Background Social isolation and loneliness are prevalent among older adults and may be exacerbated by poor musculoskeletal health. The COVID-19 pandemic led to worldwide changes in lifestyle and social interaction; here we consider associates of worsening social isolation and loneliness of older adults during the COVID-19 pandemic, including relationships with osteoarthritis, osteoporosis, falls and fractures.

Methods We studied 153 men and women from the Hertfordshire Cohort Study, a cohort of UK community-dwelling older adults. Participants completed questionnaires at baseline (2019–20) and follow-up (2020–21). At baseline, osteoporosis, fractures after age 45 years, falls in previous year, and lifestyle factors were self-reported. Physical activity was assessed using the LAPAQ questionnaire. Osteoarthritis of hand, hip, or knee was defined by clinical examination. Self-efficacy was assessed using a shortened General Self-Efficacy Scale. Social isolation was assessed at both time points using the 6-item Lubben Social Network Scale, and loneliness at follow-up using the 6-item de Jong-Gierveld scale for emotional, social, and overall loneliness.

Results Baseline median (IQR) age was 83.1 (81.5, 85.3) years; 24.1% of participants had osteoarthritis; 17.6% reported osteoporosis; 26.2% and 29.4% reported fractures after age 45 years and falls in the previous year respectively; 62.7% were married; and 39.5% were current/ex-smokers. Prevalence of follow-up social isolation was 15.9%. A history of current or past smoking was a predictor of worsening social isolation (p=0.046), with married participants (p=0.026) and those with higher self-efficacy score (p=0.03) having a lower risk of social isolation at follow-up. Greater alcohol consumption was associated with higher overall loneliness (p=0.026), while being married was related to a 36% (95% CI: 3%, 58%) reduction in emotional loneliness (p=0.037). We observed a 22% (14%, 30%) reduction in emotional loneliness (p<0.001) and a 12% (4%, 20%) reduction in overall loneliness (p=0.003) per unit increase in self-efficacy score. Neither physical activity nor any musculoskeletal condition was associated with social isolation or any loneliness measure.

Conclusion Reassuringly, no measure of musculoskeletal aging was associated with worsening social isolation or loneliness in this community-dwelling sample of older adults during the COVID-19 pandemic, but longitudinal studies in larger samples are required. Greater self-efficacy was associated with a lower prevalence of social isolation, and reduced emotional and overall loneliness. Future interventions aimed at promoting self-efficacy in older adults may help reducing social isolation and loneliness in this age group.