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By Herb Weiss, contributing writer on aging
Nearly one in four older adults residing in the community are
socially isolated. Seniors who are experiencing social isolation or loneliness
may face a higher risk of mortality, heart disease and depression, says a newly
released report from the National Academies of Sciences, Engineering and
Medicine (NASEM), a Washington, D.C. based nonprofit, nongovernmental
For seniors who are homebound, have no family, friends or do not
belong to community or faith groups, a medical appointment or home health visit
may be one of the few social interactions they have, notes the NASEM report
released on Feb. 27, 2020.
“Despite the profound health consequences — and the associated
costs — the health care system remains an underused partner in preventing, identifying,
and intervening for social isolation and loneliness among adults over age 50,”
says the report.
“I’m pleased the AARP Foundation sponsored study by NASEM confirms
the connection between social isolation or loneliness and death, heart disease
and depression for older adults. It also finds that the health care system and
community-based organizations have a critical role to play in intervening,”
says AARP Foundation President Lisa Marsh Ryerson.
“We also know social isolation, like other social determinants of
health, must be addressed to increase economic opportunity and well-being for
low-income older adults,” says Ryerson.
Addressing Social Isolation and Loneliness
The 266-page NASEM report, “Social Isolation and Loneliness in
Older Adults: Opportunities for the Health Care System,” undertaken by the
Committee on the Health and Medical Dimensions of Social Isolation and
loneliness in Older Adults, outlines five goals that the nation’s health care
system should adopt to address the health impacts of social isolation and
loneliness. It also offers 16 recommendations for strengthening health
workforce education and training, leveraging digital health and health
technology, improving community partnerships, and funding research in
Although social isolation is defined as an objective lack of
social relationships, loneliness is a subjective perception, say the NASEM
report’s authors. They note that not all older adults are isolated or lonely,
but they are more likely to face predisposing factors such as living alone and
the loss of loved ones. The issue may be compounded for LGBT, minority, and
immigrant older adults, who may already face barriers to care, stigma and
discrimination, the report says.
Social isolation and loneliness may also directly result from
chronic illness, hearing or vision loss, or having mobility issues. In these
instances, health care providers might be able to help prevent or reduce social
isolation and loneliness by directly addressing the underlying health-related
“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 Blazer, 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 in a statement announcing its release.
“Addressing social isolation and loneliness is often the entry point for
meeting seniors’ other social needs — like food, housing and transportation,”
Providing a Road Map…
The 16 recommendations in this report provides a strategy as to
how the health care system can identify seniors at risk of social isolation and
loneliness, intervene and engage other community partners.
As to improving Clinical Care Delivery, the report calls for
conducting assessments to identify at-risk individuals. Using validated tools,
health care providers should perform periodic assessments, particularly after
life events that may increase one’s risk (such as a geographic move or the loss
of a spouse).
The NASEM report also recommends that social isolation be included in electronic health records (EHRs). If a patient is at risk for or already experiencing social isolation, providers should include assessment data in clear locations in the EHR or medical records.
It’s important to connect patients with social care or community
programs, too. The NASEM report notes that several state Medicaid programs, and
private insurers already have programs that target the social determinants of
health. These programs can be more intentionally designed to address social
isolation and loneliness of the older recipients. Health care organizations
could also partner with ride-sharing programs to enable older adults to travel
to medical appointments and community events, the report recommends.
The NASEM report also suggests that as more evidence becomes
available, roles that health care providers are already performing — such as
discharge planning, case management and transitional care planning — can be
modified to directly address social isolation and loneliness in older adults.
The report also details other interventions that the health care system might
consider may include mindfulness training, cognitive behavioral therapy, and
referring patients to peer support groups focused on volunteerism, fitness, or
common experiences such as bereavement or widowhood.
Strengthening health professional education and training can be
another strategy to combating the negative impacts of social isolation and
loneliness. The NASEM report calls for schools of health professions and
training programs for direct care workers (home health aides, nurse aides and
personal care aides) to incorporate social isolation and loneliness in their curricula.
Health professionals need to learn core content in areas such as the health
impacts of social isolation and loneliness, assessment strategies, and referral
options and processes, say the report’s authors.
The NASEM report warns that there are ethical implications for
using health technology to reduce social isolation and loneliness. Technologies
that are designed to help seniors — including smart home sensors, robots and
handheld devices — might intensify loneliness and increase social isolation if they
are not easy to use or attempt to substitute for human contact. Moreover, the
report found that 67 percent of the current assistive technologies in dementia
care were designed without considering their ethical implications. Developers
of technology should properly assess and test new innovations, taking into
account privacy, autonomy and the rural-urban digital divide.
The NASEM report says that more research is needed because of
evidence gaps and calls for more funding of studies to determine the effectiveness
of interventions in clinical settings; to develop measures to identify at-risk
individuals; and identify trends among younger adults as they age (such as use
of technology and economic trends) that may inform how the health care system
should target social isolation and loneliness in the future.
More research is also needed to identify approaches and
interventions that best meet the needs of LGBT and ethnic minority populations.
The National Academies are private, nonprofit institutions that
provide independent, objective analysis and advice to the nation to solve
complex problems and inform public policy decisions related to science,
technology and medicine. They operate under an 1863 congressional charter to
the National Academy of Sciences, signed by President Lincoln.
For a copy of the NASEM report, go to http://www.nap.edu/catalog/25663/social-isolation-and-loneliness-in-older-adults-opportunities-for-the
Published in the Woonsocket Call on March 1, 2020
Herb Weiss, LRI’12, is a Pawtucket writer covering aging, health
care and medical issues. To purchase Taking Charge: Collected Stories on Aging
Boldly, a collection of 79 of his weekly commentaries, go