Social Isolation and Loneliness in Older Adults

Introduction: When “being alone” becomes a health issue

Picture an older adult who has lost a spouse, stopped driving, and now spends most days at home with the TV for company. Family might check in by phone, and doctors focus on blood pressure, diabetes, or arthritis — but nobody asks how often this person talks to another human face-to-face, or how lonely they feel.

The report Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System (National Academies of Sciences, Engineering, and Medicine, 2020) was written to address exactly this gap. It pulls together research showing that social isolation (having few social contacts) and loneliness (feeling alone) are not just sad experiences — they are serious health risks that the health care system can and should address.

This blog post summarizes the key messages of the report, explains its purpose, and offers practical suggestions for older adults, families, and health professionals on what to do when social isolation or loneliness becomes a concern.

What do “social isolation” and “loneliness” actually mean?

One important contribution of the report is that it carefully defines its terms.

Social isolation is the objective lack of or limited social contact with others — for example, rarely seeing or speaking with friends, family, or neighbors.
Loneliness is the subjective feeling of being alone or disconnected, even if you technically have people around you.

Both concepts sit under the broader umbrella of social connection, which includes the structure (how many relationships you have), function (what kinds of support those relationships provide), and quality (how satisfying they are).

You can be isolated but not lonely (for example, someone who enjoys solitude), or surrounded by people but still lonely. The report emphasizes that both isolation and loneliness matter for health and deserve attention in clinical care.

Why did this report get written – and why now?

The committee’s charge was to examine how social isolation and loneliness affect adults aged 50 and older, and to identify what the health care system can do about it.

The report’s main purposes are to:

Summarize the evidence linking social isolation and loneliness with health outcomes in older adults (such as cardiovascular disease, frailty, depression, cognitive decline, and mortality).
Describe risk and protective factors, including physical health conditions, mental health issues, life events, and environmental factors.
Highlight at-risk populations, such as immigrants, sexual and gender minority older adults, people with disabilities, and those in long-term care.
Identify opportunities for health care — clinicians, health systems, payers, and community partners — to systematically identify, prevent, and reduce social isolation and loneliness.

In short, the report treats social connection as a core part of healthy aging, not an optional “extra.”

Aging itself doesn’t cause loneliness — but risk factors pile up

One of the report’s first key messages is that aging alone does not automatically cause social isolation or loneliness. However, adults 50+ are more likely to experience events and conditions that increase risk — the death of loved ones, worsening health, sensory loss, retirement, or changes in income.

The relationships are often bi-directional:

Being isolated or lonely can worsen physical and mental health.
Health problems can make it harder to stay socially connected, creating a vicious cycle.

This is one reason the report argues that health systems must pay attention — ignoring social isolation can undermine treatment for almost every other condition.

Risk and protective factors: what makes social isolation more likely?

The report organizes risk factors into four broad categories.

1. Physical health factors

Chronic diseases (such as cardiovascular disease, stroke, COPD, chronic pain, Parkinson’s disease, HIV, and others) can limit mobility, reduce energy, or create stigma, which in turn leads to fewer social contacts and more loneliness.

Geriatric syndromes — like frailty, incontinence, sensory impairment, and frequent falls — also contribute. Frailty and loneliness seem to reinforce each other over time, and fear of falling often leads older adults to avoid going out, increasing isolation.

Incontinence is a striking example: people who worry about urinary or fecal incontinence may avoid leaving home or participating in social activities, raising their risk of isolation and loneliness.

2. Psychological, psychiatric, and cognitive factors

Conditions like depression, anxiety, and dementia can make it harder to initiate or maintain relationships. At the same time, being lonely or isolated can worsen depression and anxiety, making treatment more difficult. (These links are described throughout the report, especially in chapters that discuss mental health and cognition.)

3. Socio-cultural factors

Life events such as bereavement, divorce, relocation, or conflict within families can disrupt social networks. People with fewer financial resources may have less access to transportation, safe public spaces, or fee-based social activities.

The report also highlights immigrants and LGBTQ+ older adults as groups at particular risk:

Older immigrants may face language barriers, changes in family and community dynamics, and relationships that lack shared history — all of which can increase social isolation and loneliness, especially for first-generation elders.
Studies show that immigrants often have smaller social networks and lower social integration than non-immigrant peers, and may experience worse mental and physical health outcomes when loneliness is high.

4. Social and environmental factors

Where someone lives matters. Research shows mixed results when comparing rural and urban environments, but several patterns emerge:

Rural residents may have more family they can “count on,” yet still report feeling more left out.
People living in outer suburbs often experience more loneliness, partly because of fewer public gathering spaces and longer distances to social activities.
City dwellers often report more interaction thanks to daily encounters in buildings, parks, shops, and other communal places.

Housing settings like retirement communities and nursing homes also cut both ways. These environments can provide social activities and support, but they can also increase isolation if residents are far from loved ones, have limited meaningful contact, or share rooms with incompatible roommates.

