Social Connection in Older Age

Abstract:

While social isolation and loneliness affect individuals of all ages and backgrounds, older adults can be affected disproportionately, and are much more likely to suffer from health complications and related healthcare expenses. The COVID-19 pandemic has highlighted and heightened the severity of social isolation and loneliness, especially for people aging at home, in long-term care facilities, and in nursing homes. This article explores meaningful interventions for older adults, including some that look outside the traditional healthcare sector and in the technology, housing, transportation, and nutrition fields.

Key Words:

social isolation, loneliness, social connection, digital connection, built environment, aging, social determinants of health

There is growing awareness of the negative health outcomes associated with social isolation and loneliness in the United States and globally. The COVID-19 pandemic, demographic changes related to an aging population, and advancements in technology have catalyzed awareness and interest in social isolation, loneliness, and inversely in the protective factor of social connection. The protective factor of social connection can be used as a tool as individuals navigate various life events, including aging, reaching the ed of life, and managing grief.

Social isolation, defined as having objectively few social relationships and infrequent social contact, differs from loneliness, which is the subjective feeling of a lack of connection to other people and a desire for more satisfying relationships. The Global Initiative on Loneliness and Connection (GILC) highlights that while the two terms differ in meaning, they can co-occur (Badcock et al., 2022). Some individuals may experience social isolation without loneliness and others may experience loneliness without social isolation. Given this set of facts, it is important to differentiate these experiences to ensure that meaningful interventions can be crafted and deployed.

Despite growing public interest, social isolation and loneliness were prevalent prior to the pandemic, with more than a fifth of adults in the United States identifying as lonely, isolated, or both (DiJulio et al., 2018). Further, leading researcher Dr. Julianne Holt-Lunstad found that loneliness can increase risk of mortality by 50%, which is higher than the effects of air pollution, obesity, and excessive alcohol use (Holt-Lunstad, Smith, & Braxton, 2010).

Older Adults at an Increased Risk

While individuals of all ages and backgrounds can and do suffer from social isolation and/or loneliness, older adults can be affected disproportionately and are much more likely to suffer from health complications and related healthcare expenses. A report from the National Academies of Sciences, Engineering, and Medicine (NASEM) found that nearly one-fourth of adults ages 65 and older are socially isolated (National Academies of Sciences, Engineering, and Medicine, 2020).

Researchers have pointed to these risk factors for social isolation and/or loneliness in older adults: living alone, losing a family member or friend, suffering from a chronic illness, or hearing loss (Czaja, Moxley, & Rogers, 2021; Medical Advisory Secretariat, 2008; Smith et al., 2019). As age increases, so, too, does the likelihood of physical, functional, and cognitive decline—all risk factors for loneliness and social isolation.

Perceptions of control have been shown to predict change in loneliness in older adults, highlighting the subjective nature of loneliness (Newall, Chipperfield, & Bailis, 2014). Thus, social isolation and loneliness can create vicious cycles in older age, with social isolation and loneliness facilitating cognitive and physical decline, which then may be exacerbated by aging and further prevent social connection.

Social distancing and other safety measures used as a response to the COVID-19 pandemic exacerbated isolation as well as feelings of loneliness for older adults. Through a series of conversations called Connect+Conversations, which were held with national and local thought leaders, advocates, and change agents, we learned that during the pandemic, geriatricians observed a steep physical and cognitive decline among older adults due to prolonged isolation. For those living in nursing homes or assisted living facilities, the effects of COVID-19–related isolation have been especially detrimental. An AARP report found lockdown among older adults in long-term-care (LTC) facilities to be “fueling a mental health crisis,” riddled with depression, anxiety, and irritability (Paulin, 2020).

The Effect on Physical and Mental Health & Society

Evidence reveals that social isolation and loneliness hinder good health, especially for older adults. Being lonely can increase the risk for developing Alzheimer’s disease by about 50% (Wilson et al., 2007). Social isolation and loneliness also have been shown to increase risk for heart disease by 29% and stroke by 32% (NASEM, 2020). Loneliness also may make it harder for people to regulate behaviors such as drinking, smoking, and overeating, which may further contribute to health problems. In addition, chronic loneliness can even make you more prone to viral infections (Cacioppo & Patrick, 2008).

Social isolation and loneliness also can negatively impact one’s mental health—increasing risk for anxiety, depression, and cognitive decline (National Institute on Aging, 2019). Loneliness has proven to be a predictor of suicidal ideation and behavior, and research shows this relationship may be more significant for people ages 55 and older (McClelland et al., 2020).

The conditions of social isolation and loneliness, while detrimental for individuals to experience, also impact broader society and the cost burden of treating these chronic conditions strains the U.S. healthcare system. It is estimated that the number of Americans ages 65 and older will nearly double from 52 million in 2018 to 95 million by 2060—about one-fifth of the total population (U.S. Census Bureau, 2016). The financial implications of social isolation are great, with Medicare spending $6.7 billion annually as a result of individuals being socially isolated (Flowers et al., 2017).

The health and societal impacts of social isolation and loneliness on older adults are severe, but there are proactive and preventive solutions.

