Risk of Social Isolation - Age 65+ in Nebraska

Nebraska

In the United States, social isolation affects about a quarter of adults age 65 and older. Social isolation is generally described as the absence of meaningful social relationships. Social isolation differs from loneliness, which is the feeling of lacking meaningful social relationships, while social isolation addresses the objective lack of social relationships. An individual can be socially isolated and not lonely or feel lonely and not be socially isolated. 

Approximately 34% of older people report feeling some degree of loneliness. Life events such as retirement, loss of loved ones, and age-related mental and physical decline can make it difficult for older adults to maintain social connectedness. Strong social networks have been shown to improve physical and cognitive health and self-management of chronic illness, but many isolated older adults go through the stressful life events common to aging without the benefits of social support. Further negative impacts on physical health and mental well-being associated with social isolation include increased risk of mortality and higher rates of dementia, coronary heart disease and stroke.

The health care costs of social isolation are comparable to those of some chronic illnesses, accounting for an estimated $6.7 billion in Medicare expenditures annually.

Factors that influence social isolation include race/ethnicity, immigration status, level of English proficiency, sexual orientation and gender identity, meaningful social participation, and support of family and community. Older adults at greater risk of experiencing social isolation include:

• Those who live alone. Living alone is a well-documented risk factor for social isolation, although not all who live alone are isolated. Older adults who are divorced, widowed or separated, as well as those who never married, are therefore more vulnerable to isolation.
• Those with a disability and those who are homebound. A condition that limits daily activities can also restrict social functioning. Physical and mobility impairments may limit older adults’ ability to attend events or participate in activities, resulting in fewer social contacts and greater feelings of loneliness.
• Those living in poverty. The effects of economic hardship on one’s time, resources and safety may present a complex set of barriers to social engagement, leading to isolation.

Interventions to decrease social isolation among older adults are most successful when they directly involve older adults rather than simply providing services or training.

• Although not appropriate for all older adults, technology-based interventions have been used internationally to enhance communication and connectedness, particularly among those with geographical or mobility barriers. 
• Service provision interventions where volunteers act as intermediaries between older adults may help sustain short- and long-term social connectedness. 
• Medicare Advantage plans have begun to offer more flexible supplemental benefits that address social isolation directly or indirectly, such as home delivery meals, ride-sharing services and companionship initiatives.
• Expanded collaboration between public transportation and public health at the community level may address social isolation by increasing mobility among older adults.
• Structural interventions that support the employment of older adults can promote inclusivity and help change societal attitudes toward older adults (e.g., revising workplace policies or providing age-friendly training).

AARP points to the importance of senior and community centers in facilitating group interactions. They also offer resources for older adults experiencing social isolation, including tips to find and maintain social connections, as well as an assessment to understand your risk level.

Healthy People 2030 has identified social cohesion as a key issue in the Social and Community Context domain of the social determinants of health.

Chen, Yi-Ru Regina, and Peter J. Schulz. “The Effect of Information Communication Technology Interventions on Reducing Social Isolation in the Elderly: A Systematic Review.” Journal of Medical Internet Research 18, no. 1 (January 28, 2016): e18. https://doi.org/10.2196/jmir.4596.

Cornwell, Erin York, and Linda J. Waite. “Social Disconnectedness, Perceived Isolation, and Health among Older Adults.” Journal of Health and Social Behavior 50, no. 1 (March 1, 2009): 31–48. https://doi.org/10.1177/002214650905000103.

Cotterell, Natalie, Tine Buffel, and Christopher Phillipson. “Preventing Social Isolation in Older People.” Maturitas 113 (July 1, 2018): 80–84. https://doi.org/10.1016/j.maturitas.2018.04.014.

Dickens, Andy P., Suzanne H. Richards, Colin J. Greaves, and John L. Campbell. “Interventions Targeting Social Isolation in Older People: A Systematic Review.” BMC Public Health 11, no. 1 (August 15, 2011): 647. https://doi.org/10.1186/1471-2458-11-647.

Elder, Katie, and Jess Retrum. “Framework for Isolation in Adults Over 50.” AARP Foundation, 2012. https://www.aarp.org/content/dam/aarp/aarp_foundation/2012_PDFs/AARP-Foundation-Isolation-Framework-Report.pdf.

Flowers, Lynda, Ari Houser, Claire Noel-Miller, Jonathan Shaw, Jay Bhattacharya, Lena Schoemaker, and Monica Farid. “Medicare Spends More on Socially Isolated Older Adults.” Washington, D.C.: AARP Public Policy Institute, November 27, 2017. https://doi.org/10.26419/ppi.00016.001.

Fratiglioni, Laura, Hui-Xin Wang, Kjerstin Ericsson, Margaret Maytan, and Bengt Winblad. “Influence of Social Network on Occurrence of Dementia: A Community-Based Longitudinal Study.” The Lancet 355, no. 9212 (2000): 1315–19. https://doi.org/10.1016/s0140-6736(00)02113-9.

Gallant, Mary P. “The Influence of Social Support on Chronic Illness Self-Management: A Review and Directions for Research.” Health Education & Behavior 30, no. 2 (2003): 170–95. https://doi.org/10.1177/1090198102251030.

Henning-Smith, Carrie, Christina Worrall, Madelyn Klabunde, and Yingling Fan. “The Role of Transportation in Addressing Social Isolation in Older Adults.” The National Center for Mobility Management, July 2020. https://nationalcenterformobilitymanagement.org/wp-content/uploads/2020/06/FINAL_CONDENSED_SOCIAL-ISOLATION-RESEARCH-PAPER.pdf.

Holt-Lunstad, Julianne, Timothy B. Smith, Mark Baker, Tyler Harris, and David Stephenson. “Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review.” Perspectives on Psychological Science 10, no. 2 (March 2015): 227–37. https://doi.org/10.1177/1745691614568352.

Moran, Nora. “Aging in the Shadows: An Update on Social Isolation Among Older Adults in NYC.” New York: United Neighborhood Houses, September 2017. https://uploads.prod01.oregon.platform-os.com/instances/542/assets/documents/Aging%20In%20The%20Shadows%202017.pdf.

National Academies of Sciences, Engineering, and Medicine. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Washington, D.C.: National Academies Press, 2020. https://doi.org/10.17226/25663.

Steptoe, Andrew, Aparna Shankar, Panayotes Demakakos, and Jane Wardle. “Social Isolation, Loneliness, and All-Cause Mortality in Older Men and Women.” Proceedings of the National Academy of Sciences 110, no. 15 (April 9, 2013): 5797–5801. https://doi.org/10.1073/pnas.1219686110.

Valtorta, Nicole K., Mona Kanaan, Simon Gilbody, Sara Ronzi, and Barbara Hanratty. “Loneliness and Social Isolation as Risk Factors for Coronary Heart Disease and Stroke: Systematic Review and Meta-Analysis of Longitudinal Observational Studies.” Heart 102, no. 13 (July 1, 2016): 1009–16. https://doi.org/10.1136/heartjnl-2015-308790.