Social Isolation and Loneliness: Who's At Risk and How to Help

Editor's Note: This text-based course is an edited transcript of the webinar, Social Isolation and Loneliness: Who's At Risk and How to Help, presented by Christina Marsack-Topolewski, PhD, MSW, LMSW.

Learning Outcomes

After this course, participants will be able to:

• Explain the difference between social isolation and loneliness.
• Identify populations at risk for social isolation, exclusion, and loneliness.
• Describe the risk factors and signs of loneliness and apply effective and creative strategies and approaches to combat loneliness.

Risks and Limitations

In terms of risks and limitations, I recognize that these topics are sometimes hard and they're sometimes heavy. We know that social isolation is complex, and certainly, in our next 90 minutes together, all facets of social isolation cannot be discussed comprehensively. This is an overview to some of these topics and a way to start to think about some creative solutions and opportunities and where we might be able to even pivot in our own work. We also recognize that this topic can be really emotionally charged for people who have experienced this or maybe are even experiencing kind of the aftermath of supporting individuals who are really at risk or experiencing these facets of loneliness and isolation and so forth.

There are certainly limitations in terms of the cultural context and variations, and even different ramifications and different experiences kind of across different cultural groups and different entities. I do have a nod to that as we get into more of the material and the trends and the percentages and so forth, but I just kind of want to just recognize that as well. Some of you may be working with certain populations who are really at risk for all sorts of different reasons, and have maybe very specific cultural backgrounds that come into play. We start to think about kind of these different facets of social isolation and loneliness.

Introduction

Today, we're going to discuss social isolation and loneliness. Our focus will be on who is at risk, how to help, and the factors involved. For those of us working in behavioral health professions, we encounter many consumers and clients who experience, or are at risk for, social isolation and loneliness, or both. Although these topics have recently gained more attention, social isolation and loneliness have been longstanding issues. The COVID-19 pandemic has exacerbated these realities, making them more visible and drawing significant national and international attention.

We'll also explore the U.S. Surgeon General's recent report highlighting these issues as public health concerns. Additionally, we'll examine how the pandemic has intensified challenges for the families, individuals, and groups we serve. For many in this field, it has been a stark wake-up call, revealing significant challenges in supporting and providing resources to our populations.

The pandemic has increased service waitlists and highlighted gaps in services, along with navigation challenges. The risk of isolation and marginalization has grown, affecting more individuals and groups. We'll identify who is at risk and the signs of loneliness, and we'll discuss effective ways to reduce social isolation and loneliness.

It's encouraging to see comments from people across the United States representing various populations. Your roles and responsibilities will differ based on the populations you serve and the contexts in which you work. I'll share strategies and programmatic options that have proven effective, but remember to adapt them to your specific needs. In Michigan and on the East Coast, we've taken elements from successful programs and tailored them to the populations we serve, bringing these strategies to life.

 Social Isolation in the United States: What Comes to Mind?

What comes to mind when you think of social isolation? I'll pause there because this is a loaded question. For those of us working in various settings and supporting marginalized and vulnerable populations, different things may come to mind. If you'd like, please share your thoughts in the chat. I'll give everyone a few seconds to contribute. What comes to mind for you when you think about social isolation in our country?

So many great insights are coming through. Certainly, those living in rural areas face unique challenges. Mental health outcomes such as depression and the effects of retirement are significant. Retirement can be an exciting time for some, but for others, it brings a huge life adjustment with ramifications that might not be as positive. Forced isolation and terrorism also contribute to social isolation. Given current global events, many things have had isolating effects. Some people feel pushed aside, which can lead to school avoidance and anxiety. I'll touch on this more as we go on because I see it in my own work. Poverty, transportation issues, and work demands also play a role. Work demands, in particular, can cause social isolation. There's a PBS video I'll point out later that discusses how work can be challenging for socialization.

The death of a spouse or significant other can cause profound changes in life, leading to social isolation and loneliness. For a period in my career, I did grief counseling. I mostly supported kids who had lost a parent and the surviving parent. Many of these young parents, often in their 30s and 40s, faced social isolation because they didn't know where they fit in. It was harder for them to connect with others in similar situations, unlike older widows, who might find more normative support groups.

I appreciate all the comments in the chat. One person mentioned providing care to a loved one and how various life changes, like retirement and losing a family member, made it difficult to maintain relationships. Caregiving combined with other factors can be extremely isolating. This sheds light on the experiences of caregivers, which we'll discuss further. When we think of social isolation, many thoughts come to mind, both in the United States and worldwide. There are numerous factors at play.

I found a picture that reminds me of a cold, dark day. It has snow at the base of where a person is sitting, evoking a feeling of darkness and cold. This image reminds me of the experiences individuals shared with me during clinical treatments, describing their feelings of darkness and isolation.

Figure 1. Photo by Noah Silliman on Unsplash

Dr. Matthews shared my bio, but I'll give some context. Most of my work has been with populations with developmental disabilities in public schools and their family caregivers. In these experiences, I've seen social isolation and loneliness pervasive for about 20 years. Families sometimes feel socially excluded, and individuals with disabilities can feel lost even in large groups. My other work at the university involves research and teaching while also working in clinical settings where people discuss various realities and experiences. In the last few years, demands in K-12 have escalated. Hearing from students, particularly adolescents, I've noticed darker days and a sense of mundanity. Many feel like every day is Groundhog Day, lacking connection and purpose, which is certainly challenging.

Social Isolation vs. Loneliness

Social isolation and loneliness are not mutually exclusive, nor are they synonyms. Social isolation refers to a lack of social network or social contact. Some of you mentioned in the chat that limited regular social contact is certainly a factor. It's important to understand the differences between social isolation and loneliness. Addressing these issues requires recognizing their overlapping nature. Loneliness, on the other hand, is the feeling of distress from the cognitive appraisal or perception of being alone, separated, or disconnected.

