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Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
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Social Isolation
and Loneliness
in Older Adults

OPPORTUNITIES FOR THE
HEALTH CARE SYSTEM

Committee on the Health and Medical Dimensions of
Social Isolation and Loneliness in Older Adults

Board on Health Sciences Policy

Health and Medicine Division

Board on Behavioral, Cognitive, and Sensory Sciences

Division of Behavioral and Social Sciences and Education

A Consensus Study Report of

images

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
×

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by a contract between the National Academy of Sciences and the AARP Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978–0-309-67100-2
International Standard Book Number-10: 0-309-67100-0
Digital Object Identifier: https://doi.org/10.17226/25663
Library of Congress Control Number: 2020934003

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Copyright 2020 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

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.

Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
×

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The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.

Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
×

Image

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.

Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.

For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.

Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
×

COMMITTEE ON THE HEALTH AND MEDICAL DIMENSIONS OF SOCIAL ISOLATION AND LONELINESS IN OLDER ADULTS

DAN G. BLAZER II (Chair), J.P. Gibbons Professor Emeritus of Psychiatry, Duke University School of Medicine

SUSAN BEANE, Vice President and Medical Director, Healthfirst, Inc.

CYNTHIA M. BOYD, Professor, Johns Hopkins Bloomberg School of Public Health

LINDA BURNES BOLTON, Senior Vice President and Chief Health Equity Officer, Cedars-Sinai Medical Center

GEORGE DEMIRIS, Penn Integrates Knowledge University Professor, University of Pennsylvania

NANCY J. DONOVAN, Director, Division of Geriatric Psychiatry, Brigham and Women’s Hospital, Harvard Medical School

ROBERT ESPINOZA, Vice President of Policy, PHI

COLLEEN GALAMBOS, Professor and Helen Bader Endowed Chair in Applied Gerontology, University of Wisconsin–Milwaukee Helen Bader School of Social Welfare

JULIANNE HOLT-LUNSTAD, Professor, Brigham Young University

JAMES S. HOUSE, Angus Campbell Distinguished University Professor Emeritus, Survey Research University of Michigan Institute for Social Research

KATHLEEN McGARRY, Professor and Vice Chair, Department of Economics, University of California, Los Angeles

JEANNE MIRANDA, Professor, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles

LAURIE LOVETT NOVAK, Assistant Professor, Department of Biomedical Informatics, Vanderbilt University School of Medicine

CARLA M. PERISSINOTTO, Associate Professor of Medicine and Associate Chief of Clinical Programs in Geriatrics, University of California, San Francisco

JULIANN G. SEBASTIAN, Dean and Professor, College of Nursing, University of Nebraska Medical Center

Study Staff

TRACY A. LUSTIG, Study Director

JENNIFER A. COHEN, Program Officer

CAROLINE M. CILIO, Associate Program Officer (through October 2019)

KENDALL LOGAN, Senior Program Assistant

ANDREW M. POPE, Senior Director, Board on Health Sciences Policy

Consultant

MARITA G. TITLER, University of Michigan School of Nursing

Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
×

Reviewers

This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following individuals for their review of this report:

LINDA FRIED, Columbia University Mailman School of Public Health

TERRY T. FULMER, The John A. Hartford Foundation

CARMEN GARCIA-PENA, National Institute of Geriatrics

LOUISE HAWKLEY, NORC at the University of Chicago

MITCHELL H. KATZ, Health + Hospitals

JAMES LUBBEN, University of California, Los Angeles

JOSÉ A. PAGÁN, New York University School of Global Public Health

MICHELLE PUTNAM, Simmons University School of Social Work

NIRAV R. SHAH, Stanford University

ROBYN STONE, LeadingAge

PAUL C. TANG, Stanford University

WINSTON WONG, Kaiser Permanente

Page viii Cite
Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
×

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by BOBBIE A. BERKOWITZ, Columbia University School of Nursing and University of Washington, and NANCY FUGATE WOODS, University of Washington. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.

Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
×

Acknowledgments

The study committee and the Health and Medicine Division (HMD) project staff take this opportunity to recognize and thank the many individuals who shared their time and expertise to support the committee’s work and to inform deliberations.

This study was sponsored by the AARP Foundation. We thank the AARP Foundation president, Lisa Marsh Ryerson, for her guidance and support. We also wish to recognize the important contributions of Emily Allen and Eliza Heppner, who were instrumental in helping to launch this effort.

The committee benefitted greatly from discussions with individuals who made presentations during the committee’s open sessions: Martha Bruce, James Coen, Sara Czaja, Steve Ewell, Maureen Feldman, Linda Fried, Jeanne-Marie Guise, Sachin Jain, Michael Monson, Jessica Retrum, Lucy Savitz, Bert Uchino, and Colin Walsh. The committee is very grateful to these presenters for volunteering to share their knowledge, data, and expert opinions with the committee and members of the public who attended the committee’s open sessions. Special thanks are also extended to Sara Czaja for her early interest in this effort and her ongoing support of the National Academies’ work. The staff also recognize Martha Coven, Robin Mockenhaupt, Sheila Shapiro, and Bob Wallace for providing expertise and replying to staff inquiries.

