Social Isolation and Loneliness Among Older Adults and Their Relationship to Vision Loss

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photo of Alberta Orr
Alberta L. Orr

by Alberta L. Orr, MSW

Loneliness and social isolation are growing public health concerns in our aging society. In fact, loneliness and social isolation are international public health concerns that particularly affect the aging society globally (Fakoya et al., 2020; Campaign to End Loneliness, 2013).

Toward the end of the 20th century, the importance of “social connections,” the quantity, quality, and benefits of human relationships, became a primary focus of empirical research into the social determinants of health. Understanding the full scope and complexity of the influence of social connectedness on health is quite challenging. The absolute number/extent of social relationships and the quality of such relationships are important factors in their impact on health. Social isolation and loneliness are two significant aspects of social relationships that have become increasingly prominent in scientific literature.

While these experiences occur across the lifespan, one-half of individuals aged 60 and older are at risk of social isolation, and one-third will experience some degree of loneliness later in life (Fakoya et al., 2020). Freedman & Nicolle (2020), referred to social isolation and loneliness as the “new geriatric giants” in an article title in the Canadian Family Physician, March 2020.

Similarly, in writing about social isolation and loneliness, Galambos (2020) opens her article as follows:

“There is a killer among us. It’s a silent, unnoticed killer that reaches into bustling cities, suburban communities, and the countryside. It reaches people of all classes and backgrounds. What is this serious but underappreciated public health threat? Social isolation and loneliness, which—just like the novel coronavirus pandemic—present life-threatening health risks, especially for older adults (para. 1).”

Older people with vision loss are among this population at great risk of social isolation and loneliness.

The Social Impact of Living Alone on Older People

The extraordinary rise in the number of people living alone is among the most significant social changes of the modern world. Today, living alone is prevalent in developed, open societies, with one-person households accounting for more than 25% of all households in the United States and Canada across all age groups (Klineberg, 2012).

By 2020, approximately 27% (14.7 million) of all older adults living in the community lived alone, 9.7 women and 5 million men. They represented 33% of older women and 20% of older men. Forty-one percent of the baby boom generation is already age 65 and older. The proportion of living alone increases with advanced age for both men and women. For example, among women aged 75 and older, 42% lived alone (ACL, 2021).

Demographic Trend: More Older Women Than Men

An important demographic trend related to aging, specifically aging and isolation, is there are many more older women than older men. Since there are significantly more older women living alone and the proportion of people living alone increases with advanced age, the older people get, the more likely women are to live alone, as indicated in the above statistic. Loneliness among older women is a concern due to the life changes they experience, such as widowhood and the need to relocate from their home of many decades. These life circumstances are associated with greater vulnerability to social isolation and loneliness, affecting women more than men (Beal, 2006). 

Effects on Health and Wellbeing

Living alone may make older adults more vulnerable to loneliness and social isolation, affecting their health and well-being. Some older adults who live alone may go days without seeing or talking with another person (NASEM, 2020). Studies show that loneliness and social isolation are associated with higher risks for health problems such as heart disease, depression, and cognitive decline. Research shows that perceived social isolation (i.e., loneliness) is a risk factor for poorer overall cognitive performance, faster cognitive decline, and poorer executive functioning (Cacioppo & Hawkley, 2009).

Defining Social Isolation and Loneliness

The concept of social isolation and older adults has been studied extensively. It is frequently interchanged with the term loneliness — but while closely related, they are different.  The National Institute on Aging (2019) found that:

“Much of what we know about the causes and effects of social isolation and loneliness comes from the groundbreaking research of the late John T. Cacioppo, Ph.D., “a pioneer in the field of social neuroscience who directed the Cognitive and Social Neuroscience at the University of Chicago and was an NIA grantee” (para. 8)

Dr. Cacioppo found that being alone and loneliness are different but related. Social isolation and loneliness are both terms that denote a degree of social disconnection (Cacioppo & Cacioppo, 2018).

