{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T21:23:28Z","timestamp":1791581008866,"version":"4.3.4"},"reference-count":78,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T00:00:00Z","timestamp":1743552000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\n Loneliness and social isolation are distressing for individuals and predictors of mortality, yet data on their impact on publicly funded long-term care is limited. Using recent advances in natural language processing (NLP), we analysed pseudonymised administrative records containing 1.1 million free-text case notes about 3,046 older adults recorded in a London council between 2008 and 2020. We applied three NLP methods\u2014document-term matrices, pre-trained embeddings, and transformer-based models\u2014to identify loneliness or social isolation. The best-performing model, a bidirectional transformer, achieved an\n F<\/jats:italic>\n 1<\/jats:sub>\n score of 0.92 on a test set of unseen sentences. Using this model, we generated predictions for the full dataset and assessed construct validity through comparison with survey data and the literature. Our measure is associated with expected characteristics, such as living alone and impaired memory, and is a strong predictor of social inclusion services. Approximately 43% of individuals had a sentence indicating loneliness or isolation in their case notes at their initial care assessment, comparable to survey-based estimates. Unlike surveys, our indicator is linked to other administrative data, enabling development of models of service use with loneliness or isolation as independent variables. An open-source version of the model is available in a\n GitHub repository<\/jats:ext-link>\n .\n <\/jats:p>","DOI":"10.1371\/journal.pone.0319745","type":"journal-article","created":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T19:49:44Z","timestamp":1743623384000},"page":"e0319745","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Understanding patterns of loneliness in older long-term care users using natural language processing with free text case notes"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1921-5258","authenticated-orcid":true,"given":"Sam","family":"Rickman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4190-7341","authenticated-orcid":true,"given":"Jose-Luis","family":"Fernandez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5759-1647","authenticated-orcid":true,"given":"Juliette","family":"Malley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,4,2]]},"reference":[{"key":"pone.0319745.ref001"},{"key":"pone.0319745.ref002","article-title":"Adult social care activity and finance report, England, 2022\u201323","author":"Digital NHS","year":"2023"},{"key":"pone.0319745.ref003","article-title":"Projections of adult social care demand and expenditure 2018 to 2038","author":"B Hu","year":"2020","journal-title":"CPEC Working Paper 7"},{"key":"pone.0319745.ref004","article-title":"Unmet social care needs in England","author":"J Fernandez","year":"2020","journal-title":"CPEC Working Paper 7"},{"key":"pone.0319745.ref005","article-title":"Data on adult social care","author":"D King","year":"2015","journal-title":"NIHR school for social care research scoping review"},{"key":"pone.0319745.ref006","article-title":"Resource allocation at the micro level in adult social care: A scoping review","author":"D Challis","year":"2016"},{"key":"pone.0319745.ref007","article-title":"People at the heart of care: Adult social care reform white paper","author":"DHSC","year":"2021"},{"issue":"5","key":"pone.0319745.ref008","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1080\/13691457.2020.1870213","article-title":"Practitioner perspectives on the implementation of an electronic information system to enforce practice standards in England","volume":"24","author":"P Gillingham","year":"2021","journal-title":"Eur J Soc Work."},{"issue":"8","key":"pone.0319745.ref009","doi-asserted-by":"crossref","first-page":"e0270595","DOI":"10.1371\/journal.pone.0270595","article-title":"Multi-label classification of symptom terms from free-text bilingual adverse drug reaction reports using natural language processing","volume":"17","author":"S Chaichulee","year":"2022","journal-title":"PLoS One"},{"key":"pone.0319745.ref010"},{"issue":"1","key":"pone.0319745.ref011","doi-asserted-by":"crossref","first-page":"7155","DOI":"10.1038\/s41598-020-62922-y","article-title":"BEHRT: Transformer for electronic health records","volume":"10","author":"Y Li","year":"2020","journal-title":"Sci Rep"},{"issue":"1","key":"pone.0319745.ref012","first-page":"1","article-title":"Automatically identifying social isolation from clinical narratives for patients with prostate cancer","volume":"19","author":"V Zhu","year":"2019","journal-title":"BMC Med Inform Decis Mak"},{"issue":"6","key":"pone.0319745.ref013","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1145\/3127881","article-title":"Mining electronic health records (EHRs) a survey","volume":"50","author":"P Yadav","year":"2018","journal-title":"ACM Comput Surv. (CSUR)."