Loneliness among older adults stems from many factors
Transcript
Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.
More than a third of adults 65 and older in the United States reported loneliness during the COVID-19 pandemic.
But was that because they were socially isolated? Assistant professor of public health and preventive medicine at Upstate, and Mr. Miguel Pica was a student in his advanced biostatistics course.
Welcome, both of you, to "The Informed Patient" podcast.
Roger Wong, PhD: Thank you, Amber.
Miguel Pica: Thank you, Amber.
Host Amber Smith: So Dr. Wong, the surgeon general declared loneliness and social isolation to be a national epidemic in May 2023. Do you think the rates of both have stayed high because of the aftereffects of the pandemic?
Roger Wong, PhD: Before I answer your question, I first want to congratulate Miguel for leading this study. It's, as you mentioned, his final project from my advanced biostatistics course. It was a wonderful paper. He is the first author on it.
So Amber, your question was about the trends in loneliness and social isolation.
Before the pandemic, before 2020, it was pretty stable every year for social isolation and loneliness. It spiked in 2020 during the pandemic, and then it has remained elevated after that. It hasn't really gone down to pre-pandemic levels yet, but I think what I'm seeing from the data is that the further away we're moving from 2020, it's gradually going down to pre-pandemic levels, so I expect once we see the new data released that it'll probably be closer to pre-pandemic levels either this year or next year.
Host Amber Smith: Well, that's encouraging, but it has taken a lot longer than you would think, I guess.
Roger Wong, PhD: Yeah, and as many people would imagine, the pandemic really disrupted everyone's social networks, but this really affected older adults moreso, because they're more vulnerable to infectious diseases.
So that's why their social networks were really interrupted during the pandemic.
Host Amber Smith: So, Mr. Pica, the database you used was from the 2020 National Health and Aging Trends Study. What can you tell us about it?
Miguel Pica: The National Health and Aging Trends Study, has been utilized as a survey since 2011, collecting annual data through interviews with older adults, ages 65 and older. They've been followed every year, collecting details on a national level on disability trends and trajectories.
Roger Wong, PhD: And to add to Miguel, I think most of the responses were submitted in, I think, August 2020, so that was, like, the height of the, biggest wave of the COVID pandemic. So I think a lot of the data that we're looking at today for social isolation, loneliness, it's like right during the peak.
Host Amber Smith: How were you able to compare those that were the reports of loneliness before the pandemic and after, or during, the pandemic?
Roger Wong, PhD: Before the pandemic, as I mentioned, both loneliness and social isolation, they were both around 20% to 25% for older adults 65 years and older. And then, I think in the paper we wrote that both of them spiked to around 35% of older adults felt lonely or socially isolated during the pandemic.
We don't have any data for this specifically, for loneliness before, starting from 2011, but we do have the data at least for 2020.
Host Amber Smith: So do you know how many people were reported social isolation before, and then compared with during, the pandemic? Or is that something entirely different?
Roger Wong, PhD: Yes. So that's actually in the separate paper that a student and I are about to publish.
So before the pandemic, social isolation was pretty stable, around 20% every year, from, like, the data we have is from like 2011 through 2019. It spiked to about 35% in 2020, and then it's been elevated after that.
Host Amber Smith: Were those who were lonely the same people who were isolated?
Roger Wong, PhD: For this paper, Miguel and I looked at loneliness and social isolation individually because we were basically interested in seeing how a group of 25 sociodemographic, health, social support and community variables were associated with loneliness and social isolation. It was already a really complicated paper, so we decided to just look at those, loneliness and social isolation, individually.
And I agree with you, Amber. I think it would be really interesting to see the different combinations of loneliness and social isolation, but we didn't want to do that for this paper because it was just already really complicated.
Host Amber Smith: Well, let me ask Mr. Pica to define these terms. What is loneliness and what is social isolation?
Miguel Pica: When we look at loneliness, we took it off the National Academies of Sciences, Engineering and Medicine, and we defined loneliness in our paper as "the distressing subjective experience that rises from perceived isolation or lack of building meaningful connections."
Host Amber Smith: So what is a social connection? Is that a friendship?
Miguel Pica: When it comes to social connections, especially when we look at our paper, we actually look more for social disconnection, referring to loneliness and social isolation in combination, for brevity. For example, for social isolation, we use that more as an objective measure for the lack of, or restriction of, interpersonal relationships, group memberships and social roles and the interactions.
Roger Wong, PhD: Yeah. And to summarize -- thank you, Miguel -- what Miguel just mentioned, I think the key word here is that when we're thinking about loneliness, it's a subjective experience, whereas social isolation, it's more of an objective measure for social networks.
Host Amber Smith: This is Upstate's " The Informed Patient," with your host, Amber Smith. I'm talking with public health and preventive medicine assistant professor Roger Wong and one of his students, Miguel Pica.
Dr. Wong, were you able to describe what type of people had an increased risk for loneliness during the pandemic?
Roger Wong, PhD: Yes. So as I mentioned earlier, we were looking at a group of around, like, 25 different factors to see how they were either protective or a risk factor for loneliness. So I think I'll talk about that first, and then maybe Miguel will talk about the social isolation, protective and risk factors for the loneliness, for those that felt lonely.
