ArticlePDF Available

Abstract and Figures

Friendship is a relationship that can endure across the entire lifespan, serving a vital role for sustaining social connectedness in late life when other relationships may become unavailable. This article begins with a description of the importance of studying friendship in late life and the benefits of friendship for older adults, pointing to the value of additional research for enhancing knowledge about this crucial bond. Next is discussion of theoretical approaches for conceptualizing friendship research, followed by identification of emerging areas of late-life friendship research and novel questions that investigators could explore fruitfully. We include a presentation of innovative research methods and existing national and international data sets that can advance late-life friendship research using large samples and cross-national comparisons. The final section advocates for development and assessment of interventions aimed at improving friendship and reducing social isolation among older adults.
Content may be subject to copyright.
Innovation in Aging
cite as: Innovation in Aging, 2019, Vol. 3, No. 1, 1–18
Advance Access publication March 30, 2019
© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (
by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any
way, and that the work is properly cited. For commercial re-use, please contact
Invited Article
Friendship in Later Life: AResearchAgenda
Rosemary Blieszner, PhD,1,*, AaronM. Ogletree, PhD,2 and RebeccaG. Adams, PhD3
1Center for Gerontology, 230 Grove Lane (0555), Virginia Tech, Blacksburg. 2American Institutes for Research, Rockville,
Maryland. 3Gerontology Program, University of North Carolina at Greensboro.
*Address correspondence to: Rosemary Blieszner, PhD, Center for Gerontology, Virginia Tech, Blacksburg, VA 24061. E-mail:
Received: October 10, 2018; Editorial Decision Date: February 11, 2019
Decision Editor: J.Jill Suitor, PhD
Friendship is a relationship that can endure across the entire lifespan, serving a vital role for sustaining social connectedness in
late life when other relationships may become unavailable. This article begins with a description of the importance of studying
friendship in late life and the benets of friendship for older adults, pointing to the value of additional research for enhancing
knowledge about this crucial bond. Next is discussion of theoretical approaches for conceptualizing friendship research, fol-
lowed by identication of emerging areas of late-life friendship research and novel questions that investigators could explore
fruitfully. We include a presentation of innovative research methods and existing national and international data sets that
can advance late-life friendship research using large samples and cross-national comparisons. The nal section advocates for
development and assessment of interventions aimed at improving friendship and reducing social isolation among older adults.
Keywords: Friendship data sets, Friendship in old age, Friendship interventions, Friendship processes, Friendship research methods,
Friendship structure, Friendship theory
Why Is It Important to Study Friendship
in LateLife?
What Are the Benefits of Friendship to Old
Friendship is a relationship that can endure across the
entire life span, serving a vital role for sustaining social
connectedness in late life when other relationships, such as
with coworkers and organization members, may be relin-
quished. Although gaining new kin is common at earlier
ages, in the later years the possibility of making new friends
is greater than the likelihood of enlarging the kin network,
at least in one’s own generation.
Friend ties have been revered as vital relationships since
ancient times, when Confucius and Aristotle extolled the
benets of associating with those who encourage moral vir-
tue, complement one’s own limitations, and provide cher-
ished companionship. Aristotle, in particular, highlighted
emotional and reciprocal aspects of friendship that are
deemed important now (Mullis, 2010), as contemporary
Translational Signicance: Social isolation places older adults in jeopardy for both poor health and low
psychological well-being. Detailed research ndings on crucial elements of friendship in late life can inform
the design of social interventions aimed at enhancing personal skills and strategies for making and keeping
friends, planning of community programs to foster friend interactions and advocacy for policies that pro-
mote rather than interfere with late-life friendship.
Copyedited by: SE
Downloaded from by guest on 30 March 2019
adults focus on affection, trust, commitment, respect, reci-
procity, and the like when dening friendship (Blieszner &
Adams, 1992; Dunbar, 2018; Felmlee & Muraco, 2009).
At the same time, diversity in perceptions of important
elements of friendship occurs across life cycle stage, gen-
der, marital and parental status, geographic location and
cultural context, and historical eras (Adams, Blieszner, &
de Vries, 2000; Blieszner & Adams, 1992; Gillespie, Lever,
Frederick, & Royce, 2015). Early empirical studies of social
relationships, including those in late adulthood, generally
did not focus on friendship per se, so this nuanced aware-
ness of friendship is a recent phenomenon.
Although it is clear that friendship has long been an
important part of social life and important to well-being,
this close relationship has not received nearly as much atten-
tion historically as family ties. In fact, in 1950s and 1960s
when sociologists and family scientists examined close rela-
tionships, they tended to investigate marital and kin bonds,
but typically did not include friends in their studies. Not
until 1970s and 1980s did scholars begin to probe friend-
ship as a social role in its own right, separate from ties
with colleagues, neighbors, acquaintances, and other non-
kin, and to study friendship as a relationship rather than
friendliness as an individual attribute. They uncovered a
range of friendship forms and functions and identied both
unique aspects of friendship as distinct from other ties as
well as similarities between friendship and other informal
and close relationships (Blieszner & Adams, 1992).
Studies consistently show that friend relationships
are as important as family ties in predicting psychologi-
cal well-being in adulthood and old age (Chen & Feeley,
2014; Dunbar, 2018; Santini, Koyanagi, Tyrovolas, Mason,
& Haro, 2015). Of course, the closeness of both relatives
and friends varies, so studies examining specic relation-
ships as opposed to global categories are especially helpful
for understanding the relative impact of family members
versus friends on well-being in the later years. For exam-
ple, analyses by Lee and Szinovacz (2016) of 6,418 par-
ticipants in the 2008 Health and Retirement study showed
that although relationships with spouses tended to have the
strongest association with mental health, ties with friends
showed stronger associations with mental health than
those with other relatives. Results such as these suggest the
merits of investigations specically addressing friendship
and specically focusing on oldage.
Along with investigation of structural aspects of friend-
ship, such as friend roles and interaction frequency, came
awareness of the need to examine friendship in the con-
text of social networks; to view friendship as evolving
over the life course and proceeding through phases over
time; and to assess cognitive, affective, and behavioral pro-
cesses as dynamic aspects of friend interactions. This more
nuanced approach to friendship research emerged from
moving beyond laboratory experiments and broad sur-
veys to using in-depth interviews, which fostered a focus
on quality of friend interactions, not just quantity (Adams
& Blieszner, 1994; Blieszner & Adams, 1992) and recog-
nition that friends and interactions with friends involve
individual characteristics that evoke differential responses
according to individual preferences (Adams & Blieszner,
1995). As a result, research on friendship has ourished in
recent decades, including studies of friendship in middle-
age and beyond, yielding a wide-ranging literature on both
traditional (e.g., emerging from face-to-face interactions)
and innovative (e.g., formed via social media networking)
aspects of friend ties in later life (Blieszner & Ogletree,
Among the friendship and aging topics investigated, a
prominent focus has been on the contributions of friends
to psychological well-being (Blieszner, 1995; Blieszner &
Ogletree, 2018). Late-life adults report liking and caring
about their friends, laughing together and having fun,
feeling satised with their relationships, being able to con-
de in each other, and reminding each other to stay healthy
(Blieszner & Adams, 1992). Friend ties alleviate loneliness
(Chen & Feeley, 2014; Nicolaisen & Thorsen, 2017), offer
emotional and instrumental support (Felmlee & Muraco,
2009), and provide companionship through mutual inter-
ests and shared activities (Huxhold, Miche, & Schüz,
2014). The feelings of connectedness that these aspects
of friendship convey give meaning to older adults’ lives,
which is important for well-being (ten Bruggencate, Luijkx,
& Sturm, 2018). Indeed, exchanging many forms of social
support is one of the most important benets of friendship
in the second half oflife.
The advantages of late adulthood friendship reach be-
yond psychological well-being. Research shows that rela-
tional closeness and social support are also important for
maintaining cognitive functioning and physical health in
old age (Béland, Zunzunegui, Alvarado, Otero, & del Ser,
2005; Holt-Lunstad, Smith, & Layton, 2010). Moreover,
old age poses unique challenges, including health changes
that might require assistance or caregiving. Thus, it is
particularly important to study old age friendships, espe-
cially for those without family members, without proximal
family members, or without family members willing to care
for them. Indeed, some friends do assume direct caregiving
responsibilities (de Vries, 2018), particularly among les-
bian, gay, and bisexual older adults who might experience
strain in their family relationships (Muraco & Fredriksen-
Goldsen, 2011).
Although we can point to extensive evidence on the
importance and benets of friendship, unexplored research
questions about friendship across the adult years abound.
Key purposes of this article are to provide a comprehen-
sive yet exible conceptual framework to guide research
on late-life friendship, synthesize into one framework the
multiple aspects of friendship and its predictors suggested
by various theoretical approaches, point to unanswered
questions and useful research methods, and suggest friend-
ship-related interventions that could successfully enhance
experiences of friend partners in their special bonds. Our
2 Innovation in Aging, 2019, Vol. 3, No. 1
Copyedited by: SE
Downloaded from by guest on 30 March 2019
goal is to encourage scholars to study this rich and fascinat-
ing dimension of aging and engage in relevant translational
science to sustain and enhance the quality of life for all
elders. We begin with an examination of theories for inves-
tigating friendship.
What Theories Can Guide Friendship
Research Toward Answering Unresolved
Foundational Theories
Although many theories of interpersonal attraction and
relationship development could inform late-life friendship
research, relatively few have guided these investigations.
Social network theory, which focuses on predictors of the
structure of relationships rather than on their dynamics,
is relevant to understanding friendship opportunities and
constraints at any stage of life. Relatively little is known
about structural features of friendship dyads and networks,
though, because empirical studies guided by social network
theory usually have not distinguished between friends and
other close ties. Nevertheless, some research on structural
features of late-life friendship exists. For example, Adams
(1987) studied changes in the friend networks of old
women over 3years and found interesting patterns of both
expansion and contraction (not only contraction) of the
network membership and also intensication and weak-
ening (not only weakening) of emotional bonds among
friends in the network. These changes in network size and
closeness varied by the women’s demographic characteris-
tics, namely social and marital statuses. Looking at addi-
tional structural features of late-life close friend networks,
such as similarity of gender, race, religion, age, and extent
of inuence on the friend, Adams and Torr (1998) found
variation in friend networks of both older women and men
based on characteristics of the social and cultural environ-
ments in which the networks were embedded. This nding
shows that friend bonds are affected not only by personal
choice, but also by external inuences. Thus, investigations
of structural features of friend networks reveal the range
of similarities and differences across groups of older adults
based on cultural contexts, personal characteristics, and sit-
uational features of interactions with current or potential
Social exchange theory, the convoy model of relation-
ships, and socioemotional selectivity theory have been
the most common guides for research on the processes of
friendship development and sustainment. Early studies of
friendship dynamics in old age were grounded in social ex-
change theory (e.g., Roberto, 1989; Roberto & Scott, 1986),
which posits that social interactions involve costs and ben-
ets that participants assess as they establish and sustain
relationships. The types of resources exchanged (Blieszner,
1993; Shea, Thompson, & Blieszner, 1988) and the pre-
ferred and actual extent of equity and reciprocity in social
exchanges (Dunbar, 2018) are also considered in friendship
research conducted from this perspective. Li, Fok, and Fung
(2011) examined age group differences in the association
between emotional and instrumental support balance in re-
lation to support received from friends versus family, and
the implications for life satisfaction. Friendships were eval-
uated by older and younger adults as more reciprocal than
family ties, in keeping with the more voluntary nature of
friendship. However, older adults reported higher life satis-
faction when they felt emotionally (but not instrumentally)
over-beneted in friendships, whereas younger adults’ life
satisfaction was associated with reciprocity in emotional
support exchanges with friends. The general assumption
that equity in exchanges is preferable did not apply to the
older adults in this study, reecting the premises of socio-
emotional selectivity theory, discussedlater.
The convoy model of relationships (Antonucci &
Akiyama, 1987) provides another approach to analyzing
old age friendship and support interactions, connecting
both interactive and structural aspects of relationships. It
focuses on differences in perceived level of closeness, allow-
ing for comparisons across types and functions of friend-
ships as well as across stages of the life span (Antonucci
& Akiyama, 1995). Using the convoy model, Piercy and
Cheek (2004) investigated friendships among middle-aged
and older women who belonged to quilting bees and guilds.
