Loneliness among adults at the end of life: a systematic review of prevalence and correlates

Background: Loneliness has been linked to poorer quality of life and worse symptoms in the final weeks prior to death. However, research on prevalence at end of life has yet to be systematically reviewed.

Aim: To synthesise evidence of prevalence and correlates of loneliness among adults at the end of life.

Design: Systematic review without meta-analysis, due to high study heterogeneity, registered on PROSPERO (CRD42024581962).

Data sources: OVID Medline, PsycInfo, Web of Science, PubMed, Social Policy and Practice and Health Management Information Consortium databases were searched up to April 2025. Studies estimating prevalence of loneliness were eligible where the sample (or identifiable sub-sample) were adults with a terminal illness, receiving palliative care or retrospectively identified with a loneliness measure less than 12 months prior to death.

Results: Fifteen eligible studies were included. Most studies were North American or European, with samples based on clinical diagnosis or palliative care receipt. Prevalence estimates of moderate or worse loneliness ranged from 20% to 73% and high loneliness from 8% to 33% in studies sampling based on clinical diagnosis or care receipt, and 7%–12% and 18.6% respectively, in studies sampling retrospectively based on time to death. However, findings are presented with caution due to significant heterogeneity across studies.

Conclusions: Evidence suggests loneliness may be a difficulty faced by a significant minority of people at the end of life, requiring support for individuals, within services and communities. Research is needed in a wider range of countries, and to develop and assess effective interventions.