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Title
Qualitative study of loneliness in a senior housing community: the importance of wisdom and
other coping strategies.

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https://escholarship.org/uc/item/8d3832hz

Journal
Aging & mental health, 25(3)

ISSN
1360-7863

Authors
Morlett Paredes, Alejandra
Lee, Ellen E
Chik, Lisa
et al.

Publication Date
2021-03-01

DOI
10.1080/13607863.2019.1699022

Peer reviewed

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 Aging & Mental Health

ISSN: 1360-7863 (Print) 1364-6915 (Online) Journal homepage: https://www.tandfonline.com/loi/camh20

Qualitative study of loneliness in a senior housing

community: the importance of wisdom and other
coping strategies

Alejandra Morlett Paredes, Ellen E. Lee, Lisa Chik, Saumya Gupta, Barton W.
Palmer, Lawrence A. Palinkas, Ho-Cheol Kim & Dilip V. Jeste

To cite this article: Alejandra Morlett Paredes, Ellen E. Lee, Lisa Chik, Saumya Gupta, Barton
W. Palmer, Lawrence A. Palinkas, Ho-Cheol Kim & Dilip V. Jeste (2020): Qualitative study of
loneliness in a senior housing community: the importance of wisdom and other coping strategies,
Aging & Mental Health, DOI: 10.1080/13607863.2019.1699022

To link to this article: https://doi.org/10.1080/13607863.2019.1699022

Published online: 10 Jan 2020.

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AGING & MENTAL HEALTH
https://doi.org/10.1080/13607863.2019.1699022

Qualitative study of loneliness in a senior housing community: the

importance of wisdom and other coping strategies
Alejandra Morlett Paredesa,b , Ellen E. Leea,b,c, Lisa Chika, Saumya Guptaa, Barton W. Palmera,b,c ,
Lawrence A. Palinkasd, Ho-Cheol Kime and Dilip V. Jestea,b,f
a
Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; bSam and Rose Stein Institute for Research on Aging,
University of California San Diego, La Jolla, CA, USA; cUniversity of California, Veterans Affairs San Diego Healthcare System, San Diego,
CA, USA; dDepartment of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA; eScalable Knowledge
Intelligence, IBM Research-Almaden, San Jose, CA, USA; fDepartment of Neurosciences, University of California San Diego, La Jolla,
CA, USA

ABSTRACT ARTICLE HISTORY

Objective: Older adults are at a high risk for loneliness, which impacts their health, well-being, Received 18 July 2019
and longevity. While related to social isolation, loneliness is a distinct, internally experienced, dis- Accepted 24 November 2019
tressing feeling. The present qualitative study sought to identify characteristics of loneliness in
KEYWORDS
older adults living independently within a senior housing community, which is typically designed
Social isolation; retirement;
to reduce social isolation. aging; depression;
Method: Semi-structured qualitative interviews regarding the experience of loneliness, risk factors, compassion; older adults
and ways to combat it were conducted with 30 older adults, ages 65–92 years. The interviews
were audiotaped, transcribed, and coded using a grounded theory analytic approach based on
coding, consensus, co-occurrence, and comparison.
Results: Three main themes with multiple subthemes are described: (A) Risk and Protective factors
for loneliness: age-associated losses, lack of social skills or abilities, and protective personality traits;
(B) Experience of loneliness: Sadness and lack of meaning as well as Lack of motivation; and (C)
Coping strategies to prevent or overcome loneliness: acceptance of aging, compassion, seeking
companionship, and environment enables socialization.
Discussion: Despite living within a communal setting designed to reduce social isolation, many
older adults described feeling lonely in stark negative terms, attributing it to aging-associated
losses or lack of social skills and abilities. However, interviewees also reported positive personal
qualities and actions to prevent or cope with loneliness, several of which mirrored specific compo-
nents of wisdom. The results support the reported inverse relationship between loneliness and wis-
dom and suggest a potential role for wisdom-enhancing interventions to reduce and prevent
loneliness in older populations.