Isolation in adults aged 50 and older occurs due to a complex set of circumstances and factors at several levels: the individual, social network, community, and societal levels. Many multidisciplinary disciplines have recognized isolation as a problem in the middle to later years and offered their unique input to address it through clinical practice, community approaches, and research. The disciplines include sociology, psychology, social work, epidemiology/public health, gerontology, social neuroscience, medicine (including psychiatry, nursing, and occupational therapy), public policy, and urban planning. A literature review reveals extensive overlap across disciplines in terms of how isolation among adults aged 50 and older is defined and conceptualized (AARP Foundation, 2012).

Social isolation is the objective state of physical separation from other people, having little or infrequent social contact, and living alone. It is also commonly defined as having a low quantity and quality of contact with others. It is objective because it can be measured by observing an individual’s social network. Social isolation is also defined as physical isolation, reduced size and diversity of social network or less frequent contact with family and friends and increases the risk of loneliness. Social isolation exists when an individual lacks the opportunity to be socially connected. The lack of social contacts and having few people to interact with regularly results in social isolation (NASEM, 2020).

Loneliness is the subjective feeling of being alone or separated due to lacking social relationships. It is often defined as the discrepancy between actual and desired levels of social connection (Perlman & Peplau, 1998). Loneliness is the feeling of isolation regardless of objective social network size. It is the subjective counterpart of social isolation.

Among the novel predictions from the Cacioppo Evolutionary Theory of Loneliness (2018) is that loneliness automatically triggers a set of related behavioral and biological processes that contribute to the association between loneliness and premature death in people of all ages. Systematically studying these processes across generations is underway (Cacioppo & Cacioppo, 2018). 

Social connection and connectedness encompass a variety of terms used in the scientific literature (for example, social support, social integration, and social cohesion) that document how being physically or emotionally connected to others can influence health and well-being.

Strong social connection protects health; a lack of social connection carries risks for good health and well-being. The importance and magnitude of the risks associated with social isolation and loneliness have gained recognition and are reaching epidemic proportions, particularly since COVID-19 (Jeste et al., 2020).

Another term, social vulnerability, can help explain how social circumstances relate to health and refers to the degree to which one’s social situation leaves one susceptible to further social or health-related insults (Freedman & Nicolle, 2020). Andrew et al. (2008) operationalized the concept by constructing a Social Vulnerability Index, which includes self-report variables such as socioeconomic state, relationships, social supports, literacy, and living situation factors.

With the number of older adults aged 65 and older growing exponentially, many are socially isolated and regularly feel lonely. The coronavirus outbreak 2020 brought even more challenges due to health considerations and the need to practice physical distancing. Not being able to see family members, grandchildren in particular, or older spouses who were hospitalized or in assistive living facilities was devastating. But in this author’s opinion, being unable to touch another human being was the ultimate in social isolation and loneliness.    

Risk Factors for Social Isolation and Loneliness

Living alone has already been established as a major risk factor for social isolation and loneliness. A risk factor is any agent or situation that is known to make an individual or population more susceptible to the development of a specific negative condition and that increases a person’s chances of developing a disease, condition, or problematic circumstance such as social isolation. For example, a sedentary lifestyle is a risk factor for the development of heart disease, cigarette smoking is a risk factor for lung cancer, and obesity is a risk factor for heart disease. Age is a risk factor for many diseases and comorbidities, as well as social isolation and loneliness.

Older adults are at a higher risk for social isolation and loneliness due to changes in their health and social connections while growing older. According to Donovan & Blazer (2020), key risk factors include:

  • Sensory losses, hearing and/or vision loss
  • Memory loss, including forms of dementia, particularly Alzheimer’s disease
  • Functional disability which limits a person’s ability to socialize
  • Difficulty getting around
  • Loss of family and friends – one’s social network                                
  • Disruptive life events (such as a move to a different residence),
  • Bereavement (perhaps the most significant immediate cause of social isolation and loneliness
  • Illness and poor health
  • Retirement

