For Hopkins geriatrician Thomas Cudjoe, making house calls to older patients throughout Baltimore City is a critical part of his day’s work, thanks to the Johns Hopkins Home-Based Medicine (JHOME) program, which provide in-home primary care services to individuals who are homebound and aren’t able to get to the doctor’s office due to medical conditions or physical problems.
“Home-based care is a great investment that our institution has made, and out of this experience I have seen firsthand the toll that social isolation has on older patients, particularly those with complex health needs who live in subsidized housing,” says Cudjoe, the Caryl and George Bernstein CIM Human Aging Project Scholar. “That’s why I’ve dedicated my professional life to understanding social isolation as an important health issue — and working toward solutions.”
Even before the COVID-19 pandemic, social isolation was a significant issue, impacting one in four older adults in the United States. And more than 40 percent of older adults reported experiencing loneliness. The impact on health is sobering, particularly among the homebound who are frail, depressed or cognitively impaired, Cudjoe notes.
“We know from multiple studies that social isolation is associated with higher levels of mortality,” he says.
“We know from multiple studies that social isolation is associated with higher levels of mortality.” – Thomas Cudjoe
In one avenue of his research, Cudjoe is looking to advance the science of social isolation, or as he puts it, “the way that social isolation ‘gets under our skin’ through biological pathways.” In early work that he presented recently at the Gerontological Society of America Meeting, which drew on data from the National Health and Aging Trend Study, he reported an association between social isolation and two key biomarkers for inflammation.
“These findings are important,” Cudjoe says, “because they indicate that social isolation is an important factor that has biological influences…which may potentially lead to poor health outcomes.”
Given the health implications for older adults, says Cudjoe, it’s important for geriatricians and other primary care providers who treat older patients to routinely assess social connectedness. Questions like “Do you feel left out?” or “How many people do you feel you can depend on or feel close to?” should become a routine part of each health visit, he believes, in much the same way that geriatricians regularly monitor blood pressure and weight. “On a public policy level,” he says, “advancing regular assessments for social connectedness is critically important.”
Once social isolation has been identified, what strategies can be employed to help connect older adults who are and feel isolated?
Leveraging technology is one possible solution, Cudjoe notes. During COVID-19, the almost overnight switch to telemedicine — prompted by shelter-at-home orders — showed that smartphones and video-enabled technologies could be effective platforms for offering counseling and for connecting older adults to family and friends through virtual interactions.
But access to technology remains an important barrier, particularly among older adults of limited income or who are Black and Latino — populations particularly hard hit by COVID-19 — as well as those struggling with vision or hearing loss or cognitive decline.
To reach a broader swath of the homebound, Cudjoe sees an opportunity to “harness volunteerism” and provide more support for organizations (such as Meals on Wheels) to provide regular in-person check-ins with older adults in the community. He points as an example to the “Call & Check Visits” in Jersey, British Channel Islands, where postal workers monitor and support older adults on their delivery routes with a knock on the door and a hello. Closer to home, programs like the AARP’s “Connect2Affect” provide a way to connect people with programs and technologies to increase their engagement.
“When thinking about solutions, it’s also important to remember that there are two sides of the coin and to acknowledge that there is heterogeneity among older adults,” says Cudjoe.
“Just as some older adults are isolated, there are others who are resilient and well integrated within their communities and contributing in so many different ways. What can we learn from those who are thriving?”