Lonelier than ever? Loneliness of older people over two decades

Abstract

To live with feelings of loneliness has negative implications for quality of life, health and survival. This study aimed to examine changes in loneliness among older people, both with regard to prevalence rates, and socio-demographic, social and health-related correlates of loneliness.
This study had a repeated cross-sectional design and was based on the nationally representative Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD). Analyses of trends in loneliness covered the years 1992, 2002, 2004, 2011 and 2014, and included people aged 77 years or older (n = 2 572). Analyses of correlates of loneliness covered 2004 and 2014, and included people aged 70 years or older (n = 1 962). Logistic regression analyses were conducted with findings presented as average marginal effects.
Contrary to what is often assumed, there has been no increase in loneliness among older people over time (1992–2014). Regression analyses for 2004 and 2014 showed that social and health-related correlates were more strongly associated with loneliness than socio-demographic correlates. Psychological distress was most strongly associated with loneliness, followed by widowhood. Most associations between the correlates and loneliness were stable over time.

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Archives of Gerontology and Geriatrics
journal homepage: www.elsevier.com/locate/archger
Lonelier than ever? Loneliness of older people over two decades
Lena Dahlberg
a,b,⁎
, Neda Agahi
a
, Carin Lennartsson
a
a
Aging Research Center, Karolinska Institutet/Stockholm University, Gävlegatan 16, 113 30 Stockholm, Sweden
b
School of Education, Health and Social Studies, Dalarna University, 791 88 Falun, Sweden
ARTICLE INFO
Keywords:
Loneliness
Trend
Risk factor
Predictor
Sweden
ABSTRACT
To live with feelings of loneliness has negative implications for quality of life, health and survival. This study
aimed to examine changes in loneliness among older people, both with regard to prevalence rates, and socio-
demographic, social and health-related correlates of loneliness.
This study had a repeated cross-sectional design and was based on the nationally representative Swedish
Panel Study of Living Conditions of the Oldest Old (SWEOLD). Analyses of trends in loneliness covered the years
1992, 2002, 2004, 2011 and 2014, and included people aged 77 years or older (n= 2 572). Analyses of cor-
relates of loneliness covered 2004 and 2014, and included people aged 70 years or older (n= 1 962). Logistic
regression analyses were conducted with findings presented as average marginal effects.
Contrary to what is often assumed, there has been no increase in loneliness among older people over time
(1992–2014). Regression analyses for 2004 and 2014 showed that social and health-related correlates were more
strongly associated with loneliness than socio-demographic correlates. Psychological distress was most strongly
associated with loneliness, followed by widowhood. Most associations between the correlates and loneliness
were stable over time.
1. Introduction
Loneliness has been defined as the discrepancy between an in-
dividual’s desired and achieved levels of social relationships (Perlman &
Peplau, 1981). To live with feelings of loneliness is not only a problem
in itself, it also has implications for quality of life, physical and mental
health, and mortality (e.g. Hawkley and Cacioppo, 2010; Holt-Lunstad
et al., 2015;Hawkley & Cacioppo, 2010; Holt-Lunstad et al., 2015;
O'Luanaigh & Lawlor, 2008).
There is a common belief that older people experience loneliness
more often than other age groups. For example, in both 1982 and 2005,
the vast majority of respondents in a Swedish population survey be-
lieved that almost half of the pensioners often feel lonely (Tornstam,
2007) and images that older people suffer from loneliness are often
spread in media (cf. Ferreira-Alves, Magalhaes, Viola, & Simoes, 2014).
Another common belief is that recent cohorts of older people experi-
ence loneliness to a larger extent than previous cohorts, as a result of
changes in family patterns, such as smaller family size, increased di-
vorce rates and greater geographical distance between family members
(Dykstra, 2009), and transitions towards more individualistic societies
(World Values Survey, 2016). Changes in family patterns and societal
changes also mean that there may be other groups of people that are
vulnerable to loneliness today than in earlier cohorts, that is, that
factors associated with loneliness may have changed over time. Based
on a Swedish national survey, this study will examine whether lone-
liness among older people has increased in the last two decades and
whether there have been any changes in socio-demographic, social and
health-related factors associated with loneliness.
1.1. Trends in loneliness
The assumption that loneliness among older people has increased
over time has been disputed, and a research review has found a slight
decrease in loneliness (Dykstra, 2009). More recent studies have found
that there is no change over time (Honigh-de Vlaming, Haveman-Nies,
Groeniger, de Groot, & van ‘t Veer, 2014) or decreased levels of re-
ported loneliness (Eloranta, Arve, Isoaho, Lehtonen, & Viitanen, 2015).
