In an age where everything has become digital and home delivery services have become the norm, people have become more isolated from each other than ever before. For older, disabled, and lower-income populations, it has become increasingly difficult to bond with the community and feel connected. Social isolation has become an epidemic internationally and has begun to cause serious health concerns. This crisis has been linked to heart disease, anxiety, substance abuse, strokes, cancer, and more.
Despite these health concerns, Medicaid and Medicare populations lack the social interventions to treat and prevent the effects of social isolation. As this problem continues to sweep across the globe, governments and communities must consider solutions that will help reduce Medicaid and Medicare costs and improve the quality of life among older, disabled, and lower-income patients. Increasing the availability of social services among these populations will help reduce healthcare costs and substantially alleviate this problem.
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Social isolation is widely associated with loneliness, yet the two are distinct concepts. Social isolation is “an objective lack of interactions with others and the wider community”. It is an objective view or measurement of one’s social interactions, relationships, and social support, or lack of engagement with others, determined by the quantity of social relationships. In contrast, loneliness is “the subjective feeling of the absence of a social network or a companion.” Loneliness tends to be associated with the quality of relationships versus their quantity.
Loneliness and social isolation gained increasing attention as a social determinants of health, with impacts comparable to or even greater than those of several other health risk factors, such as smoking, alcohol consumption, physical inactivity, and obesity. Research supporting the impact of loneliness is growing, suggesting that loneliness leads to depression, sleep problems, hypertension, functional decline, and cognitive impairments among other suboptimal conditions. In addition, social isolation has been associated with various negative health outcomes, namely higher mortality, increased risk of dementia and poor mental health, disability, poor self-rated health status, and reduced quality of life. Furthermore, resulting health implications that stem from real or perceived physical or emotional remoteness include a spectrum of harsh realities ranging from feelings of low self-worth to reduced work capacity to attempts to harm oneself.
There are many theories as to how social isolation may lead to ill health, but there are three that are widely accepted. one such theory covers behavior. The first theory covers behavior, which is when people lack encouragement from family or friends, they may slide into unhealthy habits and behavior. A second theory relates to the biological effects of loneliness. Loneliness may raise levels of stress or impede sleep, and in turn harm the body. Lastly, a third theory is that loneliness can have psychological effects in that loneliness has been seen to augment depression or anxiety.
The effects of loneliness and weak social connections have been so severe as to shorten a person’s life by 15 years, which can equate to the same impact as smoking 15 cigarettes a day. In fact, a greater social connection corresponds to a 50 percent decreased risk of early death. A report, which analyzed 70 studies representing some 3.4 million individuals in North America, Europe, Asia and Australia, found that loneliness or living alone can be more harmful to a person’s health than obesity. Loneliness is not just an undesirable way to live, it can kill individuals.
While loneliness may affect almost everyone at some point in their lives, it is much more prevalent among aging adults, the disabled, and lower-income populations. These populations are much more likely to feel a lack of companionship, and feel isolated from others. In fact, loneliness among older and disabled adults is so common that it is prevalent in 30 percent to 60 percent of the US population. Since the 1980s, the percentage of American adults who say they are lonely doubled from 20 percent to 40 percent.
Loneliness, social isolation, and the rate of people lacking close relationships are increasing. The number of adults 65 years of age and older is expected to double by 2023, reaching epidemic proportions. Additionally, isolation is increasing because there is reduced intergenerational living, delayed marriage, social immobility, increased numbers of people living alone, increased age-related disabilities, and increased dual-career families. Further, individuals who are socially isolated may develop a self-perpetuating state of daytime dysfunction, social hypervigilance, and self-preservation which drives them into deeper isolation, further worsening the effects of loneliness. This has been linked to directly affect Medicaid and Medicare populations, as patients who receive these services are more likely to become isolated and suffer from these loneliness-related ailments.
One of the reasons that loneliness and its consequences have reached epidemic proportions is because of the strong stigma that surrounds seeking help for mental and emotional difficulties. As a result, many low-income patients with mental and emotional difficulties do not recognize that they have a mental health problem that could benefit from treatment. This further leads to a lack of patients receiving adequate social interventions that could possibly prevent future health problems.
In addition to the strong stigma that surrounds mental illness, those who are socially isolated are less likely to receive timely, good-quality care than adults who do not report feeling alone. Medicaid and Medicare finances do not provide for or require social integration of social financing, such as diagnostic measures for determining isolation and loneliness. This lack of appreciation for the immense role of social determinants of health proves to be the critical obstacle to the expansion and sustainability of fully integrated care. Ultimately, awareness for the need of social determinant-based diagnostics and health care would improve health outcomes for society’s most vulnerable members.
With the increased prevalence of health problems related to loneliness, healthcare costs to remedy these problems have drastically increased. Medicare spends an additional $1,608 annually on adults who are socially isolated. In 2012, roughly 13 percent, or 4 million individuals enrolled in Medicare, were socially isolated resulting in national expenditures of $6.7 billion for socially isolated individuals that year alone – and this did not include Medicaid populations. When people think of Medicaid, they do not usually think of “seniors.” However, about 6 million seniors receiving Medicare are also enrolled in Medicaid ??• and that number does not include people in their fifties and early sixties, who will likely rely on Medicaid in the near future.