Introduction may be modifiable, and person-focused interventions are

an important but underdeveloped approach (Perissinotto,
There is a public health epidemic of loneliness with serious
Holt-Lunstad, Periyakoil, & Covinsky, 2019)
physical and mental implications (Lubben, Gironda,
Several published papers have focused on the qualita-
Sabbath, Kong, & Johnson, 2015; Murthy, 2017). Loneliness tive experience of loneliness among overseas or immigrant
rivals smoking and obesity in its impact on shortening lon- populations (Wong, Chau, Fang, & Woo, 2017), medically ill
gevity. In the UK, economic consequences of loneliness for persons (Drageset, Eide, Dysvik, Furnes, & Hauge, 2015;
businesses (lost productivity, greater healthcare, and care- €berg, Edberg, Rasmussen, & Beck, 2019), and people at
Sjo
giver expenses) were estimated to be over $3 billion annu- highest risk for loneliness (Neves, Sanders, & Kokanovic,
ally, and this led to establishment of a new Ministry of 2019). However, there is little published literature on quali-
Loneliness in 2018 (McDaid, Bauer, & Park, 2017). Older tative studies of loneliness among independent living older
individuals are at a high risk for loneliness due to worsen- adults in the community. We have been studying physical,
ing physical health, loss of family and friends, as well as mental, and cognitive function in 100þ older adults living
social isolation (Lee et al., 2018). in the independent living sector of a senior housing com-
Loneliness is related to but distinct from social isolation, munity (Jeste, Glorioso, et al., 2019). Combining data from
both conceptually and psychometrically (Hawkley & multiple studies, we found a high prevalence of moderate-
Cacioppo, 2010; Tabue Teguo et al., 2016). Specifically, severe loneliness using the UCLA-3 loneliness scale (Lee
loneliness is defined as subjective distress resulting from a et al., 2018; Russell, 1996). The most significant association
discrepancy between desired and actual relationships (Ernst of loneliness was an inverse relationship with wisdom, as
& Cacioppo, 1999), while social isolation is the objective measured with the San Diego Wisdom Scale (SD-WISE;
lack of social contacts and interactions (Cornwell & Waite, Thomas et al. (2019)). Wisdom is a complex personality trait
2009; Gardner, Brooke, Ozanne, & Kendig, 1999). Loneliness comprised of several specific components: emotional

CONTACT Dilip V. Jeste [email protected]

ß 2019 Informa UK Limited, trading as Taylor & Francis Group
2 A. MORLETT PAREDES ET AL.

