Social Isolation and Loneliness Among San Francisco Bay Area Older Adults During the COVID-19 Shelter-in-Place Orders

Abstract

Background/objectives: Physical distancing during the COVID-19 pandemic may have unintended, detrimental effects on social isolation and loneliness among older adults. Our objectives were to investigate (1) experiences of social isolation and loneliness during shelter-in-place orders, and (2) unmet health needs related to changes in social interactions.

Design: Mixed-methods longitudinal phone-based survey administered every 2 weeks.

Setting: Two community sites and an academic geriatrics outpatient clinical practice.

Participants: A total of 151 community-dwelling older adults.

Measurements: We measured social isolation using a six-item modified Duke Social Support Index, social interaction subscale, that included assessments of video-based and Internet-based socializing. Measures of loneliness included self-reported worsened loneliness due to the COVID-19 pandemic and loneliness severity based on the three-item University of California, Los Angeles (UCLA) Loneliness Scale. Participants were invited to share open-ended comments about their social experiences.

Results: Participants were on average aged 75 years (standard deviation = 10), 50% had hearing or vision impairment, 64% lived alone, and 26% had difficulty bathing. Participants reported social isolation in 40% of interviews, 76% reported minimal video-based socializing, and 42% minimal Internet-based socializing. Socially isolated participants reported difficulty finding help with functional needs including bathing (20% vs 55%; P = .04). More than half (54%) of the participants reported worsened loneliness due to COVID-19 that was associated with worsened depression (62% vs 9%; P < .001) and anxiety (57% vs 9%; P < .001). Rates of loneliness improved on average by time since shelter-in-place orders (4-6 weeks: 46% vs 13-15 weeks: 27%; P = .009), however, loneliness persisted or worsened for a subgroup of participants. Open-ended responses revealed challenges faced by the subgroup experiencing persistent loneliness including poor emotional coping and discomfort with new technologies.

Conclusion: Many older adults are adjusting to COVID-19 restrictions since the start of shelter-in-place orders. Additional steps are critically needed to address the psychological suffering and unmet medical needs of those with persistent loneliness or barriers to technology-based social interaction.

Keywords: COVID-19; loneliness; older adults; social isolation; technology.

Figure 1

University of California, Los Angeles (UCLA) Loneliness Score trajectories among those who attributed worsened loneliness to COVID‐19 precautions. Participants included in the figure reported worsened loneliness due to the COVID‐19 pandemic at least once during the study period and had at least two interviews (n = 63). Participants were included in panels (A) “Loneliness scores increase” (n = 18) if UCLA Loneliness Scale scores increased on average in follow‐up interviews compared with baseline; (B) “Loneliness scores remain high” (n = 27) if all UCLA scores were 3 or higher; and (C) “Loneliness scores remain low” (n = 13) if all UCLA scores were 2 or lower. Worsened loneliness due to COVID‐19 was determined by asking, “Because of the recent coronavirus outbreak (in the last 2 weeks), are your feelings of lack of companionship, being left out, or isolated: (Responses: Worse, Better, the Same).” The severity of loneliness over time was then determined using the UCLA three‐item loneliness scale (range = 0–6 points), where 3 or more points corresponds with “high” loneliness. Colored lines show the loneliness trajectory corresponding with the participants' quotes.