Sue Coyle, in an article published in Social Work Today, stated, "One can also experience social isolation without experiencing loneliness. The latter is a possible effect of the former, not a certain one. In fact, social isolation and loneliness do not always go together. About 28% of older adults in the United States, or 13.8 million people, live alone, according to a report by the Administration for Community Living’s Administration of Aging of the U.S. Department of Health and Human Services. But many of them are not lonely or socially isolated. At the same time, some people feel lonely despite being surrounded by family and friends." This information, along with quotes from the National Institute on Aging from 2019, highlights the complexity of these issues. Coyle also noted, "Loneliness is a perception, as Crewe noted. It is a negative effect feeling of being alone and disconnected. According to the American Psychiatric Association, loneliness usually refers to the distress that people feel when their actual social involvement and relationships are not what they want them to be."

Many of you mentioned social media in the chat. It's profound to discuss this because social media can sometimes exacerbate feelings of disconnection. In clinical practice, I often advised clients to limit social media use and offered alternatives. While social media can be a tool for connection, it can also lead to negative ramifications through constant comparison.

Perception plays a crucial role in differentiating social isolation from loneliness. People might not feel socially isolated or lonely but can still experience adverse physical and mental health impacts. This is important to note as more people work remotely or in hybrid settings. Some thrive in office settings and find positivity in going to work, even in a hybrid capacity. Others find remote work beneficial. However, some may recognize that remote work leads to social isolation and loneliness, impacting their physical and emotional health. Even without perceiving loneliness, individuals can still experience adverse effects. Mother Teresa once said, "I still think that the greatest suffering is being lonely, feeling unloved, just having no one. This is the worst disease that any human being can ever experience." These words, decades old, resonate with the U.S. Surgeon General's report on the profound difficulties of social isolation and loneliness. This is not just a personal issue but a public health issue. Being socially isolated and lonely is akin to smoking 15 cigarettes a day, highlighting the severe impact on health.

Setting the Stage

I want to set the stage for our discussion. Think back to when you first realized the onset of the pandemic. For many, this was a moment of shock and uncertainty. I'll share my experience. I remember being in the grocery store, walking through the frozen food aisle. The shelves were almost empty. Everyone around me looked bewildered and stunned, hesitant to take the last of anything. That moment, for me, was a clear signal that something was seriously wrong. It was an experience unlike anything I'd encountered in my lifetime.

What about you? When did you first realize the pandemic's impact? Feel free to share your thoughts in the chat. I see some of you mentioning similar experiences—grocery shopping, noticing empty shelves, and people panic-buying. One person mentioned it was about a week before the shutdown when they truly understood the scale of it. Celebrations were canceled, workplaces closed, and kids had to be trained to wear masks. Jessica, thank you for sharing your experience with young children, especially those with sensory issues. The toilet paper crisis and bulk-buying of masks were also significant markers of the pandemic's early days. These moments set the stage for what was to come. As we look back, it's clear that this realization came at different times and in various ways for each of us. For our clients, consumers, and students, the pandemic was an amplified experience. Those already dealing with anxiety or depression faced even greater challenges.

Despite these difficulties, my colleagues and I have published work on some unexpected silver linings. We saw increased family cohesion, new communities forming, and innovative solutions emerging. However, the adolescent population and older adults were profoundly impacted. Thank you for sharing your thoughts in the chat. It's always valuable to hear different perspectives as they relate to our work.

Rising Rates of Loneliness for Many Decades

If we look back many decades, even before the 1970s, we see a long trajectory of rising loneliness across all age groups. A common misconception is that older adults are the primary victims of social isolation and loneliness. While it is true that older adults face significant barriers, such as transportation issues and declining social networks, trends show that loneliness affects all age cohorts.

The Epidemic of Social Isolation & Loneliness

Consider this: 60% of Americans feel lonely regularly. This is a profound statistic. In October, I spoke at a social isolation summit for a healthcare company, attended by professionals working with various populations. As a college professor, I see firsthand how loneliness affects students. Many of you treating college students in clinical practice might notice similar trends.

Loneliness is a public health crisis, impacting both physical and mental health. Research supports the link between social isolation, loneliness, and premature mortality. Dr. Lori Santos from Stanford University discusses these issues, noting that people are spending less time together, which exacerbates the problem. She describes the epidemic of loneliness as drastic, affecting both our bodies and minds. There are numerous causes and factors contributing to this increase.

People are not only unhappy but also more isolated than before. The lack of free time for social interaction is a significant factor. Many people spend their days on back-to-back Zoom meetings, losing the casual conversations that might occur in an office setting. These small interactions, like offering support to a colleague, are essential. A personal anecdote highlights this point. I was in the grocery store with my three-year-old daughter. We had a lot of items, so I chose not to use the self-scan and went to the cashier instead. The store was packed, and there was a long line. An elderly man behind me started a conversation, sharing that he was caring for his wife with dementia. These small dialogues, made possible by the long line, allowed us to connect.

Neighborhood and community conversations are also important, but they are not always feasible for people living in rural or unsafe areas. Dr. Lori Santos from PBS talks about the impact of technology on social interactions. Many believe technology connects us, but it often leads to constant comparison and missing out on present interactions.

For example, think about being at a restaurant or in an airport where everyone around you is on their phones. Families sit together but don’t interact because they’re engrossed in their devices. This phenomenon is especially noticeable in schools. When students were allowed to bring their own devices, interactions suffered, and behavioral issues increased. Once the devices were removed, social interactions flourished, and behavioral concerns decreased. Dr. Santos's video discusses how missing out on in-person interactions is a significant issue. Organic, spontaneous conversations are vital for our social well-being, and technology often disrupts these moments.

Health Impact on Social Isolation and Loneliness in Children and Adolescents

Let's discuss the health impacts of social isolation and loneliness in children and adolescents. These challenges encompass various aspects of health and mental health. I currently work part-time consulting for students receiving special education in public schools due to health, mental health, or other reasons. Some students have chosen to go virtual for various reasons, significantly altering their daily experiences. I assist in structuring their learning environments and work with families to provide accommodations and modifications tailored to their specific needs.