regulation with positivity, empathy and compassion, self- building includes front desk concierge services, restaurant,
reflection, decisiveness amid uncertainty, and spirituality chapel, beauty salon, bank, library, as well as a well-
(Jeste, Lee, et al., 2019). equipped fitness center with an indoor pool and regular
Older adults are increasingly moving into senior housing exercise classes.
or retirement communities (Jeste & Childers, 2017).
Investigating loneliness within such communities makes it
possible to study subjective loneliness in older adults who Quantitative loneliness measure
are not socially isolated, since the senior housing commun- To quantitatively assess loneliness, the 20-item UCLA
ities provide proximity to others, shared common areas, Loneliness Scale (Version 3) or UCLA-3 was administered to
planned social outings, transportations, and other commu- all participants (Russell, 1996). It has been shown to have
nal activities. This is in contrast to most of the older adults strong test-retest reliability, high internal consistency, and
who live by themselves or only with their spouses or part- validity. While the word ‘lonely’ is never used explicitly,
ners and are socially isolated due to their physical disabil- participants rate the frequency of several experiences (e.g.
ities as well as lack of opportunities for social interactions. ‘How often do you feel in tune with others around you?’ or
Understanding loneliness within the context of a senior ‘How often do you feel left out?’) on a 4-point Likert scale.
housing community may be relevant to better understand- The published cut-offs for loneliness severity on the UCLA-
ing loneliness within other settings, as well as advancing 3 scale are: Total score < 28 ¼ No/Low Loneliness, Total
community- and facility-based interventions for loneliness. score 28–43 ¼ Moderate Loneliness, and Total score
As loneliness is an inherently subjective internal experi- >43 ¼ High Loneliness (Cacioppo & Patrick, 2008).
ence, it is important to consider the qualitative perspec-
tives of older individuals with respect to the characteristics
and associations of loneliness. Using individual qualitative Qualitative interviews
interviews with 30 older adults, the aim of the present
The sample size for qualitative interviews (N ¼ 30) was
study was to describe the experience of loneliness and risk
determined by the point at which we observed saturation
factors for it as well as coping mechanisms employed by
of themes (Guest, Bunce, & Johnson, 2006). The first 30
these individuals to try to prevent or overcome it.
subjects from the parent study who completed qualitative
interviews were included in the present study, without con-
Methods sideration of their demographics or any information regard-
ing their clinical rating scale scores on loneliness or other
Study design measures. We did not select study participants based on
The present work is a part of a larger ongoing study of their level of loneliness as we sought to obtain an
physical, cognitive, and mental health in over 100 residents unbiased sample of residents of that senior housing com-
of the independent living sector of a senior housing com- munity. As a result, some residents were experiencing lone-
munity in San Diego County (Jeste, Glorioso, et al., 2019). liness while others were not.
All the participants provided written informed consent Qualitative interviews began in April 2018 and ended in
for study participation. Inclusion and exclusion criteria for August 2019. Semi-structured qualitative interviews were
enrollment were: i) English speaking individuals aged  conducted within the subjects’ residences by a trained staff
65 years, ii) Ability to engage in a qualitative interview, and member (LC), using a predetermined list of broad,
iii) no known diagnosis of dementia or any other severely research-driven probes developed by the investigator team.
disabling illnesses. This study protocol was approved by Primary questions were: (1) Do you ever feel lonely, and if
the University of California San Diego (UCSD) Human so, how often, and how would you describe the feelings?
Research Protections Program (HRPP), as well as the admin- (2) If you don’t feel lonely, why do you think others may
istrative leaders of the housing community. Participants for feel lonely? (3) How might aging play a role in loneliness?
the overall parent study were recruited through short pre- and (4) What do you do, or think that others can do, to
sentations at the residential community and through fliers. not feel lonely anymore?
The senior housing community is situated on 12 acres During each interview, the interviewer started with gen-
of land in a suburb of San Diego. The community has over eral questions, including those listed above, and asked add-
270 independent residential units and offers different levels itional questions based on individual responses, in order to
of care including assisted living and memory care. The elicit further details. Qualitative research techniques out-
senior housing community boasts an extensive array of lined by Patton (2002) served as the training manual.
activities and amenities designed to bring residents Interviews were no longer than 1.5 h in length, with the
together in both large and small group settings including content of each interview audio-taped and subsequently
afternoon socials and a weekly Happy Hour, quilting and transcribed.
sewing, knitting, card games, bead and art classes, as well
as games like Bingo, Mah Jong, Billiards, and Dartball.
Data analysis
There is also a well-equipped Wood Shop, an 18-hole put-
ting course, and a tennis court. Residents can obtain a gar- The transcripts were uploaded into qualitative analyses pro-
den plot to grow plants, flowers and vegetables. The gram Dedoose (Dedoose Version 8.0.35, 8.0.35, 2018) and
facility theater hosts outside musical and entertainment analyzed using the method of ‘Coding Consensus, Co-
groups, lectures, movies, and special meetings. occurrence, and Comparison’, outlined by Willms et al.
Transportation is provided weekly to off-site venues such (1990) and rooted in grounded theory (i.e. theory gener-
as restaurants and local community events. The main ated from data and illustrated using characteristic examples
 AGING & MENTAL HEALTH 3

