{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T13:45:22Z","timestamp":1777643122338,"version":"3.51.4"},"reference-count":48,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2020,11,20]],"date-time":"2020-11-20T00:00:00Z","timestamp":1605830400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100012818","name":"Comunidad de Madrid","doi-asserted-by":"publisher","award":["H2019\/HUM-5698"],"award-info":[{"award-number":["H2019\/HUM-5698"]}],"id":[{"id":"10.13039\/100012818","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008530","name":"European Regional Development Fund","doi-asserted-by":"publisher","award":["PI18CIII\/00046"],"award-info":[{"award-number":["PI18CIII\/00046"]}],"id":[{"id":"10.13039\/501100008530","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008530","name":"European Regional Development Fund","doi-asserted-by":"publisher","award":["RD16\/0005\/0002"],"award-info":[{"award-number":["RD16\/0005\/0002"]}],"id":[{"id":"10.13039\/501100008530","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008530","name":"European Regional Development Fund","doi-asserted-by":"publisher","award":["RD16\/0001\/0005"],"award-info":[{"award-number":["RD16\/0001\/0005"]}],"id":[{"id":"10.13039\/501100008530","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Purpose: Loneliness and social isolation have detrimental effects on health in old age; however, the prospective associations with quality of life (QoL) remain unclear. Furthermore, despite the existence of a European north-south gradient in the distribution of loneliness and social isolation, little is known whether the associations are context-specific. We investigated the relationships between loneliness, social isolation and QoL of older adults residing in the North (Sweden) and South (Spain) of Europe. Methods: Study sample consisted of 2995 Swedish and 4154 Spanish older adults who participated in waves six and seven of the Study on Health, Aging and Retirement in Europe (SHARE). Loneliness and social isolation were measured at the baseline, and QoL was measured at the baseline and follow-up using CASP-12. Prospective associations were assessed via multivariate linear regression. Results: In Sweden, subjects with higher vs. lower loneliness had 1.01 (95% CI: \u22121.55, \u22120.40) units lower QoL, while every standard deviation increase in social isolation was associated with a 0.27 (95% CI: \u22120.42, \u22120.09)-unit decrease in QoL. In Spain, every standard deviation increase in social isolation was associated with a 0.66 (95% CI: \u22121.11, \u22120.22)-unit decrease in QoL. The association was stronger in subjects aged \u226465 years old and those with no chronic diseases. The association with loneliness was not statistically significant in Spain. Conclusion: Loneliness and social isolation are prospectively associated with decreased QoL among older adults, yet the associations are contextually bound. Future interventions should target both exposures, among others, in order to increase QoL in this group.<\/jats:p>","DOI":"10.3390\/ijerph17228637","type":"journal-article","created":{"date-parts":[[2020,11,20]],"date-time":"2020-11-20T09:46:18Z","timestamp":1605865578000},"page":"8637","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":97,"title":["Are Loneliness and Social Isolation Associated with Quality of Life in Older Adults? Insights from Northern and Southern Europe"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2615-226X","authenticated-orcid":false,"given":"Giorgi","family":"Beridze","sequence":"first","affiliation":[{"name":"Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, 17165 Stockholm, Sweden"}]},{"given":"Alba","family":"Ayala","sequence":"additional","affiliation":[{"name":"National School of Public Health, Carlos III Institute of Health, 28029 Madrid, Spain"},{"name":"Health Services Research on Chronic Patients Network (REDISSEC), Carlos III Institute of Health, 28029 Madrid, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4740-7951","authenticated-orcid":false,"given":"Oscar","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Center for Health Technology and Services Research (CINTESIS), Department of Education and Psychology, University of Aveiro, 3810-193 Aveiro, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1075-0812","authenticated-orcid":false,"given":"Gloria","family":"Fern\u00e1ndez-Mayoralas","sequence":"additional","affiliation":[{"name":"Institute of Economics, Geography and Demography (IEGD), Spanish National Research Council (CSIC), 28037 Madrid, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3829-0675","authenticated-orcid":false,"given":"Carmen","family":"Rodr\u00edguez-Bl\u00e1zquez","sequence":"additional","affiliation":[{"name":"National Centre of Epidemiology, Carlos III Institute of Health, 28029 