As COVID-19 continues to spread worldwide, many Americans are adjusting to a new way of life that involves the routine practice of social distancing and less frequent social interaction. These drastic changes present a host of important challenges, particularly for older adults with multiple chronic conditions. Older adults not only have a higher risk of COVID-19 related mortality but are also more likely to suffer negative effects from the pandemic as a result of social isolation (i.e. infrequent social contact with others and few social relationships) and loneliness (i.e. subjective feeling of the lack of meaningful relationships).
Prior to COVID-19, social isolation among older adults was a widespread and significant, yet underappreciated, public health issue. In 2017, the U.S. Surgeon General labeled loneliness as an epidemic, highlighting the severity of impact for older adults. Other research supports this proclamation: a 2018 study found that nearly a quarter of Americans aged 65 or older reported feeling socially isolated. Some of the factors that place older adults at particularly high risk for loneliness and social isolation include living alone or in a rural community, living in a high-crime neighborhood, lower-income, chronic conditions lower education, limited functional status, being a woman, or previous loss of loved ones. These factors have been further accentuated due to recent stay-at-home orders.
Health effects of social isolation
While older adults have been recently adopting technology-based communication, their preferred communication style is face to face. Many older adults have lost the ability to connect with people in their support networks, their healthcare providers, and are spending longer periods of time alone. In addition, these restrictions and risks limit older adults’ ability to participate in community social activities or physical activity, which may be their main source of social engagement.
We know that older adults are more susceptible to chronic illness as a result of their diminished homeostatic reserve capacity of all the organ systems. But the “aging process” isn’t the only factor that puts older adults at higher risk health issues. Research provides clear evidence that socially isolated older adults are more susceptible to adverse health effects. For example, research has found that social isolation is associated with an increased risk for premature all-cause mortality. Numerous studies have also found that socially isolated older adults are at greater risk of developing physical and mental health conditions such as high blood pressure, cardiac disease, obesity, depression, and Alzheimer’s disease compared to those with higher levels of social support. Alarmingly, prior work even suggests that social isolation has the same effect on health as smoking 15 cigarettes per day.
How can we combat the negative effects of social isolation?
While we must adhere to social distancing recommendations to protect ourselves and others, it is equally important to maintain social connections, especially for the older adult population. Data has indicated that social connection is associated with 50% increased odds of survival. We’ve outlined suggestions and harm reduction strategies for older adults to address social isolation, feelings of loneliness, and their associated health impacts:
Those who may have more open time in light of the pandemic should make an effort to connect with older adults in their lives (i.e. parents, grandparents, neighbors, or friends). This can be done through interactions using physical distancing of six feet or greater and appropriate protective gear (e.g., facemask). Virtual interactions through phone calls, text messaging, and video chat also serve as a form of support that reduces feelings of social isolation and loneliness. In addition, states such as North Carolina have an established hotline to address older adult loneliness and to help connect them with local services.
Focus on supporting their own mental health as a top priority. Older adults should prioritize their own mental health as best as they can with what they have during social distancing. The CDC recommends several measures older adults can take to support themselves. This includes (a) taking breaks from check the news on any outlet (radio, computer, tv), (b) listening to your body and taking care of it, and (c) seeking help if needed. Although older adults prefer face to face communication, they are adopting technology at a rapid rate. Introducing older adults to technology like TalkSpace or other therapy apps can provide social support and affordable mental health services.
Take advantage of digital health resources and benefits. The utilization of telehealth delivery by healthcare workers for any routine care, non-urgent medical visits, preventative, and behavioral health visits may also be helpful in reducing the effects as well as elements of intervention to address loneliness and social isolation. For example, at Pack Health, our Health Advisors communicate with their members on a weekly basis through 15-minute phone calls. Our Health Advisors recognize that they are potentially the only person their member has talked to that week and take extra care in their delivery.
Older adults, especially those with pre-existing conditions, will be the most vulnerable to and the most impacted by the current pandemic sweeping our society. We must make efforts to mitigate these negative effects. For more information on COVID-19 as well as for additional resources related to managing loneliness and social isolation in older adulthood, please continue to monitor the Center for Disease Control website.
Berg-Weger, M., & Morley, J. E. (2020). Editorial: Loneliness and Social Isolation in Older Adults during the COVID-19 Pandemic: Implications for Gerontological Social Work. The journal of nutrition, health & aging, 24(5), 456–458. https://doi.org/10.1007/s12603-020-1366-8
Cacioppo, J. T., & Cacioppo, S. (2014). Social relationships and health: The toxic effects of perceived social isolation. Social and personality psychology compass, 8(2), 58-72.
Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci. 2015;10(2):227‐237. doi:10.1177/1745691614568352
National Academies of Sciences, Engineering et al. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. National Academies Press, 2020. Web.