Identifying the Impact of Social Isolation and Loneliness on Psychological Well-being among the Elderly in India: The Mediating Role of Gender, Marital Status, and Education

Abstract

Background

Social isolation and loneliness can be detrimental to the overall functioning of the older adults. The study examines the impact of social isolation and loneliness on the psychological well-being of older adults residing in various old-age homes in India and investigates the mediating role of gender, marital status, and education level in the way social isolation and loneliness affect psychological well-being.

Methods

320 individuals aged sixty years or above participated in the study. Data were collected using standardized measures like Lubben Social Network Scale- 6, revised UCLA Loneliness Scale, and shortened version of psychological well-being scale by Ryff & Keyes (1995). Multivariate and mediation analysis were performed to understand the associations of social isolation and loneliness with psychological well-being.

Results

A statistically significant MANOVA effect was obtained for social isolation (F = 3.836, p < .01), and loneliness (F = 3.782, p < .01). Gender and education as independent factors were significantly associated with the psychological well-being of individuals. However, both gender and education did not mediate the impact of social isolation and loneliness on the psychological well-being of older adults. Further, marital status had a partial mediating effect on the relationship between social isolation, loneliness, and psychological well-being.

Conclusions

The findings of the study can be incorporated into measures aiming at alleviation of feelings of social isolation and loneliness among the elderly. Further, the findings can be used to design various intervention strategies aimed at the reduction of social isolation and loneliness among older adults and the restoration of their psychological well-being.

Introduction

Senescence or old age is often accompanied by an array of concerns like declining health, cognitive abilities and social connectedness, reduced mobility, loneliness, and increased social isolation challenging their overall health and well-being [1, 2, 3, 4]. The World Health Organization has emphasized on the importance of healthy aging [5], with a comprehensive approach of well-being that incorporates physical, psychological, and social dimensions. Social isolation and loneliness have been identified as important determinants of well-being and overall functioning among the aged [6, 7, 8]. With the increasing geriatric population and changing socio-cultural context, there has been an increase in social isolation and loneliness among the older adults [9]. Social isolation is an objective phenomenon which is often defined as “a state where individuals have minimal contacts and paucity of social relationships and social engagements” [10]. Furthermore, loneliness is often defined as “a discrepancy between an individual’s desired and achieved levels of social relations” [11]. It is often understood as a discrepancy of an individual’s actual and desired state of social relationships and relationship quality [12].

India is home to one-fourth of the global geriatric population; the elderly population will rise to 319 million by 2050 [13]. According to the Ministry of Statistics & Programme Implementation, Government of India, 2021, approximately 13 percent of the population in India will comprise adults aged 60 years or above [14]. The prevalence of social isolation among elderly in India is almost 34 percent, and research evidence cites a rising trend of this phenomenon [15]. Further, prevalence of loneliness among Indian older adults is also alarming with almost 55.4 percent of older adults experiencing loneliness [16]. Social isolation and loneliness are serious yet underrated phenomena among older adults across the globe that pose health risk threats. Socially isolated and lonely individuals can be affected physically and psychologically, thereby affecting their optimal functioning [17].

Psychological Well-being, Social Isolation, And Loneliness

Successful aging incorporates the idea of growing old with a positive orientation towards life consisting of good health, functional capacity, autonomy, acceptance of self and others, deriving a sense of purpose in life. Engaging oneself in healthy social interactions is instrumental in achieving these goals, thereby fostering psychological well-being in the declining years of life. Psychological well-being is a positive psychological construct related to subjective views of oneself and life [18]. The multidimensional model of psychological well-being (PWB) encompasses six components: the meaning, purpose, and direction people give to their lives; autonomy; personal growth; mastery over one’s environment; maintaining positive relationships; self-knowledge and self-acceptance. Furthermore, Seligman (2012), in his PERMA (Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment) model of psychological well-being, has focused on engagement and social relationships as two key attributes to achieving psychological well-being [19]. According to this theory, engaging in meaningful and pleasure-eliciting activities enhances the number of positive neurotransmitters and hormones, thereby improving an individual’s sense of well-being. The model suggests that healthy relationships are basic human needs that are crucial for a meaningful life. Therefore, maintaining positive and meaningful social relationships foster well-being among individuals. These relationships promote love, intimacy, and strong emotional and physical interaction with other human beings and thereby enhance the resilience capacity of the individuals which leads to improved psychological well-being. However, social isolation and loneliness pose a threat to their psychological well-being by hampering the number and quality of relationships and creating disequilibrium in the feelings of well-being. Research findings have consistently advocated the association of perceived social connectedness with enhanced health and psychological well-being in individuals [20, 21].

