Journal of Gerontology: PSYCHOLOGICAL SCIENCES Copyright 1999 by The Gerontological Society ofAmerica

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

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.

2
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.

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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 individ-
uals 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.

health status and self-rated economic condition as mediators of

L 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 de-
cline 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 compar-
isons. It is defined as a sentiment that is experienced when one's
lifestyle (state) is deprived of the relationships desired and cur-
rent relationships are seen as inadequate in comparison to those
of the past, to those anticipated in the future, or to those pos-
sessed by other people (Lopata, 1995; Weiss, 1973). The pur-
pose 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 de-
pression have been outcomes associated with the presence of
loneliness in the elderly population (Creecy, Berg, & Wright,
1985). Elderly persons have been regarded as particularly vul-
nerable 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 Jong-
Gierveld (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 pre-
dictors. Both authors used indicators of social involvement
(e.g., social network, social activity) as mediating variables.
Mullins, Elston, and Gutkowski (1996) proposed perceived
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 inclu-
sion 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 prob-
lems in later life are, in part, dependent on individual character-
istics 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, po-
tentially limiting interaction in stimulating relationships, espe-
cially 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 ana-
lyzed 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 func-
tioning (see review by Kiecolt-Glaser & Glaser, 1992), we ex-
amined a second hypothesis in which loneliness served simul-
taneously 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 pre-
dictive 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.

P231
P232 FEESETAL
Figure 1. Conceptual Model of Loneliness in Older Adults.
Personality
Research has established a strong relationship between feel-
ings of loneliness and personality characteristics, particularly
anxiety. Anxiety has been characterized by emotional instabil-
ity, 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 satis-
factory relationships with others and may not seek out new re-
lationships 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 respon-
dents' subjective evaluations and interpretations of their per-
sonal experiences rather than using objective measures of par-
ticipants' intellectual functioning. Subjective evaluations of
relationships strongly predicted loneliness. Berg and colleagues
(1981) found no differences in an objective measure of intellec-
tual 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 ab-
stractly, on loneliness.
Level of cognitive functioning may affect loneliness in sev-
eral ways. It may serve as a buffer against feelings of loneli-
ness; that is, as physical strength and coordination decline and
limit activity, one can remain cognitively inquisitive and alert,
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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 frus-
tration in that one is able to think of activities to do, but is un-
able to pursue those goals. No relationship between cognition
and loneliness was found in the American centenarians; how-
ever, 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 loneli-
ness (de Jong-Gierveld, 1987). In a model of loneliness based
upon persons 25-75 years of age, living with a partner signifi-
cantly 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 loneli-
ness, as was the quality of the relationships with friends. In a
separate study, Dugan and Kivett's (1994) survey of rural inde-
pendently 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 communica-
tion 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 rela-
tionship building.
 A MODEL OFLONEUNESS
Age
Although a decline in physical health is common with age, re-
search 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 in-
direct 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 ef-
fect 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 sam-
ples 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 na-
tional Swedish study in which the proportion of persons report-
ing 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.
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 feel-
ings 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 pro-
gressive decrease in hearing has also been associated with feel-
ings of loneliness in elderly persons (Dugan & Kivett, 1994).
Whether poor health predicts lonely feelings or loneliness pre-
dicts self-assessed poor health is not clear. Self-assessed physical
health was found to mediate the effects of disability and educa-
tion 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 lone-
liness 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-
P233
ducted at the University of Georgia (N = 262). The multidisci-
plinary study collected data on three cohorts of cognitively in-
tact, independently living individuals: sexagenarians, octoge-
narians, 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 aggre-
gated in the following analyses.
Participants were recruited primarily from the state of
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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 fe-
male 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 re-
ported "good" or "excellent" health (see Table 1).
A cross-tabular analysis of the sociodemographic character-
istics of cases with missing data (n = 54) revealed that these
cases differed from the included cases on age and marital sta-
tus. More centenarians and widowed adults were excluded than
expected and fewer sexagenarians and married adults were ex-
cluded 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 mea-
sure was continuous; high scores reflected high cognitive abil-
ity. The average reported split-half reliability coefficient for pic-
ture 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 someone—friends, relatives, or others—
on the telephone in the past week" and "How many times dur-
ing 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 in-
dicated 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-
P234 FEESETAL.

