The “timbre” of loneliness in later life

The social distancing restrictions associated with the SARS-CoV-2/COVID-19 pandemic brought increased attention to issues of social isolation and loneliness among older adults (Vahia et al., 2020; Frenkel-Yosef et al., 2020). The body of empirical research on loneliness among older adults goes back over half a century (Munnichs, 1964), but the past decade has seen an uptick in attention in the professional and lay-press, as well as government and public policy circles (Levine, 2018; United States Senate Special Commitee on Aging, 2020). Much of the focus over the past decade has been grounded in concern about the adverse downstream biological effects of loneliness in terms of medical comorbidity, dementia, and early mortality (Frenkel-Yosef et al., 2020; Lutzman et al., 2021; Goldberg et al., 2021). Although the biological impact of loneliness is of course important, it is at least equally if not more critical to consider the adverse effects of loneliness on quality of life and mental well-being. Loneliness by definition is a form of psychological distress, i.e. distress about a perceived discrepancy in the quality or quantity of one’s relationships relative to those the person desires (Cacioppo and Patrick, 2008). The distress of loneliness can take many forms and be triggered by different types of discrepancies between one’s desired vs. perceived social relationships and environment. The triggers or social focus of loneliness may vary from a longing for relationships that do not (yet) exist to grief for relationships that have fundamentally changed or are no longer available. Moreover, the emotional distress of loneliness can be experienced as any combination of unpleasant feelings such as anxiety, sadness, resentment/anger, or despair. There have been a variety of efforts to categorize the types of loneliness. The most frequently cited is that proposed in 1973 by Weiss (1973) in terms of emotional vs. social loneliness. Emotional loneliness may be understood as an unmet desire for a close/ intimate relationship. In contrast, social loneliness may be experienced as a self-perceived deficiency in one’s broader social network of friends (Cacioppo and Patrick, 2008; Weiss, 1973). Alternatively, based on factor analyses of responses to items on the 20-item version of the UCLA Loneliness Scale (UCLA-LS), Russell et al. (1980) and Hawkley et al. (2005) differentiated three loneliness factors: intimate, relational, and collective loneliness. Hawkley and colleagues noted that these factors are not necessarily categories of loneliness that differentiate individuals but instead are different dimensions within which a lonely person may conceptualize and experience their loneliness. Another dimensional example was suggested by de Jong Gierveld (1998) in which she posited three dimensions: feelings of deprivation (longing for intimate attachment, feelings of emptiness, or abandonment), time perspective (hopeless or changeable), and the emotional aspects of loneliness (e.g. sadness, shame, guilt, frustration, or desperation). There remains a relative dearth of research on the changes of these various types or dimensions of loneliness over the age span, although the Hawkley et al.’s three-factor solution that was first identified in an undergraduate students was replicated in a sample of older adults (Hawkley et al., 2005). Aging may also bring other challenges that can contribute to a solitary life, such as loss of lifepartners, friends, and family through either death, disability, or changes in residence. Other relevant risks include changes in mobility, physical health, and cognitive decline, which can reinforce social isolation and loneliness. In addition, advancing age brings an increased risk of sensory impairments that can make communication, transportation, and socialization efforts more challenging if uncorrected. The ubiquity of such changes with advancing age would seem to place older adults at increased risk for social isolation and loneliness, but empirical data show a more complex relationship between age and loneliness. Studies of the association between age and loneliness have reported a complexity of inconsistent findings, but one conclusion is clear—the relationship between age and loneliness is not a simple linear function (reviewed in Lee et al., 2019). For example, based on the third edition of the UCLA-LS (Russell, 1996) in a survey of adults aged 27 to 101 years, our research group found loneliness peaks among those in their 20s, mid-50s, and late 80s (Lee et al., 2019). This finding was partially replicated using a 4-item short form of the UCLA-LS in a separate sample of adults aged 20 to 69 years. In the latter study, we found the highest levels of loneliness to be by respondents in their 20s and 60s, with an additional International Psychogeriatrics (2021), 33:12, 1233–1236 © International Psychogeriatric Association 2021