Most Americans got a firsthand glimpse into social isolation and the problems it can cause during the Covid-19 pandemic.

But for many – especially older adults – that isolation existed long before Covid, and it continues today.

And along with the mental health issues associated with it, social isolation can lead to chronic health problems such as heart disease, stroke, Type 2 diabetes, and dementia, and should be tackled head-on to improve quality of life and reduce health care costs, a new report concludes.

Ginny Cartee, a retired teacher, says she sees these problems often in her volunteer work.

Among the things she’s heard seniors say: “No one knows or cares if I am alive or dead,” “There are days I do not hear a human voice other than my own,” and “I don’t have anything to look forward to.”

The situation is more serious than most people realize, said Maya Pack, executive director of the South Carolina Institute of Medicine and Public Health which, along with the state Department on Aging, detailed the issue and possible solutions in the new report.

“In the past, this has typically been viewed from the perspective of a mental health challenge, for example, kids unable to go to school during Covid, so some experienced isolation. And it was the same for many of us who worked from home,” she said.

“But people who are socially isolated have increased risk factors for all sorts of chronic illnesses too,” she added. “There is substantial evidence that shows a strong correlation between social isolation and major physical and mental health challenges and their associated costs.”

Indeed, researchers in the June 19 issue of the journal Nature Human Behaviour concluded that social isolation and loneliness “significantly” increase the risk of dying from all causes.

The researchers looked at 90 studies representing more than 2.2 million people, 70 percent of whom were 50 and older. One of those studies showed that social isolation increased mortality risk by 26 percent, putting it on a par with smoking and other risk factors.

What’s more, an AARP study concluded that social isolation is associated with $6.7 billion in annual Medicare spending, Pack said.

The National Academies of Science, Engineering and Medicine reports that about 24 percent of Americans 65 and older are considered socially isolated, according to the IMPH/DOA report. That translates into millions of people.

And 19.7 percent of South Carolina’s population is 65 and older, a demographic that is expected to grow to 24 percent by 2035, said DOA Director Connie Munn.

Covid brought social isolation into perspective for everyone, but seniors have been suffering from it for years, she said, noting that it not only leads to loneliness and depression, but conditions like cardiovascular disease.

Personal circumstances vary, Pack said. People may be alone for the first time in years after losing a spouse, one or more illnesses may limit their mobility and health, and retiring can be very isolating, especially for those whose workplaces provided much of their social life, she said.

IMPH – a nonpartisan, nonprofit group that aims to improve health and health care in South Carolina – assembled a task force of academic researchers, representatives from government agencies and community organizations, and other experts who work with older adults from across the state to study the issue, she said.

“We talk about nutrition and physical activity and other risk factors for chronic disease, but in the past the concept of a lack of social connection hasn’t been part of those conversations,” Pack said. “Recognizing the incredible impact isolation has on mental and physical health, we want to elevate it as an important part of the conversation about how we can improve the state’s overall health.”

The task force also sought input from people who had personal experience with social isolation or their caregivers to ensure they were represented as well, she said. 

Known as patient experts, they are part of the Patient Experience Studio at the University of South Carolina School of Medicine Greenville which was launched in 2016 to improve the science by including patient voices in research, said its director Ann Blair Kennedy.

“If a researcher doesn’t have any personal experience with (the subject), they need a patient,” she said. “And if we can include patients on research teams, that should help that process. We also want to make sure that … the research being done matters to patients.”

Originally begun with about 10 patients, the pool has grown to more than 100 nationwide – at least a third in the Upstate – representing a variety of demographics, she said.

The patient experts in this case were asked to review the task force recommendations and provide feedback on whether they are workable, Kennedy said.  

“They can’t speak for everyone,” she said, “but (the responses) were incredibly thoughtful and clarifying.”

Cartee, 70, has been a patient expert since 2016, representing the rural voice for researchers. She provided the task force with her own experience of social isolation after months of recovering from major surgery as well as those of others she meets as a volunteer for a cancer support group.

“Many are widowed and not used to living alone, and suddenly are without social connections,” she said. “Many are grieving many losses at the same time – health, companionship – making isolation so much worse.”

The report’s recommendations, she says, are right on point.

“Being able to connect with other people that aren’t necessarily being paid to be there … is very important,” she said. “This research provides a foundation for addressing the needs and interests of seniors in ways that are sustainable and doable in any community.”