I often see co-occurring mental health challenges among these students. Additionally, I work with many adolescents suffering from chronic pain caused by conditions like fibromyalgia or short gut syndrome, which require frequent medical visits. These students often experience increased isolation and loneliness. For instance, a student receiving weekly infusions may face challenges in maintaining meaningful social interactions. It is crucial to balance health needs, particularly for those with compromised immune systems, with efforts to reduce social isolation.

Social Isolation & Older Adults

For older adults, many of you may work with this population or have personal connections to it. One in four community-dwelling adults aged 65 and older are considered socially isolated. Social isolation impacts health in various ways, which the next slide will detail. However, it's important to note that social isolation is linked to premature mortality from all causes—a profound public health issue.

Poor social relationships, characterized by social isolation or loneliness, have significant health implications. These include a 29% increase in coronary heart disease and a 32% increase in the risk of stroke. Loneliness is also associated with physical frailty, cognitive decline, dementia, and both physical and emotional declines. Additionally, it leads to higher rates of falls and, as previously mentioned, increased rates of stroke and heart disease.

Demographics & Loneliness

When discussing the demographics of loneliness, it's important to consider the diverse cultural backgrounds we work with. Disparities and differences significantly impact experiences of loneliness. We cannot apply a one-size-fits-all approach to understanding how loneliness affects people across the United States. Underrepresented racial groups, such as Hispanic adults, face disproportionate impacts. Notably, 75% of Hispanic adults report feeling lonely, a figure that surpasses the 60% national average. If you work with or know individuals in this group, be aware of this issue. Various strategies and supports can help make environments more accessible, welcoming, and inclusive. Some of these strategies will be detailed in the slides at the end.

Similarly, 68% of Black and African American adults report feeling lonely, which is higher than the 60% average. Lower-income individuals also report higher loneliness levels compared to those with higher socioeconomic statuses. Factors such as transportation, literacy, and disabilities often play a role, impacting income and contributing to these feelings of loneliness. These populations face additional barriers and challenges in mainstream society that further exacerbate their situation.

Interestingly, young adults are twice as likely to experience loneliness compared to seniors. This statistic may be surprising, especially for those working with adolescents and emerging adults. Many of you may interact with individuals in this age group, making this information particularly relevant. For instance, in Michigan, a radio station in Metro Detroit starts playing Christmas music around Halloween. The primary listeners are college-aged students who seek the nostalgia and comfort of home during their time away at college. Traditions, community, and family significantly influence young adults' sense of belonging. More young adults feel left out compared to older adults. While it's true that older adults experience loneliness and isolation, younger adults face these feelings to a greater extent. This insight emphasizes the need to maintain and expand programs and services for all age groups. Men and women report similar rates of loneliness, with men slightly more likely to feel lonely.

Age matters significantly in the context of loneliness. A survey found that three in five American adults report feeling lonely, with younger adults being the most affected. Among Generation Z, nearly 80% experience consistent loneliness. For millennials, the figure is slightly lower at 71%. In contrast, about 50% of baby boomers report feeling lonely. These statistics highlight the necessity of ongoing efforts to augment programs and raise community awareness about the widespread impact of loneliness across different age groups.

Loneliness Among Adolescents

I want to discuss adolescents for a bit. As I mentioned, the majority of my current work is with adolescents who have various disabilities and receive special education support. These disabilities include autism, learning disabilities, physical health conditions, and mental health conditions. I work with many individuals with ADHD and co-occurring mental health issues such as anxiety, depression, and suicidal ideation.

A recent study on adolescents identified five main themes based on their experiences. One theme described loneliness as an "extreme dark experience." Another theme highlighted how adolescents are "exhausted by loneliness but unable to sleep restfully." Many of you working with similar populations may notice how sleep is impacted. In my practice, we discuss sleep hygiene informally, addressing routines and late-night activities like social media use, which affect their daytime functioning and schoolwork. Adolescents also reported that loneliness revolves around difficulties with peer relationships, which become more challenging when there is family conflict. For example, since the advent of cell phones, virtual bullying has become common, amplifying peer conflict and isolation. Social media can exacerbate these challenges, even though it has benefits.

The fourth theme is that school becomes a difficult place for those experiencing loneliness. I recall working with a student who decided to take all his high school classes virtually because of severe anxiety and loneliness. He felt more comfortable in a virtual setting, and we worked with his family to provide social opportunities that suited his needs. This student, who had high-functioning autism, struggled with physical illness due to anxiety at school and felt excluded and unsafe.

Lastly, adolescents believe that coping strategies often fail to alleviate loneliness. A 15-year-old in the study stated, "Everyone says it's normal for teenagers to feel like this, but it's not." Another participant mentioned that counseling was unhelpful, as it suggested positive thinking would solve everything, which didn't address deeper systemic and relational issues. Many young adults are reluctant to share their feelings of social isolation and loneliness. Recently, I worked with a student whose grades had plummeted. He expressed feeling lonely, disconnected, and uncertain about his place and purpose daily. These transitional years are particularly challenging as students grapple with graduation, future plans, and finding their path in life. It's crucial to build supportive plans that scaffold positive experiences and address these foundational issues.

Parents & Guardians vs. Non-Parents

I found the comparison between parents and non-parents particularly interesting. Many of you here are likely parents, and as a parent myself, I can relate to these experiences. I have two young daughters, aged two and three-and-a-half, and getting out of the house can be quite a challenge. Between meals, library visits, play places, and parks, I've noticed how tired parents often look, as if we're all just trying to figure it out together.

Notably, 65% of parents and guardians, compared to 55% of non-parents, report feeling lonely. This loneliness impacts not only the parents but also their children. When parents feel lonely, defeated, or isolated, it can have significant implications for their kids. Therefore, anything we can do to augment support, recognize their struggles, and foster connections can be incredibly helpful. There's a wealth of literature supporting the importance of such interventions.

Living Arrangement Matters Usually

Many people live alone and thrive, enjoying robust social lives. I have a colleague in her 70s who lives alone and has a vibrant social life. She's always asking me about my activities, and I often find myself admiring her active lifestyle. In her case, living alone doesn't mean feeling isolated or lonely; she has many opportunities to connect with others through various groups and activities.

