Original Study| Volume 21, ISSUE 12, P1926-1930, December 2020

Download started.


Social Isolation and Loneliness as Risk Factors for Grip Strength Decline Among Older Women and Men in China

  • Bin Yu
    Address correspondence to Bin Yu, PhD, Department of Psychiatry and Psychology, School of Basic Medical Sciences, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China; or Xiaohua Jia, PhD, Institute of Automation, Chinese Academy of Sciences, 95 Zhongguancun East Road, Beijing, 100190, China.
    Department of Psychiatry and Psychology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
    Search for articles by this author
  • Andrew Steptoe
    Department of Behavioural Science and Health, University College London, UK
    Search for articles by this author
  • Kaijun Niu
    Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
    Search for articles by this author
  • Xiaohua Jia
    Address correspondence to Bin Yu, PhD, Department of Psychiatry and Psychology, School of Basic Medical Sciences, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China; or Xiaohua Jia, PhD, Institute of Automation, Chinese Academy of Sciences, 95 Zhongguancun East Road, Beijing, 100190, China.
    Department of Ultrasound, General Hospital of People's Liberation Army, Beijing, China

    Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China
    Search for articles by this author



      The purpose of this study was to examine the relationships of social isolation and loneliness, both individually and simultaneously, on changes in grip strength among Chinese older adults and whether these relations vary by gender.


      A 4-year prospective observational study.

      Setting and Participants

      This study used data from the China Health and Retirement Longitudinal Study (CHARLS). Analyses were conducted with data from 2 waves (2011 and 2015) and were restricted to those respondents aged 50 and older [n = 7025, mean age (SD) = 61.46 (7.59); male, 48.4%].


      Social isolation, loneliness, and grip strength were measured at baseline. Follow-up measures of grip strength were obtained 4 years later. Multiple linear regression was used to evaluate the associations among baseline isolation, loneliness, and decline of grip strength between 2 waves after adjustment for age, gender, education, body mass index, chronic diseases, smoking and drinking status, activities of daily living (ADL) and instrumental ADL disabilities, and depressive symptoms.


      For women, baseline loneliness (β = 0.04, P = .035) rather than isolation (β = 0.03, P = .110) significantly predicted grip strength decline after 4 years when other confounding variables were taken into account. For men, baseline isolation (β = 0.05, P = .005) rather than loneliness (β = 0.01, P = .570) significantly predicted grip strength decline. No synergistic effect of isolation and loneliness on grip strength was found for either women or men.

