— Both primary and secondary prevention are essential; can include virtual and in-person solutions
by Joyce Frieden, Washington Editor, MedPage Today September 21, 2023
PHILADELPHIA — Loneliness among both seniors and younger people is a health problem that needs more attention, Kelsey McNamara, MPH, senior director of research at Papa, an organization that provides paid companionship to people in need of social support, said at the Population Health Colloquium.
“Loneliness increases the risk of premature death, independent of other kinds of physical and mental health conditions,” said McNamara. “You probably have heard the statistic that loneliness is just as dangerous as smoking a pack of cigarettes a day. And the relationship between loneliness and chronic conditions is bi-directional: inflammation and the biological conditions of loneliness can lead to illness, but also, having a chronic condition and the isolated experience and disabilities that might come up also leads to loneliness.”
McNamara began her talk on Tuesday with the case of Marvin Schur, a 93-year-old Bay City, Michigan man who froze to death inside his home in 2009 after his electricity was restricted for non-payment of bills. “He lived alone, he had multiple notices from the utility company that if he didn’t pay his bill, the utilities would be shut off,” she said. “Marvin was confused about how to pay these bills. He actually went to the bank and tried to pay multiple times, but the bank couldn’t [accept the payments].”
“Marvin was completely isolated, and it’s a shocking story,” she added. “Imagine if he had just one person to confide in, someone who he could seek advice from, someone to bounce ideas off of. I would argue that if he had that one person, that would have been the difference between life and death for Marvin.”
To find out more about the causes and effects of loneliness, Papa surveyed 28,000 Medicare Advantage members between January and June of this year. Of those surveyed, the average age was 72; 31% were male; and 13% were “dual eligibles” who qualified for both Medicare and Medicaid.
The survey found that more than one in three respondents (40%) had difficulty finding someone to support them in a time of need (22% said finding someone would be “somewhat difficult” and another 18% said it would be “very difficult”). Those with disabilities reported the highest level of loneliness (75%) compared to the general survey population (62%).
Loneliness was also associated with more unmet social needs and more transportation barriers. “Transportation is needed to get to medical appointments, but it’s also needed to travel to social gatherings, and to get to church, family, and friends,” said McNamara. “So this is not surprising.”
Loneliness also was associated with more emergency department (ED) utilization, with 12% of respondents characterized as “severely lonely” qualifying as frequent ED users, compared with 7.4% of those qualifying as “lonely” and 4.1% of those who qualified as “not lonely,” the survey found.
“Being hospitalized makes us more vulnerable to isolation, especially when you’re recovering and mobility is limited for a while, but the inverse is also true,” McNamara said. “People who are isolated are more likely to go to the hospital when it’s not medically necessary. So in our sample there’s a greater prevalence of ED frequent users as the degree of loneliness increases … and the literature actually shows that people who are socially isolated are six times more likely to go to the emergency department.”
Loneliness needs to be treated as a population health imperative, McNamara said, noting that Surgeon General Vivek Murthy, MD, MBA, recently issued an advisory on the nation’s epidemic of loneliness and isolation and the healing effects of community. “Loneliness is like an illness in that it can be episodic — in response to significant life events or the loss of a spouse — but it can also progress to a severe and chronic state, so we need primary prevention.”
The people who are most at risk for loneliness and social isolation traditionally include women, as well as people at a lower socioeconomic status, the LGBTQ+ community, and older adults, “though now also younger adults,” as well as people who have had recent losses, she said. “So can we screen and identify these people earlier and prevent them from turning into disconnected individuals?”
Secondary prevention is also needed; this is for “the people that are starting to disconnect,” said McNamara. The important thing is to find the right intervention for a specific individual; for instance, “if someone has a recent loss, if we tell them to go to the community center more, that’s not going to help them when what they really need is grief counseling.”
Solutions should include a balance between virtual and in-person interventions. In the virtual world, there are things like Snapchat and robot pets, and while different types of interventions work for different people, “I would argue nothing can replace in-person, face-to-face” interventions, she said.
“We need to treat loneliness and social connection needs like other types of social determinants of health — housing, transportation, and food insecurity,” McNamara concluded. “We need to ensure it’s a standard part of screening, and then we actually need to act on data and do something about it. And what we see again and again is that ‘social prescribing’ is only the first step and we need to work collaboratively with patients to help them over time.”
