Richard* lived alone. He’d never married and didn’t have any kids. And, by his sixties, he’d developed some mild cognitive impairment, which can ramp up feelings of isolation and loneliness.
Richard, though, was given an Amazon Echo – an ‘Alexa’ or personal voice assistant – as part of a scientific study led by communications researcher Prof Valerie Jones at the University of Nebraska-Lincoln, in the US.
Like the 33 others taking part in the study, all over 50 and living alone, Richard needed some support to start using the device.
He was supposed to use it for at least 30 minutes every day, engaging with Alexa through, for example, greetings – “Good morning, Alexa” – meditations, jokes and games, and using the video function to make calls.
Jones’s team wanted to know if it would make him feel less lonely.
One day, Jones recalls, Richard used his Echo to video-call his niece, catching her at work on her combine harvester, riding through the fields.
“It was beautiful,” she says. “His face lit up. He hadn’t seen her in such a long time.” In that moment of joy, Richard was neither alone or lonely.
Jones saw similar responses from other participants too.
Overall, the study showed a small decrease in participants’ feelings of loneliness over three months – one that was more pronounced in those who, like Richard, got a video Echo as opposed to an audio-only version.
Jones is one of an increasing number of researchers seeing promising results when trialling personal voice assistants and AI companions to alleviate loneliness in older people.
But getting an Alexa certainly isn’t expected to be a cure-all for loneliness, which affects a staggering 1 in 6 of us worldwide.
The wider problem is more complex than that. Loneliness doesn’t just affect the older generation, for example; in the UK and US, it’s currently the younger generation who are lonelier.
And loneliness isn’t only about being alone. Plenty of us who have families, and go to busy workplaces every day, feel lonely. It gets a grip on each of us for different reasons, depending on how we’re wired and our life experiences.
What’s more, the links to our overall health are undeniable. If we can get a handle on what the US Surgeon General recently called this ‘epidemic of loneliness’, it could help us tackle a raft of chronic conditions from depression to dementia and even heart disease.
That’s why researchers are urgently seeking answers to some of the biggest questions in loneliness science: why do we feel lonely, what does it do to our bodies and brains, and, most importantly, how do we put a stop to it?
All the lonely people
Loneliness itself is a slippery concept. “What I find is that you think you understand it, and then you don’t,” as loneliness expert, Prof Roger O’Sullivan from the All Island Institute of Public Health in Dublin and Belfast, puts it.
Again, loneliness isn’t simply the result of being alone. That’s what researchers like Jones and O’Sullivan refer to as ‘social isolation’, which tends to be a bit easier to spot.
Richard, for example, might be isolated because he lives alone, but researchers wouldn’t know how lonely he was unless they asked him.
That’s because, while social isolation can be measured objectively, based on, say, how many people you live with or numbers of social contacts, loneliness is purely subjective. It’s about how you feel.
Scientists can only gauge it through participants’ responses to survey questions or statements.
At the start and end of Jones’ study, for example, Richard completed the UCLA loneliness scale, which is based on statements like “I have nobody to talk to” and “I cannot tolerate being so alone”.
In the past, social isolation and loneliness have often been thought of as one and the same. And it’s true that living alone increases your chance of being lonely. But when scientists look at the overlap between the two, “it’s actually quite small,” according to O’Sullivan.
In one recent UK study, for example, scientists used a Venn diagram to show the crossover in around 4,500 people who were either socially isolated or lonely.
Only around 9 per cent of these people fell into the overlapping area covered by both circles. In fact, most felt lonely despite objective measures showing no obvious lack of social connection.
So, then, if being alone isn’t necessarily the root cause of loneliness, what is? One suggestion is the rising use of technology.
Smartphones, social media, virtual reality and AI are all named in the US Surgeon General’s 2023 report as technologies that can erode social connection.
By living increasingly in virtual worlds, we may be damaging our relationships in the real world. And even scientists, like Jones, who are using technology to address loneliness admit that it’s probably part of the problem.
“It’s a double-edged sword,” she says.
“Yes, technology has caused us to move away from these interactions and relationships that make us human – these social connections that make life worth it. But then there’s the argument that technology has helped facilitate these connections and bring people closer together."
