<h4>Background</h4>Loneliness and social isolation are currently among the most challenging social issues. Given their detrimental impact on physical and mental health, identifying feasible and sustainable interventions to alleviate them is highly important. Friendly visiting, a befriending intervention whereby older persons are matched with someone who visits them on a regular basis, seems promising. However, it is unclear if face-to-face (F2F) friendly visiting by a volunteer (FVV) is effective at reducing loneliness or social isolation, or both.<h4>Objectives</h4>To assess the effect of F2F FVV on feelings of loneliness, social isolation (primary outcomes) and wellbeing (i.e., life satisfaction, depressive symptom experiencing and mental health; secondary outcomes) in older adults.<h4>Search methods</h4>We searched six electronic databases up until 11 August 2021. We also consulted 15 other resources, including grey literature sources and websites of organizations devoted to loneliness and ageing, between 25 October and 29 November 2021.<h4>Selection criteria</h4>We included experimental and observational studies that quantitatively measured the effect of F2F FVV, compared to no friendly visiting, on at least one of following outcomes in older adults (≥60 years of age): loneliness, social isolation or wellbeing.<h4>Data collection and analysis</h4>Two reviewers independently performed study selection, data extraction and synthesis, risk of bias and GRADE assessment. If outcomes were measured multiple times, we extracted data for one short-term (≤1 month after the intervention had ended), one intermediate-term (>1 and ≤6 months), and one long-term time point (>6 months). Data from randomized controlled trials (RCTs) and non-RCTs were presented and synthesized separately. Synthesis was done using vote counting based on the direction of effect.<h4>Main results</h4>Nine RCTs and four non-RCTs, conducted primarily in the United States and involving a total of 470 olde Study Brief name Why What — Materials What — Procedures Who provided How Where When and how much Tailoring Modifications How well—Planned How well—Actually Arthur 1973 1. Friendly visiting by the same volunteer 2. Friendly visiting by a different volunteer Volunteer companions may improve the functioning level of the older adults in a nursing home in terms of general morale and personal adjustment. This might differ when visitors rotate. Before the first visit, the investigator conducted a training session to orient the volunteers to nursing homes, the aged population and their needs, ethical considerations, and activities commonly performed by volunteers. Face‐to‐face, individually Not clearly reported, but presumably in the homes of the older adults 1 h per week for 3 months None reported None reported Not reported One of the older adults requested to discontinue the visits and therefore did not complete the study (reason is not reported). Another older adult died, and two refused to complete part of the questionnaire. No further information on intervention adherence. Calsyn 1984 Friendly visiting Companionship‐oriented friendly visiting may improve the life satisfaction of community‐dwelling older adults Visitor training consisted of 3 4‐h sessions: 1. With regard to the comparison condition of random social contacts and the control group without corresponding contacts, no positive effects on health, well‐being and activity were expected. Each visitor was assigned an older adult in each visiting condition, and was trained to carry out the experiment accurately. No referral to actual materials used. The older adults were initially told by the visitors that they wanted to gain practical experience in dealing with older people and also knew that the older people would like to have someone with whom they could talk. Next, depending on the condition: 1. Senior citizens selected from a community's directory of persons registered in the Retired Senior Volunteer Program, who underwent the orientation as mentioned in ‘What ‐ Materials’ Face‐to‐face, individually In the home of the homebound older adult Once weekly for 12 weeks None reported None reported Not reported Not reported Lawlor 2014 Friendly visiting Home visiting schemes for older people experiencing loneliness in which the visitors are peers of the participants may improve loneliness All volunteers attended 2 training sessions, which were conducted by the research team. Friendly conversation, with the hope of reducing the social isolation of the elderly and improving Five pairs of trained volunteer visitors (graduate students) from Teachers College, Columbia University, trained as mentioned in ‘What—Materials' Face‐to‐face, individually In the home of the isolated older adult 1 h‐long visits every 2 weeks for 6 months None reported None reported Not reported Not reported Reinke 1981 1. Friendly visiting focusing on conversation 2. No further information on intervention adherence. Schulz 1976–1978 1. Friendly visiting controlled by the older adult in time, frequency and duration of visits 2. Friendly visiting where the older adult was informed about the time of the visits 3. Friendly visiting on the basis of a random schedule It was predicted that having control and predictability would result in significantly greater positive effects on the physical and psychological status indicators than random visits or no visits. The visitors were ‘trained to carry out the experiment accurately’ (no further information). No referral to actual materials used. MacIntyre 1999 Methods Experimental: Randomized controlled trial Participants 26 community elderly (68% women, mean age 80 years) thought to be lonely and socially isolated (as assessed by professional nurses of nursing services) Interventions 1. Friendly visiting program in which trained community volunteers (undergraduate students studying gerontology) provided weekly visits (on average 3 h) for 6 weeks. Activities

<h4>Background</h4>The overall impact of social connectedness on health outcomes in older adults living in nursing homes and assisted living settings is unknown. Given the unclear health impact of social connectedness for older adults in congregate long-term care settings worldwide, a comprehensive systematic review is required to evaluate the overall relationship between social connectedness and health outcomes for them.<h4>Objectives</h4>The purpose of this article was to synthesize the literature regarding the health impact of social connectedness among older adults living in nursing homes or assisted living settings.<h4>Methods</h4>Using PRISMA guidelines, we identified eligible studies from Scopus, MEDLINE, PsycINFO, CINAHL and Cochrane databases (1990-2021). Bias and quality reporting assessment was performed using standardized criteria for cohort, cross sectional and qualitative studies. At each stage, ≥ 2 researchers conducted independent evaluations.<h4>Results</h4>Of the 7350 articles identified, 25 cohort (follow-up range: 1 month-11 years; with two also contributing to cross sectional), 86 cross sectional, eight qualitative and two mixed methods were eligible. Despite different instruments used, many residents living in nursing homes and assisted living settings had reduced social engagement. Quantitative evidence supports a link between higher social engagement and health outcomes most studied (e.g. depression, quality of life). Few studies evaluated important health outcomes (e.g. cognitive and functional decline). Most cohort studies showed that lack of social connectedness accelerated time to death.<h4>Conclusions</h4>Social connectedness may be an important modifiable risk factor for adverse health outcomes for older adults living in nursing homes and assisted living facilities. Most studies were cross sectional and focused on quality of life and mental health outcomes. Longitudinal studies suggest that higher social engagement delays time to death. Evidence regarding other health outcomes important to older adults was scant and requires further longitudinal studies.

<h4>Background and aims</h4>Social connection is associated with better physical and mental health and is an important aspect of the quality of care for nursing home residents. The primary objective of this scoping review was to answer the question: what nursing home and community characteristics have been tested as predictors of social connection in nursing home residents? The secondary objective was to describe the measures of social connection used in these studies.<h4>Methods</h4>We searched MEDLINE(R) ALL (Ovid), CINAHL (EBSCO), APA PsycINFO (Ovid), Scopus, Sociological Abstracts (ProQuest), Embase and Embase Classic (Ovid), Emcare Nursing (Ovid), and AgeLine (EBSCO) for research that quantified associations between nursing home and/or community characteristics and resident social connection. Searches were limited to English-language articles published from database inception to search date (July 2019) and update (January 2021).<h4>Results</h4>We found 45 studies that examined small-scale home-like settings (17 studies), facility characteristics (14 studies), staffing characteristics (11 studies), care philosophy (nine studies), and community characteristics (five studies). Eight studies assessed multiple home or community-level exposures. The most frequent measures of social connection were study-specific assessments of social engagement (11 studies), the Index of Social Engagement (eight studies) and Qualidem social relations (six studies), and/or social isolation (five studies) subscales. Ten studies assessed multiple social connection outcomes.