EXECUTIVE SUMMARY
Hospital case managers should be alert to the risk of their patients suffering from loneliness and social isolation. These conditions can worsen mental and physical health outcomes for patients and are fairly commonplace among older populations.
- The National Poll on Healthy Aging shows that one out of three older adults report they lack companionship, and one out of four say they are socially isolated.
- Seventeen percent of survey respondents reporting feelings of isolation also reported that their mental health is fair or poor, compared with 2% of those reporting rare feelings of isolation also reporting fair or poor health.
- People who report being lonely or isolated also are less likely to engage in healthy eating and activities.
Loneliness is a health risk factor that hospital case managers might overlook, and it is prevalent among older patients.
About one in four older adults say they are socially isolated, and one out of three lack companionship. Loneliness is reported more frequently among people in the 50- to 64-year-old age group than people who are 65 to 80 years old, according to the National Poll on Healthy Aging, conducted by the University of Michigan Institute for Healthcare Policy and Innovation.
“Chronic loneliness can have major effects on the overall well-being for older adults and all adults,” says Preeti Malani, MD, MS, MSJ, professor of medicine at University of Michigan Medicine and director of the National Poll on Healthy Aging, Institute for Healthcare Policy and Innovation at the University of Michigan.
The poll found that women, people with lower annual incomes under $60,000, and who lived alone or had children in the home were more likely to report a lack of companionship.
Loneliness and social isolation can impact people’s life expectancy, physical and mental health, and memory, and can lead to worse health outcomes, she adds.
One poll finding was that people who reported a lack of companionship were twice as likely to report fair or poor physical health as those who rarely lacked companionship. For the lonely, 26% reported poor or fair health vs. 13% of those who did not lack companionship.
Also, people who said they were isolated reported poor mental health: 17% of those who felt isolated rated their mental health as fair or poor while only 2% of those who rarely felt isolated reported fair or poor health.
“If someone is isolated and no one is looking in on them, then a minor health issue can go unnoticed and unchecked,” Malani explains.
The person might have been able to resolve an infection or wound with a primary care visit, but because the issue was unnoticed, it might become a major problem requiring a hospital visit, she says.
“People who are lonely are more likely to engage in unhealthy behaviors,” Malani adds. “They may not cook for themselves or shop for healthy foods or engage in physical activities.”
By contrast, a person who is socially connected might take walks with a neighbor instead of watching TV and web-surfing.
“Everyone knows that smoking is not good for health, and being sedentary is not good for your health, but I’m not sure people recognize how loneliness is the same way,” Malani says. “Physical issues can result from loneliness.”
Knowing there can be a problem is a first step. Case managers can ask patients questions to determine whether they are lonely or isolated.
“Ask, ‘Who is around to help you?’ or ‘Who checks in on you?’” Malani suggests. “These are surrogates for isolation.”
Screening for loneliness/isolation should be viewed as part of the case management job — just like asking patients questions about their safety, she says.
“We should ask about social connectedness,” Malani says.
Screening questions might include:
- “How often do you feel lonely?”
- “How often do you have contact with others?”
- “Who helps you drive?”
- “Who lives around you?”
- “How often do you see other friends or other people?”
When women report a lack of companionship, it could be the result of their neglecting themselves after spending their lives taking care of other people.
“If there are children living in the home, people are more likely to report a lack of companionship,” Malani says. “If you were screening people for loneliness, you would look for the older woman living by herself or taking care of a grandchild: 60% of them felt a lack of companionship, and 41% felt isolated.”
When patients appear to suffer from loneliness, case managers can find out if the problem might have a solvable cause. For example, some people experience undiagnosed hearing loss that can isolate them.
Malani recalls her 96-year-old grandmother’s recent hearing loss and the problems this causes in social settings: “She says, ‘I don’t even try to bother following the conversation if multiple people are talking,’” Malani says. “Those who reported their hearing was fair or poor were also more likely to report they were socially isolated.”
The poll found that 18% of people who lacked companionship reported impaired hearing, vs. 11% of those who rarely lacked companionship having the same concern.
There are some low-cost answers, such as pocket talkers that act as amplifying devices. “They work like an old Walkman, a microphone,” she says.
Malani bought her grandmother a small hearing device, allowing her to have conversations she previously struggled through.
“For someone else, loneliness might be the result of a physical barrier, and you need to bring resources to help them,” Malani says.
Hospital case managers might encounter patients who are new to the community, having followed their adult children and lost their long-time friends in the process, she says.
“You can give them suggestions on how to build new friends and make new connections,” she suggests.
Social media can help some people stay connected, but it also can isolate people who rely solely on electronic forms of human connection.
Another solution is to connect older patients with Meals on Wheels and other meal delivery services in which they see someone each day.
“For vulnerable, older adults, that ability to be checked in on is helpful and can prevent issues,” Malani says. “People are not just dropping off a meal, but are sharing a part of their day. While it’s not ideal for everybody, it’s an important option.”
Case managers also could create a guide of community social resources or borrow one from local geriatric clinics. When patients appear to be lonely or isolated, case managers could offer them the resource guide, she adds.
Health systems might even have opportunities for older adults to interact with youth and younger adults. These inter-generational friendships are special and can help everyone involved. Some hospitals have volunteers who range from teenagers to 90-year-olds. This solution typically is more of a grassroots kind of thing, Malani notes.
“Since we did this study, I started paying more attention,” Malani says. “I walked into a neighborhood coffee shop, and the place was filled with 65-year-old to 70-year-old men, having discussions over newspapers and coffee.”
People experiencing loneliness need more of that face-to-face interaction, she adds.
Hospital case managers should be alert to the risk of their patients suffering from loneliness and social isolation. These conditions can worsen mental and physical health outcomes for patients and are fairly commonplace among older populations.
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