Literature Review Social Isolation

When social isolation and loneliness are considered together, social isolation
has remained a robust predictor of mortality, but loneliness appears more
tenuous. Others found similar trends of differences in mortality by education
and income in the United States ( Pappas et al., 1993 ) and Canada ( Wilkins
et al., 1989 ). The World Health Organization (WHO) has focused attention
on the social injustices that underlie inequities and inequalities in longevity
and quality of life. There are important distinctions among these terms in
what they describe or measure, but they are often erroneously used
interchangeably. However, there is a dearth of research on how individuals
experiencing social isolation and loneliness are targeted by such industry
interventions. However, some may ask whether, in the absence of randomized
control trials, this can truly be said to be a causal association. This chapter
represents the portion of the committee’s guiding framework related to risk
factors (see Figure 4-1 ).
PDF Social Isolation and Suicide Risk Literature Review and Perspectives
While loneliness is commonly associated with clinically significant
depression, loneliness and depression are recognized as distinct constructs
that can also be experienced independently of each other. Broadly speaking,
the concept of autonomy stipulates that individuals have the right to make
their own decisions about what entails “living. Find out more about the
Kindle Personal Document Service. 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. This interplay between
individuals and their social and cultural milieus has given rise to a wide array
of inter-related research areas. It is possible, for instance, that individuals who
are isolated are more susceptible to exploitation or abuse (physical, emotional,
or financial).
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Low scores on this measure are often used as an indicator of social isolation.
Adequate informed consent entails ensuring that a patient understands the
facts of the medical issue at hand, the implications of choosing to treat or
forgo treatment, and the potential risks and benefits of the assessment or
treatment. Humans randomly assigned to loneliness induction, exclusion, or
support conditions show different health-relevant physiological responses.
This can be especially true if friends’ visits taper off over time ( Northcott et
al., 2016 ). Some older adults who live alone may go for days without seeing
or talking with another person ( Finlay and Kobayashi, 2018 ). Depression,
particularly major depression, is a clinical syndrome characterized by
persistent feelings of sadness or loss of interest and such symptoms as sleep
 problems, decreased appetite, loss of energy, difficulty concentrating, and
suicidal thoughts.
Assessment of Social Isolation and Loneliness in Research Social ...As
described in previous chapters, the scientific literature concerning social
isolation and loneliness draws on a variety of conceptual and measurement
approaches that collectively characterize related aspects of social
relationships. As mentioned earlier, these relationships are often bi-
directional. Targeting the major social and behavioral risk factors for health
offers a way to improve population health and even reduce health disparities.
The association between social relationships and suicidal ideation were
evaluated in a meta-analysis by Chang et al. (2017), which included findings
from 31 studies published between 2000 and November 2016. Unless there is
compelling evidence to suggest a new measurement tool, researchers and
program evaluators should try to use existing and validated tools (see
Recommendation 7-1 in Chapter 7 ). Therefore, the health care system has
the potential to be a critical component of a much larger solution.
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While loneliness is commonly associated with clinically significant

depression, loneliness and depression are recognized as distinct constructs
that can also be experienced independently of each other. Nevertheless, long-
term care can increase social isolation and loneliness for older adults living in
such residencies, a portion of whom may be living far from friends and loved
ones. 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. In a study based on patient interviews
conducted 1 week after discharge from a hospital stay, frailty was found to
be a risk factor for social isolation ( Andreasen et al., 2015 ). The co-existence
of other geriatric syndromes, such as urinary and fecal incontinence, with
frailty compounds the specific contribution of frailty to social isolation and
loneliness. Henning-Smith and colleagues (2019) found that individuals who
lived in areas with fewer than 10,000 people reported having more family
members they could count on and more friends than urban dwellers, but these
same rural residents also said they felt more left out. However, such efforts
are imperative in order to improve quality of care, outcomes, and population
health.
Health Impacts of Social Isolation and Loneliness on Morbidity and ...
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perks. Given the complexity of the terminology used in relation to social
isolation and loneliness, a reminder of key definitions is provided in Box 2-1.
While there are challenges in measuring social isolation and loneliness
precisely, there is strong evidence that many older adults are socially isolated
or lonely in ways that puts their health at risk. Social isolation is reflected in
Figure S-1 as a structural indicator of social connection while loneliness is
functional indicator. Such factors include social support characteristics
 (including marital status and the quality of relationships with family and
friends or pets) and the occurrence of disruptive life events (including
bereavement, illness, and retirement).
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Such factors include social support characteristics (including marital status

