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Loneliness is a major psychological challenge in older adulthood, contributing to increased risks of depression, anxiety, and mortality. Conversational agents - technologies that interact with users via natural language - have emerged as potential tools to support psychological well-being in later life. This systematic review and meta-analysis evaluated the effects of autonomous conversational agents, including robotic and nonrobotic systems, on loneliness, as well as social isolation, depression, and anxiety in older people without cognitive impairment. Seventeen studies with pre-post intervention data were included. Nine used physically embodied robots and eight employed nonrobotic agents, such as personal voice assistants, chatbots, or screen-based embodied agents. Due to the limited number of high-quality comparison studies, all meta-analyses were based on within-group pre-post comparisons. Meta-analytic results showed mild to moderate improvements in loneliness (standardized mean changes using change score [SMCC] = 0.350, 95% confidence interval [CI]: 0.180-0.520) and depression (SMCC = 0.464, 95% CI: 0.327-0.602), with no study reporting symptom worsening. No study included validated measures of social isolation, and only one assessed anxiety. These findings indicate that conversational agents may offer scalable support for older adults' mental health, with potential especially for reducing loneliness and depression. Nonetheless, methodological limitations, including la

<h4>Background</h4>Loneliness is a growing health and social challenge. The COVID-19 pandemic boosted feelings of loneliness for many people. To combat loneliness, a wide range of interventions have been developed and evaluated for their efficacy and effectiveness. As a result, many new interventions to alleviate loneliness have been developed, especially technological interventions. Therefore, the objective of this study was to conduct a comprehensive and up-to-date systematic review to identify interventions aimed at loneliness and social isolation among adults, 60 years and older published during or post-pandemic.<h4>Methods</h4>A comprehensive literature search was conducted for studies between 2020 and 2024 across five online databases: MEDLINE via PubMed, Web of Science, Scopus, Cochrane Library, and CINAHL. Title and abstract screening, critical appraisal of the studies, and data extraction were performed by two independent reviewers. A narrative approach was adopted to assess and integrate the diverse findings from the research.<h4>Results</h4>Ultimately, 79 studies were included in this systematic review. The results are structured based on the categorization of the interventions, which includes differentiation between analogue interventions, technological interventions and multicomponent (analogue and technological) interventions. The effectiveness of analogue interventions, particularly community-based interventions such as group meetings, social participation prog

<h4>Background</h4>Social isolation and loneliness (SIL) have emerged as critical population health concerns linked to various adverse health outcomes, including cardiovascular disease, stroke, dementia, depression, and premature mortality. However, the absence of a standard categorization for interventions aimed at reducing SIL has impeded consistent comparison, evaluation, and the accumulation of knowledge, affecting evidence-based policy decisions. To address this gap, we developed and empirically evaluated the ASSeTS (Access, Skills, Social engagement, Therapeutic and psychological, Systemic) classification system, a standardized approach for categorizing SIL interventions.<h4>Methods</h4>We conducted a systematic review to identify and evaluate existing classification systems used for SIL interventions. Seventeen databases were searched from inception to September 2023, with no language restrictions. Inclusion criteria encompassed established and widely used reviews with clear intervention categorizations and broad applicability to general population groups. Expert consultations supplemented the systematic review, providing iterative feedback and additional relevant literature missed from the literature search, to inform the development of the ASSeTS classification framework. The developed ASSeTS system was empirically tested by independent experts for clarity, applicability, and reliability, with inter-rater agreement assessed using Fleiss' kappa.<h4>Results</h4>The rev

<h4>Introduction</h4>Population aging poses significant societal and health challenges, with loneliness and social isolation (L/SI) recognized as pressing public health concerns. While social isolation refers to an objective lack of social contacts, loneliness reflects the subjective perception that one's social needs are not being met. Although L/SI have been associated with an increased risk of dementia and global cognitive decline, their relationship with language functioning remains largely underexplored. Given the central role of language in social interaction, examining this relationship is particularly relevant.<h4>Methods</h4>Following PRISMA-ScR guidelines, we conducted a scoping review to a) map the language domains and measures used in the literature, and b) synthesize evidence on the association between L/SI and language functioning in older adults. Web of Science, PubMed, and Scopus were searched without temporal restrictions using terms related to language, L/SI, and aging. Eligible studies included older adults (≥60 years) and examined the association between at least one language measure and one indicator of L/SI.<h4>Results</h4>Thirty-four studies met the inclusion criteria. Considerable heterogeneity was observed in both language and social-disconnection measures. The literature focused primarily on verbal fluency tasks, with comparatively less attention devoted to lexical retrieval, discourse production, semantic processing, and speech-derived computational

