Issues in Mental Health Nursing, 27:795–813, 2006

Copyright c Informa Healthcare

ISSN: 0161-2840 print / 1096-4673 online
DOI: 10.1080/01612840600781196

LONELINESS IN OLDER WOMEN: A REVIEW

OF THE LITERATURE

Claudia Beal, MN, RN, CNM

Doctoral Student, The University of Texas at Austin,
Austin, Texas, USA

Older women report more loneliness than male peers.

Loneliness is an area of concern related to the well being of
older women because it is a cause of emotional distress and
is linked to a variety of health problems in older
individuals. Life changes, including widowhood and
relocation, are associated with increased vulnerability to
loneliness. Gender, social, and cultural factors influence the
experience of loneliness in older women. Cognitive and
interactionist theoretical approaches to loneliness have
utility for nursing practice and research with older women
who experience loneliness.

The topic of loneliness in old age has generated considerable in-

terest among researchers. A large number of studies have examined
the prevalence, correlates, and contributing factors of loneliness in this
population. Evidence has emerged that older women report more lone-
liness than males of similar age. Women between the ages of 60 and
80 reported higher levels of loneliness than male peers in a meta-
analysis of 149 studies from multiple countries (Pinquart & Sorenson,
2001). More women (19%) than men (12%) reported being lonely in
a sample of 654 individuals over age 65 (Prince, Harwood, Blizard, &
Thomas, 1997). In a study of individuals over age 75, 38% of women felt
lonely compared with 24% of the men (Holmen, Ericsson, Andersson, &
Winblad, 1992).

The author is grateful to Tracie Harrison, PhD, RN, for her thoughtful critique of this
manuscript.
Address correspondence to Claudia Beal, Louise Herrington School of Nursing, Baylor
University, One Bear Place # 97333, Waco, TX 76798-7333. E-mail: [email protected]

795
796 C. Beal

Loneliness has long been recognized as a cause of human suffering

(Fromm-Reichman, 1959). A growing body of research suggests that
loneliness also is associated with a variety of adverse physical and psy-
chological health outcomes in older individuals. Loneliness was found
to increase the risk of a heart condition in a sample of 180 community
residing older individuals (Sorkin, Rook, & Lu, 2002). It was identified
as a risk factor for depression in a study of adults age 60–90 living in in-
dependent living facilities (Adams, Sanders, & Auth, 2004). Feelings of
loneliness also were associated with an increased risk for suicide among
those age 65–97 years (Rubenowitz, Waern, Wilhelmson, & Allebeck,
2001). Therefore, loneliness is a phenomenon of concern for all nurses
who interact with older individuals.
Rokach and Brock (1997) state that the manner in which loneliness
is experienced and the causes attributed to it are influenced by gender
and stage of life. Yet, few studies focus exclusively on loneliness in
older women, and much of our understanding of loneliness during this
life stage results from studies that include both sexes. Although these
studies increasingly analyze variables by gender, they do not provide
a full understanding of the experience of loneliness in older women.
In addition, although many theoretical perspectives for loneliness are
described in the literature, it is not clear which is most helpful—and
under what circumstances—to examine loneliness in older women. Fi-
nally, no recent review of the literature on loneliness in older women has
been performed. Before nurses can devise interventions to reduce lone-
liness in this population, a better understanding of loneliness is needed.
Hence, the purpose of this paper is to review the literature on loneliness
in older women and assess the applicability of two theoretical perspec-
tives, the cognitive framework of de Jong Gierveld (1987) and the inter-
actionist theory of Weiss (1973), for conceptualizing loneliness in this
population.

