Aim: Research indicates that social isolation and loneliness among older adults increase the risk of poor self-rated health (SRH) and vice versa. This study examines how loneliness may mediate the relationship between social isolation and health status among older Chilean adults. Methods: This cross-sectional study included 6755 participants aged 60 and older. The social isolation concept was operationalised using a 6-item measure adapted from Zavaleta et al.’s approach; loneliness was measured using the Three-Item Lonely Scale; and SRH status was measured with a standardised question from the Chilean Quality of Life and Health Survey. An IRT-1PL model and Confirmatory Factor Analysis were used in combination to validate the psychometric properties of social isolation. A mediation analysis using generalised structural equation modelling (GSEM), adjusted for relevant confounding factors, was conducted. Results: 30.4% of participants experienced social isolation, and 23.4% reported feelings of loneliness. Among those with poor SRH, 45% faced social isolation, and 37% experienced loneliness. GSEM indicated that the indirect effect of social isolation on poor SRH via loneliness was significant (β = ？0.183), suggesting that loneliness was an important mediator, and the direct effect of social isolation on poor SRH was also significant (β = ？0.324), indicating partial mediation. Conclusions: The association between social isolation and poor health status was significantly mediated by loneliness among Chilean older adults. The findings underscore the importance of social connectivity for the health status and well-being of older adults, and provide guidance for future interventions that promote social engagement and help older adults cope with loneliness to achieve successful ageing.
References
[1]
Akhter-Khan, S. C., van Es, W., Prina, M., Lawrence, V., Piri, I., Rokach, A. et al. (2024). Experiences of Loneliness in Lower-and Middle-Income Countries: A Systematic Review of Qualitative Studies. Social Science & Medicine, 340, Article 116438. https://doi.org/10.1016/j.socscimed.2023.116438
[2]
Asante, S., & Tuffour, G. (2022). Social Isolation and Loneliness in Older Adults: Why Proper Conceptualization Matters. Journal of Ageing and Longevity, 2, 206-213. https://doi.org/10.3390/jal2030017
[3]
Barnes, T. L., MacLeod, S., Tkatch, R., Ahuja, M., Albright, L., Schaeffer, J. A. et al. (2021). Cumulative Effect of Loneliness and Social Isolation on Health Outcomes among Older Adults. Aging & Mental Health, 26, 1327-1334. https://doi.org/10.1080/13607863.2021.1940096
[4]
Belau, M. H., Becher, H., & Kraemer, A. (2021). Loneliness as a Mediator of Social Relationships and Health-Related Quality of Life among Refugees Living in North Rhine-Westphalia, Germany. BMC Public Health, 21, Article No. 2233. https://doi.org/10.1186/s12889-021-12303-5
[5]
Cacioppo, J. T., Cacioppo, S., Capitanio, J. P., & Cole, S. W. (2015). The Neuroendocrinology of Social Isolation. Annual Review of Psychology, 66, 733-767. https://doi.org/10.1146/annurev-psych-010814-015240
[6]
Carrasco, M., Fernández, M., Alexander, E., & Herrera, M. (2021). Loneliness in Older Chilean People: Importance of Family Dysfunction and Depression. International Journal of Mental Health Promotion, 23, 99-109. https://doi.org/10.32604/ijmhp.2021.011568
[7]
Cudjoe, T. K. M., Selvakumar, S., Chung, S., Latkin, C. A., Roth, D. L., Thorpe, R. J. et al. (2022). Getting under the Skin: Social Isolation and Biological Markers in the National Health and Aging Trends Study. Journal of the American Geriatrics Society, 70, 408-414. https://doi.org/10.1111/jgs.17518
