1 BMC Public Health 2011 Vol: 11(1):647. DOI: 10.1186/1471-2458-11-647

Interventions targeting social isolation in older people: a systematic review

Targeting social isolation in older people is a growing public health concern. The proportion of older people in society has increased in recent decades, and it is estimated that approximately 25% of the population will be aged 60 or above within the next 20 to 40 years. Social isolation is prevalent amongst older people and evidence indicates the detrimental effect that it can have on health and wellbeing. The aim of this review was to assess the effectiveness of interventions designed to alleviate social isolation and loneliness in older people. Relevant electronic databases (MEDLINE, EMBASE, ASSIA, IBSS, PsycINFO, PubMed, DARE, Social Care Online, the Cochrane Library and CINAHL) were systematically searched using an extensive search strategy, for randomised controlled trials and quasi-experimental studies published in English before May 2009. Additional articles were identified through citation tracking. Studies were included if they related to older people, if the intervention aimed to alleviate social isolation and loneliness, if intervention participants were compared against inactive controls and, if treatment effects were reported. Two independent reviewers extracted data using a standardised form. Narrative synthesis and vote-counting methods were used to summarise and interpret study data. Thirty two studies were included in the review. There was evidence of substantial heterogeneity in the interventions delivered and the overall quality of included studies indicated a medium to high risk of bias. Across the three domains of social, mental and physical health, 79% of group-based interventions and 55% of one-to-one interventions reported at least one improved participant outcome. Over 80% of participatory interventions produced beneficial effects across the same domains, compared with 44% of those categorised as non-participatory. Of interventions categorised as having a theoretical basis, 87% reported beneficial effects across the three domains compared with 59% of interventions with no evident theoretical foundation. Regarding intervention type, 86% of those providing activities and 80% of those providing support resulted in improved participant outcomes, compared with 60% of home visiting and 25% of internet training interventions. Fifty eight percent of interventions that explicitly targeted socially isolated or lonely older people reported positive outcomes, compared with 80% of studies with no explicit targeting. More, well-conducted studies of the effectiveness of social interventions for alleviating social isolation are needed to improve the evidence base. However, it appeared that common characteristics of effective interventions were those developed within the context of a theoretical basis, and those offering social activity and/or support within a group format. Interventions in which older people are active participants also appeared more likely to be effective. Future interventions incorporating all of these characteristics may therefore be more successful in targeting social isolation in older people.

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Figure 1: Eligibility and screening of papers considered for the systematic review.
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References
  1. Profiles of ageing by country or areaUnited NationsWorld Population Ageing 2007New York: United Nations2007133517 World Population Ageing 2007 , 133-517 (2007) .
    • . . . In the United Kingdom, people aged 60 or above currently account for approximately 20% of the population 1 , and this proportion is expected to rise to 24% by 2030 2 . . .
  2. Office for National Statistics. Age structure of United Kingdom, 1971-2083Link , .
    • . . . In the United Kingdom, people aged 60 or above currently account for approximately 20% of the population 1 , and this proportion is expected to rise to 24% by 2030 2 . . .
  3. Magnitude and speed of population ageingUnited NationsWorld Population Ageing 2007New York: United Nations20071316 World Population Ageing 2007 , 13-16 (2007) .
    • . . . In comparison, 11% of the world's population was aged 60 or above in 2007, rising to an estimated 22% by 2050 3 . . .
  4. S Jacobzone; E Cambois; E Chaplain; JM Robine The health of older persons in OECD countries: is it improving fast enough to compensate for population ageing? , (1999) .
    • . . . The ageing population has resulted in emphasis being placed on health status trends of older people and how these trends may change in future, due to the anticipated increased demand for health and social care services 4 . . . .
  5. M Cattan; M White; J Bond; A Learmouth Preventing social isolation and loneliness among older people: a systematic review of health promotion interventions Ageing Soc 25, 41-67 (2005) .
    • . . . Many authors agree that it is a uni-dimensional concept referring to the lack of social integration 5 6 7 8 . . .
    • . . . Three previous systematic reviews 5 40 41 have synthesised the evidence of the effectiveness of interventions targeting social isolation in older people . . .
