Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA, and Morsani College of Medicine, University of South Florida, North Tampa (Drs. Wilson and Colistra and Ms. Hansen); Family Medicine Residency Program, Lehigh Valley Health Network, Allentown, PA (Dr. Giusto) lynn_m.wilson@lvhn.org
The authors reported no potential conflict of interest relevant to this article.
Social isolation and loneliness—compounded by a pandemic.The US Department of Health and Human Services notes that “community connections” are among the key factors required for healthy aging.3 Similarly, the WHO definition of healthy aging considers whether individuals can build and sustain relationships with other people and find ways to engender their personal values through these connections.2
Prioritizing interventions that identify and connect isolated older adults to social support may increase survivability.
As people age, their social connections often decrease due to the death of friends and family, shifts in living arrangements, loss of mobility or eyesight (and thus self-transport), and the onset or increased acuity of illness or chronic conditions.45 This has been exacerbated by the COVID-19 pandemic, which has spurred shelter-in-place and stay-at-home orders along with recommendations for physical distancing (also known as social distancing), especially for older adults who are at higher risk.46 Smith et al47 calls this the COVID-19 Social Connectivity Paradox, in which older adults limit their interactions with others to protect their physical health and reduce their risk of contracting the virus, but as a result they may undermine their psychosocial health by placing themselves at risk of social isolation and loneliness.47
The double threat.Social isolation and loneliness have been shown to negatively impact physical health and well-being, resulting in an increased risk of early death48-50; higher likelihood of specific diagnoses, including dementia and cardiovascular conditions48,50; and more frequent use of health care services.50 These concepts, while related, represent different mechanisms for negative health outcomes. Social isolation is an objective condition when one has a lack of opportunities for interaction with other people; loneliness refers to the emotional disconnect one feels when separated from others. Few studies have compared outcomes between these concepts, but in those that have, social isolation appears to be more strongly associated with early death.48-50
A 2013 observational study using data from the English Longitudinal Study on Aging found that both social isolation and loneliness were associated with increased mortality among men and women ages ≥ 52 years (N = 6500).48 However, when studied independently, loneliness was not found to be a significant risk factor. In contrast, social isolation significantly impacted mortality risk, even after adjusting for demographic factors and baseline health status.48 These findings are supported by a 2018 cohort study of individuals (N = 479,054) with a history of an acute cardiovascular event that concluded social isolation was a predictor of mortality, whereas loneliness was not.50
A large 2015 meta-analysis (70 studies, N = 3,407,134) of mortality causes among community-dwelling older adults (average age, 66) confirmed that both objective measures of isolation, as well as subjective measures (such as feelings of loneliness or living alone), have a significant predictive effect in longer-term studies. Each measure shows an approximately 30% increase in the likelihood of death after an average of 7 years.49
Continue to: Health care remains a connection point