At-risk populations: who needs special attention?

The report does not treat older adults as a single group. It stresses that “at-risk” or vulnerable populations include people defined by race, ethnicity, sex, age, socioeconomic status, health status, and place of residence.

It pays particular attention to:

Immigrants, who may face language barriers, discrimination, and ruptured social networks.
LGBTQ+ older adults, who may have experienced stigma over their lifetimes, be estranged from families of origin, or feel unwelcome in some senior settings.
People in long-term care, who may have limited opportunities for meaningful relationships despite being surrounded by staff and fellow residents.

Recognizing these groups is essential for designing targeted screening and interventions.

How can the health care system respond?

Although this particular section of the PDF focuses heavily on risk factors, the report as a whole points toward several key opportunities for the health care system:

Recognize social isolation and loneliness as health risks
Health systems should treat low social connection as seriously as other major risk factors, because it is linked to worse outcomes for cardiovascular disease, frailty, mental health, and quality of life.
Incorporate basic screening into routine care
Simple, validated questions about how often someone feels lonely or how frequently they talk to friends and family can be integrated into primary care visits, hospital discharge planning, or home health assessments. Frailty and functional assessments can also be strengthened by including questions about social connection.
Use a prevention mindset at all stages
The report suggests that understanding risk factors can inform initiatives at the primary, secondary, and tertiary levels of prevention — in other words, preventing isolation and loneliness before they start, identifying and addressing them early, and reducing harm when they are already present.
Connect patients to social and community resources
Health care teams cannot “fix” loneliness alone, but they can connect older adults to:
- Community centers, senior clubs, or faith-based groups
- Volunteer programs, intergenerational activities, or support groups
- Transportation services, meal programs, or home- and community-based services
Tailor interventions to individual needs and risks
An older adult with incontinence may need discreet continence management and bathroom-accessible activities; someone with vision loss might need accessible technology and orientation training; an immigrant elder may benefit from language-specific support groups and culturally familiar settings.
Support caregivers
Caregivers themselves can become isolated, especially when caring for people with complex conditions like incontinence, dementia, or severe disability. The report notes that caregivers’ social isolation is also affected by the conditions they are managing, and interventions should address both the older adult and their support network.

What can you do if you’re worried about social isolation or loneliness?

The report is written largely for health and policy professionals, but its messages are very relevant to everyday life. Here’s how different people can act on its findings.

If you are an older adult

Take your feelings seriously. Loneliness is not a personal failure or weakness; it is a health signal, just like pain or breathlessness.
Tell your doctor or nurse. Mention if you live alone, rarely see friends or family, have stopped going out, or feel lonely often. Ask directly: “Could my health problems be related to being so alone?”
Ask about local resources. Many communities have senior centers, adult day health programs, friendly visitor programs, or volunteer opportunities.
Work on one small connection at a time. A weekly phone call, a walking group, or an online class can be a powerful first step.

If you are a family member or friend

Watch for warning signs. Repeated mentions of “no one to talk to,” giving up favorite activities, avoiding going out due to fear of falling or incontinence, or obvious grief after a loss are all reasons to pay attention.
Bring it into medical conversations. When attending appointments, gently mention concerns about isolation or loneliness and ask how these might affect health or recovery.
Help with practical barriers. Transportation, technology setup (for video calls or online groups), and adapting the home for safety can all reduce isolation risk.

If you are a health professional or part of a care team

Normalize the topic. Ask about social connection the same way you ask about medications or diet.
Integrate social connection into care plans. When you address chronic disease, falls risk, or depression, include goals and referrals related to social participation.
Collaborate with community partners. Build referral pathways to local aging services, social programs, and culturally specific organizations — especially for immigrants, LGBTQ+ elders, and other at-risk groups.
Advocate within your organization. Share the report’s message that social isolation and loneliness are core health issues deserving systematic attention, training, and resources.

Conclusion: Social connection as a vital sign

Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System reframes being connected to others as a vital sign of healthy aging, not just a “nice to have.” The report shows that social isolation and loneliness are common, often hidden, and tightly interwoven with physical health, mental health, and functional ability.

For older adults, caregivers, and health professionals, the message is clear:

Notice social isolation and loneliness.
Talk about them openly.
Treat them as modifiable risk factors, not inevitable parts of aging.

By combining clinical care, community resources, and compassionate attention to each person’s social world, we can turn the report’s findings into everyday practices that help older adults feel more connected — and stay healthier, longer.

Source
National Academies of Sciences, Engineering, and Medicine. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Washington, DC: The National Academies Press, 2020.

Disclaimer
This blog post is for general educational purposes only and summarizes findings from the National Academies report on social isolation and loneliness in older adults. It does not provide medical, psychiatric, or emergency advice and should not be used as a substitute for consultation with a physician, mental health professional, or other qualified health provider. Never ignore or delay seeking professional advice because of something you read here. If you are experiencing a medical or mental health emergency, call your local emergency number immediately.