They found evidence of strong and supportive friend con-
voys with interaction patterns suggesting these friends
would have enduring positive effects on the women’s
well-being into oldest age. Levitt, Weber, and Guacci (1993)
examined social support (e.g., conding, reassurance and
respect, assistance, advice) from friends versus relatives
across the social network structures of family triad mem-
bers from three generations. The mothers and grandmoth-
ers tended to report fewer friends than relatives in their
networks and to receive less support from friends as com-
pared with the youngest women. This pattern held across
cultures, as both English-speaking and Spanish-speaking
women reported similar network structures and sources of
support. Arecent meta-analysis by Wrzus, Hänel, Wagner,
and Neyer (2013) conrmed these cross-generational dif-
ferences in network structure (i.e., size) via a meta-analysis
of data in 277 studies from 28 countries.
More recently, socioemotional selectivity theory
(Carstensen, Isaacowitz, & Charles (1999) has under-
pinned research on friendship in the later years. This theory
proposes changes in social interactions as older adults per-
ceive their remaining lifetime becoming shorter. Specically,
old people adapt to their changing circumstances by reserv-
ing their emotional energy for their most important rela-
tionships, shedding those with less meaning and value.
Sander, Schupp, and Richter (2017) found support for this
theory in a study of German adults aged 17–85. Across age
groups, the frequency of face-to-face contacts with relatives
was similar, but such interactions with friends and others
decreased in frequency. The study by Li and colleagues
Innovation in Aging, 2019, Vol. 3, No. 1 3
Copyedited by: SE
Downloaded from by guest on 30 March 2019
(2011) described previously also conrmed socioemotional
selectivity theory, with ndings suggesting that older per-
sons in the study had higher life satisfaction in the context
of nonreciprocal emotional support, probably because they
prioritize emotionally meaningful exchanges over other
interactions. These ndings imply that very close friends
can continue as central gures in older adults’ social net-
works even if the networks are shrinking, regardless, per-
haps, of frequency of face-to-face contact.
An Integrative Conceptual Framework
Social network theory highlights the value of examining
structural features of friendship, how they inuence for-
mation and retention of friendships, and whether those
features change over time. Social exchange, convoy, and
socioemotional selectivity theories share similar foci on
availability and reciprocity of support in friendship and
other close relationships. They point to numerous indi-
vidual, interpersonal, and interactional characteristics that
can have an impact on friend relationships and outcomes.
Our conceptual framework for friendship research (Adams
& Blieszner, 1994; Adams, Hahmann, & Blieszner, 2017;
Ueno & Adams, 2006) integrates the psychological and
sociological perspectives highlighted in social exchange,
convoy, socioemotional selectivity, social network, and
other theories to provide a exible and comprehensive
guide for investigating many intersecting dimensions of
friendship in old age. Propositions and hypotheses from the
focal theory can be formulated around the concepts and
variables identied in the friendship framework.
As shown in Figure 1, the integrative friendship frame-
work posits a series of reciprocal inuences on friend part-
ners that affect their typical modes of interacting and hence,
their emergent and ongoing interaction patterns. The gray
box and arrows signify that friendship patterns are dynamic
and contextualized in time and space and across cultures;
the dashed lines signify that individuals, friend dyads, and
friend networks embedded in these contexts affect them
and are affected by them. The left panel shows that friends
bring their individual characteristics to the relationship, in-
cluding both social structural positions and psychological
dispositions, which are mutually inuential through the
social psychological interpretation and internalization pro-
cesses described by Cooley and Mead (Adams & Blieszner,
1994; Cooley, 1964; Mead, 1962). That is, propensities
emerging from socialization experiences and personality af-
fect how a person internalizes expectations associated with
specic social locations, and social locations affect how
a person interprets friendship-related opportunities and
constraints. These personal characteristics lead to choices
about where to spend time and how and when to interact
with friends, as well as ways of thinking and feeling about
friends and friendship, signied as interactive motifs and
Structural, Cultural, Temporal, and Spaal Context
Interacve Mofs
Figure 1. Integrative conceptual framework for friendship research. From Ueno and Adams (2006), reprinted with permission from Routledge
Publishing, Inc.
4 Innovation in Aging, 2019, Vol. 3, No. 1
Copyedited by: SE
Downloaded from by guest on 30 March 2019
depicted in the middle of the gure. Cognitive, affective,
and behavioral interactive motifs thus affect the friendship
patterns (right panel) that occur between friend pairs and
in larger friend networks in which the pairs are embedded.
For either friend dyads or friend networks, internal struc-
tural features (homogeneity and hierarchy in dyads; size,
density, homogeneity, and hierarchy in networks) facilitate
and constrain interactive processes (cognitive, affective,
behavioral), which in turn modify or sustain the internal
structural features.
Friendships are not static, so Figure 2 demonstrates that
the patterns exhibited in Figure 1 occur across the phases
of friendship formation, sustainment, and dissolution.
Friendships have a starting point, they can become closer
or less close, and sometimes they end (Adams & Blieszner,
1994, 1998; Blieszner & Adams, 1992, 1998). Use of the
term phases avoids the notion of unidirectional stages of
relationships, which does not apply well to friendship.
Rather, movement across phases of friendship is uid and
potentially bidirectional. For example, an incipient friend-
ship might wax and wane in the formation phase before
becoming solidied as an ongoing friendship, or a dis-
solved friendship might be resumed later. Within any of the
phases, closeness and other process aspects could increase,
decrease, or remain stable. Finally, transitions across phases
are inuenced by internal structural features and interac-
tive processes.
Studies Illustrating Elements of the Friendship
The most common structural dimensions examined to
date are friendship network size and frequency of con-
tact (which is merely a proxy for interactive processes,
revealing existence of connections, but nothing about the
type or quality of the interactions). The typical interactive
dimensions appearing in late-life friendship research are
behavioral processes, such as provision of instrumental,
emotional, and social support. Few investigators have
examined the phases of friendship in late life intentionally
and systematically.
Examples of research investigating structural aspects of
friendship appear in the meta-analysis of social network
size by Wrzus and colleagues (2013) described previously.
They found reliable cross-cultural evidence that friendship
networks decrease in size across the years of adulthood.
Social structural position includes age group, and Wrzus
and colleagues noted that both normative and nonnorma-
tive life events occurring at different ages have an impact
on the friend network as needs, other relationships, and
life circumstances modulate social interactions. Indeed,
Litwin and Shiovitz-Ezra (2006) found that being embed-
ded in friend-focused networks was a protective factor
against mortality risk for older adults and de Vries, Utz,
Caserta, and Lund (2014) found that friends were partic-
ularly helpful in providing social support and assistance in
early widowhood.
Focusing on psychological disposition, Lecce and col-
leagues (2017) showed that individual differences in theory
of mind skills (extent of awareness that thoughts, beliefs,
and emotions affect social interactions) were associated
with differences in friend but not family ties among older
adults in Italy. Moreover, this theory of mind effect was
moderated by social motivation (in this study, the impor-
tance of being liked by others), such that it occurred only
for those who had a high or medium level of social mo-
tivation. Thus, understanding others and being motivated
to use social skills to foster positive relationships inuence
friendship outcomes. Looking instead at the impact of one’s
perceptions of aging on friendship outcomes and employ-
ing a longitudinal design, Menkin, Robles, Gruenewald,
Tanner, and Seeman (2017) found that holding more pos-
itive expectations about aging to begin with was associ-
ated with greater perceived availability of social support
from friends a year later and with having made more new
friends, with more of them close, 2years later. Thus, these
ndings showed that a personal attribute inuenced cogni-
tive, behavioral, and affective friendship processes, respec-
tively overtime.
Research on friendship phases as depicted in Figure 2
how older adults form, sustain, and dissolve friendships—is
scarce. Piercy and Cheek (2004) noted that quilting pro-
vided a context for older women to make new friends and
Menkin and colleagues (2017) noted existence of new
friends, but these researchers did not delve into aspects of
interaction that contributed to older adults moving from
being acquaintances to being friends. Insight into this phase
transition comes from Blieszner (1989) and Shea and col-
leagues (1988) who reported on friendship initiation over
5months among strangers who relocated simultaneously
to a newly constructed retirement community. Key con-
tributors to initiation phase transitions involved changes in
feelings and activities. Spending time together in mutually
Figure 2. Friendship phases: changes over time in internal structure
and interactive processes.
Innovation in Aging, 2019, Vol. 3, No. 1 5
Copyedited by: SE
Downloaded from by guest on 30 March 2019
appealing activities increased feelings of liking, loving, and
commitment to the friendship. These affective processes
built trust and promoted ongoing exchanges of social and
instrumental support.
Blieszner (1989) and Shea and colleagues (1988) also
found examples of older adults’ efforts to sustain both the
new and previously existing friendships through express-
ing affection, disclosing personal information and feelings,
helping one another, and engaging in activities together.
Another example of activities and feelings that sustain
friendship comes from a study of old male veterans by
Elder and Clipp (1988). They discovered that the process
of veterans sharing memories of their intense combat expe-
riences and losses with veteran friends served to perpetuate
these very long-term friendships.
Finally, in a randomly selected sample of adults aged 55
and older (n=53) and data from face-to-face interviews,
Blieszner and Adams (1998) inquired about dissolution-
related phases of friendship. Some friendships were fading
away (mentioned by 68% of participants), either because of
circumstances unrelated to the dyad, such as relocation of
one partner, or because one friend was intentionally letting
the friendship drift apart due to a problem in the relation-
ship. In addition, a small proportion of participants (25%)
had ended a friendship intentionally, usually because of
betrayal. As these research examples show, structural, cog-
nitive, affective, and behavioral aspects of friendship inter-
actions all came into play in the formation, sustainment,
and dissolution phases of friendship.
The literature also contains studies relevant to the in-
tegrative friendship framework that address multiple
dimensions simultaneously. Although we did not intend the
friendship framework to be predictive, an early operation-
alization of one component shown in Figure 1 was con-
ducted by Dugan and Kivett (1998). Using a sample of 282
rural and urban adults aged 65–97years, they sought to
determine whether personal characteristics and behavioral
motifs predicted interactive processes. Results of regression
analyses showed that two personal characteristics (gender
and education) predicted affective and behavioral pro-
cesses; behavioral motif as indexed by social involvement
in clubs, hobbies, and volunteerism, predicted behavioral
processes but not affective or cognitive ones; and proximity
predicted all three interactive processes. The effect of cul-
tural context, assessed by rural or urban residence, was not
signicant in this sample. Although this research employed
one part of the framework to predict other parts, the work
of other investigators illustrates the application of frame-
work components in studies of a diverse array of outcome
Using data from the Wisconsin Longitudinal Study,
Kahn, McGill, and Bianchi (2011) addressed the intersec-
tions of individual characteristics (age and gender) with
the friend and other nonkin behavioral interactions (pro-
viding assistance) over time. Women were more likely to
provide emotional support and men were more likely to
provide instrumental support. Both women and men with
more resources (e.g., more education) were more likely to
provide help, and after retirement or widowhood, men
increased their help giving.
Dunbar (2018) provided an overview of research illus-
trating the intersection of friendship structure at the dyadic
and network levels with cognitive, affective, and behavioral
processes. Emotional closeness affects the likelihood of en-
gaging in companionship and sharing the social and psy-
chological support that typically dene friendship. Because
developing emotional closeness and trust requires a signif-
icant time investment, the number of people in one’s circle
of closest friends is limited. Moreover, cognitive processes—
assessing implicit social contracts related to assumptions of
ongoing support, inhibiting some of one’s own preferences
and behaviors to enable friends to satisfy theirs, and the
perspective-taking that fosters understanding of friends’
needs and motives – are crucial for establishing and sus-
taining emotionally close and satisfying friendships.
As these examples of late-life friendship research show,
the integrative conceptual framework supports examina-
tion of myriad intersecting dimensions of friendship and its
outcomes in a systematic way. Combining this framework
with relationship theory permits development of hypoth-
eses to evaluate, and also can illuminate the more subtle
inuences on friendship that warrant investigation.
What Novel Aspects of Friendship Demand
Scholarly Exploration?
Despite a breadth of research on social networks across
the life course, friendship in the second half of life remains
underexplored when compared with information about kin
relationships. Moreover, the entrance of new cohorts into
old age along with social and cultural change over time
suggests the need to examine new dimensions of late-life
friendship. This section provides a brief overview of re-
search questions that remain unanswered and are now ripe
for further exploration.
Friendship, Health, and Well-Being
Much contemporary research has focused on contributions
of friends to health and psychological well-being among
older adults. At the structural level of analysis, for ex-
ample, Sander and colleagues (2017) documented a con-
nection between social contact frequency and health across
adulthood. Visits with nonfamily members declined over
the study waves relative to family visits, with an indication
that poorer health in old age explains the less frequent vis-
iting with friends, neighbors, and acquaintances exhibited
at that stage oflife.