If we're looking at sociodemographics, we found that Black older adults were less likely to be lonely. We found that female and those that had higher education were significantly more likely to feel lonely during the pandemic. And I think, the higher education aspect may be a little bit counterintuitive, but if you think about it, those that have higher education, they were more likely to be moved to telework suddenly during the pandemic.
This was exactly what happened to me. I was teaching graduate students, not in Syracuse yet, I wasn't at Upstate yet, but the grad students that I was teaching, suddenly I had to shift to telework. I was told that we could only do prerecorded lectures, so it felt really lonely for me when I was doing my job. I think that those results sort of make sense. That's kind of the sociodemographic results we found.
If we look at health in general, we found that people with poor physical health and mental health disorders, they were significantly more likely to feel lonely during the pandemic. We also found that good sleep was a protective factor for loneliness as well.
And then finally, if we're looking at more social support aspects, we found people that were married, and they also had children in the household, they were less likely to feel lonely during the pandemic.
Host Amber Smith: Mr. Pica, who was most likely to be socially isolated during the pandemic?
Miguel Pica: When we look at social isolation, starting in a similar format with Roger, when we look at the social demographics, older adults, the older they become, the more likely they are to become socially isolated. Specifically, Black older adults and Hispanic older adults were more at risk for isolation.
With income, more income was found to be protective from isolation. When it comes to health, those who were more physically active were less likely to be isolated.
When it comes to social supports, we looked at different methods of communication. Those with more modes of communication, such as cellphones, Zoom, contact with family, friends, they were less likely to be isolated. But when there was more children, unlike loneliness, we found that while it was protective for loneliness, social isolation was increased for those with multiple children in the household.
Host Amber Smith: What did you find that helped reduce social isolation? You mentioned having access to a phone and social media and things like that. Were those the only things that were found to help reduce the social isolation?
Miguel Pica: So to lessen the risk was access to technology as well as having access to transportation. This was something that was found. And being more physically active. This really reduced the social isolation aspect.
Host Amber Smith: So, Dr. Wong, before we wrap up, I'd like to ask you more about the people who were socially isolated but not lonely during the pandemic.
How did they manage that, and what can we learn from them?
Roger Wong, PhD: I feel like your underlying question is the resilience factors.
OK, these people are socially isolated, but what are they doing to protect themselves from feeling lonely? And I think that's a wonderful question. I don't think I have a direct answer for that since we didn't look at the different combinations for social isolation and loneliness. But I think some of the protective factors that I talked about earlier for loneliness are ones that I would say are probably going to be productive for those that are socially isolated objectively, but feel lonely.
So I think the ones that are a little bit more modifiable that I would recommend are making sure that your physical health is addressed and also mental health as well, because that's definitely the No. 1 risk factor that we saw in our paper for loneliness. I think for those that were depressed and also had anxiety, they had about a three times increased risk for feeling lonely during the pandemic, so that's the largest amount of degree that we could find in the study.
So I think making sure that physical health and mental health are addressed is really important. I think another modifiable risk factor is also good sleep because we're finding that to be a protective factor for loneliness as well.
And this is a little bit off topic, but I think one of the calls to action that we talk about in the paper is that we looked at a group of 25 different variables. They all range from, like, individual to community to society to policy. And the call to action that we really talked about in the paper is that it's not just one thing that we could do to protect older adults from loneliness and social isolation. There are so many things that I think each of us has a really important part in making sure that our parents and our grandparents are not feeling lonely and not socially isolated. So I think it's really important to reach out to them and see and check in with them because this is quite common among older adults.
Host Amber Smith: You mentioned taking care of physical and mental health. Does loneliness and isolation cause, or lead to, mental health issues?
Roger Wong, PhD: Starting with the physical health, I think the physical health aspect is that those with more chronic diseases, they're more likely to be homebound and not be able to be mobile enough. So I think that mechanism really makes sense for feeling lonely and socially isolated.
I think for the mental health aspects, it's interesting because I think for those that are depressed and have anxiety, it doesn't look like they're really socially isolated, but they feel lonely, though, so I think, again, the loneliness aspect is more aligned with the subjective feelings. So I think it's more related to their mental health disorder, that they're subjectively feeling lonely, even though, objectively, they're not really socially isolated. I think that's a great question, and I think that's one of the things that we're seeing for this research.
Host Amber Smith: Well, it's very interesting and it's encouraging to know that, people are looking into what can we learn from this experience that everyone in the world experienced at the same time in different ways. But we went through something, and it's good that we're going to be learning from it.
Roger Wong, PhD: Yes. And I'm really excited to see how Miguel's research, how this paper, takes off, because as you mentioned, this is a huge problem the surgeon general had mentioned in May 2023. This is a national epidemic, so I am really looking to forward to see more research in this area because I think it's definitely understudied.
Host Amber Smith: I appreciate both of you making time for this interview. Thank you.
Roger Wong, PhD: Yeah. Thank you so much for having us, Amber.
Miguel Pica: Of course. Thank you so much.
Host Amber Smith: My guests have been Dr. Roger Wong, an assistant professor of public health and preventive medicine at Upstate, and Mr. Miguel Pica, who was a student in his advanced biostatistics course.
"The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe.
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