Introduction

Social isolation may be prevented by defining risk factors in seniors and leading them to suitable resources. Social isolation is defined as the condition of reduced social belonging, reduced responsibility towards other people, social contact of a very low level, lacking in relationship quality and fulfillment (1). Health level of people suffering from social isolation is poor and it is reported that they benefit less from interventions such as cardiovascular surgery. Additionally, it has been stated that there might be a correlation between social isolation and mental health, distress, dementia, suicide and premature death (2). There is a key correlation between social isolation and personal relationships. Other areas with correlation include characteristic networks such as friendly neighborliness, social acceptance, and geographical location, living solitary or homeless, and ethnic origin. Physical and mental health levels are both pre-indicators of social isolation due to loss of communication.

Theoretically, social isolation is considered to have two dimensions: emotional isolation and social isolation. Emotional isolation is the lack of emotional connection to other, the prevention of social bonds demanded instinctively. Social isolation may be conceptualized as the individual having no accepted place in society, and emotional isolation as the individual having no loving object in their life. The social isolation dimension features the lack of a socially recognized role in society, and emotional isolation features the lack of social and emotional relationships (3).

Loneliness and Social Isolation

According to Mullins and McNicholas (4), “While many isolated individuals do not feel themselves lonely, many individuals integrated in society do. For this reason, the concepts of isolation and loneliness do not overlap.” Social inclusion occurs due to the lack of an acceptable social network. However, this is not perceived negatively for the elderly who can have fun and productive time on their own.

Isolation may also be defined as the process of people losing their contacts with other social resources or their willingness to participate (5). While isolation and loneliness do not have a direct connection, many similar factors are related to both. Those include living alone, never having been married, being a widow (er), advanced age and bad health conditions (6). The study carried out by Edelbrock et al. (7) states losses (of many kinds), poor physical health, mental diseases, low morale, having a caretaker, geographic location, and the difficulties of communication and transportation as the factors aggravating social isolation.

Adapting to social life and having a successful aging process are more frequent among well-educated individuals. It is found out that, for seniors, living with their family is not sufficient for being happy, as 45% of seniors are happy in family, while 55% feel sad and lonely, therefore these feelings may be considered to be issues related to aging (8). Studies suggest that individuals with no spouse are more inclined to an isolated life compared to those who do. It is also proven that seniors living in nursing homes feel more desperate compared to their coevals living with their families (9). The negative effects of living alone to the individual’s life are lack of confidence, fear, depression, longing for close relationships and future anxiety. The process of seniors making sense of life mostly depends on their togetherness with their families, spouses, and children. Seniors express their longing for a crowded house, children and a warm family environment. People in the later periods of life desire being together with their family members and coevals, they develop bonds with family, relatives and kin much more than they do in their youth and adulthood (10).

Reasons for Social Isolation

Social isolation has been corrected as a widespread problem in 10-43% of the population, which leads to physical and mental health problems among the elderly in the community. Social isolation is a grave and widespread problem among seniors in society causing many harmful health conditions. Social isolation that affects health, wellbeing and life quality among many seniors occurs in high prevalence and it is expected that this risk would increase in line with the globally increasing senior population (11). Social isolation among seniors has many negative effects increasing risk factors of mortality, readmission to hospital and frequent falling.

Generally, as the effects of social isolation, mortality, falling, readmission to hospital and institutional care. Furthermore, social isolation affects seniors’ health related and behavioral habits. A senior person having a social network affects their health positively by preventing risky behaviors or adapting them to their medical care (12). Seniors in lack of social networks are at risk regarding negative behaviors such as excessive alcohol and tobacco consumption and a sedentary life. Additionally, socially isolated seniors have an increased risk of malnutrition (13). Social inclusion is also deemed to affect the psychological and cognitive wellbeing among seniors. There has been an increased risk of cognitive downfall among seniors with weak social ties, not participating in social activities (14). The study carried out by Giles et al. (15) reports that social networks with high number of members are protective against mortality. Faulkner (16) reveals that the number of falling among socially isolated seniors has increased. Socially isolated seniors are readmitted to hospital four-five times a year after their first admission (17).

Social Exclusion: A Different Facet of Social Isolation

The concept of social exclusion may be useful in explaining seniors being away from the society and feeling themselves lonely. Social exclusion is defined as the condition of being deprived from civil, political, economic and social citizenship rights (18). Social exclusion signifies a “dynamic” process of being partially or fully deprived of social, economic, political and cultural platforms that provide with the individual’s integration to society (19).

Risk Factors and Frequency

The prevalence of social isolation among seniors is considered to be between 3-25%. While there have been many published scales measuring social isolation, these are generally long scales with multiple structure designs (Beck, UCLA, HRQoL). “The Friendship Scale” is, on the other hand, a scale prepared for this objective, with proven credibility and easily applicable to seniors. According to the studies made with assessment scales, the prevalence rate is found to be 7-9%, while evidence suggests that it should be much higher in senior life, 1/3 or higher. This shows that some seniors are unwilling to admit their loneliness unless it is in an apparent or serious level (20).

Social Isolation in Special Cases

Social Isolation in Senior Women

In many countries, (particularly 60-80 years old) senior women express more loneliness than their male coevals (12%). Pinquart and Sorensen (21), in their study, report over 75 years old loneliness 38% in women, and 24% in men. The cognitive frame of loneliness is defined by De Jong Gierveld and Van Tilburg (22) especially senior women’s lives; experiences such as widowhood, chronic diseases and immigration create suitable conditions for loneliness.