and the quality of relationships with family and friends or pets) and the
occurrence of disruptive life events (including bereavement, illness, and
retirement). Notably, the frequencies of telephone, written, or email contacts
were not associated with depression at 2 years, indicating that in-person
modes of contact were uniquely protective ( Teo et al., 2015 ). City dwellers
credited those social interactions to daily connections with others in their
residential spaces, relationships with building staff or caretakers, and the
existence of numerous places for socialization (e.g., parks, stores, movies,
libraries, coffee shops) that provided avenues for impromptu social
interactions. Find out more about the Kindle Personal Document Service. On
the other hand, Mullen and colleagues (2019) failed to find a significant
difference in perceived loneliness between rural and urban primary care
patients. Diabetes-related complications can limit physical mobility, which
may in turn limit an individual’s ability to initiate social interactions or may
strain relationships, thus leading to greater loneliness ( Jaremka et al., 2013b;
Ribu and Wahl, 2004 ).
Perceived Social Isolation in a Community Sampleits Prevalence and ...
Initial and periodic clarification as to whom older adults select to have access
to this information will help ensure that information is shared within the
parameters set by the older adult. Years of shared history and memories
become associated with one’s home, and leaving can be untenable for some (
Granbom et al., 2014 ). In addition, the desire to remain independent and
enmeshed in established social networks close to home can be a compelling
reason to stay ( Benefield and Holtzclaw, 2014; Herbert and Molinsky, 2019
). However, some may ask whether, in the absence of randomized control
trials, this can truly be said to be a causal association. Thus, we do not know
the degree to which these may overlap (e.g., those who are isolated or lonely
may perceive low social support). By using this service, you agree that you
will only keep content for personal use, and will not openly distribute them
via Dropbox, Google Drive or other file sharing services. A 2008 report of
WHO’s Commission on Social Determinants of Health stated.
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These difficult situations can impede communication between older adults

and their caregivers or visitors, creating feelings of social isolation or
loneliness. 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. Register for a
free account to start saving and receiving special member only perks. Upload
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Carousel Previous Carousel Next What is Scribd. This can be especially true
if friends’ visits taper off over time ( Northcott et al., 2016 ). However, the
term “social support” has many different specific meanings and measures.
PDF An overview of systematic reviews on the public health ... In part, this is
due to the heterogeneity of older people themselves and the underlying
causes of their isolation or loneliness. These five studies are all large
population-based studies, but none were conducted within the United States.
On the other hand, Mullen and colleagues (2019) failed to find a significant
difference in perceived loneliness between rural and urban primary care
patients. Socially isolated individuals are both more vulnerable to abuse (
Acierno et al., 2010 ) and more likely to become abusers ( Amstadter et al.,
2011 ). In addition to any psychological anguish it may cause, elder abuse
can lead to housing displacement or disruption, worse physical health, or, in
extreme cases, even death ( Wong and Waite, 2017 ). This creates a landscape
in which the effects of social isolation and loneliness on health are
demonstrated, but it is not always clear as to which has a greater influence.
While it is difficult to specifically define all of the subpopulations or groups
of people who would be included as at risk, the committee endeavored to
include information pertaining to any special populations for which there is
relevant social isolation or loneliness research.
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Register for a free account to start saving and receiving special member only
perks. Voluntary moves, when individuals feel they have options and can
make their own decisions and maintain autonomy, are more likely to have a
positive outcome than non-voluntary moves ( Bekhet et al., 2009 ).
Increasingly, retirement communities offer options that allow residents to
transition from independent living arrangements to assisted living if needed (
Jeste et al., 2019 ). Yet, these moves are limited to those older adults who
have the financial resources to “buy in” to such communities. Loneliness was
found to be increased in individuals who had fewer daily phone calls; this
was most evident for people who received fewer incoming calls ( Petersen et
al., 2016 ). Whether one lives in a rural or an urban area can also influence
the likelihood and quality of friendships. (See discussions on rural versus
urban living later in this chapter.). The potential impacts of social support
networks as well as the influence of different relationships—with spouses
and family members, friends and neighbors, or caregivers—are discussed
below. The prospective analysis found that perceptions of discrimination
based on sexual orientation increased loneliness. While these associations do
not establish causality, the temporal associations suggest that social isolation
and loneliness likely cause or worsen depression and anxiety, with in-person
contacts and the perceived adequacy of relationships having the largest
impacts.
Social Isolation Research Report Social isolation and loneliness represent
distinct phenomena. Socially isolated individuals are both more vulnerable to
abuse ( Acierno et al., 2010 ) and more likely to become abusers ( Amstadter
et al., 2011 ). In addition to any psychological anguish it may cause, elder
abuse can lead to housing displacement or disruption, worse physical health,
or, in extreme cases, even death ( Wong and Waite, 2017 ). Importantly,
autonomous decision making is free of outside coercion. Therefore the
subjective experience of loneliness, which may be the psychological
manifestation of social isolation, appears not to be the primary mechanism
explaining the association between social isolation and mortality in this study
( Steptoe et al., 2013 ). The index involves a five-point scale, with one point
being assigned for each of the following factors. However, the development
of algorithms to accurately predict social isolation or loneliness has proved
challenging because of the lack of a specific outcome measure that is
available at a large scale in EHRs or other sources of data (e.g., hospital
readmission or death).

