Social Isolation of Older Adults

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Social Isolation of Older Adults - #94

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Humans are social beings and connections to others are vital to our health and well-being. Social isolation (i.e., the objective absence or paucity of social interactions with others) is a social determinant of health which is related to, but distinct from, the concept of loneliness (i.e., the subjective distressing feeling of being socially isolated).1,2

Assessment

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

 

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

Context

Older adults living in the community, especially those who are living alone.

Action

Identify older patients who lack social connections to others and identify other potential co-existing conditions. Engage in advance care planning conversations and refer to aging-related social service organizations.

Incidence / Prevalence

  • Data from the 2011 National Health and Aging Trends Study revealed 7.7 million or 24% of community-dwelling older adults aged 65 and older were socially isolated, including 1.3 million (4%) who were severely socially isolated.9
  • As death approaches, social isolation intensifies, affecting more than 1 in 4 older adults in the last months of life.10
  • Public health strategies used to reduce the spread of COVID-19 (e.g., stay-at-home orders, physical distancing) have exacerbated social isolation. The 2020 National Poll on Healthy Aging surveyed adults aged 50 to 80 about the frequency of their social contacts and feelings of isolation before and during the pandemic.11
    • In 2018, 27% of older adults reported feeling isolated from others and this doubled to 56% in June 2020.
    • Similarly, 28% of older adults reported infrequent social contacts (once a week or less) with family, friend, or neighbors prior to the pandemic in 2018, compared to 46% in 2020.

Underlying Sciences

Behavioral & Social Sciences including Bioethics

Population Health including Social Determinants

Science Principles

Behavioral & Social Sciences including Bioethics
Population Health including Social Determinants

Objectives

  1. Define social isolation and distinguish it from loneliness.
  2. Describe the impact of social isolation on patient health.
  3. Identify risk factors for social isolation.

Keywords/Tags

References

  1. Veazie S, Gilbert J, Winchell K, Paynter R, Guise J-M. Addressing social isolation to improve the health of older adults: A rapid review. (Prepared by Scientific Resource Center under Contract No. 290-2017-00003-C.) Rockville, MD: Agency for Healthcare Research and Quality; 2019. AHRQ Publication No. 19-EHC009-EF.
  2. National Academies of Sciences, Engineering, and Medicine. 2020. Social isolation and loneliness in older adults: Opportunities for the health care system. Washington, DC: The National Academies Press. https://doi.org/10.17226/25663.
  3. Kuiper JS, Zuidersma M, Oude Voshaar RC, et al. Social relationships and risk of dementia: A systematic review and meta-analysis of longitudinal cohort studies. Ageing Res Rev. 2015;22:39-57. doi:10.1016/j.arr.2015.04.006
  4. Shaw JG, Farid M, Noel-Miller C, et al. Social isolation and Medicare spending: Among older adults, objective social isolation increases expenditures while loneliness does not. J Aging Health. 2017;29(7):1119-1143.
  5. Valtorta NK, Moore DC, Barron L, Stow D, Hanratty B. Older adults’ social relationships and health care utilization: A systematic review. Am J Public Health. 2018;108(4):e1-e10.
  6. Anderson GO, Thayer C. Social isolation: Myths vs. realities among adults age 40 and older. Washington, DC: AARP Research, July 2018. https://doi.org/10.26419/res.00234.001
  7. Smith ML, Steinman LE, Casey EA. Combatting social isolation among older adults in a time of physical distancing: The COVID-19 social connectivity paradox. Front Public Health. 2020;8:403.
  8. Lubben J, Blozik E, Gillmann G, et al. Performance of an abbreviated version of the Lubben Social Network Scale among three European community-dwelling older adult populations. Gerontologist. 2006;46(4):503-513.
  9. Cudjoe TKM, Roth DL, Szanton SL, Wolff JL, Boyd CM, Thorpe RJ Jr. The epidemiology of social isolation: National Health and Aging Trends Study. J Gerontol B Psychol Sci Soc Sci. 2020;75(1):107-113.
  10. Kotwal, AA, Cenzer, IS, Waite, LJ, et al. The epidemiology of social isolation and loneliness among older adults during the last years of life. J Am Geriatr Soc. 2021; 1- 11. https://doi.org/1111/jgs.17366
  11. Malani P, Kullgren J, Solway E, Piette J, Singer D, Kirch M. Loneliness Among Older Adults Before and During the COVID-19 Pandemic. University of Michigan National Poll on Healthy Aging. September 2020. Available at: http://hdl.handle.net/2027.42/162549
This GFF ___ my competence in geriatrics.

Authors

Stacy Barnes, PhD, Director, Wisconsin Geriatric Education Center and Associate Professor of Practice, College of Nursing, Marquette University

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