El impacto de la soledad y la fragilidad en el bienestar de los mayores europeos

The impact of loneliness and frailty on the well-being of older Europeans

Patricia Sancho , Trinidad Sentandreu-Mañó , Irene Fernández , José M. Tomás
Revista Latinoamericana de Psicología, (2022), 54, pp. 86-93.
Recibido el 14 de abril de 2022
Aceptado el 9 de junio de 2022



Introducción: El bienestar es un constructo importante cuyos determinantes asociados deben ser identificados para comprender con mayor profundidad los procesos para envejecer de forma saludable. El estudio del impacto de la fragilidad en el bienestar de las personas mayores requiere incorporar los dominios físico, psicológico y social. Así, el adulto mayor frágil puede definirse a partir de la fragilidad física, junto con la soledad como fragilidad social. Este estudio propone un modelo para estudiar el impacto de la fragilidad física y la soledad sobre el bienestar de las personas mayores, diferenciando entre control, autonomía, placer y autorrealización. Método: Se realizó un estudio de carácter transversal con una muestra de 13569 personas mayores provenientes de la encuesta SHARE, para estimar un modelo de ecuaciones estructurales en el que se contemplaban los efectos de la fragilidad y la soledad en el bienestar (cuestionario CASP), controlado por el género, la edad y la salud percibida. Resultados: El modelo final contemplaba el efecto del género sobre el indicador de fuerza de prensión de fragilidad. Los resultados mostraron un ajuste adecuado del modelo a los datos y consiguieron explicar un 80.1% de la varianza de control, un 48.6% de la de autonomía, un 43.6% de la de placer y un 61.3% de la varianza de autorrealización. Conclusiones: La soledad y la fragilidad presentaron efectos diferenciales en función del componente de bienestar. Se discuten las implicaciones de dichos efectos en el desarrollo de intervenciones.

Palabras clave:
Bienestar, envejecimiento exitoso, factores físicos, factores psicosociales, personas mayores


Introduction: Well-being is an important construct whose associated determinants must be identified in order to further understand the processes for healthy aging. The study of the impact of frailty on older people’s wellbeing requires the incorporation of physical, psychological and social domains. Hence, frail older adults can be defined from physical frailty, together with loneliness as social frailty. This study proposes a model to study the impact of frailty and loneliness on well-being of older adults, differentiating among control, autonomy, pleasure and self-realization. Method: A cross-sectional study was carried out with a sample of 13569 older adults from the SHARE project was employed in order to estimate a structural equation model in which frailty and loneliness affected well-being (CASP questionnaire), while controlling for gender, age and perceived health. Results: The final model additionally contemplated the effect of gender on the grip strength frailty indicator. Results showed a good fit of the model to the data and could explain 80.1% of the variance of control, 48.6% of autonomy’s, 43.6% of pleasure’s and 61.3% of the variance of self-realization. Conclusions: Loneliness and frailty showed differential effects on the different components of well-being. Implications of these effects on intervention development are discussed.

Well-being, successful aging, physical factors, psychosocial factors, older adults

Artículo Completo

Alpert, P. T. (2017). Self-perception of social isolation and loneliness in older adults. Home Health Care Management & Practice, 29(4), 249–252. https://doi.org/10.1177/1084822317728265

Andrew, M. K., Fisk, J. D., & Rockwood, K. (2012). Psychological well-being in relation to frailty: A frailty identity crisis? International Psychogeriatrics, 24(08), 1347-1353. https://doi.org/10.1017/S1041610212000269

Bao-lin, L., Wei, L., Jia-Qi, B., Qing-gang, M., & Jian-feng, F. (2016). Predicting factors associated with frailty in aged patients with bone-arthrosis pain in the clinic. Phys Sportsmed, 44(4), 391-396. https://doi.org/10.1080/00913847.2016.1247678

Barbosa, B., Sandersb, A., & Kokanovićc, R. (2019). It’s the worst bloody feeling in the world: Experiences of loneliness and social isolation among older people living in care homes. Journal of Aging Studies 49, 74-84. https://doi.org/10.1016/j.jaging.2019.100785

Bergmann, M., Scherpenzeel, A., & Börsch-Supan, A. (Eds.). (2019). SHARE Wave 7 Methodology: Panel Innovations and Life Histories. Munich Center for the Economics of Aging (MEA).

