Solutions for Social Isolation

The majority of attention from the media, philanthropy, health insurers, organizations, and others has been on addressing social isolation in the older population. In fact, we are all at risk of social isolation.

This was true before COVID-19, and it is even more so now. It is vital that policies and programs expand their focus to address social isolation across all ages and stages of life, and strengthen social connectedness for all.

People who experience inequities and are isolated from opportunity because of where they live, how much money they make or the color of their skin more often experience social isolation. Addressing inequities should be at the front and center of all efforts to strengthen social connectedness.

Although social isolation and loneliness are different, they can be related. Actual social isolation and perceived social isolation (loneliness) are associated with increased risk for early mortality. Few studies have examined the potential synergistic effects of social isolation and loneliness on health. However, in 2018, a German study explored whether loneliness, social isolation, and their interaction predict mortality.

Using a large, representative sample of German middle-aged and older adults, with a follow-up period up to 20 years, study researchers found that loneliness and social isolation do interact synergistically: the higher the level of social isolation, the larger the effect of loneliness on mortality; and the higher the level of loneliness, the larger the effect of social isolation.

They concluded that both concepts are important in predicting health status. However, more studies are needed that investigate the interactions between loneliness and social isolation. In addition, popular and professional literature could better clarify the differences between social isolation and loneliness and their synergistic effects.

Social isolation indicators are not included in current screening tools for primary care or community settings. If we don’t screen for indicators, we can’t identify people at risk in time to intervene—during the COVID-19 pandemic or later. Several researchers have proposed psychosocial “vital signs” to be included in screening tools and electronic health records (EHRs).

These psychosocial vital signs ask about the presence or absence of meaningful social connections, such as who is in your social network, who would you turn to when you feel sad or depressed, and how often you feel sad or depressed. These kinds of questions could easily be added to an assessment tool for use in primary practice. Risk factors for social isolation and its effects have increased during the pandemic and will persist as we recover.

The evidence base for social isolation interventions is sparse, and much of that evidence is anecdotal. Although qualitative evidence can be helpful in understanding how a model was used and what worked and what didn’t, lack of robust evaluation hinders full development and spread of effective models.

More research is needed to test promising interventions among different populations and settings and to consider—and make explicit—the role of social inequities as risk factors and in designing interventions.

For the United States to implement effective solutions that reduce or prevent social isolation, we need to learn from communities and organizations outside our borders that have addressed social isolation and promoted positive, healthy connections and well-being.

Because few social isolation interventions or models have been well evaluated, assessing their potential for adaptation or scaling here is challenging. There is an opportunity for global experts on these models to liberally consult with implementors in the United States working to adapt them to local environments.