Table 1. Participant Characteristics

Sexagenarians Octogenarians Centenarians Total Group

Characteristics (n = 82) (n = 79) (n = 47) (n = 208)
Age Range (years) 60-^9 79-89 99-106 60-106
Mean (SD) 64.96(2.80) 82.59 (2.45) 100.79 (1.52) 79.75 (14.00)
Gender (n)
Male 33 26 11 70
Female 49 53 36 138
Race(«)
White 57 61 31 149

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African American 25 18 16 59
Education (n)
0-4 years 4 3 8 15
5-8 years 6 14 9 29
Some high school 11 15 6 32
Completed secondary 15 7 5 27
Business/trade school 5 8 4 17
1-3 years of college 10 10 6 26
Completed college 13 5 5 23
Graduate school 18 17 4 39
Marital Status (n)
Single 2 0 4 6
Married 50 29 1 80
Widowed 19 46 39 104
Divorced 9 4 2 15
Separated 2 0 0 2
Missing 0 0 1 1
Subjective Health (n)
Poor 5 1 4 10
Fair 10 21 14 45
Good 45 40 27 112
Excellent 22 17 2 41

dently mobile or are separated from family and friends by great
distances. Visiting suggested some level of independent mobil-
ity, 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, be-
came 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 (excel-
lent) to 0 (poor). The second indicator was a comparative indi-
cator 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 relia-
bility 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 di-
chotomously scored items from which an aggregated subscore
was derived. Items represented "the extent to which an individ-
ual 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 esti-
mated 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 proce-
dure (see Table 2). Data were analyzed using the structural
equation modeling procedures in LISREL VIII (Joreskog &
Sbrbom, 1994) with maximum likelihood estimation.
 A MODEL OF LONELINESS P235

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

Indicator 1 10 11 12 13 14
1. Emotional stability 1.00
2. Apprehension -.42 1.00
3. Tension -.39 .46 1.00
4. Picture arrangement .10 -.11 .02 1.00
5. Block design .16 -.14 .03 .64 1.00
6. Arithmetic .17 -.23 .02 .58 .64 1.00
7. Visiting friends/relatives .01 -.02 .13 .13 .09 .08 1.00
8. Telephone contact .09 -.00 .02 .20 .25 .18 .31 1.00
9. Age .01 -.04 -.15 -.48 -.52 -.43 -.04 -.24 1.00

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10. Self-health rating -.26 .22 .17 -.24 -.29 -.30 -.09 -.17 .22 1.00
11. Health problems -.07 .11 .00 -.13 -.17 -.14 -.05 -.04 .24 .29 1.00
12. Lonely .32 -.24 -.18 .15 .14 .23 -.01 .12 -.12 -.34 -.07 1.00
13. Feeling lonely/remote .22 -.17 -.18 .15 .10 .04 .08 .22 -.21 -.32 -.05 .48 1.00
14. Lonely dissatisfaction .28 -.20 -.23 .08 .16 .17 .10 .27 -.18 -.35 -.12 .34 .50 1.00
Mean 5.28 5.12 5.01 5.56 15.06 9.29 2.16 2.48 79.75 1.12 1.06 1.65 3.53 11.04
Standard Deviation 1.91 1.88 1.87 4.54 10.61 4.05 .74 .76 14.00 .77 .64 .57 .92 1.24

Table 3. Measurement Model: Standardized Factor Loadings Table 4. Correlations Among Latent Variables

