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older people who are lonely are at increased risk of a range of negative health outcomes, including poor physical and mental health [ 83 ] and increased risk of developing dementia [ 84 ]. numerous studies have linked loneliness to increased mortality, with the greatest excess risks seen in relation to all-cause mortality, cardiovascular disease and cancer [ 85 ]. it is plausible that the negative effects of loneliness on health outcomes are mediated by mechanisms related to mental health and social isolation, such as reduced mental wellbeing, reduced social support and lack of engagement with others, lower physical activity, negative emotions, reduced self-efficacy and risk-taking behaviour [ 86 ]. the relationship between loneliness and health outcomes in older people is likely to be complex because of the many potential determinants of loneliness and social isolation, including health status, social support, personality, culture, gender, age, socioeconomic status, social networks and policies and social norms [ 83, 87 ]. loneliness and social isolation are two common and well-recognised correlates of depressive symptoms in older adults [ 88 ].
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the systematic scoping review was conducted in two stages, aiming to identify reviews which discussed and developed an understanding of loneliness and/or social isolation interventions for older people, in order to inform the development of an expert-based advisory group. these reviews were published between 2010 and 2015 and indexed in medline, embase and cinahl (additional file 1 : table s1).
systematic reviews of the literature are considered to be among the most rigorous forms of evidence synthesis. this type of literature review is distinct from traditional narrative reviews which, whilst identifying and discussing key literature, are not methodical in approach and often contain a focus on identifying the benefits and harms of an intervention [ 12 ]. this means that evidence synthesis methods are the recommended means of synthesising research evidence in systematic reviews. systematic review methods are a recommended practice for appraising the evidence base for complex interventions that are intended to improve health and have multiple components, which can be difficult to define. the aim of this systematic review was to identify and map the relevant literature on interventions to prevent or reduce loneliness and social isolation in older people. we also sought to describe the content of the included reviews, and to explore whether the reviews had met the criteria for being able to contribute to the development of an evidence-based practice guideline. all the literature reviews included in this paper were considered eligible for inclusion, irrespective of language.