Loneliness in Older Adults
By Chava Pollak
Loneliness has become increasingly prevalent among older adults, a trend that has escalated since the onset of the COVID pandemic (Bruce et al., 2019; Su et al., 2023). It is widely recognized that loneliness not only impacts the psychological well-being of older individuals, but also impacts physiologic health across a range of negative health outcomes, including cognitive and functional decline, depression, Alzheimer-type dementia, and mortality (National Academies of Sciences, Engineering, and Medicine, 2020).
Loneliness screening is recommended as best practice by the US Surgeon General, the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), the American Heart Association (AHA), the National Academy of Sciences, Engineering, and Medicine (NASEM); however, with all the competing priorities in clinical practice, both in primary and acute care, loneliness screening often falls by the wayside.
The therapeutic presence as an intervention is one of the earliest and oft-repeated themes of nursing education and practice and can be leveraged to address loneliness in older adults. While several validated loneliness tools exist, a single-item question inquiring how often one feels lonely can also be used to open a conversation with the patient.
Opening a conversation can establish trust, reduce stigma, and identify individuals who would benefit from intervention. Additionally, the provider can leverage their trusting relationship to educate patients that addressing loneliness is vital for their physical health. The advanced practice provider is also key to addressing reversible causes of loneliness, such as sensory or functional impairment or incontinence.
By identifying lonely individuals, screening opens the door to intervention. Besides addressing reversible causes, there are also community resources to address loneliness, such as friendly calls, intergenerational visits, senior centers, and transportation. The availability of programs varies by community, and local Offices of the Aging are a valuable resource for information about services that older adults who screen positive for loneliness can be connected to (e.g., friendly calls, intergenerational visits, senior centers, transportation).
Care for the whole person is the bedrock of nursing practice, and screening and intervention for loneliness is a core element of holistic care of older adults.
Chava Pollak, PhD, RN
chava.pollak@einsteinmed.edu
References
Bruce L.D., Wu, J.S., Lustig, S.L., Russell, D.W., & Nemecek, D.A. (2019). Loneliness in the United States: A 2018 national panel survey of demographic, structural, cognitive, and behavioral characteristics. American Journal of Health Promotion, 33(8), 1123-1133. https://doi.org/10.1177/0890117119856551
National Academies of Sciences, Engineering, and Medicine. (2020). Social isolation and loneliness in older adults: Opportunities for the health care system. National Academies Press. https://doi.org/10.17226/25663
Su, Y., Rao, W., Li, M., Caron, G., D'Arcy, C., & Meng, X. (2023). Prevalence of loneliness and social isolation among older adults during the COVID-19 pandemic: A systematic review and meta-analysis. International Psychogeriatrics, 35(5), 229-241. https://doi.org/10.1017/S1041610222000199