In a British study, levels of loneliness among older people in 1999 were
compared to findings in studies conducted between 1945 and 1960.
Even in such long time perspective, no increase in severe loneliness was
found (Victor et al., 2002).
1.2. Factors associated with loneliness
Factors associated with feelings of loneliness can be grouped into
socio-demographic, social and health-related factors. Starting with
https://doi.org/10.1016/j.archger.2017.11.004
Received 29 November 2016; Received in revised form 20 September 2017; Accepted 12 November 2017
⁎
Corresponding author at: School of Education, Health and Social Studies, Dalarna University, 791 88 Falun, Sweden.
E-mail address: ldh@du.se (L. Dahlberg).
Archives of Gerontology and Geriatrics 75 (2018) 96–103
Available online 16 November 2017
0167-4943/ © 2017 Elsevier B.V. All rights reserved.
T

socio-demographic factors, loneliness is more common among the
oldest old than in younger age groups (O'Luanaigh & Lawlor, 2008;
Pinquart & Sörensen, 2001; Routasalo & Pitkala, 2003), and loneliness
in older people increases with age (Dahlberg, Andersson, McKee, &
Lennartsson, 2015;Heikkinen & Kauppinen, 2011; Jylhä, 2004).
Loneliness is also more often found in women than men (Aartsen &
Jylhä, 2011; Cohen-Mansfield et al., 2009;Dykstra, van Tilburg, & de
Jong Gierveld, 2005). However, research has shown that these asso-
ciations with loneliness have less to do with age and gender per se than
with associated factors such as widowhood and greater levels of health
problems among the oldest old and among women (Dahlberg et al.,
2015).
Low socioeconomic status is another socio-demographic factor as-
sociated with loneliness. Education and income have often been used as
indicators of socioeconomic status. Both these indicators have been
found to be associated with loneliness, partly due to fewer possibilities
for social participation and smaller social networks among people with
low levels of income and education (see Dykstra & de Jong Gierveld,
1999; Jylhä & Saarenheimo, 2010; Pinquart & Sörensen, 2001;
Routasalo & Pitkala, 2003;Savikko, Routasalo, Tilvis, Strandberg, &
Pitkala, 2005).
Social factors influencing loneliness include, for example, marital
status, social support and social contacts. There is a large body of re-
search showing an association between marital status and loneliness.
More specifically, the loss of partner is a key predictor of loneliness in
old age (Aartsen & Jylhä, 2011; Dahlberg & McKee, 2014; Dahlberg
et al., 2015; Dykstra et al., 2005; Jylhä & Saarenheimo, 2010). As
people age and are confronted with health problems, social contacts
may focus more on the need for support, and people with larger social
support networks have been found to be less likely to report loneliness
(Dahlberg, Andersson, & Lennartsson, In press; Dykstra & Fokkema,
2007). Low levels of social contacts also increase the risk of loneliness
(e.g. Ayalon, Shiovitz-Ezra, & Palgi, 2013;Victor, Scambler, & Bond,
2009).
Finally, health problems, such as mobility difficulties and depres-
sion have been found to be associated with loneliness (Aartsen & Jylhä,
2011; Cohen-Mansfield et al., 2009; Heikkinen & Kauppinen, 2011;
O'Luanaigh & Lawlor, 2008; Tijhuis et al., 1999). People with low
physical functioning are more likely to experience loneliness (Aartsen &
Jylhä, 2011; Honigh-de Vlaming et al., 2014; Jylhä, 2004; Routasalo &
Pitkala, 2003), as mobility difficulties may be a barrier to social en-
gagement (Cohen-Mansfield & Parpura-Gill, 2007). A recent study has
shown that loneliness has become more common over time among
people with low physical functioning (Honigh-de Vlaming et al., 2014).
Psychological problems, such as depression and anxiety, have also been
found to be associated with higher levels of loneliness (Eloranta et al.,
2015; Heikkinen & Kauppinen, 2011; O'Luanaigh & Lawlor, 2008).
In this study, loneliness among the oldest old in Sweden over the
last two decades is examined. The aim is to identify changes in lone-
liness over time, both with regard to prevalence levels and to socio-
demographic, social and health-related factors associated with lone-
liness.
