As government officials sought to restrain the spread of coronavirus disease 2019 (COVID-19), among those places shuttered besides schools, workplaces, and restaurants were the community centers that many older adults rely on for social interaction. In New York City alone, 30,000 people visit senior centers daily to converse, participate in activities, receive meals, and break the isolation of life in their apartments. The COVID-19 pandemic has severed this important link to the outside world.
Health experts have long recognized that social isolation and loneliness pose serious risks for the elderly, contributing to the incidence of heart disease, dementia, and early death. Health care providers are well positioned to identify those at risk since older patients tend to have more frequent contact with health care systems than younger people, notes a new report from the National Academies of Sciences, Engineering, and Medicine (NASEM).
According to the report, Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System, about a quarter of Americans ages 65 or older are socially isolated, and 43% of those 60 and older report feeling lonely. Among other findings from the report:
* Social isolation contributes to premature death from all causes and increases the dementia risk by 50%.
* Heart failure patients who report feeling lonely are four times more likely to die than those who do not.
* Social isolation or loneliness heightens the risk of coronary heart disease by 29% and the risk of stroke by 32%. These problems may be worse for older minorities, immigrants, and those who are lesbian, gay, bisexual, or transgender.
The NASEM report includes a wide range of recommendations, among them that evidence of harm from social isolation be included in patients' electronic health records to inform clinical care, and that care teams have social care providers in addition to traditional health professionals. The report also calls for the inclusion of social isolation and loneliness awareness in professional training programs.
Stronger ties between health care systems and community resources are also needed. For example, once stay-at-home orders are lifted, health care and social service organizations could connect older adults with ride-sharing programs to drive them to medical appointments or community events. Patients could also be referred, as needed, to community services to address hearing loss, mobility, and other problems.
Finally, the NASEM report underscores a need for validated tools to help health care providers identify adults who feel isolated and lonely. Schools for health professionals should include in their curricula techniques to assess isolation and loneliness along with training in possible interventions. More support is also needed from the National Institutes of Health and Center for Medicare and Medicaid Innovation for research on the health impact of social isolation and loneliness.-Carol Potera