[8]
Czaja, S. J., Moxley, J. H., & Rogers, W. A. (2021). Social Support, Isolation, Loneliness, and Health among Older Adults in the PRISM Randomized Controlled Trial. Frontiers in Psychology, 12, Article ID: 728658. https://doi.org/10.3389/fpsyg.2021.728658
[9]
Deshmukh, M., & Martin, P. (2024). Relationship Between Loneliness and Self-Reported Health and Life Satisfaction among Older Adults. Innovation in Aging, 8, 255-255. https://doi.org/10.1093/geroni/igae098.0823
[10]
Freak-Poli, R., Ryan, J., Tran, T., Owen, A., McHugh Power, J., Berk, M. et al. (2021). Social Isolation, Social Support and Loneliness as Independent Concepts, and Their Relationship with Health-Related Quality of Life among Older Women. Aging & Mental Health, 26, 1335-1344. https://doi.org/10.1080/13607863.2021.1940097
[11]
Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J. et al. (2001). Frailty in Older Adults: Evidence for a Phenotype. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56, M146-M157. https://doi.org/10.1093/gerona/56.3.m146
[12]
Gierke, C., Navarro, C. F., Martinez, M., Delgado, C., Delano, P. H., Medel, V. et al. (2024). Characterization of Social Isolation and Perception of Loneliness in a Group of Chilean Older People Post‐Pandemic. Alzheimer’s & Dementia, 20, e089300. https://doi.org/10.1002/alz.089300
[13]
Guan, Z., Poon, A. W. C., & Zwi, A. (2023). Social Isolation and Loneliness in Family Caregivers of People with Severe Mental Illness: A Scoping Review. American Journal of Community Psychology, 72, 443-463. https://doi.org/10.1002/ajcp.12698
[14]
Güler, A., & Yıldırım, M. (2025). Social Isolation, Loneliness, Death Stress and Life Satisfaction in Older Adults: A Serial Mediation Study. Geriatric Nursing, 62, 78-85. https://doi.org/10.1016/j.gerinurse.2025.01.037
[15]
Hajek, A., Volkmar, A., & König, H. H. (2023). Prevalence and Correlates of Loneliness and Social Isolation in the Oldest Old: A Systematic Review, Meta-Analysis and Meta-Regression. Social Psychiatry and Psychiatric Epidemiology,60, 993-1015.
[16]
Hansen, T., & Slagsvold, B. (2016). Late-Life Loneliness in 11 European Countries: Results from the Generations and Gender Survey. Social Indicators Research, 129, 445-464. https://doi.org/10.1007/s11205-015-1111-6
[17]
Hao, H., Du, M., & Yue, J. (2024). Social Isolation, Loneliness, and Subjective Wellbeing among Chinese Older Adults during the COVID-19 Pandemic. Frontiers in Public Health, 12, Article ID: 1425575. https://doi.org/10.3389/fpubh.2024.1425575
[18]
Herrera, M. S., Elgueta, R., Fernández, M. B., Giacoman, C., Leal, D., Rubio, M., Marshall, P., & Bustamante, F. (2021). Calidad de vida de las personas mayores chilenas durante la pandemia COVID-19. https://sociologia.uc.cl/wp-content/uploads/2021/07/libro_calidad-de-vida-pm-y-covid-19-.pdf
[19]
Holt-Lunstad, J., Robles, T. F., & Sbarra, D. A. (2017). Advancing Social Connection as a Public Health Priority in the United States. American Psychologist, 72, 517-530. https://doi.org/10.1037/amp0000103
[20]
Hughes, M. E., Waite, L. J., Hawkley, L. C., & Cacioppo, J. T. (2004). A Short Scale for Measuring Loneliness in Large Surveys: Results from Two Population-Based Studies. Research on Aging, 26, 655-672. https://doi.org/10.1177/0164027504268574
[21]
INE (2023). Proyecciones de población por sexo y edad: Chile 2023-2050. Gobierno de Chile. https://www.ine.gob.cl/estadisticas/sociales/demografia-y-vitales/proyecciones-de-poblacion