(Glaser & Strauss, 1967). The personal interview content experience of loneliness such as feelings of sadness and
was initially coded independently by the project investi- hopelessness, while some non-lonely subjects perceived
gators at a general level in order to condense the data lonely people as lacking motivation. A number of inter-
into analyzable units. Segments of transcripts ranging viewees emphasized actions that helped them cope with
from a phrase to several paragraphs were assigned codes, loneliness. The three main themes and their subthemes are
based on key questions from the personal interview guide discussed in more details below, with illustrative quotes
or themes. In certain instances, it was appropriate for the from the participants, identified in italics.
same segment of text to be assigned more than one
code. Each transcript was independently coded by three
Theme (a): Risk and protective factors for loneliness
authors (AMP, EEL, SG), who coded two initial sets of 5
Subtheme 1. Aging-associated losses. A number of resi-
transcripts each, for themes and subthemes, and met with
dents attributed their loneliness to losses associated with
the other authors to discuss the coding and reach a con-
aging: the deaths of partners, family, and friends as well as
sensus. The authors developed a coding matrix of three
the loss of physical health with aging. Subjects commented
themes, each with several subthemes. Disagreements in
on how such losses impacted their ability to engage in
code description or assignment were resolved through
social activities and seek companionship.
discussions among investigators with the appropriate
refinement of codes, as needed. The list of codes was
 Well, as you get older, there’s less and less people. You
finalized via group consensus, and resulted in a list of
know, people die off around you, and a world of loneli-
themes, issues, and opinions related to loneliness. Next,
ness. And I suppose too, as you get older, it’s harder to
AMP, EEL, and SG independently coded the other 20 inter-
get around and see the people that you do know.
views in their entirely. Eighty-six percent of the segments
[Subject A (female)]
were assigned the same codes, indicating a high degree
of concordance among the raters (Landis & Koch, 1977).
Subtheme 2: Lack of social skills. The participants who did
Through the process of constant comparison (Glaser &
not endorse loneliness themselves perceived lonely people
Strauss, 1967), the independent categories were further
as lacking social skills that enable them to connect others.
condensed into three broad themes. These themes were
derived from the four questions, based on the theoretic-
 And so often, I hear a lot of them don’t have social skills.
ally grounded sets of categories as described by Braun
They’re perfectly capable people but they don’t have the
and Clarke (2006).
social skills. [Subject B (male)]

Results Subtheme 3. Protective personality traits (oneliness and

spirituality). Several subjects described personal qualities
Sample characteristics that were protective against loneliness. Enjoyment of soli-
The interviewees were 30 adults between the ages of 67 tude or ‘oneliness’ where one could be alone without the
and 92 years (mean age 81.6, SD ¼ 7.0). Two-thirds (67%) distress that characterizes loneliness (Alberti, 2018).
were women and 90% were Caucasian. In terms of for-
mal education, 90% had at least some college education.  I usually don’t feel lonely. I may feel alone, but that
The subjects had a mean total score of 39.3 (SD 11.9) on doesn’t mean that I have a craving to have somebody
the UCLA-3 loneliness scale: with 15% with no/low loneli- with me … This brings up the thought that I’m proud I
ness, 63% with moderate loneliness, and 22% with high can stay by myself. And handle myself, so, not saying
loneliness. Comparable scores in the non-participant sub- that’s right or wrong. [Subject C (male)]
jects from the larger parent study were: mean 36.9 (SD
9.3) with 18% with no/low loneliness, 50% with moder- A number of individuals spoke about their faith and
ate loneliness, and 32% with high loneliness. Mean lone- spirituality as an important way of coping with losses and
liness scores and severity of loneliness did not differ preventing loneliness. Some spoke about how their faith
between the groups (Mann-Whitney U ¼ 888.5, p ¼ 0.65; helped them cope with losses of a partner, while others
&Chi;2 (2) ¼ 1.33, p ¼ 0.51; respectively). The subsample described how religion helped them connect to other indi-
viduals in the community.
featured in this study did not differ in age, sex, race, or
education compared to the total sample (Jeste, Glorioso,
 Here one of the things that I enjoy is the fact that we
et al., 2019).
have all the faiths here, and also, opportunity … so I feel
very comfortable going to the Catholic Church … I go to
Qualitative findings the Protestant services … I’m in my search for God. He’s
everywhere, so I go everywhere … I read the Bible, and I
The three main themes from the qualitative interviews
more or less read the Torah. I feel very comfortable.
were: (A) Risk and Protective factors for loneliness, (B)
[Subject D (female)]
Experience of loneliness, and (C) Coping strategies to pre-
vent or overcome loneliness. Some subjects highlighted
how aging-related losses contributed to their loneliness. Theme (B): Experience of loneliness
Other participants noted particular personality characteris- Subtheme 4. Personal experience of sadness and lack of
tics or social skills that contributed to or alleviated/prevent meaning. Many participants emphasized the association of
loneliness. Many subjects described the subjective loneliness with feelings of emptiness and sadness. The lack
4 A. MORLETT PAREDES ET AL.