    • . . . Findlay 40 selected papers published between 1982 and 2002, while Cattan & White 41 included papers between 1970 and 1997, and Cattan et al 5 included papers published between 1970 and 2002 . . .
    • . . . Each of these reviews focused on loneliness and social isolation as the main outcomes under investigation, as previous research had used the terms interchangeably 5 . . . .
    • . . . This study advances the evidence base of previous reviews 5 40 41 , by including studies published since 2002 and by considering a wider range of outcomes reflecting the multi-dimensional definition of social isolation. . . .
    • . . . While the date range of our search period enabled us to identify studies published in the seven years following the most recent systematic reviews 5 40 , this is a rapidly emerging field . . .
    • . . . While interventions targeting social isolation include some of the beneficial characteristics identified in this and previous systematic reviews 5 40 , none appear to include all of them . . .
  6. L Grenade; D Boldy Social isolation and loneliness amongst older people: issues and future challenges in community and residential settings Australian Health Review 32, 468-478 (2008) .
    • . . . Many authors agree that it is a uni-dimensional concept referring to the lack of social integration 5 6 7 8 . . .
    • . . . Loneliness is a subjective concept resulting from a perceived absence or loss of companionship 6 13 14 15 . . .
    • . . . Expanding the distinction further, while social isolation may be either voluntary or involuntary, loneliness is always involuntary 6 19 . . . .
  7. M Hall; B Havens The effects of social isolation and loneliness on the health of older women Research Bulletin, Centres of Excellence for Women's Health 2, 6-7 (2001) .
    • . . . Many authors agree that it is a uni-dimensional concept referring to the lack of social integration 5 6 7 8 . . .
  8. G Wenger; R Davies; S Shahtahmasebi; A Scott Social isolation and loneliness in old age: review and model refinement Ageing Soc 16, 333-358 (1996) .
    • . . . Many authors agree that it is a uni-dimensional concept referring to the lack of social integration 5 6 7 8 . . .
  9. C Victor; S Scambler; J Bond Loneliness and social isolation: issues of theory and method The Social World of Older People: understanding loneliness and social isolation in later life , 31-80 (2009) .
    • . . . However, this assumes that all social contacts have the same social value or importance 9 . . .
  10. J Lubben; M Gironda Centrality of social ties to the health and well-being of older adults Social Work and Health Care in an Aging World , 319-350 (2003) .
    • . . . Alternate definitions of social isolation incorporate both 'structural' and 'functional' social support 10 11 . . .
  11. C Victor; S Scambler; J Bond; A Bowling Being alone in later life: loneliness, social isolation and living alone Reviews in Clinical Gerontology 10, 407-417 (2000) .
    • . . . Alternate definitions of social isolation incorporate both 'structural' and 'functional' social support 10 11 . . .
  12. WE Broadhead; SH Gehlbach; FV deGruy; BH Kaplan Functional versus structural social support and health care utilization in a family medicine outpatient practice Med Care 27, 221-233 (1989) .
    • . . . Structural social support is an objective assessment of size and frequency, while functional social support is a subjective judgement of the quality or perceived value of emotional, instrumental and informational support provided by others 12 . . .
  13. PE Routasalo; RS Tilvis; H Kautiainen; KH Pitkala Effects of psychosocial group rehabilitation on social functioning, loneliness and well-being of lonely, older people: randomized controlled trial Journal of Advanced Nursing 65, 297-306 (2009) .
  14. C Victor; A Bowling; J Bond; S Scambler Loneliness, social isolation and living alone in later life ESRC Growing Old Programme, Research Findings 17 , (2003) .
    • . . . Loneliness is a subjective concept resulting from a perceived absence or loss of companionship 6 13 14 15 . . .
    • . . . The prevalence of social isolation amongst older people is substantial, estimated to be 7 - 17% depending on the definition and outcome measure used 14 27 29 30 31 . . .
  15. GC Wenger; V Burholt Changes in levels of social isolation and loneliness among older people in a rural area: A twenty-year longitudinal study Canadian Journal on Aging 23, 115-127 (2004) .