With the changing social dynamics and patterns of social interactions, there has been an increased level of social isolation and loneliness among elderly individuals. In the Indian context, which is perceived as collectivistic in nature, the joint family system has prevailed over the years, where the older adults have had a pivotal role to play. Consequently, social isolation and loneliness experienced was less prevalent amongst the older adults. However, with the recent shifts in the societal paradigms from joint family systems to nuclear family systems, the societal roles assigned to the older adults have also changed, making them lonely and socially isolated. Further, the number of older adults residing in old-age homes have increased significantly over the recent years, leading to increased levels of social isolation and loneliness in the aged population in the Indian context. Though research evidence has studied the impact of social isolation and loneliness as individual constructs, the association among these factors is less explored. Moreover, there is a dearth of research to understand the impact that social isolation and loneliness can have on the psychological well-being of the geriatric group. In addition to this, the experiences of social isolation and loneliness might vary based on gender, given the difference in assigned societal roles [22, 23]. Further, if factors like educational status of the older adults, and their marital status have a role to play in the way social isolation and loneliness impact psychological well-being of the older adults, it is less explored. These aspects necessitate the need to assess the impact of loneliness and social isolation on psychological well-being of the elderly as it detrimentally affects their overall functioning and quality of life.

Objectives

The current study aims to assess the underlying relationship among social isolation and loneliness and tried to assess the co-existence of the two factors. Further, the paper evaluates the impact of social isolation and loneliness on the psychological well-being of the older adults residing in various old-age homes in India. Moreover, the study aims to explore the impact of social isolation and loneliness on the individual constructs of psychological well-being among the older adults. The study purports to find out if factors like gender, marital status, and educational status have a mediating role to play in the way social isolation and loneliness affect the psychological well-being of the older adults.

Methodology

Measures

Social Isolation

Lubben Social Network Scale-6 (LSNS- 6), was used to assess social isolation among older adults [24]. The items assess the social interactions an individual has with family members and friends, including how often the participant hears from his/her family and friends, and how many friends or family members he/she feels is close enough to share. It consists of six items which are rated on a six-point Likert Scale ranging from 1 (None) to 6 (Nine or more). A score > 12 is interpreted as ‘at-risk’ social isolation.

Loneliness

The Revised UCLA Loneliness Scale was used to assess the subjective feelings of loneliness [25]. The scale consists of twenty items, out of which eleven items are positively worded and nine items are negatively worded. It is measured on a four-point Likert scale with scores as 1(Never), 2(Rarely), 3(Sometimes) to 4 (Often). The range of scores varies from 20–80. Individuals scoring above 40 are considered as lonely.

Psychological Well-Being

The shortened version of the Psychological Well-Being Scale comprising 42 items by Ryff & Keyes (1995) was used to assess psychological well-being [26]. The test measures psychological well-being on six dimensions namely, autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. The items are rated on a six-point Likert Scale, where a score of ‘1’ represents ‘strongly disagree’ and a score of ‘6’ represents ‘strongly agree’. Higher scores are indicative of higher levels of well-being.

Results

Descriptive statistics were reported as means and standard deviations of the groups. Multivariate analysis was carried out to analyse the effect of social isolation and loneliness on the overall psychological well-being as well as the individual constructs of psychological well-being. Further, mediation analysis was carried out to examine the role of important socio-demographic characteristics like gender, education, and marital status in the impact of social isolation and loneliness on the psychological well-being of the older adults.

The participants have been categorised based on various dimensions like gender, education status, marital status, social isolation, and loneliness (Table 1). Males comprise 47.19 percent of the total sample, whereas 52.81 percent of the participants are females. Further, almost 46.25% (N = 148) participants are educated, whereas 53.75 percent participants are uneducated. Based on marital status participants have been categorised as ‘currently married’ (31.88 percent), ‘widowed’ (52.19 percent), ‘divorced/separated/deserted’ (5.9%), Moreover, based on the scores of social isolation, and loneliness, 84.38%(N = 270) participants are socially isolated, and 86.88 percent (N = 278) are lonely.  

Table 2 presents the mean and standard deviations of the various groups of participants on the dimension of psychological well-being as well as the individual components of psychological well-being. Older adults who had high social isolation and high levels of loneliness had the least scores on overall psychological well-being (M = 109.21, SD = 24.97), as well as for all the components of psychological well-being. Contrarily, participants who reported low on social isolation and loneliness had the best overall psychological well-being (M = 144.57, SD = 28.14). They also exhibited better results in individual components of psychological well-being as compared to their socially isolated and lonely counterparts.  