Bollen, K. A. (1989). Structural Equation Modeling with latent variables. John Wiley and Sons, Inc.

Börsch-Supan, A. (2020). Survey of Health, Ageing and Retirement in Europe (SHARE) Wave 7. Release version: 7.1.1. SHARE-ERIC. Data set. https://doi.org/10.6103/SHARE.w7.711

Cheung, G. W., & Rensvold, R. B. (2002). Evaluating goodness-of-fit indexes for testing measurement invariance. Structural Equation Modeling, 9(2), 233-255. https://doi.org/10.1207/S15328007SEM0902_5

Clegg, A., Young, J., Iliffe, S., Olde Rikkert, M., & Rockwood, K. (2013). Frailty in elderly people. Lancet, 381(9868), 752-762.

De Jong Gierveld, J. (1998). A review of loneliness: Concepts and definitions, determinants and consequences. Reviews in Clinical Gerontology, 8(1), 73-80. https://doi.org/10.1017/S0959259898008090

Dent, E., Morley, J. E., Cruz-Jentoft, A. J., Woodhouse, L., Rodríguez-Mañas, L., Fried, L. P., Woo, J., Aprahamian, I., Sanford, A., Lundy, J., Landi, F., Beilby, J., Martin, F. C., Bauer, J. M., Ferrucci, L., Merchant, R. A., Dong, B., Arai, H., Hoogendijk, E. O., … Vellas, B. (2019). Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. The Journal of Nutrition, Health & Aging, 23(9), 771-787. https://doi.org/10.1007/s12603-019-1273-z

Dykstra, P. A., Van Tilburg, T., & de Jong Gierveld, J. (2005). Changes in older adults loneliness: Results from a seven-year longitudinal study. Research on Aging, 27(6), 725-747. https://doi.org/10.1177/0164027505279712

Freedman, A., & Nicolle, J. (2020). Social isolation and loneliness: the new geriatric giants: Approach for primary care. Canadian Family Physician, 66(3), 176-182.

Finney, S. J., & DiStefano, C. (2006). Non-normal and categorical data in structural equation modeling. En G. R. Hancock & R. O. Mueller (Eds.), Structural equation modeling: A second course (pp. 269-314). Information Age.

Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Kop, W. J., Burke, G., & McBurnie, M. A. (2001). Frailty in older adults: evidence for a phenotype. Journal of Gerontology: Medical Sciences, 56(3), 146-156. https://doi.org/10.1093/gerona/56.3.m146

Gobbens, R. J., Luijkx, K. G., Wijnen-Sponselee, M. T., & Schols, J. M. (2010). In search of an integral conceptual definition of frailty: Opinions of experts. Journal of the American Medical Directors Association, 11(5), 338-343. https://doi.org/10.1016/j.jamda.2009.09.015

Griffin, S. C., Williams, A. B., Mladen, S. N., Perrin, P. B., Dzierzewski, J. M., & Rybarczyk, B. D. (2020). Reciprocal effects between loneliness and sleep disturbance in older Americans. Journal of Aging and Health, 32(9), 1156-1164. https://doi.org/10.1177/0898264319894486

Gwozdz, W., & Sousa-Poza, A. (2010). Ageing, health and life satisfaction of the oldest old: An analysis for Germany. Social Indicators Research, 97, 397-417.

