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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.

Product Details

ISBN-13: 9780309671002
Publisher: National Academies Press
Publication date: 06/14/2020
Pages: 316
Product dimensions: 6.00(w) x 9.00(h) x 0.90(d)

Table of Contents

Summary 1

1 Introduction 17

Study Context 19

Charge to the Committee 21

Relevant National Academies Reports 23

Study Approach 23

Overview of the Committee's Report 33

2 Evaluating the Evidence for the Impacts of Social Isolation, Loneliness, and Other Aspects of Social Connection on Mortality 35

A History of Understanding the Contributors to Human Health 36

Discovering Social Connections as a Determinant of Health and Longevity 39

The Current State of the Evidence on Impacts of Social Isolation, Loneliness, and Social Support on Mortality 40

A Further Note on Social Isolation, and Social Connection More Generally, as a Potential Causal Risk for Mortality 45

Findings and Conclusions 47

Next Steps and Recommendation 47

3 Health Impacts of Social Isolation and Loneliness on Morbidity and Quality of Life 49

Impact on Health Outcomes 51

Impact on Health-Related Behaviors 56

Impact on Quality-of-Life Outcomes 58

Elders at Risk for Abuse 60

Findings and Conclusions 60

Next Steps and Recommendations 61

4 Risk and Protective Factors for Social Isolation and Loneliness 63

Physical Health Factors 64

Psychological, Psychiatric, and Cognitive Factors 68

Social and Cultural Factors 71

Social Environmental Factors 81

At-Risk Populations 86

Findings and Conclusions 88

5 Mediators and Moderators 91

Mediators: Behavioral, Psychological, and Biological Mechanisms 93

Moderating Factors Influencing Mortality and Health Outcomes 100

Findings and Conclusions 104

6 Assessment of Social Isolation and Loneliness in Research 107

Measurement of Social Isolation and Loneliness 107

Measuring Impact for Social Isolation and Loneliness 114

Identification of Individuals and Populations at Risk 116

Findings and Conclusions 121

7 Role of the Health Care System 123

Health Care Access and Utilization 124

Social Determinants of Health and the Health Care System 129

Clinical Assessment of Social Isolation and Loneliness 132

Technology as Infrastructure for Coordination and Intervention 138

Findings and Conclusions 141

Next Steps and Recommendations 142

8 Education and Training 147

Framework for the Role of Education in Catalyzing Change 147

National Standards and Policy Priorities 148

Current Education and Training of the Health Care Workforce 152

Public Health Campaigns 159

Changing Practice Behaviors 162

Findings and Conclusions 164

Next Steps and Recommendations 165

9 Interventions 171

Large-Scale Reviews of Interventions 171

Types of Interventions Relevant to the Health Care System 179

Coalitions and Partnerships to Address Social Isolation and Loneliness 190

Technological Interventions 192

Ethical and Practical Considerations for Intervention 197

Financing of Interventions 206

Reframing Intervention Using a Public Health Approach 211

Findings and Conclusions 214

Next Steps and Recommendations 216

10 Dissemination and Implementation 221

Definition of Terms 222

Overview of Implementation Strategies 223

Addressing the Characteristics of the Topic 224

Addressing Users of the Evidence-Based Information 224

Communication Strategies 227

Addressing the Social Context 231

Sustainability 234

Conclusion 235

References 237


A Public Meeting Agendas 287

B Committee and Staff Biographies 291

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