      Conclusions and Implications

      In this prospective study, gender differences were found for the associations of social isolation and loneliness with grip strength decline. Our results suggest that older women and men may benefit from different social enhancement strategies for prevention of physical function decline.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Cooper R.
        • Kuh D.
        • Hardy R.
        • et al.
        Objectively measured physical capability levels and mortality: systematic review and meta-analysis.
        BMJ. 2010; 341: c4467
        • Leong D.P.
        • Teo K.K.
        • Rangarajan S.
        • et al.
        Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study.
        Lancet. 2015; 386: 266-273
        • Peterson M.D.
        • Duchowny K.
        • Meng Q.
        • et al.
        Low normalized grip strength is a biomarker for cardiometabolic disease and physical disabilities among U.S. and Chinese adults.
        J Gerontol A Biol Sci Med Sci. 2017; 72: 1525-1531
        • Holt-Lunstad J.
        • Smith T.B.
        • Baker M.
        • et al.
        Loneliness and social isolation as risk factors for mortality: a meta-analytic review.
        Perspect Psychol Sci. 2015; 10: 227-237
        • Peplau L.A.
        • Perlman D.
        Perspectives on loneliness.
        in: Peplau L.A. Perlman D. Loneliness: A Sourcebook of Current Theory, Research and Therapy. John Wiley and Sons, New York1982: 1-20
        • Shankar A.
        • McMunn A.
        • Demakakos P.
        • et al.
        Social isolation and loneliness: Prospective associations with functional status in older adults.
        Health Psychol. 2017; 36: 179-187
        • Buchman A.S.
        • Boyle P.A.
        • Wilson R.S.
        • et al.
        Loneliness and the rate of motor decline in old age: the Rush Memory and Aging Project, a community-based cohort study.
        BMC Geriatr. 2010; 10: 77
        • Perissinotto C.M.
        • Stijacic Cenzer I.
        • Covinsky K.E.
        Loneliness in older persons: a predictor of functional decline and death.
        Arch Intern Med. 2012; 172: 1078-1083
        • Buchman A.S.
        • Boyle P.A.
        • Wilson R.S.
        • et al.
        Association between late-life social activity and motor decline in older adults.
        Arch Intern Med. 2009; 169: 1139-1146
        • Salomon J.A.
        • Tandon A.
        • Murray C.J.L.
        Comparability of self-rated health: cross sectional multi-country survey using anchoring vignettes.
        BMJ. 2004; 328: 258
        • Yang K.
        • Victor C.R.
        The prevalence of and risk factors for loneliness among older people in China.
        Ageing & Society. 2008; 28: 305-327
        • Hong S.-I.
        • Hasche L.
        • Bowland S.
        Structural relationships between social activities and longitudinal trajectories of depression among older adults.
        Gerontologist. 2009; 49: 1-11
        • Kendler K.S.
        • Myers J.
        • Prescott C.A.
        Sex differences in the relationship between social support and risk for major depression: a longitudinal study of opposite-sex twin pairs.
        Am J Psychiatry. 2005; 162: 250-256
        • Cross S.E.
        • Madson L.
        Models of the self: self-construals and gender.
        Psychol Bull. 1997; 122: 5-37
        • Avlund K.
        • Lund R.
        • Holstein B.E.
        • et al.
        Social relations as determinant of onset of disability in aging.
        Arch Gerontol Geriatr. 2004; 38: 85-99
        • Guralnik J.M.
        • Butterworth S.
        • Patel K.
        • et al.
        Reduced midlife physical functioning among never married and childless men: Evidence from the 1946 British birth cohort study.
        Aging Clin Exp Res. 2009; 21: 174-181
        • Zhao Y.
        • Hu Y.
        • Smith J.P.
        • et al.
        Cohort profile: The China health and retirement longitudinal study (CHARLS).
        Int J Epidemiol. 2012; 43: 61-68
        • Ahrenfeldt L.J.
        • Scheel-Hincke L.L.
        • Kjaergaard S.
        • et al.
        Gender differences in cognitive function and grip strength: a cross-national comparison of four European regions.
        Eur J Public Health. 2019; 29: 667-674
        • Holwerda T.J.
        • Deeg D.J.
        • Beekman A.T.
        • et al.
        Feelings of loneliness, but not social isolation, predict dementia onset: results from the Amsterdam Study of the Elderly (AMSTEL).
        J Neurol Neurosurg Psychiatry. 2014; 85: 135-142
        • Gow A.J.
        • Corley J.
        • Starr J.M.
        • et al.
        Which social network or support factors are associated with cognitive abilities in old age?.
        Gerontology. 2013; 59: 454-463
        • Luo Y.
        • Waite L.J.
        Loneliness and mortality among older adults in China.
        J Gerontol B Psychol Sci Soc Sci. 2014; 69: 633-645
        • Nummela O.
        • Seppanen M.
        • Uutela A.
        The effect of loneliness and change in loneliness on self-rated health (SRH): a longitudinal study among aging people.
        Arch Gerontol Geriatr. 2011; 53: 163-167
        • Tilvis R.S.
        • Pitkala K.H.
        • Jolkkonen J.
        • et al.
        Social networks and dementia.
        Lancet. 2000; 356: 77-78
        • Teguo M.T.
        • Simo-Tabue N.
        • Stoykova R.
        • et al.
        Feelings of loneliness and living alone as predictors of mortality in the elderly: the PAQUID study.
        Psychosom Med. 2016; 78: 904-909
        • Steptoe A.
        • Shankar A.
        • Demakakos P.
        • et al.
        Social isolation, loneliness, and all-cause mortality in older men and women.
        Proc Natl Acad Sci. 2013; 110: 5797-5801
        • Glei D.A.
        • Goldman N.
        • Ryff C.D.
        • et al.
        Social relationships and inflammatory markers: An analysis of Taiwan and the US.
        Soc Sci Med. 2012; 74: 1891-1899
        • Unger J.B.
        • McAvay G.
        • Bruce M.L.
        • et al.
        Variation in the impact of social network characteristics on physical functioning in elderly persons: MacArthur Studies of Successful Aging.
        J Gerontol B Psychol Sci Soc Sci. 1999; 54: S245-S251
        • Kanamori S.
        • Kai Y.
        • Aida J.
        • et al.
        Social participation and the prevention of functional disability in older Japanese: The JAGES cohort study.
        PLoS One. 2014; 9: e99638
        • Green A.F.
        • Rebok G.
        • Lyketsos C.G.
        Influence of social network characteristics on cognition and functional status with aging.
        Int J Geriatr Psychiatry. 2008; 23: 972-978
        • Gale C.R.
        • Westbury L.
        • Cooper C.
        Social isolation and loneliness as risk factors for the progression of frailty: the English Longitudinal Study of Ageing.
        Age Ageing. 2017; 47: 392-397
        • Lund R.
        • Laban J.
        • Petersen G.L.
        • et al.
        Loneliness and objectively measured physical capability in middle-aged adults.
        Eur J Public Health. 2018; 28: 16-23
        • Taekema D.G.
        • Gussekloo J.
        • Maier A.B.
        • et al.
        Handgrip strength as a predictor of functional, psychological and social health. A prospective population-based study among the oldest old.
        Age Ageing. 2010; 39: 331-337
        • Shankar A.
        • McMunn A.
        • Banks J.
        • et al.
        Loneliness, social isolation, and behavioral and biological health indicators in older adults.
        Health Psychol. 2011; 30: 377-385
        • Pinquart M.
        • Sorensen S.
        Influences on loneliness in older adults: A meta-analysis.
        Basic and Applied Social Psychology. 2001; 23: 245-266
        • Timmers M.
        • Fischer A.H.
        • Manstead A.S.
        Gender differences in motives for regulating emotions.
        Pers Soc Psychol Bull. 1998; 24: 974-985
        • Aukett R.
        • Ritchie J.
        • Mill K.
        Gender differences in friendship patterns.
        Sex Roles. 1988; 19: 57-66
        • Hofstede G.
        • Hofstede G.J.
        • Minkov M.
        Cultures and Organizations: Software of the Mind. New York: McGraw-Hill,.
        • Petersen J.
        • Kaye J.
        • Jacobs P.G.
        • et al.
        Longitudinal relationship between loneliness and social isolation in older adults: Results from the Cardiovascular Health Study.
        J Aging Health. 2016; 28: 775-795
        • Victor C.
        • Grenade L.
        • Boldy D.
        Measuring loneliness in later life: A comparison of differing measures.
        Rev Clin Gerontol. 2005; 15: 63-70
        • Sterne J.A.C.
        • White I.R.
        • Carlin J.B.
        • et al.
        Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls.
        BMJ. 2009; 338: b2393