of meaning and hope was echoed in other quotes. There connecting with others seemed to be mutually beneficial—
was also a sense of feeling isolated and ignored by others. to others and to themselves.

 Oh, ugly. Just ugly. … I’m very silent, and I would be  Another technique that I had for years, if you’re feeling
away from everybody and everything … I can think of lonely then go out and do something for somebody
periods where I felt lonely, and it was a sense of not else … That’s proactive … [Subject G (female)]
being attached, not having very much meaning, and not
feeling very hopeful. [Subject E (female)] Subtheme 8: Seeking companionship. Some older adults
discussed feeling lonely as a choice; that an individual
Several participants reported feeling helpless and could choose to seek the company of others to combat
powerless when they were lonely—highlighting how the loneliness. A few interviewees described deliberately
social disconnectedness left them vulnerable. changing their behaviors, despite risking possible rejection.

 That there is no one else in your situation. That you do  I felt lonely because I chose to stay away from people
not know how to change it so the sudden loss of control because I was sick, but I felt alone for a while and said to
over your life maybe. I came to this home, what am I myself, did I make the right move … as soon as I started
going to do? I don’t know what to do, that being lost getting involved, everybody has welcomed you for the
and not having control and sometimes it can lead you to most part. I mean, I’ve had my rejections asking if I could
not be able to make decisions and then it just gets worse. join somebody at a table or whatever and say okay … I’ll
[Subject F(female)] go find another table, no big deal. [Subject I (female)]

Subtheme 5: Perception of others’ experience of loneliness: Subtheme 9: Environment that enables socialization.
Lack of motivation. The participants who did not endorse Several residents noted specific features of their senior
housing community structure that helped to reduce social
loneliness themselves perceived lonely people as being
isolation and combat loneliness. At the same time, some
unmotivated. This lack of motivation, desire or self-efficacy
stressed the fact that people have to exert themselves to
may hamper lonely individuals from seeking and establish-
make use of the opportunities that are available.
ing social connections.
 We have the putting green here, I can go do that. We
 It’s a feeling of nothing … You’re not feeling glad. You’re
have pool tables here, I can go on up and shoot a game
not feeling sad. You’re feeling nothing, and you don’t
of pool or something, and our poker games, and uh … If
want to do anything … that’s the bad part. People get
nothing else, I’ll go down to the lobby, and I can find
into that. They don’t want to do anything, and they’re
somebody down there to talk to, and I can go into the
expecting somebody to do something for them. [Subject library, and they’ve got a computer in there, and they got
G (female)] a dart board there, I can go that, and … but … I just
have to get up and do something. [Subject J (male)]
Theme (C): coping strategies to prevent or over-
come loneliness Discussion
Several participants highlighted specific actions to prevent
The results of this study suggest that even in structured
or cope with and overcome loneliness. These included a
community environments with considerable opportunities
number of subthemes revolving around acceptance of
for socialization, many older adults experience strong and
aging-related changes, compassion, companionship, and
distressing feelings of loneliness. However, a few individu-
activities offered through the community.
als never feel lonely while others have felt lonely at specific
time periods, often tied to losses. While there are environ-
Subtheme 6: Acceptance of aging. In contrast to the earlier
mental factors that contribute to social isolation (an object-
quotes noting the age-related losses, some participants
ive construct), there are also a number of personal qualities
noted positive changes that occurred with aging. They and traits that seemed to be protective against loneliness
reported their acceptance of the functional decline in older (a subjective feeling). Figure 1 outlines the themes and
age, noting how they had adapted their mindset to their subthemes related to loneliness. These themes and sub-
new normal. themes are inter-related with one another as they contrib-
ute to feelings of loneliness in a person.
 Well, it’s something I have to accept, cause I’ve got it, Some of the themes and subthemes expressed by the
and it’s something there’s no use being afraid of it. I’ve to participants in the current study overlap with those from
go along with what I’ve got with it … I used to mountain other published studies on loneliness. For example, the
climb … If I can’t walk anymore, I’ll crawl, so you have to experience of loneliness described in other populations of
learn how to be realistic and not brood about it … I older adults includes helplessness and alienation from soci-
know I’m getting older but I, I consider life is a transition. ety (Wong et al., 2017). However, our subjects also spoke
[Subject H (male)] at length about emptiness as well as lack of meaning and
hope. Our findings on the role of aging in loneliness sup-
Subtheme 7: Compassion. Some people described how port other qualitative work in older adults that also
helping others helped them prevent feeling lonely. Thus, reported the contribution of age-related disabilities (Finlay
 AGING & MENTAL HEALTH 5