    • . . . Loneliness is a subjective concept resulting from a perceived absence or loss of companionship 6 13 14 15 . . .
  16. RS Weiss Loneliness: the experience of emotional and social isolation , (1973) .
    • . . . Social loneliness refers to negative feelings resulting from the absence of meaningful relationships and social integration, whereas emotional loneliness refers to the perceived lack of an attachment figure or confidant 16 . . .
  17. B van Baarsen; TAB Snijders; JH Smit; MAJ van Duijn Lonely but not alone: Emotional isolation and social isolation as two distinct dimensions of loneliness in older people Educational and Psychological Measurement 61, 119-135 (2001) .
    • . . . The two forms of loneliness differ in potential duration, as the former may be alleviated through gaining new acquaintances while the latter can only be resolved by the formation of an intimate bond 17 , which may take longer. . . .
  18. J de Jong Gierveld A review of loneliness: concept and definitions, determinants and consequences Reviews in Clinical Gerontology 8, 73-80 (1998) .
    • . . . While social isolation concerns the lack of structural and functional social support, loneliness relates specifically to one's negative feelings about that situation 18 . . .
  19. J de Jong Gierveld; B Havens Cross-national comparisons of social isolation and loneliness: introduction and overview Canadian Journal on Aging 23, 109-113 (2004) .
    • . . . Expanding the distinction further, while social isolation may be either voluntary or involuntary, loneliness is always involuntary 6 19 . . . .
  20. J Holt-Lunstad; TB Smith; JB Layton Social relationships and mortality risk: a meta-analytic review Public Library of Science Medicine 7, e1000316 (2010) .
    • . . . A recent meta-analysis of 148 longitudinal studies (308,849 participants, mean age of 64 years) reported a 50% reduction in the likelihood of mortality for individuals with strong social relationships 20 . . .
  21. TE Seeman Social ties and health: The benefits of social integration Annals of Epidemiology 6, 442-451 (1996) .
    • . . . For example, social isolation is associated with increased mortality 21 , poor self-rated physical health 22 and increased susceptibility to dementia 23 in the general population of older people, and with the onset of disability among older males living alone 24 . . .
  22. EY Cornwell; LJ Waite Social disconnectedness, perceived isolation, and health among older adults Journal of Health and Social Behavior 50, 31-48 (2009) .
    • . . . For example, social isolation is associated with increased mortality 21 , poor self-rated physical health 22 and increased susceptibility to dementia 23 in the general population of older people, and with the onset of disability among older males living alone 24 . . .
  23. L Fratiglioni; HX Wang; K Ericsson; M Maytan; B Winblad Influence of social network on occurrence of dementia: a community-based longitudinal study Lancet 355, 1315-1319 (2000) .
    • . . . For example, social isolation is associated with increased mortality 21 , poor self-rated physical health 22 and increased susceptibility to dementia 23 in the general population of older people, and with the onset of disability among older males living alone 24 . . .
  24. R Lund; CJ Nilsson; K Avlund Can the higher risk of disability onset among older people who live alone be alleviated by strong social relations? A longitudinal study of non-disabled men and women Age Ageing 39, 319-326 (2010) .
    • . . . For example, social isolation is associated with increased mortality 21 , poor self-rated physical health 22 and increased susceptibility to dementia 23 in the general population of older people, and with the onset of disability among older males living alone 24 . . .
  25. A Hawton; C Green; AP Dickens; SH Richards; RS Taylor; R Edwards; CJ Greaves; JL Campbell The impact of social isolation on the health status and health-related quality of life of older people Quality of Life Research , 1-11 (2010) .
    • . . . In a recent study we found that social isolation was negatively associated with health status and health-related quality of life of older people 25 . . . .
  26. C Victor; S Scambler; J Bond Social exclusion and social isolation The Social World of Older People: understanding loneliness and social isolation in later life , 168-200 (2009) .
    • . . . Risk factors for social isolation in older people include a lack of access to private transport, minimal or no contact with friends and family, low morale and living alone 26 27 28 . . .
