1. Marshall, Katherine DNP, NP, PMHCNS-BC, CNE
  2. Hale, Deborah MSN, RN, ACNS-BC

Article Content

Loneliness is the feeling of being alone, despite the degree of social contact with others, whereas social isolation is a lack of social connections. Social isolation can lead to loneliness in some individuals, whereas others can feel lonely without being socially isolated (Centers for Disease Control and Prevention [CDC], 2020). As reported by National Academies of Sciences, Engineering, and Medicine (2020), more than one-third of adults aged 45 and older feel lonely, and nearly one-quarter of adults aged 65 and older are considered to be socially isolated.


Social isolation and loneliness can have a serious impact on health and quality of life. You may be the first to identify the first to identify individuals at risk of, or coping with, loneliness. Current Covid-19 pandemic conditions have dramatically increased the incidence of older individuals in protective isolation. Risk factors for loneliness include living alone or in rural communities, poor functional status, widowhood, female gender, lower income/education, multiple recent losses, depression, or feelings of being misunderstood (Berg-Weger & Morley, 2020). Recent immigrants have fewer social connections and limited social integration and struggle with language and cultural barriers. Bisexual, gay, and lesbian populations report increased incidence of loneliness due to discrimination, stigma, and barriers to care (CDC, 2020).


Social isolation has been associated with a 50% increase in risk of dementia. Poor social relationships have been associated with a 29% increased risk of heart disease, and a 32% increased risk of stroke. Loneliness is associated with higher rates of depression, anxiety, and suicide. Loneliness among heart failure patients is associated with a nearly four times increased risk of death, 68% increased risk for hospitalization, and a 57% increased risk for emergency department visits (CDC, 2020).


Strategies to manage and alleviate social isolation and loneliness in home healthcare patients and caregivers include:


* Help patients identify friends, family, neighbors, caregivers and church associates, and make a list of phone numbers and emails. Encourage patients to make staying in touch a priority.


* When appropriate, encourage patients to have up-to-date communication equipment. Cell phones are helpful for texts, photos, and video chats. Seeing a friendly face can decrease feelings of loneliness.


* Encourage patients to take walks outside, wave to the neighbors, sit on the porch and people-watch.


* Facility-bound patients can request socially distant window or patio visits with loved ones.


* Connect patients to online book/movie clubs, or craft groups.


* Share current events during visits.


* Connect patients and caregivers with on-line support groups.



Home healthcare clinicians are in an optimal position to assess for, and treat, social isolation and loneliness in older patients. Recognition of patients at risk and prompt attention to prevention are key. Appropriate interventions for patients struggling with social isolation and loneliness can dramatically improve their quality of life and reduce unnecessary distress and mortality.




Berg-Weger M., Morley J. E. (2020). Editorial: Loneliness and social isolation in older adults during the Covid-19 Pandemic: Implications for gerontological social work. The Journal of Nutrition, Health and Aging, 24(5), 456-458.[Context Link]


Centers for Disease Control and Prevention. (2020, May 26). Loneliness and social isolation linked to serious health conditions. In Alzheimer's Disease and Healthy Aging.[Context Link]


National Academies of Sciences, Engineering, and Medicine. (2020). Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. The National Academies Press.[Context Link]