Winter Weather Forecast: Snow Mixed with Social Isolation
With the onset of harsh winter weather, people living at home with a serious illness often find themselves unable to get out of the house and visit with friends or family. Gray skies and icy conditions mean more than taking it slow on the roads. Very often, bad weather contributes to social isolation, loneliness and depression.
Nearly 20 percent of Americans over the age of 50 experience social isolation. The primary risk factors for social isolation include having a mobility or sensory impairment or caring for someone who does. Other contributors are living alone, experiencing major life transitions and low income. While the obvious impacts of social isolation are psychological, the physical health consequences are staggering.
Socially isolated adults are more likely to participate in negative behaviors, such as drinking heavily, smoking and engaging in less physical activity. However, the impact of social isolation on poor health and increased risk of death transcends these behavioral risk factors. Loneliness is increasingly seen as a novel psychosocial risk factor for multiple negative health outcomes.
One study found that mortality increased by 26 percent to 32 percent for people who are socially isolated. Loneliness is a unique predictor of higher blood pressure and heart disease. A 2015 meta review of 70 studies showed that loneliness increases a person’s risk of dying by 26 percent.
Evidence suggests that the physiological effects of loneliness cause inflammation that may lead to heart disease and cancer. It is estimated that 55% of Medicare beneficiaries suffer from some level of loneliness. An additional 17% of seniors meet the criteria for social isolation. Loneliness and social isolation can be emotionally and physically crippling for seniors, but there are financial implications as well.
Medicare spends about $134 more per month for each socially isolated senior than it does for other members—similar to costs associated with high blood pressure and arthritis. On an annual basis, care for seniors who don’t have strong social connections is associated with an estimated $6.7 billion in additional Medicare spending. For health plans, addressing loneliness involves high-touch interventions supported by technology to identify affected seniors and address their needs.
Consider Sally, a 74-year-old woman with diabetes and deteriorating health who recently lost her husband of 50 years. Now, she lives alone while her two children live 1,500 miles away. As a widow, she lost interest in preparing meals and found it difficult to socialize, complaining, “this world is made for couples.” She became increasingly depressed, missing the companionship of her lifelong partner and unable to see her children. Her diet consisted of crackers and candy bars; she neglected to take her insulin and her medical condition worsened dramatically. One afternoon, she simply collapsed on the living room couch and was only discovered coincidentally by a UPS driver delivering a package to her door.
Population Health Responses to Social Isolation
With increased awareness of the unique health effects of loneliness and social isolation, organizations with an interest in population health are addressing the problem. One change is the expansion of Medicare Advantage (MA) guidelines to cover supplemental benefits that help to relieve the burdens of social determinants of health (SDOH), including social isolation and loneliness. As a result, a growing number of payers are introducing a community-based palliative care (CBPC) solution that has resources to:
- Identify and assess SDoH, such as social isolation
- Quantify and qualify the related risk factors
- Contact appropriate agencies, family members, religious groups and community organizations that can provide remediation and solutions
- Follow-up on all activities and report back to the case managers. These dedicated palliative care teams from the local community help to address social isolation and often provide a critical bridge to socialization as an essential solution
Creating a Healthier Environment
Teams of highly skilled CBPC nurses and social workers perform home visits to identify signs of social isolation and create treatment plans, including referrals to community resources regarding housing or transportation needs, food insecurity and caregiver stress. This process-driven, systemized approach to structured assessment for SDoH helps to identify patients who are experiencing complex psychosocial needs, including loneliness, to enhance the patient experience, mitigate hospital readmissions and improve individual outcomes.
This strategy for delivering a better health care experience—one that ensures comprehensive, holistic care while always respecting the dignity of the individual—can be adopted on a wide scale for payers seeking to ease the helplessness, loss and social isolation that seriously ill members commonly experience, especially during the winter.
Quality of Life and Improved Health for Sally
When a CBPC nurse and social worker initially visited Sally in her home, they learned that she often felt socially isolated because she wasn’t able to get out as often as she liked. Her husband had died, her children lived far away and her friends had either died or moved into retirement communities. She had few visitors, limited income for travel and did not use social media of any kind. As she told the social worker, “I wish I had close friends but now I don’t feel important to anyone.”
In addition to installing a reminder system for taking insulin, the CBPC social worker made suggestions regarding the non-clinical issues impacting Sally’s health. She contacted Sally’s church and learned that a close-by neighbor would be available to take her to services. Consequently, Sally began attending religious services and game night at a community center with a neighbor once a week. She began making other friends who invited her to dinner and holiday celebrations. Sally still missed her husband and family, but was no longer isolated and lonely, which contributed to better eating habits and an improved outlook on life. She became compliant with her medication and, when last visited by the CBPC nurse, had not required hospitalization.
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