Furthermore, the independent variables, namely social isolation and loneliness exhibited a significant negative correlation (r=-.505**), (Fig. 1) suggesting that with lower scores of social isolation, which is indicative of heightened levels of social isolation, loneliness tends to increase. Hence to further understand the co-existence of social isolation and loneliness, linear regression analysis was performed (Table 3). A significant regression equation was obtained (F= (1,318) = 109.231, p < .01), with an R² of .256. Therefore, social isolation was a significant predictor of loneliness and explained 25.6% of the variance. 

Multivariate analysis (Table 4) was carried out to examine the impact of social isolation and loneliness on psychological well-being of the participants. It was conducted to assess if there are significant differences in psychological well-being among the participants experiencing varying levels of social isolation and loneliness. Wilk’s Lambda test statistic was used for the analysis. A statistically significant MANOVA effect was obtained for social isolation (F = 3.836, p < .01), with the multivariate effect size being approximately .07, suggesting that almost seven percent of the variance was explained by social isolation while determining the attributing factors of psychological well-being among older adults. Furthermore, loneliness (F = 3.782, p < .01) also had a significant effect on psychological well-being and played a vital role in determining psychological well-being among the participants, with partial η² being .068, suggesting almost seven percent of the variance was explained by loneliness. As the interaction effect of the independent variables – that is, social isolation and loneliness – were not statistically significant; the main effects of social isolation, and loneliness were considered for the analysis.  

Furthermore, Test of Between-Subject Effects (Table 5) were analysed to determine how social isolation and loneliness affect the overall psychological well-being, as well as the individual components of psychological well-being of the participants. Results showed that social isolation (F = 12.412, p < .01, partial η² = .038) had a significant impact on the overall psychological well-being, explaining almost four percent variance. Further, social isolation had a significant impact on various components of psychological well-being, namely autonomy, personal growth, positive relations, purpose in life, self-acceptance. However, it did not impact environmental mastery significantly, suggesting that social isolation does not act as deciding factor in determining older adults’ ability to manage and modify the environmental factors and activities in accordance with their needs and benefits. Moreover, loneliness had a significant impact on the overall psychological well-being (F = 13.152, p < .01, partial η² = .040) as well as the deconstructed factors of psychological well-being. It was observed that older adults who are not socially isolated and experience lower levels of loneliness exhibit best psychological well-being (M = 144.57, SD = 28.14), encompassing the individual components.  

Mediation analysis was performed to assess the mediating role of factors like gender, education, and marital status, in the relationship between social isolation, loneliness, and psychological well-being. The results have been presented in Table 6. Further, the path diagrams (Fig. 2,3, and 4) illustrate direct effects as well the total effects in the form of regression coefficients of the independent variables and mediators on the dependent variable, i.e., psychological well-being. 

The results (Table 6) revealed that direct effect of both social isolation, and loneliness on psychological well-being were statistically significant, suggesting that social isolation and loneliness can be considered as determining factors of psychological well-being. However, both the factors namely social isolation (β₁ = .012, z₁ = .62, p₁ > .05) and loneliness (β₂ = − .003, z₂ = − .48, p₂ > .05.) had a non-significant indirect impact while assessing the role of gender as a mediating factor. This implies that gender does not impact the effect that social isolation and loneliness have on the psychological well-being of the older adults. Furthermore, education had a significant impact on the psychological well-being of the older adults (e = 3.44, z = 5.19, p < .01). This is indicative of the fact that education as an independent factor has a role to play in determining the psychological well-being of the older adults. However, it does not mediate the impact of social isolation and loneliness on the psychological well-being. This is reflected in the non-significant indirect effect of social isolation (β₁ = .013, z₁ = − .20, p₁ > .05) and loneliness (β₂ = − .010, z₂ = − .30, p₂ > .05.) on the psychological well-being with education as a mediating factor. It was observed that marital status as an independent factor did not have significant impact on the psychological well-being of the older adults. However, both social isolation (β₁=-.16, z₁= -0.62, p₁ < .05) and loneliness (β₂ = .051, z₂ = .51, p₂ < .05) exhibit statistically significant indirect effect on psychological well-being with marital status as the mediating factor. This suggests that marital status partially mediates the association of social isolation and loneliness with the psychological well-being of the older adults. Here, β_1, z_1, and p₁ denote the regression coefficient, z score, and probability values for social isolation, and β₂, z₂, p₂ are indicative of the regression coefficient, z score, and probability values for loneliness. Further, the total effect of the afore-mentioned independent variables on psychological well-being was reported to be significant, suggesting the importance of assessing social isolation and loneliness as determinants of psychological well-being.

