Journal of Gerontology: PSYCHOLOGICAL SCIENCES

1999, Vol. 54B, No. 4, P231-P239

Copyright 1999 by The Gerontological Society ofAmerica

A Model of Loneliness in Older Adults

Bronwyn S. Fees,1 Peter Martin,23 and Leonard W. Poon4
'School of Family and Human Services, Kansas State University, Manhattan.
Department of Human Development and Family Studies, Iowa State University, Ames.
3
German Center for Aging Research, University of Heidelberg, Germany.
4
Gerontology Center, University of Georgia, Athens.

ONELINESS is a pervasive issue among elderly adults, who

-/ often face a loss of committed intimate relationships and
communication with others, which are valued by the Western
culture (de Jong-Gierveld, 1987), a decline in health, and a decline in personal resources. Developing a theoretical model of
loneliness that represents the experiences of elderly persons in
everyday life has been a focus of research by gerontologists for
several decades. Loneliness is a concept that relies on comparisons. It is defined as a sentiment that is experienced when one's
lifestyle (state) is deprived of the relationships desired and current relationships are seen as inadequate in comparison to those
of the past, to those anticipated in the future, or to those possessed by other people (Lopata, 1995; Weiss, 1973). The purpose of this study was to examine predictors of loneliness and
its relationship with self-assessed physical well-being.
Forty percent of the elderly population has experienced some
form of loneliness according to data from Europe and the
United States (Weeks, 1994). Weeks (1994) further suggested
that although this percentage has been relatively stable over the
last 25 years, it may be worse than it appears. This rate has been
cause for concern given that suicide, physical ailments, and depression have been outcomes associated with the presence of
loneliness in the elderly population (Creecy, Berg, & Wright,
1985). Elderly persons have been regarded as particularly vulnerable because they are considered at high risk for "experience
of change and loss" (Lopata, 1995, p. 572).
Predictors of loneliness vary not only with transitional life
events but also with increasing maturity (Dugan & Kivett,
1994; Russell, 1996; Russell, Peplau, & Ferguson, 1978;
Weeks, 1994). Several different theoretical models of loneliness
including older adult samples have been proposed. De JongGierveld (1987) hypothesized that demographic characteristics,
living arrangements, and personality characteristics predicted
loneliness. Creecy and colleagues (1985) included demographic
characteristics, self-assessed health status, and income as predictors. Both authors used indicators of social involvement
(e.g., social network, social activity) as mediating variables.
Mullins, Elston, and Gutkowski (1996) proposed perceived

health status and self-rated economic condition as mediators of

the influence of demographic characteristics on loneliness.
The model we propose shares predictors with each of these
models; however, we believe the literature supports the inclusion of personal traits as well as interpersonal relationships as
determinants of loneliness. Our model was based on a larger
conceptual framework that assesses successful adaptation in old
age (Poon et al., 1992). We proposed that mental health problems in later life are, in part, dependent on individual characteristics including personality, level of cognitive functioning, level
of social support (e.g., social network), and physical health (see
Figure 1). Physical well-being served as a mediator between
constructs because decline in health remains a dominant issue
among older adults, compared to the younger population, potentially limiting interaction in stimulating relationships, especially among the oldest.
Martin, Hagberg, and Poon (1997) tested this conceptual
model across cultures by analyzing data from American and
Swedish centenarians. Personality (conceptualized as anxiety),
physical health, and social support were strong predictors of
loneliness in Americans, whereas social support and cognition
predicted loneliness for Swedish centenarians. Data were analyzed using Partial Least Squares Estimation (LVPLS) Soft
Modeling (Falk & Miller, 1992).
In light of recent research suggesting stressors in life may
have an adverse physiological affect on immune system functioning (see review by Kiecolt-Glaser & Glaser, 1992), we examined a second hypothesis in which loneliness served simultaneously as a predictor for physical well-being and a mediator
for the remaining constructs (see Figure 2).
The focus of the present analyses was to determine whether
the model employed by Martin and colleagues (1997) was predictive for a more inclusive age range of older Americans using
structural equation modeling with simultaneous solutions and
to further examine the relationship between physical well-being
and loneliness. Chronological age was added as a predictor to
the model to examine its effect. Each construct will be reviewed
separately in the following paragraphs.
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Loneliness and physical health status in older adults have been correlated strongly but the predictive direction is unclear. This
study examined the relationship between personality, cognition, social network, and age modeled as predictors of loneliness
in older Americans. Self-assessed health mediated the relationship. The sample consisted of 208 independently living individuals 60 to 106 years of age from the southern region of the United States. Model comparison revealed health did not mediate
the relationship significantly but that self-reported loneliness itself mediated between personal characteristics and perceived
health. Results indicate anxiety, frequency of telephone contact, and age, but notfrequency of face-to-face contact with
others or cognitive functioning, affect perceived loneliness. Perceived loneliness mediates the effects of anxiety, frequency of
telephone contact, and age on self-assessed health. Feelings of loneliness decrease one's evaluation of physical well-being.