Sensory Loss, Social Isolation, and Loneliness

According to Coyle et al., 2017, Self-reported poor vision is a strong predictor of social isolation. It is well documented that blindness/ low vision is associated with lower life satisfaction and depression. Coyle et al. go on to say, “Self-reported visual impairment is associated with social isolation, even after adjustment for demographics, chronic illness, functional limitations, and disability, and it may be a stronger predictor of social isolation than a clinical measure of acuity” (NASEM, 2020, chapter 4, para. 11.) A critical study on this topic was done by John Crews and colleagues, finding that the severity of self-reported visual impairment in older people is strongly associated with negative health-related quality of life (Crews et al., 2014). Life transitions are unavoidable life events that can vary anywhere from retirement to the death of a loved one. They often involve a loss that brings about a sense of disequilibrium. This is also the case with the onset of age-related vision loss.  In older age, it is common for multiple life transitions to occur in the same period and be related to each other, such as the loss of a spouse who began assisting their spouse experiencing vision loss.

The effects of blindness/ low vision may restrict social activity and interaction opportunities. Older adults experiencing age-related vision loss frequently experience a breakdown in their social network because their friends are uncertain how to interact with their friend who is now “going blind.” These older adults must surrender their driver’s licenses, and many do not have access to public transportation. Reduced mobility and functional limitations can directly result in shrinking the individual’s social networks by reducing access to family and friends. In today’s society, many generations live long distances from loved ones who are then not readily available to provide assistance with routine daily tasks or to provide companionship. Older adults experiencing age-related vision loss are often physically and socially isolated; the adjustment process to vision loss is a hard road, compounded by the lack of social connectedness.                                                                                               

Hearing loss also takes its toll on social connectedness. Older adults with presbycusis (age-related hearing loss caused by a lessening of hearing acuteness resulting from degenerative changes in the ear) find it hard to have conversations with friends and family which can lead to fewer interactions with people, social isolation, and higher rates of loneliness. Further, the prevalence of combined hearing and vision loss rises greatly with age; over 50% of people 65 and older with vision loss state they have hearing loss (United States, 2022).       

Loneliness Health Risks

Being alone may make older adults more vulnerable to loneliness and social isolation, affecting their health. The population aged 65 and older generally experiences a diminishing social network due to the loss of family members, friends, and neighbors. Not all older adults can replenish their support system with new social connections and relationships.

When loneliness lingers and becomes chronic, the fallout can affect all areas of life. Chronic loneliness is characterized by:

  • Inability to connect deeply with others
  • Having acquaintances but no close friends
  • Self-doubt
  • Poor self-esteem
  • Difficulty when trying to socialize

People experiencing chronic loneliness are not necessarily socially isolated. The chronically lonely individual feels set apart from others no matter their surroundings or who is with them (Impact of Social Isolation on Cognitive Health, paras. 13-14).

Interestingly, the effect of social isolation on mortality has been studied more extensively than loneliness. In contrast, the effect of loneliness on health has been studied more extensively than that of social isolation. The effects of social isolation and loneliness each impact health and well-being; they are complex, and much more research needs to be carried out (WHO, 2021; NASEM, 2020).

Physical factors such as heart disease, stroke, or cancer can increase social isolation and loneliness risks, although the relationship is often bidirectional. Decreases in intrinsic capacity, such as sensory impairment and hearing loss, increase the risks, as do psychiatric disorders such as depression, anxiety, and dementia (NASEM, 2020). Certain personality traits, such as neuroticism (i.e., negative affect), disagreeableness, and low levels of conscientiousness, increase the risk of loneliness; these are partly genetically determined (WHO, 2021).

Social Isolation and Health Risks

Older adults who are socially isolated or lonely are more likely to be admitted to the emergency room or hospitalized. Their hospital stays are frequently longer, and readmission is more frequent. Social isolation and loneliness are also associated with higher risks for medical and mental health conditions including:

Many older adults live with chronic illnesses that can exacerbate social isolation and loneliness. Leading chronic conditions among adults aged 65 and older in 2019 include:

  • Arthritis (48%);
  • Coronary heart disease (14%);
  • Myocardial infarction (9%);
  • Angina (4%);
  • Any cancer (25%);
  • COPD, emphysema, or chronic bronchitis (10%);
  • Stroke (9% in 2017-2018); and
  • Physician-diagnosed and undiagnosed diabetes (29% in 2015- 2018); (ACL, 2021).

