Belonging and health outcomes in older Americans: a scoping review

As the number of older Americans grows, there is a movement to reframe aging as extending healthspan, or time spent in good health, rather than just life expectancy. A sense of belonging has been theorized to be a positive influence on healthy longevity. This scoping review examined how belonging is associated with mental and physical health outcomes in older adults. We conducted a literature search using PubMed/MEDLINE, Scopus, PsycINFO, CENTRAL, and Google Scholar for studies published between 2015 and 2025. We followed the PRISMA Scoping Review guidelines and registered our protocol in Open Science Framework. We included original research articles conducted in the United States that conceptualized belonging as a predictor of health outcomes in older populations. We excluded studies not available in English, lacking a measure of belonging, and whose samples included individuals under 50 years old. After 1169 titles and abstracts and 81 full manuscripts were triaged, our search yielded 23 studies. Almost half of the articles examined the concept of thwarted belongingness, or an unmet need for connection, and found it was significantly associated with suicidality. Out of 23 articles, one article discussed healthy aging, encompassing healthspan, 19 discussed mental health, 9 of which were suicidality, and 3 discussed physical health. Other mental health outcomes included quality of life, depression, social disconnectedness, cognition, and PTSD. Physical health outcomes included cardiovascular health, falls, and inflammatory biomarkers. Belonging, or its absence, was significantly associated with mental health outcomes, though its relationship with physical health was mixed. Few articles studied the direct relationships between belonging and chronic health conditions and longevity, highlighting gaps in the literature. More research on this topic is warranted to delineate if sense of belonging is a modifiable resilience factor for increasing healthspan.