BACKGROUND

Loneliness is a common experience across the lifespan yet one that

eludes precise definition. Peplau and Perlman (1982) defined loneliness
as an unpleasant experience that arises when a person’s network of social
relations is deficient. Rook (1984) described loneliness as a state of
emotion characterized by a sense of estrangement in which an individual
feels misunderstood by others. Weiss (1973) considered loneliness to
be a describable—but not definable—subjective phenomenon in which
an individual lacks close emotional attachments or an engaging social
network.
Loneliness in Older Women 797

Loneliness in older individuals frequently is related to age-related

changes and losses (Ryan & Paterson, 1987). Women may be more vul-
nerable to loneliness because they live longer and experience events such
as the deaths of spouses (Holmen et al., 1992) and relocation (Rokach &
Brock, 1997) with greater frequency. One result of these changes and
losses may be the disruption of women’s social networks. Social net-
works are made up of the people with whom we frequently interact and
are the primary source of support and assistance (Andersson, 1998).
Stokes (1986) posits that women view relationships within their social
networks differently than men. Women generally develop “close, dyadic
social ties” less related to large social networks than to the “nature of
close, intimate one-to-one relationships” (Stokes, 1986, p. 8).
The literature reveals many diverse theories on loneliness, many of
which are contained within the cognitive, interactionist, psychodynamic,
and existential frameworks (Donaldson & Watson, 1996). In evaluating
the utility of these approaches for nursing research and practice with
elderly individuals, Donaldson and Watson (1996) suggest combining
aspects of cognitive and interactionist perspectives. According to these
authors, cognitive frameworks have the potential to enable nurses to
grasp the subjective aspects of loneliness while the interactionist per-
spective considers the nature of social contacts (Donaldson & Watson,
1996). Since events in the lives of older women frequently cause so-
cial network disruption, drawing on both perspectives may allow an
examination of the manner in which older women perceive their social
networks as well as how the loss of specific types of relationships are
related to loneliness. Therefore, the findings of this review will be dis-
cussed in relation to the cognitive framework of de Jong Gierveld (1987)
that emphasizes the role of perception in the experience of loneliness,
and the interactionist perspective of Weiss (1973) that views loneliness
as a response to the absence of a satisfying social network or a particular
type of relationship.

Theoretical Perspectives

The cognitive framework proposed by de Jong Gieveld (1987) (see

Figure 1) emphasized a subjective evaluation of the social network as
central to the experience of loneliness, and considers the influence of
age, gender, marital status, and personal and social norms. Central to this
conceptualization are negative feelings associated with lacking compan-
ionship, missing a certain relationship, and/or missing some qualitative
aspect of a relationship (de Jong Gierveld, 1998). This approach draws
798
FIGURE 1. The de Jong-Gierveld Loneliness Model.
Loneliness in Older Women 799

on the theoretical perspective of Perlman and Peplau (1982) in which

cognition is central to evaluating the adequacy of social relationships,
and loneliness develops when there is a discrepancy between desired
and actual social relations. De Jong Gierveld (1987) extended this cog-
nitive perspective to consider the influence of personal and societal
norms and values on the way in which individuals perceive and in-
terpret their social network. Subjective evaluations serve as the mediat-
ing factor between characteristics of the social network and the experi-
ence of loneliness. Other factors that influence this cognitive appraisal
include personality characteristics and background variables such as age,
sex, and employment.
Weiss (1973) distinguished social and emotional isolation as two dis-
tinct forms of loneliness, the former related to the “absence of an accept-
able social network” and the latter due to the “absence of an attachment
figure.” Weiss (1989) posited that the loneliness of social isolation is
related to lack of integration into a social network or community. Emo-
tional isolation is a response to the absence of a particular aspect of a
relationship and cannot be remedied merely by the presence of another
relationship. The conceptualization of emotional loneliness is rooted in
the attachment theory of Bowlby (1973) that describes the nature of
bonds between infants and parents.

METHOD

A literature search of CINAHL, MEDLINE, PsyclNFO, and Soci-

ological Collection databases was performed for 1995–2005 using the
keywords “women”, “elderly”, and “loneliness”. Limiters were English
language, age 65+, and peer reviewed journal articles. Age 65+ was
specified because the goals of the National Institute on Aging target
individuals over age 65. Inclusion criteria were quantitative studies of
women in which loneliness was a variable and qualitative research that
identified loneliness as a theme in data analysis. Two studies were in-
cluded because the average age of participants (M = 63) was close to
the specified age of 65. Two studies of women age 59–78 and 55–90
also were included because of the small number of studies that focused
exclusively on loneliness in older women.