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In addition, assessing populations more broadly allows for a focus on primary

prevention. Importantly, autonomous decision making is free of outside
coercion. Over a life course, social isolation and loneliness may be episodic or
chronic, depending on an individual’s circumstances and perceptions. It is
also important that older adults be given the opportunity to designate how
and with whom their health information should be shared. The prospective
analysis found that perceptions of discrimination based on sexual orientation
increased loneliness. However, there is a dearth of research on how
individuals experiencing social isolation and loneliness are targeted by such
industry interventions.
PDF Social isolation and social problem solving A longitudinal studyA study
 of more than 8,000 older adult participants from the U.S. Health and
Retirement Study found that nearly 18 percent of the sample reported
frequent feelings of loneliness. By adapting the Bradford Hill criteria for
social connections in general, evidence is found to support a potential causal
link between social isolation and mortality. Health care professionals also
need to learn how to work with community partners to develop, implement,
and evaluate programs for preventing or mitigating social isolation and
loneliness in older adults. Although numerous measurement tools are
available, in those cases when a researcher seeks to compare the impacts of
different interventions, it is important to use the same measurement tool for
the different interventions being compared. Therefore, the committee makes
the following recommendations. This can be especially true if friends’ visits
taper off over time ( Northcott et al., 2016 ).
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For example, support may be instrumental, emotional, or informational; it

may also be received, perceived 3 (as helpful or available if needed), or
provided. On the extreme end of the friendship continuum are older patients
who have been identified as “unbefriended.” This term is used to describe
individuals who, for example, are incapacitated and unable to make medical
decisions for themselves; lack an advanced directive; and lack friends, family,
or an authorized surrogate to assist in making medical decisions ( Farrell et
al., 2017 ). Sign up for email notifications and we'll let you know about new
publications in your areas of interest when they're released. A periodic review
of these sharing preferences should occur and any changes be noted formally.
Without reliable and affordable alternatives to driving, some former drivers
may resume their driving despite their initial reasons for stopping ( Johnson,
2008 ). Over a life course, social isolation and loneliness may be episodic or
chronic, depending upon an individual's circumstances and perceptions.
Loneliness and Social Isolation Chapter - The Cambridge Handbook ... A
study of more than 8,000 older adult participants from the U.S. Health and
Retirement Study found that nearly 18 percent of the sample reported
frequent feelings of loneliness. Most often a spouse, partner, or adult child
will fulfill this family caregiver role, but caregiving responsibilities can also be
undertaken by other family members (e.g., siblings or elderly parents),
friends, neighbors, or volunteers, and they can be provided in private homes,
assisted care, or retirement facilities ( BLS, 2017; Li and Loke, 2013 ).
Employing an unvalidated tool or, as mentioned previously, a tool that was
designed to assess social isolation for a study that is actually examining
loneliness, may yield inaccurate results. The English Longitudinal Study of
Ageing has revealed, for instance, that chronic pain (largely due to
musculoskeletal. While there are challenges in measuring social isolation and
loneliness precisely, there is strong evidence that many older adults are
socially isolated or lonely in ways that puts their health at risk. These same
questions were then asked again in relation to their friends and then in
relation to their spouse or partner.
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Alternatively, older adults may move to be with friends, relocate to a specific

