The Heterogeneity of Socially Isolated Older Adults: A Social Isolation Typology

Social distancing measures following the outbreak of COVID-19 have led to a rapid shift to virtual and telephone care. Social workers and mental health providers in VA home-based primary care (HBPC) teams face challenges providing psychosocial support to their homebound, medically complex, socially isolated patient population who are high risk for poor health outcomes related to COVID-19. We developed and disseminated an 8-week telephone or virtual group intervention for front-line HBPC social workers and mental health providers to use with socially isolated, medically complex older adults. The intervention draws on skills from evidence-based psychotherapies for older adults including Acceptance and Commitment Therapy, Cognitive-Behavioral Therapy, and Problem-Solving Therapy. The manual was disseminated to VA HBPC clinicians and geriatrics providers across the United States in March 2020 for expeditious implementation. Eighteen HBPC teams and three VA Primary Care teams reported immediate delivery of a local virtual or telephone group using the manual. In this paper we describe the manual’s development and clinical recommendations for its application across geriatric care settings. Future evaluation will identify ways to meet longer-term social isolation and evolving mental health needs for this patient population as the pandemic continues.

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Neighborhood Deterioration and Social Isolation in Later Life

The International Journal of Aging and Human Development ◽

10.2190/ubr2-jw3w-ljel-j1y5 ◽

1993 ◽

Vol 36 (1) ◽

pp. 9-38 ◽

Cited By ~ 58

Author(s):

Neal Krause

Keyword(s):

Older Adults ◽

Elderly People ◽

Social Isolation ◽

Strong Support ◽

Nationwide Survey ◽

Later Life ◽

Neighborhood Characteristics ◽

Financial Difficulties ◽

Low Levels ◽

Socially Isolated

The purpose of this study is to test a conceptual model that attempts to show how selected neighborhood characteristics are related to social isolation in later life. This model specifies that older adults with low levels of educational attainment are more likely to experience financial problems and that elderly people who are confronted by financial difficulties are more likely to reside in dilapidated neighborhoods. The model further predicts that deteriorated neighborhoods in turn tend to promote distrust of others and older adults who are more distrustful of others tend to be more socially isolated. Based on data provided by a nationwide survey of elderly people, subsequent analyses revealed strong support for the theoretical sequence described above.

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Social Isolation and Hospitalization Risk Factors Among Community-Dwelling Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.314 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 95-95

Author(s):

J Mary Louise Pomeroy ◽

Gilbert Gimm

Keyword(s):

United States ◽

Risk Factors ◽

Older Adults ◽

Social Isolation ◽

The United States ◽

Community Dwelling ◽

Psychosocial Risk ◽

Depression And Anxiety ◽

Socially Isolated ◽

Community Dwelling Older Adults

Abstract PURPOSE: This study examines psychosocial risk factors associated with hospitalization among community-dwelling older adults in the United States. METHODS: Using two waves of the National Health and Aging Trends Study from 2011 and 2015, we conducted descriptive and multivariate analyses of individual-level data from a nationally representative sample of 8,003 Medicare beneficiaries ages 65 and older. Associations between hospitalization and risk factors including social isolation, depression, and anxiety were assessed. Covariates included gender, race/ethnicity, age, region, insurance type, falls, and comorbidities. RESULTS: Overall, about 20.9% of older adults reported a hospitalization within the past year and 22.2% were socially isolated. The odds of hospitalization were higher for socially isolated adults (OR 1.17; p = .02), for depressed adults (OR 1.25; p = .01), and for individuals with anxiety (OR 1.25; p = .02). Individuals living in the Western region had lower odds of hospitalization (OR 0.71; p = .001), whereas men (OR 1.13; p = .03), those requiring assistance with activities of daily living (OR 1.48; p < .001), and those having one (OR 1.41; p = .03) or more (OR 3.05; p < .001) chronic health conditions had higher odds of hospitalization. CONCLUSION: Social isolation, depression, and anxiety represent significant psychosocial risk factors for hospitalization among community-dwelling older adults in the United States. Efforts to reduce health care costs and improve health outcomes for older adults should explore ways to strengthen social integration and improve mental health.

