Influencing factors of loneliness among older adults in China: a systematic review and meta‐analysis

China has a large and rapidly growing older population. Loneliness is associated with a range of negative health outcomes in older adults. However, to date, there is still a lack of comprehensive and systematic evidence on the factors influencing loneliness among older adults in China. Nine Chinese and English databases were searched by computer from inception to March 2022: China Knowledge Network, WanFang Data, Chinese Scientific Journal Database, SinoMed, PubMed, Embase, Web of Science, PsycINFO, and Cochrane Library. Studies on factors influencing loneliness among older adults in China were included. Two reviewers independently completed the literature screening, quality evaluation, and data extraction, and statistical analyses were performed using Review Manager 5.4 software. A total of 15 studies were included in the review, with 47 066 participants in total. Fifty‐nine influencing factors of loneliness in older Chinese were involved. Twenty factors with a total of 30 subfactors that were involved in two or more studies and with extractable data were included in the data synthesis. Eleven subfactors were not statistically significantly associated with loneliness, namely, male, female, lower age, higher education level, health status—fair, health status—poor, social support—none/low, no health insurance, smoking, alcohol consumption, and body mass index—overweight and above (all P > 0.05), while the remaining 19 subfactors (concerning 15 factors) were significantly associated with loneliness in older adults in China (all P < 0.05). This study suggested that age, education level, marital status, living arrangement, having (no) children, receiving family support, relationship with family members, being with or without chronic diseases, health status, activities of daily living, social support, social activities, financial status, satisfaction with housing conditions, and the decision‐making right for major household expenditures were the main influencing factors of loneliness among older adults in China.

[1]  Anonymous.  COVAX delivers its 1 billionth COVID-19 vaccine doseCOVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide , 2022, Saudi medical journal.

[2]  C. DeCarli,et al.  Association of Loneliness With 10-Year Dementia Risk and Early Markers of Vulnerability for Neurocognitive Decline , 2022, Neurology.

[3]  Stefan Ma,et al.  Loneliness and health expectancy among older adults: A longitudinal population‐based study , 2021, Journal of the American Geriatrics Society.

[4]  Ryan J. Piers,et al.  Associations of loneliness with risk of Alzheimer's disease dementia in the Framingham Heart Study , 2021, Alzheimer's & dementia : the journal of the Alzheimer's Association.

[5]  K. McKee,et al.  A systematic review of longitudinal risk factors for loneliness in older adults , 2021, Aging & mental health.

[6]  M. Barreto,et al.  Loneliness around the world: Age, gender, and cultural differences in loneliness , 2021, Personality and individual differences.

[7]  L. Tang,et al.  Relationships among Social Support, Coping Style, Perceived Stress, and Psychological Distress in Chinese Lung Cancer Patients , 2021, Asia-Pacific journal of oncology nursing.

[8]  A. Steptoe,et al.  The association between loneliness and depressive symptoms among adults aged 50 years and older: a 12-year population-based cohort study. , 2020, The lancet. Psychiatry.

[9]  J. Chilcot,et al.  Loneliness and type 2 diabetes incidence: findings from the English Longitudinal Study of Ageing , 2020, Diabetologia.

[10]  E. Mayo-Wilson,et al.  The PRISMA 2020 statement: an updated guideline for reporting systematic reviews , 2020, BMJ.

[11]  X. Qin,et al.  Association between social capital and loneliness among older adults: a cross-sectional study in Anhui Province, China , 2020, BMC Geriatrics.

[12]  Ben J. Smith,et al.  How the COVID-19 pandemic is focusing attention on loneliness and social isolation. , 2020, Public health research & practice.

[13]  K. Khunti,et al.  Impact of COVID-19 on routine care for chronic diseases: A global survey of views from healthcare professionals , 2020, Diabetes & Metabolic Syndrome: Clinical Research & Reviews.

[14]  Robin I. M. Dunbar,et al.  The Neurobiology of Social Distance , 2020, Trends in Cognitive Sciences.

[15]  P. Yuan,et al.  The association between sleep quality and loneliness in rural older individuals: a cross-sectional study in Shandong Province, China , 2020, BMC Geriatrics.

[16]  Ling Qiang,et al.  Loneliness and Its Correlates Among the Aged People Living Alone in Urban Areas , 2019 .

[17]  Grace C. Huang,et al.  Adapting Maslow's Hierarchy of Needs as a Framework for Resident Wellness , 2019, Teaching and learning in medicine.

[18]  Junan Zhang,et al.  Correlates of loneliness in older adults in Shanghai, China: does age matter? , 2018, BMC Geriatrics.

[19]  Y. Conwell,et al.  Loneliness in Chinese older adults in primary care: prevalence and correlates , 2018, Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society.

[20]  Jiao Zhang,et al.  Loneliness and Health Service Utilization among the Rural Elderly in Shandong, China: A Cross-Sectional Study , 2018, International journal of environmental research and public health.

[21]  Martin Knapp,et al.  Social isolation, loneliness and health in old age: a scoping review , 2017, Health & social care in the community.

[22]  Matthew Pittman,et al.  Social media and loneliness: Why an Instagram picture may be worth more than a thousand Twitter words , 2016, Comput. Hum. Behav..

[23]  W. Van den Noortgate,et al.  Gender Differences in Loneliness across the Lifespan: A Meta–Analysis , 2016, European Journal of Personality.

[24]  S. Mayor.  Loneliness is associated with higher risk of stroke and heart disease, study finds , 2016, British Medical Journal.

[25]  J. Jayawardhana,et al.  Risk Factors for Loneliness in Elderly Adults , 2016, Journal of the American Geriatrics Society.

[26]  B. Hanratty,et al.  Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies , 2016, Heart.

[27]  G. Cheng,et al.  Present Situation of the Empty Nest Elderly’s Mental Health and Research Commentary , 2013 .

[28]  L. Hawkley,et al.  Loneliness is associated with sleep fragmentation in a communal society. , 2011, Sleep.

[29]  E. Kua,et al.  Living Alone, Loneliness, and Psychological Well-Being of Older Persons in Singapore , 2011, Current gerontology and geriatrics research.

[30]  Diana Koszycki,et al.  Prenatal social support, postnatal social support, and postpartum depression. , 2009, Annals of epidemiology.

[31]  Jerome Kagan,et al.  Loneliness: Human Nature and the Need for Social Connection , 2009 .

[32]  P. Dykstra,et al.  Social Embeddedness and Late-Life Parenthood , 2007 .

[33]  N. Stevens,et al.  Loneliness, adaptation to vision impairment, social support and depression among visually impaired elderly , 2005 .

[34]  J. Bond,et al.  The prevalence of, and risk factors for, loneliness in later life: a survey of older people in Great Britain , 2005, Ageing and Society.

[35]  M. Pinquart,et al.  Influences on Loneliness in Older Adults: A Meta-Analysis , 2001 .

[36]  Z. Liang.  The epidemiologic studies on loneliness among elderly:A review , 2012 .

[37]  M. Pinquart,et al.  Risk factors for loneliness in adulthood and old age--a meta-analysis. , 2003 .

[38]  T. V. van Tilburg,et al.  Living arrangements of older adults in the Netherlands and Italy: Coresidence values and behaviour and their consequences for loneliness , 1999, Journal of cross-cultural gerontology.

[39]  M. Schlossberg.  The Concise Dictionary of Psychology. , 1991 .