A commentary article published in The American Journal of Geriatric Psychiatry reframed findings from a February 2020 review within the context of the coronavirus disease (COVID-19) pandemic. The review described methods of intervention for older adults in the United States who report social isolation or loneliness. However, the COVID-19 pandemic presents challenges for proposed interventions and may exacerbate loneliness in already isolated individuals. In their commentary piece, Nancy J Donovan, MD, and Dan Blazer, MD, PhD, describe results from the NASEM report and provide insight into the additional challenges presented by the pandemic.
In February 2020, the National Academy of Science, Engineering, and Medicine (NASEM) Committee published a report titled “Social Isolation and Loneliness in Older
Adults: Opportunities for the Health Care System.” The report described the burden of social isolation and loneliness on older Americans and identified key ways for clinicians to intervene.
Per report findings, as many as 24% of community-dwelling adults aged 65 years of older fit the criteria for social isolation, defined by an objective lack of social contact with others. Social isolation has been associated with significantly increased risk for premature mortality, coronary artery disease, stroke, and hospital re-admission following myocardial infarction. Social isolation and loneliness also have a substantial effect on mental health, with isolated individuals experiencing significantly higher rates of depression, stress, anxiety, and suicide ideation. Loneliness is also associated with cognitive disorders, including dementia.
Healthcare practitioners serve as a critical intervention point for lonely and isolated older adults, wrote the NASEM authors. Screening for loneliness and social isolation can allow for identification of individuals at high risk for poorer outcomes. Recommended screening tools include the Berkman-Syme Social Network Index, the Lubben Social Network Scale, the Revised UCLA Loneliness Scale, the de Jong Gierveld Loneliness Scale, and the Duke Social Support Index.
Most of these scales are self-report questionnaires that have been used in research to capture the effect of social isolation and loneliness. Their integration into health care is crucial to identifying individuals at risk for isolation-related morbidity and mortality. Screening can allow for earlier administration of interventions to those in need.
The NASEM report named both indirect and direct methods of intervention for individuals who experience loneliness or isolation. “Indirect” methods of intervention include addressing any underlying causes of isolation. For example, patients with hearing impairment or limited mobility may benefit from hearing aids or greater access to transportation, respectively. “Direct” intervention methods include psychotherapeutic approaches — such as behavioral therapy — and efforts to improve socialization among community-dwelling individuals. Technology-based interventions also show promise as a means to socialize isolated individuals. In several studies reviewed by NASEM, social media groups and video conferencing were associated with improvements in self-reported loneliness or isolation.
NASEM published their report in February 2020, just as COVID-19 cases were rising in the United States. As of August 2020, the pandemic has drastically transformed means of socialization in the US. And while social distancing measures have life-saving effects, they may exacerbate the effects of loneliness on the health of older adults. Reliance on technology-based socialization also fails to address loneliness in older adults without access to technology, or individuals with cognitive and sensory impairment. Additionally, many older adults are unaccustomed to using technology to communicate.
Social epidemiology research should continue to explore means of increasing social support and connectedness among older adults. “[W]hile social isolation during COVID-19 can be life-saving, it also deprives older adults of [the] fundamental human need for companionship and community,” the NASEM authors wrote. “During this historic pandemic, decades of social epidemiologic research inform us that the health protective benefits of social distancing must be balanced by the human needs for sustaining social relationships.”
Donovan NJ, Blazer D. Social isolation and loneliness in older adults: review and commentary of a national academies report [published online August 19, 2020]. Am J Geriatr Psychiatry. doi: 10.1016/j.jagp.2020.08.005