P232

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Personality
Research has established a strong relationship between feelings of loneliness and personality characteristics, particularly
anxiety. Anxiety has been characterized by emotional instability, threat sensitivity, suspiciousness, guilt, low integration, and
tension (Cattell, Eber, & Tatsuoka, 1970). Although anxiety
often manifests itself in reduced physical health, men and
women who reported being lonely also reported being anxious
(often being treated for nervousness) and feeling depressed
(Berg, Mellstrom, Persson, & Svanborg, 1981; Russell, Peplau,
& Cutrona, 1980; Russell et al., 1978). An individual with a
low self-concept (correlated with anxiety) may not have satisfactory relationships with others and may not seek out new relationships that indirectly affect loneliness (de Jong-Gierveld,
1987). Social phobia, apprehension, and fear of embarrassment
in public have been related to a decrease in interaction leading
to loneliness as well (Weeks, 1994).
Cognitive Functioning
Decreased efficiency in mental processing has been observed
in elderly adults, yet few studies include cognitive functioning
directly as a predictor of loneliness. De Jong-Gierveld (1987)
took a "cognitive processes" approach by examining respondents' subjective evaluations and interpretations of their personal experiences rather than using objective measures of participants' intellectual functioning. Subjective evaluations of
relationships strongly predicted loneliness. Berg and colleagues
(1981) found no differences in an objective measure of intellectual functioning, verbal ability, between lonely and not lonely
participants. Neither of these studies examined the effect of
fluid intelligence, the ability to think logically and to reason abstractly, on loneliness.
Level of cognitive functioning may affect loneliness in several ways. It may serve as a buffer against feelings of loneliness; that is, as physical strength and coordination decline and
limit activity, one can remain cognitively inquisitive and alert,

Figure 2. Conceptual Model of Physical Weil-Being in Older Adults.

thinking and imagining situations beyond one's own situation.

Conversely, a high level of cognition may be a source of frustration in that one is able to think of activities to do, but is unable to pursue those goals. No relationship between cognition
and loneliness was found in the American centenarians; however, cognitive functioning was negatively related in Swedish
centenarians (Martin et al., 1997).
Social Network
A number of research studies have suggested that a decline
in or absence of social support is predictive of loneliness.
Russell (1996) found that frequency of contact and number of
family members were not strongly predictive of loneliness;
however, the perceived quality of recent relationships was. Type
of living arrangement has also been determined to affect loneliness (de Jong-Gierveld, 1987). In a model of loneliness based
upon persons 25-75 years of age, living with a partner significantly and negatively predicted loneliness whereas being single
significantly and positively predicted loneliness.
Frequency of contact does appear to be predictive when the
type of relationship is considered. Mullins and Dugan's (1990)
survey of residents in urban congregate housing determined
that frequency of contact with neighbors and friends, but not
with family, was important to reducing the feelings of loneliness, as was the quality of the relationships with friends. In a
separate study, Dugan and Kivett's (1994) survey of rural independently living elderly persons revealed that infrequent visits
with family members (siblings) predicted loneliness as did the
loss of a spouse. Lack of friends was an important predictor of
loneliness in Swedish 70-year-olds (Berg et al., 1981).
Because loneliness may be realized by a lack of communication with others (de Jong-Gierveld, 1987), we chose to measure
social networks by the frequency of contact individuals had
with others, either through visits or over the telephone. Each
contact represented an opportunity for communication and relationship building.

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Figure 1. Conceptual Model of Loneliness in Older Adults.