Madrid, Spain"},{"name":"The Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED), 28031 Madrid, Spain"}]},{"given":"Vicente","family":"Rodr\u00edguez-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Institute of Economics, Geography and Demography (IEGD), Spanish National Research Council (CSIC), 28037 Madrid, Spain"}]},{"given":"Fermina","family":"Rojo-P\u00e9rez","sequence":"additional","affiliation":[{"name":"Institute of Economics, Geography and Demography (IEGD), Spanish National Research Council (CSIC), 28037 Madrid, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3935-962X","authenticated-orcid":false,"given":"Maria Jo\u00e3o","family":"Forjaz","sequence":"additional","affiliation":[{"name":"Health Services Research on Chronic Patients Network (REDISSEC), Carlos III Institute of Health, 28029 Madrid, Spain"},{"name":"National Centre of Epidemiology, Carlos III Institute of Health, 28029 Madrid, Spain"}]},{"given":"Amaia","family":"Calder\u00f3n-Larra\u00f1aga","sequence":"additional","affiliation":[{"name":"Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, 17165 Stockholm, Sweden"},{"name":"Health Services Research on Chronic Patients Network (REDISSEC), Carlos III Institute of Health, 28029 Madrid, Spain"}]}],"member":"1968","published-online":{"date-parts":[[2020,11,20]]},"reference":[{"key":"ref_1","unstructured":"(2020). World Population Ageing 2019 (ST\/ESA\/SER.A\/444), United Nations, Department of Economic and Social Affairs, Population Division. Available online: https:\/\/www.un.org\/en\/development\/desa\/population\/publications\/pdf\/ageing\/WorldPopulationAgeing2019-Report.pdf."},{"key":"ref_2","unstructured":"Peplau, L.A., and Perlman, D. (1982). Loneliness: A Sourcebook of Current Theory, Research, and Therapy, Wiley."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1346","DOI":"10.1177\/0898264312460275","article-title":"Social Isolation, Loneliness and Health among Older Adults","volume":"24","author":"Coyle","year":"2012","journal-title":"J. Aging Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2042","DOI":"10.2105\/AJPH.2016.303431","article-title":"A Prospective Study of Social Isolation, Loneliness, and Mortality in Finland","volume":"106","author":"Tanskanen","year":"2016","journal-title":"Am. J. Public Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"5797","DOI":"10.1073\/pnas.1219686110","article-title":"Social isolation, loneliness, and all-cause mortality in older men and women","volume":"110","author":"Steptoe","year":"2013","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1111\/hsc.12311","article-title":"Social isolation, loneliness and health in old age: A scoping review","volume":"25","author":"Courtin","year":"2017","journal-title":"Health Soc. Care Community"},{"key":"ref_7","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":"Smith","year":"2015","journal-title":"Perspect. Psychol. Sci."},{"key":"ref_8","unstructured":"(2020, April 25). WHOQOL: Measuring Quality of Life. Available online: https:\/\/www.who.int\/healthinfo\/survey\/whoqol-qualityoflife\/en\/."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1111\/j.1365-2648.2004.03260.x","article-title":"Loneliness as a predictor of quality of life among older caregivers","volume":"49","author":"Ekwall","year":"2005","journal-title":"J. Adv. Nurs."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Musich, S., Wang, S.S., Hawkins, K., and Yeh, C.S. (2015). The Impact of Loneliness on Quality of Life and Patient Satisfaction Among Older, Sicker Adults. Gerontol. Geriatr. Med., 1.","DOI":"10.1177\/2333721415582119"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1080\/00223980.2011.609571","article-title":"Loneliness, Depression, Social Support, and Quality of Life in Older Chronically Ill Appalachians","volume":"146","author":"Theeke","year":"2012","journal-title":"J. Psychol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1111\/j.1365-2524.2004.00519.x","article-title":"Quality of life among older people in Sweden receiving help from informal and\/or formal helpers at home or in special accommodation","volume":"12","author":"Hellstrom","year":"2004","journal-title":"Health Soc. Care Community"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1023\/B:QURE.0000015286.68287.66","article-title":"Overall and health related quality of life among the oldest old in pain","volume":"13","author":"Jakobsson","year":"2004","journal-title":"Qual. Life Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e021822","DOI":"10.1136\/bmjopen-2018-021822","article-title":"Quality of life, loneliness and health-related characteristics among older people in Liaoning province, China: A cross-sectional study","volume":"8","author":"Zhu","year":"2018","journal-title":"BMJ Open"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1177\/002214650905000103","article-title":"Social Disconnectedness, Perceived Isolation, and Health among Older Adults","volume":"50","author":"Cornwell","year":"2009","journal-title":"J. Health Soc. Behav."