[22]
INE (2024). Censo de población y vivienda de chile, 2024. Estadísticas. https://censo2024.ine.gob.cl/resultados/
[23]
Institute of Medicine (US), Division of Health Promotion and Disease Prevention (1992). Social Isolation Among Older Individuals: The Relationship to Mortality and Morbidity. In R. L. Berg, & Cassells, J. S. (Eds.), The Second Fifty Years: Promoting Health and Preventing Disability (pp. 243-262). National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK235604/
[24]
Kim, A., & Park, K. (2025). Development of Social Isolation and Social Network Assessment Tool for Older Adults: A Delphi Survey. PLOS ONE, 20, e0323198. https://doi.org/10.1371/journal.pone.0323198
[25]
Kotwal, A. A., Cenzer, I. S., Waite, L. J., Covinsky, K. E., Perissinotto, C. M., Boscardin, W. J. et al. (2021). The Epidemiology of Social Isolation and Loneliness among Older Adults during the Last Years of Life. Journal of the American Geriatrics Society, 69, 3081-3091. https://doi.org/10.1111/jgs.17366
[26]
Leach, R., Phillipson, C., Biggs, S., & Money, A. (2008). Sociological Perspectives on the Baby Boomers: An Exploration of Social Change. Quality of Ageing, 9, 19-26. https://doi.org/10.1108/14717794200800024
[27]
Lin, I., & Brown, S. L. (2012). Unmarried Boomers Confront Old Age: A National Portrait. The Gerontologist, 52, 153-165. https://doi.org/10.1093/geront/gnr141
[28]
Lissitsa, S., Zychlinski, E., & Kagan, M. (2021). The Silent Generation vs Baby Boomers: Socio-Demographic and Psychological Predictors of the “Gray” Digital Inequalities. Computers in Human Behavior, 128, Article 107098. https://doi.org/10.1016/j.chb.2021.107098
[29]
McPherson, M., Smith-Lovin, L., & Brashears, M. E. (2006). Social Isolation in America: Changes in Core Discussion Networks over Two Decades. American Sociological Review, 71, 353-375. https://doi.org/10.1177/000312240607100301
[30]
Mehrabi, F., & Béland, F. (2020). Effects of Social Isolation, Loneliness and Frailty on Health Outcomes and Their Possible Mediators and Moderators in Community-Dwelling Older Adults: A Scoping Review. Archives of Gerontology and Geriatrics, 90, Article 104119. https://doi.org/10.1016/j.archger.2020.104119
[31]
Miao, M., Fang, F., Lyu, J., Liu, Z., Wan, Z., Qin, L. et al. (2025). Relationships of Social Isolation and Loneliness with Healthy Aging among Older Adults. BMC Geriatrics, 25, Article No. 267. https://doi.org/10.1186/s12877-025-05941-6
[32]
Ministry of Health (2025). Database User Manual and Code Book. National Quality Survey Life and Health 2023-2024. Santiago de Chile. https://epi.minsal.cl/bases-de-datos
[33]
National Academies of Sciences, Engineering, and Medicine (2020). Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. The National Academies Press.
[34]
Nicholson, N. R. (2012). A Review of Social Isolation: An Important but Underassessed Condition in Older Adults. The Journal of Primary Prevention, 33, 137-152. https://doi.org/10.1007/s10935-012-0271-2
[35]
Observatorio del Envejecimiento (2025). Soledad no deseada y aislamiento social en la vejez: Prevalencia, factores de riesgo y estrategias de acción. año 6, v37. Centro de Estudios de Vejez y Envejecimiento de la Pontificia Universidad catóLica de Chile y, Compañía de Seguros con Futuro. https://observatorioenvejecimiento.uc.cl/wp-%20content/uploads/2025/05/Reporte-ODE-37-Soledad-no-Deseada-y-Aislamiento-Social-en-la-Vejez-Prevalencia-Factores-de-Riesgo-y-Estrategias-de-Accion.pdf
[36]
OECD (2023). Health at a Glance 2023: OECD Indicators. OECD Publishing.