<h4>Conclusion</h4>Research has assessed small-scale home-like settings, facility characteristics, staffing characteristics, care philosophy, and community characteristics as predictors of social connection in nursing home residents. In these studies, there was no broad consensus on best approach(es) to the measurement of social connection. Further research is needed to build an evidence-base on how modifiable built e Figure 1 PRISMA flow diagram Table 1 Description of published research articles included in scoping review Study characteristics TOTAL ( n = 45) N % Year of publication Pre‐1990 2 4.4 1990–1999 5 11.1 2000–2009 11 24.4 2010–2020 27 60.0 Region Asia 2 4.4 Europe 17 37.8 North America (United States) 24 (20) 53.3 (44.4) Other/multiple 2 4.4 Study design Cross‐sectional 16 35.6 Pre–Post 16 35.6 Cohort 10 22.2 Randomized controlled trial 1 2.2 Other/not stated 2 4.4 Sample size (nursing home residents) Less than 100 13 28.9 100–249 16 35.6 250–499 6 13.3 500 or more 9 20.0 Not stated 1 2.2 Sample size (nursing homes) Less than 10 20 44.4 10–49 12 26.7 50–99 2 4.4 100–249 5 11.1 250+ 3 6.7 Other (wards/multiple types of homes) 3 6.7 Resident‐reported measures of social connection Yes 9 20.0 No 36 80.0 Table 2 Description of social connection outcomes in studies reviewed Measure TOTAL ( n = 45) N % Index of social engagement 8 18 Qualidem, social relations subscale 6 13 Qualidem, social isolation subscale 5 11 Revised index of social engagement 4 9 Multidimensional observation scale for elderly subjects (MOSES), social withdrawal subscale 4 9 Quality of life instrument, relationships subscale 2 4 Proposed minimum data set (MDS) 3.0 section F, relationships 2 4 Assessment tool for occupation and social engagement (ATOSE) 2 4 UCLA loneliness scale 1 2 Maastricht electronic observation tool (MEDLO‐tool), social interaction 1 2 QUALID, social interaction subscale 1 2 Inventory of socially supportive behaviors 1 2 Social well‐being of nursing home residents (SWON) 1 2 Sanson‐fisher behavioral mapping, group behaviors 1 2 Interview schedule for social interaction (ISSI) 1 2 Bennett's past month index, social network 1 2 Resident assessment instrument minimum data set (RAI‐MDS), activity pursuit patterns characterized as interaction with others 1 2 Social network, concentric circle approach 1 2 Study‐specific measures : Social engagement, using indicators or counts of participation in various social activities and contacts with visitors, staff, and residents 11 24 Social interaction, using direct observation 3 7 Social support, measure of inclusion of informal caregivers in nursing and care 1 2 Loneliness, single‐item questions 1 2 Note : Column percent adds to more than 100% because some studies investigated multiple aspects of social connection. 40 A cohort study suggested the presence of a geriatric nurse practitioner did not improve social interaction among residents. 70 A cross‐sectional study assessed the association between staff attitudes towards dementia and residents' social well‐being; results showed that when care staff had a more hopeful attitude towards residents with dementia, residents displayed higher social well‐being, but there was no statistically significant association for the “person‐centeredness” attitude subscale. 71 3.5. Community‐level Five studies tested a range of community characteristics. Typically measures described the population in the area surrounding the home and were defined from census data. Second, there were also no studies that assessed the impact of culturally‐ 77 or ethno‐specific 78 nursing homes where care is tailored to a particular group, including through aspects such as staffing, offering specific foods and activities as well as building design. 79 Third, we found only five studies of community‐level characteristics and most used census‐derived measures of the population surrounding the home. A report of case studies from LTC homes in Canada, Norway, and Germany found that families and residents highlighted the importance of neighborhood amenities that allow residents to engage with the community and visitors. 86 , 87 Research testing the impact of modifiable home‐ and community‐level factors on social connection should inform public policy and local planning 88 when, for example, building and designing nursing homes as well as resourcing and delivering care. Further research is needed