However, for many Americans, living with others reduces the likelihood of feeling lonely compared to living alone. An important exception is single parents and guardians. This group can experience significant isolation, which can be detrimental to their health. They are more likely to report feelings of loneliness, highlighting the need for targeted support and interventions.

Major Impacts on Health and Mental Health

We talked about this earlier, but the impact of lacking personal connections on physical health is profound. It's more detrimental than smoking 15 cigarettes a day, being overweight or obese, or experiencing high blood pressure. These effects are significant and alarming.

This issue doesn't end here; I have additional statistics to emphasize the public health implications. As we consider the reasons behind this significant problem, it becomes clear why addressing social isolation is so crucial.

Know the Risk Factors

When considering risk factors, several key points come to mind. Many of you work with individuals who experience some or all of these issues. Living arrangements, such as living alone, certainly present a risk factor.

Individuals who are homebound, near homebound, or have ambulatory or mobility challenges are also at significant risk, particularly in cold climates. I have a friend who developed a severe physical disability after a water accident. When he lived in Michigan, his muscles would tighten up due to the cold, making it extremely difficult for him to walk. Weather challenges, whether it's too hot, too cold, or too wet, exacerbate difficulties for people with disabilities or mobility issues.

Major losses or life challenges also play a role. For example, widowhood can drastically change social structures and group dynamics. Retirement, while potentially positive, often comes with its own set of challenges. Proactive individuals plan their retirement activities, but others may struggle with the loss of daily structure. The loss of caregiving roles, especially among aging caregivers of adults with autism and other neurodevelopmental disabilities, also contributes to feelings of loneliness and social isolation.

Financial challenges can hinder people's ability to connect with others, impacting their access to transportation and other resources. Caregiving, whether for a child, an aging spouse, or a parent, often involves many hours of isolated work. Mental health or cognitive challenges can also create barriers, making it difficult for individuals to commit to plans due to unpredictable conditions.

Physical health issues can similarly deter people from making social commitments, as they might not want to cancel plans if their health declines. Other factors include language barriers, location factors, and experiences of discrimination. Unsafe areas, rural or remote locations, and hard-to-access places significantly contribute to social isolation and loneliness.

I recall working with a professor who studied older adults living in Detroit. These individuals shared their challenges and strategies for maintaining health in an unsafe environment. They discussed activities like playing bridge, attending church, participating in Bible study, and exercising. However, their ability to engage in these activities was often limited by their surroundings, further highlighting the impact of location on social isolation and loneliness.

Benefits of Social Connections

There are numerous benefits to supporting social connections in our own lives and for those around us. Many of you may be, or know, individuals who act as connectors, always introducing people and fostering new relationships. This role can be invigorating and highly beneficial.

Supporting social connections can lead to a lower risk of anxiety and depression, as well as improvements in self-esteem, empathy, and trust. Interestingly, fostering social connections can increase the chances of longevity by 50%. People with strong social ties are more likely to report good overall physical and mental health. Achieving the right balance is crucial—adequate sleep, socialization, and a healthy work-life balance all contribute to well-being. I have references available at the end for anyone interested in further reading.

Community and Belonging: What Comes to Mind When You Think of These Words?

When you think about community and belonging, what comes to mind? Feel free to add your thoughts in the chat. Community and belonging. Yes, joy, as Venus mentioned. Feeling comfortable to be yourself, support, diversity and inclusion, connection, love, social opportunities, purpose, security, respect, fulfillment. Having people to connect with, people helping one another. Reliance and social connection feed the brain and safety. These are all wonderful points.

I remember attending a training session on community, diversity, equity, and inclusion. One of the speakers emphasized the importance of these aspects. When I think of community, I recall seeing smiles appear on people’s faces as they wrote down their thoughts during that session. It was heartwarming to witness.

Many of us have roles that enable us to foster these aspects of community and belonging, whether in our personal lives, communities, or friend groups. People working together for the collective good is crucial. For many years, there has been a strong push for independence in the U.S. While independence is valuable, such as teaching my young daughters to put their dirty clothes in the hamper, I believe we should strive for interdependence. This means relying on each other, giving and taking, much like a potluck where everyone contributes and is included.

Shifting towards a stance of community, belonging, respect, and inclusivity can significantly mitigate feelings of isolation and not belonging. I love this quote from Maya Angelou: "I long, as does every human being, to be at home wherever I find myself." Let's explore the reasons behind societal disconnection. Various barriers contribute to this issue, not just in the U.S., but globally. Although it might be less pronounced in some countries, communication barriers, transportation and technology barriers, structural barriers, workplace changes, and a focus on independence rather than interdependence all play a role. What am I missing here?

A Deeper Dive Into the Root of Disconnection

When we think about the root of disconnection, what other barriers come to mind? What do you see in your own work that isn’t on this list? Yes, trauma, transportation issues, emotional factors, and fear are significant barriers. Anything else? Financial challenges, mental health issues, language barriers, anger, lack of knowledge, and shyness are also crucial factors. I work extensively with individuals with autism, and they face numerous barriers. Communication challenges are common. Transportation is often a hurdle since many don’t drive and can’t access opportunities as easily, including jobs. Structurally, our society is designed for a neurotypical population, creating additional obstacles for those with autism.

Physical challenges are another major barrier. For instance, clients with cerebral palsy face difficulties in participating in activities they enjoy with their loved ones. Transportation becomes an issue, especially in bad weather, which is common here in Michigan. If their ride gets sick, they miss out on activities like church services or going to the symphony. These barriers have significant ramifications, impacting their ability to connect and engage with their communities.

Practical Tips

Here are some practical tips I found useful when working with clients. These strategies are well-known and often come to mind as effective ways to scaffold support based on individual needs.

Practice Wellness:

• Exercise regularly
• Eat healthy
• Maintain good sleep habits
• Engage in enjoyable activities

I’ve worked with clients to implement these practices tailored to their specific needs and challenges. Staying active and connected to others is essential. These habits are often learned and integrated into one’s lifestyle. However, they may need reinforcement, especially for those significantly impacted, such as adolescents who have been hesitant to return to physical school buildings since the pandemic.

