Loneliness and social isolation in older age: risks and ways to cope

Many older people spend long periods alone, and this can affect both mood and physical health. This article explains loneliness and social isolation, why older adults are at higher risk and what can help, using information from the National Institute on Aging (NIA), the US Centers for Disease Control and Prevention (CDC) and the NHS.

1. Introduction

The NIA defines loneliness as the distressing feeling of being alone or separated, and social isolation as a lack of social contacts, with few people to interact with regularly. A person can live alone without feeling lonely, and can feel lonely while surrounded by others ^[1]. The CDC makes the same distinction and notes that social isolation can be a health risk even if a person does not feel lonely ^[2]. The NHS says most people feel lonely sometimes, for many different reasons ^[3].

2. Causes and risk factors

The CDC names older adults as a group at higher risk of social isolation ^[2]. The NIA lists these risk factors ^[1]:

• Loss of mobility, or problems with vision or hearing.
• Memory or thinking difficulties.
• Living alone or being separated from friends and family.
• The death of a family member or friend, or retirement.
• Caring for an unwell loved one.
• Money worries, lack of transport or living in a hard-to-reach area.
• Language barriers, discrimination and a lack of purpose.

The NHS adds illness or disability, bereavement and moving home as common triggers ^[3]. The CDC reports that about 1 in 3 adults in the United States say they feel lonely, and that adults living alone and people with long-term illness or disability are among those at higher risk ^[2]. Loneliness is therefore common, and having it does not mean that something is wrong with you.

3. How loneliness affects health

Between them, the NIA and the CDC link loneliness and social isolation with a higher risk of ^{[1, 2]}:

• Heart disease and stroke.
• High blood pressure and type 2 diabetes.
• Depression and anxiety.
• Dementia and cognitive decline, which means a decline in thinking and memory.
• Earlier death.

The NIA adds that lonely or isolated people may exercise less, drink more alcohol, smoke and sleep poorly, and that daily tasks such as cooking, paying bills and taking medicines can become harder ^[1]. The NHS links loneliness with stress, anxiety and low mood, and warns that using alcohol, cigarettes, gambling or drugs to cope can make mental health worse ^[3]. The NIA also notes that lonely or isolated adults are more likely to be admitted to the emergency room or a nursing home and to have longer hospital stays ^[1].

4. Signs to watch for

The NIA does not give a formal checklist, but its content points to feeling lonely or isolated much of the time, withdrawing from others, feeling low, and frustration or embarrassment in conversations. Hearing difficulty is often linked with withdrawal, and conversation difficulties are sometimes mistaken for confusion ^[1].

5. What can help

The sources suggest these ideas ^{[1, 3]}:

• Schedule regular contact with family, friends and neighbours by visit, phone call, video chat, text or even letters and cards.
• Join a group, class, community or senior centre, faith-based group or cause, and consider volunteering.
• Restart a hobby or take up a new one. If technology is a barrier, ask about a class at a library or community centre.
• Be active with others, for example in a walking club. The NIA mentions aiming for 150 minutes of moderate activity a week ^[1].
• Take care of your health with healthy eating, regular exercise and 7 to 9 hours of sleep ^[1].
• Talk to someone you trust, and spend time in public places such as parks ^[3].
• Ask your doctor about social prescribing (a service connecting people with local activities) or befriending services where available ^[3].

If a person with dementia lives alone, the NIA suggests a trusted person such as a neighbour who can call or visit and act as an emergency contact, and mentions memory cafes, which are safe places for people with memory loss and their caregivers ^[1].

6. When to see a doctor

The NIA advises telling a doctor if you feel isolated or lonely much of the time, and sharing your physical, emotional and mental symptoms along with any major life changes or losses. It also advises seeing a doctor if you suspect hearing loss, because untreated hearing problems can make isolation worse ^[1]. The NHS suggests seeing a doctor if you struggle to cope with stress, anxiety or low mood, if low mood lasts more than 2 weeks or if self-help is not working. It also says that in the UK you can refer yourself to free talking therapies without seeing a doctor first, and that a doctor can be asked for an urgent appointment if you need help quickly but it is not an emergency ^[3]. In India and elsewhere, ask your doctor or a local clinic what counselling and community services exist near you.

If you or someone you know is thinking of suicide or self-harm, get help at once. In India, call Tele-MANAS on 14416. In the United States, call or text 988. In an emergency, call your local emergency number (112 in India, 911 in the United States).

7. Conclusion

Loneliness and social isolation are common in older age and are linked to poorer physical and mental health. Staying in regular contact, joining activities, keeping active and checking hearing can all help. A doctor can help with low mood and can point to local support.