Thursday, September 29, 2016

Social isolation and health

An interesting study by the AARP sheds some light on isolation and health, which I have posted about before, but as we age we lose our support group unless we work on keeping it. So to help find a reason to maintain  a strong social network you might want to review this study (pdf file)

“Social isolation is the distancing of an individual, psychologically or physically, or both, from his of her network of desired or needed relationships with other persons. Therefore, social isolation is a loss of place within one’s group(s)”  (Biordi & Nicholson, 2009)

One of the underlying factors determining prevalence of people considered “isolated” is whether they live alone. According to a recent study by the National Council on Aging, an estimated 17% of all Americans over the age of 65 are isolated because they live alone and face one or more barriers related to geographic location, language, or disability. In addition, half of those older Americans are considered economically unstable (Ortiz, 2011).

People who have limited income are considered to be more susceptible to isolation because they have limited resources to overcome barriers associated with isolation. Many researchers agree, however, that a solitary lifestyle alone is not an accurate indicator of isolation.

Based on a synthesis of the scientific research, this paper proposes the following unifying definition of isolation. Isolation is the experience of diminished social connectedness stemming from a process whereby the impact of risk factors outweighs the impact of any existing protective factors. A person’s lack of social connectedness is measured by the quality, type, frequency, and emotional satisfaction of social ties. Social isolation can impact health and quality of life, measured by an individual’s physical, social, and psychological health; ability and motivation to access adequate support for themselves; and the quality of the environment and community in which they live.

Isolation in adults aged 50+ occurs due to a complex set of circumstances and factors that exist at the individual, social network, community, and societal levels. The primary risk factors associated with isolation are:
·       Location: rural, unsafe or inaccessible neighborhood/community;
·       Small social network and/or inadequate social support;
·       Language (non-English speaking); and
·       Membership in a vulnerable group.

These factors can be grouped into psychological, physical, and social categories.
  •  Isolation can also be triggered by the following major life changing events:

o  Change/Loss of Social Network
o  Social Role
o  Physical Health
o  Mental Health
o  Resources

  • Contextual factors that are relevant to the occurrence of isolation include individual psychosocial states that play a role in isolation, as well as social factors such as social networks, social supports, social engagement and integration, income, mobility, societal factors, and the physical environment.
  • Health and isolation are strongly linked, although further study is required to delineate the specific pathways through which isolation impacts health.
  • Events, including changes in/loss of a social role, physical and mental health, social network, resources, and location of residence, can also trigger factors, both risk and protective, that can lead a person closer to or away from isolation.

There is a great deal of diversity among intervention designs, target populations, and outcome measures for interventions. The most common interventions reviewed in the literature fall into group and one-on-one categories and have been implemented with people living in community settings (as opposed to residential care settings). These interventions have aimed to: Reduce loneliness and/or depression;
·       Increase social network size;
·       Improve quality of supports; and
·       Increase frequency of social contacts.


A strong link has been established between isolation and morbidity, and isolation is considered a risk factor in development of illness and impairments in the presence of illness (Berg & Cassells, 1992). The link between social relationships and health has been widely studied. Cacioppo and his colleagues examined the mechanisms through which loneliness can impact health. In their study results and reviews of previous literature, they identified a long list of health conditions with which loneliness (subjective isolation) is associated (Cacioppo et al., 2009).

Additionally, research has found loneliness to be a predictor of depression and suicidal ideation In her study of loneliness in a sample of adults aged 50 and older, Theeke found that chronic loneliness was associated with higher numbers of chronic illness and higher depression scores, among other health-related issues (Theeke, 2007). Isolation has also been demonstrated to be predictive of cognitive impairment in older women .

Tomaka et al. (2006) found isolation to be related to disease outcomes including diabetes, hypertension, arthritis, and emphysema. Evans et al. (2008) stated that risk exposures of isolation including likelihood of having reduced social networks could offer a major connection between income and health. Isolation resulting in lack of transportation can also have health consequences.

A 2006 report from the Transit Cooperative Research Program of the Federal Transit Administration identified that 3.6 million Americans, a large portion of whom are older, low income, and minorities, have deferred or altogether missed routine medical care due to lack of transportation. In turn, such a trend could lead to higher national health care costs

Berkman et al. (2000) propose a framework that illuminates the path from isolation to health through social networks: We have identified five mechanisms by which the structure of social networks might influence disease patterns:
1) biological and psychological pathways proximate to health status,
2) health behaviors,
3) psychological mechanisms,
4) physiologic pathways, and
5) the social environment in adulthood.

While social support is the mechanism most commonly invoked, social networks also influence health through additional behavioral mechanisms including:
(1) forces of social influence;
(2) levels of social engagement and participation;
(3) the regulation of contact with infectious disease; and
(4) access to material goods and resources.

These mechanisms are not mutually exclusive. In fact, it is most likely that in many cases they operate simultaneously (Berkman et al., 2000).

Cornwell and Waite (2009) found an independent association between their two measures of isolation and health. Higher levels of social disconnectedness and perceived isolation were associated with lower levels of self-rated physical health. 

They also determined that there is a benefit to considering both of these dimensions simultaneously (Cornwell & Waite, 2009). Evans et al. (2008) confirmed in a sample of community-dwelling (non-institutionalized) older adults that there is a relationship between lower income and poorer health.

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