Health care remains a connection point. Even when life course events and conditions (eg, death of loved ones, loss of transportation or financial resources, or disengagement from community activities) reduce social connections, most older adults engage in some way with the health care system. A 2020 consensus report by the National Academies of Sciences, Engineering, and Medicine suggests health care professionals capitalize on these connection points with adults ages ≥ 50 years by periodically screening for social isolation and loneliness, documenting social status updates in medical records, and piloting and evaluating interventions in the clinical setting.51
The report offered information about potential avenues for intervention by primary care professionals beyond screening, such as participating in research studies that investigate screening tools and multisystem interventions; social prescribing (linking patients to embedded social work services or community-based organizations); referring patients to support groups; initiating cognitive-based therapy or other behavioral health interventions; or recommending mindfulness practices.51 However, most of the cited intervention studies were not specific to primary care settings and contained poor-quality evidence related to efficacy.
Isolation creates a greater reliance on health services due to a lack of a social support system, while a feeling of emotional disconnection (loneliness) seems to be a barrier to accessing care. A 2017 cohort study linking data from the Health and Retirement Study and Medicare claims revealed that social isolation predicts higher annual health expenditures (> $1600 per beneficiary) driven by hospitalization and skilled nursing facility usage, along with greater mortality, whereas individuals who are lonely result in reduced costs (a reduction of $770 annually) due to lower usage of inpatient and outpatient services.52 Prioritizing interventions that identify and connect isolated older adults to social support, therefore, may increase survivability by ensuring they have access to resources and health care interventions when needed.
In addition, these findings underscore the importance of looking at quality—not just quantity—of older adults’ social connections. A number of validated screening tools exist for social isolation and loneliness (TABLE 253-59); however, concerns exist about assessing risk using a unidimensional tool for a complex concern,47 as well as identifying a problem without having evidence-based interventions to offer as solutions.47,51 Until future studies resolve these concerns, leveraging the physician-patient relationship to broach these difficult subjects may help normalize the issues and create safe spaces to identify individuals who are at risk.
QOL is key to healthy aging. As Kusumastuti et al4 state, “successful ageing lies in the eyes of the beholder.” A 2019 systematic review of 48 qualitative studies revealed that community-dwelling older adults ages ≥ 50 years in 11 countries (N > 4175) perceive well-being by considering QOL within 9 domains: health perception, autonomy, role and activity, relationships, emotional comfort, attitude and adaptation, spirituality, financial security, and home and neighborhood.60 Researchers found that as engagement in any one of these domains declines, older adults may shift their definition of health toward their remaining abilities.60 This offers an explanation as to why patients might rate their health status much higher than their physicians do: older adults tend to have a more holistic concept of health.
Continue to: Take a multidimensional approach to healthy aging