As loneliness and social isolation emerge as pressing public health concerns, identifying effective interventions is essential. Digital solutions offer flexible, scalable, and cost-effective approaches, yet their effectiveness remains uncertain. This systematic review and meta-analysis assess the impact of randomized controlled trials (RCTs) on digital interventions to reduce loneliness and social isolation. Following PRISMA 2020 guidelines, we searched seven databases and grey literature (2022-) and applied random-effects models to pool effect sizes by intervention type. A total of 40 RCTs involving 6062 participants were included, with one-third focusing on younger individuals. Loneliness was assessed in 36 studies, while eight examined social isolation. Interventions were classified as psychological (k = 25), social (k = 4), activity-based (k = 4), robot-based (k = 4), and social media reduction (k = 5). Psychological interventions-especially those with group or social components-along with group-based activities and robotic pets, were effective in reducing loneliness. In contrast, social contact interventions, self-guided individual activities, and conversational robots showed limited impact. Social media reduction interventions suggested potential benefits, though results were not statistically significant. The evidence base exhibited moderate to high risk of bias, heterogeneity, and limited long-term follow-up. We provide specific recommendations for future intervention

Lack of social connection is a major risk factor for Alzheimer's disease and related dementias, on a par with other common risk factors like physical inactivity and smoking. Yet we still know surprisingly little about how social connection affects cognitive health. Our review provides updated guidance for researchers interested in testing new mechanistic models of social connection and cognitive health over the life course. First, we conceptualize social connection and its various components. Second, we provide readers with a supplemental compendium of social connection measures and discuss how to tailor different types of measures to specific research goals. Third, we advance a conceptual model linking social connection to cognitive health across different social, spatial, and temporal contexts, while also considering potential sources of confounding and reciprocal causation. Finally, we outline five priority areas for future research into social connection and cognitive health across the life course.

Loneliness, the subjective perception of inadequate social connection, is increasingly recognized as a significant and modifiable determinant of health with implications extending beyond psychosocial well-being to cardiovascular and cognitive outcomes. A growing body of evidence links loneliness to increased risk of cardiovascular disease, cognitive decline, and dementia; however, these domains have often been studied in parallel. This review advances a brain-heart axis framework to integrate these literature, conceptualizing loneliness as a chronic psychosocial stressor that contributes to cognitive aging through interconnected neuroendocrine, autonomic, inflammatory, and vascular pathways. Loneliness is associated with sustained activation of stress-responsive systems, including the hypothalamic-pituitary-adrenal axis and sympathetic nervous system, leading to cumulative physiological burden, or allostatic load. These processes contribute to endothelial dysfunction, vascular injury, and increased risk of cardiovascular conditions, which in turn impair cerebral perfusion and promote neurodegeneration. In parallel, loneliness is associated with neurobiological effects, including hippocampal atrophy, neuroinflammation, and reduced cognitive reserve. Behavioral and psychological pathways further amplify these effects. This paper synthesizes epidemiologic, mechanistic, and clinical evidence to propose a multi-pathway model linking loneliness to cognitive aging through neurobiolo

<h4>Importance</h4>Loneliness affects more than half of US adults and has been declared a public health epidemic, yet whether clinically documented loneliness independently predicts mortality across diverse populations remains unclear.<h4>Objective</h4>To examine the association between clinically documented loneliness and all-cause mortality at 1, 3, and 5 years, overall and by sex, race and ethnicity, and age.<h4>Methods</h4>We conducted a propensity score-matched retrospective cohort study using the TriNetX US Collaborative Network, comprising electronic health record data from 65 health care organizations. Adults aged 18-90 years with at least one clinical encounter between January 1, 2016, and December 31, 2022, were eligible. Patients with a clinically documented diagnosis of loneliness were matched 1:1 (n = 28,944 per group) on age, sex, race and ethnicity, and 12 comorbidity domains to comparison patients with outpatient engagement and no loneliness diagnosis. The primary outcome was all-cause mortality at 1, 3, and 5 years. Between-group differences were assessed using risk differences, Kaplan-Meier survival analysis, and Cox proportional hazards models, overall and across prespecified subgroups.<h4>Results</h4>Among 57,888 matched adults (mean age, 55.4 years; 62.9% female), loneliness was associated with increased mortality at every horizon: 1-year hazard ratio (HR), 1.52 (95% CI, 1.40-1.66); 3-year HR, 1.35 (95% CI, 1.27-1.43); and 5-year HR, 1.29 (95% CI, 1.22-1.