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Social Isolation and Well-Being Among Middle-Age and Older Adults: Before and During the COVID-19 Outbreak

Innovation in Aging ◽

10.1093/geroni/igab046.141 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 38-38

Author(s):

Lydia Li

Keyword(s):

Older Adults ◽

Social Isolation ◽

Social Connectedness ◽

Well Being ◽

Symptoms Of Depression ◽

Physical Isolation ◽

Multiple Dimensions ◽

Aging And Health ◽

Socially Isolated ◽

The Relationship

Abstract This symposium brings together five studies that examined the relationship between social isolation and well-being. Two used pre-COVID data from the Health and Retirement Study (HRS). One aimed to identify patterns of social isolation trajectory in a 9-year period, where social isolation was conceptualized as a multidimensional construct. It identified four distinct patterns, and the pattern had a gradient relationship with health outcomes. Another examined the association between self-perceptions of aging (SPA) and social well-being among older adults. It found that positive SPA predicted increased social connectedness and reduced loneliness in four years. Two other studies were based on a longitudinal survey (COVID-19 Coping Survey) that began in April 2020. One reports that adults 55+ with comorbidity at pandemic onset had persistently elevated depressive symptoms in a 6-month period, regardless of their social isolation level. Another paper suggests that physical isolation at pandemic onset was associated with elevated symptoms of depression, anxiety, and loneliness throughout the following six months. The fifth paper was based on two-wave data—2019 survey and 2020 COVID supplement—from the National Aging and Health Trend Study (NAHTS). It found that older adults who were very socially isolated and completely homebound before the pandemic experienced less psychological distress during the outbreak than those who were very socially integrated and not homebound. The five studies highlight the multiple dimensions of social isolation, their antecedents and development over time, and their role in shaping mental health in a pandemic context.

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Correlates of Social Isolation Among Minority Older Adults During the COVID-19 Pandemic

Innovation in Aging ◽

10.1093/geroni/igab046.1137 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 294-295

Author(s):

Omolola Adepoju ◽

Daniel Howard ◽

Kendra Smith ◽

Luz Herrera ◽

Daikwon Han ◽

...

Keyword(s):

Older Adults ◽

African American ◽

Social Isolation ◽

Emergency Preparedness ◽

Community Support ◽

Social Needs ◽

Main Independent Variable ◽

Health Related ◽

Socially Isolated ◽

Community Supports

Abstract Background Over the past year, engagement with older adults has been severely curtailed given the high rates of COVID-19 morbidity and mortality in this population. This study examined the correlates of social isolation among African American and LatinX older adults during the COVID-19 pandemic. Methods Working with community-based organizations and senior living centers, we administered a survey to older adults 55+, in the Houston metroplex, between 11/2020 and 01/2021 (n=575). The survey assessed COVID-19 prevention behaviors and health-related social needs. Responses to “How often do you feel lonely or isolated from those around you?” were used to create a dichotomous social isolation dependent variable. The main independent variable, family/community support, was based on responses to the validated question "If for any reason you need help with day-to-day activities such as bathing, preparing meals, shopping, managing finances, etc., do you get the help you need?" Multivariate logistic regression adjusting for socioeconomic status, medical conditions, positive COVID test (for self or family), COVID-19 prevention behaviors, and emergency preparedness levels was used. Results Limited family/community support was strongly associated with social isolation (OR=6.2; p<0.01), as was having any chronic condition (OR=2.9, p=0.02). Females and seniors who reported daily social distancing were more likely to report being socially isolated (OR=2.4, p=0.04; OR=1.09; p=0.09, respectively). Of all chronic conditions examined, diabetes was the single strongest predictor of social isolation (OR=2.49, p=0.02). Conclusion Being female, having diabetes and limited family/community supports are associated with COVID-19-induced social isolation in African American and Latinx communities.

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Cumulative Effect of Loneliness and Social Isolation on Health Outcomes among Older Adults

Innovation in Aging ◽

10.1093/geroni/igab046.3305 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 920-920

Author(s):

Timothy Barnes ◽

Stephanie MacLeod ◽

Rifky Tkatch ◽

Manik Ahuja ◽

Laurie Albright ◽

...

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Health Outcomes ◽

Social Isolation ◽

Healthcare Utilization ◽

Cumulative Effect ◽

Cumulative Effects ◽

Chi Square ◽

Socially Isolated

Abstract Loneliness and social isolation are described similarly yet are distinct constructs. Numerous studies examine each construct separately; however, less research has been dedicated to exploring their impacts together. Using survey and claims data among adults age 65+ (N=6,994), the cumulative effects of loneliness and social isolation on late-life health outcomes were examined using Chi-square and multivariate regression models. Loneliness and social isolation were measured using the UCLA-3 Loneliness Scale and the Social Network Index. Participants were grouped into four categories of loneliness and social isolation based on overlap, including: lonely only (L), socially isolated only (SI), both lonely and socially isolated (LSI), or neither (N). Outcomes included quality of life and healthcare utilization and costs. Among participants, 9.8% were considered L, 20.6% SI, 9.1% LSI, and 60.5% N. Respondents were primarily female (55.0%) and 70-74 years of age (27.1%). Those considered LSI were more likely to be older, female, less healthy, depressed, with lower quality of life and greater healthcare utilization patterns. Participants who were L or LSI had higher rates of emergency room visits compared to the N group; LSI had the highest medical costs. Results demonstrate the cumulative effects of loneliness and social isolation among older adults. Findings not only fill a gap in research exploring the impacts of these constructs later in life, but also confirm the need for approaches targeting older adults who are both lonely and socially isolated. As the COVID-19 pandemic continues, this priority will continue to be urgent for older adults.