locale or community, live closer or have more access to medical facilities, feel
safer, or live more affordably ( Bekhet et al., 2009; Crisp et al., 2013;
Stimson and McCrea, 2004 ). Loneliness was found to be increased in
individuals who had fewer daily phone calls; this was most evident for
people who received fewer incoming calls ( Petersen et al., 2016 ). Whether
one lives in a rural or an urban area can also influence the likelihood and
quality of friendships. (See discussions on rural versus urban living later in
this chapter.). In the United States it has proved difficult to determine the
precise extent of elder abuse. Workforce development is needed within
formal degree and postgraduate programs for health professionals, in training
programs for direct care workers and community members, and in lifelong
learning opportunities. This section will consider various ethical issues
concerning the measurement and monitoring of social isolation and loneliness.
In a review of studies of persons with dementia living in nursing homes,
those interviewed identified meaningful relationships and support for grief
and loss as two of their eight main concerns ( Shiells et al., 2019 ). The
residents with advanced dementia in particular expressed having a fear of
loneliness.
Evaluating the Evidence for the Impacts of Social Isolation ... The committee
concludes that in particular, further research is needed to establish the
strength and robustness of the predictive association of loneliness with
mortality in relation to social isolation and to clarify how social isolation and
loneliness relate to and. There are important distinctions among these terms in
what they describe or measure, but they are often erroneously used
interchangeably. Social isolation and loneliness represent distinct phenomena.
Over a 6-year period the English Longitudinal Study of Ageing found that
loneliness predicted frailty for men and women, while social isolation
predicted frailty only for men ( Gale et al., 2018 ). These findings provide.
Rather, older adults are at increased risk for social isolation and loneliness
because they are more likely to face predisposing factors such as living alone,
the loss of family or friends, chronic illness, and sensory impairments.
Because of this potential harm from stigma, it is extremely important that
information about isolation captured in the health record be treated as
protected health information.
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While these studies confirm their respective effect on risk for premature
mortality, they also begin to elucidate more complex findings when
considering their joint contributions. On the other hand, measures of
loneliness may not be influenced by social changes because responses are
subjective to the current context. That is, the outcome of the product design
could encourage increased use of their products, leading to increased social
isolation or loneliness. The guidance for using the tool notes that “the main
purpose of this tool is to measure the change that happens as a result of an
intervention to address loneliness” ( Campaign to End Loneliness, 2019a, p.
12). The tool was developed “in partnership with over 50 older people,
service providers, commissioners and housing associations” ( Campaign to
End Loneliness, 2019a, p. 13). In addition to initial clinical education, these
approaches should apply to professional education, continuing education
modules, online learning, and other forms of lifelong learning. By adapting
the Bradford Hill criteria for social connections in general, evidence is found
to support a potential causal link between social isolation and mortality.
Summary Social Isolation and Loneliness in Older Adults ... Furthermore,
more needs to be determined about whether and when (e.g., at what stage of.
Most notably, in the late 1970s and early 1980s a commission in the United
Kingdom found that differences in mortality by occupational status had not
declined at all and perhaps had even grown in the quarter century after the
National Health Service had presumably equalized access to health services (
Black, 1982 ). By using this service, you agree that you will only keep content
for personal use, and will not openly distribute them via Dropbox, Google
Drive or other file sharing services. 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. While older adults are not
unique in having these life-altering experiences, some disruptive events are
more likely to occur, or to occur at a greater frequency, for people over the
age of 50. However, the effect of received support, which was in the
moderate range, was non-significant ( Holt-Lunstad et al., 2010 ). Uchino
(2009a, b ) and Uchino et al. (2011) have discussed multiple possible reasons
why received support may be less predictive than perceived support (or other
indicators of social connection).
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Shaming individuals for health issues that may be out of their control (like
social isolation and loneliness) could be extremely harmful. Many older
adults are choosing to stay in their privately owned houses for personal,
practical, and financial reasons, a situation known as aging in place (
Benefield and Holtzclaw, 2014; Granbom et al., 2014; Herbert and Molinsky,
2019; Pearson et al., 2019; Wick, 2017 ). Furthermore, the committee
emphasizes that the preservation of an individual’s own decisions regarding
his or her life is essential as a guiding principle for all interventions.
Employing an unvalidated tool or, as mentioned previously, a tool that was
designed to assess social isolation for a study that is actually examining
loneliness, may yield inaccurate results. Two aspects of social relationships,
social isolation and loneliness, have become increasingly prominent in the
scientific literature. Such an attribution continues to dominate much thinking
about health policy even to the present day, though its validity has been
increasingly challenged, and most health researchers now agree that clinical
medicine, public health, and social changes all contributed to this increase in
life expectancy (see House, 2015, especially Chapter 4; McGinnis et al., 2002;
McKeown, 1976, 1979, 1988; Szreter, 1988, 1997, 2000 ).
PDF Social Isolation and Health, with an Emphasis on Underlying ... Health-
related behaviors have been studied for decades, and early theories held that
being married or being a parent helped inhibit risk-taking behaviors such as
drinking, smoking, or illicit substance use because these roles afforded a sense
of importance or purpose or because having a partner helped to favorably
regulate these health behaviors ( Gove, 1973; Syme, 1974; Umberson, 1987 ).
In 2016 long-term care service providers served more than 8.3 million people
in the United States, including 1,347,600 in nursing homes and 811,500 in
residential care facilities ( Harris-Kojetin et al., 2019 ). As further work is
done to identify individuals at risk of isolation or loneliness and to identify
promising treatments for these conditions, serious consideration should be
given to ethical issues that might arise from the use of a specific assessment
tool or intervention technique. Aging in place can be isolating if social
networks or opportunities for affordable and convenient transportation are
not readily available, especially for people who cannot afford sociable leisure
activities outside the home ( Finlay and Kobayashi, 2018; Herbert and
Molinsky, 2019 ). 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. The
remainder of this chapter summarizes the current state of the evidence in
terms of overall magnitude of the effect on mortality of different aspects of
social connection (e.g., social isolation, loneliness, social support) and why
these may be causal effects.
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They found that all four of these factors predicted mortality over the
succeeding 9 years in multivariate analyses that controlled for self-reports of
physical health, socioeconomic status, smoking, alcohol consumption,
physical activity. These public health approaches led to an “epidemiological
transition”—a shift from acute to chronic illnesses as the leading causes of
death ( Omran, 1971 ). Although those who lack social contact may feel
lonely, social isolation and loneliness often are not significantly correlated.
Poor social connection precedes mortality and poor health. Two populations
in the United States that have been researched more extensively than others
are immigrants and individuals who identify as part of the gay, lesbian,
bisexual, and transgender community. The index involves a five-point scale,
with one point being assigned for each of the following factors.
PDF Loneliness, social isolation and social relationships What are ...In 2016
long-term care service providers served more than 8.3 million people in the
United States, including 1,347,600 in nursing homes and 811,500 in
residential care facilities ( Harris-Kojetin et al., 2019 ). Only recently have the
adverse health effects of social isolation and loneliness received public
attention nationally and internationally. Chappell and Badger (1989)
interviewed 743 older adults aged 60 years or older to examine 10 indicators
of social isolation—whether an older person lives alone, is married, has
children, or interacts with confidants or companions, and so on—and they
observed that companionship and confidants were more related to an older
person’s well-being than the individual’s marital status, living arrangements,
or presence of children. At that time, Lubben found that marital status and
participation in religious activities vary less in the older adult population. It is
critical to have assessment tools for social isolation and loneliness that do not
further exacerbate inequalities between minority or at-risk groups and the
general population. Also, you can type in a page number and press Enter to go
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The committee emphasizes that this is not a comprehensive list of all