},{"key":"pone.0319745.ref014","article-title":"Extracting social support and social isolation information from clinical psychiatry notes: Comparing a rule-based NLP system and a large language model","author":"BG Patra","year":"2024","journal-title":"arXiv Preprint"},{"issue":"4","key":"pone.0319745.ref015","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1086\/712734","article-title":"Automated identification of domestic violence in written child welfare records: Leveraging text mining and machine learning to enhance social work research and evaluation","volume":"12","author":"B Victor","year":"2021","journal-title":"J Soc Soc Work Res."},{"issue":"1","key":"pone.0319745.ref016","doi-asserted-by":"crossref","first-page":"e24","DOI":"10.37765\/ajmc.2021.88580","article-title":"Using natural language processing to classify social work interventions","volume":"27","author":"AT Bako","year":"2021","journal-title":"Am J Manag Care"},{"issue":"2","key":"pone.0319745.ref017","doi-asserted-by":"crossref","first-page":"e0247404","DOI":"10.1371\/journal.pone.0247404","article-title":"A natural language processing and deep learning approach to identify child abuse from pediatric electronic medical records","volume":"16","author":"AV Annapragada","year":"2021","journal-title":"PLoS One"},{"issue":"2","key":"pone.0319745.ref018","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1093\/oxfordjournals.aje.a112674","article-title":"Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents","volume":"109","author":"LF Berkman","year":"1979","journal-title":"Am J Epidemiol"},{"issue":"2","key":"pone.0319745.ref019","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1177\/1745691614568352","article-title":"Loneliness and social isolation as risk factors for mortality: a meta-analytic review","volume":"10","author":"J Holt-Lunstad","year":"2015","journal-title":"Perspect Psychol Sci"},{"issue":"11","key":"pone.0319745.ref020","doi-asserted-by":"crossref","first-page":"2056","DOI":"10.2105\/AJPH.2013.301261","article-title":"Social isolation: a predictor of mortality comparable to traditional clinical risk factors","volume":"103","author":"M Pantell","year":"2013","journal-title":"Am J Public Health"},{"issue":"8","key":"pone.0319745.ref021","doi-asserted-by":"crossref","first-page":"1346","DOI":"10.1177\/0898264312460275","article-title":"Social isolation, loneliness and health among older adults","volume":"24","author":"CE Coyle","year":"2012","journal-title":"J Aging Health"},{"issue":"1","key":"pone.0319745.ref022","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1037\/0022-3514.53.1.119","article-title":"Developing and testing a model of loneliness","volume":"53","author":"J de Jong-Gierveld","year":"1987","journal-title":"J Pers Soc Psychol"},{"key":"pone.0319745.ref023","article-title":"Psychogeriatric care in the community","author":"WHO","year":"1979"},{"issue":"8","key":"pone.0319745.ref024","doi-asserted-by":"crossref","first-page":"e034967","DOI":"10.1136\/bmjopen-2019-034967","article-title":"Consensus statement: loneliness in older adults, the 21st century social determinant of health?","volume":"10","author":"T Prohaska","year":"2020","journal-title":"BMJ Open"},{"key":"pone.0319745.ref025","article-title":"Social isolation and loneliness among older people: Advocacy brief","author":"WHO","year":"2021"},{"key":"pone.0319745.ref026","article-title":"A connected Society: a strategy for tackling loneliness\u2013laying the foundations for change. London: Department for Digital","author":"DCMS","year":"2018"},{"key":"pone.0319745.ref027","article-title":"Tackling loneliness evidence review: main report. London: Department for Digital","author":"DCMS","year":"2023"},{"key":"pone.0319745.ref028"},{"issue":"2","key":"pone.0319745.ref029","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/s10433-022-00703-4","article-title":"Revisiting the Nordic long-term care model for older people-still equal?","volume":"19","author":"T Rostgaard","year":"2022","journal-title":"Eur J Ageing"},{"issue":"1","key":"pone.0319745.ref030","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1017\/S0144686X18000843","article-title":"Day centres for older people: a systematically conducted scoping review of literature about their benefits, purposes and how they are perceived","volume":"40","author":"K Orellana","year":"2020","journal-title":"Ageing Soc"},{"key":"pone.0319745.ref031","article-title":"The changing role of the day centre for older people in addressing loneliness: a participatory action research study","author":"C Noone","year":"2023"},{"issue":"4","key":"pone.0319745.ref032","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1017\/S0047279412000311","article-title":"The return of the family? Welfare state retrenchment and client autonomy in long-term care","volume":"41","author":"E Grootegoed","year":"2012","journal-title":"J Soc Policy."