Social loneliness in older adults in rural communities in Ecuador: predictive factors and associated clinical characteristics
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Abstract
Introduction. Loneliness and social isolation are growing public health problems among older adults, especially in rural areas. In Ecuador, this vulnerability is exacerbated by limited access to health services, socioeconomic conditions, and the loss of support networks. The construct of “Social Loneliness” integrates the subjective and objective dimensions of the deterioration of social relationships. Objective. Define the predictors of Social Loneliness among older adults living in rural areas of Ecuador and analyze cognitive, emotional, and functional differences according to the participants’ level of Social Loneliness. Methodology. A cross-sectional study involving 316 older adults aged 65 and older, selected through non-probabilistic convenience sampling in rural communities in Ecuador. A medical history and comprehensive geriatric assessment were conducted. Social loneliness was assessed using the ESTE-R Scale and its four dimensions: familial, marital, social, and existential loneliness. Depression was assessed using the Yesavage Scale, cognitive status using the Mini-Mental State Examination (MMSE), and functional capacity using the Lawton and Brody Scale. Results. The main predictors were: Total loneliness (R²=0.517), existential crisis (β=0.686), living arrangement (β=-0.168), and gender (β=-0.149); Marital loneliness (R²=0.240), living arrangement (β = −0.384), and gender (β = −0.199); family loneliness (R² = 0.126), existential crisis (β = 0.300); and social loneliness (R² = 0.031), existential crisis (β = 0.138) (all p < 0.05). Participants with higher levels of social loneliness exhibited more depressive symptoms, greater existential crisis, and poorer cognitive performance (all p<0.05). Conclusion. Existential crisis was the main predictor of social loneliness among older adults in rural Ecuador. These findings support the development of preventive strategies aimed at the early identification of individuals at higher risk of unwanted loneliness. General area of study: Health Sciences. Specific area of study: Gerontology. Type of article: original.
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Axén, A., Taube, E., Sanmartin Berglund, J., & Skär, L. (2023). Loneliness in relation to social factors and self-reported health among older adults: a cross-sectional study. Journal of Primary Care & Community Health, 14, 21501319231198644. https://doi.org/10.1177/21501319231198644
Barnes, T. L., MacLeod, S., Tkatch, R., Ahuja, M., Albright, L., Schaeffer, J. A., & Yeh, C. S. (2022). Cumulative effect of loneliness and social isolation on health outcomes among older adults. Aging & Mental Health, 26(7), 1327–1334. https://doi.org/10.1080/13607863.2021.1940096
Carrasco, P. M., Prada Crespo, D., Reinoso García, A. I., Lozano Ibáñez, M., Montejo Rubio, B., & Montenegro-Peña, M. (2024). Predictive factors and risk and protection groups for loneliness in older adults: a population-based study. BMC Psychology, 12(1), 238. https://doi.org/10.1186/s40359-024-01708-7
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, 728658. https://doi.org/10.3389/fpsyg.2021.728658
Deng, S., Guo, Z., He, S., & Sun, X. (2025). Social isolation and cardiometabolic burden synergistically predict physical dysfunction in aging Chinese adults: evidence of risk thresholds and the mediating role of frailty. PLOS ONE, 20(10), e0335467. https://doi.org/10.1371/journal.pone.0335467
Dziedzic, B., Idzik, A., Kobos, E., Sienkiewicz, Z., Kryczka, T., Fidecki, W., & Wysokiński, M. (2021). Loneliness and mental health among the elderly in Poland during the COVID-19 pandemic. BMC Public Health, 21(1), 1976. https://doi.org/10.1186/s12889-021-12029-4