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1017\/S0033291711001772","article-title":"Increased risk of mortality associated with social isolation in older men: Only when feeling lonely? Results from the Amsterdam Study of the Elderly (AMSTEL)","volume":"42","author":"Holwerda","year":"2012","journal-title":"Psychol. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.eurger.2011.08.004","article-title":"Social isolation, social activity and loneliness as survival indicators in old age; a nationwide survey with a 7-year follow-up","volume":"3","author":"Tilvis","year":"2012","journal-title":"Eur. Geriatr. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1027\/\/1016-9040.7.1.70","article-title":"Causes of Loneliness in North America and Spain","volume":"7","author":"Rokach","year":"2002","journal-title":"Eur. Psychol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1007\/s10389-018-0916-6","article-title":"Loneliness among older European adults: Results from the survey of health, aging and retirement in Europe","volume":"26","author":"Vozikaki","year":"2018","journal-title":"J. Public Health"},{"key":"ref_20","first-page":"599","article-title":"Social Networks and Well-being: A Comparison of Older People in Mediterranean and Non-Mediterranean Countries","volume":"65B","author":"Litwin","year":"2010","journal-title":"J. Gerontol. Ser. B Psychol. Sci. Soc. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1017\/S0144686X00008308","article-title":"Individual Experiences as Cultural\u2014A Cross-cultural Study on Loneliness among the Elderly","volume":"10","author":"Jokela","year":"1990","journal-title":"Ageing Soc."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"B\u00f6rsch-Supan, A. Survey of Health, Ageing and Retirement in Europe (SHARE) Wave 6. 2019. Data set.","DOI":"10.1007\/978-3-319-69892-2_348-1"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"B\u00f6rsch-Supan, A. Survey of Health, Ageing and Retirement in Europe (SHARE) Wave 7. 2019. Data set.","DOI":"10.1007\/978-3-319-69892-2_348-1"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1093\/ije\/dyt088","article-title":"Data Resource Profile: The Survey of Health, Ageing and Retirement in Europe (SHARE)","volume":"42","author":"Brandt","year":"2013","journal-title":"Int. J. Epidemiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1177\/0164027504268574","article-title":"A Short Scale for Measuring Loneliness in Large Surveys: Results from Two Population-Based Studies","volume":"26","author":"Hughes","year":"2004","journal-title":"Res. Aging"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"B\u00f6rsch-Supan, A., Kneip, T., Litwin, H., Myck, M., and Weber, G. (2015). Loneliness in Europe: Do perceived neighbourhood characteristics matter?. Ageing in Europe\u2014Supporting Policies for an Inclusive Society, De Gruyter.","DOI":"10.1515\/9783110444414"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"B\u00f6rsch-Supan, A., Kneip, T., Litwin, H., Myck, M., and Weber, G. (2015). Loneliness among informal caregivers aged 50+ in Europe. Ageing in Europe\u2014Supporting Policies for an Inclusive Society, De Gruyter.","DOI":"10.1515\/9783110444414"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.ypmed.2016.07.016","article-title":"The relationship between wealth and loneliness among older people across Europe: Is social participation protective?","volume":"91","author":"Niedzwiedz","year":"2016","journal-title":"Prev. Med."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Jarach, C.M., Tettamanti, M., Nobili, A., and D\u2019avanzo, B. (2020). Social isolation and loneliness as related to progression and reversion of frailty in the Survey of Health Aging Retirement in Europe (SHARE). Age Ageing, afaa168.","DOI":"10.1093\/ageing\/afaa168"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Litwin, H., and Stoeckel, K.J. (2015). Engagement and social capital as elements of active ageing: An analysis of older Europeans. Sociol. Politiche Soc., 9\u201331.","DOI":"10.3280\/SP2014-003002"},{"key":"ref_31","unstructured":"Carmen Borrat-Besson, V.-A.R. (2015). An Evaluation of the CASP-12 Scale Used in the Survey of Health, Ageing and Retirement in Europe (SHARE) to Measure Quality of Life among People Aged 50+, FORS. FORS Working Paper Series, paper 2015-4."