Han, S. Y., & Ko, Y. (2021). A structural equation model of successful aging in Korean older women: using selection-optimization-compensation (SOC) strategies. Journal of Women and Aging, 33(1), 84-99. https://doi.org/10.1080/08952841.2019.1681883

Hawkley, L. C., Thisted, R. A., & Cacioppo, J. T. (2009). Loneliness predicts reduced physical activity: Cross-sectional and longitudinal analyses. Health Psychology, 28(3), 354-363. https://doi.org/10.1037/a0014400

Hoogendijka, E. O. Suanetc, B., Dentd, E., Deege, D. J. H., & Aartsen, M. J. (2016). Adverse effects of frailty on social functioning in older adults: Results from the Longitudinal Aging Study Amsterdam. Maturitas, 83, 45-50. https://doi.org/10.1016/j.maturitas.2015.09.002

Hu, L., & Bentler, P. M. (1999). Cut-off criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1-55. https://doi.org/10.1080/10705519909540118

Hubbard, R. E., Andrew, M. K., Fallah, N., & Rockwood, K. (2010). Comparison of the prognostic importance of diagnosed diabetes, co-morbidity and frailty in older people. Diabetic Medicine, 27(5), 603-606. https://doi.org/10.1111/j.1464-5491.2010.02977.x

Hughes, M. E., Waite, L. J., Hawkley, L. C., & Cacioppo, J. T. (2004). A short scale for measuring loneliness in large surveys results from two population-based studies. Research on Aging, 26(6), 655-672. https://doi.org/10.1177/0164027504268574

Hyde, M., Wiggins, R. D., Higgs, P., & Blane, D. B. (2003). A measure of quality of life in early old age: The theory, development and properties of a needs satisfaction model (CASP-19). Aging & Mental Health, 7(3), 186-194. https://doi.org/10.1080/1360786031000101157

Jakobsson, U., & Hallberg, I. R. (2013). Loneliness, fear, and quality of life among elderly in Sweden: A gender perspective. Aging Clinical and Experimental Research, 17, 494-501. https://doi.org/10.1007/BF03327417

Jylha, M. (2004). Old age and loneliness: Cross-sectional and longitudinal analyses in the Tampere longitudinal study on aging. Canadian Journal on Aging, 23, 157-168. https://doi.org/10.1353/cja.2004.0023

Maharani, A., Pendleton, N., & Leroi, I. (2019). Hearing Impairment, Loneliness, Social Isolation, and Cognitive Function: Longitudinal Analysis Using English Longitudinal Study on Ageing. American Journal of Geriatric Psychiatry, 27(12), 1348-1356. https://doi.org/10.1016/j.jagp.2019.07.010

Morais, D., Terassi, M., Inouye, K., Luchesi, B. M., & Pavarini, S. C. I. (2016). Chronic pain in elderly caregivers at different levels of frailty. Revista Gaúcha de Enfermagem, 37(4), 1-7. https://doi.org/10.1590/1983-1447.2016.04.60700

Mulasso, A., Roppolo, M., Giannotta, F., & Rabaglietti, E. (2015). Associations of frailty and psychosocial factors with autonomy in daily activities: a cross-sectional study in Italian community-dwelling older adults. Clinical Interventions in Aging, 11, 37-45. https://doi.org/10.2147/CIA.S95162

Muñoz, J., & Alix, C. (2002). Psicología del envejecimiento e intervención psicosocial. En J. Muñoz (Ed.), Psicología del envejecimiento (pp. 19-28). Pirámide.

Muthén, L. K., & Muthén, B. O. (1998-2017). Mplus User’s Guide, 8.ª ed. Muthén & Muthén.

