Journal of Gerontological Nursing

Feature Article Supplemental Data

Definition, Determinants, and Outcomes of Social Connectedness for Older Adults: A Scoping Review

Hannah M. O'Rourke, PhD, RN; Souraya Sidani, PhD

Abstract

Social connectedness is critical to older adults' well-being, but is defined inconsistently and its determinants and outcomes have not been comprehensively described. The current scoping review mapped the definitions, determinants, and outcomes of social connectedness for older adults. By identifying the conceptual features described in most articles, social connectedness was defined as: the opposite of loneliness, a subjective evaluation of the extent to which one has meaningful, close, and constructive relationships with others (i.e., individuals, groups, and society). Social connectedness is operationalized into: (a) caring about others and feeling cared about by others, and (b) feeling of belonging to a group or community. One's social network and life satisfaction were the most frequently proposed determinant and outcome, respectively. This review resulted in a clear definition of social connectedness and comprehensive description of its possible determinants and outcomes. This clarity will support the development of interventions to enhance social connectedness for older adults. [Journal of Gerontological Nursing, 43(7), 43–52.]

Abstract

Social connectedness is critical to older adults' well-being, but is defined inconsistently and its determinants and outcomes have not been comprehensively described. The current scoping review mapped the definitions, determinants, and outcomes of social connectedness for older adults. By identifying the conceptual features described in most articles, social connectedness was defined as: the opposite of loneliness, a subjective evaluation of the extent to which one has meaningful, close, and constructive relationships with others (i.e., individuals, groups, and society). Social connectedness is operationalized into: (a) caring about others and feeling cared about by others, and (b) feeling of belonging to a group or community. One's social network and life satisfaction were the most frequently proposed determinant and outcome, respectively. This review resulted in a clear definition of social connectedness and comprehensive description of its possible determinants and outcomes. This clarity will support the development of interventions to enhance social connectedness for older adults. [Journal of Gerontological Nursing, 43(7), 43–52.]

In 2012, approximately 810 million individuals were older than 60; by the year 2050, this number will reach 2 billion of the global population (United Nations Population Fund, 2012). Two recent systematic reviews of a combined 41 qualitative studies indicated that social connectedness enhanced the quality of life of vulnerable older adults, such as individuals with dementia and residents of long-term care (LTC) facilities (Bradshaw, Playford, & Riazi, 2012; O'Rourke, Duggleby, Fraser, & Jerke, 2015). Without appropriate support, vulnerable older adults who require gerontological nursing care can experience reduced quality of their relationships with family, friends, other residents in assisted living or LTC environments, and health care staff (Bradshaw et al., 2012; O'Rourke et al., 2015). Relationship problems are multi-faceted and extend beyond simple dyads. For example, staff behaviors may prevent development of relationships between residents of LTC facilities, contribute to residents' withdrawal from others, or compound poor resident-to-resident interactions (Ericsson, Hellström, & Kjellström, 2011).

Social connectedness is a fundamental human need (Easton-Hogg, 2013; Register & Scharer, 2010; Semino, 1990; Van Orden et al., 2013) and a distinct function of one's social network (Ashida & Heaney, 2008a). One study identified that social connectedness influenced older adults' health and well-being more than social contact, network, or support (Ashida & Heaney, 2008a). Social connectedness refers to a feeling of interpersonal connection, different from objective social network features such as isolation or interpersonal contact, or the network function of social support (Ashida & Heaney, 2008a).

Although its importance for the health and well-being of vulnerable older adults has been highlighted, social connectedness has not always been clearly or consistently defined, and its determinants and consequences have not been comprehensively reviewed. Gerontological nurses require clear description of the indicators, determinants, and outcomes of social connectedness for older adults to support their clients' interpersonal needs. The purpose of the current scoping review was to generate a clear description of social connectedness for older adults. The specific objectives were to map and clarify the critical features and indicators that define social connectedness for older adults and describe its potential determinants (or contributing factors) and outcomes.

Method

Scoping reviews can be used to identify the key characteristics of a body of literature and develop theory (Mays, Pope, & Popay, 2005). In contrast, systematic reviews are performed primarily to assess treatment effect in a more narrowly defined population (Arksey & O'Malley, 2005). Scoping review methods were used to describe the nature of definitions of social connectedness and identify its determinants/ outcomes in literature written about older adults, building theory. This approach entailed a comprehensive and systematic search, standardized inclusion/exclusion criteria and data extraction procedures, and synthesis using descriptive statistics of quantitative data and content analysis of qualitative data (Arksey & O'Malley, 2005). The databases PsycINFO, Medline, Embase, CINAHL, Abstracts in Social Gerontology, Proquest Dissertations and Theses, and OCLC Papers First were searched from inception to February 2015. Search terms reflected the concepts of older adults and social connectedness and known synonyms (e.g., elder or senior and connectedness or togetherness, respectively). A health sciences librarian was consulted to develop database-specific search strategies (available from the first author by request) that used MeSH terms and keywords.

Included articles (a) focused on social connectedness as the main topic addressed; (b) were conceptual, operational, or empirical research; (c) referred to adults >65 years old, or older adults, the aged, elderly, or seniors; and (d) had English-language full text available as published or grey literature. Articles that only used the term social connectedness to refer to another concept (e.g., social network) were excluded, as these would not clarify the distinct meaning of social connectedness. The first author (H.M.O.) screened all records (i.e., titles/abstracts) and full text articles, consulting with the second author (S.S.) as needed. To assess interrater agreement, the second author (S.S.) independently reviewed 10% of all full text articles (73% agreement; Kappa = 0.294 or fair agreement). Reviewer discrepancies were resolved through discussion.

Data extracted from each article comprised: (a) the article type, design, setting, country, and participants' culture, age, sex, and health conditions; (b) the conceptual and operational definitions (including any reported items) plus any additional descriptions of features of social connectedness; and (c) descriptions of the factors contributing to and outcomes of social connectedness. Descriptive statistics were used to summarize the articles' methodological and sample characteristics. Content analysis was used; all features of social connectedness that were defined or described in the studies, and any determinants and outcomes proposed in a conceptual framework and/or hypothesis, were coded. Key words or phrases were highlighted and categorized/coded using language the same or similar to that in the original studies; the proportion of studies that supported each code was calculated, as in meta-summary (Sandelowski & Barroso, 2007). Multiple reports of a single study were only counted once. Codes were then grouped into higher-level themes, which were defined. Each theme is described in the findings as either a feature of the definition of social connectedness, a determinant, or outcome.

Results

Search Results

The 1,180 titles/abstracts were imported from each database into Refworks, and duplicate records removed. Twenty-six articles, reporting on 23 separate investigations, met the inclusion criteria (Figure). Conceptual articles defined social connectedness and delineated its linkages with relevant concepts (n = 3). Operational articles described a quantitative measure of social connectedness (n = 2). Empirical articles explored the meaning of, tested associations with, or evaluated interventions to promote social connectedness (n = 21).

Search results for current scoping review.

Figure.

Search results for current scoping review.

Study Context

Most investigations focused on community-dwelling individuals (87%) without cognitive impairment (100%) and were conducted in the United States (61%). In the majority of investigations, the samples comprised >55% women (70%) and >70% White individuals (78%). Most were quantitative, cross-sectional, correlational studies (61%); some were quasi-experimental studies (9%). Details of included articles are in Table A (available in the online version of this article).

Methodological details and sample characteristics reported in 26 included articles (23 separate investigations)Methodological details and sample characteristics reported in 26 included articles (23 separate investigations)Methodological details and sample characteristics reported in 26 included articles (23 separate investigations)Methodological details and sample characteristics reported in 26 included articles (23 separate investigations)Methodological details and sample characteristics reported in 26 included articles (23 separate investigations)Methodological details and sample characteristics reported in 26 included articles (23 separate investigations)Methodological details and sample characteristics reported in 26 included articles (23 separate investigations)Methodological details and sample characteristics reported in 26 included articles (23 separate investigations)

Table A.

Methodological details and sample characteristics reported in 26 included articles (23 separate investigations)

Social Connectedness Definition

Twenty-one investigations included a conceptual definition or description of social connectedness, which was analyzed to derive themes (Table 1). Themes that were distinct from the determinants or outcomes of social connectedness, and were described in more than 50% of the 21 studies, were considered well-supported and used to derive a definition (Table 1). Social connectedness was defined as follows: Found on a continuum opposite loneliness, social connectedness is a subjective evaluation of the extent to which one has meaningful, close, and constructive relationships with others (i.e., individuals, groups, and/or society). The indicators of social connectedness include: (a) caring about others and feeling cared about by others, and (b) feeling of belonging to a group or community. Each feature of this definition reflects a well-supported theme, described below.

