An integrative review of loneliness and quality of life in older adults who lived alone during COVID-19: considerations for supporting reconnection

Loneliness and decreased quality of life are associated with decreased life expectancy and are regarded as serious health concerns. Understanding the impact of the pandemic on older adults living alone is essential for informing strategies to decrease loneliness and improve quality of life following the COVID-19 pandemic and in future crises. This integrative review aimed to synthesise the qualitative and quantitative evidence on the factors of the pandemic that influenced loneliness and quality of life of older adults living alone, and examine associated interventions to support this population. An integrative review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Six databases (CINAHL Plus, MEDLINE with Full Text, APA PSYCArticles, Psychology & Behavioral Sciences Collection, Academic Search Premier and Proquest Coronavirus Research Database) were searched in February 2024 for peer-reviewed studies on community-dwelling older adults (60+) living alone during COVID-19. Screening and selection were completed in Covidence. The review included 53 articles (39 quantitative, 11 qualitative, and three mixed-methods) published between 2020 and 2023. Study quality was appraised using the Mixed Methods Appraisal Tool. Data were extracted into Excel and synthesised narratively across quantitative, qualitative, and mixed-methods studies to identify factors influencing loneliness, quality of life, and related interventions. Most studies were based on cross-sectional data and represented a broad international experience. Most studies reported increased loneliness and worsened quality of life during the pandemic. Loneliness was associated with isolation, intolerance of uncertainty and anxiety, however being accustomed to isolation, unity through adherence to pandemic measures, and socialising with neighbours were protective factors. Worsened quality of life was associated with poor sleep patterns, stigmatisation from being labelled as an ‘at risk’ population and feeling imprisoned at home. Protective factors included an appreciation for activities and connections, fostering creativity, engaging in hobbies and learning new skills. Lastly, interventions utilised technology via phone calls and socially assisted robots and were shown to help older adults. Additional meaningful, engaging and accessible strategies are needed to support older adults who live alone during crises. This integrative review offers insight into global experiences of loneliness and quality of life among older adults living alone during the COVID-19 pandemic, with suggestions for effective intervention strategies.