Nilsson, I., Bernspang, B., Fisher, A.G., Gustafson, Y., & Löfgren, B. (2007). Occupational Engagement and Life Satisfaction in the Oldest-Old: The Umeå 85+ Study. OTJR: Occupation, Participation and Health, 27(4), 131-139. https://doi.org/10.1177/153944920702700403

Oksuzyan, A., Singh, P. K., Christensen, K., & Jasilionis, D. (2018). A cross-national study of the gender gap in health among older adults in India and China: Similarities and disparities. Gerontologist, 58(6), 1156-1165. https://doi.org/10.1093/geront/gnx111

Oude Voshaar, R. C., Dimitriadis, M., vandenBrink, R., Aprahamian, I., Borges, M. K., Marijnissen, R. M., Hoogendijk, E. O., Rhebergen, D., & Jeuring, H. W. (2021). A 6-year prospective clinical cohort study on the bidirectional association between frailty and depressive disorder. International Journal of Geriatric Psychiatry, 36(11), 1699-1707. https://doi.org/10.1002/gps.5588

Ožić, S., Vasiljev, V., Ivković, V., Bilajac, L., & Rukavina, T. (2020). Interventions aimed at loneliness and fall prevention reduce frailty in elderly urban population. Medicine, 99(8), 1-8. https://doi.org/10.1097/MD.0000000000019145

Palomo-Vélez, G., García, F., Araúna, D., Muñoz-Mendoza, C. L., Fuentes, E., & Palomo, I. (2020). Effects of frailty status on happiness and life satisfaction: The mediating role of self-perceived health. Revista Latinoamericana de Psicología, 52, 95103. https://doi.org/10.14349/rlp.2020.v52.10

Penninx, B. W. J. H., Van Tilburg, T., Kriegsman, D. M. W., Deeg, D. J. H., Boeke, A. J. P., & Van Eijk, J. T. M. (1997). Effects of social support and personal coping resources on mortality in older age: the longitudinal aging study Amsterdam. American Journal of Epidemiology, 146(6), 510-519. https://doi.org/10.1093/oxfordjournals.aje.a009305

Pethtel, O., & Chen, Y. (2010). Cross-cultural aging in cognitive and affective components of subjective well-being. Psychology and Aging, 25(3), 725-729. https://doi.org/10.1037/a0018511

Pinquart, M., & Sörensen, S. (2003). Risk factors for loneliness in adulthood and old age. A meta-analysis. En S. Shohov (Ed.), Advances in psychology research (pp. 111-143). Nova Science.

Pitkala, K. H., Routasalo, P., Kautiainen, H., & Tilvis, R. S. (2009). Effects of psychosocial group rehabilitation on health, use of health care services, and mortality of older persons suffering from loneliness: a randomized, controlled trial. Journal of Gerontology: Medical Sciences, 64A(7), 792-800. https://doi.org/10.1093/gerona/glp011

Russel, D., Peplau, L. A. & Cutrona, C. E. (1980). The revised UCLA Loneliness Scale: concurrent and discriminant validity evidence. Journal of Personality and Social Psychology, 39(3), 472-480. https://doi.org/10.1037/0022-3514.39.3.472

Santos-Eggimann, B., Cuenoud, P., Spagnoli, J., & Junod, J. (2009). Prevalence of Frailty in Middle-Aged and Older Community-Dwelling Europeans Living in 10 Countries. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 64A (6), 675-681. https://doi.org/10.1093/gerona/glp012

Sentandreu-Mañó, T., Badenes-Ribera, L., Fernández, I., Oliver, A., Burks, D. J., & Tomás, J. M. (2022). Frailty in the old age as a direct marker of quality of life and health: Gender differences. Social Indicators Research, 160, 429-443. https://doi.org/10.1007/s11205-019-02246-1

Smith, L., White, S., Stubbs, B., Hu, L., Veronese, N., Vancampfort, D., Hamer, M., Gardner, B., & Yang, L. (2018). Depressive symptoms, handgrip strength, and weight status in US older adults. Journal of Affective Disorders, 238, 305-310. https://doi.org/10.1016/j.jad.2018.06.016

Steverink, N., & Lindenberg, S. (2006). Which social needs are important for subjective well-being? What happens to them with aging? Psychology and Aging, 21(2), 281-290. https://doi.org/10.1037/0882-7974.21.2.281