  27. S Iliffe; K Kharicha; D Harari; C Swift; G Gillmann; A Stuck Health risk appraisal in older people 2: the implications for clinicians and commissioners of social isolation risk in older people British Journal of General Practice 57, 277-282 (2007) .
    • . . . Risk factors for social isolation in older people include a lack of access to private transport, minimal or no contact with friends and family, low morale and living alone 26 27 28 . . .
    • . . . The prevalence of social isolation amongst older people is substantial, estimated to be 7 - 17% depending on the definition and outcome measure used 14 27 29 30 31 . . .
  28. M Barnes; A Blom; K Cox; C Lessof; A Walker The Social Exclusion of Older People: evidence from the first wave of the English Longitudinal Study of Ageing (ELSA). Final report , (2006) .
    • . . . Risk factors for social isolation in older people include a lack of access to private transport, minimal or no contact with friends and family, low morale and living alone 26 27 28 . . .
  29. W Tomaszewski; M Barnes Investigating the dynamics of social detachment in old age Living in the 21st century: older people in England. The 2006 English Longitudinal Study of Ageing (wave 3) , 150-185 (2008) .
    • . . . The prevalence of social isolation amongst older people is substantial, estimated to be 7 - 17% depending on the definition and outcome measure used 14 27 29 30 31 . . .
  30. G Hawthorne Measuring social isolation in older adults: development and initial validation of the Friendship Scale Soc Indic Res 77, 521-548 (2006) .
    • . . . The prevalence of social isolation amongst older people is substantial, estimated to be 7 - 17% depending on the definition and outcome measure used 14 27 29 30 31 . . .
  31. G Hawthorne Perceived social isolation in a community sample: its prevalence and correlates with aspects of peoples' lives Social Psychiatry + Psychiatric Epidemiology 43, 140-150 (2008) .
    • . . . The prevalence of social isolation amongst older people is substantial, estimated to be 7 - 17% depending on the definition and outcome measure used 14 27 29 30 31 . . .
  32. N Savikko; P Routasalo; RS Tilvis; TE Strandberg; KH Pitkala Predictors and subjective causes of loneliness in an aged population Archives of Gerontology & Geriatrics 41, 223-233 (2005) .
    • . . . The related, but distinct concept of loneliness is reported to be experienced by approximately 40% of this age group 32 33 34 . . .
  33. L Steed; D Boldy; L Grenade; H Iredell The demographics of loneliness among older people in Perth, Western Australia Australasian Journal on Ageing 26, 81-86 (2007) .
    • . . . The related, but distinct concept of loneliness is reported to be experienced by approximately 40% of this age group 32 33 34 . . .
  34. C Victor; S Scambler; J Bond The prevalence of, and risk factors for, loneliness in later life: a survey of older people in Great Britain Ageing Soc 25, 357-375 (2005) .
    • . . . The related, but distinct concept of loneliness is reported to be experienced by approximately 40% of this age group 32 33 34 . . .
  35. Department of Work and PensionsLink-Age: developing networks of services for older peopleLondon2004 Link-Age: developing networks of services for older people , (2004) .
    • . . . The development of strategies to increase older people's participation in society has been a major, cross-cutting component of recent UK government policies regarding the delivery of health and social care, as well as wider policies and reviews relating to social cohesion and the tackling of social inequalities 35 36 37 38 39 . . .
  36. Department of HealthConfident communities, brighter future. A framework for developing well-beingLondon2010 Confident communities, brighter future. A framework for developing well-being , (2010) .
    • . . . The development of strategies to increase older people's participation in society has been a major, cross-cutting component of recent UK government policies regarding the delivery of health and social care, as well as wider policies and reviews relating to social cohesion and the tackling of social inequalities 35 36 37 38 39 . . .
  37. Marmot ReviewFair society, healthy lives. The Marmot Review: executive summaryLondon2010 Fair society, healthy lives. The Marmot Review: executive summary , (2010) .
    • . . . The development of strategies to increase older people's participation in society has been a major, cross-cutting component of recent UK government policies regarding the delivery of health and social care, as well as wider policies and reviews relating to social cohesion and the tackling of social inequalities 35 36 37 38 39 . . .