A MODEL OFLONEUNESS

Self-Assessed Physical Health

Both domestic and international studies have found that poor
self-assessed physical health (Mullins et al., 1996; Mullins,
Johnston, & Anderson, 1988; Mullins & Mushel, 1992;
Wenger, Davies, Shahtahmasebi, & Scott, 1996) and number of
chronic illnesses (Russell, 1996) correlated positively and
strongly with loneliness in elderly adults. Lonely elderly men
and women had more negative assessments of health and feelings of fatigue than did elderly men and women who were not
lonely. Lonely participants also complained of backaches,
headaches, and nonspecific nausea (Berg et al., 1981). A progressive decrease in hearing has also been associated with feelings of loneliness in elderly persons (Dugan & Kivett, 1994).
Whether poor health predicts lonely feelings or loneliness predicts self-assessed poor health is not clear. Self-assessed physical
health was found to mediate the effects of disability and education on loneliness (Mullins et al., 1996). Physical health mediated
the effect of anxiety on loneliness in American centenarians
(Martin et al., 1997). Researchers have also concluded that loneliness may be predictive of mental health. Bazargan and Barbre
(1992) found loneliness explained variance in self-evaluations of
memory loss in older Black adults. These conclusions provide
support for analysis of both models as proposed.
METHODS

Participants and Procedure

The sample for this analysis (n = 208) was drawn from Phase
1 of the Georgia Centenarian Study (Poon et al., 1992) con-

ducted at the University of Georgia (N = 262). The multidisciplinary study collected data on three cohorts of cognitively intact, independently living individuals: sexagenarians, octogenarians, and centenarians. Participant inclusion criteria included
a minimum score of 20 on the Mini-Mental Status Exam
(Folstein, Folstein, & McHugh, 1975) given at the beginning of
the interview/testing session and a Stage 2 or higher level on
the Global Deterioration Scale (Reisberg, Ferris, De Leon, &
Crook, 1982). Data from each of the three cohorts were aggregated in the following analyses.
Participants were recruited primarily from the state of
Georgia by the University of Georgia at Athens (UGA) Survey
Research Center. Interviews and testing of centenarians were
conducted at the participant's place of residence. Groups of
6-10 sexagenarians and octogenarians met in a common place
to be interviewed and tested. Two thirds of the sample were female and approximately 72% were White. Between cohorts,
the level of formal education decreased with an increase in age.
Widowhood increased with age. The majority of the sample reported "good" or "excellent" health (see Table 1).
A cross-tabular analysis of the sociodemographic characteristics of cases with missing data (n = 54) revealed that these
cases differed from the included cases on age and marital status. More centenarians and widowed adults were excluded than
expected and fewer sexagenarians and married adults were excluded than expected. No group differences were found for sex,
education, race, or income.
Variables and Instruments
Three subscales of anxiety were used from the Sixteen
Personality Factor questionnaire (16PF; Cattell et al., 1970).
The three first-order factors were measured on a normed scale
from 1 (low) to 10 (high) and included (1) emotional stability,
(2) apprehension, and (3) tension. High scores reflected high
anxiety. Reported test-retest reliability (1 to 7 days) for each of
the scales, respectively, were .79 to .82, .72 to .83, and .81 to
.90 (Cattell et al., 1970).
Cognition was measured with three subtests from the
Wechsler Adult Intelligence Scale-Revised (Wechsler, 1987):
picture arrangement, block design, and arithmetic. Each measure was continuous; high scores reflected high cognitive ability. The average reported split-half reliability coefficient for picture arrangement was .74; block design and arithmetic
exceeded .80 (Kaufman, 1985).
Social Network was measured with two questions taken
from the Older Americans Resources and Services Procedures
(OARS; Fillenbaum, 1988) Interaction scale: "About how many
times did you talk to someonefriends, relatives, or others
on the telephone in the past week" and "How many times during the past week did you spend some time with someone who
does not live with you; that is, you went to see them or they
came to visit you, or you went out to do things together." Both
measures were scored from 3 (once a day) to 0 (not at all).
Reported reliability coefficient for the scale was .56
(Fillenbaum, 1988).
Although we intended to measure the extent of involvement in
social relationships, preliminary confirmatory factor analyses indicated that we were, in fact, measuring two unique constructs.
The first was telephone interaction, which may be a dominant
means of communication among those who are not indepen-