‘Technology’, of course, is a big word. And some aspects of it could be more harmful than others when it comes to loneliness. In a 2025 survey of over 1,600 young adults, researchers found that overall time spent watching TV, gaming or online increased loneliness.
Yet it also found that some social media platforms, including Facebook and Instagram, made no impact – while using WhatsApp even seemed to protect against loneliness.
Other possible influences are highlighted by a study O’Sullivan led during the COVID-19 pandemic, in which his team surveyed over 20,000 people across 101 countries.
The pandemic itself triggered many people’s loneliness – increasing severe loneliness from 6 to 21 per cent – but the researchers were also interested in the underlying causes.
“We wanted to know ‘what is it?’ What were the risk factors, before the pandemic and during it?” he says. “And the two things that came out were poor mental health and insufficient funds.”
At a broader level, then, we can think of mental health issues and money troubles as some of the most consistent risk factors.
At an individual level, though, what’s behind loneliness can vary considerably, from disability to chronic illness, grief to unemployment, and combinations of the above.
What we also have to remember is that for each of us, how lonely we feel depends on some internal threshold that must be met in order for us to feel okay.
In his 2008 book Loneliness, social neuroscientist Prof John Cacioppo compared this variation in social neediness to a taste for hot sauce – “some people […] crave it on everything”, he wrote, while others need barely a hint to feel they’ve overdone it.
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The loneliness gap
Another way to look at loneliness is that it’s the gap between our expectations of social relationships and the reality.
This gap may remain out of sight unless an old friend, an enquiring doctor or a scientist brandishing a survey asks the right questions.
And it may do little harm if quickly closed, but the evidence suggests that, left to gape wide, it can become the dark recess where all sorts of unpleasant things begin to fester.
Take depression, for example. Surveys of 4,200 over-50s taking part in a long-running study of ageing, between 2004–2017, showed that higher loneliness scores at baseline were linked to worse depression symptoms 12 years later.
In this particular study, the loneliness seems to come first. Though, as psychologist Dr Anna Finley emphasises, it can also exacerbate existing mental health problems… and be exacerbated by them.
“It does seem loneliness will precede a depressive episode,” says Finley, who’s based at North Dakota State University, in the US. “But, also, a depressive episode will precede an increase in loneliness. So the links are bi-directional.”
Essentially, loneliness drives depression drives loneliness. And it feeds itself in other ways too.
Theories suggest loneliness disrupts thinking, causing us to focus more on the negatives when we’re interacting with other people, potentially making it more difficult to maintain relationships.
The consequences for our mental health appear even more stark when you consider the link between loneliness and dementia. People who are lonely are 31 per cent more likely to develop dementia, a 2024 study of more than 600,000 people found.
Moreover, data from a Chicago-based study suggests that people are more susceptible to dementia if they lack ‘meaning’ or ‘purpose’ in life – a sense of direction that often comes from a sense of social belonging.
While the impact may not be visible in brain imaging, as Finley explains, those with Alzheimer’s disease who report having more purpose in life have better cognition (thinking processes), even when their brains look the same.
“This suggests that there are these social factors that preserve cognitive function, even in the face of neurodegeneration,” she says. “Which is really cool.”
Loneliness doesn’t just impact on our brains, though – it has very real consequences for our whole body.
Perhaps most harrowing are 2025 figures from 52 separate studies published since 1989, showing that loneliness in over 50s increases the risk of dying (by any cause) by 14 per cent, and of dying specifically from heart disease by 30 per cent.
The cost of social isolation can be even higher – these studies put the increased risk at 35 per cent for death from all causes and 37 per cent for heart disease. But that’s hardly surprising given the practical implications of having someone support you with your health, especially if you have, say, a heart condition.
As O’Sullivan notes, “It’s having someone to check that you’re taking your medication, that you’re following up on your appointments, that you’re eating well, that you’re not drinking too much, or smoking.”
So while the health impact of loneliness might seem smaller by comparison, what it shows is that simply feeling lonely can make you ill, even though you might – on the face of it – have all the relevant support systems in place.