FINDINGS

The search yielded 34 articles, of which ten were relevant and retained
for review. The findings were categorized by study area and include wid-
owhood, immigration, chronic illness, lifelong singlehood, friendship,
800 C. Beal

and abusive relationships. A brief description of the studies within these

categories follows. Table 1 shows a summary of the findings.

Widowhood

In a longitudinal multi-cohort study Zettel and Rook (2004) examined

social network substitution and compensation in 322 widowed women
in the United States (aged 60–85, M = 71). Substitution was defined as
the degree to which social ties provided support; compensation referred
to how well the social ties contributed to feelings of depression and lone-
liness. Three cohorts, women widowed for 3–6 months, 15–18 months,
and 27–30 months were interviewed seven times in a year. Three forms
of social network substitution was assessed, including the formation of
new social relationships, rekindling dormant social ties and relying on
members of the existing social network for relationship functions previ-
ously performed by the spouse. All three types of substitution occurred
in the sample with rekindling old ties reported most frequently. None of
the three types of substitution was associated with reduction in loneli-
ness scores on a four-item version of the UCLA Loneliness Scale, and
the widows in all cohorts who formed the greatest number of new social
ties during the study period scored significantly higher on the loneliness
measure than widows whose social networks contained few new social
ties, t(320) = 2.41, p < .05.
A qualitative study using grounded theory methodology examined
the grief experience of older widows whose husbands received hospice
care (Jacob, 1996). Six widows (age 66–78, M = 74.3) were interviewed
within the first four months of being widowed and then twice more when
they had been widowed 7–10 months and 13–16 months. Five major
concepts emerged: Being Aware, Experiencing Distress, Supporting,
Coping, and Facing New Realities. Loneliness was a cause of emotional
distress in all three phases of data collection and particularly at 13–16
months.
Harrison, Kahn, and Hsu (2004–2005) conducted a hermeneutic
phenomenological study of 11 African-American widows aged 53–79
(M = 69.7) who had been married to their deceased spouses from 5–
43 years (M = 26.3). Data collection consisted of individual interviews,
writing field notes, and asking demographic questions. Four themes were
identified: Defining Needs and Relaxing Boundaries, Releasing the Sad-
ness and Keeping Busy, Being Together, and Going on Alone. Both the
state of “being alone” and feeling lonely were described by the widows
in the study.
Loneliness in Older Women 801

TABLE 1. Summary of Studies of Loneliness in Elderly Women

Authors Location Design No. Women Findings
Widowhood
Zettel, A. United States S 322 three forms social substitu
Rook, K. tion varied with duration
(2004) of widowhood; greater
substitution related to inc
reased loneliness
Jacob, S. (1996) United States Q 6 concepts: being aware; cop
ing; experiencing distress;
supporting; facing new
realities
Harrison Kahn & Hsu United States Q 11 themes: defining needs &
(2004–05) relaxing boundaries; rele
asing the sadness & keep
ing busy; being together;
going on alone
Immigration
Choudry, U. (2001) Canada Q 10 themes: isolation & loneli
ness; family conflict; eco
nomic dependence; settl
ing in & coping

Kim, O. (1999) United States S 110 loneliness related to satisfact

ion with social network,
ethnic attachment & func
tional status
Chronic Illness
Hyde et al. (1999) Australia Q 12 themes: gaining & maintain
ing control over vulner
able limbs; lifestyle con
sequences of leg ulcera
tion & impaired mobility
Abusive Relationships
Zink et al. (2003) United States Q 36 themes: having much to lose
& overcome; aging effects
Friendship Programs
Stevens, N. Netherlands PT 32 program participants: increa
Van Tilburg, T. (2000) sed new friends & impro
ved existing friendships;
decrease in loneliness
Stevens, N. (2001) Netherlands PT 40 improved existing relation
ships & reduced loneli
ness reported; widows
have lowest decrease in
loneliness
Singlehood
Baumbusch, J. (2004) Canada Q 8 themes: independence;
absence of companion
ship; support & physical
intimacy

Note: Types of design: S = survey; PT = post test; Q = qualitative.