Freak-Poli, R., Wagemaker, N., Wang, R., Lysen, T. S., Ikram, M. A., Vernooij, M. W., Dintica, C. S., Vernooij-Dasseng, M., Melis, R. J. F., Laukka, E. J., Fratiglioni, L., Xu, W., & Tiemeier, H. (2022). Loneliness, not social support, is associated with cognitive decline and dementia across two longitudinal population-based cohorts. Journal of Alzheimer’s Disease, 85(1), 295–308. https://doi.org/10.3233/JAD-210330
Gao, Q., Chua, K. C., Mayston, R., & Prina, M. (2024). Longitudinal associations of loneliness and social isolation with care dependence among older adults in Latin America and China: a 10/66 dementia research group population-based cohort study. International Journal of Geriatric Psychiatry, 39(7), e6115. https://doi.org/10.1002/gps.6115
Ge, L., Yap, C. W., & Heng, B. H. (2022). Associations of social isolation, social participation, and loneliness with frailty in older adults in Singapore: a panel data analysis. BMC Geriatrics, 22(1), 26. https://doi.org/10.1186/s12877-021-02745-2
Jia, Y., Yue, Y., & Sheng, Y. (2025). The mediating role of aging attitudes between social isolation and self-neglect: a cross-sectional study of older adults living alone in rural China. BMC Nursing, 24(1), 4. https://doi.org/10.1186/s12912-024-02637-x
Kammar-García, A., Ramírez-Aldana, R., Roa-Rojas, P., Lozano-Juárez, L. R., Sánchez-García, S., Tella-Vega, P., & García-Peña, C. (2023). Association of loneliness and social isolation with all-cause mortality among older Mexican adults in the Mexican health and aging study: a retrospective observational study. BMC Geriatrics, 23(1), 45. https://doi.org/10.1186/s12877-023-03750-3
Kino, S., Stickley, A., Arakawa, Y., Saito, M., Saito, T., & Kondo, N. (2023). Social isolation, loneliness, and their correlates in older Japanese adults. Psychogeriatrics: the official journal of the Japanese Psychogeriatric Society, 23(3), 475–486. https://doi.org/10.1111/psyg.12957
Kotwal, A. A., Cenzer, I. S., Waite, L. J., Covinsky, K. E., Perissinotto, C. M., Boscardin, W. J., Hawkley, L. C., Dale, W., & Smith, A. K. (2021). The epidemiology of social isolation and loneliness among older adults during the last years of life. Journal of the American Geriatrics Society, 69(11), 3081–3091. https://doi.org/10.1111/jgs.17366
Lee, J. H., Sutin, A. R., Hajek, A., Karakose, S., Aschwanden, D., O'Súilleabháin, P. S., Stephan, Y., Terracciano, A., & Luchetti, M. (2025). Loneliness and cognition in older adults: a meta-analysis of harmonized studies from the United States, England, India, China, South Africa, Mexico, and Chile. Psychological Medicine, 55, e58. https://doi.org/10.1017/S003329172500011X
Lin, Q., Dadar, M., Oliver, M., Barnes, L. L., & Morrison, C. (2025). Exploring the influence of loneliness on cognitive decline: differential effects in black and white older adults. The journals of gerontology. Series B, Psychological sciences and social sciences, 80(11), gbaf156. https://doi.org/10.1093/geronb/gbaf156
Liu, X., Zhang, Y., Wu, J., Zeng, Y., Guo, L., & Ye, B. (2025). Latent profiles and transitions of social isolation among older adults and their influencing factors: a person-centered approach. Frontiers in public health, 13, 1475951. https://doi.org/10.3389/fpubh.2025.1475951
Lyu, C., Siu, K., Xu, I., Osman, I., & Zhong, J. (2024). Social isolation changes and long-term outcomes among older adults. JAMA Network Open, 7(7), e2424519. https://doi.org/10.1001/jamanetworkopen.2024.24519
Moretti, M. C., Bonfitto, I., Nieddu, L., Leccisotti, I., Dimalta, S., Moniello, G., Lozupone, M., Bellomo, A., Panza, F., Avolio, C., & Altamura, M. (2024). Association of loneliness with functional and cognitive status in minor and major neurocognitive disorders. Life, 14(10), 1216. https://doi.org/10.3390/life14101216
Müller, F., Röhr, S., Reininghaus, U., & Riedel-Heller, S. G. (2021). Social isolation and loneliness during COVID-19 lockdown: associations with depressive symptoms in the German old-age population. International Journal of Environmental Research and Public Health, 18(7), 3615. https://doi.org/10.3390/ijerph18073615
