There is an increasing amount of attention being given to the positive effect that socialization appears to have on our physical and emotional wellness across the lifespan, but especially for older adults. Studies support that meaningful social connections are related to healthy aging https://pmc.ncbi.nlm.nih.gov/articles/PMC8514074/ Approximately 20 to 30 percent of older adults, however, report experiencing a sense of loneliness and social isolation. https://pmc.ncbi.nlm.nih.gov/articles/PMC7179802/ which has been described by some as a more serious health threat than smoking.    

It is important to differentiate between loneliness and social isolation. Loneliness is a feeling, a subjective emotion that can occur when a person feels remote from others and lacking in meaningful relationships. It is not necessarily about being alone but feeling disconnected. Social isolation, on the other hand, is more objective and can be best explained by having few social contacts or limited interactions with the outside community. For some, social isolation does not lead to feelings of loneliness. They may prefer solitude or the few intimate relationships they have are enough to meet their needs. It is how the individual perceives their sense of belonging, purpose, and connection that is important.   

As we age, there are some factors that can increase the risk of becoming socially isolated. Approximately one in three individuals over the age of 65 live alone. Living alone is not synonymous with being isolated, but it could contribute. After retirement, it may take considerable effort to find activities and relationships outside of the home that provide enjoyment or a sense of purpose. Physically, problems with mobility, medical conditions, and impairments in vision or hearing can all restrict social engagement. There may be socioeconomic factors impacting transportation and available resources.    

Losing intimate relationships with family and friends due to illness or death certainly elevates the potential for becoming isolated or feeling lonely. If health issues require a move from a beloved neighborhood and home to downsize or receive needed services, this can also result in a disconnect from familiar social contacts. 

Due to increasing responsibilities, family caregivers may have fewer options for social interaction and stimulation outside of the home. Lack of available or accessible support services such as counseling, support groups, and visiting programs to fill in these gaps could further add to an individual’s isolation.  

Research is emerging about the impact that extended social isolation during the pandemic and the heightened fear of serious illness and death had on older adults. One study of seniors showed that increased levels of loneliness were directly related to increased levels of depression because of the social distancing required during COVID-19. This data emphasizes the connection between social isolation and mental health. Additional studies also support that loneliness in older adults is related to an increased risk of dementia, functional decline, cardiovascular disease, stroke and overall mortality. From another perspective, in later life a broader social network and social engagement is associated with better cognitive function. https://pmc.ncbi.nlm.nih.gov/articles/PMC6700717/ Further investigation needs to be done to look at the direction of these relationships. Which comes first? Does loneliness and social isolation lead to unhealthy aging, vice versa or both?

Ideas for increasing socialization  

The American Public Health Association supports that socialization is an effective way for seniors to improve mood, cognition, memory recall and healthy behaviors such as exercising. It can also reinforce the feeling of connectedness and community and provide a sense of purpose and meaning.    As a result, a national effort has been made through The Older Americans Act and Area Agencies on Aging to support services that increase social connectedness such as Friendly Visitor Programs. Following the pandemic, the Rhode Island Office of Healthy Aging responded by launching digiAGE. This initiative teaches and supports technical skills to keep older adults connected online. Social media and internet use have been shown to decrease the sense of loneliness in seniors. “Social prescription programs” is a relatively new term to describe linking primary care patients with non-medical community resources to improve the wellbeing and the social needs of older patients. A prescription for better mental health could include facilitating a connection between the patient and an appropriate social outreach program.  

Some interventions for loneliness and social isolation in seniors appear to be more effective than others https://pmc.ncbi.nlm.nih.gov/articles/PMC10233446/. For example, activity or social based support groups and interventions with an educational or skill development focus have shown better outcomes. Structured discussions on topics relevant to older adults (i.e. nutrition, personal safety), intergenerational programs, and music-based interventions can also be effective. Internet use opens up important resources, especially to the homebound and family caregivers. There are online support groups, counselors, book clubs, faith-based groups and more.    

Local senior centers, churches, and libraries are focused on offering relevant community programs for older adults. Lifelong learning centers such as the Osher Institute at the University of RI have opportunities to teach or attend classes on a wide range of topics. Volunteering is associated with lower rates of depression and anxiety and websites like: https://serverhodeisland.com/ , https://volunteermatch.org , or https://states.aarp.org/rhode-island can connect you with organizations that fit with your interests and availability. Quilting, sewing, knitting, painting, and writing groups can all foster relationships through the creative arts.  

The Village Common of Rhode Island is expanding across the state. The plan for a Bristol-Warren Village is underway to help connect older adults in need with volunteer neighbors who can assist. Their core value statement includes: “engaging with others is central to our health and well-being. Our members and friends are active participants in social activities and volunteer work that nourish our connections to one another and to the larger community.”  Look for more information on this project over the next few months.  

Senior housing, assisted living facilities, and nursing homes offer ongoing and onsite social activity programs but for those living in the community staying connected can be more problematic. It is important for the public and for healthcare providers to recognize older individuals at risk and to encourage and help them to stay connected. There is a role for all of us to foster relationships that support healthy aging and reduce loneliness in our community.   

Bonnie Evans, RN, MS, GNP-BC, GC-C, lives in Bristol and is a geriatric nurse practitioner, End of Life Doula, and certified grief counselor. She can be reached at bonnie@bonnieevansdoula.com.