available tools and does not represent an endorsement of this committee but
rather serves to. This underscores the need for serial testing to better ascertain
changes over time. Such factors include social support characteristics
(including marital status and the quality of relationships with family and
friends or pets) and the occurrence of disruptive life events (including
bereavement, illness, and retirement). At the same time, there is an emerging
interest in understanding how to measure engagement and provide effective
opportunities for meaningful activity and engagement in persons with
dementia, including those with advanced disease ( Cohen-Mansfield et al.,
2017 ). Often, accessible housing options are not readily available ( Greiman
and Ravesloot, 2015 ). Furthermore, these findings were consistent across
age, gender, cause of death, and country of origin.
PDF Social Isolation A Conceptual AnalysisFor example, public health
campaigns have been successful in reducing the prevalence of smoking in the
American population. The three-item scale is being used widely in both
research and clinical settings in the United States as a brief assessment of
loneliness. Beneficence requires that medical procedures be provided with the
intent of doing good for the patient and serving in the patient’s best interest,
and it demands that health care providers continuously maintain their own
skills and knowledge in order to provide the best treatment for their patients.
It is important to note, however, that for assessments in health care settings
(e.g., questions about smoking and other health care risks), while patients
have the option to not answer questions, clinicians would rarely provide
informed consent for each question asked. Notably, the frequencies of
telephone, written, or email contacts were not associated with depression at 2
years, indicating that in-person modes of contact were uniquely protective (
Teo et al., 2015 ). For example, if one is looking to establish the prevalence of
loneliness in a given population, it is necessary to pick a measurement tool
that is validated to measure loneliness rather than other aspects of social
connection. ( Chapter 7 further discusses the importance of using validated
tools in clinical settings.).
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Informed consent is ongoing and provides an opportunity for older adults to

have a dialogue with their practitioners about the course of their treatment (
Price et al., 2012; Reid et al., 2018 ). Individuals are considered capable of
providing consent only if they have adequate reasoning faculties and are in
possession of all the relevant facts. Social isolation, loneliness, and other
aspects of social connection can also significantly affect the risk of
developing certain health conditions as well as the course of these health
conditions and various measures of the quality of life. 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. The recognition of the danger of tobacco was considered one of the
10 greatest public health achievements of the 20th century ( CDC, 2001 ). An
older adult should be provided the opportunity to determine how and with
whom assessment information on social isolation and. However, much of this
 success has to do with shaming individuals who smoke cigarettes.
PDF Loneliness and social isolation They found that all four of these factors
predicted mortality over the succeeding 9 years in multivariate analyses that
controlled for self-reports of physical health, socioeconomic status, smoking,
alcohol consumption, physical activity. While it is difficult to specifically
define all of the subpopulations or groups of people who would be included
as at risk, the committee endeavored to include information pertaining to any
special populations for which there is relevant social isolation or loneliness
research. The higher the score, the greater the degree of loneliness. Others
found similar trends of differences in mortality by education and income in
the United States ( Pappas et al., 1993 ) and Canada ( Wilkins et al., 1989 ).
The World Health Organization (WHO) has focused attention on the social
injustices that underlie inequities and inequalities in longevity and quality of
life. For example, oral-health-related quality of life is an independent risk
factor for loneliness among older adults, possibly due to embarrassment or
stigma ( Rouxel et al., 2017; Tonetti et al., 2017 ). These issues may be
exacerbated among some racial or ethnic minorities and low-income older
populations who lack preventative and corrective dental care ( Griffin et al.,
2012 ). However, in spite of compelling evidence linking cigarette smoking to
lung cancer and other causes of death, it took almost a quarter century to
move from the strong scientific evidence to an effective comprehensive
public health policy and then another quarter century to see major health
improvements.
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There is no set standard for the number of time-points or numbers of