Some experts think that this physical health impact is caused by wanting the right kind of social relationships, whatever those might look like for you. Wanting – but not having – these can trigger stress.
It’s Cacioppo’s vision of loneliness as a ‘social pain’, a biological signal akin to pain, hunger or thirst – a message that activates stress pathways in our nervous system.
A wider-ranging and recent theory of ‘social safety’ developed by psychiatrist Prof George Slavich at the University of California, Los Angeles, considers isolation and rejection among a slew of ‘social threats’ driving inflammation and thereby chronic diseases.
At a crossroads
Do these scientific insights give us the power to stop loneliness, and its consequences? Perhaps – if we’re aware that it’s loneliness that’s the problem.
Thankfully, awareness is now growing. Initiatives like a new WHO Commission and 2025 guidelines on social connection by Simon Fraser University, in Canada, now recognise loneliness as a public health priority.
But dealing with the problem depends on understanding why it’s happening, and as we know, the reasons aren’t universal.
Some of the best evidence currently is for talking therapies like cognitive behavioural therapy (CBT), which aim to change the disturbed thinking that can perpetuate the problem by getting back to the root of it.
“With CBT and some other therapies, you try to figure out, ‘okay, why are you feeling lonely?’ and then how you can help that individual person maximise their effort to feel more socially connected,” explains Finley.
A 2025 review of different psychological therapies found CBT ‘moderately’ reduces loneliness. But there was less evidence for other approaches, such as mindfulness.
Meanwhile, doctors are increasingly making use of so-called ‘social prescriptions’ to get a grip on the loneliness epidemic. This relatively new approach involves a referral to a link worker, who, ideally, suggests an individually tailored range of social activities.
These may be anything from art and gardening clubs to community exercise and volunteering initiatives like parkrun – the UK-based weekly walking and running programme. In 2023 alone, at least 1.3 million patients in the UK were referred to social prescribing services.
Social prescribing is also the basis of a €5 million (£4.3 million) European research project aiming to combat loneliness through social activities in green or natural spaces. The project is funding three clinical trials in cities worldwide.
Recent results from the Helsinki-based trial involving frail older adults suggest that group excursions to places like parks and forests can help reduce loneliness, as well as improving sleep.
Other suggested treatments have included a now-abandoned pill for loneliness originally developed by Cacioppo and getting a pet.
The evidence on pet ownership shows some promise, although whether it works depends on your own, very personal expectations about what constitutes enough social contact. “If you want a human and you get a pet, you may still be lonely,” says O’Sullivan.
And then there are the technologically-minded solutions like Jones’s personal voice assistants and more ‘physically embodied’ robots, which some researchers argue can offer companionship and support that can be perceived as genuine enough to reduce loneliness.
Advances in AI now offer opportunities to tailor the personalities of our digital companions to personal taste, as well as to generate dialogue based on digital memories of previous conversations.
As with all technology, however, certain uses, and overuses, could hinder rather than help.
One controversial use is in AI-generated voices that mimic those of lost loved ones – and there are apps that have already developed this capability.
But do experts see this kind of technology being regularly used by those who feel lonely? “Honestly, I do,” Jones says.
“Particularly in the US, we don’t tend to put a lot of guidelines ahead of what we should and shouldn’t do, and… I don’t know. I tend to think, ‘Who are we to get in the way of someone who really wants that?’ And I’ve seen it – people want that.”
Her biggest concern is what it could mean for real human relationships if we’re only being met with the sympathetic ear of an AI model that never pushes back. What could that do to our ability to deal with conflict?
The same goes for the AI models of more standard chatbots, now used by two thirds of US teens.
It’s not yet clear how this tension will shift in a future in which the older generation has grown up with these technologies.
On the one hand, the Richards of the world won’t need to be taught how to use an Alexa, which might prove to be a good thing for social connectivity.
But on the other hand, they might be spending their lives conversing more with robots than humans, the impact of which we can’t fully comprehend yet.
For humans, though, there will always be many other reasons to feel lonely, and, thankfully, many other ways to stop it.
*Richard is not his real name.
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