Reviews in Clinical Gerontology 2000 10; 407417

Being alone in later life: loneliness, social

isolation and living alone
Christina Victor and Sasha Scambler
St. Georges Hospital Medical School, London, UK

John Bond
University of Newcastle, Newcastle, UK

Ann Bowling
University College, London, UK

Introduction
The context for the review of loneliness and social
isolation in later life is that of successful aging
and quality of life. The term quality of life
includes a broad range of areas of life and there
is little agreement about the definition of the term.
Models of quality of life range from identification
of life satisfaction or social wellbeing to models based upon concepts of independence, control,
and social and cognitive competence. However,
regardless of how the concept of quality of life is
defined, research has consistently demonstrated
the importance of social and family relationships
in the definition of a good quality of life.
Bowling,1 using a quantitative approach, reports
that, for those aged 65 years and over, relationships with family/friends were ranked second in
importance to health as the most important area
of life. OBoyle,2 using a social judgement
approach, produced similar findings. Farquhar,3
using a qualitative perspective, reports that family, activities and other social contacts were the
three most important factors that gave quality to
life in old age. Reduced social contact, being
alone, isolation and feelings of loneliness were
associated with reduced quality of older peoples
lives. Consequently, understanding the extent of
isolation and loneliness amongst older people, and
the factors associated with these states, is important in both theoretical and policy terms. It both
enhances our understanding of the experience of
Address for correspondence: C Victor, Department of
Public Health Sciences, St. Georges Hospital Medical
School, London SW17 ORE, UK.

aging and offers the potential to develop interventions which may enhance the quality of life of
older people This review examines the concepts of
loneliness, isolation and living alone and then considers the key correlates of these concepts, before
concluding with a review of the major limitations
of current research. The review is confined to
studies which have looked at older people resident
in the community and which focus upon loneliness as the key variable.
Being alone in later life: distinguishing the
key concepts
Being alone has long been seen as a major problem of old age.4 Indeed loneliness, isolation and
social neglect are some of the most prevalent
stereotypes of old age. Included within this broad
topic area are four distinct but interrelated concepts: being alone, living alone, social isolation
and loneliness. These terms are often used interchangeably, although conceptually it is important
to distinguish between them.5 Although these
topic areas are often conceptualized as discrete
entities, they can be viewed as parts of a spectrum
which extends from complete social integration at
one extreme to isolation at the other.
Loneliness
Loneliness is a concept that has been interpreted
in a variety of ways and is often seen as the subjective counterpart to the objective measure of
social isolation or as the antithesis to social support.6 In addition to being a stand-alone concept,

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C Victor et al.

it can be seen as an important part of an understanding of both quality of life and subjective
wellbeing.7,8
There is no universal definition of the term.
Loneliness is described in various studies as: perceived deprivation of social contact,9,10 the lack of
people available or willing to share social and
emotional experiences,11 a state where an individual has the potential to interact with others but
is not doing so12 and a discrepancy between the
actual and desired interaction with others.13
Theoretical perspectives
Up to eight theoretical perspectives have been
adopted as to the appropriate explanation of the
cause of loneliness, although there are four main
theories in common use14: the existential, the cognitive, the psychodynamic and the interactionist.15
However, none of these are specific to old age or
later life, and research in this field has been largely
atheoretical, or with theoretical assumptions
remaining implicit.
The existential theory sees loneliness as a reflexive condition that provides the opportunity for an
individual to encounter and possibly build an
understanding of themselves.16 It is seen as a positive opportunity, which is compounded by the
experience of love. Loneliness is portrayed as a
necessary aspect of life, as in lifes most intimate
moments we are basically alone.15 Criticisms of
this approach include the failure to differentiate
between the objective state of being alone and the
subjective state of feeling alone,15 ignoring the
potentially negative aspects of being alone,17 and
unnecessary complexity with the introduction of
the abstract concept of love.14
The cognitive theory focuses on the response to
and experience of loneliness and occurs when
individuals fail to meet the standards they set
themselves.18 It can be seen as a self-fulfilling
prophecy, whereby a person with low self-esteem
judges themselves to be lacking, which in turn perpetuates the low self-esteem. This theory suggests
that loneliness can be combated by interventions
that raise self-esteem and social skills available to
them, and there is some empirical evidence to support this position.19,20 This theory fails to account
for the strong links between social networks and
loneliness,21 and fails to account for people with
cognitive impairment.22
The psychodynamic, or pathological, theory is