},{"issue":"6","key":"pone.0319745.ref033","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1093\/ageing\/afy095","article-title":"Loneliness as a risk factor for care home admission in the English longitudinal study of ageing","volume":"47","author":"B Hanratty","year":"2018","journal-title":"Age Ageing"},{"issue":"3","key":"pone.0319745.ref034","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1111\/j.1532-5415.2004.52118.x","article-title":"Predictors of nursing facility admission: a 12-year epidemiological study in the United States","volume":"52","author":"AJ Bharucha","year":"2004","journal-title":"J Am Geriatr Soc"},{"issue":"2","key":"pone.0319745.ref035","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1300\/J010v33n02_05","article-title":"Impact of social support, diversity, and poverty on nursing home utilization in a nationally representative sample of older Americans","volume":"33","author":"RC Kersting","year":"2001","journal-title":"Soc Work Health Care"},{"issue":"2","key":"pone.0319745.ref036","first-page":"123","article-title":"Factors associated with long-stay nursing home admissions among the US elderly population: comparison of logistic regression","volume":"10","author":"Q Cai","year":"2023","journal-title":"J Nurs Home Res"},{"issue":"3","key":"pone.0319745.ref037","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1093\/ageing\/afr015","article-title":"Integrating assessments of older people: examining evidence and impact from a randomised controlled trial","volume":"40","author":"P Clarkson","year":"2011","journal-title":"Age Ageing"},{"key":"pone.0319745.ref038"},{"key":"pone.0319745.ref039"},{"key":"pone.0319745.ref040"},{"key":"pone.0319745.ref041"},{"key":"pone.0319745.ref042","article-title":"Our epidemic of loneliness and isolation: The US Surgeon General\u2019s Advisory on the healing effects of social connection and community","author":"General Office of the Surgeon","year":"2023"},{"issue":"1","key":"pone.0319745.ref043","first-page":"18","article-title":"Social isolation","volume":"3","author":"RS Tilvis","year":"2012","journal-title":"social activity and loneliness as survival indicators in old age; a nationwide survey with a 7-year follow-up. Eur Geriatr Med."},{"issue":"1","key":"pone.0319745.ref044","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1038\/s41746-023-00970-0","article-title":"Large language models to identify social determinants of health in electronic health records","volume":"7","author":"M Guevara","year":"2024","journal-title":"NPJ Digit Med"},{"key":"pone.0319745.ref045"},{"key":"pone.0319745.ref046"},{"key":"pone.0319745.ref047","article-title":"Speech and language processing","author":"D Jurafsky","year":"2019","journal-title":"3rd ed"},{"key":"pone.0319745.ref048"},{"key":"pone.0319745.ref049","article-title":"Roberta: A robustly optimized bert pretraining approach","author":"Y Liu","year":"2019","journal-title":"arXiv Preprint"},{"key":"pone.0319745.ref050","article-title":"Python 3 reference manual. Scotts Valley","author":"G Van Rossum","year":"2009"},{"issue":"3","key":"pone.0319745.ref051","doi-asserted-by":"crossref","first-page":"276","DOI":"10.11613\/BM.2012.031","article-title":"Interrater reliability: the kappa statistic","volume":"22","author":"ML McHugh","year":"2012","journal-title":"Biochem Med (Zagreb)"},{"issue":"4","key":"pone.0319745.ref052","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1007\/s11135-004-8107-7","article-title":"Measuring the reliability of qualitative text analysis data","volume":"38","author":"K Krippendorff","year":"2004","journal-title":"Qual Quant."},{"key":"pone.0319745.ref053"},{"key":"pone.0319745.ref054","article-title":"Calculating inter-coder reliability in media content analysis using Krippendorff\u2019s Alpha","author":"K De Swert","year":"2012","journal-title":"Centre for Politics and Communication"},{"key":"pone.0319745.ref055","first-page":"2825","article-title":"Scikit-learn: Machine learning in Python","volume":"12","author":"F Pedregosa","year":"2011","journal-title":"J Mach Learn Res."},{"key":"pone.0319745.ref056","article-title":"Efficient estimation of word representations in vector space","author":"T Mikolov","year":"2013","journal-title":"In: Proceedings of the International conference on learning representations (ICLR)"},{"key":"pone.0319745.ref057"},{"key":"pone.0319745.ref058"},{"issue":"6","key":"pone.0319745.ref059","first-page":"61","article-title":"Performance of machine learning algorithms with different k values in k-fold cross-validation","volume":"13","author":"I Nti","year":"2021","journal-title":"Int J Inf Technol Comput Sci."},{"key":"pone.0319745.ref060","first-page":"8026","article-title":"Pytorch: An imperative style, high-performance deep learning library","volume":"32","author":"A Paszke","year":"2019","journal-title":"Adv Neural Inf Process Syst."