Utilize Community Resources and Events:

• Engage with faith communities, which can be effective for those who find a sense of belonging in these spaces. There’s substantial literature supporting the protective role of faith communities, spirituality, and religion in addressing health and mental health challenges.
• Participate in community events and resources, which do not always need to be local. For instance, online communities can provide significant support.

In my research, as part of a national task group on intellectual disabilities and dementia practices, I’ve seen the importance of community. My colleague and I have studied caregivers of individuals with intellectual disabilities and dementia, often including those with Down syndrome. This group of caregivers is often invisible, spending countless hours navigating services, advocating, and providing in-home care for their loved ones who are in a state of decline due to complex health needs and dementia.

One heartening example is an online support group for these caregivers. People from all over the world join this community, sharing tips, offering support, and discussing their challenges. This group has created a sense of belonging and support that transcends geographical boundaries. My colleague and I studied this group with ethical approval, and it was inspiring to see how community can uplift individuals, even from afar. This online community demonstrates how people can lift each other up, regardless of distance, offering a model for how we can foster connections and support in various contexts.

Other Possible Solutions

One possible solution involves leveraging technology. I was connected with a group in Delaware that runs a program offering in-home support for older adults and people with chronic illnesses. These individuals, who are predominantly homebound, often need additional support services and are at risk of feeling isolated or lonely. We adapted their program for our demographic in two Michigan counties and launched it just over two years ago. Essentially, it offers in-home practical support to older adults with chronic illnesses and disabilities through friendly visits from college students.

These students are training to become social workers, nurses, occupational therapists, public health professionals, and more. They seek to expand their experience with older adults, better understand health, and grasp the role of community services, identifying any gaps. We found that in-home practical support is often scarce and expensive in Michigan. While medical care is accessible, necessary in-home support is not always available, leading to loneliness and isolation among many older adults.

Each week, over a hundred older adults receive friendly visits from our students. The intergenerational benefits of this program are significant. As the program grew, we had a waitlist. In January, we piloted a telesupport program from the west side of the state. While this is not a complete replacement for in-person visits, it provides an alternative. We believe these interactions reduce psychological distress and loneliness, offering benefits across generations.

Another solution involves creating comprehensive referral and resource guides. Organizations can collaboratively build these guides to streamline the process, reducing the need for repeated searches for individual cases. Understanding the reasons behind disconnected networks can also help address the issue more effectively.

Programs like the Links Program in K-12 settings connect students with disabilities to peers, fostering relationships, social learning, and appropriate behaviors. Students often prefer learning from peers rather than teachers or social workers, making these programs highly effective.

Family support programs are invaluable. We received grant funding for a program assisting aging caregivers of adults with autism and other neurodevelopmental disabilities. Family support navigators helped these caregivers navigate aging services, disability services, and services for themselves and their loved ones. Relationships were built through this support, greatly benefiting the caregivers and their families. Unfortunately, due to funding constraints, we could not continue the program statewide in Michigan.

Faith-based communities can also be excellent sources of connection and referrals, offering support across various needs. By implementing these solutions and continually seeking innovative ways to support social connections, we can help mitigate feelings of isolation and loneliness across diverse populations.

Intergenerational Programs

Let's discuss intergenerational programs and their impacts. The program I mentioned earlier, called Lori's Hands, is a prime example. Originating in Delaware over a decade ago, this program provides in-home support for people with chronic illnesses. The foundation of their approach is intergenerational collaboration.

In Lori's Hands, college students work with individuals who have chronic illnesses across various stages of life. Here in Michigan, our program specifically focuses on older adults. This focus arose partly from identified needs and partly due to the specific requirements of the grant we received. However, intergenerational programming can take many forms and benefit a wide range of populations.

Intergenerational programs like Lori's Hands create meaningful connections between younger and older generations. These programs provide practical support to older adults while offering valuable learning experiences for students. By bridging generational gaps, they foster mutual understanding, reduce feelings of isolation, and promote overall well-being for both groups involved.

Examples of Intergenerational Programs

Let's get our brains thinking about intergenerational programs and how they can be expanded or integrated into your work. Here are some examples to consider:

• Foster Grandparent Program: This program pairs older adults with children who need extra support, providing mentorship and companionship. It's a fantastic way to foster intergenerational connections.
• Buddy Program: At Northwestern University, first-year medical students are paired with individuals in the early stages of dementia. This program promotes mentorship and social engagement for both participants, enriching their experiences and understanding.
• Opening Minds Through Art: This intergenerational art program pairs individuals with dementia with others to create art together. Art can be a powerful mode of expression, especially for those with cognitive decline, allowing them to connect and communicate beyond language barriers.
• Kindness Creator: This program focuses on fostering kindness and understanding between generations. It's another excellent example of how intergenerational interactions can be beneficial.
• Lori's Hands: As previously mentioned, this program involves college students providing in-home support to older adults with chronic illnesses. It highlights the benefits of intergenerational collaboration.
• Preschool and Retirement Complex: One particularly heartwarming example involves a collaboration between a preschool and a retirement complex. The interaction between preschoolers and older adults brings numerous benefits. For young children, learning from older adults helps shape their views and respect for the elderly. Older adults, in turn, find a renewed sense of purpose. One participant shared that knowing the children expected her made it easier to get out of bed despite not feeling well. This sense of responsibility and connection can significantly enhance the well-being of older adults.

By considering and integrating these intergenerational programs, we can create opportunities for mutual learning, understanding, and support across different age groups. These programs not only combat loneliness and isolation but also enrich the lives of all participants involved.

Benefits of Intergenerational Programming

Other benefits include a greater sense of community connection, enhanced social engagement, and a deepened sense of meaning and purpose, all of which are mutually beneficial. When we consider the advantages of intergenerational programming for different generations, one reason I am particularly fond of it is its holistic impact. I am currently part of a cohort in Michigan examining these benefits.