Studenski, S., Hayes, R. P., Leibowitz, R. Q., Bode, R., Lavery, L., Walston, J., Duncan, P., & Perera, S. (2004). Clinical global impression of change in physical frailty: Development of a measure based on clinical judgment. Journal of the American Geriatrics Society, 52(9), 1560-1566. https://doi.org/10.1111/j.1532-5415.2004.52423.x

Tilvis, R. S., Laitala, V., Routasalo, P. E., & Pitkälä, K. H. (2011). Suffering from loneliness indicates significant mortality risk of older people. Journal of Aging Research, 2011, 1-5. https://doi.org/10.4061/2011/534781

Tomás, J. M., Oliver, A., Navarro, E., Meléndez, J. C., & Molina, C. (2009). Comparación del bienestar psicológico de personas mayores dominicanas y españolas. Revista Española de Geriatría y Gerontología, 44(4), 180-185. https://doi.org/10.1016/j.regg.2009.01.004

Urtamo, A., Jyväkorpi, S. K., & Strandberg, T. E. (2019). Definitions of successful ageing: a brief review of a multidimensional concept. Acta bio-medica: Atenei Parmensis, 90(2), 359-363. https://doi.org/10.23750/abm.v90i2.8376

Van de Schoot, R., Lugtig, P., & Hox, J. (2012). A checklist for testing measurement invariance. European Journal of Developmental Psychology, 9(4), 486-492. https://doi.org/10.1080/17405629.2012.686740

Van Oostrom, S. H., Van der, D. L., Rietman, M, L., Picavet, H. S. J., Lette, M., Verschuren, W. M. M., de Bruin, S. R., & Spijkerman, A. M. W. (2017). A four-domain approach of frailty explored in the Doetinchem Cohort Study. BMC Geriatrics, 17(1), 196-207. https://doi.org/10.1186/s12877-017-0595-0

Vestjens, L., Cramm, J. M., & Nieboer, A. P. (2016). An evaluation of an integrated primary care approach to improve well-being among frail community-dwelling older people. International Journal of Integrated Care, 16(6), 1-8. https://doi.org/10.5334/ijic.2694

Vestjens, L., Cramm, J. N., Birnie, E., & Nieboer, A. P. (2018). Evaluating an integrated primary care approach to improve well-being among frail community-living older people: A theory-guided study protocol. Geriatrics, 18, 173-190. https://doi.org/10.1186/s12877-018-0832-1

Ware, J. E., & Gandek, B. (1998). Overview of the SF-36 health survey and the international quality of life assessment (IQOLA) project. Journal of Clinical Epidemiology, 51(11), 903-912. https://doi.org/10.1016/s0895-4356(98)00081-x

Wyshak, G. (2003). Health ratings in relation to illnesses, physical functioning, general mental health and well-being: self-reports of college alumnae, ages <40-80 and older. Quality of Life Research, 12, 667-674. https://doi.org/10.1023/A:1025153718661

Xue, Q. L. (2010). The frailty syndrome: Definition and natural history. Clinics in Geriatric Medicine: Home Page, 27(1), 1-15. https://doi.org/10.1016/j.cger.2010.08.009

Zebhauser, A., Hofmann-Xu, L., Baumert, J., Häfner, S., Lacruz, M. E., Emeny, R. T., Döring, A., Grill, E., Huber, D., Peters, A., & Ladwig, K. H. (2014). How much does it hurt to be lonely? Mental and physical differences between older men and women in the KORA-Age Study. International Journal of Geriatric Psychiatry, 29(3), 245-252. https://doi.org/10.1002/gps.3998

Zhou, Z., Wang, P., & Fang, Y. (2018). Loneliness and the risk of dementia among older Chinese adults: Gender differences. Aging and Mental Health, 22(4), 519-525. https://doi.org/10.1080/13607863.2016.1277976