Research programme on Ageing, Loneliness, and Mental health (REALM)

Loneliness is associated with poor health and mortality, but the causal relationships between loneliness, mental health and care use are not well understood. REALM takes a holistic perspective on loneliness in older adults, how loneliness is understood and experienced, its relationship with mental health, and how loneliness can be identified, assessed and addressed by practitioners.


Loneliness is in the public eye, often debated in the media both in Sweden and internationally and described as a new public health disease and an epidemic. Different views on loneliness and its causes have been aired in this debate, but it is important to remember that loneliness is a subjective feeling that arises when a person experiences a discrepancy between their perceived and desired social relations. As such, an understanding of loneliness can only be achieved by considering the individual experience: the same objective social conditions may give rise to loneliness in one person, but not in another; a person believed by observers to be lonely may not necessarily experience loneliness, while another person with ostensibly good social relations may feel lonely. This subjective nature of loneliness creates considerable challenges for those tasked with identifying and addressing and responding to loneliness.

Loneliness is associated with mental health-related factors, including depression and reduced well-being, as well as physical health and even mortality. However, the nature of the relationship between loneliness and mental health is complex and not fully understood. Older adults have been highlighted as a group at risk of both loneliness and mental health problems, but this vulnerability varies considerably within the older population. A greater understanding of the complex relationship between loneliness and mental health and of inequalities in loneliness is of utmost importance for targeting and effectiveness of interventions.

The public debate on loneliness has been accompanied by policy initiatives. In Sweden, there are governmental grants for development of interventions to target loneliness and new national guidelines on how to reduce loneliness in older adults. Internationally, several countries have strategies to reduce loneliness and some even have loneliness ministers. Many authorities and organisations are working hard to address loneliness in older adults, but there is a lack of evidence-based methods and instruments to identify, assess and address loneliness in practice.


The research programme will have four work packages (WPs), and take a holistic approach to loneliness to support ageing with mental health, equality, social participation, and dignity. Among older adults, the programme aims to:

  • examine inequalities in risk factors and consequences of loneliness, with a focus on causal associations
  • between loneliness, mental health and care use (WP1)
  • analyse mental health consequences of widowhood (a life event that is an established risk factor of loneliness) for the whole and subgroups of the older population (WP1)
  • explore individual subjective experiences of loneliness from a life course perspective (WP2);
  • explore the relationship between loneliness and mental health from a life course perspective (WP2);
  • develop an instrument to assess loneliness for use by practitioners (WP2);
  • create a loneliness literacy training programme for care professionals (WP3);
  • explore what can be done to enhance the recognition and response of care professionals to loneliness

Holistic approach

A holistic approach to loneliness will be applied, indicated by: a) using different theoretical and methodological approaches; b) understanding the experience of loneliness from different positions (older adults, care professionals); c) placing loneliness in a broader context of mental health; and d) acknowledging the subjective nature of loneliness while recognising the need to validly measure loneliness in order to identify and respond to it. We will use innovative methods to address gaps in understanding and generate knowledge that can be used to prevent and reduce loneliness. Collaboration with stakeholders and practice will be integral to the programme, from planning to dissemination.

Work packages research questions

To effectively address loneliness and its consequences, e.g., for mental health and care use, there must be a better understanding of factors placing people at risk. While many factors have been found to increase the risk of loneliness, the evidence-base is relatively strong for only a few. There are also notable gaps in the evidence, e.g., concerning inequalities, meso-level factors such place of residence and care use. WP1 will examine inequalities in risk factors and consequences of loneliness, with specific focus on mental health and care use. There will also be a thorough analysis of which mental health consequences that may follow from widowhood, a life event that is one of the key risk factors of loneliness in old age.

  • Are there inequalities in loneliness, e.g., by factors such as gender, socioeconomic position, functional ability and place of residence? Are there trends in these inequalities?
  • What is the relationship between loneliness and mental health in later life? How shall we understand the causal nature of the relationship?
  • What are the consequences of loneliness and mental health on care and medication use? Do these consequences vary across subgroups of the older population?
  • What is the effect of widowhood on transient and/or chronic mental health?

Loneliness is a subjective experience, but there is relatively little research in which older adults themselves describe their experience of loneliness and its links to mental health. Furthermore, there is no internationally recognised instrument to measure loneliness that has been developed on the basis of older adults’ own accounts of loneliness and for use by practitioners. Facilitating for practitioners to identify older adults who are experiencing loneliness is important if support is to be delivered that can reduce loneliness and the risk of associated mental health problems. Based on older adults’ experiences, this WP will develop an instrument to assess loneliness aimed for use in social and health care practice.