Features of Social Connectednessa

Table 1:

Features of Social Connectedness

The feature subjective evaluation, described in 71% (n = 15) of the 21 investigations, clarified that social connectedness was a perception or personal feeling. In the articles, terms used to describe this feature included subjective (Ashida & Heaney, 2008a; Daniel & Goldston, 2012; Kim, Hong, & Kim, 2015; Lee, 2014; Pan, 2011; Stanley, Conwell, Bowen, & Van Orden, 2014; Sun, Waldron, Gitelson, & Ho, 2012), perception or individual appraisal (Ashida & Heaney, 2008a; Chaves, 2008; Daniel & Goldston, 2012; Hawkley, Browne, & Cacioppo, 2005; Kim et al., 2015; Semino, 1990; Sun et al., 2012), belief (Hawkley et al., 2005; Hawkley, Gu, Luo, & Cacioppo, 2012; Van Orden et al., 2013), experience (Ashida & Heaney, 2008a; Chaves, 2008; Hawkley et al., 2012; Marshall, 2011; Pan, 2011; Stanley et al., 2014), or feeling (Ashida & Heaney, 2008a; Register & Herman, 2010; Romero, 2004; Van Orden et al., 2013; Zelenka, 2011).

The feature continuum opposite loneliness, described in 52% (n = 11) of the investigations, reflected statements that social connectedness was the conceptual opposite of loneliness (Ashida & Heaney, 2008a; Daniel & Goldston, 2012; Fässberg et al., 2012; Hawkley et al., 2005; Hawkley et al., 2012; Kim et al., 2015; Pan, 2011; Stanley et al., 2014; Van Orden et al., 2013; Zelenka, 2011). Two articles referred to a degree of connection, implying a social connectedness–loneliness continuum (Fässberg et al., 2012; Romero, 2004). Furthermore, in 44% (n = 7) of the 16 correlational quantitative or intervention studies, scales to measure loneliness were used to operationalize social connectedness (Ashida & Heaney, 2008a,b; Fässberg et al., 2012; Hawkley et al., 2005; Hawkley et al., 2012; Stanley et al., 2014; Sun et al., 2012; Zelenka, 2011): low loneliness scores indicated higher social connectedness.

The feature relationships with others was described in 90% (n = 19) of the investigations, but the descriptions of who the “others” were varied. Characteristics of others were most often unspecified, or referred to other human beings (e.g., family, health care providers) or, in one study, to pets. When unspecified, general terms were used such as “interpersonal,” “social,” or simply, “relationships with others” (Ashida & Heaney, 2008a,b; Buckley & McCarthy, 2009; Chaves, 2008; Daniel & Goldston, 2012; Hawkley et al., 2005; Hawkley et al., 2012; Lee, 2014; Marshall, 2011; Pan, 2011; Register & Herman, 2010; Register, Herman, & Tavakoli, 2011; Register & Scharer, 2010; Romero, 2004; Zelenka, 2011). When specified, relationships between individuals referred to dyads (Chaves, 2008; Hawkley et al., 2012) of the older adult and usually a family member or friend (Buckley & McCarthy, 2009; Cooney, Dowling, Gannon, Dempsey, & Murphy, 2014; Fässberg et al., 2012; Hawkley et al., 2012; Marshall, 2011; Pan, 2011; Register & Herman, 2010; Register & Scharer, 2010; Romero, 2004; Semino, 1990; Sun et al., 2012). Less often, the relationship was with health care staff (Cooney et al., 2014; Semino, 1990), a neighbor or acquaintance (Pan, 2011; Register & Herman, 2010), peers (Pan, 2011; Romero, 2004), or a pet (Stanley et al., 2014). Relationships with groups of more than two people were described using general terms such as “group” or “collective” (Buckley & McCarthy, 2009; Chaves, 2008; Hawkley et al., 2005; Hawkley et al., 2012; Sun et al., 2012), “community” (Buckley & McCarthy, 2009; Fässberg et al., 2012; Pan, 2011), or “society” (Pan, 2011).

The feature close and meaningful, described in 62% (n = 13) of the investigations, referred to social connectedness as occurring within close relationships of personal significance. Close relationships were described in the studies as characterized by attachment (Ashida & Heaney, 2008b; Easton-Hogg, 2013; Ong & Allaire, 2005; Semino, 1990), closeness (Chaves, 2008; Hawkley et al., 2012; Lee, 2014; Marshall, 2011; Pan, 2011; Romero, 2004), cohesion (Hawkley et al., 2012), or intimacy (Lee, 2014; Pan, 2011) and, unlike social contact, did not require physical proximity (Ashida & Heaney, 2008a,b; Buckley & McCarthy, 2009; Chaves, 2008; Cooney et al., 2014; Daniel & Goldston, 2012; Easton-Hogg, 2013; Hawkley et al., 2005; Hawkley et al., 2012; Kim et al., 2015; Lee, 2014; Marshall, 2011; Ong & Allaire, 2005; Pan, 2011; Romero, 2004; Stanley et al., 2014; Zelenka, 2011). The literature most commonly referred to the importance of the relationships using the term “meaningful” (Chaves, 2008; Register & Scharer, 2010; Semino, 1990; Stanley et al., 2014), but also as personal (Semino, 1990), quality social relations (Easton-Hogg, 2013; Kim et al., 2015; Ong & Allaire, 2005) that were special or significant (Chaves, 2008).

Caring and belonging, described in 67% (n = 14) of investigations, referred to social connectedness as the result of a positive or constructive relationship (Fässberg et al., 2012; Ong & Allaire, 2005; Van Orden et al., 2013) that promoted self-worth (Easton-Hogg, 2013; Register & Scharer, 2010; Van Orden et al., 2013). The indicators of social connectedness were either feeling that one cared for and was cared about by others, described in 29% (n = 6) of investigations, or a sense of belonging, described in 48% (n = 10) of studies. Caring about others and feeling cared about by others referred to concern for the well-being of significant others combined with a perception that one's well-being was of concern to others, highlighting the importance of reciprocity (Cooney et al., 2014; Register & Herman, 2010; Register & Scharer, 2010; Van Orden et al., 2013). Terminology used to describe caring relationships in the literature included caring or nurturing (Easton-Hogg, 2013; Register & Scharer, 2010; Van Orden et al., 2013) and love or affection (Ong & Allaire, 2005; Register & Herman, 2010; Register & Scharer, 2010; Semino, 1990).

Feeling of belonging to a group or community meant that older adults perceived that they held a valued place or role within a larger group. This perception was usually described using the term “belonging” (Ashida & Heaney, 2008b; Hawkley et al., 2012; Pan, 2011; Romero, 2004; Semino, 1990; Sun et al., 2012; Van Orden et al., 2013; Zelenka, 2011), but also as relating, connecting, or identifying with a group of people, collective, or the outside world (Hawkley et al., 2012; Pan, 2011; Semino, 1990; Sun et al., 2012; Zelenka, 2011). The group size was unspecified and could likely range widely (e.g., from a few friends, to extended family, workplace, neighborhood, or broader society).

Several themes were supported by <50% of investigations or reflected other concepts and were not included as features of the definition of social connectedness. Personal identity and worth (n = 5, 24%) described social connectedness as an intrinsic component of one's deeply held beliefs about him/herself (e.g., as a loner) (Hawkley et al., 2012; Romero, 2004; Semino, 1990; Sun et al., 2012; Zelenka, 2011). This finding suggests that personalities and beliefs may affect modifiability of social connectedness. In a few investigations, two determinants were included in a definition or description of social connectedness: social support (n = 6, 30%), referred to as having a reliable and supportive alliance, and social contact (n = 4, 19%), described as physical closeness or availability to interact with others (Register & Herman, 2010; Semino, 1990; Sun et al., 2012; Van Orden et al., 2013). This inclusion demonstrates that some literature conflates social connectedness with its determinants.

Determinants

Many potential determinants, or influencing factors, were proposed (Table 2). Several reflected social aspects of life: social network, group memberships, social participation, and social support. Defining these helped distinguish social connectedness from other social aspects of life.

Determinants of Social Connectedness Proposed Across Included Investigations (N = 23)Determinants of Social Connectedness Proposed Across Included Investigations (N = 23)

Table 2:

Determinants of Social Connectedness Proposed Across Included Investigations (N = 23)

Social connectedness is a perception, different from several objective, observable social factors. Social network was proposed as a determinant in eight studies (Table 2). Social networks are the structural features of social ties, including network size, density (i.e., how well members know one another), homogeneity, contact frequency, and geographic proximity. Group membership—formal affiliation with an official group (e.g., civic group, neighborhood organization, sports club)—was proposed as a determinant in three studies. Social participation, explored in just one study as a factor that may influence social connectedness, was defined as meaningful activity that is voluntarily chosen, and may bring one into social contact with others.

Social support differed from social connectedness for several reasons. Social support originates externally, can be accepted or rejected (Register & Scharer, 2010), and it does not necessarily result in feelings of connectedness—intimacy, closeness, or belonging—to others (Romero, 2004). Social support may be emotional (e.g., expressions of empathy, love), instrumental (e.g., services), informational (e.g., advice), or appraisal (e.g., helping self-evaluation) (Ashida & Heaney, 2008a). Two studies considered social support as a potential determinant.

