Emerging from COVID-19: prioritising the burden of loneliness in older people

Richard Armitage; Laura B Nellums

doi:10.3399/bjgp20X711869

Public health responses to COVID-19 have mandated the social isolation of millions of older people globally. While reducing viral transmission, this has undoubtedly exacerbated the pre-existing pandemic of loneliness among older adults, amplifying the associated burden of physical and mental ill-health.¹ As governments begin to unlock their societies, they now have an opportunity to re-prioritise this longstanding public health emergency.

While those aged over 75 are at increased risk of severe COVID-19 disease and death,²^,³ older adults are also vulnerable to the health impacts of prolonged isolation. Loneliness is often stigmatised, trivialised, or ignored, despite its strong association with physical and psychological morbidity, and premature mortality.⁴ Such marginalisation is particularly prevalent among older adults, representing an increasingly urgent public health issue in the ageing global population.¹

As societies emerge from lockdown, public health strategies must balance the risk of severe COVID-19 disease (for both older people and health services) against the burden of morbidity and mortality induced by prolonged isolation. Without a vaccine, viral transmission is expected to increase, posing greatest risk to older adults. This is reflected in governmental guidance, which continues to advise older people to stay at home and avoid contact with others outside their household.⁵ However, public health measures must avoid further marginalising of ageing communities. For example, relaxed measures permitting small groups from different households to congregate outdoors may exclude many older adults because of mobility limitations. Friends and family are still prevented from visiting older relatives at home, while daycare venues, community centres, and places of worship remain closed, denying many older adults their only sources of social contact.

There is urgent need for evidence-based discourse around minimising the risk of contagion in older adults while directly addressing the harms of loneliness. The possibility of limited social contact, such as with friends, family, or voluntary organisations, mitigated by PPE and serological testing, should be considered along with further strengthening of telephone and digital communication links.

This moment represents an opportunity to shape the way loneliness in older adults is tackled, and trigger meaningful change in how this public health emergency is addressed beyond the pandemic.