802 C. Beal

Chronic Illness

In a qualitative study of 12 Australian women (aged 70–93) with

chronic leg ulceration two major themes were revealed: gaining and
maintaining control over vulnerable limbs, and lifestyle consequences
of chronic leg ulceration and impaired mobility (Hyde, Ward, Horsfall &
Winder, 1999). Data were collected using a gender-specific collection
method to uncover the respondents’ subjective experience of chronic
illness. Loneliness emerged as a subtheme in which social isolation was
described due to physical limitations and the long-term nature of the
health condition.

Friendship Programs

Stevens and Van Tilburg (2000) conducted a study of 32 Dutch older

women (age 54–80, M = 63.2) who participated in a program aimed at
improving existing friendships or developing new ones to reduce lone-
liness. The aims of the program were to reduce loneliness when present
in older women and to empower participants to analyze their current so-
cial network, clarify friendship goals, and develop strategies to achieve
their goals. The program consisted of 12 weekly lessons on topics that
include the types and value of different types of friendships and devel-
oping competency in friendship development. Study participants were
women enrolled in the program who agreed at the end of the program to
be in the follow-up study. They were interviewed in their homes shortly
after end of the program and one year later. A control group that did
not participate in the program was drawn from a longitudinal commu-
nity survey on social networks and matched on age, marital status, and
loneliness scores. After one year, loneliness scores of both the study
participants and controls declined. A t test for independent samples was
applied to the differences in initial and one year loneliness scores be-
tween the two groups. The mean change score (−2.59) for program
participants was greater than the mean change score (−1.41) for the
control group (t = −1.96, p = .054).
Stevens (2001) conducted a follow-up of 40 participants, including
the 30 participants described by Stevens and Van Tilburg (2000), who
completed the friendship program. Almost half (48%) reported that their
friendships had improved in the past year. At the first data collection
point, 42% of participants were moderately lonely and 45% were very
lonely as measured by a loneliness scale. At the last data collection point
approximately one year after program completion, loneliness was sig-
nificantly reduced with the percentage of those very lonely decreasing
Loneliness in Older Women 803

from 45% to 15%. The author noted that final loneliness scores were in
the range of “moderately lonely.”

Immigration

Kim (1999) examined predictors of loneliness in a correlational study

of 110 Korean immigrant women (age 60–86, M = 72.45) living in
a large metropolitan area. Subjects had lived in the United States for
a mean of 14 years. Stepwise multiple regression analysis was used
to determine that satisfaction with social support, ethnic attachment,
and functional status were predictive of level of loneliness. The women
most satisfied with social support as measured by the Social Support
Questionnaire had the lowest levels of loneliness on the Revised UCLA
Loneliness Scale (RULS). Functional status as measured by the Instru-
mental Activities of Daily Living scale was inversely related to higher
levels of loneliness on RULS. High scores on the Ethnic Attachment
Questionnaire positively correlated with higher levels of loneliness on
RULS.
In a qualitative study using a descriptive exploratory approach
Choudhry (2001) interviewed ten women (age 59–78) who had im-
migrated to Canada from India. The purpose of the study was to ex-
amine the role of beliefs, values, and culture as mediators of stress in
the resettlement experience of South Asian older women. Four themes
emerged from the data: Isolation and Loneliness, Family Conflict, Eco-
nomic Dependence, and Settling In and Coping. Subthemes of Isolation
and Loneliness included lack of informal support, the fast pace of chil-
dren’s lives/no time for the elderly, and language barriers with neighbors
and grandchildren.