Many other non-social factors were examined as potential determinants of social connectedness (Table 2). Of these, the most frequently explored were age (six studies), technology use (four studies), and marital status (four studies). Increased age was proposed to decrease social connectedness, usually because older adults were considered at risk for cognitive and physical deterioration, the loss of valued roles, and the death of loved ones. Technology use referred to whether the individual was able to use and had access to technology that may facilitate contact with others, such as a webcam, computer, or the internet. Being married was proposed to positively influence the individual and intimate aspect of caring for and about others more so than feeling of belonging to a group.

Quantitative measures to operationalize social connectedness were described in 19 investigations, and the items from these were compared to the previous list of determinants to assess if they reflected the concept of social connectedness or, alternatively, its determinants (Table B, available in the online version of this article). Ten (53%) investigations used determinants of social connectedness, such as social network or social support, to operationalize social connectedness (Culley, Herman, Smith, & Tavakoli, 2013; Easton-Hogg, 2013; Fässberg et al., 2012; Kim et al., 2015; Lee, 2014; Mellor, Firth, & Moore, 2008; Ong & Allaire, 2005; Register et al., 2011; Sun et al., 2012; Van Orden et al., 2013), demonstrating a discrepancy between how social connectedness has been conceptualized (i.e., as distinct from social network and support) and operationalized.

Conceptual definitions / descriptions and operational definitions of social connectednessConceptual definitions / descriptions and operational definitions of social connectednessConceptual definitions / descriptions and operational definitions of social connectednessConceptual definitions / descriptions and operational definitions of social connectednessConceptual definitions / descriptions and operational definitions of social connectednessConceptual definitions / descriptions and operational definitions of social connectednessConceptual definitions / descriptions and operational definitions of social connectednessConceptual definitions / descriptions and operational definitions of social connectednessConceptual definitions / descriptions and operational definitions of social connectednessConceptual definitions / descriptions and operational definitions of social connectednessConceptual definitions / descriptions and operational definitions of social connectednessConceptual definitions / descriptions and operational definitions of social connectednessConceptual definitions / descriptions and operational definitions of social connectednessConceptual definitions / descriptions and operational definitions of social connectednessConceptual definitions / descriptions and operational definitions of social connectedness

Table B.

Conceptual definitions / descriptions and operational definitions of social connectedness

Outcomes

Various direct outcomes of social connectedness were theorized, including life satisfaction (n = 5), mental and emotional well-being (n = 5), physical health (n = 3), suicidal behavior (n = 2), new activity participation (n = 1), and forgiveness (n = 1). Life satisfaction, defined as “one's subjective evaluation of life as a whole” (Kim et al., 2014, p. 1), was theorized as an outcome of social connectedness in five studies (Easton-Hogg, 2013; Kim et al., 2015; Lee, 2014; Pan, 2011; Zelenka, 2011). Social connectedness was thought to improve mental and emotional well-being variables in three studies, specifically depression (Marshall, 2011; Van Orden et al., 2013), self-esteem (Lee, 2014), hope (Lee, 2014), and positive and negative affect (Ong & Allaire, 2005; Stanley et al., 2014). Regarding physical health, a deficit in social connectedness was thought to impede function in activities of daily living (Ashida & Heaney, 2008a; Ong & Allaire, 2005; Van Orden et al., 2013). Social connectedness was also explored in relation to promoting new activity participation (n = 1; Ashida & Heaney, 2008b), preventing suicidal behavior (n = 2; Daniel & Goldston, 2012; Van Orden et al., 2013), and facilitating forgiveness (n = 1; Romero, 2004).

Discussion

Definition and Indicators of Social Connectedness

The current review's findings proposed a clear definition of social connectedness by explicating its key features and indicators and describing the conceptual relationship between social connectedness and loneliness identified from the literature. Only a few previous articles clearly defined social connectedness in relation to loneliness (Stanley et al., 2014; Van Orden et al., 2013; Zelenka, 2011). More often, loneliness was referred to in the background or discussion sections, or a measure of loneliness was used to operationalize social connectedness. Loneliness is the experience of a perceived deficit in the quality or quantity of one's relationships, resulting in psychological discomfort (El Sadr, Noureddine, & Kelley, 2009). Including loneliness—a term well understood by researchers and clinicians—within the definition of social connectedness promotes conceptual clarity.

Delineating the relationship between social connectedness and loneliness also advances understanding of loneliness. Lack of an attachment figure and absence of a community are considered key indicators of loneliness by a seminal author (Weiss, 1973), but the indicators of social connectedness clarify what it means to have an attachment figure or community: (a) caring about others and feeling cared about by others, and (b) feeling of belonging to a group or community, respectively. Furthermore, knowledge of these indicators will support selection of measures, preventing incongruity between the concept of social connectedness and its operationalization in future research.

Determinants and Outcomes

The findings comprehensively list the determinants theorized to date. Most—13 of 21 determinants—were proposed in <10% of investigations, indicating incomplete or competing theories of how social connectedness is caused and maintained. The most consistently described determinant, one's social network, was proposed in 35% of studies about social connectedness and is potentially modifiable. However, the literature about loneliness has emphasized that lonely individuals (i.e., those who lack social connectedness) are not necessarily isolated (i.e., limited in their social network) (El Sadr et al., 2009; Pierce, Wilkinson, & Anderson, 2003). Further, loss (e.g., a partner, good health) may determine loneliness more so than isolation (Bekhet, Zauszniewski, & Nakhla, 2008; El Sadr et al., 2009), and solitary activity can play a protective role in preventing loneliness (Pettigrew & Roberts, 2008). Many of the other determinants proposed were non-modifiable (e.g., age, marital status, sex) or difficult to modify (e.g., living arrangement, religious affiliation). Although these are important to understand to select samples and adjustment variables for use in studies about social connectedness, understanding of modifiable factors is needed to inform the design and evaluation of interventions aimed to promote social connectedness in populations of older adults (Sidani & Braden, 2011). Careful and creative theorizing of the distinct and modifiable factors that cause and maintain social connectedness—as opposed to social contact or isolation—is needed.

The outcomes of social connectedness were clinically important and relatively consistent across studies, suggesting more clarity among researchers as to the outcomes of social connectedness, as compared to its determinants. Supporting the findings of outcomes of social connectedness identified in the current review, loneliness has also been posited to influence mental and emotional well-being (e.g., depression, anxiety, self-esteem) and physical health (e.g., blood pressure, sleep quality) (Bekhet et al., 2008). The current review also identified mental and emotional well-being as a potential determinant of social connectedness (Marshall, 2011; Zelenka, 2011), suggesting a reciprocal relationship. Although rarely theorized, such reciprocal relationships with social connectedness/loneliness may be common and require further empirical exploration and testing (El Sadr et al., 2009).

Applicability of Findings Across Individuals and Contexts

The older adult samples in these studies were mostly White, community-dwelling, not cognitively impaired, and were primarily from high-income countries. Personality, past and present experiences, beliefs, or sense of identity could all play a role in the ability and propensity to feel socially connected to others (Hawkley et al., 2012; Romero, 2004; Sun et al., 2012; Zelenka, 2011). Research and theorizing are needed to answer questions about how the concept of social connectedness may be addressed among individuals from different cultures, as well as the growing number of vulnerable older adults who require gerontological nursing care, including LTC residents and those cognitively impaired (United Nations Population Fund, 2012).

Strengths and Limitations

Strategies to reduce bias included: application of explicit inclusion/ exclusion criteria; having two independent reviewers screen 10% of the full-text articles to standardize the screening procedures; marking duplicate reports of a single study to prevent over-representation of those studies' findings; and a transparent audit trail of the analytic process. Strategies to ensure comprehensiveness included search of a wide range of databases using strategies developed in consultations with a librarian, and inclusion of both grey literature and peer-reviewed sources. The main limitations were exclusion of non-English articles and that two reviewers did not independently screen all records.

Recommendations for Research and Practice

The current scoping review was comprehensive and identified the determinants and outcomes of social connectedness proposed in the literature. However, whether associations have been demonstrated was not assessed. Systematic reviews are needed to identify which determinants have demonstrated empirical associations with social connectedness. In addition, most of the studies were quantitative cross-sectional, correlational studies. Although useful to explore associations, there are significant theoretical gaps in understanding determinants of social connectedness, as discussed above. Qualitative studies to explore older adults' perceptions of strategies to promote social connectedness may advance theory.

Clarifying the definition of social connectedness is the first step in selecting interventions to address this construct (Sidani & Braden, 2011). The definition proposed in the current study can guide clinicians to look for signs of older adults' social connectedness and try and identify interventions that target the proposed determinants of social connectedness to address observed issues. Additional research is needed to identify and describe the evidence-based interventions that clinicians can use to promote social connectedness.

Conclusion

The current scoping review mapped the definitions, determinants, and outcomes of social connectedness. The findings provided an overview of the nature of the social connectedness literature and identified the distinct features of the concept, distinguishing it from its determinants and outcomes. Further research is needed to advance understanding of modifiable determinants and identify innovative strategies to promote social connectedness and decrease loneliness among subgroups of older adults. Developing an understanding of the meaning and determinants of social connectedness is critical to inform the design and selection of targeted interventions to promote older adults' social connectedness and quality of life.