Provision of social support is the most common behav-
ioral process examined in old age friendship research.
Auseful resource for data on the connection of social sup-
port from friends and others and health with well-being
6 Innovation in Aging, 2019, Vol. 3, No. 1
Copyedited by: SE
Downloaded from by guest on 30 March 2019
outcomes is the review article by ten Bruggencate and col-
leagues (2018). These authors analyzed how having social
needs satised is a protective inuence on the health and
well-being of old people. Unmet social needs can lead to
loneliness and social isolation, which in turn can cause
health to decline. In contrast, older adults with strong ties
to family and friends are more likely to retain indepen-
dence, a sense of meaning and purpose in life, and effec-
tive physical and psychological functioning longer. Thus,
understanding the connection between friend support and
psychological problems such as depression is important for
promoting health and well-being among older adults.
A review of 51 studies (published between 2004 and
2014) of associations among social support, social net-
works, and depression from around the world by Santini
and colleagues (2015) conrmed that perceived emotional
support within large and diverse social networks is pro-
tective against depression, as is perceived instrumental
support. More research is needed, however, particularly
prospective studies, to tease out causality in the associa-
tions among social support, social networks, and depres-
sion. Are those with fewer depressive symptoms better
able to secure large friend networks and receive support
than persons exhibiting depression? Is greater availability
of social support from a robust social network protective
against the development of depressive symptoms?
Being engaged in a friend network can also buffer the
effects of life events that may occur in old age. Marital status
has traditionally been used as a benchmark for well-being,
so comparing the associations of marital status, friendship,
and well-being is one approach to understanding the role
of friends in buffering the effects of negative life events.
Studies in this domain contrast friendship effects among
married old people, those who are formerly married, and
those who never married, at least in the traditional sense.
They also illuminate variation in friendship structure and
processes across different subgroups of the older adult
Han, Kim, and Burr (2017) used longitudinal data from
the Health and Retirement Study to examine the connec-
tion between friendship and depression among married
couples. Partners who had more frequent social interac-
tions with their friends reported fewer depressive symp-
toms than those with fewer friend interactions, particularly
in the context of poorer marital quality. Moreover, dyadic
growth curve models showed that one partner’s responses
to friendship had implications for the well-being of the
other one, demonstrating that the effects of friendship ex-
tend beyond the focal person.
Concerning older adults who are no longer mar-
ried, both de Vries and colleagues (2014) and Bookwala,
Marshall, and Manning (2014) studied friendship in the
context of marital loss through widowhood. The ndings
from de Vries and colleagues showed that higher friendship
satisfaction was associated with more positive self-evalua-
tion and more positive affective responses in the rst half
year of widowhood, whereas Bookwalla and colleagues
found that having a friend condante helped mitigate de-
pressive symptoms and promote better health as reported
up to 12years after spousalloss.
Examination of friendship among committed partners
comes from the work of Kim, Fredriksen-Goldsen, Bryan,
and Muraco (2017) who demonstrated the importance of
large and diverse social networks, including the availability
of friends, for mental health among lesbian, gay, bisexual,
and transgender older adults. Although these elders may
not have as many family ties as others, having supportive
social ties within friend networks are as essential for them
as for anyone in preventing social isolation and reducing
the likelihood of depressive symptoms.
However, marriage is not the only context in which
friendship affects psychological well-being. Other struc-
tural factors besides marital status, such as cultural back-
ground, gender, racial ethnic status, and socioeconomic
status, no doubt inuence friendship opportunities and
constraints that affect social integration or isolation and
psychological well-being or depression. Research on the
friendship patterns of such subgroups in the older adult
population remains to be conducted. The integrative con-
ceptual framework for friendship research offers guidance
for investigating the effects of social locations and person-
ality characteristics on friendship patterns.
Another perspective on the connection between friend-
ship and well-being in old age is related to the notion that
relational partners are interdependent; the actions of one
affect the thoughts, feelings, and behaviors of the other
(Kelley & Thibaut, 1978). Thus, life events can have an im-
pact not only on oneself, but also on one’s friends, leading
to research questions such as whether someone’s misfortune
rallies friendships or drives friends away. Indeed, Breckman
etal. (2018) reported that family and friends who know
about an older adult’s mistreatment also suffer distress,
illustrating how friendship can have negative as well as
positive impacts. However, this cross-sectional study did
not follow the abuse victims and their social network mem-
bers, so how the friends who knew about the abuse fared
as time went on could not be assessed. What other personal
events and circumstances that have not yet been examined
for impact on others might interfere with friendship or be
buffered by friendship support?
Friendship and Caregiving
Another crucial focus for contemporary friendship research is
the contributions of friends to providing care for older adults.
Given that offspring and other relatives may live a great dis-
tance away from loved ones who require assistance and care-
giving, the potential for local friends to ll in when frailty
emerges needs systematic examination. Questions about
interest in helping one’s friends in this way and willingness
to provide more than casual support, and questions about
the efcacy of friend caregiving, remain largely unanswered.
Innovation in Aging, 2019, Vol. 3, No. 1 7
Copyedited by: SE
Downloaded from by guest on 30 March 2019
Lilly, Richards, and Buckwalter (2003) found that some
caregivers of loved ones with dementia mentioned the value
of their friends in providing the caregivers with emotional
support and social integration. No doubt, those helpful
friends buoyed the family caregivers as they dealt with mem-
ory loss. Of course, friends are not always helpful, as Abel
(1989) noted. In her interviews with adult daughters caring
for frail elderly parents, some of the participants pointed
out that friends (and relatives) often exacerbated caregiv-
ing stress instead of alleviating it, such as by trivializing
the difculties of caregiving. This type of research, however,
does not focus directly on care provision by friends. In fact,
most caregiving studies do not differentiate across family
and friends when examining helpers for older adults. Our
literature search on studies related to “friends and caregiv-
ing” uncovered 33 articles published since 2012, but all
the analyses combined responses for relatives and friends.
Therefore, whether it is practical for health care workers to
involve friends in care planning, particularly when relatives
do not live nearby, merits additional scholarly attention.
Friendship in the DigitalAge
A clear avenue for innovative friend research is the inclusion
of communication technology and social media as mecha-
nisms for understanding how older adults establish and
sustain friendships throughout adulthood. Current ndings
on Internet use and social media use through websites such
as Facebook indicate that older people are less likely than
their younger counterparts to be frequent users (Barbosa
Neves, Fonseca, Amaro, & Pasqualotti, 2018; Cotten,
McCullouch, & Adams, 2011; Yu, Ellison, & Lampe,
2018). However, older people are adopting technology to
sustain social relationships (Tsai, Shilliar, & Cotten, 2017)
and keep in contact with friends and relatives who may be
geographically distant (Tsai, Shilliar, Cotten, Winstead, &
Yost, 2015). Internet use, for example, is associated lower
rates of depression and loneliness (Cotten, Ford, Ford, &
Hale, 2012) and greater levels of social capital (e.g., quality
and quantity of social ties) when compared with adults
who did not use the Internet at all or who used it less fre-
quently (Barbosa Neves etal., 2018).
Additional research shows that older Facebook users
have smaller numbers of online “friends” but a greater
proportion of actual friends than younger Facebook users
(Chang, Choi, Bazarova, & Lockenhoff, 2015; Yu et al.,
2018), a nding consistent with socioemotional selectiv-
ity theory (Carstensen etal., 1999). Given the prevalence
of social media, it is important that future work examines
the extent to which virtual social networks complement
actual friend networks and the types of support exchanged
with both types of friends. Will friend networks become
increasingly more diverse, including friends both in-person
and online, proximal and distal? Will friendships last lon-
ger, reducing relationship dissolution, due to the ease of
connection among long-distance older persons? Will social
media inuence the ways in which old people engage in
friendship? Will completely virtual friendships interactions
differ from past patterns in which friendships typically
began with face-to-face interactions even if they were sus-
tained over long distances via mail and telephone? Research
on social media use among older adults is still in its infancy
and will be a burgeoning area of research as digital natives
age into midlife and beyond.
Friendship in the Age of theBrain
An additional area of innovation for friend research is
the association between friendship and cognitive func-
tioning. Our review of the literature yielded few studies
that explicitly explored this topic, which contrasts with
the preponderance of research on general social re-
sources and cognitive functioning in old age (Kuiper
etal., 2016). The longitudinal study by Béland and col-
leagues (2005) showed that having friends was associ-
ated with slower cognitive decline in women but not
men over the course of 7years. Béland and colleagues
argued that this finding might be due to women’s gen-
der-based social roles that necessitated greater social in-
tegration over the years. Amore recent study by La Fleur
and Salthouse (2017) found that contact with friends,
but not family, was positively associated with general
intelligence. However, this finding approached nonsig-
nificance after examining the effects of education, sug-
gesting that individuals who are better educated spend
more leisure time with friends.
These studies illuminate a path forward for friend
research and lead to the following questions: How might
cognition and, specically, problem-solving skills and
inhibitory control relate to the quality of interactions
between older adult friends? For example, research dem-
onstrates that inhibitory control is negatively associated
with impulsivity (Logan, Schachar, & Tannock, 1997),
while additional research documents that impulsivity is
related to negative interpersonal encounters in young
adults (aan het Rot, Moskowitz, & Young, 2015). Are
older adults with poorer inhibitory control more likely
to report negative interactions with friends? Conversely,
are those with better inhibitory control more likely to
report positive interactions with friends? Similarly,
problem-solving skills are associated with memory, rea-
soning, processing, and global mental status; each of
these domains is related to everyday functioning among
older adults and translates to performance on common
instrumental activities of daily living (Gross, Rebok,
Unverzagt, Willis, & Brandt, 2011). If a key domain
of adult friendship is the exchange of instrumental and
emotional support, then more research is needed to doc-
ument the implications of cognition in late-life behav-
ioral friendship processes.
8 Innovation in Aging, 2019, Vol. 3, No. 1
Copyedited by: SE
Downloaded from by guest on 30 March 2019
Table 1. Friendship Variables in Regional, National, and International Data Sets
Ages (N) at
Wave 1
Examples of friendship variables/questions
Data source Years Friendship structure Cognitive processes Affective processes Behavioral processes
Andrus Study
of Older Adult
(Adams & Blieszner,
1993 55–84 (N=53) “How many friends do you
have?”; “How close are you with
[close friend]? [very close, close,
or casual]”; “How far do you live
from [close friend]?”; “How long
have you been friends?”; “How
similar are you and [close friend]?
How willing would
[friend/s] be to provide
help if needed?”; “How
important are [attitudes,
values, and characteristics]
of friends?
How do you feel about
[different types of friends
in friend network]?”;
How do you feel
when....?”; “What are
your feelings regarding
relationships that are
changing or fading?
Has [friend name] done a favor/
provided advice or support?”;
What do you think are some
barriers to seeing or talking with
[friend]?”; “How frequently
do you [communicate] with
[friend]?”; “How do you resolve
conict and disagreements with
Americans’ Changing
Lives (ACL)a
1986, 1989, 1994,
25+ (N=3,617)
in 1986
About how many friends or other
relatives do you have whom you
could call on for advice or help if
you needed it?
In your lifetime, have
friends gotten more
important, less important,
or stayed the same [in
— “How often do you talk with
friends, neighbors, and relatives in
a week?
The Irish Longitudi-
nal Study on Ageing
2009–2011 50+ (N=8,504)
in 2009
In general, how many close friends
do you have?”; “Have any of your
close friends died in the past ve
How much do they
[friends] really understand
the way you feel about
How much do they
[friends] get on your
In the last two years, did your
neighbors or friends give you any
kind of help...
Longitudinal Aging
Study Amsterdam
1992, 2002, 2012,
2015 (on-going)
(N=3,107) in
How many years have you known
[friend]?”; “How long does it
take you to travel to [friend]?”;
How often are you in touch with
— “How often did it occur in the
last year that [friend] helped you
with daily chores in and around
the house...?”; “How often did
it occur in the last year that you
quarreled with [friend]?
Longitudinal Study
of Generations
1971, 1985, 1988,
1991, 1994, 1997,
2000, 2005
40s (Parents)
15–26 (Grand-
families) in 1971
How many close friends do you
see or hear from?
Please compare your
political views with your
close friends’”; “How
important is your role
as friend?”; “Rank your
quality of performance in
your role as a friend.”
How satised are you
with the amount of
contact with your close
Swedish Adoption/
Twin Study on Aging
1984, 1987, 1990,
1993, 2003, 2007,
(N=2,018) in
How many friends do you have
that can visit you, or who you
can visit, anytime and feel right at
home?”; “How often do friends
— “Are you satised with
support from friends?