Intergenerational programming isn't just about helping older adults or kids; it spans the entire lifespan of those involved. Participants experience diverse learning opportunities and numerous benefits. In our program with Lori's Hands, we observed reduced psychological distress and decreased loneliness among older adults. These findings are currently under review in a gerontological social work journal. Additionally, we found that our students gained self-efficacy and competence, as well as meaningful experiences.

Arizona State University hosts a Salvation Army program that provides social services to low-income adults aged 50 and above. They discovered that many seniors wanted to learn technology skills, leading to various program benefits outlined in the final slide of the presentation. However, I want to highlight some quotes from participants. An Arizona State University student noted, "I do believe we had a positive impact on the older adults at the center. Just having new people to talk with and engage with helps sustain their health and mind, making them happy." This student felt their work was impactful and fulfilling. Another student emphasized the community benefits, stating, "The most important thing I learned working with this project is the importance of continuing my involvement in the community." I find this sentiment inspiring, showcasing the profound and positive effects of intergenerational programming.

Social Support

When considering social support, much of my work focuses on this concept. Specifically, I examine quality of life, social support, and caregiver outcomes for aging caregivers of adults with autism. These areas dominate my publications, reflecting the dual focus on both quality of life and support systems.

When we think about building community, we need to consider the sources of support. Informal support encompasses unpaid assistance from family, friends, and neighbors, forming the core of our environment. Formal support, on the other hand, is paid assistance funded by the government or other mechanisms provided through organizations and agencies.

In my research, I often explore how to build caregiver communities and where social support can be derived. Both formal and informal support networks play crucial roles. As you consider your population, it's likely that community building will involve leveraging these informal networks alongside formal structures and supports.

Supporting Clients and Their Family Caregivers

Supporting clients and their family caregivers is essential, as families form a significant part of the community. This support can be provided through education, learning about and accessing resources, and building and maintaining positive relationships. Many of you may be involved in counseling families or groups, focusing on how to foster healthy, positive relationships and promoting a supportive mindset.

I noticed some excellent contributions in the chat. While I can't read all of them now, it's clear that there are many great ideas being shared. For example, the University of Maine has some impressive initiatives, and RSVP provides senior support through phone calls. Thank you for mentioning these. Such efforts highlight the diverse ways we can enhance support for clients and their caregivers.

Systematic Review

A systematic review of 53 peer-reviewed journal articles, with 11 selected for this specific study, examined the benefits of intergenerational programming. Various types of programs were considered, including artistic, educational, health-related, open-ended activities, and citizen projects. Many of you might already be involved in similar initiatives.

When I was pursuing my master's in social work at the University of Michigan, I had the opportunity to explore both aging and school social work. This dual focus allowed me to integrate my interests in aging caregiving and school-based services. During my internship, I coordinated a program where retired senior citizens provided tax preparation assistance to low-income individuals. It was remarkable to witness the extensive knowledge and expertise these seniors had in tax preparation, homestead credits, and energy and heat credits, which they generously shared with others.

Intergenerational programming offers numerous benefits. For children, these programs foster positive attitudes, behaviors, confidence, and competence. For older adults, they contribute to improvements in health, mental health, and quality of life. One significant takeaway from my work in this field is the profound impact intergenerational programs can have on combating social isolation and loneliness, which are detrimental to physical and mental health and can lead to premature cognitive decline and mortality.

Our program currently supports over 100 older adults, with students gaining internships and practicum experiences under the supervision of one paid staff member. This model has proven to be cost-effective. Intergenerational programming for older adults has been linked to decreased loneliness, increased perceived quality of life, and higher levels of generativity, life satisfaction, and positive attitudes towards children. These programs also contribute to spiritual health and overall well-being.

Where Do We Go From Here? 

Earlier, I mentioned the U.S. Surgeon General's report. In 2023, the U.S. Department of Health and Human Services published an advisory highlighting the severe consequences of loneliness and isolation, labeling them as a public health epidemic. This advisory provided a framework for addressing the issue, which is detailed in the link on this slide.

The report outlines several key recommendations. Firstly, we need to strengthen our social infrastructure. Our society is fragmented and disconnected, with significant polarization. Strengthening social ties is crucial. Secondly, public health policies should be pro-connection, fostering opportunities for people to connect. This is more important now than ever.

Additionally, mobilizing the health sector to address loneliness and reforming digital environments to make them inclusive and accessible are vital steps. Continued research to deepen our understanding of loneliness is also essential. Finally, we need to cultivate a culture of connection. Many of you might already be fostering connections in your organizations and communities. We need to expand these efforts, inspire others, and grow a culture of connection. Anything we can do to promote and nurture this culture is immensely valuable.

Key Takeaways 

As behavioral health professionals, we understand that social isolation and loneliness significantly impact over 60% of our country. These issues affect people across the lifespan, various racial, ethnic, and cultural backgrounds, and different socioeconomic statuses, though some groups are more affected than others. Social isolation impacts health, well-being, and psychological state.

To address this, we need to promote inclusive practices and create spaces for belonging and inclusivity. One approach is to return to the basics and think creatively about building inclusive environments. For example, I work with a colleague focused on third spaces, like libraries, and how to make these places more inclusive for those who rely on them as a primary gathering spot.

Consider the story of a middle school track runner with a profound visual impairment who wanted to join the track team. This student worked with another student who guided her during races, and they became close friends, forming a supportive community. This example highlights the power of innovative thinking and the significant impact of fostering inclusion and belonging. It required two willing individuals and a focus on safety, demonstrating that promoting inclusion doesn't have to be complicated.

I want to leave you with a quote from Helen Keller: "Alone, we can do so little; together, we can do so much." This sentiment is fitting as we consider how to make our world more inclusive, accepting, and connected. Thank you all for joining today.

Q&A

It seems like safety would be an issue with connecting any strangers, especially older, younger vulnerable individuals. Did any of your interventions include any safety precautions?

