More COVID-19 Fallout: Social Isolation Associated with Poor Health and Emotional Distress

As a result of social distancing and other interventions, the COVID-19 pandemic has cut many people off from their emotional and social support systems. For older adults, this may have exacerbated feelings of isolation; the percentage of those who reported feeling isolated jumped from 27 percent in 2018 to 56 percent after the start of the pandemic. This is particularly concerning for older adults with high health care needs — that is, people with multiple chronic conditions or functional limitations who require assistance with daily activities. Feelings of isolation not only create emotional distress but also have the potential to further exacerbate their already complicated health problems and even contribute to early mortality. Social distancing was an effective approach to slowing COVID-19 transmission — especially among a population at increased risk of infection — but any resulting feelings of isolation may have contributed to new health and social risks for this medically vulnerable group.

To explore how isolation affects high-need older adults and examine their experiences during the pandemic, we analyzed data from the Commonwealth Fund 2021 International Health Policy Survey of Older Adults. We found, consistent with previous research, that high-need adults are significantly more likely to report social isolation; more than one of 10 (12%) high-need older adults reported often feeling isolated from others, compared to 5 percent of older adults without high needs.

In line with previous research, isolation appears to be associated with poorer health. High-need older adults who reported feeling isolated were more likely than those not feeling isolated to report they were in fair or poor health (rather than good or excellent health); these adults were also more likely to report going to the emergency room for care that could have been provided by their regular clinician.

Among high-need adults who feel isolated, nearly two-thirds reported having a mental health diagnosis or feeling emotionally distressed in the past year; this is a significantly higher rate than high-need adults who do not feel isolated. Experts report that the relationship between mental well-being and feelings of isolation are bidirectional, with isolation worsening an individual’s mental health conditions, and mental health conditions exacerbating feelings of isolation. It is possible the COVID-19 pandemic had a multifaceted impact on the mental well-being of older adults.

Almost all high-need older adults, even those experiencing social isolation, report having a regular provider, indicating primary care clinicians are well positioned to both manage physical health needs and assess for and address isolation.

Technology allowed older adults to connect to health care and their loved ones during COVID-19. High-need isolated adults were significantly more likely than high-need adults not experiencing isolation to report having a telehealth appointment during the pandemic. In addition, nearly two-thirds of high-need older adults reported using the internet and electronic devices to connect with their friends, family, and community at least once a week during the pandemic. This suggests older adults are comfortable using technologies to connect with health care and social networks during health emergencies that require it, but, as many are still experiencing isolation, these approaches may not be sufficient replacements for in-person interaction.

Implications

It is important to understand and address the compounding impact of health issues and isolation on older adults. The health care system can play a role in identifying and addressing feelings of isolation, especially among high-need older adults, by screening for isolation or loneliness, evaluating its impact on physical and mental well-being, and connecting patients to appropriate supports. Connecting isolated older adults to effective resources such as support groups and social services could not only improve health outcomes and lower the cost of care for high-need adults, these resources could also mitigate feelings of isolation.