Impact of interventions targeting social isolation and loneliness for older adults with cardiovascular disease: a systematic review

BACKGROUND: Older adults are particularly vulnerable to social isolation and loneliness, and these factors amplify modifiable cardiovascular (CVD) risk factors for those with existing CVD. A range of interventions have been reported in the literature. This systematic review aimed to evaluate the impact of non-pharmacological interventions targeting loneliness and social isolation experienced by older adults in this target group, who are living independently or in residential facilities. METHODS: Four databases (Embase, Medline, CINAHL, and PsycINFO) were searched. Papers were screened by two independent reviewers and included if they were in English, evaluated interventions addressing loneliness, social isolation, or social support in older adults (mean age ≥ 55) with CVD. Eligible papers included qualitative and quantitative designs with outcomes related to quality of life, lifestyle factors, or cardiovascular biomarkers. Randomised controlled trials were assessed using the Cochrane risk-of-bias tool (Version 2). Methodological quality was evaluated using the Critical Appraisal Skills Programme (CASP) or the Mixed Methods Assessment Tool (MMAT). The replicability and reporting of papers was documented against the Template for Intervention Description and Replication (TIDieR) checklist and the RE-AIM framework. RESULTS: 8451 papers were identified, hand-searching identified a further 16. 5396 papers were screened for title and abstract after de-duplication. One hundred and eighteen papers were assessed for inclusion. Twelve papers were included, representing 11 studies, with interventions delivered to 651 participants across seven countries. Group-based activities, particularly those combining exercise and education, were the most common and consistently demonstrated improvements in social support, psychological wellbeing, and quality of life. Four papers reported statistically significant improvements in social support, while one reported a decline. Psychological outcomes improved in four papers, and quality of life improved in four out of five papers. Face-to-face group interventions demonstrated improvements across several key outcomes, including reduced loneliness, psychological wellbeing and quality of life. CONCLUSIONS: This review suggests face-to-face group-based exercise and education programs may provide a basis for improving loneliness and social isolation in older adults with existing CVD. Further research is warranted given the limited number of studies that have targeted this population group and there is a need for high quality studies detailing reproducible interventions to guide evidence-based practice.