According to Holt-Lunstad et al. (2010), the most profound consequence is that loneliness is associated with mortality or death. The absence of adequate social relationships in a person’s life is almost as predictive of mortality as smoking 15 cigarettes per day and more predictive of mortality than obesity or chronic exposure to air pollution. Loneliness puts an individual at greater risk of premature death and increases the risk of suicide, domestic violence, substance abuse, eating disorders, and death from all causes. This data is from a study of 8.4 million people of all ages; thus, loneliness negatively affects everyone. There’s an urgent need to help address the epidemic of loneliness in all ages (Holt-Lunstad, 2020; Perissinotto et al., 2012).

Additionally, individuals who are unexpectedly isolated due to the illness of a loved one, separation from friends or family, loss of mobility, worsening vision or hearing problems, disability, or lack of mobility or access to transportation, are at particular risk of loneliness and social isolation. Older adults may be at greater risk of social isolation and loneliness if they experience some of the following life circumstances:

  • Living alone
  • Inability to leave home
  • Had a major loss or life change, such as the death of a spouse or partner or retirement
  • Financial struggles
  • Are a caregiver for someone with a serious condition
  • Have psychological or cognitive challenges such as depression and/or anxiety
  • Have limited social support 
  • Have trouble hearing   
  • Experience age-related vision loss (NIA, 2019).

Where one lives can contribute to social isolation and loneliness as well.  Some of these factors include:

  • Living in a rural, unsafe, and/or hard-to-reach neighborhood
  • Having language barriers where you live
  • No access or limited access to public transportation
  • Experience age, racial, ethnic, sexual orientation, and/or gender identity discrimination where you live
  • They are not meaningfully engaged in activities or lack purpose (AARP Foundation, 2012).

These risk factors may also provide clues to what to look for in family members, friends, or neighbors who are isolated or lonely (AARP Foundation, 2012).

Companionship

A University of Michigan-AARP study found 1 in 3 adults over 50 lack regular companionship (AARP Foundation, 2018, and another AARP study indicated that loneliness is most common among those who have never married, at 51% (AARP Foundation, 2018). Loneliness, including feeling a lack of companionship or being socially isolated, has major implications for the health of older adults. In 2018, the University of Michigan National Poll on Healthy Aging asked a national sample of adults aged 50–80 about their health, health behaviors, experiences, and feelings related to companionship and social isolation. The study indicated that millions of older adults across the country struggle with feelings of loneliness, isolation, and a lack of regular companionship (AARP Foundation, 2018).

The study indicated that these feelings were more common for those who struggled with their physical or mental health and those living with hearing loss. This finding adds to a growing body of research that links social isolation to various negative health effects, including shorter life expectancies (AARP Foundation, 2018).

Interestingly, while a majority of those who said they felt a lack of companionship also felt socially isolated and vice versa, 37% of those who felt a lack of companionship did not feel isolated, and 20% of those who felt isolated did not feel a lack of companionship (AARP Foundation, 2018).

Risks and Protective Factors for Loneliness and Social Isolation  

In the national loneliness survey mentioned above, mental and physical health problems, living alone, or not living near family increased the likelihood of becoming lonely. Those dissatisfied with their family and social life are also more likely to report being lonely than those satisfied (AARP Foundation, 2018).

Good social support, meaningful daily interactions, being partnered, and low social anxiety are strong protective factors against loneliness. Alternatively, factors that prevent people from engaging with others, such as long-term illness, disabilities, transportation issues, unemployment, or exposure to domestic or community violence, may increase social isolation and loneliness (Holt-Lunstad, 2020).