Innovation in Aging, 2019, Vol. 3, No. 1 9
Copyedited by: SE
Downloaded from by guest on 30 March 2019
Ages (N) at
Wave 1
Examples of friendship variables/questions
Data source Years Friendship structure Cognitive processes Affective processes Behavioral processes
Wisconsin Longitudi-
nal Study (WGS)f
1957, 1964, 1975,
1992, 2004, 2011
17+ (N=10,317)
in 1957
Could you give me the names
of some of the [same-sex friends]
who were your best friends in
your senior class in high school?”;
Think back to 1957...what was
the name of your closest...friend?”;
During the past 12months, how
often did you have contact with
Overall, how do you
think you compare with
[friend]?” [In reference
to work, education, and
How much do [friends
and relatives] make you
feel loved and cared for?
Is there a friend outside your
family with whom you can share
very private concerns?”; “How
much are they [friends and
relatives] critical of what you do?
National Social Life,
Health, and Aging
Project (NSHAP)g
(N=3,005) in
[Social network approach] “How
frequently do [name from network]
and [name from network] talk to
each other?”; “About how many
friends would you say that you
have?”; “How close do you feel is
your relationship with [name from
“How often do they [friends]
make too many demands of
you?”; “How often do they
[friends] criticize you?” “How
often can you rely on them
[friends] for help if you have a
Health and
Retirement Study
1992, 1994, 1996,
1998, 2000, 2002,
2004, 2006, 2008,
2010, 2012, 2014,
2016 (on-going)
(N=12,652) in
How many friends would you say
you have a close relationship with?
How much do they
[friends] really understand
the way you feel about
How much do they
[friends] get on your
On average, how often do you do
each of the following with any of
your friends? (meet up, speak on
the phone, write or email)
Midlife in the United
States (MIDUS)i
1995, 2004, 2011,
(N=7,108) in
Considering only friends you feel
close to, how many friends do you
have contact with at least once a
month?” (2013 only)
How much do they
[friends] really understand
the way you feel about
things?”(all waves); “When
Icompare myself to friends
and acquaintances, it
makes me feel good about
who Iam.” (2004 only)
How much do they
[friends] get on your
nerves?” (all waves); I
often feel lonely because
Ihave few close friends
with whom to share my
concerns.” (2004 only)
On average, about how many
hours per month do you spend
giving informal emotional support
to each of the following people?
[including friends] (2004 only)
Survey of Health,
Ageing, and
Retirement in Europe
2011–2012, 2013,
2015 (on-going)
50+ (N=31,115
from 12
countries) in
Who gave you help?” — Which types of help has this
person provided in the last twelve
months?”; “In the last twelve
months, how often altogether have
you [or your partner] received
such help from this person?
Table 1. Continued
10 Innovation in Aging, 2019, Vol. 3, No. 1
Copyedited by: SE
Downloaded from by guest on 30 March 2019
Ages (N) at
Wave 1
Examples of friendship variables/questions
Data source Years Friendship structure Cognitive processes Affective processes Behavioral processes
German Ageing
Survey (DEAS)k
1996, 2002,
2008, 2011, 2014
40+ (N=4,838)
in 1996
How often do you visit friends or
acquaintances or invite them over
to your home?”; “How has your
relationship with friends or ac-
quaintances changed over the past
6years?”; “If you think about your
friends and acquaintances, your
family, and other people that you
have everyday dealings with, which
of these people do you spend most
of your time with?
How much currently
do you think of or do
something about...[sat-
isfying friendships, social
Are there people [in
your social network] who
are causing you worry or
concern? If so, who?”;
Are there people who
give you great joy or hap-
piness? If so, who?
Which person [in your social net-
work] can you turn to when you
need comfort or cheering up when
you are feeling sad?
Note. Dates in italic font indicate veried availability of friend variables at that wave. Dates in roman font indicate either no veried friend variables or the questionnaire was not available in English.
Table 1. Continued
Innovation in Aging, 2019, Vol. 3, No. 1 11
Copyedited by: SE
Downloaded from by guest on 30 March 2019
Friendship as a Unique Relationship
Innovative ndings on late-life friendship might also be un-
covered through the intentional inclusion of friend-related
variables as separate from family and neighbor relation-
ships. For example, research on social relationships among
lesbian, gay, bisexual, and transgender (LGBT) older adults
has focused on the importance of friendship in aging, com-
monly using language such as “chosen families” (de Vries
& Megathlin, 2009). The same attention to the value of
friendship in aging has not been applied in non-LGBT
research. This gap in the literature implies that scholars
presume the presence and supremacy of biological kin net-
works in old age, thus ignoring the value of non-biolog-
ical relationships. Investigators have used the ambiguous
grouping of friend relationships into categories, such as
“friends/neighbors,” “friends or other relatives,” and “so-
cial resources,” with the latter going so far as to subsume
all social relationships into one undifferentiated group. Yet
research clearly shows that friends, neighbors, and kin rela-
tionships provide varying levels and types of support. For
example, LaPierre and Keating (2013) found that among
324 nonkin caregivers, friends provided help with personal
care, bills, banking, and transportation whereas neighbors
were more likely to help with less personal tasks such as
home maintenance. Further, friends were more involved
in providing care for nonkin than neighbors were and as-
sisted care recipients with a greater number of tasks for
more hours per week. Such research indicates that friends
are unique voluntary relationships that are more intimate
than more emotionally distal ties that might occur with
neighbors. Moreover, friends often contribute more posi-
tively to psychological well-being than family relationships
do (Huxhold etal., 2014). Thus, it is imperative that future
research on older persons’ social network members focus
specically on friendship as a unique relationship and dis-
tinguish differential structures, functions, processes, and
phases across types of relationships in great detail.
What Innovative Designs and Technologies
Would Reveal Untapped Elements of
Friendship and ItsValue?
We identied three main ways in which friendship research
might be advanced, thus revealing untapped elements of
friend relationships and their value. First, more research is
needed that goes beyond the structure of friendship (“How
many close friends do you have?”) to explore interactive
processes that convey deeper perceptions of, feelings about,
and activities within older adult friendships—their cogni-
tive, affective, and behavioral dimensions. Second, studies
of friendship have been conducted in regional and cul-
tural silos that were not being translated across disciplines
and cultural boundaries. Third, most studies of friendship
have incorporated cross-sectional designs, inhibiting un-
derstanding of changes and stability in friendship over the
adult lifespan.
These three current limitations point to the value of
linking Adams and Blieszner’s (1994) integrative concep-
tual framework for friendship with data harmonization
techniques that permit combining regional, national, and
international data sources. For example, Hofer and Piccinin
(2010) described the potential for integrating multiple lev-
els of analysis, theories, and designs to enable synthesis
of results across multiple data sets, including longitudinal
studies of aging, to broaden the scope of research on a
given topic; Survey Research Center (2016) provided de-
tailed guidelines for such work. Existing longitudinal data
sets could be exploited for secondary analyses using Adams
and Blieszner’s framework for guidance on the variable se-
lection, thus enabling scholars to uncover prevailing trends
in friendship as well as idiosyncrasies across data sources
and across cultures andtime.
To prompt this new kind of friendship research, we offer
an analysis of the potential for nding structural, cogni-
tive, affective, and behavioral variables as enumerated in
the Adams and Blieszner (1994) conceptual framework
within regional, national, and international data sets. First,
we used the Inter-university Consortium for Political and
Social Research to conduct a search of studies that included
middle-aged and older adults. We then examined each data
source for friendship variables and, for those that included
friend variables, reviewed their list of publications for studies
with friends as a focal topic. We also searched the major ge-
rontological and relationship journals for articles related
to older adult friendship and reviewed their data sources.
This process yielded 11 large-scale longitudinal data sets
suitable for pursuing cross-national and longitudinal re-
search on adult friendship. The data sets are (1) Americans’
Changing Lives (ACL); (2) The Irish Longitudinal Study on
Ageing (TILDA); (3) Longitudinal Aging Study Amsterdam
(LASA); (4) Longitudinal Study of Generations (LSG);
(5) Swedish Adoption/Twin Study on Aging (SATSA); (6)
Wisconsin Longitudinal Study (WLS); (7) National Social
Life, Health, and Aging Project (NSHAP); (8) Health and
Retirement Study (HRS); (9) Midlife in the United States
(MIDUS); (10) Survey of Health, Ageing, and Retirement in
Europe (SHARE); and (11) German Ageing Survey (DEAS).
Next, we classied each data source’s friend-related
questions and variables according to the Adams and
Blieszner (1994) integrative conceptual framework,
as shown in Table 1. For reference, we also included
the Adams and Blieszner Andrus Study of Older Adult
Friendship (Adams & Blieszner, 1993a), which guided the
formulation of the integrative conceptual framework for
friendship and provides examples of structural, cognitive,
affective, behavioral, and phase questions. Note that the
information presented in this table is not exhaustive of
each data source’s friend-related questions; rather, it high-
lights questions corresponding to the integrated conceptual
framework for friendship. The variables derived from these
questions could be addressed by data harmonization pro-
cesses to enlarge the size of samples and scope of variables
12 Innovation in Aging, 2019, Vol. 3, No. 1
Copyedited by: SE
Downloaded from by guest on 30 March 2019
available for analysis of cognitive, affective, and behav-
ioral friendship processes and phases over time and across
Review of these longitudinal data sources demonstrates
that, indeed, there is immense potential for the future of
older adult friend research using data harmonization tech-
niques. Almost all the data sources included questions about
structural components of friendship, including number of
friends or close friends. Descriptive analyses might reveal
similarities or differences in the size and composition of
friend networks across multiple countries and regions and
changes in networks across stages of adulthood. For cog-
nitive processes, most (7 out of 11)data sources included
reective or comparative questions in reference to friends.
For example, three studies (TILDA, HRS, MIDUS) asked,
“How much do [friends] really understand the way you
feel about things?” Affective processes were assessed in 7 of
the 11 studies, as well. Four studies (TILDA, HRS, MIDUS,
DEAS) tapped negative dimensions of friend relationships,
inquiring whether friends “get on [their] nerves” or were
“causing worry.” Two studies (LSG, SATSA) evaluated
satisfaction with friends, a positive feeling. Finally, most
studies (9 out of 11)included questions that assessed be-
havioral processes, such as support exchanged, frequency
of contact, and availability of support from friends. Two
studies (WLS, NSHAP) asked the question, “How much/
often do [friends] criticize you?” Conversely, four studies
(TILDA, LASA, MIDUS, SHARE) evaluated actual support
exchanged between friends.
Exploring these structural elements and cognitive, affec-
tive, and behavioral friendship processes across large cross-
national data sources could reveal novel insights regarding
friends and aging. Are there cultural differences in sup-
port exchanges or in the size, composition, and closeness
of friend networks? What groups of older adults are more
likely to experience negative interactions with friends and
might these exchanges have implications for health over
time by affecting the availability of supportive resources?
Further, how do friendship processes change over time and
across places? There are many paths forward for the fu-
ture of friend research, but we believe that more robust use
of existing data sources is a feasible next step. Moreover,
newly launched studies should incorporate friend vari-
ables that assess nuanced dimensions of friendship pro-
cesses and phases rather than focusing solely on structural
What Interventions Can Be Employed
to Increase Satisfaction With Friend
Relationships and Improve Friend
In 1992, Blieszner and Adams described how programs
affecting the friendship patterns depicted in Figures 1 and
2, and thus individual outcomes, could be implemented at
the individual, dyadic, network, immediate environment,
community, or societal levels. Although in a subsequent
article Adams and Blieszner (1993b, p.173) stated clearly
that they did not “necessarily intend to advocate friendship
intervention,” they conservatively cautioned policymak-
ers, program planners, and human service providers not to
design and implement interventions that would inadver-
tently undermine existing social relationships. The reasons
for not fully endorsing friendship interventions at the time
were twofold. First, research on friendship was not robust
enough to suggest details of what sorts of interventions
might be most needed, efcient, and effective. Second was
recognition that friendships were culturally dened as vol-
untary and, though they are much more structurally con-
strained than many friends realize, some would nd such
interventions uncomfortable or inappropriate.
Although the friendship research literature is now more
robust, the literature assessing the effectiveness of inter-
ventions is still scarce. Increased public focus on the con-
sequences of loneliness and isolation is leading to more
recognition of the necessity of promoting friendship, but
systematic interventions into all aspects of friendship pat-
terns described in the previous sections have not been
introduced. That is, just as most research on friendship has
focused on behavioral processes such as social support to
the relative neglect of examining other behavioral processes
as well as cognitive and affective processes, so too friend-
ship intervention programs have emphasized behavioral
strategies such as skill enhancement as approaches to de-
veloping friendships, with little attention to addressing the
impact of thoughts and feelings on friendship interactions.