Lifelong Singlehood

Baumbusch (2004) used a gerontological feminist approach in a

qualitative study of ever-single older women. Respondents were eight
women (age 65–77) in a mid-sized Canadian city who had never been
married and had no children. Semi-structured interviews were con-
ducted to elicit perceptions of positive and negative aspects of life-
long singlehood. Respondents valued their independence and felt that
their experience of being single had prepared them to be alone in
their older years. Lack of companionship, social support, and inti-
macy emerged as negative aspects of singlehood and were interpreted as
loneliness.
804 C. Beal

Abusive Relationships

Zink, Regan, Jacobson, and Pabst (2003) conducted semi-structured

interviews with 36 women age 55–90 (M = 58) who had been in abusive
relationships since age 55. The purpose of the study was to understand
women’s reasons for remaining in long-term abusive relationships. The
median length of the relationships was 23 years with a range from 2
to 67 years. Data were analyzed using thematic analysis. Fear of being
alone emerged as one reason for remaining in the abusive relationships.

Summary

Ten studies on loneliness in older women from diverse countries were

reviewed. Loneliness was experienced in the context of friendship in ad-
vancing age (Stevens & Van Tilburg, 2000; Stevens, 2001), lifelong sin-
glehood (Baumbusch, 2004), widowhood (Jacob, 1996; Harrison et al.,
2004–2005; Zettel & Rook, 2004), immigration (Choudhry, 2001; Kim,
1999), chronic illness (Hyde et al., 1999), and abusive relationships (Zink
et al., 2003). Disruption of the social network occurred during widow-
hood, chronic illness, and immigration. These disruptions affected the
ability of older women to meet their needs for companionship and sup-
port. Stage of life was a factor in evaluating relationships by the single
women and those in abusive relationships.
Because the de Jong Gierveld (1987) theoretical perspective empha-
sizes how individuals evaluate their social networks and considers the
influence of age and gender, it is an appropriate framework with which
to examine the findings of this review. Two elements of this framework,
descriptive characteristics of the social network and the background vari-
ables that may affect how individuals perceive their social network, guide
this discussion. Personality characteristics are not discussed because the
literature review did not reveal relevant studies. Weiss’s (1973, 1989)
distinction between emotional and social loneliness furthers understand-
ing of how the absence of different types of relationships contributes to
feelings of loneliness in older women.
DISCUSSION

Central to the de Jong Gierveld (1998) theoretical perspective is a

subjective evaluation of characteristics of the social network. These
characteristics include the number and type of relationships, their emo-
tional depth, and the functions served by those relationships (de Jong
Gierveld, 1987). A social network may include family members, friends,
Loneliness in Older Women 805

co-workers, and neighbors, and the relationships with each of these mem-
bers is differentiated by the function it serves for an individual (de Jong
Gierveld, 1987).
Marital status influences the opportunity for establishing and main-
taining a social network (de Jong Gierveld, 1987) and is consistently as-
sociated with loneliness in the literature. Pinquart and Sorensen (2001)
reported that unmarried individuals generally report being lonelier than
those who are married. Marriage is thought to provide a buffer against
loneliness by meeting human needs for companionship and intimacy.
As individuals grow older marital status becomes less influential as is-
sues related to advancing age emerge (de Jong Gierveld & Dykstra,
1993). In this review, ever-single older women who generally expressed
satisfaction with their single status indicated that a lack of intimacy,
companionship, social support, and care giving were negative aspects
of being single in their older years (Bambusch, 2004). The author of
this qualitative study interpreted these negative aspects of singlehood as
indicators of loneliness.
The death of a spouse often causes changes in the social networks
of older women that may contribute to feelings of loneliness. Lopata
(1980) reported that part of the experience of widowhood was missing
the social aspects of being a couple such as having an escort and attend-
ing social events together. In this review, both social network disruption
and a subsequent assessment of the reconfigured network figured promi-
nently in the experiences of elderly widows. During the early stages of
bereavement, widows of hospice patients attributed the cause of their
loneliness to receiving less support from family and friends in addi-
tion to the loss of spousal support (Jacob, 1996). Companionship needs
also arose that the network could not meet (Jacob, 1996). Hospice wid-
ows attributed deficits in their social network to the fact that family
and friends were busy and “all had lives of their own” (Jacob, 1996,
p. 284). African-American widows described forgoing accustomed so-
cial events for which they felt a partner was necessary (Harrison, Kahn, &
Hsu, 2004–2005).
A central component of loneliness is “feelings associated with the ab-
sence of an intimate attachment, feelings of emptiness or abandonment”
(de Jong Gierveld, 1998, p. 74). These feelings were integral to the lone-
liness experience of widows in this review. One participant expressed the
feeling that “half of me is here, and half of me is gone” and “nothing will
ever take his place” (Jacob, 1996, p. 282). As the bereavement period
continued, an increase in loneliness occurred as family members avoided
speaking of the deceased spouse (Jacob, 1996). For African-American
widows, feelings of loneliness were closely related to the missing
806 C. Beal