References

  • Arksey, H. & O'Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8, 19–32. doi:10.1080/1364557032000119616 [CrossRef]
  • Ashida, S. & Heaney, C.A. (2008a). Differential associations of social support and social connectedness with structural features of social networks and the health status of older adults. Journal of Aging and Health, 20, 872–893. doi:10.1177/0898264308324626 [CrossRef]
  • Ashida, S. & Heaney, C.A. (2008b). Social networks and participation in social activities at a new senior center: Reaching out to older adults who could benefit the most. Activities, Adaptation & Aging, 32, 40–58. doi:10.1080/01924780802039261 [CrossRef]
  • Bekhet, A.K., Zauszniewski, J.A. & Nakhla, W.E. (2008). Loneliness: A concept analysis. Nursing Forum, 43, 207–213. doi:10.1111/j.1744-6198.2008.00114.x [CrossRef]
  • Bradshaw, S.A., Playford, E.D. & Riazi, A. (2012). Living well in care homes: A systematic review of qualitative studies. Age & Ageing, 41, 429–440. doi:10.1093/ageing/afs069 [CrossRef]
  • Buckley, C. & McCarthy, G. (2009). An exploration of social connectedness as perceived by older adults in a long-term care setting in Ireland. Geriatric Nursing, 30, 390–396. doi:10.1016/j.gerinurse.2009.09.001 [CrossRef]
  • Chaves, A. (2008). Conceptualizing connectedness: A study of older individuals [Doctoral thesis]. Available from ProQuest Dissertations and Theses database. (Order No. NR44387).
  • Cooney, A., Dowling, M., Gannon, M.E., Dempsey, L. & Murphy, K. (2014). Exploration of the meaning of connectedness for older people in long-term care in context of their quality of life: A review and commentary. International Journal of Older People Nursing, 9, 192–199. doi:10.1111/opn.12017 [CrossRef]
  • Culley, J., Herman, J., Smith, D. & Tavakoli, A. (2013). Effects of technology and connectedness on community-dwelling older adults. Online Journal of Nursing Informatics, 17(3).
  • Daniel, S.S. & Goldston, D.B. (2012). Hopelessness and lack of connectedness to others as risk factors for suicidal behavior across the lifespan: Implications for cognitive-behavioral treatment. Cognitive and Behavioral Practice, 19, 288–300. doi:10.1016/j.cbpra.2011.05.003 [CrossRef]
  • Easton-Hogg, E. (2013). An investigation of the associations between social connectedness and internet usage for older adults [Doctoral thesis]. Available from ProQuest Dissertations and Theses database. (Order No. 3565739).
  • El Sadr, C.B., Noureddine, S. & Kelley, J. (2009). Concept analysis of loneliness with implications for nursing diagnosis. International Journal of Nursing Terminologies and Classifications, 20, 25–33. doi:10.1111/j.1744-618X.2008.01110.x [CrossRef]
  • Ericsson, I., Hellström, I. & Kjellström, S. (2011). Sliding interactions: An ethnography about how persons with dementia interact in housing with care for the elderly. Dementia, 10, 523–538. doi:10.1177/1471301211409376 [CrossRef]
  • Fässberg, M.M., van Orden, K.A., Duberstein, P., Erlangsen, A., Lapierre, S., Bodner, E. & Waern, M. (2012). A systematic review of social factors and suicidal behavior in older adulthood. International Journal of Environmental Research and Public Health, 9, 722–745. doi:10.3390/ijerph9030722 [CrossRef]
  • Hawkley, L.C., Browne, M.W. & Cacioppo, J.T. (2005). How can I connect with thee? Let me count the ways. Psychological Science, 16, 798–804.
  • Hawkley, L.C., Gu, Y., Luo, Y.J. & Cacioppo, J.T. (2012). The mental representation of social connections: Generalizability extended to Beijing adults. PLoS ONE, 7(9), e44065. doi:10.1371/journal.pone.0044065 [CrossRef]
  • Kim, H.-J., Hong, S. & Kim, M. (2015). Living arrangement, social connectedness, and life satisfaction among Korean older adults with physical disabilities: The results from the national survey on persons with disabilities. Journal of Developmental and Physical Disabilities, 27, 307–321. doi:10.1007/s10882-014-9418-9 [CrossRef]
  • Lee, E. (2014). The impact of social and spiritual connectedness on the psychological well-being among older Americans. Journal of Religion, Spirituality & Aging, 26, 300–319. doi:10.1080/15528030.2013.879090 [CrossRef]
  • Marshall, G. (2011). Predictors associated with late-life depressive symptoms among older Black Americans [Doctoral thesis]. Available from ProQuest Dissertations and Theses database. (Order No. 3472177).
  • Mays, N., Pope, C. & Popay, J. (2005). Systematically reviewing qualitative and quantitative evidence to inform management and policy-making in the health field. Journal of Health Services Research & Policy, 10(Suppl. 1), 6–20.
  • Mellor, D., Firth, L. & Moore, K. (2008). Can the internet improve the well-being of the elderly?Ageing International, 32, 25–42. doi:10.1007/s12126-008-9006-3 [CrossRef]
  • Ong, A.D. & Allaire, J.C. (2005). Cardiovascular intraindividual variability in later life: The influence of social connectedness and positive emotions. Psychology and Aging, 20, 476–485. doi:10.1037/0882-7974.20.3.476 [CrossRef]
  • O'Rourke, H.M., Duggleby, W., Fraser, K.D. & Jerke, L. (2015). Factors that affect quality of life from the perspective of people with dementia: A metasynthesis. Journal of the American Geriatrics Society, 63, 24–38. doi:10.1111/jgs.13178 [CrossRef]
  • Pan, S. (2011). Online communities and older adults: The potential of social networks formed in the online community in enhancing social support, social connectedness and subjective well-being among Chinese older adults [Doctoral thesis]. Available from ProQuest Dissertations and Theses database. (Order No. 3477980).
  • Pettigrew, S. & Roberts, M. (2008). Addressing loneliness in later life. Aging & Mental Health, 12, 302–309. doi:10.1080/13607860802121084 [CrossRef]
  • Pierce, L.L., Wilkinson, L.K. & Anderson, J. (2003). Analysis of the concept of aloneness as applied to older women being treated for depression. Journal of Gerontological Nursing, 29(7), 20–25.
  • Register, M.E. & Herman, J. (2010). Quality of life revisited: The concept of connectedness in older adults. Advances in Nursing Science, 33, 53–63. doi:10.1097/ANS.0b013e3181c9e1aa [CrossRef]
  • Register, M.E., Herman, J. & Tavakoli, A.S. (2011). Development and psychometric testing of the Register-Connectedness Scale for Older Adults. Research in Nursing and Health, 34, 60–72. doi:10.1002/nur.20415 [CrossRef]
  • Register, M.E. & Scharer, K.M. (2010). Connectedness in community-dwelling older adults. Western Journal of Nursing Research, 32, 462–479. doi:10.1177/0193945909355997 [CrossRef]
  • Romero, C. (2004). Writing wrongs: An intervention to promote forgiveness and health in early and late adulthood [Doctoral thesis]. Available from ProQuest Dissertations and Theses database. (Order No. 3144770).
  • Sandelowski, M.J. & Barroso, J. (2007). Handbook for synthesizing qualitative research. New York, NY: Springer.
  • Semino, S. (1990). Integrating the experience of institutionalization: Subjective perceptions of nursing home residents [Master's thesis]. Available from ProQuest Dissertations and Theses database. (Order No. 1342986).
  • Sidani, S. & Braden, C.J. (2011). Design, evaluation, and translation of nursing interventions. West Sussex, UK: John Wiley & Sons, Inc.
  • Stanley, I.H., Conwell, Y., Bowen, C. & Van Orden, K.A. (2014). Pet ownership may attenuate loneliness among older adult primary care patients who live alone. Aging & Mental Health, 18, 394–399. doi:10.1080/13607863.2013.837147 [CrossRef]
  • Sun, F., Waldron, V., Gitelson, R. & Ho, C. (2012). The effects of loss of loved ones on life satisfaction among residents in a southwest retirement community: The mediating roles of social connectedness. Research on Aging, 34, 222–245. doi:10.1177/0164027511417594 [CrossRef]
  • United Nations Population Fund. (2012). Ageing in the twenty-first century: A celebration and a challenge. Retrieved from https://www.unfpa.org/sites/default/files/pub-pdf/Ageingreport.pdf
  • Van Orden, K.A., Stone, D.M., Rowe, J., McIntosh, W.L., Podgorski, C. & Conwell, Y. (2013). The Senior Connection: Design and rationale of a randomized trial of peer companionship to reduce suicide risk in later life. Contemporary Clinical Trials, 35, 117–126. doi:10.1016/j.cct.2013.03.003 [CrossRef]
  • Weiss, R.S. (1973). Loneliness: The experience of emotional and social isolation. Cambridge, MA: MIT Press.
  • Zelenka, A. (2011). Modeling social participation as predictive of life satisfaction and social connectedness: Scale or index? [Doctoral thesis]. Available from ProQuest Dissertations and Theses database. (Order No. 3491133).

