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Minds, Bodies and Wallets: The Cost of Social Isolation and Loneliness

James Fuccione September 2, 2019
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Mounting data and research increases understanding—and highlights the need for a range of solutions.

The growing challenge of social isolation and loneliness is costing us our health—physically, mentally and financially. The US Health Resources and Services Administration has labeled the issue an “epidemic,” with national surveys demonstrating an increasing risk among older adults.

Social Isolation and Loneliness Are Distinct Terms

In order to understand the issue, you have to understand the definitions. Although related, social isolation and loneliness are distinct.

“Social isolation is the general absence of meaningful social interactions and relationships with friends and family,” notes Preeti Malani, MD, Professor of Medicine, University of Michigan and Director of the National Poll on Healthy Aging. “Loneliness is more of a subjective feeling. A lack of companionship. There are individuals who are surrounded by people but suffering from loneliness. Conversely, there are individuals who are socially isolated but not lonely.”

The University of Michigan poll gathered insight from more than 2,000 adults ages 50 to 80. Of those respondents, one-quarter answered that they feel isolated from other people at least some of the time, and one in three say they lack regular companionship.

Other national surveys show similar results. A 2018 survey from AARP Foundation found that one-third of adults age 45 and older report feeling lonely. Global health services company Cigna surveyed 20,000 people over age 18, and respondents reported sometimes or always feeling alone (46%) or left out (47%).

National data, which also includes surveys from Kaiser Family Foundation and Pew Research Bureau more often focuses on loneliness—because social isolation is harder to measure.

“I am not aware of a single gold standard definition to determine social isolation,” said Malani.

For loneliness, however, UCLA has created a well-regarded measuring stick called the Loneliness Scale, which was the basis for the Cigna and AARP Foundation surveys.

Social Isolation and Loneliness Increase Health Risks

Despite the distinctions, both issues can lead to adverse health outcomes. Studies show that that poor social relationships were associated with a 29% increase in risk of coronary heart disease and a 32% increase in risk of stroke. An oft-cited analysis finds that loneliness and social isolation are twice as harmful to a person’s physical and mental health as obesity—and increase health risks as much as smoking 15 cigarettes a day. Other reports find connections to everything from dementia and depression to cancer and susceptibility to infectious diseases.

A critical finding in the national surveys is that social isolation and loneliness hit harder among certain groups. AARP Foundation found that half of older adults earning less than $25,000 per year are likely to be lonely. And midlife and older adults who identify as LGBTQ are more likely to be lonely (49%) compared to those who do not (35%).  In an American Cancer Society analysis, social isolation was associated with death among all races, but the association was even stronger for black men and women.

Healthcare Costs Rise with Increased Needs

In addition to the implications for our collective health and wellbeing, the cost to the healthcare system provides added incentive for action.

By examining Medicare spending data, a 2017 study by the AARP Public Policy Institute found that a lack of social contacts among older adults is associated with an estimated $6.7 billion in additional federal spending annually. The program spent an estimated $134 more monthly ($1,608 annually) for each socially isolated older adult than it did for those with stronger social connections.

“This increase in inpatient spending without a similar increase in use suggests that socially isolated individuals may be sicker when hospitalized, or may lack the support necessary to transition out of the hospital as quickly as connected individuals,” the study states.

Response to the Research

All of this research has led to action. CareMore, a Medicare Advantage Plan operating in seven states, named a Chief Togetherness Officer. The home care industry has a longstanding offering of “companionship services.” The United Kingdom, faced with much of this type of data, appointed a Minister of Loneliness.

The World Health Organization recognized the need to combat social isolation among older adults on a global scale, naming “Social Participation” as one its eight domains of an Age-Friendly Community—a movement also supported through AARP’s Livable Communities initiative. Many Dementia Friendly Communities promote “Memory Cafes” to provide a social opportunity for both individuals living with dementia and their caregivers. (Unpaid caregivers are another group identified in the AARP Foundation report as being acutely vulnerable to loneliness and social isolation.)

AARP Foundation has mounted its own programming and corresponding campaign aimed at the issue: Connect2Affect Connected Communities.

“The program that connects low-income older adults to their senior housing communities by enabling them to access community information using voice-assisted technology,” explained AARP Foundation President Lisa Marsh Ryerson.

“Among the residents who participated in the pilot,” Ryerson continued, “we tracked measurable increases in social interaction, and communities are adapting the program in unexpected ways. For example, forming small, informal gatherings where residents share new things they’ve learned.”

Those looking to address the challenge of loneliness and social isolation will benefit from still more research.

Ryerson noted the AARP Foundation is laying the groundwork for a new body of research, including sponsoring a National Academies of Sciences, Engineering, and Medicine study to examine the health and medical dimensions of social isolation in older adults.

“This study will look at predictors of social isolation and loneliness, the impact of these conditions on cognitive, emotional, medical and quality-of-life outcomes, and factors that may mitigate the link between isolation and health outcomes.”

Stria sponsors GrandPad and Home Instead made “The Role of Technology in Social Isolation” special editorial series possible.

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James Fuccione

James Fuccione is the Senior Director at the Massachusetts Healthy Aging Collaborative.

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