The task force called for increased funding to support programming that fosters social connectedness; developing more programs in the future that support social connection; investing in digital equity through training and enhanced access for social networking, telehealth and virtual programming; and expanding public and private transportation options for older adults.

“Investing in programs that promote connection, improving data and information sharing, endorsing digital literacy and expanding transportation services can all improve the lives of older adults in South Carolina,” Munn said. “We have a large task ahead to make sure we have a system in place to serve these older individuals.”

The report recognizes the benefits of community organizations, like Senior Action in Greenville, that provide senior services, and says they should be expanded.

Calling social isolation “a real health challenge,” Senior Action Executive Director Andrea Smith said the report makes the argument for increased funding of services for the aging and represents prevention of social isolation and its consequences rather than medical intervention after the fact.

“We want to prevent all these health problems by keeping (seniors) engaged and in contact with people,” said Smith, who also served on the task force.

“It’s time for us to start funding and supporting social connection just like we fund other preventive health programs,” she added, “… (or) the impact down the road will be much sicker people, and more expensive care that’s more difficult to fund. It’s worth the investment.”

At Senior Action’s seven locations, she said, the goal is building community around a shared activity, from painting to playing cards to exercise classes, Smith said, adding those connections lead to friendships and activities, like lunch, that extend outside of center.

“Everything we do has this at the heart of it,” she said. “If you go to exercise classes …you’re with a group, making friends, building that network of people you need as you age. It gives you reasons for getting up in the morning and getting out.”

Patient expert Kenneth Baxter, 75, says he sees just how important social contact is as a volunteer for Meals on Wheels, which also keeps him active and engaged.

“We might be the only person (clients) see all day long,” said the Greenville man. “When I get out to hand them a meal, they’re waiting for me at the door. These folks are looking for human contact. If I miss a date, they want to know where I was.”

Enhancing funding to senior centers would also be beneficial, he said, adding that his mother went to a center where she enjoyed socializing with others.

“Community centers are a good place for older adults to congregate,” said Baxter, a retired district manager with AT&T who went back to school and got his master’s degree to teach high school.

“In my neighborhood, we have a senior place, and they play bridge, bingo, talk to each other, go on field trips. It keeps seniors … active,” he said. “And there’s a full house every day.”

The father of two and grandfather of three also favors expanding broadband to allow homebound seniors to have contact with others.

“I never had heard of Zoom until Covid. Now we can’t live without it,” he said. “You can still see people and talk to people even though you’re not in the room with them.”

Social isolation impacts quality of life through the loss of relationships, physical decline, and often, mobility and transportation issues that lead to a lack of independence, among other things, says Cartee, who has two children and two grandchildren.

“One lady recently told me that she would attend activities more often, but because of her health, some days she can’t walk the long ramp from the parking lot to the classroom door,” she said, adding that residents of an assisted living facility where she previously volunteered told her that they had adopted TV characters as family.

Social connections give people something to look forward to through meetings, lunch with friends, a variety of classes, book clubs, holiday sing-alongs, and support groups and wellness activities like walking and yoga to enhance strength and flexibility, she said.

“People only sitting at home or in assisted living lose their strength,” Cartee said. “We need to focus on people when they can still get out.”

Pack said that DOA is looking at the funding models they use to allocate resources to local Area Agencies on Aging, which help fund local programs like Senior Action.

“A lot of the resources in that allocation are for food and transportation services for older adults,” she said. “They are looking at flexibilities of allocating certain resources to prioritize social connection.”

Munn said that while additional funding is vital, collaboration between various stakeholders, who appear to be on the same page, can also get things done.

For example, Pack said, the state Department of Administration is already involved in a campaign to invest in broadband expansion and address other barriers to connectivity, such as affordability and digital literacy.

And the Office for the Study of Aging at the University of South Carolina’s Arnold School of Public Health also will continue the work of the task force to build partnerships and foster intervention strategies across sectors to address social isolation in older adults.

Each recommendation has a timeline for implementation that will take anywhere from months to years, Pack said, noting some are already underway.

“This is a case for prevention,” she said. “The cost of not addressing this challenge is enormous because of the health and personal costs associated with these poor health outcomes.”

To read the full report, go to Addressing Social Isolation in Older Adults as a Determinant of Health (imph.org).