Risk and Protective Factors Experience of Loneliness Coping Strategies

Aging-associated losses Personal experience: Acceptance of aging

Lack of Social Skills Sadness & Lack of meaning Compassion
Seeking companionship
Protective personality traits Perception of others’ experience: Environment enables socialization
(Oneliness, Spirituality) Lack of motivation

Figure 1. Diagram illustrating inter-connected themes and subthemes related to loneliness.

& Kobayashi, 2018; Li, Xu, & Chi, 2018) and shrinking social prevent or cope with wisdom involved compassion, a key
network (Finlay & Kobayashi, 2018; Li et al., 2018; Wong component of wisdom.
et al., 2017), though the adaptation to aging has not been In addition, these findings open up the opportunity to
observed. Similarly, other studies have reported ways in reflect on the current social environment these housing
which older adults cope with loneliness, such as keeping communities offer and how small changes in their social
busy by oneself (Drageset et al., 2015; Stanley et al., 2010) activities could effectively increase meaning and purpose
and doing activities interacting with others (Drageset et al., of life for individuals, possibly strengthening interpersonal
2015; Finlay & Kobayashi, 2018). An Australian study relationships that could create meaningful and positive
reported benefits to being alone, which aligned with our results on a person’s emotional state (e.g. reduce loneli-
characterization of oneliness or comfort with solitude, as a ness). Appropriately cultivated social environment and well-
time to self-reflect and conduct spiritual activities (Stanley planned shifts in social programming can effectively
et al., 2010). One community-based study suggested that increase a sense of meaning and purpose for residents,
specific neighborhood features (racial inclusiveness, repre- possibly strengthening interpersonal relationships as well,
sentation of own ethnic group, shared public spaces, and via shared efforts to create meaningful results. The success
communal resources/amenities) were associated with lower of such programs depends on ensuring that they meet the
levels of loneliness (Finlay & Kobayashi, 2018; Li needs of each individual resident’s desire for a genuine
et al., 2018). social connection Future studies should look at these inter-
To our knowledge, our study is the first one to examine actions (current activities and the addition of meaningful/
loneliness in senior housing communities, which are struc- purposeful activities) in order to personalize the residents’
tured and operated with a goal of promoting social activ- social agenda as this may be what distinguishes feeling
ities. Whereas several residents commented on the alone and feeling socially engaged.
availability of such opportunities to socialize as a way to As a whole, the results from this study suggest that peo-
overcome loneliness, it is notable that many other resi-
ple’s experience of living with loneliness is shaped by a
dents still felt lonely despite a lack of objective social isola-
number of personal and environmental factors which
tion. Thus, our results stress the critical role of positive
