Editor's note: This popular story from the Daily Briefing's archives was republished on June 12, 2019.

Read Advisory Board's take: 3 lessons on how providers can best address loneliness

Baby boomers are now the loneliest generation in U.S. history—and that designation comes with its own unique set of health risks, Janet Adamy and Paul Overberg report for the Wall Street Journal. 

Why are baby boomers so lonely?

About eight million baby boomers are aging without the companionship of a partner, spouse, or living child—and that number is expected to increase, according to Adamy and Overberg.

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The reason is threefold, Adamy and Overberg report. After retirement, adults' social circles often shrink and health issues, such as declining mobility, can prevent seniors from taking part in group activities. Baby boomers are particularly vulnerable to loneness because they "prized individuality" more than previous generations, Adamy and Overberg report. As such, one in six boomers live alone and one in four are divorced or never married.

The result, is baby boomers are more likely to feel lonely often than previous generations. According to the 2014 General Social Survey, about 8% of baby boomers reported feeling lonely often, compared to about 7% of the silent generation and 2% of millennials. Senior women and seniors with little finances, who are less likely to cohabitate are the most affected by loneliness, Adamy and Overberg report. Of women over 50, 27% are widowed or unmarried compared to 16% of senior men, research shows.

Yes, loneliness can kill you

Research has consistently shown that loneliness can be deadly. According to Adamy and Overberg, loneliness is linked to early mortality in ways similar to drinking more than six alcoholic beverages or smoking up to 15 cigarettes each day. What's more is that loneliness is even more closely linked to early mortality than obesity or lack of exercise, Adamy and Overberg report.

Research also has shown that people who are socially isolated are at an increased risk of cognitive decline, depression, and dementia. Loneliness can also affect blood pressure, the immune system, and adherence to medication—and for seniors, these negative effects of loneliness are often exacerbated by age.

For some baby boomers, living alone can be the difference between life or death—especially for those living with an affliction.

Gary Grasmick, a 68-year-old former IT worker, lives alone. He has no children and isn't married.

One day, Grasmick lost stability in his knee when he was carrying groceries in his house. Unable to move, Grasmick was alone on the floor for at least two nights without water or a way to call for help. He lay helpless as his kidneys began to shut down.  

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"I heard the mailman come once in a while and I would yell out. Nobody heard me," Grasmick said. "I remember being thirsty and having weird dreams."

Grasmick became dehydrated and developed a urinary tract infection, and eventually developed sepsis. 

A friend of Grasmick called the police after he failed to return her calls. When the first responders found Grasmick, his brain had swelled and he was delirious. He spent two weeks in the ICU and six months in a nursing facility before living at home again. Now, he has an emergency call box in his home and always carries a cell phone—especially before bed.

"You almost die from it and you realize this isn't really kidding around," he said of living alone.

Combatting chronic loneliness amongst seniors

Medicare spends $6.7 billion each year on hospitalization and nursing facilities for seniors who lack close kin, according to a study by Stanford University, Harvard University, and AARP.

In order to curb medical costs and decrease mortality, Donald Berwick, former CMS administrator, said the nation will "have to address loneliness."

U.S. Assistant Secretary for Aging Lance Robertson said the Trump administration is exploring expanding faith-based partnerships to decrease isolation among seniors. And programs like Meals on Wheels is expanding its services to deliver food and social assistance to millions of American seniors. Now, if a meal recipient feels socially isolated, the organization will refer them to a care coordinator.

For some seniors, Meals on Wheels employees are "the only people they see," said President and CEO Ellie Hollander. "This has been an ongoing issue that I think has been a silent epidemic" (Adamy/Overberg, Wall Street Journal, 12/11).

Advisory Board's take

Tomi Ogundimu, Practice Manager, Population Health Advisor and Clare Wirth, Senior Analyst, Population Health Advisor

I commend articles like this for bringing attention to the growing epidemic of loneliness, as it's an issue we've been growing increasingly concerned about (and not just among seniors). We know that loneliness is remarkably widespread—a recent survey from Cigna of over 20,000 Americans found that 46% sometimes or always felt alone. And we know that is can have a devastating impact on our health—one meta-analysis found that it increased one's risk of death by 26-45%.

The US is, in many ways, behind the rest of the world in addressing the issue. Australia formed a Coalition to End Loneliness in 2016 and the United Kingdom appointed a minister for loneliness earlier this year. But without a similar government effort in the US, the issue has increasingly fallen on the backs of hospitals and health systems.

Several leading organizations have taken on the charge and begun taking steps to address social isolation among their patients—particularly their senior populations. Here are three lessons we've learned from them:

1. Screen for social isolation. Since isolation can be a taboo topic, few patients will be forthcoming about it. In response, CareMore, the integrated health plan and care delivery system, identified 1,000 seniors who might be socially isolated and sent them a letter asking if they needed assistance—or just wanted to have a conversation. They received over 300+ self-referrals. These patients, as well as thousands of patients they've identified since through routine appointment-based screening, have been enrolled in their Togetherness Program. As part of the program, at-risk patients are connected to CareMore staff for regular phone conversations and home visits to discuss standard topics related to medications and driving habits. They've also organized informal social hubs at clinics to facilitate interpersonal relationships (e.g., workout classes, connection to community organizations during the holidays).
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3. Create regional networks through partnerships. Providers can connect with local businesses and elder care entities to serve as a potential support system for people suffering from social isolation. For instance, ElderCare of Alachua County (a 501c3 entity owned by University of Florida Health) partnered with the City of Gainesville to open the ElderCare Senior Recreation Center, which offers educational seminars, physical fitness classes, structured artistic and cultural activities, and social and volunteer events for local seniors. This has created a local forum for social interaction and has helped the community form social connections.
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5. Build social connection (and loyalty) though groups. Several hospitals, including Sibley Memorial in Washington, D.C., have begun offering membership-based social groups for local seniors. Sibley's group is open to all those age 50+, even if they haven't been a patient, for a one-time membership fee of $40. It offer activities like language classes, day trips to museums, and even tango lessons—and counts over 10,000 people as members. These programs can foster belonging among senior patients so that they feel a sense of social connection, and can be a good business strategy for building brand loyalty.

To learn more about how to best engage baby boomers, read our research report, Meet Your New Medicare Patient.

Read the Report

Then, to learn more about how to integrate psychosocial needs beyond social isolation (like financial hardship, language barriers and housing instability) into patient care, download our report on Integrating Psychosocial Risk Factors into Ongoing Care.

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