assessments per unit of time used to determine social isolation and loneliness.
These associations were found to be independent of many factors, including
age, sex, educational attainment, wealth, levels of depression, and physical
activity ( Saczynski et al., 2006; Shankar et al., 2013 ). Greater loneliness in
older adults has also been associated with worsening performance on
measures of global cognition and on specific tests of immediate and delayed
recall ( Holwerda et al., 2014; Shankar et al., 2013; Tilvis at al., 2004; Wilson
et al., 2007 ). It is not intended to serve as a comprehensive review of every
study published on these topics. Depression was very strongly associated
with perceived social isolation. Inclusion and participation are valued and
encouraged as cohabitants share common meals and activities and help with
day-to-day operational matters ( Glass and Vander Plaats, 2013 ). Gaining a
broad understanding of risk factors for social isolation and loneliness and also
elucidating which factors are most closely linked to them can lead to new
initiatives to improve health outcomes at primary, secondary, and tertiary
stages of prevention.
Risk and Protective Factors for Social Isolation and Loneliness ... Register for
a free account to start saving and receiving special member only perks. The
English Longitudinal Study of Ageing has revealed, for instance, that chronic
pain (largely due to musculoskeletal. Correspondingly, close relationships and
social support may be experienced as more acutely inadequate in those who
 are depressed because of the distress and disabilities imposed by these
symptoms. That is, an individual’s levels of alcohol and tobacco use may be
affected by the degree of use of his or her social contacts or, in the case of
cessation, by the strength of his or her social supports. Individuals who lack
family are more apt to be socially isolated and to experience higher rates of
loneliness ( Verdery and Margolis, 2017 ). These same questions were then
asked again in relation to their friends and then in relation to their spouse or
partner.
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At that time, Lubben found that marital status and participation in religious
activities vary less in the older adult population. Over a life course, social
isolation and loneliness may be episodic or chronic, depending upon an
individual's circumstances and perceptions. The body of evidence for the
association of social connection (particularly of social isolation) with all-cause
mortality is strong, and the magnitude of this association may rival that of
other risk factors that are widely recognized and acted upon by the public
health and health care systems (e.g., smoking, obesity, physical inactivity).
Older adults who live alone without such support systems in place are more
likely to report symptoms related to loneliness and depression ( Herbert and
Molinsky, 2019 ). For example, because social isolation and loneliness may be
episodic for some, it is important to have several time periods of measurement
in order to determine if observed differences are true reflections of changes
in outcomes or if they represent measurement variability or natural
fluctuations over time. However, much of this success has to do with
shaming individuals who smoke cigarettes.
Social Isolation Essay PDF Social Networking Service Suburb However, this
does not mean that the health care system should not strive to help improve
the health and well-being of those who suffer the adverse health impacts of
social isolation and loneliness. The number of post-retirement individuals in
the United States is rising quickly, and retired individuals are living longer (
Boyle, 2019; Pew Research Center, 2019a ). 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. However, much of this success has to do with shaming
individuals who smoke cigarettes. The prospective analysis found that
perceptions of discrimination based on sexual orientation increased loneliness.
In the Hawton et al. (2011) study, older adults who were severely socially
isolated were found to have particularly low HRQL scores when compared to
peers of similar age in the general population.
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Therefore, this report focuses on the role of the health care system as a key
and relatively untapped partner in efforts to identify, prevent, and mitigate
the adverse health impacts of social isolation and loneliness in older adults.
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. Some of these populations include people who
were studied on the basis of their racial or ethnic background, sex (i.e., male
or female), age, socioeconomic status, health status, or place of residence
(e.g., rural, urban). Research pertaining to these populations is included
throughout the report. Therefore, the committee makes the following
recommendations. Several of these factors, including anxiety and depression
as well as cognitive factors such as dementia, are briefly discussed below.
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.
PDF Preventing social isolation and loneliness among older people a ...Some
of these populations include people who were studied on the basis of their
racial or ethnic background, sex (i.e., male or female), age, socioeconomic
status, health status, or place of residence (e.g., rural, urban). Research
pertaining to these populations is included throughout the report. As a result,
“public health has shifted its primary focus from addressing infectious
disease to tackling chronic disease” ( IOM, 2012, p. 3). Understanding the
impacts of the physical, chemical, and biological environments on health led
to the recognition of a broader set of determinants of health that is beyond
clinical medicine, though still largely within the biomedical framework.
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. The last three items come from the three-item UCLA Loneliness
Scale (described above). Supportive relationships can decrease self-reported
loneliness, while difficult or unfulfilling relationships can increase feelings of
loneliness ( Cohen-Mansfield et al., 2016; Shiovitz-Ezra and Leitsch, 2010 ).
Rates of divorce are also increasing in adults over 50 years of age, with
divorce rates highest among individuals who have been married two or more
times, among those with less education and a lower income, and among
African Americans ( Brown and Lin, 2012 ).
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Such services could allow individuals to travel to health care appointments