Now that more recent research has demonstrated the im-
portance of friendships to well-being, health, and longevity,
it seems prudent to begin designing, intentionally imple-
menting and assessing a broad range of friendship inter-
ventions among older adults. First, we present examples
of research assessing intervention programs that address
various parts of the integrative conceptual framework and
levels of intervention, then cite literature pointing to other
possibilities for enhancing friendship among older adults.
This section ends with suggestions for enacting and assess-
ing such friendship interventions.
Examples of Friendship Intervention Research
Stevens and colleagues in The Netherlands have been inves-
tigating intervention strategies for enhancing friendship
at the individual level of analysis. For example, Stevens,
Martina, & Westerhof (2006) showed that participating
in a 12-week program designed to promote self-esteem
(individual characteristic) and relational competence, so-
cial skills, and friendship formation skills (behavioral
processes) enabled older women to establish new friend-
ships and improve existing ones, thus reducing loneliness
and improving well-being. These outcomes endured for
at least a year. Building on that work, Martina, Stevens,
and Westerhof (2012) used self-management of well-being
Innovation in Aging, 2019, Vol. 3, No. 1 13
Copyedited by: SE
Downloaded from by guest on 30 March 2019
theory to probe mechanisms underlying friendship-related
improvements. Interview data from the intervention partic-
ipants and control group members revealed that compared
with control group members, women who completed the
friendship enrichment program showed greater increases
in behaviors related to taking the initiative and engaging
in actions aimed at developing and improving friendships
(behavioral processes). Extending the in-person friend-
ship intervention approach to an online one, Bouwman,
Aartsen, van Tilburg, and Stevens (2017) demonstrated the
effectiveness of focusing on network development (struc-
ture), adapting personal standards for friendship, and re-
ducing the salience of the discrepancy between actual and
desired relationships (cognitive processes). Both follow-up
studies showed continued promise for assisting old persons
with honing friendship skills that can improve relation-
ships and boost personal well-being. In related work, re-
search by both Lecce and colleagues (2017) and Vargheese,
Sripada, Masthoff, and Oren (2016) suggests interventions
related to cognitive processes. The Lecce team focused on
the importance of both increasing theory of mind skills, or
the understanding of others’ mental states, and increasing
social motivation to use those skills in friendship interac-
tions, which could reduce loneliness and social isolation.
The Vargheese group demonstrated that professionals can
employ theoretically derived persuasive strategies to en-
courage older adults to participate in social activities.
Development and assessment of additional interventions
addressing a broad range of affective, cognitive, and be-
havioral friendship patterns would offer more options for
assisting lonely or isolated old people with improving their
friendships. Acknowledging the dynamic nature of friend-
ship, these programs should give attention to skills for ini-
tiating versus sustaining friendships, rejuvenation of faded
friendships, and repair of problematic and conictual ones.
Directions for New Friendship Interventions
Research on associations across older adults’ personal
preferences for friendships and their social needs, health,
and well-being point to many possibilities for friendship
interventions related to the elements of the integrative con-
ceptual framework for friendship research described pre-
viously. Earlier life experiences and current age-related life
events can affect older adults’ social needs, their friend
networks, and their friend-related cognitive, affective, and
behavioral processes (Blieszner & Ogletree, 2017; Wrzus
etal., 2013). Older adults vary with respect to the number
and types of friends they prefer to have, whether they desire
only close or more peripheral relationships, the importance
they place on various friendship interaction processes and
forms of social support, and the amount of reciprocity they
expect among their friendships—and those preferences can
change over time (Blieszner, 1995; ten Bruggencate et al.,
2018). The contexts in which older adults are living, in-
cluding the family versus friend composition of their
social network, their residence (community-dwelling, as-
sisted living, nursing home), and the presence or absence
of socially isolating chronic health conditions, also affect
their needs for friends and options available for interven-
tions (Blieszner & Ogletree, 2017; Litwin & Shiovitz-Ezra,
2006; Vargheese etal., 2016).
Taken together, these research ndings indicate that dif-
ferent friendship-related intervention strategies are needed
for different people and segments of late life. Developing
interventions that are exible and take the diversity of ex-
pectations and preferences among older adults into account
is more likely to be successful than attending only to the
practitioner’s perceptions of friendship or assuming a given
intervention will be equally successful across all elders.
Enacting and Assessing Interventions
We suggest that gerontological researchers form partner-
ships with service providers interested in increasing the so-
cial connectedness of older adults to plan interventions and
appropriate assessment components. Designing research-
informed interventions aimed at addressing identied needs
could lead to more nuanced, hence more effective, inter-
ventions. As shown by research ndings described in this
article, different groups of older adults would likely benet
from programs targeting specic aspects of friendship struc-
ture versus interactive processes and dyadic versus network
outcomes. The results of such collaborations could also in-
form friendship research by increasing knowledge of the
antecedents and consequences of friendship patterns and
how these change across the life course.
This suggestion also is consonant with Cornwell,
Laumann, and Schumm’s (2008) urging increased dialogue
between social gerontological and social network research-
ers. The former researchers tend to have a more applied
orientation and to have ties with those in direct contact
with older adults, whereas the latter tend to have more ap-
preciation for the complexity of friendships. Perhaps so-
cial gerontological researchers could act as bridges between
professionals who work with older adults and social net-
work researchers.
Gerontological practitioners are more likely to be in-
terested in collaboration on friendship intervention design
and evaluation now than in the past because today the im-
portance of social connectedness for older adults is more
widely recognized and the need for interventions is a sub-
ject of public dialogue. For example, in the introduction
to an issue of the Public Policy & Aging Report, Hudson
(2017, p.121) discussed isolation, loneliness, and a lack
of social connection among older adults, noting that “[p]
olicymakers, practitioners, and researchers have come to
focus attention on this little-recognized and dangerous
condition facing so many older people.” In the same issue,
Ryerson (2017) described AARP’s Connect2Affect ini-
tiative (, which is facilitating
the type of collaboration between researchers and service
14 Innovation in Aging, 2019, Vol. 3, No. 1
Copyedited by: SE
Downloaded from by guest on 30 March 2019
providers we recommend. This collaborative effort with
the Gerontological Society of America, Give an Hour, the
National Association of Area Agencies on Aging, and the
UnitedHealth Group provides tools and resources designed
to assess risk and help isolated older adults become more
involved with their communities. The initiatives Ryerson
described use technology to improve connectedness—de-
velopment of a ride-hailing app to increase the use of public
transportation, examination of whether the use of hands-
free voice-controlled communication devices decreases
isolation, and evaluation of the effectiveness of phone
outreach in helping retirees feel more connected to oth-
ers. Although these interventions were designed to increase
connectedness in general rather than in friendships per se, it
is promising that AARP is facilitating collaboration among
service providers and researchers, evaluating the effective-
ness of selected interventions, and producing results that
could lead to the systematic implementation of programs
at the community, state, or national levels.
The clear benets of social engagement among old people
and concern about lack of social connectedness point to
the value of and need for continued collaboration among
researchers and service providers. The framework for con-
ceptualizing friendship structure, processes, and phases
discussed previously and illustrated in Figures 1 and 2 pro-
vides guidelines for identifying needs and designing tailored
interventions targeted to addressing them. Accumulating
evidence that such programs are effective in increasing con-
nections among friends, improving friendship quality, and
benetting older adults’ health and well-being is essential
prior to advocating for policies to support systematic im-
plementation of programs across groups of older adults in
need of better social integration.
Friendship is a relationship that can last longer over the life
course than any other. The majority of adults participate
in friendship, even as the end of life draws near. The likeli-
hood of older adults continuing to enjoy and benet from
interactions with friends combined with the potential for
social isolation in old age suggests the importance of inves-
tigating friendship in creative new ways to advance un-
derstanding of friendship structure, processes, and phases
along with their implications for health and well-being.
In turn, ndings from research on friendship can inform
strategies for enhancing friendship opportunities and inter-
actions in order to prevent or alleviate loneliness, social iso-
lation, and depression.
As this review of theories relevant to friendship research
in old age and available literature on late-life friendship
shows, many unanswered questions about the roles of
friends in supporting psychological well-being and health
of older adults exist. The integrative conceptual framework
combined with theory pertinent to social relationships
offers guidance for additionalwork.
Some structural elements of friendship, such as number
of friends and frequency of contact, may not require fur-
ther investigation—at least, in Western cultures, yet rela-
tively less information is available on the effects of other
structural features on friendship, such as gender, racial
ethnic status, subcultural group, and the contexts in which
older adults enact friendship. Likewise, many studies have
explored various forms of social support, but much less is
understood about other behavioral processes. Data on cog-
nitive processes in late-life friendship are scarce, including
how people think about and analyze their friend relation-
ships or how perceptions of friends and friend interactions
inuence friendship initiation, stability, or loss. Similarly,
few studies have examined the inuence of emotions on
friendship quality and phases. An implicit assumption
seems to be that friend relations are positive and benecial,
which is generally true. After all, being friends with a partic-
ular person is optional. Nevertheless, evidence shows that
older adults can be quite troubled by problems with friends
yet do not necessarily wish to terminate the relationship
(Adams & Blieszner, 1998; Blieszner & Adams, 1998). We
need to know more about any dark sides of friendship.
As shown in the section on interventions, most programs
aimed at improving friendship opportunities and outcomes
for older adults address behavioral processes useful in the
phases of forming new ties and enhancing those that exist,
in service of preventing or mitigating loneliness and social
isolation. Certainly more programs like those are needed
as the population of elders increases around the globe.
Nevertheless, it also important for community practitio-
ners to focus on problem-solving in friendships, not just in
family relationships, to help elders sustain rewarding friend
ties that may entail minor disagreements and annoyances,
as well as to provide strategies for dissolving friendships
that are not merely uncomfortable, but actuallytoxic.
Friendship intervention programs must also be assessed
for suitability to friendship styles in late adulthood as well
as programs’ effectiveness in achieving desired outcomes.
To build on the intervention research described previously,
we suggest that expanding research on friendship in old
age will yield useful data on potential suitability and effec-
tiveness of existing programs and might suggest different
approaches to explore. It is difcult to plan better-targeted
interventions without knowing more about friendship
structure and processes. We need studies on the social and
psychological costs of friendship, not just benets, and on
what interferes with friendship enactment and satisfac-
tion, not just what promotes it. We need investigations of
similarities and differences in friendship across cultural
subgroups both domestically and internationally so inter-
ventions can vary by context as needed.
The deeper understanding of friendship in old age will
also result from mining the data sets identied in Table 1
and exploring data harmonization techniques to conduct
cross-national comparisons. In addition to the countries
represented in Table 1, we cited friendship research from
Innovation in Aging, 2019, Vol. 3, No. 1 15
Copyedited by: SE
Downloaded from by guest on 30 March 2019
Spanish-speaking individuals, participants from Hong
Kong, Israel, Italy, and Norway, and residents of rural
versus urban communities. The articles by ten Bruggencate
and colleagues (2018) and Wrzus and colleagues (2013)
included data from multiple countries. Though we might
rightly assume that friendship is a universal role found in
every country, the literature on friendship in late life lacks a
comprehensive global perspective.
Initiating more longitudinal studies to track friend-
ship transitions across stages of adulthood and changes in
health would conrm or expand cross-sectional ndings.
Employing designs that tap perspectives of friend dyads
and friend networks and using statistical procedures such
as latent growth curve analysis and hierarchical linear
modeling would permit identifying reciprocal effects of
friends on one another and the reciprocal impact of friend
networks on dyads and individuals. The results of all these
recommendations would offer important and useful new
insights about this crucial relationship in the advanced
years of life.
None reported.
R. Blieszner conceived of the manuscript, drafted sec-
tions, and integrated sections written by coauthors. A.M.
Ogletree conducted an extensive literature review, drafted
sections, developed Table 1, and helped to review the man-
uscript. R.G. Adams contributed to the literature review,
drafted the interventions section, and helped to review the
manuscript. R.G. Adams and R.Blieszner developed and
revised Figures 1 and 2 over the course of their research
collaboration. We appreciate the assistance of Koji Ueno in
suggesting the concept of cognitive and affective motifs and
drafting Figure 2.