remain in a constant, inter-connected relationship to one
psychological traits that can help a person prevent or cope
another and determine the way people adjust to loneliness
with loneliness—e.g. acceptance of the changes associated
over time. This is consistent with the complexity theory
with aging, compassion, and spirituality. While a number of
described by Thelen (2005) and Gorska, Forsyth, and
loneliness interventions have focused on strengthening
Maciver (2018), which considers the aging experience from
social networks, the results have been mixed (Cohen-
multiple varied and interacting perspectives (cultural, bio-
Mansfield & Perach, 2015).
logical, social, etc.)
In this study, we observed several interesting relation-
An important feature of the present study is that it sup-
ships of loneliness with several components of wisdom
ports the previously published quantitative finding of an
(spirituality, emotional regulation, self-reflection, decisive-
ness, compassion, spirituality). Spirituality, a component of inverse relationship between loneliness and wisdom (Lee
wisdom, was highlighted as a personal quality that was et al., 2018). There might even be a possible biological
protective against loneliness for some people. Under the basis for such a relationship. Recent genomics research has
theme of the Experience of Loneliness, the interviewees revealed an association between loneliness and genes
mentioned emptiness and sadness, which stood in contrast expressed in the prefrontal and anterior cingulate cortices
with emotional regulation with positivity, a component (Abdellaoui et al., 2018)—the same areas as those puta-
of wisdom. Several individuals attributed others’ loneliness tively related to components of wisdom (Meeks & Jeste,
to inability and lack of motivation to act on loneliness, 2009). It is worth noting that wisdom is a potentially modi-
which has a parallel to lacking decisiveness (a component fiable trait, as there are a number of studies with effective
of wisdom). With aging, we saw two opposite perspec- interventions for subcomponents of wisdom. There is evi-
tives. Some subjects attributed their loneliness to aging- dence that psychosocial interventions can improve emo-
associated loss of friends, family, and physical health, tional regulation and compassion/empathy as well as
whereas others accepted the inevitable losses that occur spirituality (Kelly & Carter, 2015; Margolin, Beitel, Schuman-
with aging (self-reflection). Baltes and Baltes, pioneers in Olivier, & Avants, 2006; Weiss et al., 2018). For example,
the field of wisdom research, proposed the Model of mindfulness-based stress reduction has been shown to
Selective Optimization with Compensation for successful improve self-compassion in medical students (Erogul,
aging (Baltes & Baltes, 1990). Our findings were consistent Singer, McIntyre, & Stefanov, 2014), while goal manage-
with their model, especially in how older adults would ment training increased emotional regulation in adults with
adjust their goals, adapting to age-related disabilities acquired brain injuries (Tornas, Lovstad, Solbakk, Schanke,
through acceptance. Finally, successful strategies to & Stubberud, 2016).
6 A. MORLETT PAREDES ET AL.