Older adults are at increased risk of loneliness, social isolation and use of analgesics such as over-the-counter (OTC) medications and opioids. While evidence suggest that loneliness and social isolation may influence patterns of pain medication use, longitudinal studies remain limited. Data from the Health and Retirement Study (2014-2022) were analysed for 9,454 US adults aged 50+. Continuous-time multistate Markov models examined how social isolation and loneliness were associated with the likelihood of transitioning between states of medication use, non-use, and death whilst controlling for sociodemographic and health-related factors. Loneliness was associated with higher risks of initiating both opioids (HR = 1.19, 95%CI: 1.03-1.37) and OTC (HR = 1.12, 95%CI: 1.01-1.25). Conversely, social isolation was not associated with transitions into opioid use, but it was associated with a reduced likelihood of initiating OTC medication (HR = 0.85, 95%CI: 0.77-0.95). Neither factor was associated with medication discontinuation. Loneliness and social isolation are thus differentially related to pain medication transitions in older adults; whereas loneliness may contribute to increased likelihood of initiating medication use, social isolation relates to lower OTC uptake. These findings highlight the need to consider subjective and objective social connection as critical components of safer pain management in older adults.

BACKGROUND: Loneliness and social isolation are established risk factors for adverse cardiovascular, cerebrovascular and cognitive outcomes in later life, yet the pathways underlying these associations remain underexplored. This study tests the structure of a published framework linking social isolation and loneliness to health outcomes through psychological, behavioural and physiological pathways. METHODS: We analysed cross-sectional data from 1,685 Singaporean adults over the age of 60 from the Wellbeing of the Singapore Elderly study. Path analysis was used to examine the psychological (subsyndromal and syndromal anxiety and depression), behavioural (smoking, alcohol use, poor diet and sedentary lifestyle), and physiological (hypertension, obesity, diabetes and sleep disruption) pathways from social isolation and loneliness to health outcomes (cardiovascular, cerebrovascular and cognitive health). RESULTS: The final model fit the data well (χ²(60) = 67.62, p = .233; CFI = 0.986; TLI = 0.993; RMSEA = 0.009). Loneliness was positively associated with psychological burden (b = 0.20, p < .001), unhealthy behaviours (b = 0.06, p = .001), and physiological burden (b = 0.06, p = .005). Social isolation was positively associated with psychological burden (b = 0.07, p = .005) and unhealthy behaviours (b = 0.14, p < .001). Physiological burden was positively associated with cardiovascular disease (b = 0.22, p < .001) and cerebrovascular conditions (b = 0.34, p < .001), while unhealt

<h4>Background</h4>Social isolation and loneliness are associated with mortality, but their impact on cause-specific mortality in cancer survivors remains unclear.<h4>Methods</h4>This cohort study enrolled UK Biobank participants with cancer at baseline, followed up from March 2006 to September 2024. Social isolation and loneliness were assessed by self-reported questionnaires. Outcomes included all-cause, cancer-specific, and cardiovascular disease (CVD)-related mortality. Associations were evaluated using Cox proportional hazards models.<h4>Results</h4>A total of 32,524 participants were included in this study (60.2% women; mean age, 60.3 years). During a median 15.7-year follow-up, 5,945 deaths occurred. Social isolation was significantly associated with increased all-cause (HR, 1.22; 95%CI, 1.12-1.32), cancer-specific (HR, 1.16; 95%CI, 1.04-1.28), and CVD-related (HR, 1.32; 95%CI, 1.07-1.63) mortality. Loneliness was not associated with all-cause mortality (HR, 0.98; 95%CI, 0.93-1.04), but independently associated with increased CVD-related mortality (HR, 1.26; 95%CI, 1.08-1.47). Exploratory analyses identified distinct prognostic impacts of specific isolation measures: living alone was linked to higher all-cause and non-cancer mortality across most cancer types, while weekly social activities and monthly family/friends visits were protective.<h4>Conclusions</h4>Social isolation was associated with increased risks of all-cause, cancer-specific, and CVD-related mortality.

As populations age and healthcare systems increasingly adopt digital health technologies and alternative models of service delivery, understanding their broader social impact is becoming increasingly important. Digital health technologies are transforming how older adults access and manage healthcare services and may help alleviate pressure on healthcare systems. However, there is limited research examining whether digital health technologies mitigate or exacerbate experiences of loneliness and social isolation among older adults. Loneliness refers to the subjective feeling of inadequate social connection, while social isolation denotes the objective absence of social relationships. Both are associated with poorer physical and mental health, increased healthcare utilisation, and become more prevalent in later life. This protocol outlines a scoping review that will map the existing literature on the relationship between digital health technologies and loneliness and social isolation among older adults. The review will identify the types of digital health technologies that have been studied, examine how loneliness and social isolation have been defined and measured, and highlight gaps in the current evidence base to inform future research, policy, and practice. To our knowledge, this will be the first scoping review to comprehensively examine the intersection of digital health, loneliness, and social isolation in older adults. The protocol has been preregistered on the Open Sci

