Anchored or adrift? : social connection, health, and loneliness in later life

<p dir="ltr">People aged 80 and older are the fastest-growing segment of the population, yet they remain underrepresented in research and are often portrayed through a lens of isolation and loneliness. Social connectedness, the ways individuals interact with and experience their social world, is a fundamental aspect of human life. In later life, changes in health, family, and social roles can reshape opportunities for connection. More people are now reaching older ages with higher levels of functional ability, lower rates of dementia, and more peers alive. Yet despite the importance of social connectedness in very old age, it remains underexplored.</p><p dir="ltr">The aim of this thesis was to further our understanding of social connectedness in later life through patterns of change over time and associations with health and wellbeing. The first two studies established trends over time in light of changing conditions for social connectedness.</p><p dir="ltr">Study I described trends in social participation among the oldest old (77+) in Sweden using the Swedish Panel Study of the Living Conditions of the Oldest Old (SWEOLD, 2002-2021). Leisure and informal participation increased until 2014 but declined in 2021, likely due to the COVID-19 pandemic, while formal participation rose slightly. Although one third of older adults reported low participation levels, overall participation increased over time. These changes could partly be attributed to compositional shifts in education and functional ability, reflecting broader societal and health developments.</p><p dir="ltr">Study II described how friendship contact changed across cohorts using data from individuals born between 1905 and 1984, aged 15-97. The data was collected between 1968 and 2021 in the Swedish Level of Living survey (LNU) and SWEOLD. Friendship contact decreased across the life span, plateauing in midlife. Later-born cohorts reported more frequent contact, but these differences diminished in the oldest ages. Cohort differences in contact with relatives were not found. These patterns suggest that friendships may become increasingly important across cohorts, while old age may level out such differences.</p><p dir="ltr">The next two studies examined relationships between social connectedness, health and wellbeing.</p><p dir="ltr">Study III examined whether different types of social relationships (partners, children, relatives, friends, and weak ties) show distinct associations with life satisfaction, while considering the psychosocial pathways of perceived emotional and practical support, and loneliness using SWEOLD 2021. Close family relationships, partners and children, showed the strongest associations with life satisfaction. Relationships with children were directly and positively associated with life satisfaction and showed indirect associations through social support. Positive indirect associations with partners operated through social support and loneliness, while the direct association was equal in size and negative. Friendships were associated with life satisfaction through emotional support and reduced loneliness, whereas relationships with other relatives and weak ties showed no significant associations. These patterns suggest that different types of relationships fulfil distinct emotional and practical functions in very old age.</p><p dir="ltr">Study IV investigated loneliness trajectories surrounding the onset of mobility limitations using longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE) for adults aged 65+. Loneliness increased following onset, particularly for those with persistent limitations, while individuals who recovered showed stabilised levels. Those with high neighbourhood attachment had lower loneliness prior to onset but steeper increases over time. This study highlights the potential negative impact of mobility limitations on social connectedness.</p><p dir="ltr">Together, the four studies provide a multifaceted understanding of social connectedness in later life. Older adults today are generally more socially active and maintain more diverse networks than previous generations, yet experiences of connectedness remain heterogeneous and sensitive to health decline and social context. Different relationship types serve distinct emotional and practical purposes, and maintaining connection depends on both individual capacities and supportive environments. This thesis shows that very old age is not defined by inevitable isolation and loneliness, but by the ongoing negotiation of connection within changing personal and structural conditions.</p><h3>List of scientific papers</h3><p dir="ltr">I. <b>Augustsson, E;</b> Fors, S; Rehnberg, J; Lennartsson, C; Agahi. N. (2024) 20-year trends in the social participation of the oldest old. Scandinavian Journal of Public Health. 14034948241261720. <a href="https://doi.org/10.1177/14034948241261720">https://doi.org/10.1177/14034948241261720</a></p><p dir="ltr">II . <b>Augustsson, E;</b> Celeste, RK; Fors, S; Rehnberg, J; Lennartsson, C; Agahi, N. (2025). Friends and Trends: Friendship across life phases and cohorts. Archives of Gerontology and Geriatrics, 135, 105872. <a href="https://doi.org/10.1016/j.archger.2025.105872">https://doi.org/10.1016/j.archger.2025.105872</a></p><p dir="ltr">III. <b>Augustsson, E;</b> Celeste, RK; Dahlberg, L; Lennartsson, C; Agahi, N. Social relationships and life satisfaction among the oldest old: differentiating psychosocial pathways. [Submitted]</p><p dir="ltr">IV. <b>Augustsson, E;</b> Fors, S; Dahlberg, L; Lennartsson, C; Agahi, N. Trajectories of loneliness in relation to mobility limitations and neighbourhood context. [Submitted]</p>