Loneliness linked to health issues among older adults

Photo: Basak Gurbuz Derman/Getty Images

Social isolation and loneliness among seniors has become a prevalent issue, so much so that the Elevance Health Public Policy Institute has issued a white paper showing that this trend can have negative impacts on seniors' health, such as increasing the likelihood of depression, dementia, heart disease, stroke and even death.

Loneliness is often connected to other social drivers of health, such as reliable and accessible transportation, community inclusion, and availability of nutritious food choices, the paper found.

More than one-third of adults aged 45 and older feel lonely, and nearly a quarter of adults aged 65 and older are considered socially isolated. The population of people 65 and older in the U.S. grew by over a third since 2010, the fastest growing segment during that period.

To crunch the numbers, Elevance Health engaged Health Management Associates to describe the characteristics of Medicare beneficiaries with a mental health diagnosis using the 2018 Medicare Current Beneficiary Survey. The MCBS includes survey responses from nearly 16,000 Medicare beneficiaries, selected to be representative of the entire Medicare population, including Medicare Advantage beneficiaries and traditional Medicare fee-for-service enrollees.

One of the key findings that resulted from this effort is that about 28% report having been told they have a mental health condition. Nearly one in four beneficiaries reported having both depression and another mental health condition.

Beneficiaries with a mental health diagnosis were more likely to live alone, and they indicated more limited social activities during the past month attributable to their health status.

WHAT'S THE IMPACT?

The white paper cited research from the National Library of Medicine showing a significant link between loneliness and death among older adults. Even after adjusting for demographics, socioeconomic status, depression and other health and functional measures, the risk of death was 22.9% among lonely individuals, versus 17.9% among the control group during the six-year follow-up period.

Research further suggests that loneliness among older adults may contribute to reduced appetite and food intake, decreased physical activity and increased prevalence of smoking. It has also been shown to predict increased depressive symptoms, impaired cognition and dementia progression and significant likelihood of nursing home admission.

A two-decade long, population-based longitudinal study found that the effect of social isolation on hypertension exceeded that of clinical risk factors such as diabetes in old age. Social isolation has been associated with about a 50% increased risk of dementia, and has been linked to higher odds of skilled nursing facility stays and nursing home placement.

By way of offering a solution, Elevance Health highlighted its own Member Connect Program, the goal of which is to improve physical, psychological, and social wellbeing by encouraging participants to re-engage with healthcare, connect with community-based organizations and increase physical activity.

Elevance Health's affiliated MA plan members are identified as a potential fit for the Member Connect program through a number of means, including the house call program, care management and behavioral healthcare case management participation, cancer care programs, and customer service entry points.

To qualify, members must either live alone; live with others, but be isolated for most of the day, lack social support such as a long-distance caregiver, self-report loneliness or isolation, be newly widowed, have a recent diagnosis of a serious or terminal illness, or have a diagnosis of dementia.

On the University of California Los Angeles Loneliness Scale there was an average of 4% improvement in respondents' feelings of loneliness and social isolation among a sample of 117 people.

THE LARGER TREND

Loneliness doesn't have its own ICD code, so being reimbursed for treating it can be a difficult endeavor. 

According to Pyx Health cofounder and CEO Cindy Jordan, that's a problem. Pyx Health is a healthcare technology company focused on supporting individuals dealing with loneliness through member engagement and screening tools for social determinants of health.

Calling loneliness an epidemic, Jordan said one positive thing emerged from the pandemic: It unlocked funding for a ton of research. That research revealed that one in three adults are chronically lonely, with the most prevalence actually occurring in the 18-24 age group.

The problem, from a health system and payer perspective, is that feelings of loneliness often drive people to the emergency room – and are a driver for what is considered inappropriate ER utilization. Jordan estimated that about 60% of people utilizing the ER are not there for an appropriate need, and this drives thousands of dollars in Medicare spend for a given year ICD codes are needed, she said, because it would provide for easier reimbursement.
 

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com