Discussion

With the rising number of older adults residing in old-age homes, it has become imperative to investigate the aspects ensuring optimal functioning of the elderly. Among the various other aspects, psychological well-being is a prominent determinant of a fulfilling life in senescence. The present study aims to assess the impact of social isolation and loneliness on the psychological well-being of older adults residing in various old-age homes in India. The study elucidates an insightful evaluation of the prevalence of social isolation and loneliness among residents of old-age homes in the Indian context. It also attempts to understand if social isolation and loneliness affect the different components of psychological well-being differently. Further, the study assays the mediating role of factors like gender, marital status, and education in the association of social isolation and loneliness on the psychological well-being of the older adults.

The findings of the study paint a gloomy picture with almost 84.38 percent older adults living in old-age homes being socially isolated. Further, almost 86.88 percent older adults reported to be experiencing higher levels of loneliness. Our results align with the findings of Taylor et al., (2018) who opined that almost 70 percent elderly residing in old-age homes or senior housing communities reported to be experiencing moderate or severe levels of loneliness [27]. Results indicate that social isolation predict loneliness significantly stating their co-occurrence to a large extent [28]. Older adults staying in old-age homes may have less social support from management as well as family members and have diminished opportunities to engage themselves in various occasions or programs, therefore leading to heightened levels of social isolation and loneliness [29].

Furthermore, the study assesses of the impact of objective and subjective dimensions of social interactions on the psychological well-being of older adults residing in old-age homes which demonstrates an increasing trend in the changing socio-cultural context of India. Results reveal that both social isolation and loneliness have a significant impact on the psychological well-being of the older adults. Socially isolated and lonely older adults exhibit poorer psychological well-being as compared to their counterparts who do not experience heightened levels of social isolation and loneliness. Interpersonal relationships have shown significant positive associations with psychological well-being of individuals [30]. Therefore, reduced objective social interactions as well as lessened perceived social ties that foster a greater sense of companionship, can be considered as causal factors for diminished psychological well-being among the elderly. Our findings are concurrent with the findings of Birditt et al. (2021), and Rook (2015), who opine that social isolation and loneliness are predictive of deteriorated psychological well-being among the older adults [31, 32]. Reduced independence to move out of the old-age homes, because of deterred physical health, lack of resources can increase the feelings of social isolation and loneliness, thereby affecting the psychological well-being of the inmates. Moreover, social isolation and loneliness have been reported to have significant impact across all individual components of psychological well-being. However, social isolation has been seen to report no significant impact on the environmental mastery component of psychological well-being unlike the findings of Hausler et al., (2017) who reported a strong association between environmental mastery and social isolation [33]. Individuals residing in old age homes move out of the comfort of their homes, and a lifestyle they have been leading for years, and try to adapt in a new scenario with limited resources which decreases their sense of ability to manage or control various aspects around them.

The study further aimed to assess the mediating impact of various socio-demographic factors in the association of social isolation and loneliness on the psychological well-being of the participants. It was assumed that socio-demographic factors like gender, education, and marital status might mediate the way social isolation and loneliness impact psychological well-being. It was observed that education as an independent factor predicts psychological well-being significantly. The results suggest that education fosters a sense of control among the elderly, and prevents decline in psychosocial functioning. It also helps them become resilient against changes that come with lowered sense of control and hopelessness that are experienced by aging individuals, thereby having a positive impact on the psychological well-being of the aging population [34]. However, gender did not have a significant impact on the psychological well-being of the older adults. The findings are not concurrent with some earlier research evidence, where Matud et al., (2020) opined that men exhibit better psychological well-being particularly in the dimensions of greater self-acceptance, purpose in life, autonomy, and environmental mastery [35]. According to them, the strict gender-specific norms, and roles assigned to men and women in the Indian context where authoritarian attributes are mostly attached to men might be a result of this difference. However, with changing societal roles of males and females, the gender gap might diminish resulting in a no-gender difference in the assessment of psychological well-being. Additionally, the participants of the study are residents of old-age homes, where both males and females stay in a similar environmental setup. Hence, gender differences do not have a significant impact while determining their psychological well-being.