If the government could spend a fraction of what they spend on tobacco control and prevention activities, it is likely that loneliness among vulnerable populations would decrease as well as the health-related ailments associated with loneliness. Smoking-related illnesses in the United States cost more than $300 billion each year; $170 billion of this amount is spent on direct medical care of adults. As a result, in 2011, states spent $658 million on tobacco control and prevention activities. During 2012, 13 percent of Medicare enrollees, or 129,596 older Minnesotans, were living in loneliness. For the older individuals, lack of community support has been linked to the higher use of skilled nursing facilities, raising costs for socially isolated individuals. Essentially, the cost of smoking-related ailments, which is one of the top killers among smoking adults, is relatively comparable to the cost of loneliness-related ailments among socially isolated adults. If the government could spend a fraction of the amount of money spent on tobacco control towards preventing loneliness, we could decrease the amount of hospitalizations due to loneliness and in turn heavily reduce costs.
Healthcare industry leaders have researched the issue of loneliness for many years. Healthcare providers suggested ways in which the costs and health-related illnesses of loneliness can be reduced in simple and cost-effective ways. Many of these interventions have come from campaigns launched internationally. In 2011, the United Kingdom launched a national campaign to fight loneliness, an effort that Australia emulated shortly thereafter. Denmark has introduced piecemeal efforts to address isolation, such as its “Denmark eats together” campaign to encourage everyone, from government entities to private companies, to host dinner parties. However, the United States has not implemented similar large-scale efforts to address the health impacts of loneliness. Most of the work that is being done to combat loneliness is happening on a hyperlocal level: YMCAs hosting social nights for seniors, for example, or animal rescue centers running cat foster care programs for homebound adults. But, experts say a local approach might not be a bad place to start at tackling this epidemic.
One of the main issues with Medicaid and Medicare is that they look at diseases through coding but have no measurement of function. Functional limitations are twice as expensive as limitations associated with chronic conditions. This why it may be increasingly important to standardize non-medical health assessment questions. If loneliness is associated with poor health outcomes, and even death, a few precious minutes of an annual visit should be devoted to the topic. In fact, practices that spend more time asking questions about social support have better patient health outcomes than those that do not ask such questions, including improved quality of life and fewer hospitalizations. Providers should assess high-need patients for loneliness, evaluate the impact it has on their health, mental health, and access to care and refer them as needed to appropriate supports. This could include the collection of data for a person’s activities of daily living, their habits, and their relationships. Other professionals have suggested the use of interactive services to help connect isolated individuals with the community in order to feel more connected. These services include: telephone-based interventions, community involvement, online and digital solutions, and resilience training
Telephone-based interventions can provide older adults with opportunities for social connections. Telephone services are often relatively easy to implement, offer a wide reach, and require fewer resources than in-person interventions. In addition, they do not require participants to leave their homes, a potential barrier to the success of in-person programs designed for older adults who may also have mobility limitations.
In-person approaches focusing on community involvement primarily through volunteering have been used in efforts to generally address loneliness, and loneliness with older adult populations. Programs include volunteering, events, and parties that are within reach of these populations. In some programs, the volunteers recruit older adults who act as older peers to and relate with participants.
The recent growth in internet use among older adults has subsequently led to using social media, mobile applications, and other potential digital solutions to address loneliness. Social media websites for both general and older audiences are gaining popularity among older adults. These websites aim to create social connections and networks based on common interests or activities, regardless of geographic location.
Social resilience refers to the capacity to sustain positive relationships, endure, and recover from social stressors. Research demonstrates that high levels of resilience can protect against the effects of loneliness and social isolation, in addition to the benefits of resilience in adapting to other stressors and improving health outcomes.
Simply put, there are many cost-effective strategies to combat loneliness and social isolation that are well worth the investment. The ultimate goal is for everyone to start looking at social interactions as an integral part of a person’s well-being, like eating well and getting enough sleep. A healthy lifestyle checklist usually includes among others, exercise, eating vegetables, and not smoking, but does not usually contain criteria regarding socially connecting with others.
The Centers for Medicare & Medicaid Services (CMS) have begun expanding home care and social services for Medicare and Medicaid recipients. Medicaid is increasingly focusing on how different programs can cover and reimburse non-clinical interventions, like addressing loneliness, particularly in managed care. CMS and major private payers are beginning to realize the distinct advantages and benefits of reducing loneliness.
It is clear that loneliness has a large effect on the well-being of a major portion of the US population. This effect in turn costs the United States billions of dollars due to the ill conditions that arise from isolation and loneliness. There are a number of cost-effective and easy-to-implement interventions that can help reduce Medicare and Medicaid costs as well as reduce the length of hospitalizations among these patients.
However, there still remains a lack of awareness regarding this issue today. Countries around the world have begun to realize how effective interventions are in reducing unnecessary hospitalizations, ill health, and ultimately healthcare costs. Multiple studies have also been conducted that confirm the seriousness of this epidemic. Governments must begin to realize that this issue is not going away without further intervention. Most importantly, the Medicaid and Medicare communities encompassing older adults, the disabled, and lower-income populations, deserve the right to feel included and connected with their communities. With the help of evidence-based interventions, international studies, and increased awareness of this problem, it is possible to lower Medicaid and Medicare costs which in turn can benefit the entire country. It is entirely possible for social isolation to be a problem of the past and for these populations to once again feel the bond of community.
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