# Testing a conceptual framework of loneliness, social isolation and health outcomes in older adults

## TL;DR

This study explores how loneliness and social isolation in older adults affect health through psychological, behavioral, and physiological pathways, linking them to cardiovascular, cerebrovascular, and cognitive issues.

## Contribution

The study empirically validates a conceptual framework connecting loneliness and social isolation to health outcomes via multiple pathways in older adults.

## Key findings

- Loneliness and social isolation are positively linked to psychological and physiological burdens.
- Unhealthy behaviors and physiological factors are associated with cardiovascular and cerebrovascular conditions.
- Social isolation directly correlates with poorer cognitive function and lower cardiovascular disease probability.

## Abstract

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.

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).

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 unhealthy behaviours were positively associated with cerebrovascular conditions (b = 0.21, p = .003) and poorer cognitive function (b = -0.14, p = .004). Social isolation also showed direct associations with poorer cognitive function (b = -0.09, p = .007) and lower probability of cardiovascular disease (b = -0.08, p = .014).

Social isolation and loneliness are associated with behavioural and physiological factors that increase vulnerability to cardiovascular, cerebrovascular and cognitive conditions. Routine screening and public health strategies to address social disconnection and associated factors can improve wellbeing and reduce healthcare burden. Longitudinal research can clarify causal mechanisms and inform targeted interventions.

The online version contains supplementary material available at 10.1186/s12877-026-07003-x.