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Age
Although a decline in physical health is common with age, research literature has been inconclusive regarding the role of age
in predicting loneliness among older adults. College students
have been found to report higher levels of loneliness than older
adults (Russell, 1996). However, among rural adults 65 years of
age and older, Dugan and Kivett (1994) found that over half
(68%) of the sample reported social loneliness "sometimes" or
"quite often." The authors concluded this rate was similar to that
of the general population of persons aged 65 years and older.
Creecy and colleagues (1985) concluded that age had an indirect effect on loneliness that was mediated by social activity
and social fulfillment, explaining less than 1% of the variance
in loneliness. Similar results were reported by de Jong-Gierveld
(1987), who found that age did not have a significant direct effect on loneliness in persons 25-75 years old. However, others
suggest a positive relationship between age and loneliness
(Fischer & Phillips, 1982). Examination of single cohort samples does suggest that loneliness and age are related. Berg and
colleagues (1981) found that 19% of their Swedish sample of
septuagenarians reported "some" or frequent loneliness.
Approximately one third of a sample of centenarians in the
United States reported loneliness "sometimes" or "often," as
did 44% of Swedish centenarians (Martin et al., 1997). A national Swedish study in which the proportion of persons reporting loneliness increased from 20% in sexagenarians to over
40% in octogenarians was cited by Berg and colleagues (1981).
Our intent was to further examine the direct effect of age on
physical health and loneliness and the effect on each construct
when mediated by the other.

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FEESETAL.

Table 1. Participant Characteristics

Octogenarians
(n = 79)

Centenarians
(n = 47)

Total Group
(n = 208)

60-^9
64.96(2.80)

79-89
82.59 (2.45)

99-106
100.79 (1.52)

60-106
79.75 (14.00)

Gender (n)
Male
Female

33
49

26
53

11
36

70
138

Race()
White
African American

57
25

61
18

31
16

149
59

Education (n)
0-4 years
5-8 years
Some high school
Completed secondary
Business/trade school
1-3 years of college
Completed college
Graduate school

4
6
11
15
5
10
13
18

3
14
15
7
8
10
5
17

8
9
6
5
4
6
5
4

15
29
32
27
17
26
23
39

Marital Status (n)

Single
Married
Widowed
Divorced
Separated
Missing

2
50
19
9
2
0

0
29
46
4
0
0

4
1
39
2
0
1

6
80
104
15
2
1

Subjective Health (n)

Poor
Fair
Good
Excellent

5
10
45
22

1
21
40
17

4
14
27
2

10
45
112
41

Age Range (years)

Mean (SD)

dently mobile or are separated from family and friends by great

distances. Visiting suggested some level of independent mobility, in which case there may be less reliance on the telephone
than for less able-bodied persons or for those who live farther
from family and friends. Additionally, deterioration in hearing
may actually discourage telephone communication and increase
reliance on visiting, if possible. Each question, therefore, became a single-item indicator reflective of separate constructs;
high scores reflected frequent interaction. Age, in years, was
self-reported.
Two indicators from the OARS (Fillenbaum, 1988) served as
indicators for the latent construct Physical Illness. The first
measure assessed current perceived overall health, "How would
you rate your overall health at the present time," from 3 (excellent) to 0 (poor). The second indicator was a comparative indicator of health, "Is your health now better, about the same, or
worse than it was five years ago," from 2 (better) to 0 (worse).
Measures were recoded so that high scores reflected illness.
Reported reliability for the items was .74 (Fillenbaum, 1988).
Loneliness was measured with three indicators. The first,
"Do you find yourself feeling lonely quite often, sometimes, or
almost never" (OARS; Fillenbaum, 1988), was coded as 0
(often), 1 (sometimes), and 2 (seldom). The item was a part of
the Affective dimension of social support, with a reported reliability of .71. The second measure was taken from the Bradburn
Affect Balance Scale (BABS; Bradburn, 1969): "During the

past few weeks did you ever feel very lonely or remote from
other people," with four values ranging from 1 (not at all) to 4
(often). This item was part of the negative affect balance scale
with a reported test-retest reliability of .81 (Bradburn, 1969).
The final measure was a subscale score from the Philadelphia
Geriatric Center Morale Scale (PGC; Lawton, 1975) labeled as
"lonely dissatisfaction." This subscale was composed of six dichotomously scored items from which an aggregated subscore
was derived. Items represented "the extent to which an individual feels lonely and dissatisfied with life" (Sauer & Warland,
1982, p. 223). Cronbach's alpha was reported as .85 (Lawton,
1975) for the six-item scale. Measures were recoded so that a
high score reflected greater loneliness.
Reliability of the measures within the model may be estimated from the factor loadings; that is, the factor loading is a
measure of the validity of a construct. Because the square root
of reliability is its validity, validity squared is an estimate of the
reliability of the measure (Bollen, 1989). The presence of error
is calculated as part of model estimation. Refer to Table 2 for
estimated reliabilities within the model.
Data Analysis
A covariance matrix was generated using a listwise procedure (see Table 2). Data were analyzed using the structural
equation modeling procedures in LISREL VIII (Joreskog &
Sbrbom, 1994) with maximum likelihood estimation.

