Assessing Social Isolation and Loneliness in Older Adults: The Role of the Health Care Provider

Social isolation and loneliness in adults are significant public health concerns in our society. Although these issues can occur in any age, they are especially common in older adults. Individuals experiencing social isolation or loneliness may suffer a wide range of mental and physical health problems (Salari et al., 2025). In 2023, the U.S. Office of the Surgeon General (OSG) issued an advisory highlighting the epidemic of loneliness and social isolation and emphasizing the healing effects of social connection in the community. Because health care providers (HCPs) serve as the entry point of care into the health care system, it is essential that they screen older adults’ experiences with social isolation and loneliness during clinical visits (National Academy of Sciences [NAS], 2020).

For the purposes of this discussion, social isolation is defined as the objective state of having few social relationships, or infrequent social contact with others. Loneliness is defined as a subjective feeling of being isolated. Going forward, these two concepts will be abbreviated as SI/L.

Health Care Providers’ Responsibilities

The National Academy of Sciences (2020) outlined five goals for enhancing the role of the health care sector in addressing SI/L in older adults. These goals have been summarized as:

1)       Develop a more robust evidence base on SI/L

2)       Translate current SI/L research into health care practices to reduce SI/L

3)       Improve awareness among the health care workforce and public on the health impacts of SI/L

4)       Strengthen ongoing education and training related to the care of older adults

5)       Strengthen ties between the healthcare system and community- based resources

(p. 5)

To illustrate one goal in greater depth, Goal #2--(Translate Current SI/L Research into Practice) will be highlighted here. While many intervention efforts originate from community-based organizations, additional research is needed to better understand and address the SI/L needs of older adults who live in the community. The NAS (2020) provided several recommendations associated with this goal:

·       Recommendation 1: Health care providers and practices should periodically perform an assessment using validated tools to identify older adults experiencing SI/L in order to initiate potential preventive interventions after having identified individuals who are at an elevated risk due to life events (e.g., loss of a significant relationship, geographic move, relevant health condition).

·       Recommendation 2: Healthcare systems should create opportunities for clinicians to partner with researchers to evaluate the application of currently available evidenced-based tools to asses social isolation and loneliness in clinical settings, including testing and applications for specific populations.

·       Recommendation 3: The committee endorses the recommendation of previous National Academies reports that social isolation should be included in the electronic health record or medical record (pp.9-11).

Despite the importance of routine SI/L concerns at regular visits, many HCPs feel unprepared to discuss sensitive topics or lack training related to SI/L (Hou, 2024). Using an interdisciplinary approach is essential! Physicians, nurses, social workers, and case managers must be trained to assess and intervene when older adults exhibit SI/L. HCPs should understand how to support both older adults and their families by providing strategies to reduce their SI/I and by making referrals to community services (NAS, 2020).

Screening Tools for Assessing SI/L

When assessing SI/L in the clinical area, providers should use brief, validated tools. It is important not to rely on assumptions about who may or may not be lonely. Because SI/L levels may fluctuate, serial or repeated assessments over time are recommended (NAS, 2020; Perissinotto et al, 2019). Here are commonly used instruments that can be used to assess SI/L in older adults:

Social Isolation

·       Lubben Social Network Scale (LSNS-6). This 6-item scale was developed specifically for older adults and was adapted from the Berkman-Syme Social Network Index.  The scale measures the number and frequency of social contacts with friends and family members (Lubben et al., 2006; NAS, 2020). Examples of questions include: “How many relatives do you see or hear from at least once a month?” and “How many friends do you feel at ease with that you can talk about private matters?” 

·       Steptoe Social Isolation Index. This 5-point scale provides an index of social isolation measures by evaluating marital status, less than monthly contact with children, family, and friends, and level of participation with community groups. Higher scores reflect social isolation. Participants who score 2 points or more are socially isolated. (NAS, 2020; Steptoe, 2000).

Loneliness   

·       The Revised UCLA Loneliness Scale. The 3-item scale, originally developed from the 20-item tool, is widely used to assess subjective loneliness in older adults, using a 3-point score. The 3-item tool was originally developed for use with telephone interviews, but is widely used in research and clinical settings. Higher scores reflect more loneliness. Examples of questions include: “How often do you feel that you lack companionship,” How often do you feel left out?”, and “How often do you feel isolated from other?”(Hughes et al., 2004; NAS, 2020).