2. Design and methods
2.1. Sample
This study has a repeated cross-sectional design and is based on the
Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD)
(Lennartsson et al., 2014). SWEOLD is a nationally representative
survey of the oldest old (born between 1892 and 1944) living in Sweden
at the time of data collection. SWEOLD provides comparable data from
1992, 2002, 2004, 2011 and 2014. The SWEOLD sample includes re-
spondents aged 77 years or older in 1992, 2002 and 2011. In 2004 and
2014, the sample was extended to include individuals aged 70 years or
older. Face-to-face interviews were carried out as the main interview
mode in 1992, 2002 and 2011. In 2004 and 2014, telephone interviews
were used as the main interview mode. In 2004, 2011 and 2014, postal
questionnaires were used if the respondent did not agree to an ordinary
interview or was unable to conduct an ordinary interview due to, for
example, hearing problems. There were no significant differences in
reported loneliness across the interview modes (p = 0.192).
The response rates varied between 84.4 and 95.4 percent (see
Table 1). The low non-response rates, the inclusion of institutionalized
persons and the use of proxy informants for people unable to be in-
terviewed directly ensure that the SWEOLD sample is representative of
older people in Sweden in each interview wave. In total, 4 566 inter-
views have been conducted. In some interview waves, only directly
interviewed respondents have received the question about loneliness.
Therefore, the analytical sample for this study excluded respondents
who could not perform the interview on their own (see Table 1).
In this study, analyses of the trends in loneliness from 1992 to 2014
included people aged 77 years or older, with an analytical sample of
2 572 (approximately 500 in each data collection wave; see Table 1). In
analyses to determine whether the association of sociodemographic,
social and health factors with loneliness have changed over time, 2004
and 2014 interview waves were used. These interview waves used the
same main interview mode and included people age 70 years or older,
with an analytical sample of 1 962 (n = 921 in 2004; n = 1 041 in
2014).
Informed verbal consent was obtained prior to each interview.
Ethical approvals for the SWEOLD study have been provided by
Uppsala University Hospital (reg.no. 247/91), Karolinska Institutet
Regional Research Ethics Committee (reg.no. 03-413) and the Regional
Ethical Review Board in Stockholm (reg.no. 04-314/5; 2010/403-31/4;
2014/1003-31/5).
2.2. Material
2.2.1. Dependent variable
Loneliness was measured through the item: “Are you ever bothered
by feelings of loneliness?”with four response categories. Analyses of
trends in the prevalence of loneliness present data on all four response
categories. Due to small numbers in some of the response categories,
loneliness was transformed into a dichotomous variable for the re-
gression analyses, indicating being frequently lonely (collapsing
Table 1
Number of respondents and response rates in SWEOLD for people aged 77 years or older in 1992, 2002, 2004, 2011 and 2014, and for people aged 70 years or older in 2004 and 2014.
1992 2002 2004 2011 2014 2004 2014
Age 77+ Age 77+ Age 77+ Age 77+ Age 77+ Age 70+ Age 70+
n% n% n% n% n% n % n %
Respondents 537 95.4 621 84.4 648 89.3 647 86.4 575 84.6 1110 87.5 1226 84.4
Direct interviews 473 88.1 539 86.8 509 78.5 541 83.6 553 96.2 929 83.7 1106 90.2
Indirect interviews 64 11.9 82 13.2 139 21.5 106 16.4 22 3.8 181 16.3 120 9.8
Non-response 26 4.6 115 15.6 78 10.7 102 13.6 105 15.4 158 12.5 227 15.6
Gross sample 563 100.0 736 100.0 726 100.0 749 100.0 680 100.0 1268 100.0 1453 100.0
L. Dahlberg et al. Archives of Gerontology and Geriatrics 75 (2018) 96–103
97

response categories: nearly always and often) and rarely lonely (col-
lapsing response categories: seldom and almost never).
2.2.2. Independent variables
Socio-demographic variables included gender, age in years and
educational level (1 = lower education level, defined as grade school,
0 = higher education level, defined as beyond grade school).
Social factors included marital status (married/cohabiting, di-
vorced/unmarried and widow/widower), social support and social
contacts. Regarding marital status, divorced and unmarried individuals
were grouped due to small numbers of respondents in these groups.
Information about social support was collected via the item “One
sometimes needs help and support from someone. Do you have any
relative or close friend who helps out if you need to talk to someone
about personal problems?”(response alternatives: Yes; No). Social
contacts were measured via four items concerning visiting and/or being
visited by friends and/or relatives (response alternatives: No (0); Yes,
sometimes (1); Yes, often (2)). This social contact scale was reversed
and ranged from no social contacts (8) to frequent social contacts (0).
