Social isolation and loneliness are serious yet underappreciated public health risks that affect a significant portion of the older adult population. Approximately one-quarter of community-dwelling Americans aged 65 and older are considered to be socially isolated, and a significant proportion of adults in the United States report feeling lonely. People who are 50 years of age or older are more likely to experience many of the risk factors that can cause or exacerbate social isolation or loneliness, such as living alone, the loss of family or friends, chronic illness, and sensory impairments. Over a life course, social isolation and loneliness may be episodic or chronic, depending upon an individual's circumstances and perceptions. A substantial body of evidence demonstrates that social isolation presents a major risk for premature mortality, comparable to other risk factors such as high blood pressure, smoking, or obesity. As older adults are particularly high-volume and high-frequency users of the health care system, there is an opportunity for health care professionals to identify, prevent, and mitigate the adverse health impacts of social isolation and loneliness in older adults. Social Isolation and Loneliness in Older Adults summarizes the evidence base and explores how social isolation and loneliness affect health and quality of life in adults aged 50 and older, particularly among low income, underserved, and vulnerable populations. This report makes recommendations specifically for clinical settings of health care to identify those who suffer the resultant negative health impacts of social isolation and loneliness and target interventions to improve their social conditions. Social Isolation and Loneliness in Older Adults considers clinical tools and methodologies, better education and training for the health care workforce, and dissemination and implementation that will be important for translating research into practice, especially as the evidence base for effective interventions continues to flourish.

Contents

• The National Academies of SCIENCES • ENGINEERING • MEDICINE
• COMMITTEE ON THE HEALTH AND MEDICAL DIMENSIONS OF SOCIAL ISOLATION AND LONELINESS IN OLDER ADULTS
• Reviewers
• Acknowledgments
• Preface
• Summary
  • STUDY CONTEXT AND CHARGE
  • DEFINING ASPECTS OF SOCIAL RELATIONSHIPS
  • GOALS AND RECOMMENDATIONS
  • DISSEMINATION AND IMPLEMENTATION
• 1. Introduction
  • STUDY CONTEXT
  • CHARGE TO THE COMMITTEE
  • RELEVANT NATIONAL ACADEMIES REPORTS
  • STUDY APPROACH
  • OVERVIEW OF THE COMMITTEE'S REPORT
• 2. Evaluating the Evidence for the Impacts of Social Isolation, Loneliness, and Other Aspects of Social Connection on Mortality
  • A HISTORY OF UNDERSTANDING THE CONTRIBUTORS TO HUMAN HEALTH
  • DISCOVERING SOCIAL CONNECTIONS AS A DETERMINANT OF HEALTH AND LONGEVITY
  • THE CURRENT STATE OF THE EVIDENCE ON IMPACTS OF SOCIAL ISOLATION, LONELINESS, AND SOCIAL SUPPORT ON MORTALITY
  • A FURTHER NOTE ON SOCIAL ISOLATION, AND SOCIAL CONNECTION MORE GENERALLY, AS A POTENTIAL CAUSAL RISK FOR MORTALITY
  • FINDINGS AND CONCLUSIONS
  • NEXT STEPS AND RECOMMENDATION
• 3. Health Impacts of Social Isolation and Loneliness on Morbidity and Quality of Life
  • IMPACT ON HEALTH OUTCOMES
  • IMPACT ON HEALTH-RELATED BEHAVIORS
  • IMPACT ON QUALITY-OF-LIFE OUTCOMES
  • ELDERS AT RISK FOR ABUSE
  • FINDINGS AND CONCLUSIONS
  • NEXT STEPS AND RECOMMENDATIONS
• 4. Risk and Protective Factors for Social Isolation and Loneliness
  • PHYSICAL HEALTH FACTORS
  • PSYCHOLOGICAL, PSYCHIATRIC, AND COGNITIVE FACTORS
  • SOCIAL AND CULTURAL FACTORS
  • SOCIAL ENVIRONMENTAL FACTORS
  • AT-RISK POPULATIONS
  • FINDINGS AND CONCLUSIONS
• 5. Mediators and Moderators
  • MEDIATORS: BEHAVORIAL, PSYCHOLOGICAL, AND BIOLOGICAL MECHANISMS
  • MODERATING FACTORS INFLUENCING MORTALITY AND HEALTH OUTCOMES
  • FINDINGS AND CONCLUSIONS
• 6. Assessment of Social Isolation and Loneliness in Research
  • MEASUREMENT OF SOCIAL ISOLATION AND LONELINESS
  • MEASURING IMPACT FOR SOCIAL ISOLATION AND LONELINESS
  • IDENTIFICATION OF INDIVIDUALS AND POPULATIONS AT RISK
  • FINDINGS AND CONCLUSIONS
• 7. Role of the Health Care System
  • HEALTH CARE ACCESS AND UTILIZATION
  • SOCIAL DETERMINANTS OF HEALTH AND THE HEALTH CARE SYSTEM
  • CLINICAL ASSESSMENT OF SOCIAL ISOLATION AND LONELINESS
  • TECHNOLOGY AS INFRASTRUCTURE FOR COORDINATION AND INTERVENTION
  • FINDINGS AND CONCLUSIONS
  • NEXT STEPS AND RECOMMENDATIONS
• 8. Education and Training
  • FRAMEWORK FOR THE ROLE OF EDUCATION IN CATALYZING CHANGE
  • NATIONAL STANDARDS AND POLICY PRIORITIES
  • CURRENT EDUCATION AND TRAINING OF THE HEALTH CARE WORKFORCE
  • PUBLIC HEALTH CAMPAIGNS
  • CHANGING PRACTICE BEHAVIORS
  • FINDINGS AND CONCLUSIONS
  • NEXT STEPS AND RECOMMENDATIONS
• 9. Interventions
  • LARGE-SCALE REVIEWS OF INTERVENTIONS
  • TYPES OF INTERVENTIONS RELEVANT TO THE HEALTH CARE SYSTEM
  • COALITIONS AND PARTNERSHIPS TO ADDRESS SOCIAL ISOLATION AND LONELINESS
  • TECHNOLOGICAL INTERVENTIONS
  • ETHICAL AND PRACTICAL CONSIDERATIONS FOR INTERVENTION
  • FINANCING OF INTERVENTIONS
  • REFRAMING INTERVENTION USING A PUBLIC HEALTH APPROACH
  • FINDINGS AND CONCLUSIONS
  • NEXT STEPS AND RECOMMENDATIONS
• 10. Dissemination and Implementation
  • DEFINITION OF TERMS
  • OVERVIEW OF IMPLEMENTATION STRATEGIES
  • ADDRESSING THE CHARACTERISTICS OF THE TOPIC
  • ADDRESSING USERS OF THE EVIDENCE-BASED INFORMATION
  • COMMUNICATION STRATEGIES
  • ADDRESSING THE SOCIAL CONTEXT
  • SUSTAINABILITY
  • CONCLUSION
• References
• A. Public Meeting Agendas
• B. Committee and Staff Biographies

Suggested citation:

National Academies of Sciences, Engineering, and Medicine. 2020. Social isolation and loneliness in older adults: Opportunities for the health care system. Washington, DC: The National Academies Press. https://doi.org/10.17226/25663.

Digital Object Identifier: https://doi.org/10.17226/25663

Library of Congress Control Number: 2020934003

Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

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