Social Isolation and Loneliness in Older Adults—A Mental Hea
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Health care workers, as well as society at large, recognize that social isolation and loneliness (SI/L) are major public health concerns in higher-income countries. Almost one-fourth of community-dwelling older adults are socially isolated, while 35% of adults 45 years and older report feeling lonely. Social isolation and loneliness increase mortality risk.

Having SI/L increases the risk of depression (as well as suicide) and dementia and it is distinct from these disorders. Higher loneliness in mid to late life has been associated with elevated cardiovascular and neuroendocrine markers of stress, impaired sleep, and proinflammatory physiological effects, which may accelerate neurodegeneration in the hippocampus and in other brain regions important for emotional regulation and cognition.

Advances in health technologies, increases in data collection (especially using the electronic health record), and predictive analytics should improve the ability to identify those who have SI/L.

One of the most critical deficits is a paucity of evidence-based interventions. A theoretical framework was recommended to bring together and optimize resources supporting new interventions. Their interventions may include specific approaches, such as one-on-one befriending protocols in which volunteers make telephone calls or in-person visits to individuals identified with SI/L.

Appropriate measures for assessing SI/L should be valid and reliable and allow for changes to be tracked over time. If successful, interventions may be expanded and sustained through additional allocated resources. Finally, results derived from intervention trials should be published in peer-reviewed journals and shared with others (data sharing). More novel interventions are increasingly used, such as the use of social robots (eg, a robotic animal or conversational agent). The committee encouraged future research in this area yet cautioned that interventions using novel agents should be carefully monitored for potential harmful effects.

Education will be key to improving methods of identifying SI/L and implementing interventions. Despite limited research on the effectiveness of selected interventions for SI/L, health professionals, including community health workers, should learn core content in areas such as the prevalence, morbidity, and mortality of SI/L, risk factors, assessment strategies, and referral options, such as referral for hearing loss when appropriate. Mental health care clinicians face substantial time challenges, including limited time allocated to evaluation and therapy, which do not yet include standardized assessments of SI/L.