About a quarter (24 percent) of Americans age 65 and older who live in the community consider themselves socially isolated, and a significant proportion of. Social isolation and loneliness are widespread: it is estimated that 1 in 4 older people suffer from social isolation and between 5 and 15 percent of adolescents feel alone. A large body of research shows that social isolation and loneliness have a serious impact on physical and mental health, quality of life and longevity. The effect of social isolation and loneliness on mortality is comparable to that of other well-established risk factors, such as smoking, obesity and physical inactivity.
Did you know that 26.8% of people age 65 and older in North Carolina live alone? For older adults who live alone in a home, their limited ability to participate in activities they like or to socialize in their community can put them at greater risk of being affected by social isolation. Social isolation among older adults is an urgent problem that has important implications for people's well-being, putting a person at greater risk of developing heart disease, dementia, or other life-altering conditions. Loneliness and isolation are increasingly part of the experience of growing older. The reduction of intergenerational life, the increase in social and geographical mobility, the increase in the number of single-person households: all these trends mean that older adults can become more socially isolated.
For older people with the resources to choose to live in a retirement community, travel to visit friends, or simply connect to the Internet, the adverse consequences of loneliness may be minor. For other people vulnerable to illness or poverty — perhaps after a lifetime of poor access to health care in countries without comprehensive social care provision — the impact of loneliness and isolation can be profound. The experience and consequences of loneliness and isolation vary depending on social position. Addressing these issues, therefore, has the potential to play a role in reducing inequalities in health, as well as improving people's quality of life. The way in which people define loneliness and social isolation is important because it influences the way they measure these concepts.
There are several self-assessment measures of loneliness that are widely used, such as the University of California at Los Angeles (UCLA) loneliness scale or the De Jong Gierveld loneliness scale. The UCLA measure contains elements to measure self-perception of isolation and relational and social connection. The De Jong Gierveld loneliness scale combines social and emotional subscales, and covers issues such as the feeling of emptiness and the lack of people nearby, with the presence of people to trust and feel nearby. A wider range of approaches have been applied to measuring isolation, from judging levels of social contact and the size of social networks to recording marital status or household composition.
Community studies have reported rates of severe loneliness among adults aged 65 and over of between 2% and 16%, 3 while at any given time up to 32% of people over 55 feel alone, 4 The prevalence of loneliness among institutionalized older adults is less documented, but it is believed to be a common experience in long-term care. A study found that more than half of nursing home residents without cognitive impairment reported feeling lonely.5 Like loneliness, social isolation among older adults is substantial, with increasing trends in populations around the world. In 2004, a non-institutionalized American was much more likely to report being completely isolated from people with whom they could talk about important issues, compared to two decades earlier.6 Factors that have been linked to social isolation and loneliness in old age range from sociodemographic characteristics to material resources and health status (figure).This is one of the main limitations of research in this area. Poor health and immobility that make people less likely to socialize can lead to isolation and loneliness.
Alternatively, loneliness can be a causal factor for health problems. Without further longitudinal studies, it may be impossible to unravel this and the independent effect of the different variables that interact with each other. Therefore, the identification of old age as a risk factor can be attributed to interactions with other factors, such as the loss of contemporaries, cognitive decline, and disability. Risk factors for social isolation and loneliness among older adults Compared to our understanding of risk factors such as smoking and obesity, we know much less about the mechanisms through which loneliness and social isolation affect health.
The association between loneliness and blood pressure has implicated physiological functioning as a causal factor, but there is increasing evidence on the role of neuroendocrine effects and hormonal influences on genetic transcription and cellular immunity.9 Other research suggests that the association with health behaviors may be important. Social relationships have been shown to promote healthy behaviors, and the health of socially isolated people may deteriorate because they lack the social and environmental support that is essential for maintaining independence. at a later stage in life. On the contrary, a change in health behavior does not seem to explain the association between loneliness and worse health outcomes.13 Research shows that socially isolated and lonely adults are more likely to be admitted prematurely to residential or nursing care, 14 Loneliness has been identified as an important factor in physician utilization, regardless of health status, depression and somatic problems, although evidence of a higher consultation rate in the medicine of British family is contradictory, 15,16 Greater loneliness has been independently associated with emergency hospitalization—but not with planned hospital admissions—among older adults living in the community 17, researchers from Los Angeles discovered that social isolation among older people was related to a four- to five-fold increase in the likelihood of rehospitalization within a year.18 Various interventions have been directed to alleviate loneliness and social isolation, ranging from social activities and physical ones such as rehearsals in choirs, food clubs, visits to schools and sports groups to counseling and therapy.
The heterogeneity of interventions, the multiplicity of measurement tools and outcome measures, together with poor methodological quality and focus on subgroups of the population, have limited the ability of researchers to draw definitive conclusions about the effectiveness of interventions. Initiatives are often introduced by community groups or charities in local neighborhoods, and are rarely evaluated. When evaluations have been carried out, success has tended to be judged on the basis of the process, such as the number of people served and the degree of satisfaction of the participants. The degree to which interventions have affected participants' loneliness or social isolation often remains unknown; and contextual circumstances are often not taken into account.