The committee is grateful for the many staff within HMD who provided support at various times throughout this project. Special thanks are extended to Rebecca Morgan, senior librarian, who compiled literature searches; Bardia Massoudkhan, the financial associate for this project; and Robert Pool, for his editorial assistance provided in preparing the final report.

Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
×

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Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
×

Preface

Human beings are social by nature, and high-quality social relationships are vital for health and well-being. Like many other social determinants of health, however, social isolation (an objective lack of social contact with others) and loneliness (the subjective feeling of being isolated) are significant yet underappreciated public health risks. Social isolation and loneliness are associated with poor physical and mental health outcomes, including higher rates of mortality, depression, and cognitive decline. Recent research documents the high prevalence of social isolation and loneliness among older adults. For example, data from the National Health and Aging Trends Study found that 24 percent of community-dwelling older adults are considered socially isolated, and a 2018 survey by the AARP Foundation found that more than one-third (35 percent) of adults aged 45 and older are lonely. Additionally, a 2018 study by the Kaiser Family Foundation found that 22 percent of adults in the United States say they “often or always feel lonely, feel that they lack companionship, feel left out, or feel isolated from others.”

While the science of social relationships and their consequences on health and well-being has been documented for decades, the topics of social isolation and loneliness have recently garnered increased attention in the mass media. For example, in the past few years, articles in The New York Times featured headlines such as “How Social Isolation Is Killing Us” and “The Surprising Effects of Loneliness on Health.”

In particular, the AARP Foundation has played a key role in bringing attention to the health and medical impacts of social isolation and loneliness. In this context, the AARP Foundation came to the National Academies of Sciences, Engineering, and Medicine for an examination of the health and medical dimensions

Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
×

of social isolation and loneliness and for recommendations on the role of the health care system in helping to reduce the incidence and adverse health impacts of social isolation and loneliness among older adults in clinical settings. This exploration is notable in that relatively few stakeholders have paid attention to the particular role that health care professionals and providers can play.

During this broad-based review of the issues of social isolation and loneliness, the committee identified several overarching challenges. Most prominently is the multiplicity of terms for different aspects of social relationships (such as social isolation, social support, loneliness, and social networks, among others). Furthermore, the terms social isolation and loneliness are often conflated, but they represent distinct concepts, each with their own measures. As a result, the literature base on the health and medical impacts of social isolation and loneliness, as well as potential interventions, are confounded by this confusion of terminology. In the report, the committee sought to carefully report the evidence accurately in terms of the specific aspects of social isolation and loneliness that were actually targeted and measured.

This report presents a comprehensive review of the impacts of social isolation and loneliness on mortality and morbidity, the risk factors for social isolation and loneliness, the mechanisms by which social isolation and loneliness impact health, the factors that affect those mechanisms, and the ways in which researchers measure social isolation and loneliness and their resultant impacts on health. Furthermore, the committee discusses the role of the health care system in addressing these issues, the ways in which we can better educate and train our health care workforce, and which interventions (particularly for the clinical setting) show the most promise. Finally, the committee discusses general principles of dissemination and implementation that will be important for translating research into practice, especially as the evidence base for effective interventions continues to flourish.

Overall, this committee comes to the firm conclusion that the health care system is well poised to develop and evaluate methods and processes to identify social isolation and loneliness among older adults in clinical settings. In fact, the committee notes that a single interaction with the health care system may represent the only opportunity to identify those individuals who are the most isolated and lonely. However, we emphasize that the health care system cannot solve the problems of social isolation and loneliness alone; rather, the goals and recommendations presented in this report represent a vision for how the health care system can help as part of a larger global effort to combat the adverse health impacts of social isolation and loneliness among adults aged 50 and older in the United States.

As chair of the committee I would like to recognize and thank each committee member for his/her contributions to the report. Our committee was most engaged with, even passionate, about the topic yet throughout our discussions and drafting of the report the committee maintained the highest level of critical

Page xiii Cite
Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
×

thinking and reliance on the evidence available to us. The entire committee owes a special thanks to Tracy Lustig, Jennifer Cohen, Caroline Cilio, and Kendall Logan. We could not have asked for a more dedicated and thoughtful staff from the National Academies. Finally I offer thanks to Andy Pope, the senior director of the Board on Health Sciences Policy at the National Academies and to the AARP Foundation for supporting this exciting and meaningful exploration.

Dan G. Blazer II, Chair

Committee on the Health and Medical Dimensions of Social Isolation and Loneliness in Older Adults

Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
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Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
×
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Suggested Citation:"Front Matter." 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. doi: 10.17226/25663.
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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.

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