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1849","DOI":"10.2105\/AJPH.2008.141499","article-title":"Measuring Socioeconomic Differences in Use of Health Care Services by Wealth Versus by Income","volume":"99","author":"Allin","year":"2009","journal-title":"Am. J. Public Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1192\/bjp.174.4.330","article-title":"Development of the EURO\u2013D scale\u2014A European Union initiative to compare symptoms of depression in 14 European centres","volume":"174","author":"Prince","year":"1999","journal-title":"Br. J. Psychiatry"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Rubin, D.B. (1987). Multiple Imputation for Nonresponse in Surveys, John Wiley & Sons Inc.","DOI":"10.1002\/9780470316696"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1177\/0164027511423258","article-title":"Use of Direct Versus Indirect Approaches to Measure Loneliness in Later Life","volume":"34","author":"Ayalon","year":"2012","journal-title":"Res. Aging"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1037\/0882-7974.21.1.140","article-title":"Loneliness as a specific risk factor for depressive symptoms: Cross-sectional and longitudinal analyses","volume":"21","author":"Cacioppo","year":"2006","journal-title":"Psychol. Aging"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1007\/s11136-018-1997-y","article-title":"More than health: Quality of life trajectories among older adults\u2014Findings from The Irish Longitudinal Study of Ageing (TILDA)","volume":"28","author":"Ward","year":"2019","journal-title":"Qual. Life Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1016\/j.healthplace.2011.08.012","article-title":"Residential satisfaction, sense of belonging and loneliness among older adults living in the community and in care facilities","volume":"17","author":"Forjaz","year":"2011","journal-title":"Health Place"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1177\/0022146510395592","article-title":"Mechanisms Linking Social Ties and Support to Physical and Mental Health","volume":"52","author":"Thoits","year":"2011","journal-title":"J. Health Soc. Behav."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/S0306-4530(03)00086-6","article-title":"Loneliness and neuroendocrine, cardiovascular, and inflammatory stress responses in middle-aged men and women","volume":"29","author":"Steptoe","year":"2004","journal-title":"Psychoneuroendocrinology"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Gellert, P., H\u00e4usler, A., Suhr, R., Gholami, M., Rapp, M., Kuhlmey, A., and Nordheim, J. (2018). Testing the stress-buffering hypothesis of social support in couples coping with early-stage dementia. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0189849"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Luna, E., Ruiz, M., Malyutina, S., Titarenko, A., Kozela, M., Paj\u0105k, A., Kubinova, R., and Bobak, M. (2020). The prospective association between frequency of contact with friends and relatives and quality of life in older adults from Central and Eastern Europe. Soc. Psychiatry Psychiatr. Epidemiol.","DOI":"10.1007\/s00127-020-01834-8"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1080\/08870446.2014.979823","article-title":"Longitudinal associations between social connections and subjective wellbeing in the English Longitudinal Study of Ageing","volume":"30","author":"Shankar","year":"2015","journal-title":"Psychol. Health"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1037\/0003-066X.54.3.165","article-title":"Taking time seriously: A theory of socioemotional selectivity","volume":"54","author":"Carstensen","year":"1999","journal-title":"Am. Psychol."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Wolf, C., Joye, D., Smith, T.W., and Fu, Y. (2016). The Sage Handbook of Survey Methodology, Sage Reference.","DOI":"10.4135\/9781473957893"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/bs.aesp.2018.03.003","article-title":"Loneliness in the Modern Age: An Evolutionary Theory of Loneliness (ETL)","volume":"Volume 58","author":"Cacioppo","year":"2018","journal-title":"Advances in Experimental Social Psychology"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1097\/CEJ.0b013e3282f75e48","article-title":"Effectiveness of smoking cessation interventions among adults: A systematic review of reviews","volume":"17","author":"Lemmens","year":"2008","journal-title":"Eur. J. Cancer Prev."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1037\/amp0000103","article-title":"Advancing social connection as a public health priority in the United States","volume":"72","author":"Robles","year":"2017","journal-title":"Am. Psychol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/22\/8637\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:35:08Z","timestamp":1760178908000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/22\/8637"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,20]]},"references-count":48,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2020,11]]}},"alternative-id":["ijerph17228637"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17228637","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,20]]}}}