Social relationships are essential for health and wellbeing, but social isolation is becoming increasingly common, especially as the pandemic persists.
While social isolation can impact anyone, seniors face one of the highest risks, as they may have fewer friends, live alone, have a disability or the inability to drive, and/or battle a chronic disease. A 2020 National Academy of Science, Engineering and Medicine (NASEM) study, commissioned by the AARP Foundation, found that nearly one-quarter of community-dwelling adults aged 65 and older are socially isolated.
Social isolation contributes to premature mortality and a myriad of poor health outcomes, such as an increase in inflammation and stress hormone levels, elevated blood pressure, and increased risk of coronary artery disease, stroke, and obesity. The National Council on Aging likens the health risks of prolonged isolation to smoking 15 cigarettes per day.
Loneliness can be just as problematic, but it does not always go hand-in-hand with social isolation. Loneliness is the feeling or perception of being socially isolated, even if you’re surrounded by other people. Physician Dhruv Khullar wrote in a 2016 New York Times piece, “All told, loneliness is as important a risk factor for early death as obesity and smoking.”
COVID-19 and social distancing protocols have only exacerbated feelings of loneliness across the country, instilling the urgent need to address social isolation as an often overlooked, but highly prevalent social driver.
How does social isolation impact health?
The NASEM study found that social isolation or loneliness in seniors was associated with:
- 50 percent increased risk of developing dementia
- 29 percent increased risk of incident coronary heart disease
- 32 percent increased risk of stroke
- A nearly 4 times increased risk of death, 68 percent increased risk of hospitalization, and 57 percent increased risk of emergency department visits among heart failure patients
A September 2021 Yale study found similar associations in socially isolated seniors, including an increased likelihood of death for those who enter intensive care units and an increased risk of disability after discharge. According to the study, socially isolated patients died within three years of discharge at a rate three to five times higher than the general senior population.
And research shows that depression, anxiety, and suicidal ideation increase with social isolation and feelings of loneliness.
Utilize screenings and predictive analytics to identify socially isolated patients
Chronic loneliness is closely linked to high healthcare utilization rates and increased primary care visits, making providers and clinicians well-positioned to identify socially isolated seniors and provide appropriate interventions or referrals.
Dr. Lauren E. Ferrante, a pulmonary and critical care physician and senior author of the Yale study, calls on providers to identify socially isolated patients before they are discharged.
“Hospitalization may be our only chance of identifying people who are socially isolated,” she says. “In the hospital, we are all aware of the patient’s medical details, but we need to be more aware of the patient’s social situation as well.”
Once at-risk patients are identified, Ferrante suggests connecting them with social engagement programs, providing transportation for medical appointments, or deploying volunteers to check in with the patients through weekly outreach.
The process of screening for social isolation and loneliness
Using patient questionnaires, screenings, and other tools, payers and providers have the capability to identify risk, but how often is social isolation considered? When assessing patient populations, either digitally, in-person, or through paperwork, payers and providers should use language that does not further stigmatize those experiencing social isolation or loneliness and prioritize privacy so a patient’s social risk is protected.
“It is critical to have assessment tools for social isolation and loneliness that do not further exacerbate inequalities between minority or at-risk groups and the general population,” the NASEM report points out. Recommended screening tools include the self-reported Berkman-Syme Social Network Index and the 20-item UCLA Loneliness Scale.
In addition to quality screenings, predictive analytics should be used to identify socially isolated patients. With predictive analytics, you don’t need patient input to determine risk. You can pull from a myriad of data sources, including individual electronic health records (EHR), wearable medical devices or patient health-tracking apps, and higher-level county, state, or population data. Factors like car ownership, distance to walkable areas, and household size can help reveal a person’s risk.
Partner with agencies and community-based organizations (CBOs) to build interventions
Seniors who live alone or have few social connections have a greater need for direct resources, such as ready-made meals, groceries, disability home modifications, dressing or bathing support, housekeeping, or technology that helps them stay in touch with friends and family. To support at-risk patients outside of the clinical setting, providers and payers should partner with Area Agencies on Aging (AAAs), Aging and Disability Resource Centers (ADRCs), and CBOs that specialize in providing engagement and resources to seniors.
Our national partner Papa, for example, is a national assistance service that connects seniors and families with “Papa Pals” that provide regular social visits or help with errands, transportation, and household tasks. Their goal is to provide a new category of care that improves health outcomes by directly focusing on social drivers like social isolation. Members can sign up for the Papa service through their health plan and request support for themselves or a family member using the secure app.
At Healthify, powered by WellSky, we are on a mission to ensure that no one’s health is hindered by their need. We are combatting social isolation by working closely with payers, providers, and CBOs to ensure that social services are easily accessible to seniors in need. We have a large network of providers and are closely connected to AAAs and ADRCs through WellSky’s nationwide network.
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