relationship. “I am just a lonely person. Lonely. . . . Open the door and

not look back. That’s what I felt as a widow because once a point in
time, I went through that door and he was behind me but now when I go
through that door, I’m going alone. I am alone” (Harrison, Kahn, & Hsu,
2004–2005, p. 145). These responses indicated that the widows acutely
felt the absence of their partner and viewed the lost spousal relationship
as unique. These findings are consistent with Weiss’s (1973) proposition
that a particular aspect of a missing relationship is central to feelings of
loneliness.
In addition to loneliness, the concept of being alone was reported
to be part of the experience of older women. It is generally accepted
that aloneness and loneliness are not synonymous, and one can be
alone but not lonely and conversely, one can feel lonely in the pres-
ence of others (Peplau & Perlman, 1982). In contrast to loneliness,
which is almost universally described as a negative experience, being
alone can be a positive state (Fromm-Reichman, 1959). Ever-single older
women reported that independence was a positive aspect of being alone
(Baumbusch, 2004). The African-American widows reported positive
effects of being alone such as evolving independence, the opportunity to
consider personal needs, and pride in home maintenance skills (Harrison
et al., 2004–2005). However, a darker side of being alone was revealed
in the study of older women who remained in abusive relationships. The
fear of being alone was described as one reason for remaining with their
abusers (Zink et al., 2003). The desire to avoid being alone was related
to perceptions of aging coupled with concerns that the women would
not find another partner (Zink et al., 2003).
Once deficits in social relationships are perceived, individuals may re-
spond with resignation or attempt to alter the situation (de Jong Gierveld,
1998). Rebuilding social networks and establishing new relationships
are usual and effective ways to cope with loneliness (Rokach, 1990).
The widows studied by Zettle and Rook (2004) instituted three types
of social substitution, with rekindling dormant ties the most common.
Loneliness levels were not significantly decreased as a result of social
substitution; in fact, the widows with the most new social ties were found
to be lonelier than those with few new ties (Zettle & Rook, 2004). In one
study of a friendship program for older women, widows had the smal-
lest reduction in loneliness compared with other women (Stevens, 2001).
One explanation for these findings may be that the new relationships
were evaluated as qualitatively different from the missing relationship
and thus were ineffective in reducing feelings of loneliness. This ex-
planation is congruent with Weiss’s (1973) perspective that emotional
loneliness is related to a particular aspect of the missing relationship
Loneliness in Older Women 807

and cannot be assuaged by the substitution or development of other

relationships.
Old age is identified as a time when friendships may decline due
to changes such as heath problems and relocation (Van Tilburg, 1998).
Friendships are an integral part of social networks and are usually based
on freedom of choice, shared interests, and providing a forum to discuss
personal issues (de Jong Gierveld, 1998). In older individuals, contact
with friends was associated with lower levels of loneliness than contact
with family members (Pinquart & Sorensen, 2001). For older women,
friendships provide both companionship and support functions (Rook,
1984). Companionship is thought to contribute to well being because
it provides an escape from work and family concerns and is a vehicle
for shared interests and activities (Rook, 1990). Intimate personal rela-
tionships within the network provide a sense of belonging and protect
against loneliness (de Jong Gierveld, 1998).
In a study of a friendship program for older women, loneliness lev-
els were significantly reduced one year after completion of the program
(Stevens, 2001). A sizable number (48%) of participants reported that
their existing friendships had improved since the program ended. A
social network that included friends that fulfill the need for companion-
ship as well as more intimate friends who provide emotional support
was found to buffer older women against loneliness after completion of
the friendship program. Although a causal relationship between these
programs and reduced loneliness cannot be drawn due to potential self-
selection bias in the study design, these studies lend support to the role of
friendship as a protective factor against loneliness later in life. However,
the fact that average loneliness scores remained in the moderately lonely
range after the programs indicates that loneliness is a multi-dimensional
phenomenon as posited by de Jong Gierveld (1998) and not related to
only one type of relationship.
Another factor that may influence the subjective evaluation of the
social network and the intensity of loneliness in later life is geographic
mobility (de Jong Gierveld, 1987). Two studies in this review revealed
loneliness to be part of the experience of relocation, and in both stud-
ies culture emerged as a dominant theme. The immigration experience
marks a significant transition in the lives of women, and emotional dis-
tress, including loneliness, is often is associated with such transitions
(Schumacher & Meleis, 1994). An elderly woman who immigrated to
Canada from India described herself as “alone in this whole word [with]
no one to listen to and nobody to talk to” (Choudhry, 2001, p. 385).
For elderly South Asian female immigrants, balancing affiliations to
previous beliefs and traditions while simultaneously adapting to a new
808 C. Beal