},{"key":"pone.0319745.ref061","article-title":"Huggingface\u2019s transformers: State-of-the-art natural language processing","author":"T Wolf","year":"2019","journal-title":"arXiv Preprint"},{"issue":"3","key":"pone.0319745.ref062","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1177\/014662167700100306","article-title":"The CES-D scale: A self-report depression scale for research in the general population","volume":"1","author":"LS Radloff","year":"1977","journal-title":"Appl Psychol Meas."},{"key":"pone.0319745.ref063"},{"key":"pone.0319745.ref064"},{"key":"pone.0319745.ref065","article-title":"Python machine learning: Machine learning and deep learning with Python","author":"S Raschka","year":"2019"},{"key":"pone.0319745.ref066","article-title":"An R companion to applied regression. 3rd ed. Thousand Oaks CA: Sage","author":"J Fox","year":"2019"},{"key":"pone.0319745.ref067","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1007\/s11135-006-9018-6","article-title":"A caution regarding rules of thumb for variance inflation factors","volume":"41","author":"RM O\u2019Brien","year":"2007","journal-title":"Qual Quant."},{"issue":"4","key":"pone.0319745.ref068","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1093\/ageing\/afx046","article-title":"Changes over time in the health and functioning of older people moving into care homes: analysis of data from the English longitudinal study of ageing","volume":"46","author":"I Green","year":"2017","journal-title":"Age Ageing"},{"key":"pone.0319745.ref069","doi-asserted-by":"crossref","DOI":"10.1002\/9781444316568.wiem02057","article-title":"Social desirability bias","author":"P Grimm","year":"2010","journal-title":"Wiley international encyclopedia of marketing"},{"key":"pone.0319745.ref070","article-title":"How accurate are self-reported diagnoses? Comparing self-reported health events in the English Longitudinal Study of Ageing with administrative hospital records","author":"G Stoye","year":"2020","journal-title":"IFS Working Papers"},{"issue":"10","key":"pone.0319745.ref071","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1016\/0895-4356(96)00210-7","article-title":"Measuring functional status: cross-sectional and longitudinal associations between performance and self-report (Zutphen Elderly Study 1990\u20131993)","volume":"49","author":"N Hoeymans","year":"1996","journal-title":"J Clin Epidemiol"},{"issue":"6","key":"pone.0319745.ref072","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1177\/0164027500226006","article-title":"Comparison of a self-reported and a performance-based assessment of mobility in the hispanic established population for epidemiological studies of the elderly","volume":"22","author":"R Angel","year":"2000","journal-title":"Res Aging."},{"issue":"3","key":"pone.0319745.ref073","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1037\/pag0000075","article-title":"A cross-lagged model of the reciprocal associations of loneliness and memory functioning","volume":"31","author":"L Ayalon","year":"2016","journal-title":"Psychol Aging"},{"issue":"6","key":"pone.0319745.ref074","doi-asserted-by":"crossref","first-page":"1937","DOI":"10.1093\/ije\/dyz085","article-title":"Exploring the bidirectional associations between loneliness and cognitive functioning over 10 years: the English longitudinal study of ageing","volume":"48","author":"J Yin","year":"2019","journal-title":"Int J Epidemiol"},{"key":"pone.0319745.ref075","article-title":"Siamese cbow: Optimizing word embeddings for sentence representations","author":"T Kenter","year":"2016","journal-title":"arXiv Preprint"},{"issue":"1","key":"pone.0319745.ref076","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1177\/00131640121971103","article-title":"Lonely but not alone: Emotional isolation and social isolation as two distinct dimensions of loneliness in older people","volume":"61","author":"B Van Baarsen","year":"2001","journal-title":"Educ Psychol Meas."},{"issue":"11","key":"pone.0319745.ref077","doi-asserted-by":"crossref","first-page":"e013591","DOI":"10.1136\/bmjopen-2016-013591","article-title":"Predictors of care home and hospital admissions and their costs for older people with Alzheimer\u2019s disease: findings from a large London case register","volume":"6","author":"M Knapp","year":"2016","journal-title":"BMJ Open"},{"issue":"3","key":"pone.0319745.ref078","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1093\/ageing\/afs022","article-title":"Gender differences in care home admission risk: partner\u2019s age explains the higher risk for women","volume":"41","author":"M McCann","year":"2012","journal-title":"Age Ageing"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0319745","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T19:51:25Z","timestamp":1743623485000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0319745"}},"subtitle":[],"editor":[{"given":"Mario","family":"Graff-Guerrero","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,4,2]]},"references-count":78,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4,2]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0319745","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,2]]}}}