The Biology of Loneliness

Losing a sense of connection and community changes how an individual perceives life and the world. Someone experiencing chronic loneliness may feel threatened and mistrustful of others, which activates a biological defense mechanism. Dr. Steven Cole, director of the Social Genomics Core Laboratory at the University of California, Los Angeles, and his NIA-funded research focused on understanding the physiological pathways of loneliness (how it affects how your mind and body function) and developing social and psychological interventions to combat it.  For example, loneliness may alter the tendency of cells in the immune system to promote inflammation, which is necessary to help our bodies heal from injury. However, inflammation that lasts too long increases the risk of chronic diseases. The research shows that lonely individuals have more inflammation and a less responsive immune system (Cole, 2015).

Dr. Steven Cole (2015) states loneliness is a “fertilizer for other diseases.” “The biology of loneliness can accelerate the buildup of plaque in arteries, help cancer cells grow and spread, and promote inflammation in the brain leading to Alzheimer’s disease. Loneliness promotes several types of wear and tear on the body”  (NIA, 2019, para. 15).

He added that people who feel lonely may also have weakened immune cells that have trouble fighting off viruses, making them more vulnerable to some infectious diseases. Evidence suggests that chronic loneliness also may harm us on a genetic level. If loneliness is chronically persistent, it can have a physiological effect that activates genes involved with inflammation and, in turn, can be a risk factor for heart disease and cancer (Cole, 2015).

Types of Health and Mental Health Risks of Social Isolation and Loneliness

Although it is hard to measure social isolation and loneliness precisely, there is strong evidence that many adults aged 50 and older are socially isolated or lonely in ways that put their health and mental health at risk. Recent studies found that:

  • Social isolation significantly increases a person’s risk of premature death from all causes, a risk that may rival those of smoking, obesity, and physical inactivity.
  • Social isolation was associated with about a 50% increased risk of dementia.
  • Poor social relationships (characterized by social isolation or loneliness) were associated with a 29% increased risk of heart disease and a 32% increased risk of stroke.
  • Loneliness was associated with higher rates of depression, anxiety, and suicide.
  • Loneliness among heart failure patients was associated with nearly four times increased risk of death, 68% increased risk of hospitalization, and 57% increased risk of emergency department visits. Some factors that contribute to developing these conditions among people who are socially isolated and/or lonely include:
  • Drinking too much alcohol
  • Cigarette smoking
  • Not getting a sufficient amount of sleep

These negative factors can further increase the risk of serious health conditions.

Cognitive Health

Older adults will likely face age-related brain changes, such as dementia and stroke, as they mature. Social isolation, especially the extreme sort brought about by the pandemic, can make age-related brain issues worse, and older adults without severe cognitive issues are nevertheless at risk for cognitive health decline when they experience social isolation.

Social isolation and loneliness may also hurt cognitive functioning and brain health. Loneliness and social isolation have been linked to poorer cognitive function and higher risk for dementia, especially Alzheimer’s disease (NIA, 2021).

Lonely individuals have also been found to score lower on tests of executive function compared to their nonlonely peers (Cacioppo & Hawkley, 2009). It is hypothesized that these cognitive-emotional biases may lead to a cycle of worsening withdrawal and loneliness.

Also, little social activity and being alone most of the time may contribute to a decline in the ability to perform everyday tasks such as driving, paying bills, taking medicine, and cooking.

Depression

In considering loneliness, one health outcome is depression, and we know that loneliness predicts changes in depressive symptoms, but not vice-versa. Someone who is depressed is not necessarily more likely to experience loneliness, but someone lonely is more likely to have a change in depressive symptoms (Cacioppo et al., 2010; Klinenberg, 2012). 

Some depressed older adults experience broad deficits in social connectedness, including high loneliness, low social support, and fewer social connections. Other older adults with clinical depression or generalized anxiety report high levels of loneliness unrelated to structural (i.e., institutions, social policies, ideologies) measures of social network or support (NASEM, 2020). 

It is important to consider the emotional pain associated with loneliness because it can activate the same stress responses in the body as physical pain. Individuals who are lonely experience emotional pain. Losing a sense of connectedness and community can change how a person views life. Individuals who experience long-term chronic loneliness may experience feeling a lack of safety and feeling threatened and mistrustful of others. They may develop chronic inflammation (overactive or prolonged release of factors that can damage tissues) and reduced immunity (ability to fight off disease). This raises the risk of chronic diseases and can leave people more vulnerable to infectious diseases (Fakoya et al., 2020).