culture represented important challenges in resettlement (Choudhry,

2001). The tension between cultures was evident in the accounts of
older women who emigrated from India to Canada to live with their
sons, a living arrangement consistent with Indian tradition. The émigrés
attributed their loneliness in part to the fact that their sons were in the
process of adapting to a foreign, fast paced, culture and had less time to
spend with them (Choudhry, 2001).
Bennett and Detzner (1997) proposed that the clash between South-
east Asian cultures in which reciprocity and interdependence character-
ize social interactions, and Western society in which autonomy domi-
nates, contributes to loneliness in immigrants. The South Asian women
in Choudhry’s (2001) study were without the extended network of family
and friends that previously had been an important source of social sup-
port. Neighbors had been such an important part of the social network in
India that they were described as “like a big family” (Choudhry, 2001).
The women in this study perceived their new neighbors as less friendly
than those in India, and language barriers hindered their attempts to
establish new social ties (Choudhry, 2001).
Consistent with de Jong Gierveld’s (1987) contention that personal
and social norms influence the perception of loneliness, the women who
immigrated to Canada evaluated their new social networks with ref-
erence to the social and cultural traditions of India. The émigrés also
experienced the social and emotional loneliness described by Weiss
(1973). The absence of usual patterns of social exchange and support
coupled with language barriers contributed to social loneliness, and emo-
tional loneliness was evident in the changed relationships with their
sons.
The extent of satisfaction with the social network is a more important
factor in the perception of loneliness than the number of relationships
in the network (de Jong Gierveld, 1987). Low quality of social con-
tacts was reported as a better predictor of loneliness than low quantity
of contacts among older individuals (Pinquart & Sorensen, 2001). For
the elderly Korean female immigrants discussed in this review, social
network satisfaction was a more significant predictor of loneliness than
network size (Kim, 1999). For these women, loneliness also was related
to their degree of sociocultural attachment. Those with the strongest
ethnic attachments, as measured by involvement with Korean neigh-
bors, church, language, and history, had higher levels of loneliness
than those who were less attached (Kim, 1999). These findings sug-
gest that maintaining strong ethnic attachments affects the manner that
new social networks are evaluated and may influence the perception of
loneliness.
Loneliness in Older Women 809

Other Findings

Health status is not a component of the de Jong Gierveld (1987)

