Table 1_Nurse-led pathways for loneliness and social isolation in older adults: a narrative review of assessment, relational mechanisms, and implementation.docx

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.</p>