Features of Social Connectednessa

Level 2 CodeInvestigations (n, %)Level 1 CodeInvestigations (n, %)
Meaningful and close13 (62)Meaningful7 (33)
Close11 (52)
Caring and belonging14 (67)Sense of belonging10 (48)
Caring and cared for6 (29)
Positive connection3 (14)
Relationship between the older adult and others: individuals or groups19 (90)Individuals13 (62)
Groups7 (33)
Others (unspecified)16 (76)
A perception or personal feeling15 (71)Perception9 (43)
Subjective8 (38)
Experience6 (29)
Feeling5 (24)
Connectedness–loneliness continuum11 (52)Loneliness11 (52)

Determinants of Social Connectedness Proposed Across Included Investigations (N = 23)

CategoryInvestigations (n, %)DefinitionReference
Social network8 (35)The structural characteristics of one's social tiesAshida & Heaney, 2008a; Easton-Hogg, 2013; Hawkley, Browne, & Cacioppo, 2005; Hawkley, Gu, Luo, & Cacioppo, 2012; Mellor, Firth, & Moore, 2008; Pan, 2011; Van Orden et al., 2013
Age6 (26)Years of ageChaves, 2008; Hawkley et al., 2005; Hawkley et al., 2012; Pan, 2011; Stanley, Conwell, Bowen, & Van Orden, 2014; Zelenka, 2011
Technology use4 (17)Whether the individual was able to use and had access to technology (e.g., webcam, computer, internet)Culley, Herman, Smith, & Tavakoli, 2013; Easton-Hogg, 2013; Mellor et al., 2008; Pan, 2011
Marital status4 (17)Whether one is married, widowed, divorced, single, or in a common-law relationshipHawkley et al., 2005; Hawkley et al., 2012; Pan, 2011; Zelenka, 2011
Group membership3 (13)Formal affiliation with a recognized groupHawkley et al., 2005; Hawkley et al., 2012; Pan, 2011
Sex or gender3 (13)Whether one is male or female, or a man or womanChaves, 2008; Hawkley et al., 2012; Pan, 2011; Van Orden et al., 2013
Living arrangement3 (13)Whether one lives alone or with a spouse or othersHawkley et al., 2012; Kim, Hong, & Kim, 2015; Stanley et al., 2014
Income3 (13)Yearly household incomeHawkley et al., 2012; Pan, 2011; Zelenka, 2011
Social support2 (9)The provision or receipt of emotional (e.g., expression of empathy), instrumental (e.g., a service), informational (e.g., advice), or appraisal (e.g., information) supportAshida & Heaney, 2008a; Pan, 2011
Self-reported health status2 (9)An overall assessment that an individual makes about his/her own health (e.g., excellent, good, fair, bad, poor)Pan, 2011; Zelenka, 2011
Mental or emotional well-being2 (9)Objective and subjective signs of an imbalance of one's thoughts and feelings toward a negative state (e.g., depression, stress)Marshall, 2011; Zelenka, 2011
Cognitive ability2 (9)Whether one experiences mild, moderate, or severe cognitive impairmentBuckley & McCarthy, 2009; Semino, 1990
Education2 (9)Highest level of formal educationHawkley et al., 2012; Zelenka, 2011
Religious affiliation2 (9)Membership in a religious groupHawkley et al., 2005; Hawkley et al., 2012
Social participation1 (4)Meaningful activity, voluntarily chosen that may bring one into contact with othersZelenka, 2011
Interpersonal conflict style1 (4)Whether one focused on the benefits of forgiveness and empathy for the offenderRomero, 2004
Family composition1 (4)The number and type of members of one's immediate family (e.g., number of children)Hawkley et al., 2012
Ethnicity1 (4)Ethnic or cultural backgroundHawkley et al., 2005
Service use1 (4)Use of agencies, departments, or organizations that provide health or social care (e.g., primary care clinic, hospital, home care agency, Meals on Wheels, day care)Van Orden et al., 2013
Pet ownership1 (4)Owning a domesticated animalStanley et al., 2014
Loss of loved ones1 (4)Death of a spouse, family member, or close friendSun et al., 2012

Methodological details and sample characteristics reported in 26 included articles (23 separate investigations)

First Author (Year)TypeDesign & Baseline Sample SizeAge in Years% FemaleHealth StatusCountry & CultureSite
Ashida 2008aReport 1 of 2Ashida 2008bReport 2 of 2EmpiricalCross-sectional correlational N=126Mean= 73.1 (SD 5.5) Range= 65 to 8563%Cognitive Impairment: no major cognitive problems noted, based on informal interviewer assessment Health Conditions: not confined to home due to any physical conditionCountry: United States Culture: About 90.0% self-identified as White; 9.5% self-identified as BlackCommunity dwelling, urban low-income neighborhood
Buckley 2009EmpiricalPhenomenology N=10Mean= 83 Range= 71 to 99100%Cognitive Impairment: participants were cognitively intact (≥ .6 on the Abbreviated Mini Mental Test Score)Country: Southern Ireland Culture: Not reportedAn urban long-term care residential hospital
Chaves 2008EmpiricalCross-sectional correlational N=184Mean= 74.0 (SD 8.6) Range= 55 to 94 (‘seniors’)67%Health Conditions: Not reported Cognitive Impairment: Not reported Health Conditions: Not reportedCountry: Canada Culture: 84% Caucasian; 10% not CaucasianCommunity dwelling, owned their own home, rented, lived in a senior's home, or in someone else's home
Cooney 2014ConceptualNarrative review of 14 articles, 2 book chaptersOlder people, not specifiedNot reportedCognitive Impairment: not specifically reported, but at least some of the included studies did include people with cognitive impairment Health Conditions: Not reportedCountry: Not reported Culture: Not reportedResidential care
Culley 2013EmpiricalCross-sectional descriptive N=86Mean= 74.6 (SD 5.9) Range= 65 or older79%Cognitive Impairment: Not reported Health Conditions: report only that the sample had ‘little disability’Country: United States Culture: 96% white; 4% Hispanic; English-speakingCommunity dwelling, from a Lion's club meeting
Daniel 2012ConceptualNarrative review; number of articles included not reportedOlder adults, not specifiedNot reportedCognitive Impairment: Not reported Health Conditions: Not reportedCountry: Not specified Culture: Not specifiedNot reported
Easton-Hogg 2013EmpiricalCross-sectional correlational N=189Mean=68.6 Range= 43 to 93 (yet target sample was ‘older adults 55 yrs of age and up’)55%Cognitive Impairment: Not reported Health Conditions: Not reportedCountry: United States Culture: 86% Caucasian; 5.6% African AmericanCommunity dwelling, from churches and the YMCA
(Fassberg et al., 2012)EmpiricalSystematic review (of case control studies) of 16 articles (across 14 independent samples)Range= 65 and olderNot reportedCognitive Impairment: Not reported Health Conditions: Not reportedCountry: Included studies were conducted in Canada (n = 2), Germany (n = 1), Hong Kong (n = 1), Japan (n = 1), Singapore (n = 1), Sweden (n = 2), Taiwan (n = 1), the U.K. (n = 2), and the U.S. (n = 3) However, few reflected a distinct subjective definition of social connectedness Culture: Not reportedCommunity dwelling, population based
Hawkley 2005EmpiricalCross-sectional correlational N=197Mean=57.5 (SD 4.4) Range= 50 to 68 (‘older adults’)51%Cognitive Impairment: Not reported Health Conditions: Not reportedCountry: United States Culture: African Americans (34%), Hispanics (26%), Caucasians (39%)Community dwelling, population based sample
Hawkley 2012EmpiricalCross-sectional correlational N=246Mean=58.2 (SD 5.8) Range= 50 to 65 (‘older adults’)50%Cognitive Impairment: Not reported Health Conditions: Not reportedCountry: China Culture: ChineseNot reported
Kim 2015EmpiricalCross-sectional correlational N=1221Mean=72.9 (95% confidence interval 72.49, 73.24) Range= 65 and older59%Cognitive Impairment: Not reported Health Conditions: Older adults with physical disabilitiesCountry: South Korea Culture: South KoreanCommunity dwelling, people residing in households
Lee 2014EmpiricalCross-sectional correlational N=1024Mean= 77.5 (SD 6.2) Range= 66 or older63%Cognitive Impairment: Not reported Health Conditions: Not reportedCountry: United States Culture: Black or white, English-speaking, and practicing ChristiansCommunity dwelling, people residing in households
Marshall 2011EmpiricalCross-sectional correlational N=1108Mean=66.5 (SD 10.9) Range= 55 to 93 (‘older persons’)59%Cognitive Impairment: Not reported Health Conditions: Not reportedCountry: United States Culture: African American (76%), Caribbean Black (24%)Community dwelling, not jailed, homeless, in the military, or institutionalized
Mellor 2008EmpiricalQuasi-experimental uncontrolled, one-group, pre-test with four follow-up tests during 12 month intervention N=20Mean= 75.9 (SD 7.6) Range= 55 to 88 (‘older adults’)Not reportedCognitive Impairment: Participants that withdrew experienced considerable difficulty with memory Health Conditions: Note reportedCountry: Australia Culture: Not reportedCommunity dwelling, retirement village
Ong 2005EmpiricalLongitudinal correlational N=33Mean=74 (SD 5.6) Range= 60 to 8770%Cognitive Impairment: Not reported Health Conditions: Not reportedCountry: United States Culture: White (94%); African American (6%)Community dwelling, from senior centers
Pan 2011EmpiricalCross-sectional correlational N=196Mean = 64.0 (SD 6.7) Range= 50 to 8335%Cognitive Impairment: Not reported Health Conditions: Not reportedCountry: China Culture: ChineseCommunity dwelling, people who were a part of an active senior-oriented online community
Register 2010Report 1 of 3EmpiricalGrounded theory N=12Older adults 65 and over58%Cognitive Impairment: Not reported Health Conditions: Not reportedCountry: United States Culture: Mostly White and ProtestantCommunity dwelling, private homes and assisted living facilities
Register 2011Report 2 of 3OperationalCross-sectional, exploratory factor analysis N=428Mean= 76 (SD 7.0) Range= 65 to 9870%Cognitive Impairment: Not reported Health Conditions: 20% required assistance to complete the instruments due to physical disability or low literacy skillsCountry: United States Culture: 74% White; 26% Black; all English-speaking and readingCommunity dwelling
Register 2010Report 3 of 3Conceptual Summarizes progression of definition, referring to reports 1 & 2Concept synthesis N=see reports 1 & 2Older adults 65 and oversee reports 1 & 2Cognitive Impairment: see reports 1 & 2 Health Conditions: see reports 1 & 2Country: United States Culture: see reports 1 & 2Community dwelling, private homes and assisted living facilities
Romero 2004EmpiricalQuasi-experimental controlled, three groups, pre-test with double post-test N=33Mean= 73.0 (SD 8.8) Range= 58 to 92 (‘older adults’)87%Health Conditions: No conditions that would make journal writing difficult (e.g., severe arthritis in hands, blindness, severe depression) Cognitive Impairment: cognitively intactCountry: United States Culture: Caucasian (94%); Roman Catholic (88%)Community dwelling, from community groups
Semino 1990EmpiricalGrounded theory N=5Mean= 84 Range= 76 to 92100%Cognitive Impairment: All participants oriented to person, place and time Health Conditions: Varied by participant, and all experience multi-morbidity (e.g. COPD, Diabetes, Pulmonary edema, artrial fibrillation, decreased mobility, etc.)Country: United States Culture: Jewish faith (n=3), Catholic (n=1), no religious affiliation (n=1)Long term care facility
Stanley 2014EmpiricalCross-sectional correlational N=830Mean = 72.2 (SD 8.3) Range= 60 and older (‘older adults’)58%Cognitive Impairment: Not reported Health Conditions: Not reportedCountry: United States Culture: Not reportedCommunity dwelling, primary care patients
Sun 2012EmpiricalCross-sectional correlational N=734Mean= 67 (SD 9.6) Range= 55 and older (‘older adults’)62%Cognitive Impairment: Not reported Health Conditions: Not reportedCountry: United States Culture: 96.5% WhiteCommunity dwelling, retirement community
Van Orden 2013OperationalStudy protocol for a randomized controlled trial N=400 (planned sample)older adults, over 60 years50%Cognitive Impairment: Subjects to be free of significant cognitive impairment Health Conditions: Subjects to have adequate hearing to allow communication with the interviewerCountry: United States Culture: 76% White of 153 at baseline; inclusion criteria state must be English-speakingCommunity dwelling, primary care patients who were not in assisted living or skilled nursing facilities
Zelenka 2011EmpiricalCross-sectional correlational N=4346Mean (men)=74.6 (SD 6.6) Mean (women)= 74.8 (SD = 7.2)58%Cognitive Impairment: Not reported Health Conditions: Not reportedCountry: United States Culture: NotreportedCommunity dwelling, non-institutionalized