High level loneliness not only affects life quality in women, but also affects cardiovascular health negatively as it increases the coronary disease risk (23).

Social Isolation in Cancer Patients

Factors related to cancer, such as cancerous area, stage of the disease is not related with the level of loneliness (24). No factor related to cancer is completely demonstrated to be related to increasing loneliness. However, there is a reported indication on gradual increase of loneliness after being diagnosed as a cancer patient (25).

Social Isolation among Senior with Mental Diseases

Adapting to social life and having a successful aging process are more frequent among well-educated individuals. Elder, desperate and lonely people carry the highest risk of depression and suicide (26). DiNapoli et al. (27) show that social isolation has a positive correlation with general and specific cognitive fields.

Social Isolation among Internet-using Seniors

Lower levels of social isolation are observed especially among seniors who use the Internet in order to communicate with their relatives and friends, while seniors using the Internet to meet new people face higher emotional isolation. Internet may help people keep their social family ties. Whether the Internet use may increase or decrease social and psychological benefits is under discussion in the literature (28). Some scholars state that the use of Internet has positive effects on persons and groups as it supports our communicative skills by keeping social communication despite geographic restraints (29). The study carried out by Sum et al. (30) reports that social isolation among seniors decreases as the use of Internet as a means of communication increases.

Religion and Social Isolation among Seniors

People who attend religious activities feel compelled to be gentle to their friends as they expect kindness based on self-sacrifice and mutuality. Being supported and encourage by the environment in a negative environment makes a great impact as an initial form of therapy. Being called or visited by friends in cases of not being able to attend the mosque may also develop feel of religious belonging in seniors (31). Rote et al. (32) state that participating in religious activities go hand in hand with social participation and support and this would decrease the level of loneliness.

Social Isolation among Productive Seniors

Working is a source of social relationships. People who work enrich their life experience through interaction with the world, acquire new ideas, express their ideas, test their views on themselves against the world and mature (33). The senior individual with reduced or perished productivity feels alone due to feelings of having no function and worthlessness, thus their psyche is affected negatively. Studies show that the majority of the seniors living in health and care institutions feel depressive emotions and therefore constitute a risk group. Also, hopelessness is a frequent emotion among seniors (34). Activities suitable for seniors such as sport, group therapy, activity therapy would render them more active and raise their hope as well as their conduct of life. The study carried out by İlhan et al. (35) reports that age, except health issues, does not affect seniors’ productivity, and individuals could endure their productivity until the end of their lives.

Social Isolation in Underprivileged Seniors

Poverty is the most visible facet of social exclusion. Poverty can be a type of social exclusion, as well as the reason for it. Poverty is related to income and can be measured, albeit relatively the elders in our country are obliged to have a more restricted life compared to their coeval seniors in socially developed countries (36). Seniors who cannot afford or have difficulties in affording their basic needs such as housing, nourishment, clothing and treatment are deprived of the necessary income to be integrated into the society, participate in social and cultural activities, and pursue a productive life. This restricts their relationship with the social life (37).

Solutions and Suggestions

Adams et al. (38), suggest, in order to prevent isolation in seniors, methods such as participating in activity groups with other people in society, adult education courses, penmanship, telephone support programs, visit programs, and social clubs. Other methods feature contact with youth (especially children) and animals. Transportation and increase in physical activities are incentives that support both mental and physical health. Hicks (39) states that using friends and family as emotional resources, participating in catered occasions to continue social contact, being involved in certain productive one-person activities such as reading and gardening reduce loneliness. Specific educational and social group activities may also reduce social isolation and loneliness among seniors. The efficiency of house visits and friendship schemes is still uncertain (40). It should not be forgotten that encouraging seniors to share their experiences to and continue producing as long as possible is important socially and for their contribution to the economy (41).

Based on all this information, following suggestions are developed for the resolution of poverty and loneliness in seniors.

• In order to increase the frequency of social activities that are proven to have a positive effect on life quality, the institutions where seniors live collectively should be motivated and the participants should take active roles in society.

• Researches on defining seniors’ nationwide poverty and loneliness level, as well as their needs, should be conducted, projects should be developed, and the seniors should be included within care insurance like other age groups to ensure their health and social security of the highest level.

• There should be a viable and regular social aid mechanism for people under threat of social isolation. Healthy aging strategies can be implemented to include more seniors in social and economic life.

• Far-reaching events targeting seniors and strong social ties encourage personal strengthening.

• Regulating public transportation according to senior-friendly city criteria can increase seniors’ participation in society.

• It is important to develop and pursue rehabilitation exercise programs aiming to resolve social isolation (42).

Ethics

Peer-review: Externally peer-reviewed.

Authorship Contributions

Surgical and Medical Practices: E.P., Concept: E.P., R.Ç.A., Design: E.P., R.Ç.A., Data Collection or Processing: E.P., Analysis or Interpretation: E.P., R.Ç.A., Literature Search: E.P., R.Ç.A., Writing: E.P.

Conflict of Interest: No conflict of interest was declared by the authors.

Financial Disclosure: The authors declared that this study received no financial support.