Dr. Gregory Weiss reflects on the impact of isolation and loneliness on older patients during the COVID-19 pandemic.
Gregory Weiss, MD
As life expectancies have risen so have the numbers of elderly Americans. Even before the COVID-19 pandemic as many as one in four adults 65 and older were considered socially isolated.1 There is a growing body of evidence that social isolation and loneliness affect more than just the mental health of our aging population.
According to the Centers for Disease Control (CDC) social isolation is not only associated with dementia, it significantly increases a person’s risk of premature death, heart disease, and stroke.1 Elderly patients with heart failure who felt loneliness were four times more likely to die, three times more likely to be hospitalized and twice as likely to visit the emergency room.1 A study published in the Journal of the American Heart Association found that identifying those at risk creates opportunities to intervene.2
Just how lonely are older Americans? According to the National Social Life, Health, and Aging Project as many as one-third of older adults report that they frequently feel lonely.3 Some causes of isolation and loneliness include retiring from work, losing a partner, and or losing mobility. Leaving the workforce can cause a drastic reduction in social interaction while losing a spouse or partner compounds the grief of the loss itself with loneliness.
Christian Hakulinen, PhD, a professor of psychology and logopedics at the University of Helsinki, Finland states, “Having social support from significant others or from persons who are in a similar situation is good for your health, and socially isolated or lonely individuals might not have possibilities for this kind of support.”4
There is strong evidence for the notion that close relationships promote health. Harvard University has been conducting a study looking at health and well-being for the last 80 years. This study has found that healthy social relationships at age 50 are a better predictor of physical health at age 80 than midlife cholesterol levels.3
In an editorial published in the British Medical Journal, Julianne Holt-Lunstad, PhD, and Timothy Smith, MD, PhD, explore the underlying causes of increased cardiovascular disease (CVD) and mortality in isolated and lonely seniors. Evidence suggests that social isolation and loneliness are associated with negative changes in biomarkers for CVD such as hypertension, body mass index, waist circumference and inflammation.5 Furthermore, being isolated may lead to decreased exercise and increased negative behaviors such as smoking and drinking alcohol.5
So, what can we do as clinicians to help the lonely hearted? The first step is to identify the problem. In a study published in the Journal of the American Heart Association, a four-question survey was used successfully to identify patients at risk.6 A 1 to 5 score corresponding to an answer of “Never”, “Rarely”, “Sometimes”, “Usually”, or “Always” was given for the following questions:
With scores ranging from 4 to 20 patients with higher scores could be identified as possessing greater perceived social isolation.6 Once identified a strategy should be made with the goal of reducing, not only the perception of isolation and loneliness, but also the comorbid behaviors and biomarkers associated with that isolation. A large portion of the increased CV risk in lonely adults can be attributed to the physical consequences of being alone.
When I encounter a patient with feelings of isolation, they often seem withdrawn and less interactive. When people are used to being alone, they often communicate less with clinicians. It is up to us to engage patients and offer strategies to mitigate the isolation we know can impact their health. One way we can help is by encouraging these patients to maintain existing relationships with family and friends which may involve, during the COVID-19 pandemic, assessing their ability to video call, zoom, or facetime others.
There is no doubt the pandemic increases the likelihood of loneliness and isolation especially in the elderly who are often times frightened due to their increased risk of dying from it. My suggestion is to get creative. There are many hobby groups, church activities, classes, and interactive games to be found on the internet. Just the same as prescribing the right drug for a medical condition or providing exercise and nutrition advice to a patient, we need to adapt and become educated about how to alleviate the widespread isolation and loneliness in our patients lest the owners of a lonely heart become owners of broken hearts.