Conflict of Interest
None reported.
aanhetRot,M., Moskowitz,D.S., & Young,S.N. (2015). Impulsive
behaviour in interpersonal encounters: Associations with quar-
relsomeness and agreeableness. British Journal of Psychology
(London, England: 1953), 106, 152–161. doi:10.1111/
Abel,E.K. (1989). The ambiguities of social support: Adult daugh-
ters caring for frail elderly parents. Journal of Aging Studies, 33,
211–230. doi:10.1016/0890-4065(89)90017-0
Adams, R. G. (1987). Patterns of network change: A longitudinal
study of friendships of elderly women. The Gerontologist, 27,
222–227. doi:10.1093/geront/27.2.222
Adams,R.G., & Blieszner,R. (1993a, June). Older adult friendship
patterns and mental health. Washington, DC. Final report of a
study sponsored by the AARP Andrus Foundation.
Adams, R. G., & Blieszner, R. (1993b). Resources for friendship
intervention. Journal of Sociology and Social Welfare, 20, 159–
175. doi:10.1177/000312240807300201
Adams, R. G., & Blieszner, R. (1994). An integrative conceptual
framework for friendship research. Journal of Social and Personal
Relationships, 11, 163–184. doi:10.1177/0265407594112001
Adams, R. G., & Blieszner, R. (1995). Aging well with friends
and family. American Behavioral Scientist, 39, 209–224.
Adams,R.G., & Blieszner,R. (1998). Structural predictors of prob-
lematic friendships in later life. Personal Relationships, 5, 439–
447. doi:10.1111/j.1475–6811.1998.tb00181.x
Adams, R. G., Blieszner,R., & deVries, B. (2000). Denitions of
friendship in the third age: Age, gender, and study location
effects. Journal of Aging Studies, 14, 117–133. doi:10.1016/
Adams, R. G., Hahmann, J., & Blieszner, R. (2017). Interactive
motifs and processes in old age friendship. In M. Hojjat &
A.Moyer (Eds.), The psychology of friendship (pp. 39–55). New
York: Oxford University Press.
Adams,R. G., & Torr, R. (1998). Factors underlying the structure
of older adult friendship networks. Social Networks, 20, 51–61.
Antonucci,T.C., & Akiyama,H. (1987). Social networks in adult
life and a preliminary examination of the convoy model. Journal
of Gerontology, 42, 519–527. doi:10.1093/geronj/42.5.519
Antonucci,T.C., & Akiyama,H., (1995). Convoys of social rela-
tions: Family and friendships within a life span context. In
R.Blieszner & V.H.Bedford (Eds.), Handbook of aging and the
family (pp. 355–371). Westport, CT: Greenwood Press.
BarbosaNeves,B., Fonseca, J.R. S., Amaro,F., & Pasqualotti,A.
(2018). Social capital and internet use in an age-comparative
perspective with a focus on later life. PLoS One, 13, e0192119.
Béland,F., Zunzunegui,M.V., Alvarado,B., Otero,A., & DelSer,T.
(2005). Trajectories of cognitive decline and social relations. The
Journals of Gerontology, Series B: Psychological Sciences and
Social Sciences, 60, P320–P330. doi:10.1093/geronb/60.6.P320
Blieszner, R. (1989). Developmental processes of friendship. In
R. G. Adams & R. Blieszner (Eds.), Older adult friendship:
Structure and process (pp. 108–126). Newbury Park, CA: Sage
Blieszner, R. (1993). Resource exchange in the social networks of
elderly women. In U.G.Foa, J. Converse, Jr., K.Y. Törnblom, &
E.B.Foa (Eds.), Resource theory: Explorations and applications
(pp. 67–79). San Diego: Academic Press.
Blieszner,R. (1995). Friendship processes and well-being in the later
years of life: Implications for interventions. Journal of Geriatric
Psychiatry, 28, 165–183.
Blieszner, R., & Adams,R. G. (1992). Adult friendship. Newbury
Park, CA: Sage.
Blieszner, R., & Adams, R. G. (1998). Problems with friends in
old age. Journal of Aging Studies, 12, 223–238. doi:10.1016/
Blieszner,R., & Ogletree,A.M. (2017). We get by with a little help
from our friends. Generations, 41(2), 55–62.
16 Innovation in Aging, 2019, Vol. 3, No. 1
Copyedited by: SE
Downloaded from by guest on 30 March 2019
Blieszner, R., & Ogletree, A. M. (2018). Relationships in middle
and late adulthood. In A.L. Vangelisti & D. Perlman (Eds.),
Cambridge handbook of personal relationships (2nd ed., pp.
148–160). New York: Cambridge University Press.
Bookwala,J., Marshall,K.I., & Manning,S.W. (2014). Who needs
a friend? Marital status transitions and physical health outcomes
in later life. Health Psychology: Ofcial Journal of the Division
of Health Psychology, American Psychological Association, 33,
505–515. doi:10.1037/hea0000049
Bouwman,T.E., Aartsen,M.J., vanTilburg,T.G., & Stevens,N.L.
(2017). Does stimulating various coping strategies alleviate lone-
liness? Results from an online friendship enrichment program.
Journal of Social and Personal Relationships, 34, 793–811.
Breckman, R., Burnes, D., Ross, S., Marshall, P. C., Suitor, J. J.,
Lachs, M. S., & Pillemer, K. (2018). When helping hurts:
Nonabusing family, friends, and neighbors in the lives of
elder mistreatment victims. The Gerontologist, 58, 719–723.
tenBruggencate,T., Luijkx,K.G., & Sturm,J. (2018). Social needs
of older people: A systematic review. Ageing & Society, 38,
1745–1770. doi:10.1017/S0144686X17000150
Carstensen, L. L., Isaacowitz, D. M., & Charles, S. T. (1999).
Taking time seriously. A theory of socioemotional selec-
tivity. The American Psychologist, 54, 165–181.
Chang, P. F., Choi, Y.H., Bazarova, N. N., & Lockenhoff, C. E.
(2015). Age differences in online social networking: Extending
socioemotional selectivity theory to social network sites. Journal
of Broadcasting & Electronic Media, 59, 221–239. doi:10.1080
Chen,Y., & Feeley,T.H. (2014). Social support, social strain, lone-
liness, and well-being among older adults: An analysis of the
health and retirement study. Journal of Social and Personal
Relationships, 32, 141–161. doi:10.1177/0265407513488728
Cooley,C. H. (1964). Human nature and the social order. New
York: Schocken.
Cornwell, B., Laumann, E. O., & Schumm, L. P. (2008). The
social connectedness of older adults: A national pro-
le*. American Sociological Review, 73, 185–203.
Cotten, S. R., Ford, G., Ford, S., & Hale, T.M. (2012). Internet
use and depression among older adults. Computers in Human
Behavior, 28, 496–499. doi:10.1016/j.chb.2011.10.021
Cotten, S. R., McCullouch, B. M., & Adams, R. G. (2011).
Technological inuences on social ties across the life span. In
K.L.Fingerman, C.A.Berg, J.Smith, & T.C.Antonucci (Eds.),
Handbook of lifespan development (pp. 647–671). New York:
Springer Publishing Company.
Dugan, E., & Kivett, V. R. (1998). Implementing the Adams and
Blieszner conceptual model: Predicting interactive friend-
ship processes of older adults. Journal of Social and Personal
Relationships, 15, 607–622. doi:10.1177/0265407598155002
Dunbar, R. I. M. (2018). The anatomy of friendship. Trends in
Cognitive Sciences, 22, 32–51. doi:10.1016/j.tics.2017.10.004
Elder,G.H., Jr., & Clipp, E.C. (1988). Wartime losses and social
bonding: Inuences across 40 years in men’s lives. Psychiatry,
51, 177–198. doi:10.1080/00332747.1988.11024391
Felmlee, D., & Muraco,A. (2009). Gender and friendship norms
among older adults. Research on Aging, 31, 318–344.
Gillespie, B. J., Lever, J., Frederick, D., & Royce, T. (2015).
Close adult friendships, gender, and the life cycle. Journal
of Social and Personal Relationships, 32, 709–736.
Gross, A. L., Rebok, G. W., Unverzagt, F. W., Willis, S. L., &
Brandt,J. (2011). Cognitive predictors of everyday functioning
in older adults: Results from the ACTIVE cognitive interven-
tion trial. The Journals of Gerontology, Series B: Psychological
Sciences and Social Sciences, 66, 557–566. doi:10.1093/geronb/
Han,S.H., Kim,K., & Burr,J.A. (2017). Friendship and depression
among couples in later life: The moderating effects of marital
quality. The Journals of Gerontology, Series B: Psychological
Sciences and Social Sciences, 74, 222–231. doi:10.1093/geronb/
Hofer, S. M., & Piccinin, A. M. (2010). Toward an integra-
tive science of life-span development and aging. The Journals
of Gerontology, Series B: Psychological Sciences and Social
Sciences, 65, 269–278. doi:10.1093/geronb/gbq017
Holt-Lunstad,J., Smith,T.B., & Layton,J.B. (2010). Social relation-
ships and mortality risk: Ameta-analytic review. PLoS Medicine,
7, e1000316. doi:10.1371/journal.pmed.1000316
Hudson, R. B. (2017). Lack of social connectedness and its con-
sequences. Public Policy & Aging Report, 27(4), 121–123.
Huxhold, O., Miche,M., & Schüz,B. (2014). Benets of having
friends in older ages: Differential effects of informal social activ-
ities on well-being in middle-aged and older adults. The Journals
of Gerontology, Series B: Psychological Sciences and Social
Sciences, 69, 366–375. doi:10.1093/geronb/gbt029
Kahn, J. R., McGill, B. S., & Bianchi, S. M. (2011). Help to
family and friends: Are there gender differences at older
ages? Journal of Marriage and the Family, 73, 77–92.
Kelley, H. H., & Thibaut, J. W. (1978). Interpersonal relations:
Atheory of interdependence. New York: Wiley.
Kim,H. J., Fredriksen-Goldsen,K. I., Bryan,A. E., & Muraco,A.
(2017). Social network types and mental health among LGBT
older adults. The Gerontologist, 57, S84–S94. doi:10.1093/
Kuiper, J. S., Zuidersma, M., Zuidema, S. U., Burgerhof, J. G.,
Stolk,R. P., OudeVoshaar,R.C., & Smidt,N. (2016). Social
relationships and cognitive decline: A systematic review and
meta-analysis of longitudinal cohort studies. International
Journal of Epidemiology, 45, 1169–1206. doi:10.1093/ije/
LaFleur,C.G., & Salthouse,T.A. (2017). Which aspects of social
support are associated with which cognitive abilities for which
people? The Journals of Gerontology, Series B: Psychological
Sciences and Social Sciences, 72, 1006–1016. doi:10.1093/
LaPierre,T.A., & Keating,N. (2013). Characteristics and contribu-
tions of non-kin carers of older people: Acloser look at friends
and neighbours. Ageing & Society, 33, 1442–1468. doi:10.1017/
Innovation in Aging, 2019, Vol. 3, No. 1 17
Copyedited by: SE
Downloaded from by guest on 30 March 2019
Lecce,S., Ceccato,I., Bianco,F., Rosi,A., Bottiroli,S., & Cavallini,E.
(2017). Theory of mind and social relationships in older adults:
The role of social motivation. Aging & Mental Health, 21, 253–
258. doi:10.1080/13607863.2015.1114586
Lee, H. J., & Szinovacz, M. E. (2016). Positive, negative, and
ambivalent interactions with family and friends: Associations
with well-being. Journal of Marriage and Family, 78, 660–679.
Levitt,M.J., Weber,R.A., & Guacci,N. (1993). Convoys of social
support: An intergenerational analysis. Psychology and Aging, 8,
323–326. doi:10.1037/0882-7974.8.3.323
Li,T., Fok,H.K., & Fung,H.H. (2011). Is reciprocity always ben-
ecial? Age differences in the association between support bal-
ance and life satisfaction. Aging & Mental Health, 15, 541–547.
Lilly,M. L., Richards,B.S., & Buckwalter, K. C. (2003). Friends
and social support in dementia caregiving. Assessment and
intervention. Journal of Gerontological Nursing, 29, 29–36.
Litwin,H., & Shiovitz-Ezra,S. (2006). Network type and mortality
risk in later life. The Gerontologist, 46, 735–743. doi:10.1093/
Logan, G. D., Schachar, R. J., & Tannock, R. (1997). Impulsivity
and inhibitory control. Psychological Science, 8, 60–64.
Martina,C.M., Stevens,N.L., & Westerhof,G.J. (2012). Promotion
of self-management in friendship. Aging & Mental Health, 16,
245–253. doi:10.1080/13607863.2011.596806
Mead,G.H. (1962). Mind, self, and society. Chicago: University of
Chicago Press.
