Although social distancing has become a “core tool in our effort to save lives and help flatten the curve of COVID-19, social isolation cannot become the new normal, especially for our older adults population,” Sen. Susan Collins (R-ME) said Thursday during a hearing of the Senate Special Committee on Aging, of which she is chairman.
The hearing, titled “Combating Social Isolation and Loneliness During the COVID-19 Pandemic,” focused a spotlight on the adverse health effects prolonged social isolation and loneliness can have on older adults, including those who live in senior living communities.
Sen. Bob Casey (D-PA), ranking member of the committee, noted that more than 40% of all COVID-19 deaths nationwide have been either residents or workers in long-term care settings.
“Those who have recovered from the virus or who are trying to remain healthy are isolated from their family and friends,” he said. “It is interaction with our loved ones that sustains all of us. Seniors are living and dying, often scared and alone, due to this virus.”
Nursing home residents represent a fraction of 1% of the population, Casey said. An even greater population of people reside in assisted living or other long-term care facilities and face the same issues, however, said hearing witness Carla Perissinotto, M.D., MHS, associate professor of medicine at the University of California, San Francisco.
The best way to keep workers and family members safe and interacting with older adults, she said, is to better understand the epidemiology of the virus and have a better tracking of symptoms. Perissinotto has been researching the health effects of loneliness and isolation in older adults for more than 10 years.
“Loneliness and isolation are a national and global public health problem whose widespread effects may be even more pressing now in the midst of the COVID-19 pandemic,” Perissinotto said, adding that the health effects can increase the risk of premature mortality and contribute to a 50% increased risk of developing dementia.
“Seemingly overnight, we saw our social structures dissolve as we were all forced to socially distance ourselves,” she said. “The challenge of all of this is that to protect our lives and health now, we have had to subject ourselves and others to the potential risks that we may be worsening our health and shortening our life expectancies in the future.”
Among her recommendations are encouraging the U.S. Department of Health and Human Services to advocate for including measures of social isolation and loneliness in major large-scale health strategies, the creation of team-based care by healthcare providers, organizations and systems, and ensuring technologic innovations are properly assessed and tested for use by older adults.
“What is concerning is that because of physical distancing, many healthcare and social programs have shifted to technological solutions, and this may be leaving out many older adults who do not have access to these technologies, and these may be more difficult for those with vision and hearing impairments,” Perisonotto said.
First efforts in 2017
The Aging Committee had held its first hearing on the effects of social isolation and loneliness on older adults in 2017, finding that the “silent epidemic has devastating physical and emotional health effects by increasing the risk of stroke, heart disease, depression and dementia,” Collins said. “As the pandemic continues and the epidemic of loneliness and isolation worsens, we run the risk of an infectious disease causing a mental health crisis.”
Thursday’s hearing highlighted a report, “Social Isolation and Loneliness in Older Adults,” from the National Academies of Science, Engineering, and Medicine and funded by the AARP Foundation. The report, released in February, said improved direct care worker training and technology could help relieve social isolation and loneliness among older adults.
Perisonotto was one of several witnesses who testified as part of a panel of experts supporting older adults in assisted living, home health, nursing homes, hospitals and the community.
Another witness, Betsy Sawyer-Manger, CEO of Western Maine’s Agency on Aging – SeniorsPlus, said her organization has been inundated with calls to its helpline, fielding nearly 100 calls per day from older adults on issues such as Medicare counseling, food insecurity, how to get groceries or pharmacy deliveries.
Like many other groups, the agency has turned to technology to deliver services. But she said many seniors do not have the technology and connectivity. Her agency secured some private funding and is using CARES funds to buy tablets and hotspots to provide options to show seniors open to learning new technology.
“Social isolation is detrimental to our health,” Sawyer-Manger said. “We can feel the need for human interaction in every call and virtual contact that we have.”
Peter Reed, Ph.D., director of the Sanford Center for Aging at the University of Nevada-Reno School of Medicine, said he has “never seen a crisis with the potential to cause as much harm to older adults as the COVID-19 pandemic.”
He called loneliness, helplessness and boredom the “plague of elderhood” and extreme challenges in any congregate or residential care community, including assisted living and group homes. He said it’s important to find ways to keep older adults connected to family and community.
“It’s incumbent on [the Centers for Medicare & Medicaid Services] and states, while protecting elders and maintaining their safety, to also find the right guidelines and procedures to require homes to begin allowing families and communities to engage with elders,” Reed said.
Najja Orr, president and CEO of the Philadelphia Corporation for Aging, said senior nutrition programs, like home-delivered and congregate meal programs, “provide isolated seniors with a regular form of social engagement through safety checks, and a friendly neighbor to engage with.”
He highlighted the need for increased funding and education to bridge the “digital divide” in communities and the COVID-19 pandemic shifted many programs and resources to online platforms. He also called for expanded flexibility of funding awarded to states and Area Agencies on Aging through the Older Americans Act, which would allow local governments and agencies to “better meet the needs specific to their communities.”
Since the Senate Aging Committee’s initial hearing in 2017, Congress has taken steps to combat isolation, including the Supporting Older Americans Act of 2020 signed into law in March, which reauthorized Older Americans Act services, including nutrition, home care and caregiver support. This year’s reauthorization includes grants specifically to combat social isolation and improve multigenerational collaboration.
Casey said work to address the needs of seniors during the pandemic also is being addressed by the Families First Coronavirus Response Act and the Coronavirus Aid, Relief and Economic Security (CARES) Act, as well as the Coronavirus Relief for Seniors and People with Disabilities Act.