The Perils of Social Isolation in Older Individuals

The second half of 2020 was a devastating time for many older individuals, even without catching COVID. A patient I will call Oscar, for example, had a neurocognitive disorder that impaired his ability to speak. Still, he had previously thrived on going outside with his wife Phyllis and being around other people. Despite her best efforts, however, Oscar didn’t understand the meaning of masks or social distancing, and so Phyllis had no choice but to keep him cloistered at home. I watched him withdraw and wither away month by month until he simply gave up and stopped eating. His subsequent death was like hundreds of thousands of others in the US that were not counted as COVID-caused but were indeed COVID-related.

The coronavirus has been an obvious foe that yielded, with time, to a predictable algorithm of diagnosis and treatment. Less recognized has been its impact on the lives of aging individuals who avoided the disease itself by isolating themselves at home. With time, however, we are beginning to understand how the limiting and lack of social contact has been as devastating and deadly as the actual virus. Its impact is another part of the tale that we cannot afford to lose among the science and unfortunate politics of the disease.   

What’s The Problem with Social Isolation?

Social isolation, defined by a lack of contact with other people, is a well-studied phenomenon that has been exacerbated but certainly not created by COVID-19. Loneliness is its subjective component and has long been recognized as a public health crisis. A major consensus study report released in 2020 by the National Academies of Sciences, Engineering, and Medicine that prior to the pandemic an estimated 25% of older adults felt socially isolated, and 43% reported loneliness. Factors that worsen social isolation and loneliness include increasing age, physical disability, cognitive impairment and living in a long-term care facility (National Academies of Sciences, Engineering, and Medicine. 2020). Social isolation can deprive people of access to the type of care and resources necessary in later life and is associated with significantly increased rates of depression, dementia, and incidents from heart disease and stroke. Despite these well-established scientific findings, social isolation and loneliness somehow routinely escape the attention of our doctors when we are assessed for all of the usual suspects that are critical to both our general health and the quality of our lives.

Our bodies and minds do better when we are with others, supported by studies showing that individuals who attend religious services, belong to civic organizations, or serve as volunteers are healthier and live longer. When National Geographic explorer Dan Buettner began studying the so-called Blue Zones around the world to identify the secrets of long-lived individuals, one of the key elements was social connectedness. Individuals like the elders and numerous centenarians of Okinawa who belong to life-long social support groups called moai, he found, had a key longevity advantage (Buettner, 2010). And it isn’t simply about living longer but living better. For example, we see the advantages to social connections in the findings of the Middle Age in the United States or MIDUS Study, in which having a sense of purpose, largely driven by social connections, reduced rates of heart attacks and stroke, and improved longevity (Hill & Turiano, 2014; Cohen et al., 2016). Repeatedly, both the science and the psychology of social isolation points to the singular fact that the close presence of others is life-giving, and their absence is a killer.

Does Social Isolation have Benefits?

I’ve railed against the social isolation costs that arguably were necessary and life-saving during the pandemic, but there is a flip side that must be explored. Social isolation itself does not always equate with feeling lonely but can be coupled and offset with a sense of solitude, defined as simply being alone. Solitude can be a blessing in giving us time to reflect, pray, study, and find oneself amidst the storms and strife of both everyday life and a pandemic. It can provide us with opportunities to renew, revitalize and repair relationships in our homes or across the lines of communication we’ve created while socially distanced.

At the same time, social isolation has been what I would call a stress test for the soul,  prompting us to find creative ways to cope, maintain connections with others, and start new pursuits. Indeed, many aging individuals finally learned to master the technology of their smartphones and computers. They created new classes, re-engaged with religious congregations and other communities, and became activists for various causes from the comforts and confines of their homes and neighborhoods. Older and younger generations in families and friendship groups who might have seen one another sporadically and only at very happy or sad occasions are now conversing regularly on zoom calls and discussing their thoughts and feelings together. They are worshiping and singing together, supporting one another in meaningful ways that belie the distance, politics, and social strife that have been driving us apart these past few years. In all of these circumstances, social distance and even isolation provides a buffer for individuals to actually approach one another and form connections in new ways.

Where Are We Heading? The Lessons of Social Isolation

The era of coronavirus brought a Devil’s bargain. Wherever the virus was raging, social isolation in the form of quarantines was the fastest and most effective way to slow and shut it down. But in doing so, the social isolation and its companion of loneliness are at one of the healthiest substrates of our lives and led to even more suffering and death. In the short run, it’s a bargain worth making; in the long run, the toll rises precipitously. So, is there a middle ground – a way to more effectively socially isolate without incurring all the known hazards? Fortunately, we’ve learned lessons from the past year to inform our post-pandemic world. We can adapt medicine and other businesses to video platforms, but we still need the regular physicality of being in the presence of others.  We have to identify social isolation and loneliness as our scourges and integrate mitigation strategies into medical care and social services. Finally, we must ensure that when technology is used, it can be geared towards older individuals' needs, interests, and abilities and does not become a sole substitute for in-person meetings.

I valued the opportunities brought by Telehealth throughout the pandemic, and yet I missed seeing my aging patients in person. Video chats just weren’t as informative or engaging as face-to-face encounters. My experience is not unique and highlights an essential characteristic of our neural wiring that not only depends upon social connections but only thrives with them.  While we hope that we will not face anytime soon the same degree of pandemic-related isolation, it is clear that social isolation and loneliness have always been with us and exact a devastating toll. The good news is that once we recognize their presence in the lives of those around us, we all have it within both our personal and professional abilities to counter this isolation by simply reaching out with regular in-person contact.

References

Buettner D: The Blue Zones: Lessons for Living Longer from the People Who've Lived the Longest. Washington DC: National Geographic (illustrated edition), 2010.

Cohen R, Bavishi C, Rozanski A: Purpose in life and its relationship to all-cause mortality and cardiovascular events: A meta-analysis. Psychosomatic Medicine, 2016, 78(2), 122-133.

Hill PL, Turiano NA: Purpose in life as a predictor of mortality across adulthood. Psychological Science, 2014, 25(7), 1482-1486.

National Academies of Sciences, Engineering, and Medicine. 2020. Social isolation and loneliness in older adults: Opportunities for the health care system. Washington, DC: The National Academies Press. https://doi.org/10.17226/25663. Accessed May 27, 2021 at: https://www.nap.edu/read/25663/chapter/1#ii

Marc Agronin, MD is a geriatric psychiatrist in Miami at Miami Jewish Health, and the author of The End of Old Age: Living a Longer, More Purposeful Life.