June 18, 2024

In order to make an impact and improve physical and mental health, we need to recognize the need to approach loneliness as a condition. Building connections through social intervention is the most direct way to affect change.

Loneliness is more than a state of being. It can make the difference between health and sickness, even between life and death. Among people aged 60 and older who regularly feel alone — what I would call the condition of “chronic loneliness” — 45 percent have an increased risk of dying sooner than their socially-connected peers. Just this month, the American Heart Association highlighted the risks between cardiovascular disease and loneliness and social isolation. And a new study from the University of Michigan linked the length of loneliness to accelerated memory decline.

Melancholy woman resting at the terrace

As loneliness has been studied, the health risks have been tied to it have been found to be greater than obesity, physical inactivity, excessive alcohol consumption, or even smoking up to 15 cigarettes per day. These  are alarming and eye opening. As an epidemiologist, I see the rise of chronic loneliness and social isolation as an epidemic, affecting physical and mental health as much as any other social determinant of health (SDoH). To improve the health of our population, we need to understand loneliness as a chronic health condition; identify its causes and provide solutions that work for all populations; and focus on prevention.

Our national loneliness epidemic is rooted in the structural depersonalization of a more automated, digital way of life, where the social interactions that combat loneliness have eroded. However, on an individual level, the determinants of situational, episodic, and chronic loneliness are more personal. For the healthcare industry, that presents an opportunity to address people’s loneliness.

Loneliness as social health

As with any chronic condition, we can begin by examining who’s most affected. Race and income level contribute to higher rates of loneliness. One study found that 75% of Hispanic adults and 68% of Black adults are classified as lonely – compared to 58% of the total adult population. Sixty-three percent of adults earning less than $50,000 per year are classified as lonely — a 10% differential from higher earners. Seventy-two percent of people who receive health benefits through Medicaid are classified as lonely, compared to 55% of adults covered by private or employer-provided health insurance.

We can’t give people a pill for loneliness, but as with other chronic conditions, there are ways to prevent and manage it. If someone is diagnosed with diabetes, their intervention includes everything from diet and nutrition counseling to insulin management. What would a similar approach look like for loneliness?

Knowing the disproportionate impact of loneliness on people of color and economically disadvantaged populations, we must ask ourselves: What are the best methods to reach people and what can be done to make them feel more engaged with their communities? If social contact is the most direct means to do so, how can that be engineered?

Managing loneliness as a chronic condition

Loneliness can be quantified to reflect its cause and severity (situational, episodic, chronic), and that can determine what type of intervention (primary, secondary, tertiary) can be most appropriate and effective. For example, the long-term cumulative effect of physical or mental health issues can contribute to chronic loneliness. Once a person has reached chronic loneliness in such a case, a tertiary intervention would be appropriate. That would include ongoing social support; for example, a visit from a companion, twice per week for a full year. While they may not necessarily improve in loneliness, the aim is that they not decline further in mental health.

Episodic loneliness, such as after the loss of a loved one, or recovery after hospitalization, may be effectively served by a short-term program that helps the individual recover and adjust to their new situation. For example, a 12-week companion program that has weekly in-person visits after a hospital discharge, then a monthly check-in can get someone through a post-hospital discharge event. I would consider that a secondary intervention.

Screening for loneliness periodically and quickly turning on a program for people who score as lonely is another means of secondary prevention. The goal is to mitigate the episodic loneliness so it doesn’t turn into a chronic loneliness condition.

There’s urgency to this epidemic. More and more people are reporting severe loneliness but we have found that clinical outcomes of social interventions in that time have demonstrated the positive effect of companionship.

Building human connections

For years, we’ve seen the prevalence of loneliness factors that don’t present overtly in a physician’s office, but affect health as much as any other SDoH. Since 2020, the Covid-19 pandemic has both exacerbated and brought greater attention to the condition. Perhaps the collective lightbulb has finally gone off.

In order to make an impact and improve physical and mental health, we need to recognize the need to approach loneliness as a condition. Building connections through social intervention is the most direct way to affect change. Understanding loneliness and social isolation as an SDoH is the crucial step in addressing the health of millions of people affected by the loneliness epidemic.

Ellen Rudy

Dr. Ellen Rudy serves as the Vice President of Health and Social Impact at Papa with the responsibility to evaluate Papa’s impact on members’ quality of life, health outcomes and total cost of care. Dr. Rudy earned her Ph.D. in Epidemiology from University of California, Los Angeles and completed a postdoctoral fellowship in Health Policy and Research at RAND/UCLA. She most recently worked at Molina Healthcare, a managed care organization providing Medicaid and Medicare health care services with leadership responsibility across Population Health Management, Health Policy and Research, Quality and Healthcare Operations.

She currently serves as an expert faculty member at University of Southern California Sol Price School of Public Policy. She is an avid hiker, skier, and mom of two kids and two rescue dogs.

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