Nurse-led pathways for loneliness and social isolation in older adults: a narrative review of assessment, relational mechanisms, and implementation

Loneliness and social isolation in later life are major public health concerns that can compromise emotional wellbeing, participation, function, quality of life, and healthy aging. Intervention effects nevertheless remain heterogeneous and difficult to translate into routine services. This narrative review addresses a specific gap left by modality-based syntheses: how nursing assessment, relational work, and service implementation can be assembled into an accountable pathway from detection to sustained connection. A PubMed/MEDLINE search through 19 June 2026 was supplemented by focused publisher-record and citation-chain verification. Evidence was classified as nurse-led, nurse-delivered or supervised, transferable mechanism evidence, or implementation evidence. Direct nursing-role evidence remains limited by small samples, multicomponent interventions, inconsistent allocation and blinding, restricted populations, and short follow-up. Quantitative syntheses show average benefit but substantial between-study heterogeneity and possible small-study effects. We therefore propose a six-stage, review-derived pathway-detect and invite; differentiate and formulate; define a valued outcome; match and prepare; connect and verify; and review and adapt-with a separate failure-repair trigger rather than a seventh stage. The nursing contribution is described as clinical-relational integration: linking clinical assessment to the practical and interpersonal work required for an older adult to enter, test, and sustain a meaningful relationship or role. The pathway is a clinical heuristic, not a validated decision rule. Future studies should use hybrid effectiveness-implementation designs, report first-contact completion using an explicit denominator, assess relational harms, and examine equity and durability across settings.