Loneliness and social isolation are increasingly recognized as critical public health issues, linked to adverse outcomes such as cardiovascular disease, cognitive decline, depression, and increased healthcare utilization. Despite their significance, these factors are underrepresented in medical education curricula. This Perspective advocates for the integration of loneliness and social isolation into undergraduate medical education (UME), emphasizing their roles as social determinants of health and their disproportionate impact on marginalized populations. We propose a multifaceted curricular framework encompassing foundational knowledge, clinical skills, innovative interventions, interprofessional education, and reflective practice. We provide strategies for addressing social isolation and social connection in medical education curricula using literature-based tools and experiential learning activities. By equipping future physicians with the competencies to address social disconnection, medical education can play a pivotal role in advancing health equity and improving patient outcomes.

<h4>Background</h4>Cardiac disease is the leading cause of morbidity and mortality among older adults, yet the psychosocial pathways through which it accelerates functional decline remain poorly characterized. Social isolation and loneliness are plausible mediators, but their longitudinal roles in the cardiac disease-disability-mortality cascade have not been examined in an integrated framework.<h4>Methods</h4>We analyzed 5,654 US Medicare beneficiaries aged ≥65 from the National Health and Aging Trends Study (NHATS) followed across Rounds 7-14 (2017-2024). Cardiac disease was ascertained at baseline via self-reported physician diagnosis. Social isolation was measured via a validated composite index; loneliness was assessed with a single-item measure. Disability outcomes included Nagi physical function, mobility limitation, activities of daily living (ADL) impairment, and instrumental activities of daily living (IADL) impairment. We estimated group differences using generalized estimating equations (GEE), mortality using Kaplan-Meier and Cox proportional-hazards models, and mediation using the counterfactual framework.<h4>Results</h4>At baseline, 1,361 participants (24.1%) had cardiac disease. The CD group exhibited higher social isolation prevalence (19.2% vs 16.8%, p=0.048), lower Nagi scores (7.1 vs 8.5, p<0.001), and greater comorbidity burden (2.9 vs 2.1 conditions, p<0.001). Over follow-up, CD was associated with persistently worse physical function (Round 14 Nagi: 7.1

Social disconnection, including loneliness and social isolation, is increasingly recognized as an important social determinant of adult health, but its relationship with chronic disease-related outcomes remains dispersed across disease areas and study designs. This systematic review aimed to synthesize evidence on the associations of loneliness and social isolation with chronic disease-related outcomes among adults in community, primary care, outpatient, registry-based, and population-based settings. PubMed/MEDLINE, Scopus, Web of Science, Web of Science East Mediterranean Region, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, the Cochrane Library, Google Scholar, and reference lists were searched from database inception to May 10, 2026, for original studies reporting loneliness or social isolation in relation to cardiovascular, metabolic, respiratory, renal, frailty-related, behavioral, biological, functional, quality-of-life, morbidity, or mortality outcomes. Thirty-one studies were included and synthesized narratively because of heterogeneity in populations, exposure measures, outcomes, study designs, follow-up periods, adjustment strategies, and reported effect estimates. The included evidence was mainly observational and suggested associations between loneliness, social isolation, and a broad range of adverse chronic disease-related outcomes, with more consistent associations reported for cardiovascular disease, cardiometabolic condi

<h4>Purpose of review</h4>Social isolation and loneliness have emerged as important cardiovascular risk factors, yet the biological mechanisms linking adverse social experiences to cardiovascular disease remain incompletely understood. This review examines current evidence relating social isolation and loneliness to subclinical atherosclerosis and explores the underlying neuroendocrine, autonomic, inflammatory, and vascular mechanisms.<h4>Recent findings</h4>Recent epidemiological studies have associated social isolation and loneliness with endothelial dysfunction, arterial stiffness, carotid plaque, carotid intima-media thickness, and coronary artery calcium. Advances in transcriptomic and proteomic research have identified molecular signatures characterized by increased inflammatory signaling and altered immune regulation in socially isolated individuals. Experimental animal studies further support a causal relationship between adverse social environments and accelerated atherosclerosis. Accumulating evidence suggests that social isolation and loneliness contribute to subclinical vascular disease through interconnected pathways involving hypothalamic-pituitary-adrenal axis activation, autonomic dysregulation, chronic inflammation, oxidative stress, and endothelial dysfunction. Although available studies are limited and predominantly cross-sectional, findings support a biologically plausible link between social disconnection and early atherogenesis. Future longitudinal studi