What factors can make older people at higher risk of isolation and exclusion from others?

Social isolation is an important and widespread health problem among community-dwelling older adults (Nicholson, 2012). Older adults are not likely to admit feeling lonely and rates might actually be higher than those reported (Pinquart & Sörensen, 2001). As the number of older people who live alone is growing (Chen & While, 2019), loneliness could be an increasing problem among older people. Notwithstanding these difficulties and demographic changes (Peters, Pritzkuleit, Beske, & Katalinic, 2010), there is only a limited number of studies that investigate loneliness and social isolation among older people. Moreover, there are few publications investigating the relationship between falls and social relations among older people (Hajek & König, 2017).

Every year, one in four persons suffers from a fall (Bergen, Stevens, & Burns, 2016), however less than half notify their health care providers (Stevens et al., 2012). A fall is an event, which results in a person coming to rest inadvertently on the ground or other level. It can be a consequence of the following: Sustaining a violent blow, loss of consciousness, sudden onset of paralysis, as in a stroke, an epileptic seizure (Author unknown, 1987). The World Health Organization (WHO) revealed that falls are the second leading reason for accidental or unintentional injury deaths worldwide, and that adults aged 65 years and older sustain of the majority of fatal falls (, 2008). Falls among those aged 60 and older are not rare. They can result in traumatic brain injuries, fractures or loss of independence (Ahlqvist, Nyfors, & Suhonen, 2016). In addition, an older persons’ recovery from a fall injury is often protracted, which can also lead to further falls (Rubenstein, 2006). To date, most studies have focused on investigating falls caused by fear of falling (FOF) (Kempen, van Haastregt, McKee, Delbaere, & Zijlstra, 2009), vision problems, hearing problems, strength, home safety (Fabre, Ellis, Kosma, & Wood, 2010) or dementia (Lach, Harrison, & Phongphanngam, 2017). The association between falls and depression among older people has also been investigated in some studies (Launay et al., 2013).

To understand the key concepts loneliness and social isolation of this study, it is necessary to be aware of them often being used synonymously (Victor, Scambler, Bond, & Bowling, 2000) even though they represent different concepts (Finlay & Kobayashi, 2018). Commonly loneliness is defined as an undesired subjective experience which stands for ‘unfulfilled intimate and social needs’ (Courtin & Knapp, 2015; Peplau & Perlman, 1982). Lots of studies compare loneliness with perceived social isolation and distinguish perceived social isolation from objective social isolation (Hawkley & Caciopoppo, 2010). It has been shown that social isolation can either be defined as a unidimensional concept with the use of, e.g. the number of people in regular contact, or as a multidimensional concept (Courtin & Knapp, 2015). A multidimensional concept leads to the assumption that social isolation is heterogeneous including, e.g. the quality of relationships (Cornwell & Waite, 2009; Courtin & Knapp, 2015). In addition to that, in this study we assume that social isolation is a part of social exclusion (Gallie et al., 2003; Taket et al., 2009) and used social exclusion as a keyword as well. Social exclusion develops from several depletions and unfairnesses a person can undergo considering not only geographical, economical influences but also the cultural influence and social fabric (Taket et al., 2009). Similar to social isolation, we define social exclusion as a societal phenomenon arising from e.g. ‘marginalising, rejecting and isolating processes’ (Taket et al., 2009). Findings from different studies propose that social isolation also arises from defiencies in the social fabric such as ‘lack of relationships, psychological barriers, physical barriers’ and defiencies in financial or environmental manner as well (Nicholson, 2009).

The aim of this systematic review is to provide an overview on publications analyzing the relationship between falls, social isolation and/or loneliness among people aged 60 and older. This study considers not only social isolation, but also loneliness, due to key differences in these two concepts mentioned above (Cornwell & Waite, 2009). Another relevant variable taken into account in this study is the living status of the individual, namely whether they live alone or not. Current data concerning falls and loneliness and/or social isolation is limited. On the other hand there are more studies focusing on the living alone status in relation to falls (Leung, Chi, Lou, & Chan, 2010). Therefore, another interesting aspect of this study is to evaluate if older people living alone, tend to feel lonelier than people living with other persons. Some studies suggest that living alone is somewhat related to loneliness and social isolation in late life, e.g. living alone can contribute to increased loneliness (Cohen-Mansfield, Hazan, Lerman, & Shalom, 2016; Iliffe et al., 2007; Victor, Scambler, Bowling, & Bond, 2005). Otherwise not all individuals living alone feel lonely (Tabue Teguo et al., 2016).