  38. Department of Work and PensionsOpportunity age: meeting the challenges of ageing in the 21st centuryLondon2005 Opportunity age: meeting the challenges of ageing in the 21st century , (2005) .
    • . . . The development of strategies to increase older people's participation in society has been a major, cross-cutting component of recent UK government policies regarding the delivery of health and social care, as well as wider policies and reviews relating to social cohesion and the tackling of social inequalities 35 36 37 38 39 . . .
  39. HM GovernmentBuilding a society for all agesLondon2009 Building a society for all ages , (2009) .
    • . . . The development of strategies to increase older people's participation in society has been a major, cross-cutting component of recent UK government policies regarding the delivery of health and social care, as well as wider policies and reviews relating to social cohesion and the tackling of social inequalities 35 36 37 38 39 . . .
  40. R Findlay Interventions to reduce social isolation amongst older people: where is the evidence? Ageing Soc 23, 647-658 (2003) .
    • . . . Three previous systematic reviews 5 40 41 have synthesised the evidence of the effectiveness of interventions targeting social isolation in older people . . .
    • . . . Three previous systematic reviews 5 40 41 have synthesised the evidence of the effectiveness of interventions targeting social isolation in older people. Findlay 40 selected papers published between 1982 and 2002, while Cattan & White 41 included papers between 1970 and 1997, and Cattan et al 5 included papers published between 1970 and 2002 . . .
    • . . . This study advances the evidence base of previous reviews 5 40 41 , by including studies published since 2002 and by considering a wider range of outcomes reflecting the multi-dimensional definition of social isolation. . . .
    • . . . While the date range of our search period enabled us to identify studies published in the seven years following the most recent systematic reviews 5 40 , this is a rapidly emerging field . . .
    • . . . While interventions targeting social isolation include some of the beneficial characteristics identified in this and previous systematic reviews 5 40 , none appear to include all of them . . .
  41. M Cattan; M White Developing evidence based health promotion for older people: a systematic review and survey of health promotion interventions targeting social isolation and loneliness among older people Internet Journal of Health Promotion , (1998) .
    • . . . Three previous systematic reviews 5 40 41 have synthesised the evidence of the effectiveness of interventions targeting social isolation in older people . . .
    • . . . Findlay 40 selected papers published between 1982 and 2002, while Cattan & White 41 included papers between 1970 and 1997, and Cattan et al 5 included papers published between 1970 and 2002 . . .
    • . . . This study advances the evidence base of previous reviews 5 40 41 , by including studies published since 2002 and by considering a wider range of outcomes reflecting the multi-dimensional definition of social isolation. . . .
  42. CM Masi; H-Y Chen; LC Hawkley; JT Cacioppo A meta-analysis of interventions to reduce loneliness Personality and Social Psychology Review , (2010) .
    • . . . A recent meta-analysis of 50 studies exclusively aimed at ameliorating feelings of loneliness 42 has been published since the date of our literature search . . .
  43. JJ Deeks; JPT Higgins; DG Altman What is heterogeneity? Cochrane Handbook for Systematic Reviews of Interventions , (2009) .
    • . . . There is considerable academic debate regarding the appropriateness of meta-analysis in the context of such clinical heterogeneity 43 44 . . .
    • . . . Due to the heterogeneity of both the interventions studied and the outcome data extracted, quantitative synthesis of the data using meta-analytical techniques was deemed inappropriate 43 . . .
  44. M Petticrew; H Roberts Synthesizing the evidence Systematic Reviews in the Social Sciences , 164-214 (2006) .
    • . . . There is considerable academic debate regarding the appropriateness of meta-analysis in the context of such clinical heterogeneity 43 44 . . .
  45. Centre for Reviews and DisseminationSystematic reviews: CRD's guidance for undertaking reviews in health careYork: CRD, University of York2009307043421468289 Systematic reviews: CRD's guidance for undertaking reviews in health care , (2009) .
    • . . . Systematic reviews represent a scientific synthesis of evidence using reproducible and pre-determined methods 45 . . .