Conceptual definitions / descriptions and operational definitions of social connectedness

First Author (year)Conceptual Definition or DescriptionOperational DefinitionOperationalization specific to social connectedness?
Ashida (2008) Report 1 of 2Definition: Not stated Description: A function of a social network (p 873) “subjective psychological component…Individuals' appraise their social relationships and assess the extent to which they feel socially connected…A lack of social connectedness may be experienced as feelings of loneliness and a desire for companionship” (p 874–875)2 items

---the frequency of respondents' feelings of loneliness

---the frequency with which respondents wished for more people to spend time with (companionship)

Yes
Ashida (2008) Report 2 of 2Definition: Not stated Description: “socially engaged through interconnections with network members, giving a sense of belonging and attachment” (p 43)2 items

---the frequency of respondents' feelings of loneliness

---the frequency with which respondents wished for more people to spend time with (companionship)

Yes
Buckley (2009)“the relationships people have with family friends and others” (p 390) the interaction of one person with others, his or her community, groups, and the environment, which offers reassurance and contentment.” (p 390) Description: Not statedInterview guide included topics on the relationships residents had with family and relatives, friends and the outside world, staff, and other residents.No—broader assessment of relationships
Chaves (2008)Definition: “the perception of having a meaningful relation or connection with … significant other(s).” (p 1) Description: “… perceiving meaningful, close, and significant relationships with other human beings.” (p 2) “…connectedness may occur between two individuals in a dyadic context (e.g., between spouses, best friends) or between an individual and several people in a group context (e.g., bridge group, hiking club).” (p 3) “Within … the…contexts identified above, connectedness could be experienced in three different ways, e.g., physically, emotionally or cognitively… Experiencing connectedness in a physical way involves the body and physical experiences or activities, e.g., holding hands, touching and making love; …Experiencing connectedness in an emotional way involves experiencing positive and/or negative affective states with someone… e.g., sharing one's feelings such as worries, hopes, joy, and fears with a special person or with a social group of people; Experiencing connectedness in a cognitive way involves conscious mental processes, e.g., having deep discussions and being on the same “wavelength” with a special person or a group of people; …” (pp 3–4)12 items related to a special person

---I feel emotionally connected and close with a special person in my life, e.g., spouse, partner, close friend.

---I share my deepest feelings with a special person in my life, e.g., worries, hopes, fears.

---I am satisfied with the amount of emotional connection and closeness I have with a special person.

---I am physically (non-sexually) connected and comfortable with a special person in my life, e.g., hugs, touch.

---I show my physical (non-sexual) connection and comfort with a special person, e.g., give hugs, touch.

---I am satisfied with the amount of physical (non-sexual) connection and comfortableness I have with a special person.

---I am sexually connected and physically celebrate my sexuality with a special person in my life, e.g., sexual intercourse.

---I show my sexual connection and sexual celebration with a special person, e.g., sexual intercourse.

---I am satisfied with the amount of sexual connection I have with a special person.

---I am mentally connected with and understand a special person in my life, e.g., have “deep” discussions, on the same “wavelength.”

---I share my deepest thoughts with a special person in my life, e.g., ideas, beliefs, philosophy.

---I am satisfied with the amount of mental connection and mutual understanding I have with a special person.

9 items related to social groups:

---I feel emotionally connected and close with a social group of people, e.g., clubs, dance group, organization.

---I share my deepest feelings with a social group of people, e.g., worries, hopes, fears.

---I am satisfied with the amount of emotional connection and closeness I have with a social group of people.

---I am physically connected and comfortable with a social group of people, e.g., we meet, shake hands, give hugs, pats on back.

---I engage in activities that help me be physically connected and comfortable with a social group, e.g., organizing, driving others, clean-up.

---I am satisfied with the amount of physical connection and comfortableness I have with a social group.

---I am mentally connected with and understand a social group of people, e.g., we have “deep” discussions, on the same “wavelength.”

---I share my deepest thoughts with a social group of people, e.g., my ideas, beliefs, philosophy.

---I am satisfied with the amount of mental connection and mutual understanding I have with a social group.

Yes
Cooney (2014)Definition: “residents' social relationships, including their continued connection with their community” (p 193) “encompass relationships with family and friends, other residents, staff and the wider community” (p 193) Reciprocity in relationships with staff (relationships with other residents not emerging strongly)” (p 195) Description: Not statedNot statedNot applicable
Culley (2013)Definition: Not stated Description: Not statedRegister Connectedness Scale for Older Adults, subscales: being part of a family (10 items about satisfaction) & having friends (5 items about satisfaction).No includes some items that measure social contact
Daniel (2012)Definition: “Lack of connectedness to others has been defined in multiple ways, but generally refers to lack of social support, poor integration into a social network, or perceptions of social isolation. We consider lack of connectedness to others to include actual social support and/or perceived social support (i.e., one's subjective sense of connection to others).” (p 288) Description: Not statedNot statedNot applicable
Easton Hogg (2014)Definition: “the presence of quality relationships in which individuals' needs for attachment, social integration, opportunity for nurturance, reassurance of worth, reliable alliance, and guidance, are met.” (p 3) Description: Not stated22-item Social Provisions Scale (Russell & Cutrona, 1984) Six scales: Attachment, social integration, opportunity for nurturance, reassurance of worth, reliable alliance, and guidance regarding current relationship with friends, family members, coworkers, community members, etc:

---I feel that I do not have close personal relationships with other people.

