Care Redesign
Integrating Mental, Social, and Physical Health

The Growing Imperative to Address Senior Loneliness

Article · February 27, 2018

In a 2010 commentary, philosophy Professor Kwame Anthony Appiah, PhD, asked the question, “What will future generations condemn us for?” In addition to our prison system, industrial meat production, and our treatment of the environment, Appiah listed America’s treatment of “the institutionalized and isolated elderly.” In Harvard Business Review, former Surgeon General Vivek H. Murthy, MD, wrote about the epidemic of loneliness affecting the United States. He remarked, “During my years caring for patients, the most common pathology I saw was not heart disease or diabetes; it was loneliness.” The problem of loneliness and social isolation is increasingly well-recognized as a societal ill, but maddeningly difficult to address. What can we do to address a problem that has roots that are not just economic, but cultural in nature, and that has downstream implications that include an undeniable effect on health?

Last year, CareMore Health, a care delivery system and subsidiary of Anthem that serves Medicare and Medicaid patients, introduced its Togetherness Program, a comprehensive initiative aimed at identifying and intervening in the loneliness among its senior patients; the intervention is a benefit provided through participation in their Anthem health plan. CareMore asserts that loneliness is a health condition that can be diagnosed and treated through community-based interventions and close engagement with patients.

Since the launch of the program, we have assessed our patient base of more than 80,000 patients and identified 2,000 lonely seniors through our regularly scheduled Healthy Start screenings that patients undergo when they first become CareMore patients. Of those 2,000 patients, more than 600 have elected to participate and have been enrolled in an intensive intervention that includes weekly phone calls, home visits, and encouragement and connection to community-based programs.

Several early learnings have emerged:

Loneliness Has Many Causes

Our early analyses suggest that loneliness has a number of significant and predictable causes in the senior population. Many of our affected patients suffer from depression or underlying medical issues that have been untreated. Many seniors are grieving the loss of spouses, friends, or other loved ones. And many seniors no longer feel comfortable driving and remain homebound. One focus of CareMore’s engagement with patients is encouraging them to seek medical care for conditions that have often been neglected — and accordingly providing a transportation benefit so that barrier is addressed.

Community Resources Exist to Address Loneliness

Resources exist to address loneliness, but seniors often are unaware of the opportunities. The challenge is in connecting seniors with these resources. Community-based nonprofits, faith-based organizations, and community senior centers are often poorly utilized by the people who need them most.

Encouraging seniors to volunteer has been particularly meaningful for some, as these opportunities not only provide social interaction, but also enhance their sense of self-worth and contribution to the community. CareMore has emphasized access to senior-focused gyms that many of our patients use. These gyms have a number of exercise programs that have a significant social component. Senior workouts and self-defense classes for those who use canes engage seniors in exercises that are consistent with their capability level, while providing a forum for socialization.

Loneliness Comes with Stigma

Many seniors are ashamed that they feel lonely or that they are socially isolated at a time in their lives when they are expected to be surrounded by friends and family. CareMore has been deliberate to describe its efforts in the positive — branding the initiative as focusing on generating greater degrees of “togetherness” rather than solving the problem of loneliness. This positive framing has been appealing to many patients who otherwise might not engage or participate in the program. The organization has hosted a number of Togetherness Forums in the communities in which it operates in partnership with local nonprofits to raise awareness of the challenge and destigmatize the issue. The forums have participation from local senior citizens as well as local community leaders.

Untapped Opportunities to Help Patients Are Sizeable

There is significant untapped potential in addressing the issue of loneliness in the community. When CareMore announced the new Togetherness Program to its 1,600 associates, 170 (>10%) volunteered to participate in making weekly outreach calls to lonely seniors; they undergo formal training through a web-based tool. Many wanted to participate in personal visits to lonely seniors. CareMore appointed a Chief Togetherness Officer to coordinate its efforts in this area and lead external and internal partnerships to capitalize on the broader interest in addressing the issue. Our experience suggests that there is broader underutilized will to solve this issue in the community that can be leveraged to serve seniors.

While it is too early to say whether the intervention has affected overall health and costs — an analysis will be complete in late 2018 — there are early indications that the program has already made a meaningful difference in the lives of some of the patients we serve.

