Robert’s Story

Robert, a veteran living in California, has several health challenges. But his biggest challenge actually may be social isolation.
Social isolation – defined as the absence of meaningful social relationships – is a growing public health challenge among seniors in particular. According to a Kaiser Family Foundation study, one in five Americans say they feel lonely or socially isolated. Social isolation is profoundly detrimental to the health of older adults and can be equal to the health risks of smoking 15 cigarettes a day, according to a 2015 study published in Perspectives on Psychological Science. Fortunately for Robert, whose last name is omitted at his request, prior to the COVID-19 pandemic he received regular visits from nurse practitioners to monitor his health and wellbeing. “I get visits two or three times a month,” says Robert. “It’s really nice. They do their health checks and I like to talk to them.”
Ron Ordona, DNP, FNP-BC, of Senior Care Clinic in Lincoln, Calif., is one of a team of clinicians who make medical house calls to patients like Robert – a Vietnam War veteran who lives alone in an RV at a mobile home park. “He is fiercely independent,” Ordona says of Robert, “but he has COPD, is oxygen dependent, has PTSD and suffered multiple surgeries and falls.” Ordona says Robert fits many of the categories linked to social isolation in seniors. Living alone is a well-documented risk factor for social isolation – those who live alone are more likely to have difficulty socializing with others and may experience loneliness. Further, life events such as retirement, loss of loved ones such as a spouse or friends, and age-related physical changes and possible cognitive decline can make it difficult for seniors to maintain social connectedness.
Effective interventions to prevent and address social isolation will be increasingly important to public health with the growing older adult population. When Ordona visits Robert, “it takes him some time to recognize me but once he gets acclimated he recalls and calls me as ‘Dr. Ron.’” Robert says, “I kid Dr. Ron and he kids me. I don’t go anywhere; I just stay in my home and watch TV so I really like it when he visits.”

Risk of Social Isolation

The United Health Foundation partnered with the Gerontological Advanced Practice Nurses Association (GAPNA) on the America’s Health Rankings Senior Data 2020 Update to help identify emerging health concerns and challenges such as social isolation.
The COVID-19 pandemic threatens older adult health and well-being as seniors are at higher risk for severe illness from COVID-19. Necessary public health safety measures such as physical distancing has the potential to exacerbate the issue of social isolation in older adults. Knowing the factors that place older adults at risk for social isolation is critical in identifying high risk populations of seniors during this crisis. Factors that influence risk of social isolation among seniors include race and ethnicity, immigration status, level of English proficiency, sexual orientation and gender identity, income and education levels, marital status and urbanicity.
To provide a deeper look into local profiles for risk of social isolation among seniors – defined, as informed by an AARP report, by the following risk factors: poverty; living alone; divorced, separated or widowed; never married; disability; and independent living difficulty – America’s Health Rankings has developed the measure at the county level using data from the American Community Survey.
“The data has helped steer our work in recognizing isolation as a substantial public health problem that calls for increased attention,” says Rachel Zimmer, Chair, House Calls Special Interest Group, GAPNA. As a nurse practitioner in North Carolina, Zimmer says she finds it helpful to know that older adults in her state have challenges related to a high prevalence of food insecurity, and a rising rate of multiple chronic conditions among Medicare enrollees. “These data help health care providers like me prioritize strategies for screening and proactively treating our patients,” she says. “Armed with the data, nurse practitioners can also partner with community organizations whose goal is to address seniors’ health concerns, allowing for collective impact strategies to support seniors’ health.”
That, in turn, helps socially isolated seniors like Robert.

County-level Risk of Social Isolation Maps

America’s Health Rankings provides a county level analysis for risk of social isolation relative to all U.S. counties. To view and download your state’s county level map:
  • Click on “Explore” / “Explore Report Data”
  • Select “Senior Data”
  • Select your state
  • Click on “State Summary” in the upper right corner
  • Click “County-level Social Isolation Map Download”

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