---There is no one I can turn to for guidance in times of stress.

---There are people who enjoy the same social activities I do

---Other people do not view me as competent.

---I feel personally responsible for the well-being of another person.

---I feel part of a group of people who share my attitudes and beliefs.

--I do not think other people respect my skills and abilities.

--If something went wrong, no one would come to my assistance.

--I have close relationships that provide me with a sense of emotional security and well-being.

---There is someone I could talk to about important decisions in my life.

---I have relationships where my competence and skills are recognized.

---There is no one who shares my interests and concerns.

---There is no one who really relies on me for their well-being.

---There is a trustworthy person I could turn to for advice if I were having problems.

---I feel a strong emotional bond with at least one other person.

---There is no one I can depend on for aid if I really need it.

---There is no one I feel comfortable talking about problems with.

---There are people who admire my talents and abilities.

---I lack a feeling of intimacy with another person.

---There is no one who likes to do the things I do.

---There are people I can count on in an emergency.

---No one needs me to care for them.

No—this scale incudes items that measure social support.
Fassberg (2012)Definition: “the degree of positive involvement with family, friends, and social groups.” (p 723) “the degree to which older adults are connected to family, friends, and their communities” (p 725) Description: Not statedMarital status, Living arrangement, Religion, Frequency of social contact, Social integration, Social support, Relationship discord, Loneliness (Single item: Do you feel lonely?)No—many social factors are measured
Hawkley (2005)Definition: Three domains of social connectedness: Isolation: “pervasive sense of aloneness and social dissatisfaction at the Personal level” (p 802) Relational Connectedness: “social satisfaction at the interpersonal level” (p 803) Collective connectedness: “social satisfaction at a group level” (p 803) Description: “individuals' conceptual organization of their relationships to others” (p 798) “mental representations of loneliness-connectedness appear to originate from three highly related but distinct aspects of the social domain Isolation, Relational Connectedness, and Collective Connectedness” (p 801) “the conceptual space representing satisfaction with social connectedness” (p 803)20-item UCLA Loneliness Scale Isolation: (2) I lack companionship; (3) there is no one I can turn to; (4) I feel alone; (7) I am no longer close to anyone; (8) My interests and ideas are not shared by those around me; (11) I feel left out; (12) My social relationships are superficial; (13) No one really knows me well; (14) I feel isolated from others; (17) I am unhappy being so withdrawn; (18) People are around me but not with me Relational Connectedness: (10) there are people I feel close to; (15) I can find companionship when I want it; (16) There are people who really understand me; (19) There are people I can talk to; (20) There are people I can turn to Collective Connectedness: (1) I feel in tune with the people around me; (5) I feel part of a group of friends; (6) I have a lot in common with the people around me; (9) I am an outgoing personYes
Hawkley (2012)Definition: Three factors: “Intimate Connectedness: experiences of social value as an individual…posited to represent deeply-held beliefs about our individual social value” (pp 1–2) Relational Connectedness: experiences of social value in dyadic friendship relationships…posited to represent feelings of closeness and support” (pp 1–2) Collective Connectedness: “experiences of collective identity and belonging in a group…posited to represent feelings of group identification and cohesion” pp 1–2 Description: “organized mental representations of our social connections…mental representations of …experiences of social connectedness or loneliness” (p 1)20-item UCLA Loneliness Scale Isolation: (2) How often do you feel that you lack companionship?; (3) How often do you feel that there is no one you can turn to?; (4) How often do you feel alone?; (7) How often do you feel that you are no longer close to anyone?; (8) How often do you feel that your interests and ideas are not shared by those around you?; (11) How often do you feel left out?; (12) How often do you feel that your relationships with others are meaningless?; (13) How often do you feel that no one really knows you well?; (14) How often do you feel isolated from others?; (17) How often do you feel shy?; (18) How often do you feel that people are around you but not with you? Relational Connectedness: (10) How often do you feel close to people? (15) How often do you feel you can find companionship when you want it? (16) How often do you feel that there are people who really understand you? (19) How often do you feel that there are people you can talk to? (20) How often do you feel that there are people you can turn to? Collective Connectedness (1) How often do you feel that you are “in tune” with the people around you? (5) How often do you feel part of a group of friends? (6) How often do you feel that you have a lot in common with the people around you? (9) How often do you feel outgoing and friendly?Yes
Kim (2015)Definition: Subjective evaluation of social connectedness includes perceived social support, quality of social relations, and loneliness and belongingness.” (p 3) Description: Not stated3 items for social participation: asked about participation or involvement in (1) family activities such as eating out, shopping, gardening, etc., (2) other social activities such as meeting with friends or relatives during the past week, and (3) volunteer work during the past week. 2 items for quality of social relations: the level of satisfaction with the participants' close social networks: how satisfied they were with (1) the relationship with their family members, and (2) the number of their friends.No—for the measure of social participation Yes—for the measure of quality of social relations
Lee (2014)Definition: “an individual's subjective awareness of interpersonal closeness with people and the social world” (pp 301–302) Description: “Social connectedness could be perceived as the broader construct that encompasses the various ways of building closeness and relatedness with others.” (p 302)7 Items of support received in church context

--Other than your minister, pastor, or priest, how often does someone in your congregation let you know they love and care for you?

--How often does someone in your congregation talk with you about your private problems and concerns?

--How often does someone in your congregation express interest and concern in your well-being?

--How often does someone in your congregation give you a ride to church services?

--How often does someone in your congregation provide you with transportation to other places, like the grocery store or doctor's office?

--How often does someone in your congregation help you with things that need to be done around your home, such as household chores or yard work?

--How often does someone in your congregation help out when you or a member of your family are ill?

7 items for support provided to others in church context

--How often do you show someone in your congregation that you love and care for him/her?

--How often have you talked with someone in your congregation about his/her private feelings and concerns?

--How often have you expressed interest and concern in the well-being of someone in your congregation?

--How often do you provide transportation to church for someone in your congregation?

--How often do you provide transportation for someone in your congregation to other places, like the grocery store or the doctor's office?

--How often do you help someone in your congregation with things that need to be done around his/her home, such as household chores or yard work?

--How often have you helped take care of someone in your congregation when he/she was ill?

No—measured social support (tangible and emotional) instead of feelings of closeness
Marshall (2011)Definition: “also known as social engagement refers to the strength in the closeness or ties older adults experience through friendships, family, and other relationships.” (p 84) Description: Not Stated3 items

--How close do you feel to your church members?

--How close do you feel to your family members?

--How close do you feel to your friends?

Yes
Mellor (2008)Definition: Not Stated Description: Not stated16 item Social Connectedness Scale (Lee and Robins 1995) Subscale 1, 8 items: measures the extent to which the respondent feels connected to others (e.g., “Even around people I know, I don't feel that I really belong”). Subscale 2, 8 items: measures the extent to which the respondent feels the need for social reassurance from others. (e.g., “I feel more comfortable when someone is constantly with me”)Yes—subscale 1 No subscale 2— need for social reassurance may be a different concept
Ong (2005)Definition: “having quality ties to others (p 476) Description: “positive aspects of social relationships (e.g., affection, attachment, intimacy)” (p 477)14-item Positive Relations With Others subscale of the Psychological Well-Being Measure (Ryff & Keyes, 1995). Item examples: “Most people see me as loving and affectionate” and “I know that I can trust my friends, and they know they can trust me.”No—example suggests that items may also reflect how one feels they are perceived by others
Pan (2012)a subjective awareness of interpersonal closeness with the social world ...” (p 35) This sense of closeness is based on the aggregate experiences with all kinds of relationships, such as parents, friends, peers, strangers, communities, and society… A person struggling to feel connected may feel different and distant from other people.” (p 35) a broad definition of social connectedness includes feelings of intimacy with others and belonging to the outside world.” (p 43) Description: Not statedAdapted version of the Social Connectedness Scale (Lee and Robins 1995). One subscale was selected that measured the extent to which the respondent felt connected to others. Examples from this subscale were “Even around people I know, I don't feel that I really belong,” and “I feel so distant from people.”Yes
Register (2010a) Report 1 of 3Definition: Not stated Description: “…social connectedness originates intrinsically” (p 465) “Involvement in meaningful and reciprocal relationships” (p 475) “Relationships with family and friends were a principal concern for older adults in this study. The older men and women expressed the importance of continued and ongoing companionship and socialization in a variety of ways. The desire and need to be with people was universally expressed. The older adults in this study had a great capacity for giving, sharing, and loving. At the same time, they expressed a need to know that they were loved, cared for, and important to someone.” (p 472) “One of the married women illustrated the reciprocal nature of relationships. She derived a great deal of pleasure in giving to others… In contrast, a widow, who lived alone, expressed an overwhelming need for companionship in her life.” (p 472)Not statedNot applicable
Register (2011) Report 2 of 3Definition: “Connected to others includes human interpersonal relationships that are free of spatial or temporal constraints.” (p 62) Description: Two critical attributes of social connectedness: Being part of a family: “Seeking ongoing interactions with family members and feeling needed, wanted, and loved by family members” (p 69) “ Being part of a family is also characterized by wanting to be with one's family, spending time with one's family, talking with a family member, and worrying about a family member.” (p 69) Having friends: “A variety of activities, thoughts, and feelings older adults engage in that are associated with friendship” (p 69) “Having friends includes appreciating one's friendships, being with one's friends, and wishing more friends were in close proximity.” (p 69)10 items about being part of a family;

