Social isolation and loneliness are America's next public health issue

At our core, people are social beings. Whether we are a part of a sports team, social group or professional society, we all have the need for some type of social network. These connections give us opportunities to thrive, learn new things and enjoy healthier lives. However, for some older adults these social connections begin to dwindle as they age, and they experience a distancing from social networks or relationships with other people.

This well-studied phenomenon called social isolation is frequently interchanged with the term loneliness — but there is a difference. Social isolation exists when an individual lacks opportunities to be socially connected, whereas loneliness is distress experienced by an individual due to lack of social relationships. For example, an individual may be socially isolated but not lonely and vice versa.

How do social isolation and loneliness affect health?

Being socially isolated and experiencing loneliness can negatively affect one's health. Adults who are socially isolated are more likely to participate in negative behaviors such as drinking heavily, smoking and engaging in less physical activity. Additionally, social isolation is a significant risk factor for poor health and increased risk of death. In 2015, Brigham Young University found that mortality increased by 26 percent to 32 percent for people who are socially isolated. Social isolation and loneliness are associated with higher blood pressure and heart disease. A 2015 meta review of 70 studies showed that loneliness increases a person's risk of dying by 26 percent.

Conditions like depression and anxiety are associated with a 21 percent increase in mortality, so people who are lonely have a higher mortality risk. Evidence suggests that chronic loneliness also may harm us on a genetic level. If loneliness is chronically persistent, it can have a physiological effect that activates genes involved with inflammation and, in turn, can be a risk factor for heart disease and cancer.

What are the primary risk factors for social isolation?

According to a study by AARP, nearly 20 percent of Americans over the age of 50 experience social isolation. The primary risk factors for social isolation are living alone, having a mobility or sensory impairment, experiencing major life transitions, having low socioeconomic status, or caring for someone with severe impairment and sociological vulnerabilities. In some cases, geographical location can affect social isolation. While the identified drivers of social isolation are behavioral, psychological and physiological, the health consequences are vast.

What is the impact of social isolation and loneliness on the health care system?

In addition to health consequences, social isolation and loneliness have an impact on hospitals and health systems. The costs of treating patients experiencing social isolation are comparable to the costs for treating chronic conditions. On average, more than $1,608 is spent annually on socially isolated adults, which is $204 more than annual spending to treat arthritis. Additionally, people who are socially isolated and have one or more chronic conditions have longer hospital stays and higher readmission rates.

To help address these issues, hospitals and health systems can:

  • screen patients for social isolation;
  • develop support groups for patients who experience social isolation;
  • deploy community health workers to conduct home visits; and
  • develop strategies for case managers and care coordination teams to connect patients with social programming in their communities.

Will millennials be a lonelier generation?

Vox reports that 22 percent of millennials (ages 23 to 38) say they have "no friends." If millennials are truly lonely, it is quite concerning as research shows that as people get older, loneliness tends to increase.

This raises a question: Are people who are lonely, including millennials, more socially isolated because of the internet? Downstream risks, which ultimately result from decisions made today, for lonely millennials may lead to chronic stress, behavioral health issues and poor health decisions, which in turn may have adverse long-term health effects. On the other hand, evidence shows that being digitally connected can help alleviate social isolation and loneliness, but this relationship is bidirectional. For example, internet use may increase loneliness by replacing offline relationships, but it also may reduce loneliness by enhancing existing relationships.

Whatever the effects, research shows that loneliness is highest among young adults, declines over midlife and increases modestly as we get older.

How can hospitals and health systems address social isolation and loneliness?

Hospitals and health systems can play a role in reducing loneliness in their patients. Examining the root causes of loneliness and how to mitigate them will help hospitals and health systems address these issues upstream.

In the Skilled Nursing Facility Prospective Payment System final rule for fiscal year 2020, CMS requires SNF providers to report standard patient assessment data elements, including social isolation. Providers will be required to ask patients, "How often do you feel lonely or isolated from those around you?" This question would be part of the Accountable Health Communities Health-Related Social Needs Screening Tool and offer five possible answers ranging from "never" to "always."

To begin thinking upstream about these issues, hospitals and health systems can:

  1. Begin screening patients for social isolation and loneliness at admission or in emergency departments.
  2. Stratify data by age and place to pinpoint demographics most in need.
  3. Create support groups for patients that focus on social connection. For nonprofit hospitals and health systems, this can be part of their community benefit strategy.
  4. Promote and offer volunteer opportunities within the organization to encourage social interactions.
  5. Develop innovative and sustainable community partnerships. For example, a local arm of the American Society for the Prevention of Cruelty to Animals can connect patients with pets who need a home. Research has shown that owning a pet improves well-being, including easing loneliness.

Although there is no one-size-fits-all approach to address social isolation and loneliness, mitigating these challenges for patients will lead to healthier communities, better patient engagement and fewer readmissions. Human connections matter. To affect real change, health care leaders must realize the importance of social connections and act quickly to mitigate the long-term effects on patients.

Examples from the field:

Parkland Health and Hospital System, based in Dallas, analyzed organizational data and found that 80 patients accounted for 5,139 ED visits in one year, at an estimated cost of $14 million. Further analysis identified loneliness as the number one factor for these ED visits, with other contributing factors such as poverty and hunger. The health system has established a higher level of case management, which includes an interdisciplinary team of physicians, nurses, social workers, chaplains and other health professionals, to help connect these patients to companions in the community.

At Los Angeles-based CareMore Health, a subsidiary of Anthem, Sachin Jain, MD, president and CEO, and Robin Caruso, chief togetherness officer, are seeing positive outcomes from the Togetherness Program, which uses togetherness connectors — social workers and volunteer associate phone pals —  to help decrease and prevent social isolation among beneficiaries. The Togetherness Program has shown positive health results:

  • Exercising has increased by 56.6 percent for program participants.
  • ED utilization among enrolled participants decreased by 3.3 percent.
  • Hospital admissions among program participants are 20.8 percent lower.

 

More articles on population health:

CDC: White adults had highest e-cigarette use in 2014, 2018
1 in 4 youth report problematic cellphone use, boosting risk for depression, anxiety
Abortion rates decline in US: 4 CDC findings

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