Loneliness in old age: a matter of health, not mood

Researchers distinguish two concepts. Social isolation is what can be counted: how many contacts a person has and how often they talk to anyone. Loneliness is the feeling that contacts are lacking or that they are empty.

The one without the other happens all the time. A woman who has someone at home every day can feel lonely because no one asks how she is. A man who lives alone and is content with it may not be lonely at all. So the phrase “but she has a daughter” proves nothing.

Both states are counted, and they are measured separately. When numbers follow, look at what exactly they are about: the fact of contacts or the feeling.

In June 2025 WHO published the report of its Commission on Social Connection. One person in six in the world feels lonely, and loneliness is linked to more than 871,000 deaths a year, roughly a hundred every hour. Social isolation affects a third of elderly people.

A systematic review in the journal Heart collected sixteen long-term studies, from three to 21 years each, and showed that weak social ties gave a 29% higher risk of ischaemic heart disease and a 32% higher risk of stroke.

Another study followed 1,604 Americans over 60, average age 71. Those who called themselves lonely died more often over six years (22.8% against 14.2%) and about one and a half times more often lost the ability to manage daily tasks: dressing, washing, cooking.

The Lancet Commission in 2024 listed fourteen modifiable risk factors for dementia. By its estimate, if all of them could be eliminated, about 45% of cases could be prevented. Social isolation is among these fourteen. This is no longer about mood.

By the estimate of HelpAge International, almost nine million elderly people live in Ukraine, that is, a quarter of the country's population.

44% of people over 70 live alone, without family support. Almost half of elderly women also live alone. 63% say their mental wellbeing is worse than at the start of the war, and 62% say their income does not cover even basic needs.

Help does not reach everyone: by the same estimate, only 32% of elderly people receive support from humanitarian organisations. The rest rely on family, neighbours or no one.

The war also narrows the circle physically. In 2024 elderly people made up half of the civilians killed: it is harder to leave, harder to get down to a shelter, harder to leave the house at all. Someone who has stopped going out very quickly stops seeing anyone.

In 2020 in Texas, 240 people, average age about 69, were randomly divided into two groups. Half were called not by professionals but by young people aged 17 to 23. The training lasted one hour by video link and was about one thing: listening and asking about the person, not talking about yourself.

The calls aimed at ten minutes and were allowed to be shorter. In the first week there were five, after that the person chose two to five a week themselves. No therapy, no advice.

After four weeks, scores for loneliness and for depressive and anxiety symptoms on the scales were lower than in the group without calls. The difference is small in size but stable, and it appeared within a month. The results were published in JAMA Psychiatry in 2021.

This is not treatment, and no call replaces a doctor. But “doing nothing” and “calling for ten minutes” gave a different result after a month.

In the same study, after the first week participants decided the frequency themselves. 58% asked for the maximum, five calls a week. Not longer, but more often.

To be honest, long infrequent conversations were not compared there with short frequent ones, so this study cannot prove the advantage of one over the other. But the choice of people who tried it themselves also counts for something.

An explanation suggests itself simply. A person who knows that on Thursday at eleven someone will call lives in a different week from a person who knows nothing. There is something to prepare for and something to tell. One long visit once every six months does not give that.

The temptation to replace live contact with technology is great, but the evidence behind it is so far thin. A 2020 Cochrane review found only three studies of video calls against loneliness, all in care homes in Taiwan, and called the evidence very uncertain. So “let's give her a tablet” is not yet an answer.

The work is the same when help is delivered by hand. Our fund buys groceries and medicine every month for lonely elderly people and hands them over through helpers by hand; a hundred people are in its care. The monthly pack is also a reason that repeats: with it comes the fact that the person is seen and talked to.

Agree on a day and time, and do not reschedule. Ten minutes every Tuesday is better than an hour “sometime this month”. Set a reminder on your phone, do not rely on memory.

Ask about today, not about health. “How is your health” gets the answer “fine” and a dead end. What did she eat, who dropped in, what is on TV, is anything blooming on the windowsill: there is something to answer to that.

Talk less than you listen. Young people in that Texas study were taught exactly this. A pause in conversation is not awkwardness; let the person fill it.

Divide the weeks among relatives and acquaintances so that the calls are spread across the month and do not coincide on one day. Separately, agree with the neighbour that someone sees the person once a week, not only hears them.

Poor hearing and poor sight are also about contact. The 2024 Lancet Commission names untreated hearing and vision loss among its fourteen factors. I do not claim that new glasses will prevent anything for a specific person. I will put it more simply: someone who cannot make out words on the phone gradually stops picking up, and a loud phone with big buttons does more here than persuasion.

Signs worth noticing: she has stopped leaving the house even for the nearest shop; she does not answer calls she used to answer; she does not cook and has switched to tea with bread; no outsider has visited the flat for months; it has become noticeably harder to recall names and events she always remembered.

This is not a diagnosis, and neither you nor I may make one. It is a reason to come yourself or ask someone nearby to look in, and a reason to talk to her family doctor.

The simplest rule goes like this. If you catch yourself thinking “I should call, but it is too late now”, call tomorrow at a convenient hour and agree on a regular time. Regularity starts with one day written in the calendar.