Menkin, J.A., Robles,T. F., Gruenewald,T. L., Tanner, E. K., &
Seeman,T.E. (2017). Positive expectations regarding aging linked
to more new friends in later life. The Journals of Gerontology,
Series B: Psychological Sciences and Social Sciences, 72, 771–
781. doi:10.1093/geronb/gbv118
Mullis,E.C. (2010). Confucius and Aristotle on the goods of friend-
ship. Dao, 9, 391–405. doi:10.1007/s11712-010-9185-y
Muraco, A., & Fredriksen-Goldsen, K. (2011). “That’s what
friends do”: Informal caregiving for chronically ill midlife and
older lesbian, gay, and bisexual adults. Journal of Social and
Personal Relationships, 28, 1073–1092. doi:10.1177/0265
Nicolaisen, M., & Thorsen, K. (2017). What are friends for?
Friendships and loneliness over the lifespan-from 18 to 79years.
International Journal of Aging & Human Development, 84,
126–158. doi:10.1177/0091415016655166
Piercy,K. W., & Cheek, C. (2004). Tending and befriending: The
intertwined relationships of quilters. Journal of Women &
Aging, 16, 17–33. doi:10.1300/J074v16n01_03
Roberto, K. A. (1989). Exchange and equity in friendship. In
R. Adams & R. Blieszner (Eds.), Older adult friendship:
Structure and process (pp. 147–165). Newbury Park, CA:
Roberto, K. A., & Scott,J. (1986). Friendships of older men and
women: Exchange patterns and satisfaction. Psychology and
Aging, 2, 103–109. doi:10.1037/0882-7974.1.2.103
Ryerson,L.M. (2017). Innovations in social connectedness. Public
Policy & Aging Report, 27(4), 124–126. doi:10.1093/ppar/
Sander, J., Schupp, J., & Richter, D. (2017). Getting together:
Social contact frequency across the life span. Developmental
Psychology, 53, 1571–1588. doi:10.1037/dev0000349
Santini,Z.I., Koyanagi,A., Tyrovolas,S., Mason,C., & Haro,J.M.
(2015). The association between social relationships and depres-
sion: Asystematic review. Journal of Affective Disorders, 175,
53–65. doi:10.1016/j.jad.2014.12.049
Shea,L., Thompson,L., & Blieszner,R. (1988). Resources in older
adults’ old and new friendships. Journal of Social and Personal
Relationships, 5, 83–96. doi:10.1177/0265407588051005
Stevens,N.L., Martina,C.M., & Westerhof,G.J. (2006). Meeting
the need to belong: Predicting effects of a friendship enrichment
program for older women. The Gerontologist, 46, 495–502.
Survey Research Center. (2016). Guidelines for Best Practice in
Cross-Cultural Surveys. Ann Arbor, MI: Survey Research Center,
Institute for Social Research, University of Michigan. Retrieved
Tsai,H.S., Shillair,R., & Cotten,S.R. (2017). Social support and
“playing around”: An examination of how older adults acquire
digital literacy with tablet computers. Journal of Applied
Gerontology: The Ofcial Journal of the Southern Gerontological
Society, 36, 29–55. doi:10.1177/0733464815609440
Tsai,H.S., Shillair,R., Cotten,S.R., Winstead,V., & Yost,E. (2015).
Getting grandma online: Are tablets the answer for increas-
ing digital inclusion for older adults in the U.S.? Educational
Gerontology, 41, 695–709. doi:10.1080/03601277.2015.1048
Ueno,K., & Adams,R.G. (2006). Adult friendship: Adecade review.
In P.Noller & J.A.Feeney (Eds.), Close relationships (pp. 151–
169). New York: Psychology Press.
Vargheese, J. P., Sripada, S., Masthoff, J., & Oren, N. (2016).
Persuasive strategies for encouraging social interaction for older
adults. International Journal of Human-Computer Interaction,
32, 190–214. doi:0.1080/10447318.2016.1136176
deVries,B. (2018). The unsung bonds of friendship—and caring—
among older adults. Generations, 42, 77–81.
de Vries, B., & Megathlin, D. (2009). The dimensions and pro-
cesses of older GLBT friendships and family relationships:
The meaning of friendship for gay men and lesbians in the
second half of life. Journal of GLBT Family Studies, 5, 82–98.
deVries,B., Utz,R., Caserta, M., & Lund,D. (2014). Friend and
family contact and support in early widowhood. The Journals
of Gerontology, Series B: Psychological Sciences and Social
Sciences, 69, 75–84. doi:10.1093/geronb/gbt078
Wrzus,C., Hänel,M., Wagner,J., & Neyer, F.J. (2013). Social net-
work changes and life events across the life span: Ameta-analy-
sis. Psychological Bulletin, 139, 53–80. doi:10.1037/a0028601
Yu,R. P., Ellison,N. B., & Lampe, C. (2018). Facebook use and
its role in shaping access to social benets among older adults.
Journal of Broadcasting & Electronic Media, 62, 71–90. doi:10.
18 Innovation in Aging, 2019, Vol. 3, No. 1
Copyedited by: SE
Downloaded from by guest on 30 March 2019
... A social network is often described as a significant determinant of physical and psychological health [1][2][3]. In later life, having a diverse network (e.g., family, friends, caregivers) is a predictor of better health outcomes, lower morbidity and mortality [4][5][6] and well-being [7]. ...
... In later life, events such as losing relatives and friends, chronic illness or relocation to a retirement home can disrupt the structure of the social network [3,9]. Friends, while playing a key role in maintaining social ties, are the most threatened by this remodeling [10]. ...
... Friends, while playing a key role in maintaining social ties, are the most threatened by this remodeling [10]. In addition, the likelihood of making new friends in later life is lower than in adulthood [3]. Unlike the family bond, the friendship bond is based on the interest of individuals and is more likely to be broken by a lack of reciprocity [10]. ...
Full-text available
Background: This article focuses on how older persons perceive their friends' role in their daily experience of chronic pain. It reports part of the results of a study in which we interviewed 49 participants, aged 75 and older, about the way they communicate about chronic pain within their social network. Methodology: Using discourse and content analysis, we first examine older persons' definition of friendship, and then identify the various dimensions of friendship that are engaged in the communication about chronic pain. Results: Participants define close friends as people with whom they share intimacy and social proximity (same gender, age and experience of pain). These dimensions allow older persons to talk freely about their pain without the fear of being judged or rejected, particularly when it is related to a dynamic of reciprocity. Conclusions: This article shows that the contribution of friends to the everyday life of older persons with chronic pain is mainly that of providing emotional support.
... Furthermore, high-quality friendships in adulthood and later in life may offset the costs of having lower-quality familial or marital relationships (Han et al., 2019). Longitudinal research has linked the presence of higher-quality adult friendships with better health and greater well-being across the life span, particularly in old age (Béland et al., 2005;Blieszner et al., 2019). Despite these beneficial outcomes, the development of satisfactory adult friendships has received less attention and is less well understood than the development of other types of relationships, especially those with family members or romantic partners. ...
... In addition to these health impacts, isolation and loneliness are associated with greater health care utilization and spending among older adults (AARP Public Policy Institute, 2017;Gerst-Emerson & Jayawardhana, 2015;Valtorta et al., 2018). Given these substantial negative outcomes, health care providers and payers are increasingly focused on designing and delivering programs to reduce loneliness and social isolation, and research is increasingly committed to understanding relationships among social connection, loneliness, and isolation (Blieszner et al., 2019). ...
Background and Objectives Social isolation and loneliness are common among older adults and associated with negative health outcomes including cognitive decline, depression, suicide ideation, and mortality. Information and communication technology interventions are often used to combat loneliness and social isolation; however, homebound older adults face barriers to access. This study reports findings from a novel pilot intervention, called Talking Tech, designed to reduce loneliness and social isolation in homebound older adults by providing one-on-one, in-home technology training, a tablet, and the internet, to promote digital literacy and participation in a virtual senior center. Research Design and Methods 21 homebound older adults participated in this 14-week, volunteer-delivered program. We used qualitative interviews with participants, volunteers, and program staff, weekly progress reports from volunteers, and quantitative pre- and post-intervention surveys with participants to examine experiences and to evaluate the impact of the intervention on loneliness and social isolation. Qualitative data were analyzed using content analysis and pre- and post-intervention survey data were compared. Results Participants reported increased technological literacy and use, increased access to online activities, and improved facilitation of social connections to existing and new networks. Additionally, during interviews, many participants reported that participating in Talking Tech alleviated their loneliness. While not statistically significant, our quantitative analysis revealed trends towards decreased participant feelings of loneliness and increased technology use. Additionally, intervention adoption and retention were high, with only one participant withdrawing from the intervention. Discussion and Implications This evaluation of the novel Talking Tech pilot intervention provides critical insights into strategies to reduce loneliness and isolation for older adults, with implications for future research, policy, and practice. Findings demonstrate that individualized technology training may be an acceptable way to improve well-being for homebound older adults.
... Friendships require more effort than family relationships and the emotional intensity of friendships decreases without physical presence (Stadtfeld et al., 2018). A series of large international studies show the positive benefits of close friendship, regardless of age and sex, such as increased social support, life satisfaction, physical health and wellbeing (Amati et al., 2018;Pillemer and Rothbard, 2018;Blieszner et al., 2019;Oh et al., 2020). Friendship amongst the student population can be defined as a dyadic, co-constructed phenomenon characterized by reciprocity, closeness and intimacy (Schneider, 2000;Bagwell and Schmidt, 2011). ...
Full-text available
COVID-19 lockdown presented a novel opportunity to study the experiences of people attempting to maintain friendships in the context of worldwide, government-enforced physical distancing and lockdown. Here we report on an experiential, idiographic qualitative project with a purposive sample of Scottish students. Data was collected via one-to-one on-line interviews with nine student participants (N = 9). Data was transcribed and analyzed using Interpretative Phenomenological Analysis (IPA). Analysis highlighted three group-level experiential themes (GETs) and associated subthemes. Participants’ shared experiences of maintaining friendships were reflected in a dynamic process by which (1) ‘changes to communication’ were associated with experiences of (2) ‘effort and balance’ across friendships. Participants reported becoming particularly aware of the psychological processes involved in maintaining friendships, in turn, this was associated with (3) ‘reflection and growth.’ These experiential findings resonate well with several longstanding classic theories; however, they also speak to the particularities of the context in which the study was conducted. They suggest the need for a pandemic psychology that moves beyond the typical focus on the direct impacts of infectious disease to address the wider psychosocial impacts with equal vigor.
... A more comprehensive friendship intervention could improve other mechanisms of friendship-building skills, including the ways people think (cognitive mechanisms) and feel (emotional mechanisms) about friendships. 11 Cognitive mechanisms include (1) reducing maladaptive biases about friendships and (2) learning the importance of shared similarities (homophily). Emotional mechanisms include increasing gratitude and compassion. ...
... Victor (2005, p. 225) has found that widowhood may lead to high rate morbidity, mortality and impinge on the state of health. Strong ties with friends in the old age has a positive impact on the psychological well-being of the elderly (Blieszner, Ogletree, & Adams, 2019). Jerrome (1990) discussed the contribution of friends in the alleviation of illness. ...
Full-text available
Friendship is an intrinsic aspect of living across generations. However, the significance of friendship for the silver generation has received limited attention from gerontological studies in India. Considering that widowhood is accompanied by loneliness, bereavement and stigma, I am interested to understand the implications of widowhood for elderly women and to what extent friendship has the potential in countering and negotiating with ageing and widowhood. This is further important in demystifying the myth of transient nature of female friendship and illuminate on the spaces of female solidarity. The study has incorporated qualitative interviewing and oral narratives administered through semi-structured questionnaire conducted in the setting of the respective residence of the respondents. It was found that the social context of ageing and the structural context shape the experiences of friendship. Friendship can be low maintenance for these women; however a friend is one through interaction with whom one derives equanimity contentment and meaning for leading life without the presence of spouse. They challenged the notion of normative understanding of friendship by identifying kin members sometimes across generations as friends. Female friendship is not fragile and they feel that it is more intense and laden with emotions compared to male friendship.
... Nevertheless, a growing number of scholars recognize changes in family practices and the emergence of different types of support and social solidarities that are as important as nuclear family to older people's lives (Blieszner et al., 2019;Lapierre and Keating, 2013;Martin--Matthews, 2017). Values that characterize modern societies, such as greater freedom of choice and autonomy, can support the development of networks of solidarity, new forms of social integration, and construction of identities in later life (Phillipson, 2003). ...