Absolutely. Let me discuss our Lori's Hands program as an example. In this program, both college students and consumers, such as older adults or individuals with chronic illnesses, undergo background checks to ensure safety. There's a thorough screening process in place for this. Given the intensity and impact of COVID-19, we implemented additional precautions. Some services were adapted to be contactless to reduce risk. It's essential to always have mechanisms to promote safety, and these precautions need to be tailored to the specific needs of each population and program. Different groups will require different safety measures to ensure that all participants are protected.

Is social isolation harmful if the person doesn't feel lonely?

That's an excellent question, and I appreciate you asking it. It's important to consider that some people may not report feeling lonely or isolated and may appear to be happy. However, this doesn't necessarily mean they aren't experiencing the adverse impacts of social isolation and loneliness.

My deep dive into the literature revealed that even those who don't openly acknowledge these feelings can still suffer from their effects. It's a cautionary note for us all: just because someone isn't reporting loneliness doesn't mean they're not experiencing its negative consequences. We need to be aware of the broader implications and ensure we're attentive to these hidden struggles.

What about individuals experiencing homelessness or heavily justice involved?

Absolutely, and thank you for raising this point. Populations such as those who are homeless or heavily involved with the justice system face significant vulnerabilities, impacting their sense of connection and belonging. This issue is substantial and worth deep consideration. I'd like to share a story to illustrate this. A few years ago, I visited a shelter for older adults in Ann Arbor, and one encounter left a lasting impression on me. A woman I met was struggling with homelessness, and one of her biggest barriers was not having a place for her dog. This dog was a major source of connection for her. This experience made me think about the growing body of literature on animal-assisted support for older adults and individuals with disabilities, highlighting the importance of such connections.

The literature and our daily experiences show that people experiencing homelessness are often fragmented from everyday community life. They face challenges in maintaining human connections, as society frequently dehumanizes them. This fragmentation makes it difficult for them to connect with others for various reasons. Addressing these issues requires a deeper understanding and a compassionate approach to fostering connections and belonging for these vulnerable populations.

References

Fuller-Rowell, T. E., Nichols, O. I., El-Sheikh, M., Burrow, A. L., Ong, A. D., & Ryff, C. D. (2024). The pandemic and social experience: For whom did discrimination and social isolation increase? Cultural Diversity & Ethnic Minority Psychology, 30(1), 107-117. https://doi.org/10.1037/cdp0000561

Giraudeau, C., & Bailly, N. (2019). Intergenerational programs: What can school-age children and older people expect from them? A systematic review. European Journal of Ageing, 16, 363-376. https://doi.org/10.1007/s10433-018-00497-4

Harrington, K. D., Vasan, S., Sliwinski, M. J., & Lim, M. H. (2023). Loneliness and cognitive function in older adults without dementia: A systematic review and meta-analysis. Journal of Alzheimer's Disease, 91(4), 1243-1259. https://doi.org/10.3233/JAD-220832

Hayashi, T., Umegaki, H., Makino, T., Huang, C. H., Inoue, A., Shimada, H., & Kuzuya, M. (2020). Combined impact of physical frailty and social isolation on rate of falls in older adults. The Journal of Nutrition, Health & Aging, 24, 312-318. https://doi.org/10.1007/s12603-020-1316-5

Hemberg, J., Östman, L., Korzhina, Y., Groundstroem, H., Nyström, L., & Nyman-Kurkiala, P. (2022). Loneliness as experienced by adolescents and young adults: An explorative qualitative study. International Journal of Adolescence and Youth, 27(1), 362-384. https://doi.org/10.1080/02673843.2022.2109422

Hutten, E., Jongen, E. M., Hajema, K., Ruiter, R. A., Hamers, F., & Bos, A. E. (2022). Risk factors of loneliness across the life span. Journal of Social and Personal Relationships, 39(5), 1482-1507. https://doi.org/10.1177/02654075211059193

Jarrott, S. E., & Lee, K. (2023). Shared site intergenerational programs: A national profile. Journal of Aging & Social Policy, 35(3), 393-410. https://doi.org/10.1080/08959420.2021.2024410

Jarrott, S. E., Scrivano, R. M., Park, C., & Mendoza, A. N. (2021). Implementation of evidence-based practices in intergenerational programming: A scoping review. Research on Aging, 43(7-8), 283-293. https://doi.org/10.1177/0164027521996191

Johnson, E., & Volsche, S. (2024). Covid-19: Companion animals help people cope during government-imposed social isolation. Society & Animals, 32(1), 56-73. https://doi.org/10.1163/15685306-BJA10035

Joyce, J., Ryan, J., Owen, A., Hu, J., McHugh Power, J., Shah, R., Woods, R., Storey, E., Britt, C., Freak-Poli, R., & ASPREE Investigator Group. (2022). Social isolation, social support, and loneliness and their relationship with cognitive health and dementia. International Journal of Geriatric Psychiatry, 37(1). https://doi.org/10.1002/gps.5644

Juris, J. J., Bouldin, E. D., Uva, K., Cardwell, C. D., Schulhoff, A., & Hiegl, N. (2022). Virtual intergenerational reverse-mentoring program reduces loneliness among older adults: Results from a pilot evaluation. International Journal of Environmental Research and Public Health, 19(12), 7121. https://doi.org/10.3390/ijerph19127121

Kenning, G., Ee, N., Xu, Y., Luu, B. L., Ward, S. A., Goldwater, M. B., Lewis, E., Radford, K., Anstey, K. J., Lautenschlager, N. T., Fitzgerald, J. A., Rockwood, K., & Peters, R. (2021). Intergenerational practice in the community—What does the community think? Social Sciences, 10(10), 374. https://doi.org/10.3390/socsci10100374

Kojima, G., Taniguchi, Y., Aoyama, R., & Tanabe, M. (2022). Associations between loneliness and physical frailty in community-dwelling older adults: A systematic review and meta-analysis. Ageing Research Reviews, 81, 101705. https://doi.org/10.1016/j.arr.2022.101705

Lampraki, C., Hoffman, A., Roquet, A., & Jopp, D. S. (2022). Loneliness during COVID-19: Development and influencing factors. PloS One, 17(3), e0265900. https://doi.org/10.1371/journal.pone.0265900