Finally, health-related factors covered limitations in activities of
daily living (ADL) and psychological distress. ADL reflected the number
of the following areas with which the respondent reported difficulties:
eating, getting into and out of bed, going to the toilet, getting dressed,
and washing one’s hair (scale range: 0–5). Psychological distress was
measured via an item asking whether respondents had experienced
“anxiety, nervousness or angst”in the 12 months preceding the inter-
view (response categories: No; Yes, mild; Yes, severe).
2.3. Analysis
Analysis was directed towards determining trends in loneliness for
the total sample. This was done via descriptive analyses. For tests of
statistical significance in trends over time, linear and logistic regression
analyses were used. Gender differences were analysed via Chi-square
tests.
Thereafter, analyses were performed to identify correlates of lone-
liness in 2004 and 2014. As a first step, descriptive analyses were
performed for the total sample in 2004 and 2014. Thereafter, logistic
regression analyses were undertaken for the same samples with the
margins option in STATA 12. This produces coefficients as average
marginal effects (AME). Unlike odds ratios, AMEs can be compared
across models and outcomes. AMEs are interpreted as the average im-
pact on the probability of experiencing loneliness. Bivariate analyses
were performed to identify associations between independent variables
and loneliness (dependent variable) in 2004, and between independent
variables and loneliness (dependent variable) in 2014. In addition,
multivariable logistic regression analyses were performed with AMEs
for 2004 and 2014, respectively. All independent variables were en-
tered simultaneously into each regression analysis. Changes in corre-
lates over time were further examined via analyses of interaction be-
tween correlates and survey year.
Some respondents have been included in SWEOLD at more than one
wave of data collection. Therefore, Huber-White sandwich estimator of
variance was used to account for intra-individual correlations for ana-
lyses of change over time. For all analyses, the criterion for test sig-
nificance was p < 0.05. Data were analysed using STATA 12.
3. Results
3.1. Characteristics of the 77+ sample
Analyses of trends in loneliness among older people over the last
two decades are based on samples of people aged 77 years or older in
1992, 2002, 2004, 2011 and 2014. The characteristics of these samples
were presented in Table 2.The majority of the respondents were
women and the average age was approximately 83 years. There was a
decrease in people with lower education over the study period. Re-
garding social factors, there was an increase in the proportion of mar-
ried respondents and a decrease in the widowed respondents. Engage-
ment in social contacts and access to social support increased over the
years (although the item on social contacts was not included in 1992).
Seen over the entire study period, there was no significant change in
ADL problems, but there was a decrease in ADL problems from 1992 to
2004 (p= 0.019), and an increase in the years after that (p= 0.045).
Finally, there was a decrease in psychological distress among the re-
spondents.
3.2. Trends in loneliness from 1992 to 2014 (77+)
Fig. 1 presents trends in loneliness, and shows that the proportion of
older people reporting feelings of loneliness was fairly stable over the
study period. Over the years, between 3.86 (year 1992) and 1.86 (year
2014) percent of the respondents reported being bothered by feelings of
loneliness almost all the time, while between 8.6 (year 1992) and 11.1
(year 2004) percent of the respondents reported being bothered by
feelings loneliness often. Changes in prevalence level of loneliness over
the years were not significant.
A higher proportion of women than men reported loneliness, sig-
nificant for 2002, 2004 and 2011 (χ
2
= 21.93, p < 0.001;
χ
2
= 18.76, p < 0.001; χ
2
= 18.88, p < 0.001). These years, a lower
proportion of women than men responded ‘almost never’being lonely,
while higher proportions of women responded that they were ‘seldom’
and ‘often’lonely.
3.3. Characteristics of the 70+ sample
Characteristics of the 2004 and 2014 samples of people aged 70
years or older are presented in Table 3. Both years, a majority of the
sample was women, and the average age was approximately 78 years. A
higher proportion of the respondents in 2004 than in 2014 had a lower
education. There was an increase in the proportion of respondents that
was married and a decrease in the proportion of respondents that was
widowed between these years, while the proportion that was unmarried
or divorced was fairly stable.
Regarding social variables, in 2004 the respondents on average had
fewer social contacts than the respondents ten years later. The majority
of the respondents had access to social support both years, and there
was an increase in access to social support over the study period. The
vast majority of the respondents had no ADL limitations and there was
no significant change over the study period. Similarly, the majority of
the respondents did not report psychological distress and such problems
became less common from 2004 to 2014.
