Screening for Social Isolation in the Community-Dwelling Older Adult in the Primary Care Setting

A significant majority of older adults (age greater than 65) in the United States are socially isolated. It is well documented that social isolation and loneliness in older adults leads to significant morbidity and mortality across all aspects of health. Despite the prevalence of research on loneliness and social isolation's associated negative outcomes, screening for these phenomena in primary and geriatric care is almost non-existent. Additionally, the COVID-19 pandemic has had significant impact on older adults as many of them are experiencing worsening isolation and loneliness. This state of the science review looks to use prior studies on social isolation and loneliness in community dwelling adults to argue for the need of screening older adults in the clinical setting. For the purposes of this review, "social isolation" is defined as the objective lack of or limited social contact with others. "Loneliness" is defined as a subjective perception of an individual's quality and quantity of social relationships. A review of the literature was conducted to aid in supporting the argument that all community dwelling older adults should be screened at primary or geriatric care visits for social isolation. Included in this review was the breadth and scope of the problem, the health consequences of social isolation and loneliness, the impact of the COVID-19 pandemic on older adults, and a comparison of the various screening instruments available to providers to use in the primary care setting. Screening tools were carefully analyzed for complexity, ease of use in the clinical setting, and for ability to assess for both loneliness and social isolation. Based on this review of the science, it was determined that the most effective way to assess older adults for both loneliness and social isolation is by using a combination of two validated screening tools: the LSNS-6 and the Three-Item Loneliness scale. The health consequences of isolation and loneliness are significant, especially in a time where older adults are social distancing. Most older adults over the age of 65 warrant some form of screening using a validated instrument. Future research is needed on the ways in which technology has changed social connection for older adults and expert consensus is needed to establish practice standards for screening in the primary care and geriatric setting.