Among the characteristics most likely to be associated with effective interventions are the presence of a theoretical framework that supports it, active rather than passive participation, and group rather than individual births, 19,20 The influence of loneliness and isolation on mortality is significant. The relationship with health is not clearly understood, but there is substantial data on pathophysiological mechanisms and there is increasing evidence of their association with an established disease. On their own, these are sufficient reasons to interest doctors, but what if loneliness and isolation also influenced the success or failure of some medical treatments? Effects on physiological functioning may reduce the effectiveness of treatments and, if loneliness or isolation influence health behavior, it is plausible that compliance with advice or medication may be affected. In elderly care and family medicine, if lonely and isolated patients are treated more often than others, health professionals are well placed to play a key role in identifying those most at risk.
We still don't know what is the best way for each doctor to intervene once they have identified isolated or solitary patients in the clinic; but what is clear is that addressing this problem more directly could have benefits for the health system and for the people affected. In addition to experiencing higher levels of morbidity, people who are alone and isolated seem to use more healthcare resources and are more likely to need long-term care. Older adults are the biggest consumers of healthcare, so it should be noted that, for example, the hospital readmission rates of older adults alone quadrupled. The interventions that have been implemented to address loneliness and isolation (social activities or psychological therapies) are low-cost compared to many medical technologies.
A campaign to address loneliness and isolation could prove to be one of the most cost-effective strategies a health system could adopt and counteract the rising costs of caring for an aging population. The evidence from current research on loneliness, social isolation, and health in older adults is based on work from a variety of different disciplines. Demographers, sociologists, psychologists, neuroscientists, gerontologists and others have framed challenges and solutions since their own perspectives. This has contributed to the wealth of our knowledge, but the absence of a clear message from a single body of work may also have allowed policymakers to ignore the potential health benefits derived from addressing loneliness and isolation, dedicating attention and resources to more tangible and clearly defined problems.
For professionals and policymakers to take the loneliness and social isolation of older adults seriously, we need to renew the research agenda and focus more on public health risks. Demographic changes and high prevalence among some groups of older people should place prevention at the center of any strategy to combat loneliness and isolation. Primary prevention of loneliness is likely to require action earlier in life, for example, working to conserve social networks or build resilience. Longitudinal studies will allow us to better understand how loneliness, social isolation and health interact over time, and to distinguish between cause and effect.
Research must also consider the different ways in which interventions can reach lonely and isolated older adults. Population-based strategies are essential, since we know that focusing on high-risk people can increase social inequalities, but if consultation rates are high among this group of lonely older people who are difficult to reach, the opportunities offered by contacts with health services should be thoroughly explored. In relation to loneliness and isolation, secondary prevention activities can identify people who feel lonely but healthy, while tertiary prevention acts to minimize the progression of the adverse effects of loneliness for health. Both require a systematic needs assessment and an interdisciplinary approach that recognizes the complexity of interventions and overcomes barriers between health and society, public health and medicine.
The empirical basis for the implications of loneliness and social isolation in older adults is growing, but the extent of the public health challenge posed by loneliness and social isolation, as well as the potential health benefits of the intervention, are currently uncertain. In times of financial difficulty and with an aging population, the possibility of offering a low-cost option to improve health should not be overlooked. A renewed research program focused on public health principles and encompassing the role of health and social interventions would be the best option to answer some of the most important questions faced by those who care about lonely and isolated older people. The authors thank the Campaign to End Loneliness, whose research center provides a valuable forum for researchers.
Social isolation and loneliness are widespread, and some countries report that up to one in three older people feel alone. A large body of research shows that social isolation and loneliness have a serious impact on the longevity of older people, their physical and mental health, and their quality of life. The effect of social isolation and loneliness on mortality has been compared with that of other well-established mortality risk factors, such as smoking, obesity and physical inactivity. People can be referred to local agencies on aging and other community resources, such as centers for the elderly or local libraries, that can help address unmet social needs, including opportunities for social connection.
This report uses the specific terms social isolation, loneliness, or other terms when the data is specific to these terms. Discussion, counseling, therapy or education), social activities, in the form of social programs, physical activity (fitness program or recreational activity), technology (e.g., addressing the social isolation of older adults requires a multifaceted approach that encompasses community support, technological integration and health initiatives).Social isolation and loneliness are important, but often overlooked, social determinants of health at all ages, even for older people. The Department of Health and Human Services must establish and fund a national resource center to centralize evidence, resources, training and best practices on social isolation and loneliness, including those aimed at older adults and diverse and at-risk populations. Focusing on major social and behavioral health risk factors offers a way to improve population health and even reduce health disparities.
There is no single approach to addressing loneliness or social isolation, and hence the need to adapt interventions to the needs of individuals, specific groups or the degree of experienced loneliness. A new promotion report highlights the serious consequences of social isolation and loneliness on the health of older people and calls for greater political priority for the issue. For other people, when the path to loneliness is not the result of social isolation, these interventions are likely to have limited impact. Health service delivery systems are studying the feasibility and impact of using practice-based strategies to identify and address social determinants of health, including social isolation and loneliness.
National Academies of Sciences, Engineering and Medicine; Behavioral Sciences and Social and Educational Sciences Division; Health and Medicine Division; Behavioral, Cognitive and Sensory Sciences Board; Health Sciences Policy Board; Committee on the Health and Medical Dimensions of Social Isolation and Loneliness in Older Adults. Only recently have the adverse health effects of social isolation and loneliness received public attention at the national and international levels. Alternatively, in circumstances where a person is geographically isolated, an intervention that improves the social network may be more appropriate.