3.4. Loneliness and its bivariate correlates in 2004 and 2014 (70+)
As presented in Table 4, 9.88 percent of the respondents reported
feelings of loneliness in 2004 compared to 7.68 percent in 2014 (not
significant change). Table 4 also presents descriptive results on lone-
liness in relation to different characteristics of the respondents, and
bivariate associations between loneliness and these characteristics in
2004 and 2014, respectively. Starting with socio-demographic factors,
more women than men were bothered by feelings of loneliness, al-
though the association between loneliness and gender was only sig-
nificant in 2014, when 10.0 percent of women reported loneliness
compared to 4.9 percent of men. The likelihood of loneliness was as-
sociated with higher age both years. In 2004, loneliness was more often
reported by people with lower than higher education level. There was
no such association in 2014.
The analyses show that social factors are important for loneliness.
Regarding marital status, a lower proportion of married individuals
reported loneliness. In 2004, a higher proportion of non-married/di-
vorced and widowed respondents reported loneliness, with particularly
L. Dahlberg et al. Archives of Gerontology and Geriatrics 75 (2018) 96–103
98

high proportions of loneliness among those widowed. Both years,
people who lacked access to social support and people with fewer social
contacts were more likely to report loneliness. Regarding health factors,
in both years ADL limitation and psychological distress increased the
likelihood of loneliness.
The interaction between each correlate and survey year was tested
(not shown in table). A significant interaction term was found regarding
ADL limitations (p= 0.043), where there was a significantly stronger
association between ADL limitations and loneliness in 2004 than in
2014. For all other variables, the interaction with survey year was
Table 2
Characteristics of samples aged 77 years or older in 1992, 2002, 2004, 2011 and 2014 (%), n = 2572.
1992 2002 2004 2011 2014 pfor trend
(n = 466) (n = 518) (n = 505) (n = 536) (n = 547)
Loneliness 12.4 13.3 14.9 13.4 11.3 0.709
Female gender 59.4 57.7 59.9 60.1 57.8 0.854
Lower education level
1
78.7 69.3 65.3 57.1 51.6 0.000
Marital status
Married 39.3 39.2 40.3 46.1 48.8 0.001
Unmarried/divorced 12.0 12.7 11.3 14.9 13.2 0.311
Widowed 48.7 48.1 48.4 39.0 38.0 0.000
Lack of access to social support
2
4.55 9.02 10.3 8.49 8.18 0.038
Psychological distress
3
No problem 76.5 74.3 73.8 71.4 81.6 0.404
Mild problem 18.4 19.7 21.1 21.6 14.9 0.495
Severe problem 5.18 5.98 5.17 7.01 3.49 0.662
M (SD) M (SD) M (SD) M (SD) M (SD) pfor trend
range range range range range
Age 82.7 (3.95) 82.8 (4.54) 82.6 (4.43) 83.1 (4.91) 82.7 (4.61) 0.574
77–98 77–98 77–97 77–101 77–95
Fewer social contacts
4
–4.15 (1.96) 4.19 (1.97) 3.79 (1.96) 3.91 (1.93) 0.002
0–80–80–80–8
ADL limitations
5
0.40 (0.96) 0.37 (0.90) 0.22 (0.65) 0.27 (0.77) 0.33 (0.97) 0.085
0–50–50–40–50–5
1
Item non-response varied between 1 and 12.
2
Item non-response varied between 1 and 65. The item was not included in the postal questionnaire.
3
Item non-response varied between 3 and 8.
4
Item non-response varied between 1 and 2. The item was not included in 1992.
5
Item non-response varied between 1 and 5.
Fig. 1. Trends in loneliness among people aged 77
years or older in the period of 1992–2014 (%) (1992:
n= 466; 2002: n= 518; 2004: n= 505; 2011:
n= 536; 2014: n= 547).
L. Dahlberg et al. Archives of Gerontology and Geriatrics 75 (2018) 96–103
99

Table 3
Characteristics of samples aged 70 years or older in 2004 and 2014 (%), n = 1962.
2004 2014 pfor difference
(n= 921) (n= 1041)
Loneliness 9.88 7.68 0.078
Female gender 59.1 54.9 0.026
Lower education level 57.2 45.0 0.000
Marital status
Married 52.0 60.8 0.000
Unmarried/divorced 13.2 14.1 0.525
Widowed 34.7 25.1 0.000
Access to social support 90.6 94.1 0.002
Psychological distress
No problem 74.9 83.2 0.000
Mild problem 20.6 13.4 0.000
Severe problem 4.45 3.36 0.199
M (SD) M (SD) pfor difference
range range
Age 78.2 (5.99) 77.7 (6.13) 0.065
70–97 70–95
Fewer social contacts 3.81 (2.05) 3.58 (1.80) 0.005
0–80–8
ADL limitations 0.14 (0.53) 0.20 (0.76) 0.063
0–40–5
Table 4
Bivariate associations between loneliness and independent variables among respondents aged 70 years or older in 2004 and 2014, n= 1962.