based on the Freudian approach. This proposes

that loneliness stems from experiences in infancy
and childhood and the development of interpersonal attachments.23 Followers of this theory
approach the study of loneliness through the study
of each individual and their early development.24
The major criticism of this approach is that it
focuses solely on a pathological explanation for
feelings of loneliness, and fails to take into
account any aspect of the social world: culture,
gender, age, social class or ethnicity.15
The interactionist theory of loneliness17 is based
upon the attachment theory of Bowlby25 and combines the individual emotional aspects of loneliness with the social aspects. It is proposed that
loneliness was caused by a combination of the
lack of an attachment figure and the absence of
an adequate social network, and that the experience of loneliness was dependent on the individuals personality type. This has been criticized
because the conditions described as causing loneliness are not necessarily negative conditions, and
therefore other factors must be involved in creating the state of loneliness26 and that social loneliness (i.e. social isolation) is an objective position
which does not necessarily cause loneliness.27
These different theoretical perspectives illustrate the varying ways in which the study of loneliness has been approached and what may be
meant by the concept in different studies.
However few studies make the theoretical basis of
their approach to loneliness explicit.
The prevalence of loneliness
Most estimates suggest that the majority of older
people (i.e. those aged 65 years and over) are
neither lonely nor socially isolated. Current estimated prevalence rates of loneliness in people over
the age of 65 in Britain are somewhat lower than
rates of loneliness in younger people and those
reported in other parts of Europe.28 Early British
studies,6,29 based on self-reported measurements
of loneliness pioneered by Sheldon,30 estimated
that 7% and 9% respectively were very or often
lonely. Other major British community studies
have reported rates of loneliness in people
over the age of 65 ranging from 5% to
16%,30,9,31,32,10,33,34,35 with a median of 910%
(see Table 1).
However, self-reported rates of loneliness may
be an underrepresentation of the true levels of

Being alone in later life

Table 1.

409

Prevalence of isolation and loneliness: summary of major British community studies

% 65+

Date

Author

Study area

Sample size

Very/often lonely

Socially isolated

1948
1957
1962
1966
1978
1982
1984
1985

Sheldon30
Townsend9
Townsend6
Tunstall29
Hunt31
Bond and Carstairs32
Wenger10
Jones et al.33

1989
1991

Qureshi and Walker34

Bowling35

Wolverhampton
London
England
Four centres
England
Clackmannan
North Wales
South Wales
Mid Wales
Sheffield
Hackney
Essex

400+
203
4044
538
2622
1000+
534
654
628
306
1053
288

10
5
7
9
13
7
5
5*
2*
12**
16
8

10
2
20

*% aged 70+ **% aged 75+

loneliness because of the stigma associated with

being identified as lonely. The stigmatization of
loneliness may make people unwilling to identify
themselves as lonely and makes denial a possibility. Furthermore, all these figures are based upon
individuals who reported being very or often
lonely and thus precludes the many people who
feel lonely for at least some of the time. This, combined with the stigma of admitting to loneliness,
suggests that the numbers of older people actually
feeling lonely could be significantly higher than
published estimates.
Social isolation
Social isolation relates to the integration of individuals (and groups) into the wider social environment. Social isolation, like loneliness, is a
concept that has been defined or understood in a
myriad of ways. It is often described as an objective state that is linked to the subjective concept
of loneliness and some suggest that loneliness
itself is the subjective component of social isolation.36,37 Others point out that social isolation and
loneliness are often taken together, despite the fact
that no causal relationship between the two concepts is evident,10,26 although there may well be
an association between them.
At its most basic level, social isolation has been
defined as the lack of meaningful and sustained
communication,38 or as having minimal contact
with either the family or the wider community.9,26

However, the term isolation is often used in a

variety of ways, resulting in problems in reaching
a universal definition. Measures used to categorize social isolation are not standardized, so that
questions may not stand independently of each
other and the instruments employed may not be
appropriate for use in studies of older people. The
various approaches to measuring isolation
involve recording levels of social contact, enumerating social participation and quantifying
social networks.
The nature of a persons social network has
been identified as key to the level of social isolation that they experience. Networks are described
as identified social relationships that surround a
person, their characteristics, and the individuals
perceptions of them.39 Social networks can be
identified by size (number of people in the network), density (the degree to which members of
the network are interrelated) and the accessibility
and reciprocity of the relationships.
The prevalence of isolation
Older people may experience social isolation in
four main ways:
1) in comparison with their contemporaries (peergroup isolation)
2) by comparison with younger people (generation-contrasted isolation)
3) in comparison with themselves at a younger
age group (age-related isolation) or

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C Victor et al.