Furthermore, this systematic review includes studies that treated falls either as dependent or independent variable. Due to the analysis of falls in relation to social isolation and loneliness being either a dependent or independent variable, this review offers results from bidirectional analyzes. First of all, it appears to be plausible that falls can lead to higher levels of loneliness and social isolation in older persons which may be explained by the fact that fallers tend to avoid activities of daily living, enrolling them in society (Hacihasanoğlu, Yildirim, & Karakurt, 2012; Perissinotto, Stijacic Cenzer, & Covinsky, 2012). Conversely, a potential mechanism for the influence of social isolation and loneliness on falls may be that these older persons lose their physical abilities when they are not physically encouraged or socially supported (Lach, Krampe, & Phongphanngam, 2011). Social and physical support for older people could significantly keep them from falls (Albert & King, 2017; Olij et al., 2017).

All in all, this article will contribute to the current state of knowledge by systematically reviewing studies which investigate the relationship between social isolation and falls, loneliness and falls. So far, lots of studies as systematic reviews focused on different examined relations to falls (Ambrose, Paul, & Hausdorff, 2013; Deandra et al., 2010; Jiam, Li, & Agrawal, 2016). It is important to understand this relation between falls and social isolation/loneliness in general because it offers more information about an important link in older persons‘ life, namely falls and social isolation as well as loneliness (Khow & Visvanathan, 2017). Understanding this relation could help avoid social isolation or loneliness in older people if studies suggest them to be influenced by falls or avoid falls if falls are significantly influenced by social isolation/loneliness. Both social isolation and loneliness are commonly among older people and then combined with higher morbidity or mortality (Ong, Uchino, & Wethington, 2016; Tanskanen & Anttila, 2016). Falls themselves often affect older people and can result in consequences like hospitality, fractures (De Baat et al., 2017), long-term care, less autonomy (Hajek & König, 2019) etc. Interventional strategies to avoid or at least postpone these factors may contribute to successful ageing.

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  Show abstractNavigate Down

  It remains unclear how falls affect older people's social relations. In particular, the characteristics of fallers in their second half of life are unclear. Several studies have reported that people with a low educational level fall more often, and that low educational level is a predictor for perceived social exclusion. We conducted the first longitudinal analysis on the association between falls and social relations among people of different educational levels.

  Longitudinal data were used from two waves (2014 and 2017) of the German Ageing Survey with an analytical sample of 11,227 individuals aged ≥ 40 years. Fall history in the past 12 months (yes; no) was assessed. Perceived social exclusion (outcome measure) was assessed using a validated scale developed by Bude and Lantermann. Loneliness (outcome measure) was measured using a short form of the validated De Jong Gierveld Loneliness Scale.

  Controlling for various potential confounding variables, fixed effects regression analysis stratified by educational level and gender revealed that experiencing a fall was associated with greater perceived social exclusion (β = 0.21 p < 0.05) among men with low/medium educational level. The experience of a fall was not associated with increased loneliness.

  Our results suggest an association between falls and feelings of social exclusion. This association was found only for men in their second half of life with low/medium educational level. Falls were not associated with loneliness.

  What are the factors that lead to social isolation in older adults?

  Causes of Social Isolation in Elderly Adults.

  Disability..

  Living alone..

  Limited finances..

  Impaired mobility..

  No family close by..

  Never having married..

  Transportation challenges..

  Divorced, separated, or widowed..

  What are five factors that can lead to isolation?

  Here are some of the leading causes:.

  Living alone..

  Being age 80 or older..

  Having a compromised health status or multiple health problems..

  Having no children or contact with family..

  Lacking access to transportation..

  Living with low income..

  What are risk factors for social isolation?

  Factors that prevent people from engaging with others, such as long-term illness, disabilities, transportation issues, unemployment, or exposure to domestic or community violence, may increase social isolation and loneliness. Those younger than fifty are more likely to report loneliness than those age fifty and older.

  What are risk factors for older adults?

  Older adults are at higher risk for chronic health problems like diabetes, osteoporosis, and Alzheimer's disease. In addition, 1 in 3 older adults fall each year, and falls are a leading cause of injury for this age group. Physical activity can help older adults prevent both chronic disease and fall-related injuries.