2004 2014
(n=921) (n = 1041)
Rarely lonely (%) Frequentlylonely (%) AME
2
Rarely lonely (%) Frequently lonely (%) AME
2
Gender
Female 88.6 11.4 0.039 90.0 10.0 0.054
**
Male 92.3 7.7 95.1 4.9
Education level
Lower 88.0 12.0 0.051
*
91.4 8.6 0.012
Higher 92.9 7.1 93 7.0
Marital status
Married 98.1 1.9 1 97.2 2.8 1
Non-married/divorced 86.9 13.1 0.112
***
91.2 8.8 0.060
*
Widowed 79.4 20.6 0.187
***
81.2 18.8 0.159
***
Social support
Access to support 91.6 8.4 93.6 6.4
Lack of support 75.9 24.1 0.108
***
72.1 27.9 0.118
***
Psychological distress
No problem 93.9 6.1 1 94.7 5.3 1
Mild problem 85.3 14.7 0.086 84.3
**
15.7 0.104
**
Severe problem 48.8 51.2 0.451 65.7
***
34.3 0.290
***
M M AME
2
M M AME
2
(SD) (SD) (SD) (SD)
range range range range
Age 77.8 (5.82) 81.8 (6.27) 0.009
***
77.4 (6.04) 81.0 (6.34) 0.006
***
70–97 70–94 70–95 70–95
Fewer social contacts 3.64 (2.00) 5.36 (1.85) 0.038
***
3.49 (1.74) 4.70 (2.11) 0.026
***
0–80–80–80–8
ADL limitations 0.10 (0.44) 0.48 (0.96) 0.065
***
0.17 (0.70) 0.58 (1.21) 0.028
***
0–40–40–50–5
Note 1:
*
p< 0.05,
**
p< 0.01,
***
p< 0.001.
Note 2: Bivariate associations presented as average marginal effects (AME).
L. Dahlberg et al. Archives of Gerontology and Geriatrics 75 (2018) 96–103
100

statistically non-significant, which suggests that the bivariate associa-
tions between these correlates and loneliness were stable over the two
time points.
3.5. Multivariable analyses for 2004 and 2014 (70+)
In the multivariable models for 2004 and 2014, presented in
Table 5, none of the socio-demographic variables remained sig-
nificantly associated with loneliness in older people. All social factors
included in the study were still associated with loneliness. Being wi-
dowed was particularly important for loneliness. This group had 15.2
percent higher likelihood of loneliness in 2004 and 12.3 percent higher
likelihood in 2014 than respondents who were married. Also non-
married/divorced respondents were more likely to report loneliness
than married respondents. Furthermore, respondents who lacked access
to social support and had fewer social contacts were more likely to
report loneliness than respondents with access to social support and
more social contacts.
Finally, health problems were significantly associated with lone-
liness in the full model. In 2004, but not in 2014, respondents with ADL
limitations had a significantly higher likelihood of loneliness than
people without ADL limitations. Psychological distress was found to be
the strongest correlate for loneliness. In 2004, respondents reporting
severe psychological distress were 36.6 percent more likely to report
loneliness than respondents without psychological distress. In 2014, the
corresponding figure was 20.7 percent.
The interaction between each correlate and survey year was tested
in the full models (not shown in table). Interactions between correlates
and survey years were found regarding education (p= 0.047). Post hoc
analyses regarding education show that this may be explained by
changes in social factors. For example, increases in social contacts over
the years have been greater among people with lower than higher
education.
4. Discussion
Based on repeated cross-sectional nationally representative surveys
of older people in Sweden, the aim of this study was to examine changes
in loneliness among older people. Firstly, we examined prevalence le-
vels of loneliness in people aged 77 years or older between 1992 and
2014. Overall, it can be concluded that there has been no increase in
loneliness among older people in Sweden in the last two decades.
Recent cohorts of older people do not report loneliness to a greater
extent than previous cohorts of older people, despite societal changes
towards more individualistic societies (World Values Survey, 2016).