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Sexagenarians
(n = 82)

Characteristics

A MODEL OF LONELINESS

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Table 2. Correlation Matrix, Means and Standard Deviations for Measurement Model (n = 208)
Indicator

10

11

12

13

14

1.00
-.42
-.39
.10
.16
.17
.01
.09
.01
-.26
-.07
.32
.22
.28

1.00
.46
-.11
-.14
-.23
-.02
-.00
-.04
.22
.11
-.24
-.17
-.20

1.00
.02
.03
.02
.13
.02
-.15
.17
.00
-.18
-.18
-.23

1.00
.64
.58
.13
.20
-.48
-.24
-.13
.15
.15
.08

1.00
.64
.09
.25
-.52
-.29
-.17
.14
.10
.16

1.00
.08
.18
-.43
-.30
-.14
.23
.04
.17

1.00
.31
-.04
-.09
-.05
-.01
.08
.10

1.00
-.24
-.17
-.04
.12
.22
.27

1.00
.22
.24
-.12
-.21
-.18

1.00
.29
-.34
-.32
-.35

1.00
-.07
-.05
-.12

1.00
.48
.34

1.00
.50

1.00

Mean
Standard Deviation

5.28
1.91

5.12
1.88

5.01
1.87

5.56
4.54

15.06
10.61

9.29
4.05

2.16
.74

2.48
.76

79.75
14.00

1.12
.77

1.06
.64

1.65
.57

3.53
.92

11.04
1.24

Table 3. Measurement Model: Standardized Factor Loadings

Latent Construct and Indicators

Factor Loading

Estimated Reliability

Personality
Emotional stability
Apprehension
Tension

-.64
.66
.62

.41
.44
.38

Cognition
Picture arrangement
Block design
Arithmetic

.76
.84
.75

.58
.71
.56

Visiting Friends/Relatives

1.00

1.00

Telephone Contact

1.00

1.00

Age

1.00

1.00

Physical Health
Self-health rating
Health problems

.78
.37

.61
.14

Loneliness
Feeling lonely (OARS)
Feel very lonely/remote (BABS)
Lonely dissatisfaction (PGC)

.60
.74
.67

.36
.55
.45

"Validity (factor loading) squared is an estimate of the reliability of the indicator (Bollen, 1989). x2 (60) = 88.11,/? < .05.

RESULTS

An advantage of structural equation modeling was the use of

multiple indicators of latent constructs. Multiple indicators reflected the specific domain of content defined by the latent variable, allowed estimation of measurement error, and simultaneous estimation of parameters in the model. Preliminary
confirmatory factor analyses were conducted using LISREL
VIII (Joreskog & Sorbom, 1994) to estimate the measurement
model with significant indicators of the latent constructs. The
proposed measurement model and regression model were conducted concurrently (see Table 3 for factor loadings and Table 4
for correlations among latent variables).
To examine the direct, indirect, and total effects of the latent
exogenous constructs on loneliness, nested models were com-

Table 4. Correlations Among Latent Variables

Latent Variable
1.
2.
3.
4.
5.
6.
7.

