Having quality relationships is the top predictor of happiness and overall health, according to an 85-year longitudinal study from Harvard University. But as you get older, maintaining these connections and making new ones can be challenging.

Earlier this month, journalist Josie Duffy Rice asked her Twitter followers about ways that people over 60 can make friends or build community, after a pal of hers expressed that their parent was feeling “very isolated.”

Her question reflects the struggles with loneliness that people face throughout their lives, but particularly as they age. One study found that 43% of Americans over 60 reported feeling lonely. Research has shown that loneliness and social isolation are linked with an increased risk of negative health outcomes like dementia, heart disease, stroke, depression and even premature death.

Loneliness is a state of mind in which you feel alone. Social isolation means you have few social contacts or people to interact with regularly. “Social isolation can lead to loneliness in some people, while others can feel lonely without being socially isolated,” according to the Centers for Disease Control and Prevention.

After age 60, certain life changes may explain why a person can feel alone or have a hard time making new connections. Maybe they’re an empty nester, divorced or widowed, or they’ve recently moved to a new place.

Maybe they’re retired, nearing retirement or watching their longtime work friends retire. “The loss of work relationships can be an important contributor to loneliness,” Los Angeles psychologist David Narang told HuffPost.

“You may also be developing chronic health issues such as heart problems or back pain. And unfortunately, feeling physically vulnerable can injure your social confidence as well,” said Narang, the author of “Leaving Loneliness.”

“You might feel, for example, that if you are unable to do everything — like long hikes, traveling the world, working long days — that you once could, that you are no longer as valuable to others.”

And for some, the time, effort and initial discomfort that come with trying a new activity or getting to know someone may seem like too big of a hurdle.

Ten years ago, Anne R. — a divorced mother of two grown kids — retired from her career as a surgeon. She went from talking to 50 or 100 people a day at the office to not speaking with anyone on some days, she said.

After she retired, her work friends stopped reaching out to her.

“If I had to talk to them for one reason or another, they go, ‘Oh, let’s go for lunch.’ I was like: ‘OK, you let me know. You’re working, I’m retired. I’ll come whenever you can come.’ Never heard from them,” said the 67-year-old, whose last name has been withheld to protect her privacy.

“It was a complete shock,” she said. “These are people that I would have considered friends, people that I talked to multiple times a week.”

Anne still stays in touch with a few dear friends she’s known for decades. “I don’t necessarily talk to them every day,” she said. “But I know if I pick up the phone and they hear I’m not right, they’re right there.”

She has also met some people through her local gym and training classes for her dogs. In recent years, though, these new acquaintances haven’t turned into genuine, lasting connections.

“There are a whole lot of people that I’ve met through my dogs, but I have not really found the energy or desire to meet them outside of the dogs as a friend,” she said.

These days, she said she’s “much more selective” and “much more cautious” with her friendships.

“I’m finding people are getting very egocentric. And so they might say, ‘Oh, I’m having surgery.’ You say, ’Oh, OK, I’ll drive you.’ Then you say to them, ‘I’m having surgery, will you drive me?’ They’re like, ‘Oh, I’ve got to do this, I’ve got to do that,’” Anne said.

“So if I’m going to give of myself what I consider the energy that you should give in a friendship, I need to know there’s going to be some reciprocity.”

Craig Tomashoff, a divorced 63-year-old father, writer and producer, said he’s noticed that after 60, making new friends “is something that requires effort in a way making friends in your 20s doesn’t.”

“When you’re young, you have co-workers and roommates around all the time. You go out in groups where you meet other people. You find a mate, and his or her friends become yours,” Tomashoff told HuffPost.

“At my age now — with the only thing shrinking more than the working days I have left are the ages of my co-workers — there’s no natural way to just meet people who you want to share time with. It’s all about signing up for classes or, as I recently had to do, using apps not to date but to just make acquaintances.”

Tomashoff realized that he had spent so much of his adult life focused on his kids and working hard to save for retirement that he left little time for socializing and making friends.

Between your 20s and 50s, you’re constantly “reminded that you need to save money for your golden years. Everything is geared toward putting every dollar you can into savings so you’ll live a comfortable life when you hit your 60s,” he said.

“The one thing you never hear about, though, is doing the same for your social life. Seldom do you read articles or watch commercials telling you to bank as many friends as you can for the lonely years ahead.”

He called this the “biggest mistake” of his life.

“I’ve hit my 60s, and my social circle is the size of a Cheerio,” Tomashoff said. “I do wish I projected ahead not so much to how I’ll pay my mortgage, [but] more to how I’ll spend those days once the mortgage gets paid.”

To find your people as an older adult, tap into your interests. That might mean signing up for an art class, getting a part-time job, looking for a book club at the local library, trying a new activity like pickleball, or joining a religious, political or volunteer group for a cause that’s close to your heart.

No matter what you choose, expect some initial awkwardness as you get to know people in this new community. Tolerating that temporary discomfort is a “required part of the process,” Narang said.

“In young adulthood, we expect everything to feel new and are less bothered if the experience of joining a new group is initially uncomfortable,” he said. “We can keep that openness to new experiences throughout our lives by expecting new experiences to feel awkward for a time, and allowing for that temporary discomfort required to rebuild social community.”

Because society isn’t “organized around having gathering places that everyone visits on a regular basis,” Narang said, know that you do have to be intentional about seeking out these social connections.

Choosing a class, activity or group that meets on a regular basis can be key for building new relationships. Repeated exposure to the same people can bring you closer and help you feel like you’re part of something.

“You’re around people,” Anne said. “And if you don’t show up, people say: ‘Where are you? What are you doing?’ Sometimes they’ll call — ‘Why haven’t you been here for a week?’ And that makes you feel connected.”

Anne also has a scheduled bagel date once a week with a friend she’s known since kindergarten. This ensures they spend time face to face on a regular basis. Putting it on the calendar means they’re more likely to stick to it.

“What we’ve found is that if I call you today and say, ‘Hey, you want to go have lunch?’ — if you’re not feeling quite up to it, you’re probably going to bag,” she said.

“If I have a standing date with you, you’re probably going to come. And what it does is it allows us a better support system for each other because we come regardless of how we feel.”

And finally, remind yourself that you have something valuable to offer and that your people are out there.

“Everybody has the need to connect, to be understood, to get close to others and to have companionship,” Narang said. “If you can offer that connection and companionship, there is someone out there with those needs whose personality would mesh well with yours, and that person would want you as a friend.”

Need help with mental health or substance use disorder issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.