Comparative effects of different interventions on loneliness, social support, and depression in older adults: A network meta-analysis of randomized controlled trials.

BACKGROUND

The prevalence of loneliness among older adults is increasing and associated with significant health risks, yet the comparative effectiveness of interventions remains unclear.

METHODS

We conducted a systematic search of major databases (including MEDLINE, Embase, and Cochrane CENTRAL) from inception to September 2025. We included randomized controlled trials (RCTs) evaluating non-pharmacological interventions for loneliness in older adults and conducted a frequentist network meta-analysis (NMA) to compare intervention effects.

RESULTS

Forty-five RCTs (N = 5736) were included. Music therapy (Standardized mean difference (SMD) = -2.94; 95% confidence interval (CI): -4.41 to -1.46), animal-assisted therapy (SMD = -1.19; 95% CI: -2.16 to -0.22), and counseling (SMD = -1.07; 95% CI: -1.82 to -0.33) exhibited the largest effect sizes for alleviating loneliness. For depressive symptoms, animal-assisted therapy ranked highest (SMD = -0.67; 95% CI: -1.43 to 0.09), though this was not statistically significant. Technology-based interventions were associated with the greatest improvement in social support (SMD = 1.42; 95% CI: 0.35 to 2.49). Sensitivity analyses yielded consistent results. The certainty of evidence for all comparisons between interventions was rated as very low.

CONCLUSIONS

In this systematic review, we found that sufficient evidence has not yet accumulated to conduct an NMA capable of adequately addressing the prespecified clinical question. Although statistically significant differences were detected between some interventions, given the very low certainty of evidence, conclusions regarding the superiority of specific interventions cannot be drawn. Further accumulation of direct comparative trials is warranted.