Physical Illness
Loneliness
Anxiety
Cognition
Visiting
Telephone Contact
Age

-.55
.38
-.40
-.11
-.19
.27

-.50
.24
.09
.31
-.26

-.19
.04
-.03
-.10

.12
.27
-.61

.31
-.04

-.24

Note: n = 208

pared. First, a nonmediated model was tested in which the direct

path coefficient from the mediator to the outcome was fixed to
zero and all other paths were estimated (Baron & Kenny, 1986).
Second, a fully recursive, mediated model was run to assess mediation. Total effects were decomposed in the later model.
Model A: Loneliness as Outcome
The focus of thisfirstset of analyses was to examine the direct
and mediated effects of each construct on loneliness. Results of
the nonmediated model indicated a reasonable fit of the model to
the data, x2 (60) = 88.11,/? < .05, GFI = .95, AGFI = .90.
Regression coefficients were significant between Anxiety and
Physical Illness (standardized coefficients reported), 7 = .48, t =
4.16, as well as Anxiety and Loneliness, 7 = .60, t = 4.57. Higher
levels of anxiety were related to higher levels of physical illness
and higher levels of loneliness. Age significantly predicted
Physical Illness, 7 = .23, t = 2.03, and Loneliness, 7 = .36, t =
3.16, suggesting the older the individual, the higher the evaluation
of physical illness and the greater loneliness experienced.
Telephone contact negatively predicted Loneliness, 7 = -.23, t =
2.73. Cognition and Visiting were not predictive of either criterion
variable.
According to Baron and Kenny (1986), mediation is present
if the significant coefficients between the latent exogenous
(Anxiety and Age) and the latent endogenous (Loneliness) are
reduced (partially mediated) or become nonsignificant (fully
mediated) when the mediating path is present and significant in

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1. Emotional stability
2. Apprehension
3. Tension
4. Picture arrangement
5. Block design
6. Arithmetic
7. Visiting friends/relatives
8. Telephone contact
9. Age
10. Self-health rating
11. Health problems
12. Lonely
13. Feeling lonely/remote
14. Lonely dissatisfaction

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FEESETAL.

Figure 4. Structural Model of Physical Weil-Being in Older Adults.

Table 5. Model A: Decomposition of Effects of Personal

Characteristics on Loneliness
Loneliness

Physical Illness
Variables

Direct

Anxiety
.35***
Cognition
-.22
Visiting Others
-.07
Telephone Contact -.06
.15
Age
Physical Illness
R2

Indirect

Total

Table 6. Model B: Decomposition of Effects of Personal

Characteristics on Physical Illness

Direct

Indirect

25*** .42*** .13

-.22
.22
-.08
-.07
-.02
-.03
-.21*** -.02
-.06
.15
.28*** .05
.37*
.28

Loneliness
Total

Variables

55***
.14
-.04
-.23***
.34***
.37*
.50

55***
Anxiety
Cognition
.14
-.04
Visiting Others
Telephone Contact -.23***
24***
Age
Loneliness
R2

Note: n = 208. Standardized regression coefficients shown.

*p < .05; **p < .01; ***p < .001.

the model (in this analysis, the direct path between Physical
Ulness and Loneliness). The mediated model, x2 (59) = 76.66, p
>.05, GFI = .95, AGFT = .91, was a significant improvement in
fit over the nonmediated model, A \ 2 (1)= 11.45, p < .001 (see
Figure 3). However, the mediational path between Physical
Illness and Loneliness barely reached significance (t = 1.97).
Several coefficients changed as a consequence of mediational
path estimation. A reduction in the standardized regression coefficient between Anxiety and Loneliness from .60 to .42 was observed, which remained significant (t = 3.20). The coefficient
from Anxiety to Physical Illness decreased slightly to .48 from
.35 and also remained significant (t = 3.45). The path coefficient
was reduced to nonsignificance between Age and Illness (t =
1.44), and the coefficient between Age and Loneliness remained
significant (t = 2.59). The path coefficient between Telephone
Contact and Loneliness dropped slightly (.23 to .21) but remained significant. The effects of Cognition and Visiting on
Loneliness were unaffected by the addition of the mediational
path. The mediated model accounted for 28% of the variance in
Physical Illness and 50% of the variance in Loneliness.

Direct

Indirect

Physical Illness
Total

Direct

Indirect

Total

24*** 35***
.55*** .11
.14
-.28**
.06
-.22
-.07
-.04
-.02
-.05
-.10** -.06
-.23*** .04
24*** .00
.15** .15
44***
.44***
.40
.40

Note: n - 208. Standardized regression coefficients shown.

*p < .05; **p < .01; ***p < .001.

