Why Loneliness Interventions Are Unsuccessful: A Call for Precision Health

Abstract

Background: Loneliness has drawn increasing attention over the past few decades due to rising recognition of its close connection with serious health issues, like dementia. Yet, researchers are failing to find solutions to alleviate the globally experienced burden of loneliness.

Purpose: This review aims to shed light on possible reasons for why interventions have been ineffective. We suggest new directions for research on loneliness as it relates to precision health, emerging technologies, digital phenotyping, and machine learning.

Results: Current loneliness interventions are unsuccessful due to (i) their inconsideration of loneliness as a heterogeneous construct and (ii) not being targeted at individuals' needs and contexts. We propose a model for how loneliness interventions can move towards finding the right solution for the right person at the right time. Taking a precision health approach, we explore how transdisciplinary research can contribute to creating a more holistic picture of loneliness and shift interventions from treatment to prevention.

Conclusions: We urge the field to rethink metrics to account for diverse intra-individual experiences and trajectories of loneliness. Big data sharing and evolving technologies that emphasize human connection raise hope for realizing our model of precision health applied to loneliness. There is an urgent need for precise, integrated, and theory-driven interventions that focus on individuals' needs and the subjective burden of loneliness in the ageing context.

Keywords: cognitive decline; dementia; healthy ageing; intervention research; isolation; long-term care; person-centered care; prevention; social relationships; technology.

Figure 1.

Possible interacting mechanisms of the loneliness-health cycle with the example of Alzheimer’s disease (AD). Bidirectional relationships between these constructs depict the complexity of how loneliness interacts with physical health. Light blue arrows indicate unidirectional pathways from AD to loneliness. Red arrows indicate unidirectional pathways from loneliness to AD, and green arrows indicate bidirectional pathways moderated by physical health and potential biomarkers.

Figure 2.

Precision Health Interventions for Loneliness. Interventions (i₁, i₂, i_n) need to be tailored to individuals’ (p₁, p₂, p_n) needs and situation. Individuals’ needs can relate to their personal resources (micro level), their social environment (meso level), and other interconnected factors, which are indirectly associated with loneliness (macro level). Indeed, interventions can be integrated to address needs on all three levels. Green arrows indicate that all levels influence each other, thus, are not distinct.

Figure 3.

Interventions targeted at reducing loneliness across different time stages of AD onset. Loneliness can occur at any timepoint, whereas functional ability declines with AD onset. The three levels (see Figure 2) can address loneliness and functional ability differently across time. The primary focus lies on prevention through personal resources (micro), social environments (meso), and health services (macro).