01 Aug 2018 Key Takeaways: Social Isolation on Rural Aging Population Discussion in Health

Studies show a 29 percent increased risk of mortality associated with social isolation and a 26 percent increased risk with loneliness. Moreover, a lack of social connectedness among older adults was found to increase Medicare spending by $6.7 billion annually. Recently, BPC hosted a roundtable discussion on the effects of social isolation on the nation’s rural aging population. The event was designed to further the conversation on this critical issue with a diverse group of experts and stakeholders around the country. BPC released an issue brief on the group’s insights last month. Here are BPC Action’s key takeaways. Click here for the full summary.

• The Issue of Social Isolation is Often Misunderstood

Most people have a general sense of what social isolation means, but few agree on a specific definition, partially because social isolation and loneliness are often used interchangeably despite having different meanings. The roundtable acknowledged social isolation as an objective measure that draws from factors such as a lack of meaningful relationships or regular social contact with other people. Loneliness is purely subjective, based on the feeling of being alone or running a discrepancy between the level of social connectedness a person desires and they level they actually have.

Due to the objective nature of social isolation, it is relatively easier to track and to identify specific causes. In America’s aging population, people living alone can find diminishing family connections to be their reality, while factors such as poor health and an inability to use technology impede their ability to form connections on their own.

• Social Isolation is More Serious and Prevalent than Widely Assumed

Roundtable participants discussed research indicating that social isolation and loneliness increase mortality rates irrespective of age, gender, and country of origin. One analysis found that social isolation led to a 29 percent increase in mortality, with loneliness at 26 percent. Furthermore, a recent study found that almost 50 percent of all Americans, not just within our aging population, currently “feel alone” and that those aged 18-29 may be the “loneliest generation ever.” This means that the problems we face today will be immensely larger in the decades to come, making it even more vital to explore potential national and local-level solutions.

• Solutions Should Build on and Improve Existing Resources, Infrastructure, and Policy

Many solutions to this problem exist but may need further testing and evaluation. Roundtable participants discussed potential solutions both big and small, focusing on those that could be readily implemented and demonstrate quick and effective results. Participants noted that several necessary structures are already in place to aid such approaches, such as: encouraging seniors to utilize local community and care navigators, encouraging local community and healthcare resources to collaborate, and ensuring that programs already connecting with seniors in their homes include screening for social isolation.

In the public policy domain, the group discussed including social isolation among the social determinants of health and requiring the Healthy People 2030 report to specifically address the issue, to increase its visibility. Other solutions such as providing computer training to seniors and their caregivers, leveraging internet-based supports for health care, transportation, and education, and prioritizing broadband access in rural areas could expand communications and help keep seniors connected.

• Reforming Health Care Delivery and Payment Systems is a Must

Larger solutions could be explored at the health system level, and there is plenty of fertile ground in the health care delivery and payment reform arena. An important first step would be to analyze whether it is appropriate to modify federal health care programs to allow payment for social support services that can improve social connectedness. Policymakers would need to develop models and functioning mechanisms to shore up rural health care systems and develop a valid screening tool to track social isolation. Such a tool could be implemented during Welcome to Medicare and annual Medicare exams to minimize inconvenience. Other potential solutions include analyzing whether programs such as Medicare Advantage need reform to increase flexibility and examining whether there are appropriate opportunities to address social isolation through Medicaid waivers or CMS Center for Medicare and Medicaid Innovation (CMMI) models.

• This Issue Should be Addressed on the National Level

Given the prevalence and adverse outcomes stemming from social isolation, BPC roundtable participants stressed that the discussion should be raised to the national level. Participants advocated for a collaborative effort to establish a broad-based national campaign to raise public awareness about social isolation, the damage it causes, and the steps that can be taken to reverse it. This campaign would be especially targeted towards the public health community and seniors themselves, raising awareness of what to expect and how to find resources to improve social connectedness. The campaign could also help seniors connect with housing, medical or social services, transportation, and other local resources to meet their needs. Roundtable participants also urged the federal government to appoint a high-ranking official to establish and coordinate the implementation of national strategies to end social isolation as a major cause of poor health outcomes and mortality in America.