Such societal changes have perhaps been counteracted by changes in
other factors associated with loneliness, such as increased proportions
of married older people and people with higher education. This finding
challenges the common myth that loneliness is becoming more pre-
valent among older people (see Dykstra, 2009). Similar trends of stable,
or even slightly decreasing levels, of loneliness have been found in
studies conducted in Finland, the Netherlands and Great Britain
(Eloranta et al., 2015; Honigh-de Vlaming et al., 2014; Victor et al.,
2002). In addition, the study found that more women than men tended
to report loneliness. This finding echoes previous research (Aartsen &
Jylhä, 2011; Cohen-Mansfield et al., 2009; Dykstra et al., 2005).
Secondly, we examined changes in correlates of loneliness among
people aged 70 years or older between 2004 and 2014. Generally, the
same correlates were important for loneliness both years, but there
were some exceptions, which will be further discussed below.
This study identified associations between loneliness and female
gender, higher age and lower education. The association between
gender and loneliness was significant in 2002, 2004 and 2011 for those
aged 77 years or older, and in 2014 for those aged 70 years or older.
Regarding education it was observed that while lower education was
associated with an increased likelihood of loneliness in 2004, there was
no significant association between education and loneliness in 2014.
There was a significant interaction between education and survey year
in reporting loneliness, which suggests that the association between
education and loneliness is changing. An explanation for this may be
that the increase in social contacts has been greater among respondents
with lower education than among respondents with higher education.
The importance of other factors than socio-demography was also
confirmed in that none of these socio-demographic correlates were
significantly associated with loneliness in the multivariable models for
2004 and 2014. In other words, although loneliness is more common
among women, people with higher age and lower level of education, it
is not gender, age and education level as such that are important for
loneliness but other factors that correlate with this (cf. Dahlberg et al.,
2015). Turning to such factors, social factors (widowhood, lack of ac-
cess to social support, fewer social contacts) as well as health-related
factors (ADL limitations, psychological distress) proved influential on
loneliness. Most social and health-related correlates remained sig-
nificant in the multivariable models. There is strong evidence that so-
cial factors are important for loneliness (for a review, see Routasalo &
Pitkala, 2003). The loss of a partner is a particularly strong trigger for
loneliness (e.g. Aartsen & Jylhä, 2011; Dykstra et al., 2005; Jylhä &
Saarenheimo, 2010), and the importance of widowhood for loneliness
was confirmed in our study.
Our results also confirm earlier research showing that physical and
mental health is related to loneliness (Routasalo & Pitkala, 2003), as
poor health may limit the possibility to lead a socially active life. Dif-
ferent forms of mental health problems, such as depression, are closely
linked to loneliness (Heikkinen & Kauppinen, 2011; O'Luanaigh &
Lawlor, 2008). In this study, mental health was measured via psycho-
logical distress, and this was the most important factor for loneliness in
the analysis. Previous research has shown that lonely individuals are
more likely than non-lonely individuals to perceive the world as
threatening and may develop maladaptive behaviours that enhance the
feeling of loneliness (cf. Cacioppo & Hawkley, 2009; Schoenmakers
et al., 2015). In other words, the feeling of loneliness and psychological
distress may reinforce one another (cf. O'Luanaigh & Lawlor, 2008).
The association between ADL limitations and loneliness changed
significantly over time, with a weaker association in 2014 than in 2004.
The extent to which physical functioning presents a barrier to social
engagement is in part dependent on physical resources in the neigh-
bourhood such as shops, service points, and barriers in the physical
environment including hills and poorly maintained road surfaces
(Honigh-de Vlaming et al., 2014;Phillips, Siu, Yeh, & Cheng, 2005;
Smith, 2009). With more inclusive design and adaptations of existing
Table 5
Multivariable analysis presented as average marginal effects for the likelihood of being
frequently bothered by feelings of loneliness among respondents aged 70 years or older in
2004 and 2014, n= 1962.
2004 (n= 921) 2014 (n= 1041)
Female gender −0.031 0.012
Age 0.002 0.000
Lower education level 0.022 −0.022
Marital status
Married 1 1
Non-married/divorced 0.090
***
0.036
Widowed 0.152
***
0.123
***
Lack of social support 0.044
*
0.059
*
Fewer social contacts 0.021
***
0.014
**
ADL limitations 0.023
*
0.012
Psychological distress
No problem 1 1
Mild problem 0.058
**
0.058
*
Severe problem 0.366
***
0.200
**
Note 1: Reference category = rarely lonely.
Note 2:
*
p< 0.05,
**
p< 0.01,
***
p< 0.001.