4) in comparison with older people from preceding generations (preceding cohort isolation)9
Research has concentrated upon investigating
peer-group isolation; few of the other dimensions
of this concept have been examined for older
people. Most research suggests that social isolation is not very common, affecting approximately
10% of the samples studies (range 220%) (Table
1).
The extent of a persons network is implicitly
seen as indicative of social isolation. The mean
size of an older persons network has been reported to be in the range of five to seven, as compared with 20+ for younger age groups, and is
predominantly made up of kin.10,35,39 This configuration may change with future cohorts of older
people who have much smaller family sizes. In
both inner London and Essex, approximately onethird of those aged 65+ have networks in the
range of one to three,35,39 although few have no
network.28,40 Networks are clearly dynamic and
change over time. Over a three-year period, for
those aged 85 years and over, 42% reported a
change (usually a decrease) in the size of their network.40 The optimal network size remains unclear.
Wenger10 proposes a method of classifying social
networks which is based upon the proximity of
close kin, the degree of involvement of family,
friends and neighbours and levels of interaction,
and links this typology to the need for services.
Living alone and being alone
Living alone is simply a measure of the type of
household in which an individual lives, but is
often used as an implicit surrogate measure of
being alone. The household composition of older
people has shown massive changes in the post-war
period. For example in 1945, approximately 10%
of older people (aged 65 years and over) lived
alone30 and by the 1960s, this had risen to about
20%.29 The most recent estimate is that 31% of
those aged 6574 years live alone, 50% of those
aged over 75 years.41 Living alone is, at every age
group, much more common amongst women than
men. The high percentage of older people living
alone reflects the household changes resulting
from death of a spouse (or their entry into longterm care) and the trend for older people and
adult children to live independently. With the projected increase in numbers of people living inde-

pendently, it is likely that future cohorts of older

people will illustrate even higher rates of solo
living. However, living alone is not necessarily
co-terminus with being alone, which represents
the amount of time individuals spend alone.
Loneliness, isolation and living alone
The interrelationships between isolation, loneliness and living alone are complex. The presence
of a large social network does not necessarily
imply the presence of a confiding relationship or
the absence of loneliness (and vice-versa). However, living alone is not necessarily synonymous
with being alone or loneliness, although the link
with isolation is much closer (i.e. not all those
who live alone are isolated, whilst most of the isolated live alone). Tunstall29 reported that 17% of
those living alone were often lonely, compared to
4% of those living in other household types.
Similarly, 68% of those living alone were classified as socially isolated, compared with 3% in
other household types. Of the 21% who were
defined as isolated, 25% reported that they were
often lonely. Similarly, of the 8.6% defined as
often lonely, 50% were classified as isolated.
Andersson41 proposes a fourfold typology (neither
lonely nor isolated, isolated but not lonely, lonely
but not isolated, and both isolated and lonely) as
a way of investigating these related concepts.
For the population surveyed by Tunstall,29 5%
were classed as both lonely and isolated; 16%
as isolated but not lonely; 3% as lonely but
not isolated and 76% as neither isolated nor
lonely. Clearly, isolation, loneliness, being alone
and living alone are related but not coincident
categories.
Key correlates of isolation and loneliness
A considerable number of studies have been
carried out looking at the links between old age
and loneliness and isolation. Although there is not
a perfect relationship between the concepts of
living alone, isolation (including poor social networks and lack of social support), living alone
and loneliness, similar social factors are associated
with these varying concepts (Table 2). These may
be summarized as personal characteristics (e.g.
personality and coping), demographic characteristics (age, sex, marital status), resources (e.g.
income, social networks and health), and life-

Being alone in later life

Table 2.

411

The correlates of living alone, isolation and loneliness

Personal Circumstances
Age
Female
Ethnicity
Widowhood
Never married
No children

Living alone

Isolation

Loneliness

Resources
Social class
Income
Physical ill health
Mental ill health
Restricted social network

Life events
Retirement migration
Entry into care
Bereavement

Adapted from Tunstall29 and Wenger26

These relationships are largely based upon univariate statistical analysis. Using multivariate analysis of her North
Wales sample, Wenger20 proposes the following models which require testing in a nationally representative data
set.
Social isolation marital status, number of years widowed, social class, type of network, length of time known
the confidant.
Loneliness marital status, household composition, type of network, self-assessed health, desire for more
friends, length of time known their confidant

Background factors including

Age, sex, ethnicity etc.

Resources including income,

social network, health etc.

