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J Am Geriatr Soc. 2019 Apr;67(4):657-662. doi: 10.1111/jgs.15746. Epub 2019 Feb 14.

A Practical Approach to Assessing and Mitigating Loneliness and Isolation in Older Adults.

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Department of Medicine, University of California, San Francisco, San Francisco, California.
Department of Psychology, Brigham Young University, Provo, Utah.
Stanford Aging and Ethnogeriatrics Center.
Stanford University, School of Medicine, Palo Alto, California.
VA Palo Alto Health Care System, Palo Alto, California.


Loneliness and social isolation are strongly associated with several adverse health outcomes in older persons including death and functional impairments. The strength of these associations has been compared with smoking. Accordingly, loneliness and isolation have significant public health implications. Despite the adverse impacts of loneliness and social isolation on quality of life, and their strong association with health outcomes, the evaluation of loneliness and isolation have not been integrated into medical care. The risks for loneliness may be of particular concern to persons with serious illness as patients and caregivers cope with the experience of loss, loss of independence, and increasing care needs. To date, there has been no uniform way of evaluating and documenting loneliness and social isolation as a part of a review of a patient's social determinants of health. This article provides a framework for healthcare systems, providers, and community members working with older adults to (1) understand loneliness, isolation, and its counterpart social connection; (2) describe the different ways loneliness affects health; and (3) create a framework for asking about and documenting these experiences. Finally, because the lack of studies assessing whether targeting loneliness can improve health outcomes is a major gap, we provide guidance on the future of interventions. J Am Geriatr Soc 67:657-662, 2019.


isolation; loneliness; older adults; serious illness


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