Advances in Technology

From care coordination platforms and tech-smart diagnostic tools to telemedicine and consumer health apps, the past few decades have seen a dramatic rise in digital health technologies. Digitization has the potential to expand the reach of healthcare, physically and conceptually. Given this, there are opportunities to integrate concepts like social connectedness, social isolation, and loneliness into U.S. health systems.

Technological interventions can come in a variety of forms—they can be used to connect aging adults to people already within their networks, such as family and friends, or help them to expand their networks to peers.

Home Connect, developed by the Community Tech Network (CTN), provides tablets to San Francisco–based elders to help them stay connected to friends and family who may be more tech savvy. For those who do not have access to the internet, Home Connect enrolls them in one of the available low-cost internet options. CTN staff connect with older adults by phone and help them through the process of connecting a tablet to the internet and use a remote training tool with screen sharing to facilitate the process. In addition to training elders in how to use the device and the internet, they provide education on protecting personal safety, evaluating the validity of various news and information sources, and identifying security threats encountered online.

Other solutions, such as Storii, address the needs of people at the end of their life. Storii is an online platform that allows older individuals to record memories and their life story with family and friends. The platform prompts the individual to share a memory or a story and then choose if they would like to write their memory, record their voice, make a video, or send in pictures. Memories are shared with family members on a profile customized for their loved one. Practicing life-story therapy has been shown to reduce depression and suffering among terminally ill patients (Chochinov et al., 2005). Reminiscence and reflecting on one's life are important components at the end of life and solutions such as Storii help provide that, while also increasing social connection.

Some tech solutions that alleviate social isolation and loneliness may not necessarily involve other people. Robotic pets, like the ones made by Joy for All and Paro, are one example of this type of solution and are particularly suited for older adults, especially those living in assisted living facilities and nursing homes. Research has demonstrated that robotic pets decrease stress and anxiety levels for people experiencing dementia and alleviate loneliness in older adults, especially those who live alone or have few social connections (Hudson et al., 2020; Petersen et al., 2017).

These solutions are just a few of the many approaches to addressing social isolation and loneliness using technology. As these issues continue to affect society and enter the mainstream discourse on health and well-being, we will likely see more solutions.

Understanding Social Determinants of Health

In addition to technological interventions, understanding social determinants of health can be valuable in reducing the harmful effects related to social isolation and loneliness. Increasingly, researchers have looked outside the healthcare sector for solutions, such as ensuring equitable access to stable housing, transportation, and nutrition, especially for older adults.

The design of physical spaces largely influences how meaningful connections are formed and maintained. This concept encompasses a range of ideas, including encouraging conversation between residents in communal areas of housing, planning public spaces to ensure safety, and prioritizing accessible community spaces in which groups of people can meet.

Researchers and experts in the senior living sector have claimed that living alone can contribute to feelings of loneliness. In 2020, 14.7 million older adults lived alone, and the rate of living alone increases with age for men and women. Notably, nearly half of women older than age 75 live alone (Administration for Community Living, 2021). Also, LGBTQ+ older adults are twice as likely to live alone, according to SAGE (2018). Some older adults have turned to co-living to bolster their social connectedness. Organizations like The Villages Network—a consumer-driven, grassroots community-based group formed with the goal of helping older adults age in place and remain connected to their communities—have been shown to improve population health, reduce isolation, and increase independence.

There is evidence that when transportation is accessible and affordable, it can foster connection. When transportation is not available, it creates a barrier to potential group activities and social engagements, as well as to attending medical appointments. According to the National Council on Aging, 41% of older adults believe transportation in their communities is inaccessible or inadequate (Samuels, 2022).

Companies like Uber Health have a role in reducing these barriers to transportation for the older adult population. In 2021, Uber Health partnered with Papa, a startup tackling loneliness among older adults to mitigate isolation and its negative health outcomes (Landi, 2021). Through this collaboration between Uber Health and Papa, older adults can get to medical appointments, errands, and community events, as well as gain social interaction and companionship.

Similar to housing and transportation, the nutrition sector can play a part in reducing the adverse consequences older adults feel as a result of social isolation and loneliness. Meals on Wheels America has recognized the nation’s growing older adult population and its elevated risk of social isolation and loneliness. Meals on Wheels (2021) daily meal delivery and other programming provides social connection and meaningful human interaction, with research showing that older adults who received daily delivered meals report improved feelings of connectedness.

Conclusion

The disproportionate effects of social isolation and loneliness on older adults are paramount, with mitigation tactics related to COVID-19 exacerbating these effects. Despite the severity of social isolation and loneliness on older adults, proactive and preventive solutions exist, and must be accessible, affordable, and equitable. Interventions related to technology, housing, transportation, and nutrition, among other sectors, can be valuable in reducing the harmful physical, emotional, and mental health outcomes associated with social isolation and loneliness.

Edward Garcia III, MHS, is the founder and executive director of the Foundation for Social Connection (F4SC), co-director of the Coalition to End Social Isolation & Loneliness (CESIL), and co-director of the Global Initiative on Loneliness and Connection, a partnership with 10 countries. He may be contacted at edward@social-connection.org.

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