ArticleBMC geriatrics2026
Testing a conceptual framework of loneliness, social isolation and health outcomes in older adults.
Article in BMC geriatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLoneliness and social isolation are established risk factors for adverse cardiovascular, cerebrovascular and cognitive outcomes in later life, yet the pathways underlying these associations remain underexplored. This study tests the structure of a published framework linking social isolation and loneliness to health outcomes through psychological, behavioural and physiological pathways.
methodsWe analysed cross-sectional data from 1,685 Singaporean adults over the age of 60 from the Wellbeing of the Singapore Elderly study. Path analysis was used to examine the psychological (subsyndromal and syndromal anxiety and depression), behavioural (smoking, alcohol use, poor diet and sedentary lifestyle), and physiological (hypertension, obesity, diabetes and sleep disruption) pathways from social isolation and loneliness to health outcomes (cardiovascular, cerebrovascular and cognitive health).
resultsThe final model fit the data well (χ²(60) = 67.62, p = .233; CFI = 0.986; TLI = 0.993; RMSEA = 0.009). Loneliness was positively associated with psychological burden (b = 0.20, p < .001), unhealthy behaviours (b = 0.06, p = .001), and physiological burden (b = 0.06, p = .005). Social isolation was positively associated with psychological burden (b = 0.07, p = .005) and unhealthy behaviours (b = 0.14, p < .001). Physiological burden was positively associated with cardiovascular disease (b = 0.22, p < .001) and cerebrovascular conditions (b = 0.34, p < .001), while unhealthy behaviours were positively associated with cerebrovascular conditions (b = 0.21, p = .003) and poorer cognitive function (b = -0.14, p = .004). Social isolation also showed direct associations with poorer cognitive function (b = -0.09, p = .007) and lower probability of cardiovascular disease (b = -0.08, p = .014). DISCUSSION: Social isolation and loneliness are associated with behavioural and physiological factors that increase vulnerability to cardiovascular, cerebrovascular and cognitive conditions. Routine screening and public health strategies to address social disconnection and associated factors can improve wellbeing and reduce healthcare burden. Longitudinal research can clarify causal mechanisms and inform targeted interventions.
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