One of the many lessons we should have learned from the Covid-19 pandemic is the cost to older adults of loneliness and social isolation. While nearly 900,000 older adults died from the virus, tens of thousands were sickened and may have died from the isolation the pandemic caused.
But what have we learned from that tragic experience? Whether older adults are living in their long-time homes, senior living communities, or nursing homes, we continue to struggle to keep them engaged with others.
A Widespread Problem
The Covid tragedy focused attention on the problem. And now, several organizations are pursuing solutions. Few are especially out-of-the-box. But that almost doesn’t matter. What is important: The solutions are getting desperately needed attention.
These feelings of isolation and loneliness among older adults hardly is new. Even before the pandemic, about 28 percent of seniors reported feeling alone. And a separate study by the Johns Hopkins Center on Aging and Health found that about one-quarter of older adults felt socially isolated while about 4 percent, or one million seniors, were “severely socially isolated.”
And the consequences? A broad study of older adults found that those with the highest levels of self-reported loneliness were nearly twice as likely to die over the period 2002-2008 than those with low levels of loneliness, even after correcting for demographics, income, marriage, and health behaviors such as smoking.
Then the pandemic happened, and made it all worse.
Highlighting Solutions
Back in January, the New York Academy of Medicine (NYAM) brought together 70 experts from around the country to brainstorm solutions. Last month, the group summarized its recommendations in a report. That work follows a host of academic studies, the 2020 National Academies of Sciences Engineering and Medicine study called Social Isolation and Loneliness in Older Adults, and a 2023 US Surgeon General Advisory on the Healing Effects of Social Connection and Community.
All differ in some respects. For example, the NASEM report highlighted the role of medical providers. The Surgeon General focused on the population at large and not just older adults. But all pointed in the same general direction. Critically, all treat loneliness as a public health problem.
Linking Medicine and Social Supports
The most recent, by the New York Academy of Medicine, includes several important recommendations:
First, it highlights the importance of identifying isolated older adults, a necessary first step before providing assistance, and then rethinking care models so they incorporate efforts to help people maintain or redevelop social connections.
It acknowledges the important role that can be played by community-based organizations that serve older adults (for example, Meals on Wheels). But to take on this additional work, it concludes these groups need more funding.
Primary care physicians, hospitals, and the full range of senior living facilities also play a critical role to play in identifying and supporting those suffering from social isolation.
For doctors, assessing isolation and loneliness takes time, training, and resources, as well as a new way of thinking. Primary care docs need to recognize that for many patients shoring up social supports is at least as important as traditional medical interventions.
Care facilities, including hospitals and nursing homes, need to recognize loneliness as a condition that requires intervention, though these too are likely to be social rather than medical, and in most circumstances not directly reimbursed by Medicare.
How To Help
What specifically can help those who are socially isolated?
The NYAM report described a New York City initiative called DOROT, which engages 1500 teens and young adults and 700 older adults in a variety of volunteer initiatives. (Full disclosure: I am a board member of a different community organization that connects older adults and school-age children with intergenerational programming).
A key to such programs is engaging older adults as volunteers themselves and not just recipients of assistance. One survey of more than 30 studies in multiple countries found that volunteering consistently reduced depression among older adults.
Among NYAM’s other suggestions: improving measurement and data collection so we can more fully understand the prevalence of loneliness among older adults and its consequences, engaging older adults themselves in designing research (and, I’d add, developing solutions), and better use of technology (though count me a skeptic on that one).
The specific recommendations of the NYAM, the Surgeon General, and the National Academies are useful. But more important is the simple recognition by these groups that social isolation and loneliness are faced by millions of older Americans. And that they are manageable conditions.
Social isolation and loneliness never will be properly addressed until medical and social service providers work together to address them. And the NYAM report is just the latest call from an organization with credibility among physicians, payers, and health systems to do just that.
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