  46. D Ogilvie; M Egan; V Hamilton; M Petticrew Systematic reviews of health effects of social interventions: 2. Best available evidence: how low should you go? J Epidemiol Community Health 59, 886-892 (2005) .
    • . . . Evidence suggests that restricting eligibility to RCTs may be unhelpful 46 , particularly within health promotion and public health contexts where experimental designs are often not possible or feasible . . .
    • . . . While experimental study designs are not always feasible or acceptable 90 91 , efforts to use randomisation where possible should be encouraged 46 . . .
  47. JPT Higgins; DG Altman The Cochrane Collaboration's tool for assessing risk of bias Cochrane Handbook for Systematic Reviews of Interventions , (2009) .
    • . . . The Cochrane risk of bias tool 47 includes six domains ('random sequence generation', 'random allocation concealment', 'blinding', 'incomplete outcome data', 'selection outcome reporting', and 'other sources of bias'), each of which were completed according to whether they had been addressed in the study (yes/no/unclear) . . .
    • . . . a Refer to Higgins & Altman 47 for a definition of these categories . . .
  48. GA Wells; B Shea; D O'Connell; J Peterson; V Welch; M Losos; P Tugwell Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analysis Link , (2009) .
    • . . . The Newcastle-Ottawa Scale (NOS) for cohort studies 48 was used to assess the quality of non-randomised trials . . .
    • . . . a Refer to Wells et al 48 for full description of these categories . . .
  49. BJ Bushman Vote-counting procedures in meta-analysis The Handbook of Research Synthesis , 193-213 (1984) .
    • . . . To aid interpretation of the substantial number of studies identified, we also adopted an approach similar to vote-counting 49 , whereby we categorised intervention effects as 'significantly beneficial' or 'not beneficial'. . . .
  50. D Moher; A Liberati; J Tetzlaff; DG Altman Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement BMJ 339, b2535 (2009) .
    • . . . The systematic review was reported according to the PRISMA Statement 50 . . . .
  51. P Brennan; S Moore; K Smyth The effects of a special computer network on caregivers of persons with Alzheimer's disease Nursing Research 44, 166-172 (1995) .
  52. P Drentea; OJ Clay; DL Roth; MS Mittelman Predictors of improvement in social support: Five-year effects of a structured intervention for caregivers of spouses with Alzheimer's disease Soc Sci Med 63, 957-967 (2006) .
  53. R Toseland; C Rossiter; T Peak; G Smith Comparative effectiveness of individual and group interventions to support family caregivers Social Work 35, 209-217 (1990) .
  54. R Toseland; G Smith Effectiveness of individual counseling by professional and peer helpers for family care-givers of the elderly Psychology and Aging 5, 256-263 (1990) .
  55. S Fukui; M Koike; A Ooba; Y Uchitomi The effect of a psychosocial group intervention on loneliness and social support for Japanese women with primary breast cancer Oncology Nursing Forum 30, 823-831 (2003) .
  56. M Savelkoul; LP de Witte Mutual support groups in rheumatic diseases: Effects and participants' perceptions Arthritis & Rheumatism 51, 605-608 (2004) .
  57. J O'Loughlin; MC Laurendeau; G Gagnon An evaluation of a volunteer visitor program for socially isolated adults with chronic mental-health problems. [French] Canadian Journal of Community Mental Health 8, 31-52 (1989) .
  58. K Heller; M Thompson; P Trueba; J Hogg; I Vlachos-Weber Peer support telephone dyads for elderly women: was this the wrong intervention? American Journal of Community Psychology 19, 53-74 (1991) .
  59. R Schulz Effects of control and predictability on the physical and psychological well-being of the institutionalized aged Journal of Personality and Social Psychology 33, 563-573 (1976) .
  60. B Arnetz; T Theorell Psychological, sociological and health behaviour aspects of a long term activation programme for institutionalized elderly people Soc Sci Med 17, 449-456 (1983) .
  61. M Baumgarten; D Thomas; L Poulin de Courval; C Infante-Rivard Evaluation of a mutual help network for the elderly residents of planned housing Psychology and Aging 3, 393-398 (1988) .
