches which target different types of loneliness.

Encouraging social connections, providing emotional support, mindfulness training, utilising technology effectively, encouragement of existing relationships, fostering community engagement through volunteering and/or joining of clubs or classes are some of the strategies that can help mitigate different types of loneliness. Seeking professional help, practising self-care and utilising grief support groups are other strategies that can be helpful.

The National Strategic Policy for Active Ageing: Malta 2023-2030 underlines the importance of creating an age-friendly society that respects and supports the independence and participation of older adults. This policy includes measures aimed at improving the quality of life for older individuals, thereby addressing loneliness as a significant concern.

Roberta Sultana is an allied health practitioner occupational therapist and the educational officer for the Maltese Association of Gerontology and Geriatrics (MAGG).