Research Findings

Social isolation, loneliness, and social vulnerability have been determined to have important health consequences. According to the work of the National Academies of Sciences, Engineering, and Medicine (2020), the following findings result from social isolation and loneliness prevalent in the older population.

  • There is evidence that social isolation and loneliness significantly increase the risk of premature mortality; conversely, social connection reduces this risk.
  • Social isolation and loneliness are also associated with increased morbidity and dysregulation of various health biomarkers, such as inflammation.
  • Public health policy affecting social connectedness should be considered across all governmental sectors including health, transportation, education, housing, employment, food and nutrition, and environment.

More evidence is needed to establish effective interventions to reduce social isolation and loneliness and lessen their health impacts (Holt-Lunstad, 2020).

While there are challenges in measuring social isolation and loneliness precisely, there is strong evidence that many older adults are socially isolated or lonely in ways that put their health at risk. For example:

Poor social relationships (characterized by social isolation or loneliness) have been associated with a 29 percent increased risk of incident coronary heart disease and a 32 percent increased risk of stroke. (CDC, n.d.)  

In addition, NASEM (2020) reported that social isolation and loneliness need to continue to be independently examined as potential predictors of the other related aspects of social connection as well as of health outcomes. More importantly, they need to be examined together for two important reasons: “(1) to discover potential pathways by which one may be operating through, or in combination with, the other in determining health outcomes; and (2) to better estimate the relative strength of their impacts on health outcomes and mortality” (NASEM, 2020, Introduction, para. 23). 

Strategic Interventions

Numerous interventions addressing loneliness and social isolation have been studied including:  

  • Social facilitation (including technology)
  • Exercise
  • Psychological therapies
  • Health and social services
  • Animal therapy
  • Befriending
  • Leisure and skill development

However, current evidence of effectiveness is limited. A person-centered approach is essential to the selection of interventions, and that is particularly important for people with dual sensory impairments as well as marginalized and underserved populations.

Underserved populations include new immigrants, older adults identifying as LGBTQ+ (lesbian, gay, bisexual, transgender, queer or questioning, and related communities), indigenous seniors, and seniors living in poverty or near poverty (CDC, n.d.). Older caregivers experiencing social isolation and loneliness also require further evaluation (Freeman & Nicolle, 2020). Identifying effective interventions for social isolation and loneliness is the greatest challenge, particularly as the country and the world attempt to reestablish levels of “normalcy.”

The Benefits of Pet Ownership   

It is hard to think about social isolation and loneliness without thinking about the power of owning a pet and the pet’s contribution to the older adult’s social supports which may be limited. Studies have shown that the bond between people and their pets can increase fitness, lower stress, and bring happiness to their owners. Some of the health benefits of having a pet include decreased blood pressure, decreased cholesterol, and triglyceride levels, decreased feelings of loneliness, and increased opportunities for socialization (Greco, 2019).

According to the American Heart Association (AHA), a panel of heart disease experts convened by AHA found that having a pet is associated with reducing risk of heart disease and that there are a variety of reasons that may be at work that influence this. It may be that healthier people are more likely to be pet owners or that people with dogs tend to exercise more. Owning a dog means getting outdoors, walking one’s dog through the neighborhood, and getting to know your neighbors. This is one way pets provide social support to their owners, contributing to social connectedness and minimizing loneliness (Wells, 2009).