Ng, T. K. S., Beck, T., Dennis, K. R., Desai, P., Krueger, K., Dhana, K., Wilson, R. S., Evans, D. A., & Rajan, K. B. (2025). Social isolation, loneliness, and their joint effects on cognitive decline and incident Alzheimer's disease: findings from the Chicago health and aging project. The Journal of Prevention of Alzheimer's Disease, 12(3), 100046. https://doi.org/10.1016/j.tjpad.2024.100046
Noguchi, T., Saito, M., Aida, J., Cable, N., Tsuji, T., Koyama, S., Ikeda, T., Osaka, K., & Kondo, K. (2021). Association between social isolation and depression onset among older adults: a cross-national longitudinal study in England and Japan. BMJ Open, 11(3), e045834. https://doi.org/10.1136/bmjopen-2020-045834
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(1), 282. https://doi.org/10.1186/s13690-025-01764-4
Pavlidis, G. (2025). Exclusionary states in older age and their temporary effects on cognitive decline. BMC Psychology, 13(1), 264. https://doi.org/10.1186/s40359-025-02574-7
Pecchinenda, A., Yankouskaya, A., Boccia, M., Piccardi, L., Guariglia, C., & Giannini, A. M. (2024). Exploring the relationship between perceived loneliness and subjective cognitive decline in older individuals. Aging & Mental Health, 28(1), 73–82. https://doi.org/10.1080/13607863.2023.2242291
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(1), 290. https://doi.org/10.1186/s12877-025-05947-0
Prada Crespo, D., Montejo Carrasco, P., Díaz-Mardomingo, C., Villalba-Mora, E., & Montenegro-Peña, M. (2024). Social loneliness in older adults with mild cognitive impairment: predictive factors and associated clinical characteristics. Journal of Alzheimer’s Disease, 97(2), 697–714. https://doi.org/10.3233/JAD-230901
Ramírez López, A. B., Rodríguez-Agudelo, Y., Paz-Rodríguez, F., Tafoya, S. A., Guerrero López, B., & Díaz Olavarrieta, C. (2024). The role of functional deficits, depression, and cognitive symptoms in the perceived loneliness of older adults in Mexico City. International Journal of Environmental Research and Public Health, 21(8), 977. https://doi.org/10.3390/ijerph21080977
Southerland, J. L., Zheng, S., Dodson, K., Mauck, E., Bacsu, J. R., Brown, M. J., Holloway, J., Kim, S. M., Malatyali, A., & Smith, M. L. (2024). Social isolation and loneliness prevention among rural older adults aging-in-place: a needs assessment. Frontiers in public health, 12, 1404869. https://doi.org/10.3389/fpubh.2024.1404869
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(101287), 101287. https://doi.org/10.1016/j.ssmph.2022.101287
Wang, Z., Jin, Y., Tian, W., & Zhou, X. (2025). The various effect of social isolation on depression risk among old population in China during covid-19 pandemic: a population-based survey. PLOS One, 20(6), e0325595. https://doi.org/10.1371/journal.pone.0325595
Wei, K., Liu, Y., Yang, J., Gu, N., Cao, X., Zhao, X., Jiang, L., & Li, C. (2022). Living arrangement modifies the associations of loneliness with adverse health outcomes in older adults: evidence from the CLHLS. BMC Geriatrics, 22(1), 59. https://doi.org/10.1186/s12877-021-02742-5
Wu, Y., Su, B., Chen, C., Zhao, Y., Zhong, P., & Zheng, X. (2023). Urban-rural disparities in the prevalence and trends of depressive symptoms among Chinese elderly and their associated factors. Journal of Affective Disorders, 340, 258–268. https://doi.org/10.1016/j.jad.2023.07.117
Zhao, Y., Huo, X., Du, H., Lai, X., Li, Z., Zhang, Z., & Yang, L. (2025). Moderating effect of instrumental activities of daily living on the relationship between loneliness and depression in people with cognitive frailty. BMC Geriatrics, 25(1), 121. https://doi.org/10.1186/s12877-025-05700-7
Zhang, W., Zhang, J., & Gao, N. (2025). Social isolation and cognitive decline in older adults: a longitudinal study across 24 countries. BMC Geriatrics, 25(1), 775. https://doi.org/10.1186/s12877-025-06430-6