[37]
Olivares-Tirado, P. (2026). Social Isolation and Loneliness among Community-Dwelling Older Chilean Adults: A Gender Perspective. Open Journal of Social Sciences, 14, 222-254. https://doi.org/10.4236/jss.2026.141016
[38]
Palladino, R., Tayu Lee, J., Ashworth, M., Triassi, M., & Millett, C. (2016). Associations between Multimorbidity, Healthcare Utilisation and Health Status: Evidence from 16 European Countries. Age and Ageing, 45, 431-435. https://doi.org/10.1093/ageing/afw044
[39]
Pan, C., Ye, J., Yu, L., & Cao, N. (2025). Reciprocal Associations between Social Isolation and Self-Rated Health among Older Adults in China: Findings from the China Longitudinal Aging Social Survey (2018-2020). Archives of Public Health, 83, Article No. 282. https://doi.org/10.1186/s13690-025-01764-4
[40]
Pilehvari, A., You, W., & Lin, X. (2023). Retirement’s Impact on Health: What Role Does Social Network Play? European Journal of Ageing, 20, Article No. 14. https://doi.org/10.1007/s10433-023-00759-w
[41]
Pollak, C., Pham, Y., Ehrlich, A., Verghese, J., & Blumen, H. M. (2025). Loneliness and Social Isolation Risk Factors in Community-Dwelling Older Adults Receiving Home Health Services. BMC Geriatrics, 25, Article No. 290. https://doi.org/10.1186/s12877-025-05947-0
[42]
Pomeroy, M. L., Umoh, M., Qian, Y., Gimm, G., Ornstein, K. A., & Cudjoe, T. K. M. (2024). Social Isolation and Hospitalization in Community-Dwelling Older Adults by Dementia Status. The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 79, glae224. https://doi.org/10.1093/gerona/glae224
[43]
Prince, M., Comas-Herrera, A., Knapp, M., Guerchet, M., & Karagiannidou, C. (2015). The Global Impact of Dementia: An Analysis of Prevalence, Incidence, Cost and Trends. World Alzheimer Report 2015, Alzheimer’s Disease International. https://www.alzint.org/u/WorldAlzheimerReport2015.pdf
[44]
Puyané, M., Chabrera, C., Camón, E., & Cabrera, E. (2025). Uncovering the Impact of Loneliness in Ageing Populations: A Comprehensive Scoping Review. BMC Geriatrics, 25, Article No. 244. https://doi.org/10.1186/s12877-025-05846-4
[45]
Rico-Uribe, L. A., Caballero, F. F., Olaya, B., Tobiasz-Adamczyk, B., Koskinen, S., Leonardi, M. et al. (2016). Loneliness, Social Networks, and Health: A Cross-Sectional Study in Three Countries. PLOS ONE, 11, e0145264. https://doi.org/10.1371/journal.pone.0145264
[46]
Russell, D., Peplau, L. A., & Cutrona, C. E. (1980). The Revised UCLA Loneliness Scale: Concurrent and Discriminant Validity Evidence. J Pers Soc Psychol., 39, 472-480.