Life events and losses including bereavement,

entry of friends/relatives into care/retirement/
migration

Isolation
Figure 1

Loneliness

Schematic model of the relationship between resources, life-events and loneliness/social isolation

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C Victor et al.

events (e.g. bereavement, retirement, migration).

However, the nature of the relationships between
these factors is unclear, and there is a clear need
to undertake multivariate modelling of the interrelationships between the factors, of the type
undertaken by Wenger,26 and for more theoretical
work to understand the nature of the interrelationships (Figure 1).
Socio-demographic factors
Living alone
Living alone has been included in many of the
studies that look at social isolation/loneliness and
is often included in the definition of these concepts. There is, however, a clear association
between isolation and living alone. Research has
consistently demonstrated that, whilst not everyone who lives alone is isolated, nearly everyone
who is isolated lives alone.26 The link between
living alone and loneliness is not so clear. The
view that people who live alone are more likely
to experience loneliness than people who live with
others10,31 has been challenged by studies which
focus on the positive aspects of living alone,27 or
find no evidence to support the assertion that
people who live alone are more likely to experience loneliness.42,43 Living in a larger household
size does not prevent feelings of loneliness nor
isolation.29
Age
It has been consistently reported that loneliness
and social isolation are more common in people
who are very old. This may be because it is more
likely that the losses throughout the life-course
that cause social isolation will have occurred and,
more specifically, the loss of contemporaries, both
friends and relatives, who would have provided
social contact.44,45 However, whilst rates of loneliness and isolation increase with age, it is unclear
if this association represents an true age-effect or
is, in fact, the result of some other factor, such as
health or gender, which is independently related
to age.
Gender
The majority of the studies report that older
women are more likely to experience loneliness

and isolation than men,9,29,34 a gender-differential

that has been observed in both Australia46 and
North America.47 Although Mullins and Mushel48
challenged this view, the consistency with with
gender gap has been observed is important.
However, it is unclear as to whether this is the
result of reporting bias (it being more acceptable
for women to report loneiness), the confounding
effects of age and ill health or the greater accumulation of losses across the life-course by
women. Women are more likely to have close confidante relationships than men at all ages and
these are more likely to occur outside the family,
whilst a man is more likely to cite his wife as a
confidante.4952
Social class
There is little evidence to associate loneliness with
social class. However, older people from a working-class background are more likely to experience isolation than similarly aged people in other
classes.53,54 The type of social contact varies with
class being predominantly family-based for groups
from lower socioeconomic class and friendshipbased for those from higher socio-economic
groups.55
Resources
Social networks
Initially, a simple linear relationship between
network size and loneliness/isolation was hypothesized; bigger networks were seen as most
protective.56,57 This simplistic view has been challenged by research that emphasizes the quality of
the network rather than its size.58
The networks of older people are familydominated and contain fewer friends than other
age groups. Lack of children has been associated
with both loneliness and isolation,59 although
other research suggested that older people who
did not have children are unlikely to be more
lonely than those with children, because families
adapt to provide alternative sources of support.60
Frequency of contact with children or grandchildren makes little difference to experiences of loneliness.61

Being alone in later life

413

Friendship

Health

Relationships with close friends may be more

important in preventing loneliness than relationships with family members.62 Lack of a spouse
and children may not lead to more loneliness, as
friendships can take the place of close family relationships.60 However, being single is linked to the
experiences of both isolation and loneliness,
despite the presence of friendship networks.63
Women have more friendships than men and
there is also a reduction in the friendships maintained by men after retirement.64 Whilst family
are most likely to help with intimate or longterm care-giving, friends are more important
when considering emotional wellbeing and life
satisfaction.65,66

There is a consistent and enduring relationship

between loneliness, isolation and poor physical
and mental health, especially depression.59,33,26
There is, however, some disagreement on whether
poor health causes loneliness and/or isolation, or
whether isolation or loneliness causes poor health.
Increasing health problems may cause restricted
social contact that may, in turn, result in increased
levels of loneliness and isolation.77,40 Loneliness
and isolation are thus seen to be a symptom of
health problems rather than a cause.

