Social Isolation and Loneliness Among San Francisco Bay Area Older Adults During the COVID‐19 Shelter‐in‐Place Orders

Abstract

Background/Objectives Physical distancing during the COVID‐19 pandemic may have unintended, detrimental effects on social isolation and loneliness among older adults. Our objectives were to investigate 1) experiences of social isolation and loneliness during shelter‐in‐place orders and 2) unmet health needs related to changes in social interactions. Design Mixed‐methods, longitudinal phone‐based survey administered every 2 weeks. Setting Two community sites and an academic geriatrics outpatient clinical practice. Participants 151 community‐dwelling older adults. Measurements We measured social isolation using a 6‐item modified Duke Social Support Index, social interaction sub‐scale, which included assessments of video‐based and internet‐based socializing. Measures of loneliness included self‐reported worsened loneliness due to the COVID‐19 pandemic, and loneliness severity based on the 3‐item UCLA loneliness scale. Participants were invited to share open‐ended comments about their social experiences. Results Participants were on average 75 years old (SD = 10), 50% had hearing or vision impairment, 64% lived alone, and 26% difficulty bathing. Participants reported social isolation in 40% of interviews, 76% reported minimal video‐based socializing, and 42% minimal internet‐based socializing. Socially isolated participants reported difficulty finding help with functional needs, including bathing (20% vs 55%, p = .04). Over half (54%) of participants reported worsened loneliness due to COVID‐19, which was associated with worsened depression (62% vs 9%, p < .001) and anxiety (57% vs 9%, p < .001). Rates of loneliness improved on average by time since shelter‐in‐place orders (4–6 weeks: 46% vs 13–15 weeks: 27%, p = .009), however, loneliness persisted or worsened for a subgroup of participants. Open‐ended responses revealed challenges faced by the subgroup experiencing persistent loneliness, including poor emotional coping and discomfort with new technologies. Conclusions Many older adults are adjusting to COVID‐19 restrictions since the start of shelter‐in‐place orders. Additional steps are critically needed to address the psychological suffering and unmet medical needs of those with persistent loneliness or barriers to technology‐based social interaction.

Depressive Symptoms, Fatigue and Social Relationships Influenced Physical Activity in Frail Older Community-Dwellers during the Spanish Lockdown due to the COVID-19 Pandemic

“…Consequently, social connections are essential to foster activity and PA in older adults and are an important component of PA group programs success [ 11 , 61 ]. Although during the first COVID-19 outbreak the population, especially older adults, may have progressively adapted to the new daily routines and limitations, this situation has a clear negative impact on social relationships and loneliness [ 62 , 63 , 64 ]. Tackling loneliness and social relationships requires specific implementation strategies [ 65 ], and these need to be adapted and implemented to promote the adherence to exercise programs [ 23 , 66 ], particularly in these challenging times.…”

Frequency of Contact and Explanations for Increased Contact between Grandchildren and Their Grandparents during the COVID-19 Pandemic

“…Because the CDC's recommendations for quarantining have necessitated physical distancing (Ayalon et al, 2020;Centers for Disease Control and Prevention, 2020), older adults may be at increased risk of loneliness and social isolation (Armitage & Nellums, 2020). In fact, research that has emerged concomitantly with the global spread of COVID-19 indicates that feelings of loneliness have increased since the beginning of the pandemic among several groups, including older adults, who reported an uptick in feelings of loneliness at the beginning of the pandemic (Kotwal et al, 2020;Luchetti et al, 2020). As a result, meaningful intergenerational relationships, and communication within those relationships, may buffer against loneliness and perceived social isolation among older adult grandparents (Ong et al, 2016).…”

Association of state social distancing restrictions with nursing home COVID-19 and non-COVID-19 outcomes

“…In addition, many older adults during the pandemic have experienced exacerbated social isolation and feelings of loneliness due to disrupted in-person social activities. 21 The negative consequences of disrupted social and family connectedness, which include death in worst case scenarios, 19,20 This study has several limitations. First, we were only able to track state social-distancing measures and nursing home COVID-19 and non-COVID-19 outcomes starting in June due to the lack of national data in early period of the pandemic.…”

“…Concerns about the downside effect of prolonged social distancing restrictions have been expressed, although empirical evidence is limited on how these restrictions affect the physical and mental health outcomes of individuals. [14][15][16][17]21 Deaths in the US attributed to noninfectious causes, such as heart disease and dementia, increased throughout the spring and summer surges in COVID-19 cases, 14,15 possibly due to disruptions in medical care access and delivery subsequent to shelter-in-place orders. It is conceivable that compared to community-living older adults, nursing home residents are more vulnerable to disrupted care routines given their advanced ages, complex morbidity patterns, and highly impaired functional status.…”

“…16,17 Moreover, disruptions of in-person social activities during the pandemic have led to increase in social isolation and loneliness among older adults, another serious public health issue that is associated with psychological suffering, unmet personal and health care needs, and deaths. [18][19][20][21] Starting from early March, most states in the US implemented non-pharmaceutical public health interventions to contain coronavirus transmission. These policies took a variety of forms -such as statewide shelter-in-place orders, closure of non-essential businesses, and bans on large and small-group gatherings -and were implemented at different times and with different levels of enforcement across states.…”