[47]
Santini, Z. I., Jose, P. E., York Cornwell, E., Koyanagi, A., Nielsen, L., Hinrichsen, C. et al. (2020). Social Disconnectedness, Perceived Isolation, and Symptoms of Depression and Anxiety among Older Americans (NSHAP): A Longitudinal Mediation Analysis. The Lancet Public Health, 5, e62-e70. https://doi.org/10.1016/s2468-2667(19)30230-0
[48]
Sorinmade, O., Elugbadebo, O., & Peisah, C. (2025). Ensuring Dignity in an Ageing World: Improving Care through a Human Rights Approach. Academia Mental Health and Well-Being, 2, 1-7. https://doi.org/10.20935/mhealthwellb8053
[49]
Steptoe, A., & Kivimäki, M. (2013). Stress and Cardiovascular Disease: An Update on Current Knowledge. Annual Review of Public Health, 34, 337-354. https://doi.org/10.1146/annurev-publhealth-031912-114452
[50]
Svensson, M., Rosso, A., Elmståhl, S., & Ekström, H. (2022). Loneliness, Social Isolation, and Health Complaints among Older People: A Population-Based Study from the “Good Aging in Skåne (GÅS)” Project. SSM-Population Health, 20, Article 101287. https://doi.org/10.1016/j.ssmph.2022.101287
[51]
Teo, R. H., Cheng, W. H., Cheng, L. J., Lau, Y., & Lau, S. T. (2023). Global Prevalence of Social Isolation among Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis. Archives of Gerontology and Geriatrics, 107, Article 104904. https://doi.org/10.1016/j.archger.2022.104904
[52]
Uchino, B. N. (2006). Social Support and Health: A Review of Physiological Processes Potentially Underlying Links to Disease Outcomes. Journal of Behavioral Medicine, 29, 377-387. https://doi.org/10.1007/s10865-006-9056-5
[53]
UN (2020). Resolution 75/131: United Nations Decade for Healthy Ageing. https://docs.un.org/en/A/RES/75/131
[54]
UN (2022). United Nations Decade for Healthy Ageing:2021-2030. The Platform. https://www.decadeofhealthyageing.org/
[55]
Warren, A. (2025). Loneliness as a Driver of Allostatic Load: Mechanisms Linking Social Disconnection to Physiological Dysregulation and Health Disparities. Stress, 28, Article 2594067. https://doi.org/10.1080/10253890.2025.2594067
[56]
WHO (2020a). Decade of Healthy Ageing: Plan of Action. https://www.who.int/publications/m/item/decade-of-healthy-ageing-plan-of-action
[57]
WHO (2020b). Guidelines on Physical Activity and Sedentary Behaviour. World Health Organization. https://www.who.int/publications/i/item/9789240015128
[58]
WHO (2021). Social Isolation and Loneliness among Older Adults [Advocacy Brief]. United Nations Department of Economic and Social Affairs. https://www.who.int/publications/i/item/9789240030749
[59]
WHO (2024). Ageing and Health. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
[60]
WHO (2025). From Loneliness to Social Connection: Charting a Path to Healthier Societies. Report of the WHO Commission on Social Connection. https://www.who.int/publications/i/item/978240112360
[61]
Wong, E. L., Qiu, H., Cheung, A. W., Leung, H. H., Chen, F. Y., & Yeoh, E. (2023). Association of Social Isolation with Health Status among Community-Dwelling Chinese Older Adults Living with Homecare Services: A Cross-Sectional Survey in Hong Kong. Frontiers in Public Health, 11, Article ID: 1099734. https://doi.org/10.3389/fpubh.2023.1099734
[62]
Xia, N., & Li, H. (2018). Loneliness, Social Isolation, and Cardiovascular Health. Antioxidants & Redox Signaling, 28, 837-851. https://doi.org/10.1089/ars.2017.7312
[63]
Yang, R., Wang, H., Edelman, L. S., Tracy, E. L., Demiris, G., Sward, K. A. et al. (2020). Loneliness as a Mediator of the Impact of Social Isolation on Cognitive Functioning of Chinese Older Adults. Age and Ageing, 49, 599-604. https://doi.org/10.1093/ageing/afaa020
[64]
Yildirimer, K. S. (2025). On the Threshold of Social Erosion: The Dynamic of Sociological and Psychological Collapse. IRASS Journal of Arts, Humanities and Social Sciences, 2, 155-160. https://irasspublisher.com/assets/articles/1753113061.pdf
[65]
Zavaleta, D., Samuel, K., & Mills, C. T. (2017). Measures of Social Isolation. Social Indicators Research, 131, 367-391. https://doi.org/10.1007/s11205-016-1252-2
[66]
Zhang, Y., Hu, W., & Feng, Z. (2021). Social Isolation and Health Outcomes among Older People in China. BMC Geriatrics, 21, Article No. 721. https://doi.org/10.1186/s12877-021-02681-1
