woman looking lonely

Editor’s note: This is the first article in a series on how loneliness and isolation are affecting seniors at home. It stems from writer Diane Eastabrook’s participation in the 2021 Age Boom Academy, a free training fellowship of the Columbia Journalism School and the Mailman School of Public Health.

A stroke four years ago turned 74-year-old David Walker’s life upside down, leaving the affable Navy veteran with vision trouble and paralysis in one leg. Except for occasional visits from a caregiver, Walker is mostly alone and confined to his San Francisco studio apartment.

The sense of isolation and loneliness is sometimes debilitating for a man who loves to chat about cooking, music and his many other interests. Walker’s one lifeline to the outside world is the Institute on Aging’s Friendship Line, which connects homebound seniors via telephone to volunteers.

“I usually call twice a day and then someone will call me in the afternoon usually,” Walker told McKnight’s Home Care Daily Pulse. “I look forward to it every day just to spread a little sunshine.” 

Walker’s situation is indicative of what has become a global health crisis: social isolation and loneliness. The World Health Organization reported earlier this year that a third of older adults feel lonely. A quarter of Americans 65 and older are considered socially isolated and more than 40% reported feeling lonely, according to a 2020 report by the National Academy of Sciences.  

Social isolation vs. loneliness

Important to note is that social isolation and loneliness are two distinct conditions. People who are socially isolated have few social relationships and infrequent contact with others. Loneliness is the subjective feeling of being isolated. Both can be lethal to the elderly. According to the Centers for Disease Control and Prevention, social isolation can increase a person’s risk of premature death from all causes and increases the risk of dementia by 50%. Loneliness is associated with higher risks of depression, anxiety and suicide. 

Geriatrician Linda Fried, M.D., dean of Columbia University’s Mailman School of Public Health, told McKnight’s Home Care Daily Pulse that loneliness can trigger chronic inflammation in the body that can cause or worsen heart disease and stroke.

“There is a summary statistic that chronic loneliness — not just feeling lonely one day or in a week — but loneliness that persists for a long period of time has health consequences in the order of smoking a half-pack of cigarettes a day for many years,” Fried said. 

The COVID-19 pandemic has exacerbated the problem, but it has also shined a much-needed light on the health consequences and economic costs of social isolation and loneliness. Healthcare providers and payers, in particular, are now developing ways to mitigate both at a time when millions of Americans are aging in place. 

MA at the helm

Medicare Advantage plans are among those leading the charge. Humana’s Bold Goal program, which addresses social determinants of health and health-related social needs, is zeroing in on loneliness. A survey of Humana MA plan members found those who reported being lonely experienced 29 unhealthy days a month, according to a Centers for Disease Control and Prevention index, which tracks the number of days a person feels his mental and physical health isn’t good. By contrast, diabetes patients reported on average 16 unhealthy days a month.

“That gave us perspective on where we needed to focus and what would have the biggest impact,” Andrew Renda, Humana vice president of Bold Goal and population strategy, told McKnight’s Home Care Daily Pulse. 

Humana has recently doubled the number of social determinants of health screenings to better identify at-risk beneficiaries. Those who report being lonely can get support in a variety of ways, including the Institute on Aging’s Friendship Line or through Papa, a company that pairs seniors with college students or families for companionship. The company plans to integrate Bold Goal into Kindred at Home, the home care firm it acquired earlier this year.

SCAN Health Plan, a California nonprofit Medicare Advantage plan, launched a Togetherness Program last spring to address loneliness among its beneficiaries. Peer advocates and SCAN volunteers reach out to members through a Friendly Phoner program. Beginning in January, SCAN will offer virtual and in-person classes that will allow members to connect with each other through shared interests. The company has set a goal of reducing loneliness among its members by 15% in the first year. Chief Togetherness Officer Lisbeth Briones-Roberts is confident SCAN can reach that target.

“People were more willing and more open about talking about loneliness, where in the past they were a little bit more shameful,” Briones-Roberts told McKnight’s Home Care Pulse. 

View from Washington

Finally, policymakers in Washington also have acknowledged the problem. The Build Back Better initiative before Congress would funnel $250 million in grants to help community-based organizations develop strategies to address social isolation and loneliness. Additionally, the Coalition to End Social Isolation and Loneliness wants some of the $150 billion earmarked for home-and-community-based services to be used to train and support caregivers on the issue.

“Caregivers are a priority population on social isolation and loneliness,” coalition co-director Eddie Garcia told McKnight’s Home Care Daily Pulse. “We’re looking at how we might support them more broadly, not only in the care that they’re delivering, but for themselves.”

Coming Tuesday: An interview with geriatrician Carla Perissinotto, M.D., director of the Care at Home program at the University of California San Francisco, which offers home-based primary care to people 65 and older.