How improving social interaction can help address the loneliness epidemic

By Mia Haney

When COVID-19 emerged in 2020, people worldwide were urged to stay home, practice social distancing and avoid large crowds. Social events were canceled, establishments were shut down and "six feet apart" became the new normal to fight the spread of COVID-19.

While these actions were considered necessary for the health and safety of all people—especially older and more vulnerable Americans—an undesirable side effect was taking place: loneliness.

The 37 million adults living alone were more isolated than ever before; with measures in place to keep people apart, many Americans didn't come in contact with another human being for days on end. Even those living with others may have been impacted if they or someone in their household contracted the virus and isolated to keep themselves or others healthy.

Loneliness and social isolation

Although many people may have faced loneliness for the first time due to the pandemic, it's not a recent phenomenon. In fact, loneliness increased worldwide by 5% during the pandemic, according to a study by the American Psychological Association. In 2019, just before the emergence of COVID-19, Cigna named loneliness an epidemic when 61% of those surveyed reported high levels of loneliness—a 7% increase from 2018.

Loneliness is often understood in conjunction with social isolation, defined as "the objective state of being isolated from people and lacking meaningful contact with a social network or community." The perception of being in this state may create feelings of loneliness that many people experience every day. In other instances, however, individuals may feel alone without being socially isolated. Regardless of the reason people feel lonely, those who suffer from chronic loneliness may suffer from long-term effects, which are often more than unpleasant feelings. Long-term loneliness may lead to acute illness and, in some cases, lasting negative health outcomes.

The health effects of loneliness

Feeling socially isolated can impact one's health in a variety of ways, beyond being at higher risk for mental health afflictions such as depression and anxiety. The Centers for Disease Control and Prevention (CDC) list the potential health effects as increased risk of:

• premature death, possibly rivaling the risk caused by smoking, obesity, and a sedentary lifestyle
• heart disease or stroke when coupled with poor social relationships {a byproduct of social isolation and loneliness)
• death, hospitalization and emergency department visits for those with a preexisting heart failure condition
• dementia by 50%

The gravity of these potential health risks has concerned health professionals and organizations, especially in recent years. U.S. Surgeon General Dr. Vivek Murthy, among other health leaders, has cited loneliness as a public-health issue and is working to raise awareness of the potential health ramifications. Additionally, the World Health Organization (WHO) has begun discussing the creation of a commission that would target loneliness and social isolation and connection, according to Christopher Mikton, a technical officer in WHO's social determinants of health division.

At-risk populations

While everyone can experience loneliness, several groups are at higher risk for social isolation and loneliness than others due to factors such as race, age, socioeconomic status and physical ability.

Demographic groups at risk of suffering from loneliness:

• Underrepresented racial groups
• Adults with low annual incomes
• Adults with a disability or chronic condition
• Older adults

Each demographic may feel lonely for different reasons, however, some specific risk factors include:

• Living alone
• Loss of a friend or loved one
• Divorce
• Unemployment
• Major life transitions
• Emergence of new health problems

This list is not all-encompassing. Many factors can contribute to and exacerbate loneliness, and they may vary across one's life. Helping to address loneliness is, therefore, extremely complex. Those who experience loneliness or know someone who does must consider a variety of factors in attempting to alleviate it.

Solutions for the loneliness problem

As social isolation often leads to loneliness, the first step toward lessening or eradicating loneliness may be addressing the factors that influence isolation. For many, however, this is easier said than done.

There are persistent barriers to social interaction that are difficult to navigate, especially for someone who is already suffering from the effects of loneliness.

For many, regular appointments with a mental health professional may help alleviate feelings of loneliness. For others, becoming a part of a support group or club may be beneficial.

The bottom line: we are social creatures. Without consistent social interaction, we have fewer opportunities to express ourselves, discuss our innermost thoughts and emotions and find that "connection" with another person that so many crave. This unspoken connection fuels our moods and may even support our health.

We know a social connection is important—and there are many avenues in which to achieve it for most—but what about those who experience greater and more enduring barriers to social interaction?

How can we help improve access to needed healthcare resources while alleviating loneliness?

Caregivers and companionship

Out of the groups mentioned above, a few may have a harder time accessing the resources needed to help address the loneliness they experience. Homebound older adults with chronic illnesses or mobility challenges often face a life of solitude they never desired.

In the U.S. alone, 4.5 million Medicare beneficiaries became homebound during a seven-year study that explored 2012-2018 data sets.

“People who are homebound have many medical and social needs. Our findings highlight the importance of assuring that homebound patients and their families have access to needed care to remain safely in the community, including paid caregivers, home-based services (e.g., meal delivery), telehealth, portable medical equipment, and the expansion of home-based medical care,” according to the report.

In a separate JAMA Internal Medicine study, data from the National Health and Aging Trends Study found that in 2020 there were “an estimated 4.2 million adults aged 70 years or older were homebound compared with 1.6 million in 2019.”

In-home caregivers may be the most important source of friendship and companionship in the world today. These women and men bring friendship and companionship to the homebound while assisting with activities of daily living. Today, there are approximately 4.5 million care workers in the U.S., while the need is expected to grow by another 1.1 million caregivers by 2028.

Caregivers are the eyes and ears of the healthcare industry and can help close gaps in care thanks to their daily contact with the individuals they serve. Through the hard work of caregivers, the healthcare industry has an opportunity to effect real change by bringing together people and resources in a cohesive way to make a difference in the everyday lives of those experiencing social isolation.

Together, we can work to defeat loneliness through improved contact between caregivers and the homebound while improving the health and wellness of those we assist.

Mia Haney is Chief Operating Office at Modivcare Home.