With particular focus on availability of family care, research on relationships in later life have often emphasized dynamics inside homes and connections with direct family members. However, a growing number of scholars recognize changes in family practices and the prominence of different types of non-kin ties that are as important as family to older people. Connidis has proposed a sociological approach to capture the realities of personal relationship in later life. Informed by Connidis’ approach, we apply qualitative lenses to study social capital in analyzing 40 semi-structured interviews conducted with Chilean people aged 60–74 years. We used a thematic analysis to examine the circumstances under which older people mobilize help through different types of kin and non-kin ties as bonding or bridging social capital. Though literature on social capital describes friends and family members as bonding ties, our findings indicate that they play a double role as bonding and bridging social capital in their own unique way, depending on circumstances. Friends, in comparison to family ties, bridge the older person with a variety of worldviews and lifestyles, helping them to advance their wellbeing in the face of life transitions and challenges experienced with aging. Study participants associated seeking help from others with notions of material and physical dependency, laziness, and a commitment to return help. The preference to seek different types of support from a variety of relationships can be interpreted as a way to manage ambivalence within a larger socio-cultural context.
... Furthermore, demographic changes and historical shifts (e.g., historical delays in childbearing and marriage) necessitate the need for a flexible theoretical framework that can explain not only the already existing heterogeneity of social networks but can also account for ongoing socio-historical changes . Some existing frameworks addressing social relationships in older adults acknowledge the important role of context in shaping social ties (e.g., Antonucci et al., 2014;Blieszner et al., 2019) but are difficult to examine empirically because they do not posit specific testable mechanisms. On the contrary, those models that do offer empirically testable mechanisms for change (Carstensen, 1992;Charles, 2010) do not comprehensively account for the vast heterogeneity of older adults (Nelson & Dannefer, 1992), the diversity of social functions provided by different types of ties Sutcliffe et al., 2012;Weiss, 1974), or the influence of the context Huxhold & Fiori, 2019), which encompasses other organisms, physical environments, and proximal (e.g., family) and distal (e.g., politics and social policy) social institutions (Lerner, 1991). ...
Empirical evidence about the development of social relationships across adulthood into late life continues to accumulate, but theoretical development has lagged behind. The Differential Investment of Resources (DIRe) model integrates these empirical advances. The model defines the investment of time and energy into social ties varying in terms of emotional closeness and kinship as the core mechanism explaining the formation and maintenance of social networks. Individual characteristics, acting as capacities, motivations, and skills, determine the amount, direction, and efficacy of the investment. The context (e.g., the living situation) affects the social opportunity structure, the amount of time and energy available, and individual characteristics. Finally, the model describes two feedback loops: (a) social capital affecting the individual’s living situation and (b) different types of ties impacting individual characteristics via social exchanges, social influences, and social evaluations. The proposed model will provide a theoretical basis for future research and hypothesis testing.
Social connection is important across the life course, but overall levels have been declining. The COVID-19 pandemic presented a unique context to examine social connectedness and adaptive capacity in times of social adversity. We used a parallel mixed method design to collect online survey data from a representative U.S. sample (N = 359). Applying an exploratory sequential approach, we used a general linear model multivariate approach to repeated measures to test for differences in participants’ perceptions of social connectedness by time and age category and qualitative analysis to gain insights about disrupted social contexts. Results indicated that social connectedness decreased after mitigation restrictions for all age groups, but individuals in emerging and late adulthood felt the greatest impact. Two themes emerged: differing emotional responses to altered communication and intentionality of maintaining and/or creating social connections. Experiences of social connectedness need to be understood as a function of life stage and developmental timing.
Objectives: We investigate whether depressive symptoms and social isolation are independent predictors of two-year all-cause mortality among the elderly using data from a population-based cohort. Methods: A total of 1,033 participants (320 men and 713 women) older than 60 years of age participated in this study. Depressive symptoms, social isolation status, and sociodemographic and health-related covariates were assessed at baseline. The primary outcome measure was two-year all-cause mortality. Data were collected through in-person interviews by trained interviewers. The Genmod procedure was used to calculate relative risks (RRs). Results: Of the 1,033 participants, 102 (40 men and 62 women) died within a follow-up period of two years. During the two-year follow-up period, 17.8% of depressed men and 12.3% of depressed women died, and 29.8% of socially isolated men and 14.9% of socially isolated women died. Social isolation was an independent predictor of mortality in old men (adjusted relative risk (aRR): 4.6, 95% confidence interval (CI): 2.0-10.2), while depressive symptoms were an independent predictor of mortality in old women (aRR: 2.0, 95% CI: 1.3-3.6) when controlling potential confounding factors. However, depressive symptoms detected by the geriatric depression scale (GDS) were not associated with mortality in men and social isolation was not associated with mortality in women. Conclusion: The effects of depressive symptoms and social isolation on two-year all-cause mortality in an elderly population differed according to gender. It is necessary to develop gender-specific community-based interventions to potentially reduce two-year all-cause mortality in the elderly.
Full-text available
Older adults (aged 65+) are still less likely to adopt the Internet when compared to other age groups, although their usage is increasing. To explore the societal effects of Internet usage, scholars have been using social capital as an analytical tool. Social capital pertains to the resources that are potentially available in one’s social ties. As the Internet becomes a prominent source of information, communication, and participation in industrialized countries, it is critical to study how it affects social resources from an age-comparative perspective. Research has found a positive association between Internet use and social capital, though limited attention has been paid to older adults. Studies have also found a positive association between social capital and wellbeing, health, sociability, and social support amongst older adults. However, little is known about how Internet usage or lack thereof relates to their social capital. To address this gap, we used a mixed-methods approach to examine the relationship between Internet usage and social capital and whether and how it differs by age. For this, we surveyed a representative sample of 417 adults (18+) living in Lisbon, Portugal, of which 118 are older adults. Social capital was measured through bonding, bridging, and specific resources, and analyzed with Latent Class Modeling and logistic regressions. Internet usage was measured through frequency and type of use. Fourteen follow-up semi-structured interviews helped contextualize the survey data. Our findings show that social capital decreased with age but varied for each type of Internet user. Older adults were less likely to have a high level of social capital; yet within this age group, frequent Internet users had higher levels than other users and non-users. On the one hand, the Internet seems to help maintain, accrue, and even mobilize social capital. On the other hand, it also seems to reinforce social inequality and accumulated advantage (known as the Matthew effect).
Full-text available
This article traces characteristics and patterns of friendship for Summer of Love participants when they were young, in middle-age, and now in older age. Research on friendships of persons at the leading edge of the baby boomer cohort reveals continuity in preferences for friends, interactions with friends, and effects of friendships on health and well-being in adulthood. Friendships may be particularly salient and central in late life when family and work obligations are less prominent. Professionals can apply lessons from the research in efforts to enhance older adults' friendships and sustain quality of life.
Relative to North American familial kinship, friendship is held in a subordinate status. Friends, however, have deep and wide-ranging bonds—ties that can have positive consequences for older adults’ health and well-being. This article examines some of the ways in which friendship is limited by North American culture (i.e., the language used, expectations) and illustrates some of the supports that friends provide for one another (i.e., intrapersonal and interpersonal support, including caregiving). These examples and analyses suggest the strong, unrecognized potential of friendship in the lives of older adults.
Adults who are 65 years or older have increasingly adopted social network sites (SNSs), Facebook in particular. Yet the ramifications of SNS use in this population remain understudied. Using a nationally representative sample of U.S. adults (N = 2,003), this study focuses on Facebook users (N = 1,138) and examines patterns of Facebook use by younger (aged 18–65 years) and older users (aged 65 or older), as well as the social benefits associated with older users’ Facebook use. Findings show that older users have different network structures, but the frequency of their visits and engagement in Social Media Relationship Maintenance Behaviors (SMRMB), a measure of perceived likelihood to engage with others via social media, do not significantly differ from those of younger users. Moreover, our results suggest that among older users (N = 98), the number of self-reported “actual” friends on Facebook and SMRMB positively predict perceived support, while SMRMB contributes to perceptions of access to useful information. Overall, the study highlights unique usage patterns and social benefits associated with Facebook use among older adults. As such, its findings provide insights for the future design of technological interventions to help older adults better access social benefits associated with SNS use.
Friendship is the single most important factor influencing our health, well-being, and happiness. Creating and maintaining friendships is, however, extremely costly, in terms of both the time that has to be invested and the cognitive mechanisms that underpin them. Nonetheless, personal social networks exhibit many constancies, notably in their size and their hierarchical structuring. Understanding the processes that give rise to these patterns and their evolutionary origins requires a multidisciplinary approach that combines social and neuropsychology as well as evolutionary biology.
Frequent social interactions are strongly linked to positive affect, longevity, and good health. Although there has been extensive research on changes in the size of social networks over time, little attention has been given to the development of contact frequency across the life span. In this cohort-sequential longitudinal study, we examined intraindividual changes in the frequency of social contact with family and nonfamily members, and potential moderators of these changes. The data come from the 1998, 2003, 2008, and 2013 waves of the German Socio-Economic Panel (SOEP) study (N = 36,716; age range: 17–85 years). Using latent growth curve analysis, we found that the frequency of in-person contact with family members remained relatively stable across the life span. In contrast, the frequency of visits to and from nonfamily members (neighbors, friends, and acquaintances) declined following a cubic trajectory and dropped below the frequency of family visits when respondents were in their mid-30s. Relationship status and gender had a slight effect on both of these relationship trajectories. Subjective current health status and employment status influenced the life span trajectory of nonfamily social contact only. Changes of residence and the birth of a child, both of which constitute major turning points in the life course, did not affect the life span trajectory of either family or nonfamily in-person contact. The findings are discussed here in the context of earlier findings and in relation to socioemotional selectivity and social convoy theory and the evolutionary life history approach.
Objectives: The aims of the study were to examine within-person associations between social interactions with friends (one's own and partner's) and depressive symptoms over time among couples in later life and to investigate whether marital quality moderated the associations. Methods: We used longitudinal data from the Health and Retirement Study (2004-2012) to examine a sample of coupled individuals (dyad N = 6,833). Dyadic growth curve models were employed to test the study hypotheses. Results: Results indicated that more frequent social interactions with friends were associated with fewer depressive symptoms of individuals and there were cross-spousal effects for this association. Further, marital quality moderated the within-person association between social interaction with friends and depressive symptoms such that the association was stronger for individuals experiencing poor marital quality compared to those with better marital quality. Discussion: Friendship is an important contributor to individuals' mental health in later life, with its benefits having far-reaching consequences for one's significant other. The implications of friendship interactions for other health domains also require investigation within the marital context.
Social needs are important basic human needs. When social needs are not satisfied, this can lead to mental and physical health problems. With a growing population of older adults and the need for them to stay healthy and community-dwelling, satisfying social needs is important. The aim of this review is to give more insight into the social needs of older people and subsequently into the characteristics of effective interventions for satisfying older people's social needs. A systematic review of the existing literature on quantitative, qualitative and mixed empirical studies on the social needs of older people was conducted. The themes that emerged were diversity, proximity, meaning of the relationship and reciprocity. These themes offered several intervention implications. Participation in hobbies and in volunteer work and being connected were among the main findings. The social needs of older people are diverse. They focus on both the intimate and the peripheral members of their networks. When satisfying social needs, reciprocity is important. The feeling of connectedness to others and to a community or neighbourhood contributes to wellbeing as well as a feeling of independence. Staying active by doing volunteer work or participating in (leisure) social activities satisfies social needs. Therefore, interventions should focus especially on the connectedness, participation and independence of the older adult.
Purpose of the Study Elder mistreatment is an epidemic with significant consequences to victims. Little is known, however, about another affected group: nonabusing family members, friends, and neighbors in the lives of the older victim or “concerned persons.” This study aimed to identify (a) the prevalence of adults aged 18 and older who have encountered an elder mistreatment situation, (b) the proportion of these who helped the elder victim, and (c) the subjective levels of distress experienced by respondents who helped the victim versus those who did not. Design and Methods Data were collected from a nationally representative telephone survey of 1,000 adults (18+). Multiple linear regression was used to test the relationship between “helping status” and personal distress attributed to an elder mistreatment, defined as someone aged 60 and older experiencing violence, psychological abuse, financial exploitation, or neglect by a caregiver. Results Nearly 30% of adults knew a relative, friend, or neighbor who experienced elder mistreatment. Of these, 67% reported personal distress resulting from the mistreatment at a level of 8 or more out of 10. Assuming a helping role was associated with significantly higher levels of personal distress. Greater distress was also associated with being a woman, increasing age, and lower household income. Implications Knowing about an elder mistreatment situation is highly distressing for millions of adults in the United States, particularly for those assuming a helping role. We suggest intervention approaches and future research to better understand the role and needs of concerned persons.