Senior Isolation During a Pandemic

Social isolation is defined as the objective state of having few social relationships or infrequent social contact with others while loneliness is a subjective feeling of being isolated. Social isolation and loneliness are serious yet underestimated public health risks that affect a significant portion of the older adult population. In the U.S., approximately one-quarter of community-dwelling older adults are considered to be socially isolated, and 43% of them report feeling lonely. The COVID-19 pandemic is increasing the number of older adults who are socially isolated including both community-dwelling older adults and nursing home residents, as many countries have issued stay-at-home orders and banned visits for nursing home residents.

Prior to the disease outbreak, the vast major of community-dwelling older adults actively participated in social activities, such as attending senior centers, churches activities, traveling, and many other social events. Community-based long-term care services are commonly available in developed countries and some developing countries. While family members can be primary caregivers caring for older adults with functional and cognitive impairment, community-based long-term care also plays an important role for many frail older adults. These community services and programs cover adult-day care, respite care, homemakers, meals on wheels, and home health services. For frail older adults living alone, meal delivery staff may be the only person they meet on a daily basis. For nursing home residents, family visits are an important way for them to feel socially connected, and family members are their link to the outside world. However, due to the lockdown policy, all these services and programs are no longer available. These restrictions would certainly increase social isolation and the feelings of loneliness of older adults. In the context of COVID-19, social isolation may be especially detrimental to family caregivers being that the majority are older adults themselves and are already at increased risk of stress, anxiety and depression.

Increasing evidence demonstrates that social isolation has detrimental impact on individual’s health and well-being. Studies, including our own, have found that social isolation and loneliness are major risk factors that have been linked with poor physical and mental health status: increased blood pressure, heart disease, obesity, diminished immune system functioning, depression, anxiety, poorer cognitive functioning, increased risk of Alzheimer’s disease, and mortality. Social isolation has been associated with an approximately 50% increased risk of developing dementia, a 29% increased risk of incident coronary heart disease and a 32% increased risk of stroke. We need to be cognizant that the social isolation resulting from efforts to decrease the spread of COVID-19, can at the same time increase the risk of these negative outcomes, potentially having a profound impact on their health and wellbeing.

HOW TO DECREASE SENIOR ISOLATION

Public health messaging: maintaining social connection While each country has asked their citizens to keep social distancing, this message of social distancing can be misleading. In fact, the public messaging of keeping physical distancing and maintaining socially connected is becoming more important than ever. Studies have shown that social support can mediate social isolation and improve mental health status. It is critical to mobilize the resources from family members, community-based networks and resources that address social isolation and loneliness in older adults. There is also great potential for older adults to be volunteers to provide much needed peer support for isolated individuals. In our early work, we found that many older adults, including the oldest old (age 85+), were actively providing support to their family, friends, and neighbors, such as providing companionship, giving comfort, cooking meals, and shopping for others [8]. In nursing homes, family and staff can play an essential role in helping residents socially connect through technology, such as video and social media.

THE ROLE OF TECHNOLOGY

It is important to develop innovative technology-based interventions to improve social connection for this population. Mobile technologies can be instrumental, as they are transforming the way in which we interact with others, find information, access resources, and deliver services. Our recent study found that 92% of the Chinese American older adults with low income and education had a smart device, and 72% used WeChat, the most commonly used social media software application in Chinese population. Anecdotal evidence and our personal observation suggest that Chinese Americans use social media applications such as WeChat to connect people from a distance to alleviate social isolation. It is time to develop more person-centered applications with the input from older adults and their family members. Existing evidence-based interventions for older adults can be used as the basis for creating needed social support via instant messaging apps or videos. In addition, peer support via social media may enhance the effects of evidence-based professional support, such as information resources, health promotion and counseling, and problem solving. On the other hand, we also need to be aware that as with other areas of health care, ethical and legal considerations especially must be explored when the technology is used in interventions for isolation and loneliness.

The outbreak of COVID-19 will have a long-term and profound impact on older adults’ health and well-being globally. Social isolation and loneliness are likely to become major risk factors that affect older adults’ health outcomes. Some strategies to address these issues can be implemented in many countries. These strategies include: raising awareness of the health and medical impact of social isolation and loneliness across the health care workforce and among members of the public; developing innovative technology based interventions to mobilize the resources from family members, community-based networks and resources that address social isolation and loneliness in older adults; and engaging the health care system to begin the process of developing methods to identify social isolation and loneliness in health care settings.

National Centers for Health Statistics. Provisional death counts for Coronavirus disease (COVID-19). 2020; https://www.cdc.gov/nchs/nvss/vsrr/COVID19/index.htm. Accessed 18 Apr 2020.

National Academics of Sciences Engineering and Medicine. Social isolation and loneliness in older adults: opportunities for the health care system. Washington, DC: The National Academic Press; 2020.

Bei Wu, PhD., is Dean’s Professor in Global Health, Director for Research at the Hartford Institute for Geriatrics Nursing, New York University Rory Meyers College of Nursing. She is also an inaugural Co-Director of the NYU Aging Incubator.