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Social Isolation and Loneliness Among San Francisco Bay Area Older Adults During the COVID ‐19 Shelter‐in‐Place Orders
Author(s) -
Kotwal Ashwin A.,
HoltLunstad Julianne,
Newmark Rebecca L.,
Cenzer Irena,
Smith Alexander K.,
Covinsky Kenneth E.,
Escueta Danielle P.,
Lee Jina M.,
Perissinotto Carla M.
Publication year - 2021
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.16865
Subject(s) - loneliness , social isolation , ucla loneliness scale , medicine , gerontology , social distance , anxiety , social support , clinical psychology , covid-19 , psychology , psychiatry , social psychology , disease , pathology , infectious disease (medical specialty)
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 A total of 151 community‐dwelling older adults. MEASUREMENTS We measured social isolation using a six‐item modified Duke Social Support Index, social interaction subscale, that 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 three‐item University of California, Los Angeles (UCLA) Loneliness Scale. Participants were invited to share open‐ended comments about their social experiences. RESULTS Participants were on average aged 75 years (standard deviation = 10), 50% had hearing or vision impairment, 64% lived alone, and 26% had 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). More than half (54%) of the participants reported worsened loneliness due to COVID‐19 that 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. CONCLUSION 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.