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March 17, 2020

In Time of Social Distancing, Report’s Call for Health Care System to Address Isolation and Loneliness Among Seniors Resonates

Author Affiliations
  • 1Consulting Editor, JAMA Health Forum and JAMA
JAMA Health Forum. 2020;1(3):e200342. doi:10.1001/jamahealthforum.2020.0342

As many people across the globe are learning, rapid implementation of social distancing is essential to reduce transmission of the COVID-19 virus and protect those most vulnerable, particularly older adults and individuals with underlying medical conditions. But without question, the ripple effects of this crucial strategy include an exacerbation of social isolation and loneliness.

Just as COVID-19 threatens to cause an economic recession, it will also cause a “social recession” that will most affect older adults and people with disabilities or preexisting health conditions, explained writer Ezra Klein in an article published March 12.

Long before the emergence of COVID-19, however, social isolation and loneliness were preexisting conditions in the US, as detailed in a report issued last month by the National Academies of Sciences, Engineering, and Medicine. It describes how the US health care system falls short in preventing social isolation and loneliness among older adults—as well as in identifying and intervening to address the problem in those already affected.

The report, Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System, was sponsored by the AARP Foundation. It distinguishes between social isolation, defined as an objective sparseness of social connections, and loneliness, defined as a subjective perception of social isolation or feeling of being lonely. The 2 conditions often are not significantly correlated, which is why this distinction is considered important.

Some 24% of community-dwelling US adults aged 65 or older are considered to be socially isolated, and a significant proportion of adults in the US—35% of adults aged 45 or older and 43% of adults aged 60 or older—feel lonely, according to the report. Older adults are more likely to have factors that predispose them to isolation or loneliness, such as living alone or losing a loved one, as well as living with chronic illness, vision loss, and impaired hearing, the report says.

“Substantial evidence shows that social isolation and loneliness are strongly associated with a greater incidence of major psychological, cognitive, and physical morbidities and lower perceived well-being or quality of life,” the report notes.

Social isolation or loneliness is linked with the risk of cardiovascular and cerebrovascular morbidities, worsening depression and anxiety, accelerated cognitive decline in older adults and an increased risk of developing dementia, a substantially increased risk of hospitalization or death among patients with heart failure, and other damaging effects on health and well-being, according to the National Academies Committee on the Health and Medical Dimensions of Social Isolation and Loneliness in Older Adults, which wrote the report.

“Loneliness and social isolation aren’t just social issues—they can also affect a person’s physical and mental health, and the fabric of communities,” said Dan G. Blazer II, MD, MPH, PhD, J.P. Gibbons Professor of Psychiatry Emeritus and professor of community and family medicine at Duke University, and chair of the committee that wrote the report. “Addressing social isolation and loneliness is often the entry point for meeting seniors’ other social needs—like food, housing, and transportation.”

Because nearly all older adults interact with the health care system in some way, the report focused on the system’s role as an important and “relatively untapped partner” in efforts to address the issue. The report lays out recommendations for how the health care system can identify individuals at risk of social isolation or loneliness and engage community partners to work with them to address the issue. For example, it calls for clinicians to conduct periodic assessments to identify at-risk individuals, especially after events such as the loss of a spouse, and to include social isolation in electronic health records.

The committee also recommended strengthening ties between the health care system and community-based networks and resources to connect patients with social care and community-based programs and develop strategies to address social isolation and loneliness in older adults. For example, such a partnership could enable older adults to use a ride-sharing program to travel to medical appointments and community events.

Other recommendations include developing a more robust evidence base to better understand the health effects of social isolation and loneliness—including among understudied groups of older adults such as low-income and LGBT individuals—and to develop interventions to prevent and mitigate these effects. The report also calls for strengthening ongoing education and training for health care professionals by including information related to social isolation and loneliness in curricula and advises professional organizations to incorporate information about the issue into their advocacy, practice, and education initiatives.

The report’s authors also urged the US Department of Health and Human Services “to centralize evidence, resources, training, and best practices on social isolation and loneliness, including those for older adults and for diverse and at-risk populations.”

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