--Wanted to be with my family

--Felt needed by my family

--Felt loved by my family

--Spent time with my family

--Talked with a family member

--Felt needed by someone

--Wished my family lived closer to me

--Felt wanted by someone

--Felt close to a family member who lives far away

--Worried about a family member

Having friends

--Felt good about having friends close by

--Wanted to be with friends

--Spent time with a friend

--Felt good about my friendships

--Thought about a friend

--Talked with an old friend

--Wished I had more friends close by

No—some items refer to contact frequency with family or friends
Register (2010b) Report 3 of 3Definition: “Includes all human interpersonal relationships including, but not limited to, family, friends, neighbors, and acquaintances both living and deceased” (p 56) Description: Having relationships: being part of a family and having friends (p 58)Not statedNot applicable
Romero (2004)Definition: “the degree to which an individual feels interpersonal closeness with his or her social world (e.g. family, friends, peers).” (p 40) “…reflects a pervasive, internal sense of belonging.” (p 40) Description: Not stated20 item Social Connectedness Scale-Revised (Lee, Draper, and Lee 2001); further revised in this study to measure recent social connectedness by adding the qualifier ‘during the past week’Yes—social assurance is no longer measured as a subscale in this instrument; additional items were added to measure belongingness
Semino (1990)Definition: “the need for social ties and/or attachments” (p 11) “…experience of connectedness with meaningful or valued sources of [social] attachment” (pp 42–43) Description: “On the whole, those connections which were difficult to establish and/or sustain did not play a significant role in the lives of these subjects.” (p 84) “the individual perceptions of the subjects in relation to their view of … their relationships with other people. The value placed on these relationships reflects some commonalties of experience in that the most significant relationships were characterized by a personal connection. This type of connection was usually found with family members or with friends who knew a particular subject pre-institutionalization. However, as in the case of the third and fifth subjects and their respective aide/companions, a personal connection can also incorporate a unique and special connection made during, after, or as a result of institutionalization.” (pp 94–95) “In general, the values placed on certain connections were reflective of their function in the lives of the subjects in this sample. Connections which were highly valued were those which were sustained despite a subject's entrance into the long-term care institution. People with whom the subjects had these social ties included members of the immediate family such as children, the children's spouses, and grandchildren. Friends outside the institution who made an effort to maintain contact were also highly valued as a source of connection to the outside world. In the case of the third and fifth subjects both of whom did not have family members in the state, a highly valued connection consisted of a special caretaker/friend who knew them on a personal level in addition to attending to their physical needs. The main function of highly valued connections was that these connections helped meet the subjects' normative psychosocial needs for love and belonging (Maslow; cited in Schaie & Willis, 1986). These connections also served to keep three out of the five subjects in touch with their past; namely, the meaningful roles they played in their family structures as mothers and wives.” (p 85) “Moderately valued connections included impersonal relationships which served an important function in the lives of two of the subjects at the present time. These connections were with the staff of the nursing home who represented these subjects' need for physical care and health supervision. These connections were reflective of these subjects' needs for safety and security … Minimally valued connections included those connections which could not meet the subjects' psychosocial needs for love, belonging, and/or companionship.” (pp 85–86)Interview guide:

--What contacts did the individual have inside and outside the nursing home?

--Which contacts did the individual value and/or consider meaningful?

--What efforts, if any, did the individual and/or others make to establish and/or maintain these connections? How are these efforts demonstrated?

--Were there any other sources of attachment that provided the individual with a sense of connectedness; such as certain places, ideas, or objects?

--How had the individual's experience of affiliation and/or connection with these sources of attachment changed since coming to the nursing home?

--What were the explanations that the individual gave for the change in connections and/or affiliations?” pp 50–51

No—questions are broader about contact and efforts to maintain meaningful contact
Stanley (2014)Definition: “Loneliness the subjective experience of feeling socially disconnected from others” (p 394) Description: “…pets may be a source of social connectedness that buffer against feelings of loneliness” (p 394) “Social connectedness is often thought of as the presence of meaningful connections with other human beings; however, in some instances, certain older adults may have their need for connectedness met, in part, by owning a pet.” (p 397)1 item: ‘In the past two weeks, I have felt lonely’Yes
Sun (2012)Definition:the extent to which a person participates in relationships with others.” (p 225) “Individual connectedness referred to a person's subjective psychological assessment of his or her identity as an isolated person or one who is linked closely with others.” (p 226) “…relational connectedness was a person's sense that he or she belonged to a network of friends and family members: people who were available and supportive.” (p 226) “Collective connectedness was an elder's perception of social belonging.” (p 226) Description: Not statedIndividual connectedness: 5 items from the UCLA Loneliness Scale (Russell, 1996):

--There are people that I talk to

--There are people I can turn to

--I feel alone

--I feel I am no longer close to anybody

--I lack companionship

Relational connectedness:

--the average number of people from whom participants could receive assistance in eight different areas: financial assistance, technical advice, caregiving support, making new friends, helping with chores, sharing feelings, resolving family conflicts, and boosting confidence

--4-items adapted from the Social Support Questionnaire (Sarason et al., 1987): satisfaction with the amount of emotional support, advice and information support, help received in times of health problems, and friends made in the retirement community.

Collective connectedness:4 items of membership in organizations:

--Do you belong to a social club?

--Do you belong to a religious organization?

--Do you currently engage in volunteer work within the retirement community?

--Do you currently volunteer in a setting outside of your retirement community?

6 items of engagement in social activities.

--number of activities that participants did on a regular basis (i.e., sports, playing games, attending workshops, going to cultural events, working on crafts, and attending musical events)

No—measures social support, and support network size, group membership and social activity engagement
Van Orden (2013)Definition: Psychological connectedness: “ …low belonging and feeling like a burden on others…indicate the presence of perceived social disconnectedness. Low (or thwarted) belonging is a psychologically painful mental state that results when the fundamental need for social connectedness…is unmet. The need to belong is satisfied by feeling both positively connected to and cared about by others. The need to belong is most easily met by feeling as if one ‘belongs to’ caring relationships that involve frequent, proximal contact. Feelings of loneliness are one indicator that the need to belong is not fully met. Perceived burdensomeness is a mental state characterized by perceptions that one is not making positive contributions to relationships, and in a more extreme manifestation, the belief that others would be “better off if I were gone.” (p 118) Description: Not stated15-item Interpersonal Needs Questionnaire (Van Orden et al. 2012)

--low belongingness subscale “These days, I feel lonely”

--perceived burdensomeness subscale (e.g. “These days I feel like a burden on the people in my life”)

Yes—low belongingness subscale No—feeling like a burden may be slightly a different concept
Zelenka (2011)Definition: “The opposite of loneliness has been defined as “embeddedness,” …and as “feelings of belongingness”; here I call it “perceived social connectedness” or just “social connectedness.” … affective sense of being embedded in a network of social ties…” (p 12) “a person's sense of being in relationship with others, of having people they can turn to when they need help, of being embedded in one or more social networks, and of being around people they can relate to.” (p 47) Description: “Reversing the scale so that higher is better can be considered a measure of perceived social connectedness…” (p 60)11 items from the UCLA Loneliness Scale Version 3 (Russell, 1996) (e.g. How often do you: feel that you are 'in tune' with the people around you? feel isolated from others? have people you can talk to? have people you can turn to? have people who understand you? feel that there are people you feel close to? feel you have a lot in common with friends? feel part of a group?)Yes
Authors

Dr. O'Rourke is Post-doctoral Fellow, and Dr. Sidani is Professor, Canada Research Chair (Health Interventions: Design and Evaluation), Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada.

The authors have disclosed no potential conflicts of interest, financial or otherwise. This work was supported by the Canadian Institutes for Health Research (trainee award to H.M.O.). The sponsor was not involved in any aspect of the design or conduct of this review.

The authors acknowledge Don Kinder, Ryerson University, for his assistance in development of the search strategy for this review.

Address correspondence to Hannah M. O'Rourke, PhD, RN, Post-doctoral Fellow, Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, Ontario, Canada, M5B 2K3; e-mail: hannah.orourke@ryerson.ca.

Received: March 11, 2016
Accepted: January 12, 2017
Posted Online: April 11, 2017

10.3928/00989134-20170223-03

Sign up to receive

Journal E-contents