The National Academy of Sciences, Engineering and Medicine recently published a report on social isolation and loneliness that brought to light a long standing issue for many of us that has been exacerbated by the physical distancing required by the pandemic. Greater than 35 million Americans live alone, and the percentage of those with only 1 person in the household has increased from less than 17% (in 1969) to greater than 28% (in 2019). Many adults older than 63 (43%) reported loneliness before COVID, so understandably we expect that number to have increased, although no exact figures are currently available.
There is a distinction between “being alone” and “feeling lonely”. Aloneness may or may not be a choice. However, even for those who are comfortable with aloneness, the duration of separation inflicted by the pandemic may result in it becoming unwelcome. Loneliness is subjective; missing relationships you have had is very different than relationships you wished you had. “Social Isolation” can be related to loneliness, but it is more about the number and types of relationship you have that determines if one feels isolated.
Loneliness is associated with serious health risks, and has been estimated to be equivalent to the adverse effects of smoking 15-20 cigarettes daily. The risk of chronic illness is also substantial in lonely Americans—an increase in dementia, cardiovascular death, and premature death are all noted. In addition, health costs are higher by an estimated at $6.7 billion per year. COVID-19 disease has forced the reality on all of us fearing social isolation, and we also face the compounded concerns of how this virus will impact our lives and health expenditures, especially as threats of loss of health coverage loom in political debate.
This is not exclusively an older adult issue; younger adults are working more from home and facing different challenges than older Americans. While we have all been grateful for online platforms that allow engagement and commerce, a balance is needed. Many of the younger Americans have not embraced communities such as organized religion and social clubs that have traditionally served as social safety nets. Not surprisingly, it’s been estimated that approximately three quarters of Millennials have reported feeling lonely.
Questions abound in the pandemic era of COVID-19. Social Isolation is indeed not Physical Isolation. But what level of contact is OK? How far is it OK to stay physically apart—6 feet, 3 feet, 20 feet? Will we ever be able to hug again? Can recommendations for distancing be imposed on those individuals in vulnerable populations without their choice? Does “quality of life “ play a role in decisions? What about loneliness and isolation in nursing homes, prisons, assisted living and memory care units? What are our responsibilities as citizens to protect each other and our vital institutions? And perhaps one of the harder questions —How do we recover after this is over?
So what can we do, as individuals and as members of this community to curtail this massive problem? Mental health expenditures and addiction services need to be maintained at a higher level. Embrace those social and psychiatric services and be generous in your financial support of them. We all need to slow the spread, continue to remain physically distant as much as we possibly can, even to a point of excess. This communicates to people that we compassionately care for others around us. Certainly this virus has shown that it spares no one definitively, and although some quote low mortality figures, there is no absolute way to predict who —young or old—will be struck next. And speaking of collective action, these authors suggest that we as a community reach out to those who may be outside of our usual circle—the elderly neighbor who generally remains inside the house, the single mother of small children at risk for losing job and eviction, the old friend who we haven’t spoken to in a while because our lives are busy and we’ve fallen apart. Reach out, beyond your comfort level. Connect. Physical distancing is not the same as social distancing.
We all need to feel like we belong —maybe this is our Talbot Purple moment, and let’s call it Talbot Connects.
Michael Fisher, M.D. and Lisa V. Stone, M.D. are citizen-participants on Shore Regional Health’s Incident Command Task Force.