The scourge of loneliness and social isolation

 We have so many ways to communicate with each other today that didn’t exist 50 years ago, such as through the Internet and with mobile phones, yet we report greater social isolation and loneliness than ever before.  Research studies suggest that about a quarter of the U.S. older adult population suffers from loneliness (e.g., affirming an item asking if you have felt lonely over the past week). We see this in some of our research projects where we telephone-screen large numbers of older adults and sometimes get the comment that we are the first person that they have talked to in days.

This problem is not just an aging adult issue.  In some surveys younger adults self-report even more loneliness than other age groups.  

Although loneliness and social isolation are related, they are separable constructs.  Social isolation is usually defined in terms of objective measures of social contact (e.g., frequency of talking to or meeting in person with other people). Loneliness refers to a subjective state, such as the perception of lacking affection and closeness (emotional loneliness) and lacking close friends and family (relational loneliness).  Another way to think of these distinctions is to consider that living alone is not necessarily indicative of loneliness, but it certainly raises the risk of social isolation.  

Important risk factors for loneliness and social isolation are age (older people are more likely to report being lonely), physical and mental health (greater disability is associated with greater loneliness), lack of access to mobility options (driving, public transportation), lower income levels and living arrangements (living alone).  Taking on the role of full-time caregiver for a loved one can also lead to social isolation.

Because humans are social animals, social isolation is bound to lead to negative consequences. Indeed, research has shown that lack of social relationships is associated with negative health outcomes. Lack of social connectedness is associated with greater risk than obesity and is roughly equivalent to smoking 15 cigarettes a day; negative outcomes include morbidity (disease) and mortality (earlier death).  In fact, about a year ago, the United Kingdom appointed a Minister for Loneliness as a cabinet post.

Now, cross-sectional association studies leave much to be desired for formulating social policy and for justifying interventions.  Such studies indicate associations, not causal relations. Nonetheless, here in Tallahassee our Senior Center implemented (in 2018) an intervention program, UPSLIDE, with funding from Florida Blue Foundation, to counteract potential negative effects.

The CREATE team has been looking at technology-based approaches to mitigating social isolation in older adults. In our first clinical field trial, the PRISM study, we modified an existing computer system to enhance its interface to suit aging users and then provided in-home training on its use.  Features included e-mail, buddy lists, Internet access, links to community and national services, educational topics, a calendar, and games. We enrolled aging adults, age 65 and older, who were not computer users and who were at risk for social isolation (living alone, not working, not doing significant volunteer work).  

We showed that after six months there was reduced loneliness compared to a control condition that provided similar features in paper format (the binder control condition, lacking interactivity).  However, by 12 months the two groups showed equivalent gains in well-being measures suggesting only a short-term benefit for PRISM. So, there was some promise for using technology to improve social interaction.

In our second study, still in the field, we designed the interface and apps for a tablet-based system and are comparing the impact on wellbeing measures to a control group using the same tablet but without our specially designed interface. Both groups are getting trained in tablet use.  We are eagerly awaiting the results.

Facilitating social connectivity is an important challenge for an aging population that near end of life is at risk of losing important social connections.  Partners, friends, and family members may die or move away. Mobility may become impaired, making it difficult for aging adults to leave home.  So, we and others continue to look at whether it is possible to leverage modern technology to address the challenges of mitigating social isolation and loneliness.