US Surgeon General Vivek Murthy made headlines last week by declaring an “epidemic of loneliness.” He warned that loneliness is associated with “a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety, and premature death.” This statement is the first time a Surgeon General has used their national advocacy platform to raise loneliness to the same warning level as smoking, obesity, and the opioid crisis.
Several commentators pointed out that Dr. Murthy took a holistic approach outlining the national strategy to promote social connections and to decrease loneliness among different ages. Six focus areas of recommendations are made to a broad group of stakeholders, including health care systems and payors, government, employers, educators, families, and caregivers. 
The Difference Between Loneliness and Social Isolation
Many countries, including Canada, have been studying loneliness and social isolation for some time, especially in the context of their aging populations. At the national level, Canada has published a toolkit of resources to define and address social isolation. And it has been identified that approximately 30% of older Canadians over 65 are at risk of becoming socially isolated. 
While social isolation and loneliness are often used interchangeably, they are different. The terms were defined in the comprehensive report Understanding Social Isolation and Loneliness Among Older Canadians and How to Address It by the National Institute on Aging, published in 2022. Social Isolation is an objective and measurable deficit in the number of social relationships that a person has. Loneliness is a personal subjective experience, an unpleasant sensation felt when a person’s social relationships lack quality and/or quantity compared to what they desire.
The Factors Putting Older People at Risk of Loneliness And Social Isolation
What factors put older people at risk of social isolation? Studies often cite a list of risk factors; however, combining some key factors can tip the balance into isolation. For example:
- Living alone with multiple chronic health problems that affect health and well-being.
- Being a caregiver of a partner with multiple health conditions, with little support or access to services and programs.
- Pivotal life transitions such as retirement, death of a spouse/partner, or losing a driver’s license.
- Having no children or no contact with family or supportive friends.
- Living in a location with little access to transportation and unable to drive.
- Lack of financial resources.
The impact of the recent COVID pandemic only intensified the lack of social connectedness among people in our communities, especially older people at risk.
The Health and Wellness Risks Of Loneliness and Social Isolation
The National Institute on Aging report documents a range of studies confirming significant and shocking consequences for mental and physical health. Isolation and loneliness are linked to declining mental health, such as higher rates of depression, anxiety, and suicidal thoughts. Isolation and loneliness also affect physical health, with a 50% increased risk of developing dementia, a 59% increased risk of functional decline, and a 45% increased risk of death. Those are in addition to an increased risk of stroke, coronary heart disease and cancer.  These health impacts are consistent with the US Surgeon General’s report declaring loneliness and social isolation a public health threat.
In Elder Planning, Address the Risk of Loneliness and Social Isolation
In assessing an older person’s needs or planning for healthy ageing, social isolation and loneliness are key factors that require significant attention. Many older people are unaware of the risks of isolation and do not plan for the day that they may not have easy access to transportation or may lose their partner whom they depend on for caregiving. The US Surgeon General’s report is a clear call to action. We need to listen and learn.
In my next blog, I’ll examine some Canadian solutions.