Loneliness may be modifiable through use of technol- Disclosure statement

ogy to facilitate social interactions (Tsai & Tsai, 2011) or to
The authors declare no financial or other relationship relevant to the
foster new relationships (Weinert, Cudney, & Hill, 2008). subject of this article.
However, strong evidence for technological or other inter-
ventions in older community-dwelling individuals is lacking
(Cohen-Mansfield & Perach, 2015), and person-focused Funding
interventions for social isolation are an important but This study was supported, in part, by the NARSAD Young Investigator
underdeveloped approach (Perissinotto et al., 2019). The grant from the Brain and Behavior Research Foundation (PI: Ellen E.
current study has potential implications for developing Lee, MD), National Institute of Mental Health [NIMH T32 Geriatric
new interventions to tackle or prevent loneliness. While liv- Mental Health Program MH019934 (PI: Dilip V. Jeste) and
R01MH094151-01 (PI: Dilip V. Jeste, MD)], by the Stein Institute for
ing alone contributes to social isolation, promoting wisdom
Research on Aging (Director: Dilip V. Jeste, MD) at the University of
may enhance the quality of social relationships through California San Diego, and by the IBM Research AI through the AI
compassion and emotional regulation with positivity, and Horizons Network.
offer a unique solution to loneliness, beyond external inter-
ventions such as support groups and facilitation of social
interactions through technology and social media
(Kharicha, Manthorpe, Iliffe, Davies, & Walters, 2018). References
There are several limitations to our study. First, partici- Abdellaoui, A., Sanchez-Roige, S., Sealock, J., Treur, J. L., Dennis, J.,
pants were recruited from a senior housing community in Fontanillas, P., … Boomsma, D. I. (2018). Phenome-wide investiga-
San Diego County and were mostly well educated tion of health outcomes associated with genetic predisposition to
Caucasians from middle or upper socioeconomic strata. loneliness. bioRxiv 468835. doi:10.1101/468835
Alberti, F. (2018). Loneliness is a modern illness of the body, not just the
Thus, the results may not generalize to people from other mind. Retrieved from https://www.theguardian.com/commentisfree/
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Authors contribution adults and their residential contexts in the Minneapolis metropol-
itan area, USA. Social Science & Medicine, 208, 25–33. doi:10.1016/j.
A. M. Paredes helped design the study, coded transcripts,
socscimed.2018.05.010
and edited the manuscript. E. E. Lee helped design the Foti, S. A., Khambaty, T., Birnbaum-Weitzman, O., Arguelles, W.,
study, coded transcripts, and prepare the manuscript. L. Penedo, F., Espinoza Giacinto, R. A., … Llabre, M. M. (2019).
Chik conducted the qualitative interviews. S. Gupta coded Loneliness, cardiovascular disease, and diabetes prevalence in the
transcripts, and edited the manuscript. B. W. Palmer helped hispanic community health study/study of latinos sociocultural
plan loneliness probes and edited manuscript. L. A. ancillary study. Journal of Immigrant and Minor Health, 1–8. doi:10.
1007/s10903-019-00885-7
Palinkas helped with data analysis and edited the manu-
Gardner, I., Brooke, E., Ozanne, E., & Kendig, H. (1999). Improving social
script. H-C. Kim helped design the study and edited the networks, a research report: improving health and social isolation in
manuscript. D. V. Jeste helped design and implement the the Australian veteran community. Melbourne: Lincoln Gerontology
study, analyzed results, and helped prepare the manuscript. Centre, La Trobe University.
 AGING & MENTAL HEALTH 7

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8 A. MORLETT PAREDES ET AL.

Appendix: Coding schema for assessment of 3. Unattached

loneliness among older adults 4. Feeling insignificant
5. Feeling like an outsider
A. Risk and protective factors for loneliness 6. Lack of control
2. Perception of others’ experience
1. Age-associated losses i. Lack of motivation or desire to seek relationships
i. Loss of partners, family, friends (deaths, moving) 1. Lack of self-efficacy to find new relationships
1. Loss of social supports and network
ii Loss of physical health and functioning
C. Coping strategies
1. Pain, mobility
2. Hampering ability to engage in social activities 1. Acceptance of aging
2. Lack of social skills i. Modifying expectations of one’s own physical abilities
i. Interpersonal skills to connect with others ii. Improvements with aging
3. Protective personality traits 1. Less preoccupied with pleasing others
i. Oneliness 2. Learning from experiences on engaging with others
1. Enjoyment of solitude and solitary activities 3. Learning how to manage one’s own grief
2. Not feeling a need for other people and loneliness
ii. Spirituality 2. Compassion
1. Self-transcendence i. Helping others with specific tasks
2. Organized religious practices ii. Reaching out to others for social connection
iii. Get involved in causes larger than themselves
B. Experience of loneliness 3. Seeking companionship
i. For organized activities
1. Personal experience ii. For meals
i. Sadness iii. For conversations
1. Emptiness 4. Environment enables socialization
2. Depression i. Communal dining area
ii. Lack of Meaning ii. Communal gaming areas
1. Helplessness iii. Communal library
2. Hopeless iv. Organized activities—posted in a central location