Effects were decomposed in the mediated model (see Table

5). The total effects of Anxiety, Telephone Contact, and Age on
Loneliness were significant. However, although the direct path
coefficient from Anxiety to Physical Illness was significant, the
indirect effect on Loneliness was not (t = 1.81). No significant
indirect effects were found.
Model B: Loneliness as Mediator
The second set of analyses reversed the direction of the arrow
between Loneliness and Physical Illness, making Loneliness
the mediating variable. As expected, path coefficients and the fit
of the nonmediated model were identical to that of Model A, \ 2
(60) = 88.11, p < .05, GFI = .95, AGFI = .90.
The fit of the mediated model was, again, identical to the fit
of Model A's mediated version; however, the mediational path
in Model B was highly significant (standardized beta = .44, t =
3.31; see Figure 4). When compared to the nonmediated model,
the standardized coefficient between Anxiety and Illness was
reduced to nonsignificance, y = .11, t = .89. The coefficient between Anxiety and Loneliness decreased only slightly from .60

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Figure 3. Structural Model of Loneliness in Older Adults.

A MODEL OFLONEUNESS

to .55 (t = 4.34). The path from Age to Illness dropped from .23
to .00 and was not significant (t = .02). Age to Loneliness (t =
3.00) and Telephone Contact to Loneliness (t = 2.78) remained
virtually unchanged. Cognition emerged as a negative predictor
of Physical Illness, 7 = -.28, t = 2.41. Visiting was not predictive. The mediated model accounted for 40% of the variance in
Loneliness and 40% of the variance in Physical Illness.
Total effect of Anxiety on Physical Illness was significant (t =
3.45). In contrast with Model A, the indirect effects of Anxiety,
Telephone Contact, and Age on Physical Illness were significant
(see Table 6). Although Cognition had a significant regression
coefficient, neither it nor Visiting had significant effects.
DISCUSSION

a significant total effect on feelings of loneliness; the older the

participants were, the more likely they were to report loneliness. Our results also suggest the effect of old age on serf-evaluation of health is effectively mediated by loneliness. With advancing age, feelings of loneliness affect perceptions of health
rather than self-perceived health affecting feelings of loneliness.
Health status does appear to decline with age: centenarians
reported proportionally more "poor" and "fair" health whereas
sexagenarians and octogenarians reported higher percentages of
"good" and "excellent" health. An exception to the trend, however, is that fewer octogenarians report poor physical health,
leading us to ask what is the effect of cohort as a moderating
variable rather than age as a predictor. Additional analyses need
to examine how well this modelfitsthe data for each cohort.
Consistent with the literature, a predictive positive relationship is present between anxiety and feelings of loneliness (e.g.,
Berg et al., 1981; de Jong-Gierveld, 1987); greater anxiety is
reflected in greater feelings of loneliness. However, like age,
when loneliness was the mediator, the effect of anxiety on physical well-being was totally indirect. High levels of anxiety increase feelings of loneliness, which in turn decrease assessment
of well-being. The outcome of anxiety may be both poor feelings about relationships and health.
Although an anxious personality may serve a positive function (e.g., motivation for action or learning), high and continuous anxiety (characterized by emotional instability, apprehension and tension) heightens sensitivity to any feelings of illness
or may manifest itself in concrete physical illness. Inadequate
relationships may be the consequence of a lack of stimulating
interaction or in overly cautious, serf-conscious behavior, characteristic of an anxious personality. These results suggest that
the linkage by which anxiety affects interaction and perceptions
of health needs to be explored more fully.
The difference in effect between the two social network variables is noteworthy. Participating in frequent telephone conversations not only reduced the loneliness perceived by participants but also affected perceived health indirectly and
significantly. Visiting with someone other than a spouse or
roommate had no predictive relationship with either outcome
variable. We measured frequency of contact rather than with
whom one had contact, specifically. Our results, therefore, are
somewhat discrepant with previous research by Russell (1996)
and the conclusions of Marangoni and Ickes (1989), in which
loneliness in older adults was found to be related weakly to the
number of persons in the social network and average frequency
of social contact but strongly related to perceived quality of
contact. These results suggest frequency of contact, via the telephone, is important. Older adults may be more limited in their
physical mobility or lack the means to travel independently.
The telephone, then, becomes a dominant and readily accessible mechanism (used by all ages) to remain in contact with distant family members, such as children, and friends, allowing
adults to maintain an emotionally intimate relationship. Once
again, it is important to note the characteristics of the sample.
All participants were living independently. Most centenarians
in this sample were widowed, and more than half of the sexagenarians were married as were about one third of the octogenarians; therefore, for many younger participants, the presence of a
spouse may limit the reliance on the physical presence of outsiders for interaction.