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Social Support, Isolation, Loneliness, and Health Among Older Adults in the PRISM Randomized Controlled Trial

Frontiers in Psychology ◽

10.3389/fpsyg.2021.728658 ◽

2021 ◽

Vol 12 ◽

Author(s):

Sara J. Czaja ◽

Jerad H. Moxley ◽

Wendy A. Rogers

Keyword(s):

Social Support ◽

Older Adults ◽

Social Network ◽

Social Isolation ◽

Network Size ◽

Functional Impairments ◽

Social Connectivity ◽

Social Network Size ◽

Socially Isolated ◽

Aging Adults

Objectives: Social isolation and loneliness are serious public health issues given the association with negative physical, mental; and cognitive health outcomes and increased risk for mortality. Due to changes in life circumstances many aging adults are socially isolated and experience loneliness. We examined the relationships among four correlated but distinct constructs: social network size, social support, social isolation, and loneliness as they relate to indices of health and wellbeing among diverse subpopulations of older adults. Guided by WHO’s International Classification of Functioning, Disability and Health (ICF) we also examined factors that predict loneliness and social isolation.Methods: Analyses of baseline data from sample of older adults who participated in an intervention trial that examined the beneficial effects of a software system designed to support access to resources and information, and social connectivity. Participants included 300 individuals aged 65–98, who lived alone, were primarily of lower socio-economic status and ethnically diverse. Participants completed a demographics questionnaire, self-report measures of health, depression, social network size, social support, and loneliness.Results: Loneliness was strongly associated with depression and self-ratings of health. In turn, greater social isolation and less social support were associated with greater loneliness. Social isolation was associated with depression and lower self-ratings of health. The association between social isolation and health was mediated by loneliness. Individuals in the older cohorts (80+) reported less social support. With respect to loneliness, having a smaller social network, more functional limitations, and limitations in engaging meaningful activities was associated with higher levels of loneliness and greater social isolation.Conclusion: The findings underscore the importance of social connectively to wellbeing for older adults and suggest that those in the older cohorts, who have a small social network, and with greater physical and functional impairments may be particularly vulnerable to being socially isolated and lonely. The findings provide guidance for future interventions. In this regard, we discuss how Information and Communication Technologies (ICTs) may be used to promote social connectivity and engagement. Strategies to make the usability and availability of these applications for aging adults are highlighted.

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24 Loneliness, Social Isolation and Frailty Among Older Adults in England: Results From the English Longitudinal Study of Ageing

Age and Ageing ◽

10.1093/ageing/afab029.03 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

pp. i7-i11

Author(s):

K Davies ◽

A Maharani ◽

T Chandola ◽

C Todd ◽

N Pendleton

Keyword(s):

Older Adults ◽

Longitudinal Study ◽

Relative Risk ◽

Social Isolation ◽

Social Inclusion ◽

Smoking Status ◽

Frailty Index ◽

Isolation Measure ◽

Socially Isolated ◽

English Longitudinal Study

Abstract Introduction Ten percent of over 65 s and between a quarter and half of over 85 s are frail. Loneliness and social isolation are associated with increased falls, rates of hospitalisation and mortality. Lonely and socially isolated older adults may also be at risk of frailty. We examined the relationship between loneliness, social isolation and incident frailty among older adults in England longitudinally over 12 years. Methods The study sample are 9,171 older adults aged ≥50 years participating in a population representative longitudinal panel survey, the English Longitudinal Study of Ageing Waves 2–8. To define frailty across the biannual waves, we used the Frailty Index (FI), analysed continuously and into categories (FI ≤0.08 non-frail, 0.08–0.25 pre-frail and ≥ 0.25–1 frail). We used baseline (Wave 2): loneliness measure using the UCLA 3-item loneliness scale; social isolation measure using previously reported method (Banks et al. The Institute for Fiscal Studies. 2006.). Both were categorised into low/medium/high. To examine relationships, we used linear mixed methods modelling (for the continuous FI), and Cox proportional hazard model (for the categorical FI). Results Loneliness (β = 0.023; 95% CI = 0.022, 0.025) and social isolation (β = 0.007; 95% CI = 0.003, 0.010) were significantly associated with increased FI, after adjusting for cofounders (gender, age, marital status, smoking status and wealth). There was a 60% greater relative risk of belonging to the frail class with a medium loneliness score compared to low (HR = 1.570; 95% CI 1.492, 1.652) and a 160% greater relative risk with high loneliness score compared to low (HR = 2.621; 95% CI 2.488, 2.761). Although less pronounced, there was a 1% greater relative risk of developing frailty with a medium social isolation score compared to low (HR = 1.010, 95% CI 1.010, 1.197) and a 30% greater relative risk with high social isolation score compared to low (HR = 1.267; 95% CI 1.154, 1.390). Conclusions Our research indicates both loneliness and social isolation increase risk of developing frailty, expanding on previous evidence. This provides further support to the importance of understanding approaches to promote social inclusion of older adults.