  62. H White; E McConnell; E Clipp; L Bynum; C Teague; L Navas; S Craven; H Halbrecht Surfing the net in later life Journal of Applied Gerontology 18, 358-378 (1999) .
  63. RG Winningham; NL Pike A cognitive intervention to enhance institutionalized older adults' social support networks and decrease loneliness Aging & Mental Health 11, 716-721 (2007) .
  64. H White; E McConnell; E Clipp; L Branch; R Sloane; C Pieper; T Box A randomized controlled trial of the psychosocial impact of providing internet training and access to older adults Aging & Mental Health 6, 213-221 (2002) .
  65. B Bergman-Evans Beyond the basics. Effects of the Eden Alternative model on quality of life issues Journal of Gerontological Nursing 30, 27-34 (2004) .
  66. RE Constantino Comparison of two group interventions for the bereaved IMAGE: Journal of Nursing Scholarship 20, 83-88 (1988) .
  67. JE Harris; JL Bodden An activity group experience for disengaged elderly persons Journal of Counseling Psychology 25, 325-330 (1978) .
  68. I Kremers; N Steverink; F Albersnagel; J Slaets Improved self-management ability and well-being in older women after a short group intervention Aging & Mental Health 10, 476-484 (2006) .
  69. J Lokk Emotional and social effects of a controlled intervention study in a day-care unit for elderly patients Scand J Prim Health 8, 165-172 (1990) .
  70. K Ollonqvist; H Palkeinen; T Aaltonen; T Pohjolainen; P Puuka; K Hinkka; S Pontinen Alleviating loneliness among frail older people - findings from a randomised controlled trial International Journal of Mental Health Promotion 10, 26-34 (2008) .
  71. I MacIntyre; P Corradetti; J Roberts; G Browne; S Watt; A Lane Pilot study of a visitor volunteer programme for community elderly people receiving home health care Health and Social Care in the Community 7, 225-232 (1999) .
  72. K Slegers; MP van-Boxtel; J Jolles Effects of computer training and Internet usage on the well-being and quality of life of older adults: a randomized, controlled study The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 63, 176-184 (2008) .
  73. RL Evans; BM Jaureguy Phone therapy outreach for blind elderly Gerontologist 22, 32-35 (1982) .
  74. Y Fujiwara; N Sakuma; H Ohba; M Nishi; S Lee; N Watanabe; Y Kousa; H Yoshida; T Fukaya; S Yajima REPRINTS: effects of an intergenerational health promotion program for older adults in Japan Journal of Intergenerational Relationships 7, 17-39 (2009) .
  75. CM Martina; NL Stevens Breaking the cycle of loneliness? Psychological effects of a friendship enrichment program for older women Aging & Mental Health 10, 467-475 (2006) .
  76. C Rosen; S Rosen Evaluating an intervention program for the elderly Community Mental Health Journal 18, 21-33 (1982) .
  77. N Stevens; T van Tilburg Stimulating friendship in later life: a strategy for reducing loneliness among older women Educational Gerontology 26, 15-35 (2000) .
  78. G Bogat; L Jason An evaluation of two visiting programs for elderly community residents International Journal of Aging and Human Development 17, 267-280 (1983) .
  79. T Fokkema; K Knipscheer Escape loneliness by going digital: a quantitative and qualitative evaluation of a Dutch experiment in using ECT to overcome loneliness among older adults Aging & Mental Health 11, 496-504 (2007) .
  80. M Mulligan; R Bennett Assessment of mental health and social problems during multiple friendly visits: the development and evaluation of a friendly visiting program for isolated elderly International Journal of Aging and Human Development 8, 43-65 (1977) .
  81. KS Rook; DH Sorkin Fostering social ties through a volunteer role: implications for older-adults' psychological health International Journal of Aging & Human Development 57, 313-337 (2003) .
  82. M Eccles; J Grimshaw; M Campbell; C Ramsay Research designs for studies evaluating the effectiveness of change and improvement strategies Quality & Safety in Health Care 12, 47-52 (2003) .
    • . . . The interventions may have been poorly developed, lacking appropriate theoretical basis and subsequent components to impact on the measured outcome domains 82 83 . . .