and to overcome individual transportation-related barriers to being more
integrated into local community events, both of which could help to reduce
social isolation and loneliness. Such an attribution continues to dominate
much thinking about health policy even to the present day, though its validity
has been increasingly challenged, and most health researchers now agree that
clinical medicine, public health, and social changes all contributed to this
increase in life expectancy (see House, 2015, especially Chapter 4; McGinnis
et al., 2002; McKeown, 1976, 1979, 1988; Szreter, 1988, 1997, 2000 ). While
a private home can provide comfort and security, it can also become a hazard
if occupants are faced with changes in functional abilities (e.g., trouble
walking or navigating stairs) ( Herbert and Molinsky, 2019 ). This list is not
comprehensive, and serious thought should be given to other potential ethical
concerns that may arise due to the nature of a specific assessment tool or
monitoring program. That is, the overall quality of the evidence base needs to
be improved, adequate funding of research will be required, and research on
major gaps in the current evidence base needs to be prioritized. Alternatively,
older adults may move to be with friends, relocate to a specific locale or
community, live closer or have more access to medical facilities, feel safer, or
live more affordably ( Bekhet et al., 2009; Crisp et al., 2013; Stimson and
McCrea, 2004 ).
PDF Loneliness and social isolation causal association with health ...Notably,
the frequencies of telephone, written, or email contacts were not associated
with depression at 2 years, indicating that in-person modes of contact were
uniquely protective ( Teo et al., 2015 ). The committee emphasizes that this is
not a comprehensive list of all available tools and does not represent an
endorsement of this committee but rather serves to. Content may require
purchase if you do not have access.) 313 Cited by Cited by Loading.
Furthermore, more needs to be determined about whether and when (e.g., at
what stage of. Over a 6-year period the English Longitudinal Study of
Ageing found that loneliness predicted frailty for men and women, while
social isolation predicted frailty only for men ( Gale et al., 2018 ). These
findings provide. That is, an individual’s levels of alcohol and tobacco use
may be affected by the degree of use of his or her social contacts or, in the
case of cessation, by the strength of his or her social supports.
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SOURCE: Holt-Lunstad et al., 2017. subsequent measurement of both social

isolation and loneliness, there is some evidence that the magnitude of the
effect on mortality risk may be comparable to or greater than other well-
established risk factors such as smoking, obesity, and physical inactivity
(which also have their own challenges in terms of determining causality).
Such an attribution continues to dominate much thinking about health policy
even to the present day, though its validity has been increasingly challenged,
and most health researchers now agree that clinical medicine, public health,
and social changes all contributed to this increase in life expectancy (see
House, 2015, especially Chapter 4; McGinnis et al., 2002; McKeown, 1976,
1979, 1988; Szreter, 1988, 1997, 2000 ). While both social isolation and
loneliness can affect health throughout the life course, this report focuses on
the health impacts of social isolation and loneliness among adults aged 50
and older. Caregivers commonly suffer from physical issues such as illness,
loss of appetite or sleep, or exhaustion as well as mental health issues,
trouble maintaining relationships with friends, or difficulty participating in
community or social activities ( Blum and Sherman, 2010; Dhruva et al.,
2012; Haines et al., 2018; Li and Loke, 2013 ). Despite the limits of the
evidence base concerning how best to implement these tools in clinical
settings, the committee concluded that an important aspect of selecting a tool
for use in clinical settings is standardization. Years of shared history and
memories become associated with one’s home, and leaving can be untenable
for some ( Granbom et al., 2014 ). In addition, the desire to remain
independent and enmeshed in established social networks close to home can
be a compelling reason to stay ( Benefield and Holtzclaw, 2014; Herbert and
Molinsky, 2019 ).
Guidebook for Social Work Literature Reviews and Research Questions ...
Driving is important for adults who want to maintain independence and
mobility; however, declines in physical health or cognitive function or
deficits in reaction time or coordination can lead older adults to stop driving (
Chihuri et al., 2016; Hwang and Hong, 2018; Johnson, 1999, 2008 ). For each
one, tell me how often you feel that way. A longitudinal community-based
cohort study of 985 older adults. The period since the 18th century saw the
development of modern biomedical health science as well as such public
health advances as the decline in infectious disease between the mid-18th and
mid-20th centuries and the decline in rates of smoking in the last half of the
20th century. With increasing cognitive impairment, individuals often
disengage from community groups and reduce their social ties as they are
experiencing parallel functional losses in other aspects of daily living ( Morris,
1993 ). For others, remaining single is a conscious choice, and many.
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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. Other work done in the context of older people’s social
networks has found social isolation to be associated with decreased
satisfaction with one’s life, hopelessness, increased risk of depressed mood,
and decreased happiness ( Golden et al., 2009 ). Additionally, research has
illustrated how certain dimensions of social isolation might have a greater
effect than others on an older person’s quality of life. Older adults in the
United States are increasingly choosing to live in supportive co-housing
communities, which can increase these adults’ social connections ( Glass and
Vander Plaats, 2013; Graham et al., 2014; Lubik and Kosatsky, 2019; Wick,
2017 ). Driving is important for adults who want to maintain independence
and mobility; however, declines in physical health or cognitive function or
deficits in reaction time or coordination can lead older adults to stop driving (
Chihuri et al., 2016; Hwang and Hong, 2018; Johnson, 1999, 2008 ). One
study found that individuals with a smaller social network size were more
likely to have newly diagnosed and previously diagnosed T2DM; no such
relationship was found for pre-diabetes ( Brinkhues et al., 2017 ). On the
other hand, pre-diabetes was found to be associated with a lack of social
participation, and living alone was associated with a greater likelihood of
previously diagnosed T2DM in men, but not in women ( Brinkhues et al.,
2017 ). Furthermore, this will support a step-wise approach to care that
includes the identification of individuals at risk, the provision of education,
and ultimately, intervention.
PDF Community intervention to reduce social isolation in older adults ...
Increasingly, these behaviors joined cigarette smoking as major targets of
intervention in both health care and broader public health policy ( HHS,
2001, 2010 ). 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. Register for a free account to
start saving and receiving special member only perks. 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. Upload Read for free FAQ and support Language
(EN) Sign in Skip carousel Carousel Previous Carousel Next What is Scribd.
The committee emphasizes that this is not a comprehensive list of all
available tools and does not represent an endorsement of this committee but
rather serves to.
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Click here to buy this book in print or download it as a free PDF, if available.
This list is not comprehensive, and serious thought should be given to other
potential ethical concerns that may arise due to the nature of a specific
assessment tool or monitoring program. To enhance the role of the health care
sector in addressing the impacts of social isolation and loneliness among
older adults, the committee identifies the following goal. This report uses the
specific terms “social isolation,” “loneliness,” or other terms when the data
are specific to these terms. 2. That is, the overall quality of the evidence base
needs to be improved, adequate funding of research will be required, and
research on major gaps in the current evidence base needs to be prioritized.
For example, studies have shown that smoking cessation among one’s social
contacts improves the likelihood that an individual will stop smoking, while
living with a smoker or having smokers among one’s social networks
decreases the likelihood of smoking cessation ( Holahan et al., 2012; Lacey et
al., 1993; Moore et al., 2014 ).
Preventing loneliness and social isolation interventions and outcomesOn the
other hand, Mullen and colleagues (2019) failed to find a significant
difference in perceived loneliness between rural and urban primary care
patients. Although research on these topics is sparse, it provides insight into
how these experiences can disrupt people’s lives and how they could lead to
social isolation or feelings of loneliness. 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. Loneliness and
other aspects of social connection are also emerging potential risk factors for
mortality. As mentioned earlier, these relationships are often bi-directional. It
is also important that older adults be given the opportunity to designate how
and with whom their health information should be shared.
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Qualitative aspects of social relations, such as social support, the quality of