Further, it was observed that marital status partially mediated the impact of social isolation and loneliness on the psychological well-being of the older adults. Research evidence has highlighted the importance of a spouse for reduced distress and enhanced psychological well-being, particularly in the later years of life [36]. Additionally, Cheng, et al., (2021), have opined that widowhood results in deteriorated subjective well-being, thereby citing the importance of marital status in the declining years of life [37]. Furthermore, research evidence advocates in favour of marital status being an important determinant for reduced levels of loneliness and social isolation [38]. Our results align with the earlier findings. Though social isolation and loneliness seem to impact psychological well-being significantly in a negative way, the impact is reduced in case of married older adults, suggesting the importance of social support in form of marital relationship. Further, the results suggests that irrespective of the gender, level of education, and marital status of the elderly, social isolation and loneliness have a negative association with the psychological well-being of older adults.

Conclusion

The study comprehensively assesses the impact of social isolation and loneliness on the psychological well-being of the older adults residing in old age homes in India. The findings of the study can be considered to understand the voids resulting from increased social isolation and loneliness among older adults who are residents of old-age homes. The inferences will provide an insight in developing intervention strategies to minimize the feelings of social isolation and loneliness, as well as enhance psychological well-being among them. Increasing social network usage, engaging them in various leisure activities can help in alleviating feelings of social isolation and loneliness. Further, provision of necessary resources to interested and able individuals to engage in various vocations can also help in enhancing a sense of control and autonomy, thereby reducing the feelings of hopelessness, and enhancing psychological well-being among the elderly. Policies aimed to ensure an optimal functioning of the elderly can be framed by incorporating the findings. Based on the findings of the study, the government can incorporate various measures in policies aimed to improve psychological well-being of the elderly. Designing measures where the older adults to empower them with digital technology can aid in reduction of social isolation and loneliness as well as enhance psychological well-being among older adults. Further, providing older adults with opportunities to interact in various social groups to impart their knowledge, like teaching in orphanages, can help in enhancing their overall quality of life. Though the study is first of its kind in the Indian context and holds relevance in the current social scenario given the number of old-age homes increasing at a rapid rate, the study has certain limitations. The study has not considered the physical health status and economic status, which might have an impact on the psychological well-being of the participants. Further, collecting data from various states may help in assessing the impact of varied socio-cultural contexts on psychological well-being within India. Future studies can consider a longitudinal analysis for the above-mentioned factors to gain an insight into the temporal aspects about the impact of social isolation and loneliness on the psychological well-being of the older adults.

Abbreviations

PERMA: Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment

LSNS- 6: Lubben Social Network Scale-6

Declarations

We confirm that all methods, including ethics approval and consent to participate, were performed in accordance with the relevant guidelines and regulations or in accordance with the Declaration of Helsinki. 

Ethical Approval: The study is part of an ongoing Doctoral Research work, and it has been approved by the Doctoral Scrutiny Committee of the National Institute of Technology, Rourkela, and the ethics committee of the same institute.  The study has obtained data using the survey method and does not include any invasive methods of data collection. Further, all the participants have been briefed about the process and purpose of the study and informed consent has been received from each participant.

Consent to Participate: Each participant was briefly explained regarding the purpose of the study. Participants either read the informed consent or the interviewer read it aloud for them where the process and purpose of the interview was clearly mentioned. They were further asked if they agreed to be a part of the study. Individuals who answered in affirmative were then asked to give their consent. Written informed consent was obtained from all the participants (educated) and for illiterate or uneducated participants informed consent was obtained in the form of a signature or thumb impression.

We hereby confirm that the informed consent procedure was approved by the Doctoral Scrutiny Committee of the National Institute of Technology, Rourkela, and the ethics committee of the same institute.  

Consent for Publication: Not Applicable

Availability of Data and Materials: Data sharing is not applicable to this article yet as it is a part of an on-going doctoral research. The dataset used and/or analysed during in the article are available from the corresponding author on reasonable request. 

Competing Interests: The author(s) declare no competing interests.

Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work is supported by the Indian Council of Social Science Research (ICSSR) [Grant Number: RFD/2019-20/GEN/PSY/282]. 

Authors’ Contributions: Design of the study: SD and BM. Wrote the Paper: BM and SD Analysed the data: JP, SD, and BM. Finalizing the article: JP, SD, and BM.

Acknowledgment:  The first author is a recipient of the Indian Council of Social Science Research (ICSSR) Doctoral Fellowship. Her article is largely an outcome of her doctoral work sponsored by ICSSR. However, the responsibility for the facts stated, opinions expressed, and the conclusions drawn is entirely that of the author.

Notes: Not Applicable

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