Life-events, loss and bereavement

Life-events and age-related losses of all kinds have
been linked with the experience of loneliness and
isolation in older adulthood.67,68 Losses can refer
to losses of loved ones, pets, roles, jobs, children
and homes. It has been hypothesized that the ways
in which people deal with losses experienced
throughout the life-course affect the likelihood of
their experiencing loneliness in later life.69,70
Widowhood
This factor has been consistently linked with
experiences of loneliness and social isolation in a
variety of different cultures and contexts.7173
Loneliness is often most extreme in early widowhood and does not seem to be mediated by the
presence of children or the frequency of their
visits.74 Whilst the majority of widowed older
people are women, it would seem likely that
widowhood is just as likely to cause loneliness in
older men.75
Life experiences such as retirement, migration
and entry into care have all been associated with
increased levels of loneliness and isolation. Older
people, especially those admitted to or living in
nursing and residential homes, are vulnerable to
feelings of existential loneliness, because of their
loss of a meaningful role in life and the loss of
roles they may previously have had.76

Income
Whilst there is some evidence of decreased levels
of isolation and loneliness amongst more affluent
older people, the relationship to income is unclear
and has been researched only at a superficial level.
Other themes
Spirituality and pet-ownership have been suggested as factors that may protect against loneliness and isolation.7880
Discussion
Although a significant amount of research has
been carried out amongst older people in the
community, looking at the links between old age,
loneliness, social isolation and living alone, there
are a number of obvious limitations to our current understanding in this area. The first is that
the key studies were conducted well over thirty
years ago and may not reflect the current position
of older people in society. A number of important
changes have occurred which need to be taken
into account, such as the reduction of state pensions and benefits, the reduction in family size, the
increasing number of older people living alone,
the increasing age of the population as a whole,
the increasing ethnic diversity of the British
population, reduction in retirement age and
changes in our understanding of old age in general, including what it means, involves and when
it starts. All of these changes must be examined,
both in the light of the original studies and of any
new factors and developments which may need to
be taken into consideration. In addition to this,
aside from the pioneering studies carried out in

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C Victor et al.

the 1950s and 1960s, most studies have been

locally- rather than nationally-based, making
generalization of conclusions problematic.
Furthermore, much recent work comes from
America or Australia and is not necessarily
directly comparable with the experiences of older
people in Britain. Hence there is a clear need for
nationally representative studies of isolation and
loneliness in later life.
Further limitations to our current understanding concern the variable use of terminology. There
are clearly a large number of different conceptualizations of the terms loneliness and social isolation.8183 Not only are they measured in a large
number of different ways but are also understood
in different ways. There is a failure to differentiate between the quality and quantity of social contact. More contact is assumed to be a good
thing. Precedence is given to family contact rather
than contact with friends or neighbours. The
importance of more impersonal forms of contact
such as the telephone and, more recently, e-mail,
is largely disregarded by researchers.
There is a wide use of pre-set scales to determine levels of loneliness and isolation. This presupposes a common understanding of what it is
to be lonely and/or isolated. The usefulness of
many of these scales and their validity and reliability for use with older people in Britain is questionable. Little research has been carried out
looking at peoples understanding of loneliness
and what they are trying to convey when they
describe themselves in this way. Also, the majority of the studies carried out have been quantitative rather than qualitative in nature:8488 the
emphasis has been upon enumerating rather
than understanding. Consequently, there are very
few qualitative studies looking in depth at the
experiences, conceptualizations and social
world of older people who classify themselves, or
are classified as, lonely and/or isolated. This
is an area in which more research is desperately
needed.
In conjunction with this, it would be useful to
look in more detail at the experiences of the older
people from a life-course perspective. There is a
failure in the existing research to look at the lifecourse of individuals, which would allow
researchers to distinguish between people who
have always been lonely and people who have
only become lonely in later life, also between people who have always lived alone and people who

have only lived alone as they have got older. There

are clear differences between these groups that the
existing research fails to pick up on and thus has
not, to date, explored in full.
When examining the correlates of isolation and
loneliness, there are both methodological and conceptual issues. At a methodological level, most
studies have examined the relationship between
predictive factors and the outcome variable (loneliness/isolation) is a simplistic univariate fashion.
Yet many of the predictive factors, such as the
clear links between age, gender and widowhood,
are interrelated. There is a need for multivariate
analysis, and for the inclusion of commonly
excluded variables such as ethnicity or social class.
Furthermore, the onus in research has been upon
predicting loneliness and not upon identifying
the factors which may be protective against this
experience (thereby possibly offering the potential
for interventions to improve the quality of life of
older people).
Finally, in the majority of studies that have been
carried out, there is very little development of a
theoretical perspective which would help to
increase our understanding of the area. More
research is needed to develop the theoretical
framework through which we can understand old
age, loneliness and social isolation.
Acknowledgement
This paper forms part of the project Loneliness,
social isolation and living alone in later life,
funded by the ESRC Growing Older Programme.
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