Lee, K., Jarrott, S. E., & Juckett, L. A. (2020). Documented outcomes for older adults in intergenerational programming: A scoping review. Journal of Intergenerational Relationships, 18(2), 113-138. https://doi.org/10.1080/15350770.2019.1673276

Lippke, S., & Warner, L. M. (2023). Understanding and overcoming challenges in times of personal or global crisis—Editorial on the Special Issue on Loneliness and Health. Applied Psychology: Health and Well‐Being, 15(1), 3-23. https://doi.org/10.1111/aphw.12420

Loades, M. E., Chatburn, E., Higson-Sweeney, N., Reynolds, S., Shafran, R., Brigden, A., Linney, C., McManus, M. N., Borwick, C., & Crawley, E. (2020). Rapid systematic review: The impact of social isolation and loneliness on the mental health of children and adolescents in the context of COVID-19. Journal of the American Academy of Child & Adolescent Psychiatry, 59(11), 1218-1239. https://doi.org/10.1016/j.jaac.2020.05.009

National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Health and Medicine Division; Board on Behavioral, Cognitive, and Sensory Sciences; Board on Health Sciences Policy; Committee on the Health and Medical Dimensions of Social Isolation and Loneliness in Older Adults. (2020). Social isolation and loneliness in older adults: Opportunities for the health care system. National Academies Press (US).

Pengpid, S., & Peltzer, K. (2021). Associations of loneliness with poor physical health, poor mental health and health risk behaviours among a nationally representative community‐dwelling sample of middle‐aged and older adults in India. International Journal of Geriatric Psychiatry, 36(11), 1722-1731. https://doi.org/10.1002/gps.5592

Peters, R., Ee, N., Ward, S. A., Kenning, G., Radford, K., Goldwater, M., Dodge, H. H., Lewis, E., Xu, Y., Kudrna, G., Hamilton, M., Peters, J., Anstey, K. J., Lautenschlager, N. T., Fitzgerald, A., & Rockwood, K. (2021). Intergenerational Programmes bringing together community dwelling non-familial older adults and children: A Systematic Review. Archives of Gerontology and Geriatrics, 94, 104356. https://doi.org/10.1016/j.archger.2021.104356

Petersen, J. (2023). A meta-analytic review of the effects of intergenerational programs for youth and older adults. Educational Gerontology, 49(3), 175-189. https://doi.org/10.1080/03601277.2022.2102340

Phang, J. K., Kwan, Y. H., Yoon, S., Goh, H., Yee, W. Q., Tan, C. S., & Low, L. L. (2023). Digital intergenerational program to reduce loneliness and social isolation among older adults: Realist review. JMIR Aging, 6(1), e39848. https://doi.org/10.2196/39848

Prada Crespo, D., Montejo Carrasco, P., Díaz-Mardomingo, C., Villalba-Mora, E., & Montenegro-Peña, M. (2024). Social loneliness in older adults with mild cognitive impairment: Predictive factors and associated clinical characteristics. Journal of Alzheimer’s Disease, 97(2), 697-714. https://doi.org/10.3233/JAD-230901

Pstross, M., Corrigan, T., Knopf, R. C., Sung, H., Talmage, C. A., Conroy, C., & Fowley, C. (2017). The benefits of intergenerational learning in higher education: Lessons learned from two age friendly university programs. Innovative Higher Education, 42, 157-171. https://doi.org/10.1007/s10755-016-9371-x

Senese, V. P., Catone, G., Pezzella, A., Almerico, L., Iorio, M., Maresca, M., Nasti, C., Matascioli, N., & Pisano, S. (2024). The association between social isolation, loneliness and psychological problems in young adults: A study during the acute phase of COVID‐19 in Italy. International Journal of Psychology, 59(1), 184-191. https://doi.org/10.1002/ijop.12962

Shen, C., Rolls, E. T., Cheng, W., Kang, J., Dong, G., Xie, C., Zhao, X. M., Sahakian, B. J., & Feng, J. (2022). Associations of social isolation and loneliness with later dementia. Neurology, 99(2), e164-e175. https://doi.org/10.1212/WNL.0000000000200583

Steward, A., & McDevitt, K. (2023). “Otherwise we would be like an island”: A phenomenological understanding of intergenerational engagement aimed at reducing social isolation. Journal of Intergenerational Relationships, 21(2), 215-233. https://doi.org/10.1080/15350770.2021.1997870

Suleman, R., & Bhatia, F. (2021). Intergenerational housing as a model for improving older-adult health. BC Medical Journal, 63(4), 171-173.

Surkalim, D. L., Luo, M., Eres, R., Gebel, K., van Buskirk, J., Bauman, A., & Ding, D. (2022). The prevalence of loneliness across 113 countries: systematic review and meta-analysis. BMJ, 376. e067068. https://doi.org/10.1136/bmj-2021-067068

The Cigna Group. (2023). The loneliness epidemic persists: A post-pandemic look at the state of loneliness among U.S. adults. https://newsroom.thecignagroup.com/loneliness-epidemic-persists-post-pandemic-look

Verity, L., Yang, K., Nowland, R., Shankar, A., Turnbull, M., & Qualter, P. (2022). Loneliness from the adolescent perspective: A qualitative analysis of conversations about loneliness between adolescents and Childline counselors. Journal of Adolescent Research, 0(0). https://doi.org/10.1177/07435584221111121

Xu, L., Fields, N. L., Chen, Z., Zhou, A., Merchant, A., & Zhou, A. (2022). Big and Mini: A promising intergenerational program for social connections. International Journal of Environmental Research and Public Health, 19(8), 4566. https://doi.org/10.3390/ijerph19084566

Zhu, S., Kong, X., Han, F., Tian, H., Sun, S., Sun, Y., Feng, W., & Wu, Y. (2024). Association between social isolation and depression: Evidence from longitudinal and Mendelian randomization analyses. Journal of Affective Disorders, 350, 182-187. https://doi.org/10.1016/j.jad.2024.01.106