relations, and a confidant relationship, were most consistently associated with
the presence or absence of depression in the cross-sectional studies. This
 interplay between individuals and their social and cultural milieus has given
rise to a wide array of inter-related research areas. Along this pathway,
depression can act as a partial mediator between loneliness and work
disability. Most notably, in the late 1970s and early 1980s a commission in
the United Kingdom found that differences in mortality by occupational
status had not declined at all and perhaps had even grown in the quarter
century after the National Health Service had presumably equalized access to
health services ( Black, 1982 ). In addition to initial clinical education, these
approaches should apply to professional education, continuing education
modules, online learning, and other forms of lifelong learning. 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.
Social Media Use and Perceived Social Isolation - I. Introduction ...
Furthermore, the committee recognizes that in the larger context of
addressing social isolation and loneliness, the most effective interventions
may not require the participation of the health care system. Furthermore, this
will support a step-wise approach to care that includes the identification of
individuals at risk, the provision of education, and ultimately, intervention.
Communicating with neighbors or others via the telephone can also have an
impact on one’s sense of social isolation or loneliness. This analysis, which
examined studies with data from more than 300,000 participants, found that
having a stronger social connection was associated with 50 percent greater
odds of survival. 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. Given the many life circumstances
implied by living alone (e.g., being independent), these data alone are of little
use in identifying patients at risk for negative outcomes related to social
isolation and loneliness ( LaWall et al., 2019 ). (See Chapter 7 for more on the
use of information technology in clinical settings.).

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As with the R-UCLA Loneliness Scale, the length of this instrument can be
challenging to use in large surveys. Close this message to accept cookies or
find out how to manage your cookie settings. That is, social isolation or
loneliness may increase the chances of developing a chronic health condition
(see Chapter 3 ), while, conversely, a chronic health condition may contribute
to social isolation or loneliness by interfering with the quality, quantity, or
structure of relationships or by worsening pathophysiological processes. In
particular, researchers should examine improved measures to identify
individuals who may be at. In addition to initial clinical education, these
approaches should apply to professional education, continuing education
modules, online learning, and other forms of lifelong learning. The Privacy
Rule, part of the U.S. federal law known as the Health Insurance Portability
 and Accountability Act (HIPAA), gives individuals rights over their own
protected health information and sets rules and limits on who can access and
share or receive that information when it is documented in electronic format.
Furthermore, some factors may increase the risk for social isolation and
loneliness (and ultimately, result in negative health impacts) while other
factors may provide protective benefits. The Privacy Rule, part of the U.S.
federal law known as the Health Insurance Portability and Accountability
Act (HIPAA), gives individuals rights over their own protected health
information and sets rules and limits on who can access and share or receive
that information when it is documented in electronic format. However, in the
longitudinal studies a lower quantity of social interactions was most often
associated with depression over time. Also, you can type in a page number
and press Enter to go directly to that page in the book. In a review of studies
of persons with dementia living in nursing homes, those interviewed
identified meaningful relationships and support for grief and loss as two of
their eight main concerns ( Shiells et al., 2019 ). The residents with advanced
dementia in particular expressed having a fear of loneliness. Communication
disorders have been linked to social isolation, reduced social participation,
and higher rates of loneliness ( Palmer et al., 2016 ).
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