By Anna Faul, PhD

Loneliness and isolation under social adults have been a public health crisis even before COVID-19 hit American society in March of 2020. Data from 2019 suggests that one in every three older adults experienced loneliness and/or social isolation before COVID-19. Those most at risk were older adults living alone, those living in rural communities, those living far away from children, those with health concerns and those who already suffered from depression.

During COVID-19 this crisis has intensified, affecting older adults in all living arrangements – living at home in the community and living in long-term care facilities. Preliminary data suggested that within the first month of COVID-19 loneliness increased by more than 30 percent, resulting in older adults experiencing much higher emotional distress than before. Older adults living in the community had to quarantine in place, resulting in almost no contact with other human beings for months. Those living in long-term care facilities experienced similar isolation as they had to quarantine in their rooms, with very limited contact with staff.

The usual ways to connect with others in the community and in long-term care facilities had to be suspended and older adults could not access senior centers, exercise facilities and church communities to support them combatting the feelings of loneliness and isolation. In long-term care facilities all social activities were suspended, and older adults could no longer connect with fellow residents as even meals were delivered in the rooms.

Loneliness and social isolation can negatively impact physical and mental health outcomes. Social isolation increases the risk of mortality and increases the risk of developing chronic conditions. Furthermore, without social connections, recovery from illnesses is compromised.

Programs in Place

When COVID-19 hit our community, the Trager Institute already had some programs in place to combat loneliness and social isolation. Our staff were delivering the Program to Encourage Active, Rewarding Lives (PEARLS) to community dwelling older adults struggling with late-life depression. The focus of this program is to visit older adults in their homes and focus on brief behavioral techniques to empower older adults to take action and make lasting changes so they can lead more active and rewarding lives.

We also were in the planning phase of launching our Friendly Visitors Program. The Friendly Visitor Program provides opportunities for isolated older adults to participate in social engagement with a friendly visitor volunteer whose sole purpose is to socialize with them. The program benefits older and disabled adults by addressing their basic, social, emotional and environmental needs through routine visits by a volunteer who talks with the older adult, assist with minor chores and tasks, like writing a letter, reading mail or assisting with a hobby.

Lastly, we had active microclinics with older adults struggling with chronic conditions who would come together to educate themselves and give each other social support to prevent and manage diseases. The program is built on social relationships and social capital and puts the power of health directly into the hands of the people who need it most. Small groups of older adults meet weekly for 16 weeks and then monthly for an additional eight months to support each other on their journey back to health. Lasting supporting relationships are built with this program that combats isolation and loneliness.

COVID-19 Challenges

When society came to a standstill in March 2020, the Trager Institute had to stop seeing older adults in the PEARLS program, ended implementation of the Friendly Visitors Program and cancelled our Microclinics. It was soon clear that COVID-19 is going to be a long-term problem and that we had to find solutions to the increased loneliness of older adults during this time. The team decided to change all these programs to virtual programs using a variety of technology platforms. We developed a technology survey that we used to understand the technology skills of current participants in these programs. We then applied for funding to buy technology for older adults who may not have any technology at home to engage with these programs.

The most important lesson we learned by adjusting all our social connection programs to virtual platforms is that technology can be a highly effective tool to reduce social isolation. Even for the older adult with very little technology skills, connecting them to care providers, friends and families using basic technology devices that are already easily available on the market, is greatly effective in reducing social isolation and loneliness and improving mental health.

– Anna Faul, PhD is with the Trager Institute at the University of Louisville.

Although it is hard to measure social isolation and loneliness precisely, there is strong evidence that many adults aged 50 and older are socially isolated or lonely in ways that put their health at risk. Recent studies found that:

• Social isolation significantly increased a person’s risk of premature death from all causes, a risk that may rival those of smoking, obesity, and physical inactivity.
• Social isolation was associated with about a 50 percent increased risk of dementia.
• Poor social relationships (characterized by social isolation or loneliness) was associated with a 29 percent increased risk of heart disease and a 32 percent increased risk of stroke.
• Loneliness was associated with higher rates of depression, anxiety and suicide.
• Loneliness among heart failure patients was associated with a nearly four times increased risk of death, 68 percent increased risk of hospitalization and 57 percent increased risk of emergency department visits.

^{-Centers for Disease Control and Prevention}