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E-grāmata: Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System

  • Formāts: 316 pages
  • Izdošanas datums: 14-May-2020
  • Izdevniecība: National Academies Press
  • Valoda: eng
  • ISBN-13: 9780309671033
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  • Formāts: 316 pages
  • Izdošanas datums: 14-May-2020
  • Izdevniecība: National Academies Press
  • Valoda: eng
  • ISBN-13: 9780309671033
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Social isolation and loneliness are serious yet underappreciated public health risks that affect a significant portion of the older adult population. Approximately one-quarter of community-dwelling Americans aged 65 and older are considered to be socially isolated, and a significant proportion of adults in the United States report feeling lonely. People who are 50 years of age or older are more likely to experience many of the risk factors that can cause or exacerbate social isolation or loneliness, such as living alone, the loss of family or friends, chronic illness, and sensory impairments. Over a life course, social isolation and loneliness may be episodic or chronic, depending upon an individual's circumstances and perceptions.



A substantial body of evidence demonstrates that social isolation presents a major risk for premature mortality, comparable to other risk factors such as high blood pressure, smoking, or obesity. As older adults are particularly high-volume and high-frequency users of the health care system, there is an opportunity for health care professionals to identify, prevent, and mitigate the adverse health impacts of social isolation and loneliness in older adults.



Social Isolation and Loneliness in Older Adults summarizes the evidence base and explores how social isolation and loneliness affect health and quality of life in adults aged 50 and older, particularly among low income, underserved, and vulnerable populations. This report makes recommendations specifically for clinical settings of health care to identify those who suffer the resultant negative health impacts of social isolation and loneliness and target interventions to improve their social conditions. Social Isolation and Loneliness in Older Adults considers clinical tools and methodologies, better education and training for the health care workforce, and dissemination and implementation that will be important for translating research into practice, especially as the evidence base for effective interventions continues to flourish.

Table of Contents



Front Matter Summary 1 Introduction 2 Evaluating the Evidence for the Impacts of Social Isolation, Loneliness, and Other Aspects of Social Connection on Mortality 3 Health Impacts of Social Isolation and Loneliness on Morbidity and Quality of Life 4 Risk and Protective Factors for Social Isolation and Loneliness 5 Mediators and Moderators 6 Assessment of Social Isolation and Loneliness in Research 7 Role of the Health Care System 8 Education and Training 9 Interventions 10 Dissemination and Implementation References Appendix A: Public Meeting Agendas Appendix B: Committee and Staff Biographies
Summary 1(16)
1 Introduction
17(18)
Study Context
19(2)
Charge to the Committee
21(2)
Relevant National Academies Reports
23(1)
Study Approach
23(10)
Overview of the Committee's Report
33(2)
2 Evaluating The Evidence For The Impacts Of Social Isolation, Loneliness, And Other Aspects Of Social Connection On Mortality
35(14)
A History of Understanding the Contributors to Human Health
36(3)
Discovering Social Connections as a Determinant of Health and Longevity
39(1)
The Current State of the Evidence on Impacts of Social Isolation, Loneliness, and Social Support on Mortality
40(5)
A Further Note on Social Isolation, and Social Connection More Generally, as a Potential Causal Risk for Mortality
45(2)
Findings and Conclusions
47(1)
Next Steps and Recommendation
47(2)
3 Health Impacts Of Social Isolation And Loneliness On Morbidity And Quality Of Life
49(14)
Impact on Health Outcomes
51(5)
Impact on Health-Related Behaviors
56(2)
Impact on Quality-of-Life Outcomes
58(2)
Elders at Risk for Abuse
60(1)
Findings and Conclusions
60(1)
Next Steps and Recommendations
61(2)
4 Risk And Protective Factors For Social Isolation And Loneliness
63(28)
Physical Health Factors
64(4)
Psychological, Psychiatric, and Cognitive Factors
68(3)
Social and Cultural Factors
71(10)
Social Environmental Factors
81(5)
At-Risk Populations
86(2)
Findings and Conclusions
88(3)
5 Mediators And Moderators
91(16)
Mediators: Behavioral, Psychological, and Biological Mechanisms
93(7)
Moderating Factors Influencing Mortality and Health Outcomes
100(4)
Findings and Conclusions
104(3)
6 Assessment Of Social Isolation And Loneliness In Research
107(16)
Measurement of Social Isolation and Loneliness
107(7)
Measuring Impact for Social Isolation and Loneliness
114(2)
Identification of Individuals and Populations at Risk
116(5)
Findings and Conclusions
121(2)
7 Role Of The Health Care System
123(24)
Health Care Access and Utilization
124(5)
Social Determinants of Health and the Health Care System
129(3)
Clinical Assessment of Social Isolation and Loneliness
132(6)
Technology as Infrastructure for Coordination and Intervention
138(3)
Findings and Conclusions
141(1)
Next Steps and Recommendations
142(5)
8 Education And Training
147(24)
Framework for the Role of Education in Catalyzing Change
147(1)
National Standards and Policy Priorities
148(4)
Current Education and Training of the Health Care Workforce
152(7)
Public Health Campaigns
159(3)
Changing Practice Behaviors
162(2)
Findings and Conclusions
164(1)
Next Steps and Recommendations
165(6)
9 Interventions
171(50)
Large-Scale Reviews of Interventions
171(8)
Types of Interventions Relevant to the Health Care System
179(11)
Coalitions and Partnerships to Address Social Isolation and Loneliness
190(2)
Technological Interventions
192(5)
Ethical and Practical Considerations for Intervention
197(9)
Financing of Interventions
206(5)
Reframing Intervention Using a Public Health Approach
211(3)
Findings and Conclusions
214(2)
Next Steps and Recommendations
216(5)
10 Dissemination And Implementation
221(16)
Definition of Terms
222(1)
Overview of Implementation Strategies
223(1)
Addressing the Characteristics of the Topic
224(1)
Addressing Users of the Evidence-Based Information
224(3)
Communication Strategies
227(4)
Addressing the Social Context
231(3)
Sustainability
234(1)
Conclusion
235(2)
References 237(50)
Appendixes
A Public Meeting Agendas 287(4)
B Committee And Staff Biographies 291