·       De Jong Gierveld Loneliness Scale. The 6-item scale, originally developed from the 11-item scale, measures two types of loneliness due to lack of a close, intimate relationship, and broader social network. Higher scores reflect more isolation. Examples of questions include: “I experience a general sense of emptiness,” “I miss having people around,” and “There are plenty of people I can rely on when I have problems” (Score is reversed with last question (de Jong Gierveld & Tilberg, 2006; NAS, 2020).

Single-Item Questions in the Clinical Area

It is worth noting that using a single item question to assess loneliness, such as “Do you feel lonely,” is a quick way of getting a response from the client. But, the response may be under-reported due to a perceived stigma related to the term, lonely (Ohiokpehai et al., 2025). However, other health care researchers have found positive results with using a single question assessment. For example, Kotwal and colleagues (2025) successfully used the single question, “How often are you lonely?” in a national study to assess loneliness in adults during the COVID-19 pandemic and asserts that single questions can reduce barriers to screening in clinical settings.

Conclusion   

The “loneliness” epidemic is growing in the United States! Therefore, it is imperative that HCPs regularly screen older adults for SI/L so they can better address their SI/L needs and improve the well-being of their older adult patients.

References

de Jong Gierveld, J., & Tilburg, T. V. (2006). A 6-item scale for overall, emotional, and social loneliness: Confirmatory tests on survey data. Research on Aging, 28(5), 582–598. https://doi.org/10.1177/0164027506289723

Hou, X. (2024). Loneliness and social isolation – To screen or not? Providers’ communications and comfortability. Global Journal of Aging & Geriatrics Research, 24, 1-5. https://irispublishers.com/gjagr/pdf/GJAGR.MS.ID.000562.pdf

Hughes, M. E., Waite, L. J., Hawkley, L. C., & Cacioppo, J. T. (2004). A short scale for measuring loneliness in large surveys: Results from two population-based studies. Research on Aging, 26(6), 655–672. https://doi.org/10.1177/0164027504268574

Kotwal, A. A., Cenzer, I. S., Waite, L. J., Smith, A. K., Alexander, A.K., Perissinotto, C. M., & Hawkley, L. C. (2025). A single question assessment of loneliness in older adults during the COVID-19 pandemic: A nationally-representative study. Journal of the American Geriatric Society, 70, 5, 1342-1345. https://pmc.ncbi.nlm.nih.gov/articles/PMC9106870/

Lubben, J., Blozik, E., Gillmann, G., Iliffe, S., von Renteln Kruse, W., Beck, J. C., & Stuck, A. E. (2006). Performance of an abbreviated version of the Lubben Social Network Scale among three European community-dwelling older adult populations. The Gerontologist, 46(4), 503–513. https://doi.org/10.1093/geront/46.4.503

National Academy of Sciences. (2020). Social isolation and loneliness in older adults: Opportunities for the health care system. National Academies Press.

Office of the Surgeon General. (2023). Our epidemic of loneliness and isolation: The U.S. Surgeon General’s advisory on the healing effects of social connection and community. U.S. Department of Health & Human Services.

Ohiokpehai, O., Gammack, J. K., Siddiqui, M., & Nyahoda, T. (2025). Loneliness and social isolation in older adults. Missouri Medicine, 122(2),118-123. https://pmc.ncbi.nlm.nih.gov/articles/PMC12021383/

Perissinotto, C. M., Cenzer, I. S., & Covinsky, K. E. (2019). Loneliness in older persons: A predictor of functional decline and death. JAMA Internal Medicine, 172(14), 1078–1083. https://doi.org/10.1001/archinternmed.2012.1993

Salari, N., Najafi, H, Rasoulpoor, S., Canbary, Z., Heidarian, P., & Mohammadi, M. (2025). The global prevalence and associated factors of loneliness in older adults: A systematic review and meta-analysis. https://www-nature-com.loyno.idm.oclc.org/articles/s41599-025-05304-x

Steptoe, A., Shankar, A., Demakakos, P., & Wardle, J. (2013). Social isolation, loneliness, and all-cause mortality in older men and women. PNAS, 110(15), 5797-5801. https://www.pnas.org/cgi/doi/10.1073/pnas.1219686110  

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