Last summer, the program began outreach to Maria, a 72-year-old widow who suffers from diabetes. In her first calls with a CareMore Connector, a dedicated Togetherness representative, she would cry on the phone calls, describing her loneliness as a “hole in her heart.” After receiving intensive outreach from paid Togetherness Program staff, including additional calls and visits, she reports that she is less weepy and is now receiving weekly visits from CareMore social work team members who escort her to a local senior center where she is again pursuing her interests in arts and crafts. She was previously afraid of going to the senior center, but, after being accompanied by the CareMore clinician, is less anxious about doing so.

The program also began outreach to Barbara, a 93-year-old widow who reports that her calls from the Togetherness Program are the only calls she gets most days. Her visits with a social work intern identified her vision as a barrier to her making phone calls. As she is no longer able to see the phone numbers in her phone book because of her diminishing eyesight, the social work intern rewrote her phone book in larger numbers so that she could make calls again. She is now able to make her own phone calls and is less lonely.

With an increasingly aging population and long-term trends that point to declining social capital and engagement, we face an uphill battle in addressing the challenge of loneliness and social isolation. The strong connection between social connectedness and health suggests that we must strive to ensure that future generations will no longer condemn us for leaving untreated the epidemic of senior loneliness. Seniors like Maria and Barbara reveal why we must not ignore our lonely elders, and why we must commit to addressing this eminently treatable human condition.

New call for submissions ­to NEJM Catalyst

Now inviting longform articles

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

More From Care Redesign
Summary of Comprehensive Approach to Physician Behavior and Practice Change

Engaging Stakeholders to Produce Sustainable Change in Surgical Practice

How an initiative designed to improve patient outcomes and satisfaction while containing costs led to sustainable change in surgical practice and physician behavior.

Myths and Realities of Opioid Use Disorder Treatment.

Primary Care and the Opioid-Overdose Crisis — Buprenorphine Myths and Realities

There is a realistic, scalable solution for reaching the millions of Americans with opioid use disorder: mobilizing the primary care physician (PCP) workforce to offer office-based addiction treatment with buprenorphine, as other countries have done.

Coffey02_pullquote family-centered care in medical and surgical procedures

What If Family-Centered Care Were Extended to Medical and Surgical Procedures?

Though the concerns are valid, early experiences suggest that family member engagement may be an effective tool for improving the value of care.

Evidence Needed for Health Systems Change to Address Social Determinants of Health and Obesity and Diet-Related Diseases in Turn

Better Clinical Care for Obesity and Diet-Related Diseases Requires a Focus on Social Determinants of Health

To more effectively treat the problems of obesity and diet-related conditions, health systems need to restructure the traditional medical model of care delivery to address the social determinants of health.

People Living with Dementia Around the World - Value-Based Chronic Illness and Dementia Care

Value-Based Care Must Strengthen Focus on Chronic Illnesses

To effectively control costs and improve value, new models must address our increasingly older patients and chronic care patients, especially those with Alzheimer’s and related dementias.

The Barriers to Excellent Care Vary Widely Across Geographic Regions - both Rural Health Care and Urban Health Care

Survey Snapshot: Rural Health Innovations Born from Challenges

According to NEJM Catalyst Insights Council members, every health system has to develop its own definition of what is meant by “rural” health.

Same-Day Breast Biopsy Workflow at Baylor College of Medicine

How Care Redesign and Process Improvement Can Reduce Patient Fear

Seeing how clinicians take care of their own when they are in frightening situations was the epiphany that led to a same-day breast biopsy program.

Rural Health Care Is Rated Comparable or Worse Across Quadruple Aim Aspects

Care Redesign Survey: Lessons Learned from and for Rural Health

Although care delivery models in rural and urban/suburban areas are distinct, by virtue of geographic density and resource availability, each locale affords lessons for the other.

Comprehensive Intervention Review at Lurie Childrens Hospital - improving patient flow and length of stay

Reducing Length of Stay in the ED

A comprehensive redesign of triage and ED care.

Pumonary Nurse Post-Discharge Follow-Up Note for Patients with COPD

TOPS: Telephonic Outreach in the Pulmonary Service at VA Boston Healthcare System

A nurse-directed intervention targeting veterans who had been hospitalized for COPD resulted in improved access to ambulatory care and a reduced rate of readmissions.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

Social Needs

88 Articles

Better Clinical Care for Obesity and…

To more effectively treat the problems of obesity and diet-related conditions, health systems need to…

A Successful Pilot to Improve Access…

Actionable data and modest financial incentives can help motivate clinicians to adjust their behavior around…

Coordinated Care

129 Articles

The Evolution of Primary Care: Embracing…

Primary care must leverage disruptive innovations to ensure that patients receive first-access, comprehensive, coordinated, continuous…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now