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The models examined in these analyses were unique with respect to previous models in that they examined the effects of
the level of cognitive functioning and personality on loneliness
mediated by self-assessed physical health. Loneliness as a mediator was modeled as well, given research suggesting perceived inadequate relationships affect physical well-being.
One of the most provocative findings of these analyses is the
relationship between loneliness and self-evaluation of health.
Elevated feelings of loneliness not only predict poor subjective
health evaluations but also transform the effects of increasing
age and anxiety on health. These findings are consistent with
the psychoneuroimmunology literature which suggests that
one's psychological characteristics, including evaluations of
personal relationships, affect one's physical health and, in this
case, one's feelings about physical health. Kiecolt-Glaser,
Garner, Speicher, Perm, and Glaser's (1984) analyses of loneliness in medical students found loneliness to be negatively related to immune functioning.
Although the relationship between health status and loneliness
in Model A was in the expected direction (poor subjective health
status predicts greater feelings of loneliness), a stronger effect was
anticipated given Martin and colleagues' results (1997) for
American centenarians and the significant change in path coefficients for anxiety and age. Self-assessed health did not serve as a
strong mediator of the effects of the other constructs. Several possible explanations exist for the apparent discrepancy. First, it may
be a consequence of the difference in estimation procedures between LVPLS and LISREL. Partial least squares uses component
analyses (such as principal component analyses) to estimate the
regression coefficients, whereas the maximum likelihood estimation procedure uses simultaneous solutions. Second, the sample
represents a broader age range including individuals in the "Third
Age" (approximate age range of 60-75 years) and "Fourth Age"
(persons 85 and older; Baltes & Baltes, 1998), which are theorized to be distinctly different groups in terms of physical and psychological functioning. A third potential explanation for the relatively weak relationship between the two may be the relative
homogeneous nature of our sample on health; mat is, about two
thirds of the participants in this study were reporting good or excellent health. Consequently, physical illness may have a greater
mediational effect for those who experience poorer health.
However, given the near significance of die coefficient from health
to loneliness, we believe the results deserve further examination
by cohort (age groups) with a more heterogeneous health sample.
Contrary to the conclusions of de Jong-Gierveld (1987) and
Creecy and colleagues (1985), our results indicate that age has

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FEESETAL.

A second possible explanation for the discrepancy is that respondents, as a whole, were expressing more emotional loneliness rather than social loneliness (Weiss, 1973). The amount of
face-to-face contact with others (i.e., visiting) would be less relevant than having an intimate confidant, a relationship that
could be maintained over the telephone. This explanation is
consistent with the strong positive relationship between anxiety
and loneliness given that anxiety was in part assessed by emotional stability (Cattell et al., 1970).

ACKNOWLEDGMENTS

Funding for this research was provided by NIH Grant R01-43435.

The authors would like to thank Dan Russell, PhD, for his review and comments on this manuscript, and acknowledge a reviewer's suggestion to test the
model with loneliness as the mediating variable.
Address correspondence to Dr. Peter Martin, German Center for Research
on Aging, University of Heidelberg, Bergheimer Str. 20, 69115 Heidelberg,
Germany. E-mail: pxmartin@dzfa.uni-heidelberg.de
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Limitations and Implications

We recognize several limitations in this analysis. The first is
in the manner in which loneliness was assessed. Participants
were asked, in three separate measures, if they felt lonely. As
such, the definition of loneliness was left to the individual; multiple interpretations of loneliness may be represented in the
analysis. The feelings of the participants appeared genuine, reflecting their perception of their personal status. The nature of
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The statement that "correlation does not prove causation"
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future data collection and analyses that are able to isolate, if
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The generalizability of this study is limited by the characteristics of the sample. As noted, all participants were living independently and lived in the southern region of the United States;
consequently, an analysis of institutionalized older adults or
adults from different regions of the country may produce results different from those presented here.
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elderly persons living independently, loneliness is more prevalent with increasing age. Anxiety is particularly detrimental by
increasing perceived loneliness and thus perceived ill-health. It
is clear too that the telephone is a fundamental tool for older
adults living independently to maintain relationships. Increasing
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concern to effective telephone usage. As Baltes and Baltes

(1998) suggest, we are challenged to create a cultural support

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be alert to the level of functioning and health in the individual.
Model replication relies on further analyses specifically examining the moderating effects of cohort and of residential status,
that is, dependent care versus independent living, and following
individuals over time.

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