Whole Person Care for Older Adults: A Focus on Social Isolation

Social isolation and loneliness have been associated with increased risk of chronic conditions such as cardiovascular disease, type 2 diabetes, dementia, depression, and anxiety.^1-3 Perceived and objective social isolation have also been linked to increased all-cause mortality.⁴ Compared to other age groups, isolation and loneliness may be more harmful to the physical, mental, and emotional health outcomes of older adults, who may have reduced mobility and daily activity engagement or may be managing multiple chronic conditions and mental health challenges. 

Social isolation is a public health issue,⁵ and as such, it is always relevant when considering optimal health for older adults. After the recommended physical distancing during the COVID-19 pandemic, the connection between isolation, loneliness, depression, and negative health outcomes for older adults highlighted an important health challenge for this population.^6,7

Isolation’s Impact on Healthcare Costs

While more research is needed to assess the current economic burden associated with loneliness and social isolation, a US-based 2017 study released by AARP indicated that social isolation among older adults added an additional $6.7 billion dollars in annual Medicare spending.⁸ An in-depth analysis of the study indicated that objective isolation not only predicts higher Medicare spending due to increased hospitalizations and institutionalization but also predicts greater risk of mortality despite the additional health care.⁹ A 2019 study investigated the association between loneliness and incidence of emergency department (ED) visits for patients with chronic obstructive pulmonary disease (COPD).¹⁰ Patients with an average age of 65 responded to questionnaires that asked about loneliness and social isolation. Results indicated that loneliness in patients with COPD is significantly and independently associated with increased ED visits and with a poorer perception of health.¹⁰ This study suggests that addressing loneliness may not only improve a patient’s health perception and quality of life but potentially decrease their ED visits and subsequent healthcare costs. 

Patient-Centered & Whole Person Care

Older adults in long-term care, dementia care, and hospice care services with complex needs have benefited from patient-centered care practices, and research studies continue to investigate the essential components of person-centered care for older adults in outpatient and out-of-hospital settings.¹¹ Recent systematic reviews have identified the most prominent factors that define patient-centered care for older adults, including:^12,13

• Whole person care
• Respect and value
• Autonomy and choice
• Dignity
• Self-determination
• Purposeful living

Expanding on the patient-centered healthcare strategy, the Whole Health model is personalized, patient-driven care that also emphasizes the patient’s relationship with their community and those self-care strategies that are based on the patient’s values, needs, and goals.¹⁴ A recent study investigated the benefits of implementing a Whole Health model at a community mental health center that offered outpatient mental and substance use disorder treatment services.¹⁵ Besides monitoring patients’ overall health needs and their wellness education within treatment services, the Whole Health model improved care coordination between providers and reduced Medicare expenses, ED visits, and hospitalization rates.¹⁵

Lifestyle Practices 

Nutrient-dense diets, exercise programs, and healthy relationships all contribute to a patient’s optimal wellness, and social isolation may disrupt these vital routines and activities. For example, grocery shopping or accessing food and nutrition assistance programs may be interrupted. Food security is a suggested risk factor for depression, stress, and anxiety, and older adults are at a higher risk of depression due to food insecurity, according to a 2020 meta-analysis.¹⁶ Ensuring access to adequate amounts of healthy foods and following healthy dietary patterns like the Mediterranean diet may improve health outcomes and quality of life. A 2018 systematic review found that for older adults, maintaining a healthy dietary pattern led to better self-rated health and quality of life that spanned physical, social, and emotional well-being.¹⁷ A 2023 meta-analysis of 19 randomized controlled trials found that among older adults, following healthy dietary patterns such as the Mediterranean diet has cognitive benefits.¹⁸

Exercise and physical activity reduces the risk of many chronic diseases, may increase longevity and healthy aging,¹⁹ and has been suggested to alleviate depressive symptoms in older adults.^20,21 A 2020 meta-analysis of 15 randomized controlled trials (n=596) compared the effectiveness of aerobic, resistance, and mind-body exercise programs in clinically depressed adults older than 65 years of age.²⁰ Results suggested the largest improvement on depressive symptoms after mind-body exercise, followed by aerobic and resistance exercise routines.²⁰ Researchers also suggested that since there were no statistically significant differences between the exercise types, patient preference would be highly encouraged for optimal treatment implementation and sustainability.²⁰

Social disconnection is a potential risk factor for chronic diseases, and increasing social connection may help reduce disease risk through reduction of chronic stress and allostatic load.²² Personalized therapeutic strategies that address social support related to physical, mental, and emotional well-being help to promote optimal patient health. In addition, practitioners can offer increased contact frequency for their lonely, isolated patients. High-touch care with virtual health coach visits and/or shared medical appointments may be a relevant option for a patient’s health strategy.

Conclusion

The functional medicine model addresses how social factors such as isolation and loneliness may contribute to chronic disease risk and progression for older patients. Examining the mental, emotional, and spiritual components of a patient’s health journey is a foundational aspect of the patient-centered, whole person, therapeutic approach of functional medicine care. 

A collaborative patient-practitioner relationship reinforces patient empowerment through personalized health plans that address modifiable lifestyle factors. These factors may help to enhance social connectivity, mend disrupted self-care routines, and identify those nutrition and mobility strategies that support physical and mental health resiliency. Learn more about tools and strategies to help patients achieve sustainable lifestyle change and improve their well-being through IFM’s new course Lifestyle: The Foundations of Functional Medicine.