L. Dahlberg et al. Archives of Gerontology and Geriatrics 75 (2018) 96–103
101

environments, people with functional limitations are offered more op-
portunities to stay socially active. The need for improvements of the
physical environment has received attention internationally (e.g. United
Nations, 2006; World Health Organization, 2007), and in Sweden a
legislation has been passed stating that public areas should be acces-
sible for all citizen (Prop. 1999/2000: 79). In so far as the legislation
change has led to improvements in the physical environment, this may
be part of the explanation of a weakening association between ADL
limitation and loneliness in older people. A study conducted in the
Netherlands has found, though, that loneliness had become more
common amongst people with functional limitations over time (Honigh-
de Vlaming et al., 2014). These contradictory findings suggest that
further research is needed on the development of loneliness in older
people with functional limitations.
4.1. Strengths and limitations of the study
This study is based on SWEOLD, which covers a relatively long
study period and includes a broad range of variables, enabling an ex-
amination of trends in loneliness and its correlates over time. SWEOLD
includes nationally representative samples of older people with high
response rates in each wave of data collection. This means that the
respondents were highly representative of the population, including
frail and institution-based older people (see Lennartsson et al., 2014),
although people who were too frail to be interviewed in person were
not included in the analyses presented in this article. Given the asso-
ciation between loneliness and health problems, this may mean that
this study underestimates the prevalence of loneliness among older
people and may also affect the association between loneliness and
health problems.
The repeated cross-sectional design of the present study means that
no conclusions can be drawn regarding causal associations between
loneliness and its correlates. Previous longitudinal research based on
this data has shown, though, that social factors, such as marital status,
social support and social contacts, and health-related factors are im-
portant predictors of loneliness (Dahlberg et al., 2015;Dahlberg,
Andersson, & Lennartsson, in press).
A potential limitation of the study is that the modes of data col-
lection varied across the data collection points. In 1992, 2002 and 2011
data was predominately collected via face-to-face interviews, and in
2004 and 2014 it was collected via telephone interviews. One could
perhaps assume that the mode of data collection could influence self-
disclosure and affect reported loneliness. However, there were no sig-
nificant differences in reported loneliness across the main data collec-
tion modes, and post hoc analysis showed that trends in prevalence le-
vels of loneliness were not significant even when controlling for data
collection mode. Similarly, Victor, Scambler, Marston, Bond, and
Bowling (2006) argue that reports of loneliness do not vary sub-
stantially with the data collection mode within the context of a struc-
tured questionnaire. However, previous studies comparing the effects
on reported loneliness across different data collection modes have
found mixed results (de Leeuw & Hox, 1993; van Tilburg & de Leeuw,
1991). In the present study, analyses of correlates of loneliness were
made for two waves of data collection using the same main data col-
lection mode, which rules out the possibility of any mode effect in these
analyses.
5. Conclusions and practice implications
Contrary to what is often assumed, there has been no increase in
loneliness among older people over the last two decades. Many older
people who reported loneliness also experienced psychological distress.
Loneliness and psychological distress may reinforce one another, and
are also associated with other health problems. Work to prevent and
reduce loneliness should therefore be of high priority. The importance
of social factors for loneliness, shown in this study and previous
research, calls for efforts to support social integration and a sense of
belonging. This could be done in the form of interventions and activities
provided by formal care providers or voluntary organisations.
Unfortunately, the evidence base for effective loneliness interventions is
weak (Cohen-Mansfield & Perach, 2015) and there is no specific fra-
mework guiding practitioners in how to prevent loneliness (De Jong
Gierveld & Fokkema, 2015). Still, it has been recommended that in-
terventions should be targeted at specific groups (Cattan, White, Bond,
& Learmouth, 2005). Our study and previous research, has found that
widows and widowers are particularly vulnerable to loneliness.
Work to prevent and reduce loneliness among older people who are
in receipt of care could also be undertaken as an integrated part of
already existing services, such as home help or residential care. The
Swedish Social Service Act states that social services should support
older people in leading an active life together with other people.
However, with enhanced economic pressure, local authorities in
Sweden have introduced stricter guidelines and raised the thresholds
for services, thus concentrated their resources on older people with
larger rather than smaller care needs (Szebehely & Trydegård, 2012).
An ambition to prevent or reduce loneliness within existing services
would require that social and psychological needs are fully acknowl-
edged and that the currently dominating priority of physical and
medical needs over social needs in care services (National Board of
Health & Welfare, 2010) is reconsidered.
Funding
This work was supported by Swedish Research Council for Health,
Working Life and Welfare (FORTE), grant numbers 2015-00440 and
2012-1704.
Conflict of interest
The authors declare that they have no conflict of interest.
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