theoretical framework although it may affect an individual’s ability to
establish and maintain social relationships (de Jong Gierveld, 1998). In
one study in this review, women with a chronic condition reported that
their social networks were altered as a direct result of their condition,
resulting in social isolation and loneliness. In another study, an inverse
relationship between functional heath status and loneliness was reported.
Elderly Korean immigrant women who scored lowest on a measure of
functional health status had the highest levels of loneliness (Kim, 1999).
This is consistent with previous findings that individuals age 60 to 75
with moderate to severe physical heath impairments reported greater
loneliness than those with less impairment (Badger, 1993).
Hyde et al. (1999) identified social isolation in elderly women with
chronic leg ulceration. The women had limited contact with others due to
age, physical limitations, and the chronicity of their condition and were
for the most part housebound. One woman looked forward to visits from
the nurse and supermarket delivery boy as these were her only social
contacts, and another respondent described feelings of boredom (Hyde
et al., 1999). It should be noted that social isolation and loneliness are not
synonymous though they are closely related and often co-exist. Social
isolation refers to a lack social contacts and is not the same as subjective
feelings of loneliness (Carpenito-Moyett, 2004). Social isolation was
posited to lead to loneliness in a previous study of individuals with
chronic obstructive pulmonary disease (Keel-Card et al., 1993).
Social isolation may result from concern about the reaction of others
to visible manifestations of illness. Stigma is a major theme in chronic
illness (Lubkin & Larson, 2002). Goffman’s (1963) classic study traces
the use of the word to ancient Greece and refers to stigma as “bodily signs
designed to expose something unusual and bad about the moral status of
the signifier” (Goffman, 1963, p. 1). Women with chronic leg ulceration
in this review reported an acute awareness of smell and leakage and
described strategies to conceal these signs of illness from others (Hyde
et al., 1999). Women with HIV/AIDS, a highly stigmatized disease in
North American culture, similarly described trying to hide the “AIDS
look” by using makeup and layering clothing (Klitzman, 1997).
The relationship between chronic illness and loneliness has impor-
tant implications for the nursing care of older women since the incidence
of these conditions increases with age and is associated with disabili-
ties. Forty-three percent of women aged 65 and older report a sensory,
physical, mental, or self-care disability, or difficulty leaving their homes
810 C. Beal

(Waldrop & Stern, 2003). Since recent research suggests that loneliness
has an adverse affect on health, the potential for loneliness to further
compromise the health of individuals who are already experiencing ill-
ness is of concern.

CONCLUSION

According to de Jong Gierveld (1987), loneliness is a subjective phe-

nomenon not causally related to situational factors. The studies in this
review indicate that certain life events trigger changes in social rela-
tionships that make women vulnerable to loneliness. In particular, wid-
owhood, chronic illness, and the immigration experience are events in
older women’s lives that appear to create the opportunity for loneliness.
In addition, the studies in this review indicated that loneliness in ever-
single older women and those in abusive relationships was influenced
by their appraisal of their stage of life. One should infer that loneliness
is an inevitable accompaniment of these events with caution, however,
because to do so would negate the heterogeneity of women’s experience.
Nonetheless, the studies in this review reveal loneliness to be a salient
feature of a variety of life events experienced by older women.
The conclusions drawn from this review are limited by the small
number of studies that focus exclusively on loneliness in older women.
The paucity of studies on loneliness in this population corresponds to a
general trend in gerontological research. “In much of the literature ‘old’
remains a genderless category, with research on women undifferenti-
ated by age, and research on older people undifferentiated by gender”
(Feldman, 1999, p. 2). This review indicates that the experience of lone-
liness for older women is mediated by gendered social and cultural
beliefs. For example, the women who remained in abusive relationships
were influenced by their perceptions of how aging women are viewed
by society. Older South Asian women immigrated to Canada because
of cultural expectations that they should live with their sons even if it
meant leaving their homes and established social networks in India.
The findings in this review indicate that both cognitive and interac-
tionist theoretical approaches may assist nurses to better understand the
influence of gender on the manner in which loneliness is experienced
in older women. Because of its emphasis on cognitive processes, the
de Jong Gierveld (1987) framework has the potential to elucidate the
ways in which older women evaluate their social networks, and how
this evaluation relates to their experience of loneliness. The dimension
of social loneliness described by Weiss (1973) was helpful in shed-
ding light on the relationship between lack of social integration and
Loneliness in Older Women 811

loneliness in older female émigrés. The concept of emotional loneliness

was especially relevant to the experience of widows who keenly felt the
loss of the unique relationship with their spouse. It is hoped that nurses
can use the knowledge gained from this review to assess the vulnerabil-
ity of older women for loneliness and to devise interventions to address
loneliness in this population.

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