A Social Model of Loneliness: The Roles of Disability, Social Resources, and Cognitive Impairment

Abstract

Purpose of the studyWe consider the points at which cognitive impairment may impact on the pathway to loneliness for older people, through impeding social interaction with family and friends, or by interfering with judgments concerning satisfaction with relationships.Design and methodsWe conceptualize a mediation model anticipating that social resources (LSNS-6) will mediate the pathway between disability (Townsend Disability Scale) and loneliness (De Jong Gierveld 6-item scale) and a moderated-mediation model in which we hypothesize that cognitive impairment (MMSE) will moderate the association between disability and social resources and between social resources and loneliness. To validate the hypothesized pathways, we draw on the CFAS Wales data set (N = 3,593) which is a nationally representative study of community-dwelling people aged 65 and older in Wales.ResultsDisability had a significant indirect effect on loneliness through the mediating variable social resources. Cognitive impairment was significantly associated with social resources, but did not moderate the relationship between disability and social resources. Cognitive impairment had a significant impact on loneliness, and moderated the effect of social resources on loneliness.ImplicationsSocial structures can (dis)empower people with cognitive impairment and lead to exclusion from social resources or impact on the social construction of aging, cognitive impairment, and dementia. The sense of self for an older person with cognitive impairment may be influenced by social norms and stereotypes, or through a temporal social comparison with an “earlier” sense of self. We conclude that loneliness interventions should be theoretically informed to identify key areas for modification.

A critical review and development of a conceptual model of exclusion from social relations for older people

“…Therefore, it is essential to understand the circumstances under which older people are able to manage losses and experience good outcomes. Despite a corpus of research on cognitive processes including automatic comparison (Mussweiler et al 2004), unrealistic optimistic comparison (Bortolotti and Antrobus 2015) and resilience (Aburn et al 2016), theoretical and measurement models have not considered the moderating or mediating effect of psychological processes on the pathway between exclusion from social relations and outcomes for older people (for exceptions see, Burholt and Scharf 2014;Burholt et al 2016c), and further research is required in this area.…”

“…For example, the evidence reviewed indicated that a clinical feature of dementia is a decline in social cognition including recognition of emotions (American Psychiatric Association 2013) and insight which in turn may contribute to a decline in social relations. However, the observed decline in social functioning is unlikely to be due to brain injury alone, but is also influenced by social dynamics such as cultural values, environmental accessibility and discrimination, psychological resources and socio-emotional processes such as sense of control or resilience (Burholt et al 2016c). Conversely, other reviews of research studies have demonstrated that loneliness (an outcome of exclusion from social relations) can lead to impaired cognitive function and decline over time (Cacioppo and Hawkley 2009;Hawkley and Cacioppo 2010).…”

“…Upward, downward or lateral comparison may not involve deliberate selection of a similar standard, but instead automatic selection can be representative of an extreme state. Consequently, dominant negative societal discourses about ageing, or diseases associated with old age, may be internalized and self-evaluations assimilated towards this stereotype (Burholt et al 2016c). Neither automatic comparison (Mussweiler et al 2004) nor unrealistic optimistic social comparison (Bortolotti and Antrobus 2015) is likely to yield useful information, and in the case of expectations, social relations may contribute to poor outcomes for older people.…”

“…Neither automatic comparison (Mussweiler et al 2004) nor unrealistic optimistic social comparison (Bortolotti and Antrobus 2015) is likely to yield useful information, and in the case of expectations, social relations may contribute to poor outcomes for older people. Additionally, cognitive processes (cognitive impairment, depression, anosognosia) may hamper optimal regulation through social comparison (Burholt and Scharf 2014;Burholt et al 2016c).…”

“…Similarly, experiences of racial discrimination (Burholt et al 2016a;Viruell-Fuentes et al 2012), homophobia and heterosexism (Butler 2017;Villar et al 2014) and the stigmatization of certain disabilities [e.g. dementia (Burholt et al 2016c)] impact on social participation, social relations, and distal outcomes.…”