  83. NC Campbell; E Murray; J Darbyshire; J Emery; A Farmer; F Griffiths; B Guthrie; H Lester; P Wilson; AL Kinmonth Designing and evaluating complex interventions to improve health care BMJ 334, 455-459 (2007) .
    • . . . The interventions may have been poorly developed, lacking appropriate theoretical basis and subsequent components to impact on the measured outcome domains 82 83 . . .
  84. M Woodward Confounding and interaction Epidemiology: study design and data analysis , 145-190 (1999) .
    • . . . Limitations with study design (e.g. small sample sizes, high attrition rates) or data analysis may also have caused the true intervention effects to be missed or over estimated due to confounding variables 84 . . . .
  85. H Wang; JP Boissel; P Nony Revisiting the relationship between baseline risk and risk under treatment Emerging Themes in Epidemiology 6, (2009) .
    • . . . In the remaining 20 studies, the underlying 'baseline risk' 85 of social isolation or loneliness was implicitly assumed due to other characteristics of the specific client group, such as being a resident in a nursing home . . .
  86. M Egger; P Juni; C Bartlett; F Holenstein; J Sterne How important are comprehensive literature searches and the assessment of trial quality in systematic reviews? Empirical study Health Technology Assessment 7, 1-76 (2003) .
    • . . . Limiting study eligibility to those published in English may also have introduced bias 86 , although this decision was made for pragmatic reasons . . .
  87. KH Pitkala; P Routasalo; H Kautiainen; RS Tilvis Effects of psychosocial group rehabilitation on health, use of health care services, and mortality of older persons suffering from loneliness: a randomized, controlled trial J Gerontol A Biol Sci Med Sci 64, 792-800 (2009) .
    • . . . For example, since the end of our search period (May 2009), new analysis 87 of data derived from a study already included in our review 13 has provided additional evidence suggesting beneficial effects for a psychosocial group intervention. . . .
  88. A Britton; M McKee; N Black; K McPherson; C Sanderson; C Bain Choosing between randomised and non-randomised studies: a systematic review 13, (1998) .
    • . . . While we acknowledge that non-randomised studies are at increased risk of bias, there is an argument that poor quality RCTs may be lower value than well-conducted non-randomised controlled trials 88 89 . . .
  89. M Petticrew; H Roberts Evidence, hierarchies, and typologies: horses for courses J Epidemiol Community Health 57, 527-529 (2003) .
    • . . . While we acknowledge that non-randomised studies are at increased risk of bias, there is an argument that poor quality RCTs may be lower value than well-conducted non-randomised controlled trials 88 89 . . .
  90. H Thomson; R Hoskins; M Petticrew; D Ogilvie; N Craig; T Quinn; G Lindsay Evaluating the health effects of social interventions BMJ 328, 282-285 (2004) .
    • . . . While experimental study designs are not always feasible or acceptable 90 91 , efforts to use randomisation where possible should be encouraged 46 . . .
  91. ML Barreto Efficacy, effectiveness, and the evaluation of public health interventions Journal of Epidemiology & Community Health 59, 345-346 (2005) .
    • . . . While experimental study designs are not always feasible or acceptable 90 91 , efforts to use randomisation where possible should be encouraged 46 . . .
  92. KF Schulz; DG Altman; D Moher CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials BMJ 340, c332 (2010) .
    • . . . Increased adherence to reporting guidelines such as CONSORT 92 for RCT studies and STROBE 93 for observational studies will also enhance the utility of intervention evaluations . . .
  93. E von Elm; D Altman; S Pocock; P Gotzsche; J Vandenbroucke Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies BMJ 335, 806-808 (2007) .
    • . . . Increased adherence to reporting guidelines such as CONSORT 92 for RCT studies and STROBE 93 for observational studies will also enhance the utility of intervention evaluations . . .
  94. D Craig; P Dieppe; S Macintyre; S Michie; I Nazareth; M Petticrew Developing and evaluating complex interventions: new guidance , (2008) .
    • . . . The inclusion of rigorous process evaluations within trials may also shed light on the mechanisms through which social isolation may be reduced 94 . . . .
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