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Social Isolation as a Risk Factor for Cigarette Smoking in Older Adults

Innovation in Aging ◽

10.1093/geroni/igab046.467 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 122-122

Author(s):

Gilbert Gimm ◽

Mary Lou Pomeroy ◽

Thomas Cudjoe

Keyword(s):

Older Adults ◽

Risk Factor ◽

Cigarette Smoking ◽

Social Isolation ◽

National Sample ◽

Community Dwelling ◽

Increased Risk ◽

Dual Eligible ◽

Socially Isolated ◽

Using Data

Abstract Objective This study examined the prevalence of social isolation and cigarette smoking in a national sample of community-dwelling older adults, and assessed the role of social isolation on the risk of cigarette smoking. Methods Using data from 8,044 participants (age 65+ years) across two waves of the National Health and Aging Trends Study (NHATS), we analyzed the prevalence of social isolation in older adults and as a risk factor for cigarette smoking. Social isolation was measured across 4 relationship domains (Cudjoe, 2018) on a scale of 0 to 4, using objective measures of social interactions. Descriptive and logistic regression analyses were conducted to assess how social isolation is associated with smoking. Results Preliminary results showed that 18.2% of older adults were socially isolated (3.5% severely isolated) and 7.1% of participants reported current smoking. We found that both social isolation (OR = 2.5, p<.001) and severe isolation (OR = 5.9, p<.001) increased the odds of smoking. Also, older adults with depression (OR = 1.6, p<.01) and dual-eligible beneficiaries (Medicare and Medicaid) with TRICARE coverage (OR = 4.6, p<.05) had greater odds of smoking. However, we did not find evidence that the odds of smoking varied significantly by the number of chronic conditions. Conclusion Social isolation is associated with an increased risk of cigarette smoking among older adults. Smoking may be an important behavior in the pathway between social isolation and its association with morbidity and mortality.

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Internet use, social isolation and loneliness in older adults

Ageing and Society ◽

10.1017/s0144686x20000550 ◽

2020 ◽

pp. 1-24

Author(s):

Stephanie Stockwell ◽

Brendon Stubbs ◽

Sarah E. Jackson ◽

Abi Fisher ◽

Lin Yang ◽

...

Keyword(s):

Older Adults ◽

Logistic Regression ◽

Longitudinal Study ◽

Social Isolation ◽

Odds Ratio ◽

The Internet ◽

Cross Sectional ◽

Men And Women ◽

Socially Isolated ◽

English Longitudinal Study

Abstract The aim of this study was to explore associations between internet/email use in a large sample of older English adults with their social isolation and loneliness. Data from the English Longitudinal Study of Ageing Wave 8 were used, with complete data available for 4,492 men and women aged ⩾ 50 years (mean age = 64.3, standard deviation = 13.3; 51.7% males). Binomial logistic regression was used to analyse cross-sectional associations between internet/email use and social isolation and loneliness. The majority of older adults reported using the internet/email every day (69.3%), fewer participants reported once a week (8.5%), once a month (2.6%), once every three months (0.7%), less than every three months (1.5%) and never (17.4%). No significant associations were found between internet/email use and loneliness, however, non-linear associations were found for social isolation. Older adults using the internet/email either once a week (odds ratio (OR) = 0.60, 95% confidence interval (CI) = 0.49–0.72) or once a month (OR = 0.60, 95% CI = 0.45–0.80) were significantly less likely to be socially isolated than every day users; those using internet/email less than once every three months were significantly more likely to be socially isolated than every day users (OR = 2.87, 95% CI = 1.28–6.40). Once every three months and never users showed no difference in social isolation compared with every day users. Weak associations were found between different online activities and loneliness, and strong associations were found with social isolation. The study updated knowledge of older adults’ internet/email habits, devices used and activities engaged in online. Findings may be important for the design of digital behaviour change interventions in older adults, particularly in groups at risk of or interventions targeting loneliness and/or social isolation.

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