Structured Social Engagement Versus Digital Connection Intervention for Chronic Loneliness in Community-Dwelling Older Adults: A Three-Arm Randomized Trial

This study investigates comparison of structured in-person social engagement versus digital connection platform (video call facilitation) versus waitlist control for reducing chronic loneliness and improving well-being in community-dwelling adults aged 65+ within the context of geriatric psychiatry and social medicine, an area of growing scientific importance given its implications for aging-in-place loneliness intervention design, social prescription program development, and digital health platform efficacy benchmarking for social isolation. Using three-arm RCT with UCLA-3 loneliness, PHQ-9 depression, EQ-5D-5L quality of life, and salivary IL-6 assessed at baseline, 6 weeks, 12 weeks, and 6-month follow-up with ITT analysis, we examine structured social engagement providing meaningful role, reciprocal relationship, and shared activity reducing perceived social isolation through genuine relational exchange, more effective than digital substitute which lacks physical co-presence and spontaneous interaction cues in 324 adults aged 65+ (mean age 74.2, 68% female, mean UCLA-3 score 52.4), 108 per arm, 88% retention at 12 weeks and 82% at 6-month follow-up drawn from community centers and primary care practices in New York metropolitan area with digital arm using iPad + facilitated Zoom calls 3x/week and social arm using in-person activity groups 2x/week. Results indicate that structured social engagement arm achieves UCLA-3 reduction of −14.2 points (d=0.84) vs. digital −8.4 (d=0.52) vs. waitlist −2.4 (d=0.14) at 12 weeks, with 6-month durability of social arm effect maintained (−12.8 vs. baseline, p<0.001); IL-6 reduced 28.4% in social arm only (p < 0.001), with UCLA-3 -14.2 pts (d=0.84) social arm; IL-6 -28.4%; 6-month effect maintained as the primary quantitative benchmark. Concordance between primary and confirmatory measurement approaches exceeded 93%, validating the analytical framework. These findings contribute empirically to geriatric psychiatry and social medicine and carry actionable implications for the design of programs and policies targeting aging-in-place loneliness intervention design, social prescription program development, and digital health platform efficacy benchmarking for social isolation.