Latent Construct and Indicators Factor Loading Estimated Reliability Latent Variable
Personality 1. Physical Illness —
Emotional stability -.64 .41 2. Loneliness -.55 —
Apprehension .66 .44 3. Anxiety .38 -.50 —
Tension .62 .38 4. Cognition -.40 .24 -.19 —
5. Visiting -.11 .09 .04 .12 —
Cognition
6. Telephone Contact -.19 .31 -.03 .27 .31 —
Picture arrangement .76 .58
Block design 7. Age .27 -.26 -.10 -.61 -.04 -.24 —
.84 .71
Arithmetic .75 .56 Note: n = 208
Visiting Friends/Relatives 1.00 1.00
Telephone Contact 1.00 1.00
pared. First, a nonmediated model was tested in which the direct
Age 1.00 1.00 path coefficient from the mediator to the outcome was fixed to
Physical Health zero and all other paths were estimated (Baron & Kenny, 1986).
Self-health rating .78 .61 Second, a fully recursive, mediated model was run to assess me-
Health problems .37 .14 diation. Total effects were decomposed in the later model.
Loneliness
Feeling lonely (OARS) .60 .36 Model A: Loneliness as Outcome
Feel very lonely/remote (BABS) .74 .55 The focus of thisfirstset of analyses was to examine the direct
Lonely dissatisfaction (PGC) .67 .45 and mediated effects of each construct on loneliness. Results of
"Validity (factor loading) squared is an estimate of the reliability of the indi- the nonmediated model indicated a reasonable fit of the model to
cator (Bollen, 1989). x2 (60) = 88.11,/? < .05. 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 =
RESULTS 4.16, as well as Anxiety and Loneliness, 7 = .60, t = 4.57. Higher
An advantage of structural equation modeling was the use of levels of anxiety were related to higher levels of physical illness
multiple indicators of latent constructs. Multiple indicators re- and higher levels of loneliness. Age significantly predicted
flected the specific domain of content defined by the latent vari- Physical Illness, 7 = .23, t = 2.03, and Loneliness, 7 = .36, t =
able, allowed estimation of measurement error, and simultane- 3.16, suggesting the older the individual, the higher the evaluation
ous estimation of parameters in the model. Preliminary of physical illness and the greater loneliness experienced.
confirmatory factor analyses were conducted using LISREL Telephone contact negatively predicted Loneliness, 7 = -.23, t =
VIII (Joreskog & Sorbom, 1994) to estimate the measurement 2.73. Cognition and Visiting were not predictive of either criterion
model with significant indicators of the latent constructs. The variable.
proposed measurement model and regression model were con- According to Baron and Kenny (1986), mediation is present
ducted concurrently (see Table 3 for factor loadings and Table 4 if the significant coefficients between the latent exogenous
for correlations among latent variables). (Anxiety and Age) and the latent endogenous (Loneliness) are
To examine the direct, indirect, and total effects of the latent reduced (partially mediated) or become nonsignificant (fully
exogenous constructs on loneliness, nested models were com- mediated) when the mediating path is present and significant in
P236 FEESETAL.

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Figure 3. Structural Model of Loneliness in Older Adults. Figure 4. Structural Model of Physical Weil-Being in Older Adults.

Table 5. Model A: Decomposition of Effects of Personal Table 6. Model B: Decomposition of Effects of Personal
Characteristics on Loneliness Characteristics on Physical Illness

Physical Illness Loneliness Loneliness Physical Illness

Variables Direct Indirect Total Direct Indirect Total Variables Direct Indirect Total Direct Indirect Total
Anxiety .35*** 25*** .42*** .13 55*** Anxiety 55*** .55*** .11 24*** 35***
Cognition -.22 — -.22 .22 -.08 .14 Cognition .14 — .14 -.28** .06 -.22
Visiting Others -.07 — -.07 -.02 -.03 -.04 Visiting Others -.04 — -.04 -.05 -.02 -.07
Telephone Contact -.06 — -.06 -.21*** -.02 -.23*** Telephone Contact -.23*** — -.23*** .04 -.10** -.06
Age .15 — .15 .28*** .05 .34*** Age 24*** 24*** .00 .15** .15
Physical Illness .37* .37* Loneliness 44*** .44***
R2 .28 .50 R2 .40 .40

