Numerous studies have linked social isolation to poor health and higher healthcare utilization. Poor health is both a contributor to social isolation (e.g., health issues prevent older adults from maintaining social relationships) and a result of social isolation (e.g., the stress brought on by social isolation affects health outcomes).

• Social isolation is associated with significant increased risk for premature mortality from all causes, as well as higher rates of depression, increased risk of heart disease and stroke, and cognitive decline.²
•  Social isolation is associated with a 50% percent increased risk of dementia, which is comparable to other dementia risk factors such as physical inactivity, low education, type 2 diabetes mellitus, and late-life depression.³
• Previous research has also found that socially isolated older adults have higher rates of healthcare utilization such as hospital readmissions, more frequent physician visits, and longer hospital stays.^4,5

Older adults are at particular risk of social isolation. Predisposing factors include:

• living alone
• loss of family and friends
• sensory impairments (e.g., vision, hearing)
• first generation immigrants
• chronic illness
• restricted mobility
• poverty or low income
• cognitive impairment
• lack of access to transportation
• being a caregiver
• environmental barriers (e.g., unsafe neighborhood, living in a rural or frontier area, language barrier).²

Healthcare providers are in a unique position to identify socially isolated older adults; a doctor’s appointment or visit from a home health nurse may be one of the few social encounters isolated patients have during the week. Yet only 15% of middle-aged and older adults report having a health professional ask them about social isolation during a medical exam.⁶

Use of a single measure (e.g., living alone, being unmarried) has been shown to be a poor proxy for social isolation; instead, multiple measures are recommended and should be repeated to monitor change over time.^1,7

• The Lubben Social Network Scale-6 is a short questionnaire with good psychometric properties that can be used within clinical settings to identify social isolation in patients aged 65 and older.⁸ The instrument and instructions regarding cutoff scores can be accessed here: https://www.phenxtoolkit.org/toolkit_content/supplemental_info/social/measures/Social_Support_Lubben_Scale.doc

When a socially isolated patient is identified, it may be appropriate to:

• Assess for other potential co-existing conditions that are contributing to the isolation (e.g., hearing loss, depression, safety concerns, cognitive impairment)
• Engage in conversation about advanced care planning, particularly if the individual has no family or friends.
• Refer the patient to the aging social services network for support, volunteer opportunities, and/or wellness programs.^1,2,7