  • What are older adults’ experiences of loneliness from a life course perspective?
  • What connections do they see between their experiences of loneliness and their mental health from a life course perspective?
  • Does an instrument measuring loneliness in older adults demonstrate satisfactory reliability and validity?
  • Does an instrument measuring loneliness in older adults demonstrate satisfactory suitability, acceptability, and feasibility for use from the perspective of older adults and practitioners? 

Common stereotypes about loneliness in old age may contribute to older adults themselves seeing loneliness as a natural part of ageing and prevent them from seeking support. Care professionals may also hold such stereotypes. Thus, it is important that care professionals have an adequate level of loneliness literacy to recognise and respond to signs of loneliness, i.e., that they have skills to access, understand, and use loneliness-related information to prevent and reduce loneliness and promote good health. Hardly any research has been done on loneliness literacy in Sweden, and little internationally. In this WP, a training programme to enhance loneliness literacy will be developed and piloted with the aim of improving care professionals’ ability to identify and respond to loneliness.

  • What loneliness literacy knowledge and competencies do care professionals have and what do they lack in relation to recognising and responding to loneliness in older adults?
  • What content and structure should a loneliness literacy programme for care professionals have?
  • How do care professionals experience participating in a loneliness literacy training programme?

There will be close collaboration across the WPs, facilitated by WP4. In this WP, research quality will also be monitored. Finally, this WP addresses the relevance of the research programme for older adults and other stakeholders and ensures that the knowledge generated is possible to implement in practice. Stakeholders will inform specific research questions and assist in interpretation and dissemination of findings. Through this collaboration, the WP will also explore what can be done to enhance the recognition and response of care
professionals to prevent and reduce loneliness in older adults:

  • How can new methods and ways of working be implemented?
  • How can communication and collaboration across services be improved?

Research team

The multidisciplinary research team has extensive experience in undertaking and analysing quantitative longitudinal surveys, register data, qualitative studies, and developing instruments, and in working in collaboration with stakeholders. The researchers have the required expertise and experience to successfully complete the programme activities. By involving junior and early career researchers, this programme contributes to capacity building. The skill development of researchers and productivity of the programme will be further strengthened through seminars and conference symposia involving eminent researchers from different disciplines and countries.

Project leader

Lena Dahlberg

Professor, Högskolan Dalarna and affiliated researcher at Aging Research Center, KI


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Stefan Fors


Kevin McKee

Professor, Dalarna University

Kevin McKee's profile page at Dalarna University.

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Josefin Wångdahl

Assistant Professor

Other participating researchers

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Neda Agahi

Principal Researcher
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Serhiy Dekhtyar

Principal Researcher
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Federico Triolo

Postdoctoral Researcher
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Jonas Wastesson

Senior Research Specialist

Academic reference group

An academic reference group is linked to the programme and includes:

  • Research Professor Marja Aartsen, OsloMet, Norway 
  • Honorary Senior Research Fellow Christopher Gilleard, University College London, UK
  • Professor Martijn Huisman, Vrije University, Netherlands 
  • Dr Oliver Huxhold, German Centre of Gerontology, Germany 
  • Senior Researcher Giovanni Lamura, Italy's National Institute of Health and Science on Ageing, Italy 
  • Assistant professor Andrea de Winter, University Medical Center Groningen, Netherlands

Stakeholder reference group

  • Johanna Nordin, MIND
  • Zarah Melander, Nationell Samverkan för Psykisk Hälsa (NSPH)
  • Carina Benjaminsson, Pensionärernas riksorganisation (PRO)
  • Marie Louise Söderberg, SPF Seniorerna
  • Jan Sjögerud, Svenska Kyrkan
  • Nina Sagovinter, Svenska Kyrkan
  • Jeanette Hjortsberg, Region Dalarna
  • Tereza Keprdova, Kristianstads kommun
  • Liberta Mehmedi, Sollentuna kommun
  • Karin Stenberg, Sollentuna kommun
  • Caroline Helenius, Sollentuna kommun
  • Sara Fritzell, Folkhälsomyndigheten
  • Marjan Vaez, Folkhälsomyndigheten
  • Vera Gustafsson, Socialstyrelsen
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