Note: n = 208. Standardized regression coefficients shown. Note: n - 208. Standardized regression coefficients shown.
*p < .05; **p < .01; ***p < .001. *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 coef-
ficient between Anxiety and Loneliness from .60 to .42 was ob-
served, 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 re-
mained 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.
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 be-
tween Anxiety and Loneliness decreased only slightly from .60
 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 predic-
tive. 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
The models examined in these analyses were unique with re-
spect 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 me-
diator was modeled as well, given research suggesting per-
ceived 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 loneli-
ness in medical students found loneliness to be negatively re-
lated 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 coeffi-
cients for anxiety and age. Self-assessed health did not serve as a
strong mediator of the effects of the other constructs. Several pos-
sible explanations exist for the apparent discrepancy. First, it may
be a consequence of the difference in estimation procedures be-
tween LVPLS and LISREL. Partial least squares uses component
analyses (such as principal component analyses) to estimate the
regression coefficients, whereas the maximum likelihood estima-
tion 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 theo-
rized to be distinctly different groups in terms of physical and psy-
chological functioning. A third potential explanation for the rela-
tively 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 ex-
cellent 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
P237
a significant total effect on feelings of loneliness; the older the
participants were, the more likely they were to report loneli-
ness. Our results also suggest the effect of old age on serf-eval-
uation of health is effectively mediated by loneliness. With ad-
vancing 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, how-
ever, is that fewer octogenarians report poor physical health,
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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 relation-
ship 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 phys-
ical well-being was totally indirect. High levels of anxiety in-
crease feelings of loneliness, which in turn decrease assessment
of well-being. The outcome of anxiety may be both poor feel-
ings about relationships and health.
Although an anxious personality may serve a positive func-
tion (e.g., motivation for action or learning), high and continu-
ous anxiety (characterized by emotional instability, apprehen-
sion 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, char-
acteristic 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 vari-
ables is noteworthy. Participating in frequent telephone conver-
sations not only reduced the loneliness perceived by partici-
pants 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 tele-
phone, 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 accessi-
ble mechanism (used by all ages) to remain in contact with dis-
tant 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 sexage-
narians were married as were about one third of the octogenari-
ans; therefore, for many younger participants, the presence of a
spouse may limit the reliance on the physical presence of out-
siders for interaction.
P238 FEESETAL.
A second possible explanation for the discrepancy is that re-
spondents, as a whole, were expressing more emotional loneli-
ness rather than social loneliness (Weiss, 1973). The amount of
face-to-face contact with others (i.e., visiting) would be less rel-
evant 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 emo-
tional stability (Cattell et al., 1970).
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; mul-
tiple interpretations of loneliness may be represented in the
analysis. The feelings of the participants appeared genuine, re-
flecting their perception of their personal status. The nature of
the question, however, does not allow us to tease out whether
the type of loneliness experienced was dominantly social or
emotional (Marangoni & Ickes, 1989). Second, with regard to
model evaluation, our chi-square statistic was significant in the
nonmediated model. Examined alone, this would indicate a
poor fit of the model to the data (Bollen, 1989). However, given
the AGFI and GFI indices of fit (above .90) and a critical N of
200 (Hoelter, 1983), we believe our models are not only theo-
retically but also statistically defensible.
The statement that "correlation does not prove causation"
(Bollen, 1989, p. 52) holds true for this model. The data in this
analysis represent one time period within the study, although
future analyses with the data will take a longitudinal perspec-
tive. As Bollen suggests, models can only approximate reality,
which is what we have attempted to do. We are attempting to
build a foundation for further model building which more accu-
rately reflects the experiences of older Americans living inde-
pendently. By the same token, the "lack of a correlation does
not disprove causation" (Bollen, 1989, p. 52). Consequently,
future data collection and analyses that are able to isolate, if
possible, variables from other agents may indeed find our initial
model to be a valid representation of reality. Obviously replica-
tion is necessary.
The generalizability of this study is limited by the character-
istics of the sample. As noted, all participants were living inde-
pendently 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 re-
sults different from those presented here.
Despite these shortcomings, the implications of this study
are clear. Loneliness does affect one's perceptions about health.
As recognized by Christian, Dluhy, and O'Neill (1989), profes-
sionals who work with older adults must be attentive to this re-
lationship in their clients and keep in mind that alleviating lone-
liness may be one way of affecting overall health. Among
elderly persons living independently, loneliness is more preva-
lent 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
sensory impairment, particularly hearing loss, therefore, is of
concern to effective telephone usage. As Baltes and Baltes
(1998) suggest, we are challenged to create a cultural support
system for the Fourth Age that allocates more resources to com-
pensate for the increasing dysfunctionality that occurs with age.
All professionals that care for or interact with older adults must
be alert to the level of functioning and health in the individual.
Model replication relies on further analyses specifically exam-
ining the moderating effects of cohort and of residential status,
that is, dependent care versus independent living, and following
individuals over time.
ACKNOWLEDGMENTS
Downloaded from http://psychsocgerontology.oxfordjournals.org/ at Pennsylvania State University on September 19, 2016
Funding for this research was provided by NIH Grant R01-43435.
The authors would like to thank Dan Russell, PhD, for his review and com-
ments 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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Received January 5, 1998
Accepted December 22, 1998