Ways to Stay Connected or Get Reconnected  

According to the National Institute on Aging (NIA), lifestyle changes can often alleviate the negative effects of social isolation on older adults. Some ways older adults can take charge of their lifestyles include:

  • Taking care of their physical health
  • Managing high blood pressure
  • Being physically active
  • Stimulating their minds
  • Staying socially active
  • Managing stress

Ways to Stay Healthy

There are ways to protect oneself and loved ones from loneliness and social isolation. Most importantly, people should consider eating a heart-and-brain-healthy diet, getting sufficient sleep, and engaging in enjoyable activities. Activities, and activity in general, can help manage stress and enable the older individual to stay as mentally and physically healthy as possible. Physical activity can help:

Older adults must do aerobic, muscle-strengthening, and stretching exercises weekly and balance activities as needed for optimal health benefits. Appropriate planning must take into account factors such as prescribed medications, nutrition, injuries, hip and knee arthroplasties, and chronic conditions.

People who engage in meaningful, productive activities they enjoy with others feel a sense of purpose and tend to live longer. Studies show these activities may help boost mood and improve well-being and cognitive function (Shankar et al., 2013).

People who live an active lifestyle are:

NIA-supported research shows that having a sense of mission and purpose in life is linked to healthier immune cells. Helping others through caregiving or volunteering also helps individuals feel less lonely and allows individuals to have a sense of mission and purpose (2021). 

NIA has further underscored the critical importance to older adults of staying connected by developing a campaign and infographic to spread the word:

Infographic: STAY CONNECTED to combat loneliness and social isolation. feeling lonely and being isolated are bad for your health
Stay Connected infographic. Reprinted from National Institute on Aging, n.d. Retrieved from . Copyright 2022. Reprinted with permission.

Conclusion and Call to Action

As detailed in the article, social isolation, loneliness, and related terms are similar but different in important ways. Considerable research and literature on these topics existed before the COVID-19 pandemic; post-pandemic research literature has grown significantly. Moreover, the pandemic underscored that rigorous research on the health impact of social isolation and loneliness and the development of interventions to prevent or address these conditions are needed now more than ever.

It is important to understand the meanings and implications of these concepts, especially concerning older adults and those older adults experiencing age-related vision loss. 

As noted in the article, older adults who are blind or low vision, especially with dual sensory impairments, are at greater risk of social isolation and loneliness because their sensory loss impairs their ability to maintain connectedness. 

The Independent Living Services for Older Individuals Who Are Blind program, through which services are provided nationwide, can make a difference by recognizing older adults at risk, promoting social connectedness for individuals, including involvement in support groups virtually or in person, and involvement in activities in the community such as senior centers, craft groups, etc.

The healthcare industry also has a major role to play. The report of the National Academies of Sciences, Engineering, and Medicine (2020) makes recommendations specifically for clinical settings of health care to identify those who suffer the resultant negative health impacts of social isolation and loneliness and target interventions to improve their social conditions.

Older adults are particularly high-volume and high-frequency users of the healthcare system; thus, there is an opportunity for healthcare professionals such as family physicians or nurse practitioners to identify, prevent, and mitigate the adverse health impacts of social isolation and loneliness in older adults. If not identified by the healthcare system, many older adults will remain unrecognized in their communities. Older people who are blind or low vision remain particularly vulnerable as most eye care professionals do not refer them for vision rehabilitation services (Low Rate of Referral, 2018).   

Need for Public Health Agenda

Given the strength of the evidence of the health effects of social connection and isolation, there is a need for a solid policy agenda to address this public health issue.

Policymakers should address social isolation and loneliness among older adults through public health campaigns and develop initiatives and services extending to all communities, especially low-income ones. The Healthy People initiative carried out through the National Institutes of Health, is a place to start these initiatives. They already have objectives related to sensory and communications disorders, including referral to vision rehabilitation services.

Community social service agencies should extend outreach efforts to make every effort to reach those who are unable or unwilling to leave their homes. Given their expertise in building networks and community responses, social workers have a unique skill set to implement such programs.

Establishing neighborhood connectedness can positively impact older adults with long-felt social isolation, loneliness, and insufficient social support.

Strategic interventions have been developed to address social isolation and to address loneliness. Standardizing interventions is impossible; no one-size-fits-all approach to addressing loneliness or social isolation is possible. Interventions must be developed or selected to meet the needs of individuals, specific groups, or the degree of loneliness or social isolation experienced.

Future research should be aimed at determining which intervention works for whom, in what particular context, and how.

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