Isolation UPD

"There is robust evidence that social isolation and loneliness significantly increase risk for premature mortality, and the magnitude of the risk exceeds that of many leading health indicators," Holt-Lunstad says.

Isolation

"Our research really shows that the magnitude of risk presented by social isolation is very similar in magnitude to that of obesity, smoking, lack of access to care and physical inactivity," she says. In the study, investigators weighted several standard measures of social isolation, including marital status, frequency of religious service attendance, club meetings/group activities and number of close friends or relatives. They found that overall, race seemed to be a stronger predictor of social isolation than sex; white men and women were more likely to be in the least isolated category than were black men and women.

Loneliness and social isolation in older adults are serious public health risks affecting a significant number of people in the United States and putting them at risk for dementia and other serious medical conditions.

A report from the National Academies of Sciences, Engineering, and Medicine (NASEM) points out that more than one-third of adults aged 45 and older feel lonely, and nearly one-fourth of adults aged 65 and older are considered to be socially isolated.1 Older adults are at increased risk for loneliness and social isolation because they are more likely to face factors such as living alone, the loss of family or friends, chronic illness, and hearing loss.

Loneliness is the feeling of being alone, regardless of the amount of social contact. Social isolation is a lack of social connections. Social isolation can lead to loneliness in some people, while others can feel lonely without being socially isolated.

Your doctor can assess your risk for loneliness and social isolation and get you connected to community resources for help, if needed. The following national organizations also offer helpful resources:

NASEM recommends that clinicians periodically assess patients who may be at risk and connect them to community resources for help. In clinical settings, NASEM recommends using the Berkman-Syme Social Network Index (for measuring social isolation) and the three-item UCLA Loneliness Scale (for measuring loneliness).

But patients must make their own decisions. Some people may like being alone. It is also important to note that social isolation and loneliness are two distinct aspects of social relationships, and they are not significantly linked. Both can put health at risk, however.

If you have COVID-19, you should stay home away from others for at least 5 days. You should isolate even if you have no symptoms and/or if you have been vaccinated or infected in the past. Follow the isolation instructions below to protect others.

*Note: LAC DPH strongly recommends that you get a negative test for COVID-19 before ending isolation between Day 6-10. If you do test, it is best to use antigen tests (including self-tests) to lower the risk of false positives.

If your COVID-19 symptoms return or get worse after you end isolation, you may have COVID-19 rebound. Take an antigen test. If you test positive, you should restart isolation at Day 0. Talk to your doctor about your symptoms or concerns.

*You are considered to be infectious (meaning you can spread COVID-19 to others) from 2 days before your symptoms began until you meet criteria to end isolation. If you test positive for COVID-19 but do not have any symptoms, you are considered to be infectious from 2 days before your test was taken through Day 5.

Isolation is for individuals who have been infected with COVID-19, even if they don't have symptoms. You isolate in order to prevent spreading the virus to others. You should also isolate if you are sick and suspect that you have COVID-19 but do not yet have test results. If your results are positive, follow the full isolation recommendations. Follow the CDC guidance about when and how long to isolate when testing positive for COVID-19.

If you continue to have a fever or your other symptoms have not improved after 5 days of isolation, wait to end your isolation until you are fever-free for 24 hours without the use of fever-reducing medication and your other symptoms have improved.

If you tested positive for COVID-19 but have not had any symptoms, isolate for at least 5 days* after you tested positive for COVID-19. You can leave isolation after 5 full days if you have not developed symptoms.

You can use antigen testing before leaving isolation to decrease your risk of infecting others and to determine if you can remove your mask before 10 days after your symptom onset. See What to do if you test positive for COVID-19 for guidance about using antigen testing to determine when to leave isolation and remove your mask.

People doing a 5-day isolation and people who have been exposed to COVID-19 should avoid activities where they cannot wear a mask and avoid being around people who are at high risk for severe disease until after day 10.

If you have tested positive for COVID-19 infection or if a healthcare provider or public health official has told you that COVID-19 infection is suspected, you must follow the home isolation instructions below. These steps will help prevent the disease from spreading to others in your household and community. You should also follow these instructions if you suspect that you have COVID-19, even if you do not have a known exposure. The most common symptoms of COVID-19 are fever, cough, and/or shortness of breath.

After you leave isolation, you should continue to wear a mask around others until 10 days have passed since your positive laboratory test or symptom onset. Please see more information about mask wearing after leaving isolation, including what to do if you are unable to wear a mask here: -ncov/your-health/isolation.html#when-to-isolate. After 10 days, please continue to follow local masking recommendations or ordinances.

Regardless of the day you leave isolation or ability to wear a mask, you should avoid people who are immunocompromised or at high risk for severe disease, and nursing homes and other high-risk settings, until after at least 10 days.

After you have ended isolation, if your COVID-19 symptoms recur or worsen, restart your isolation at day 0. Talk to a healthcare provider if you have questions about your symptoms or when to end isolation.

*A limited number of persons with severe illness (you were admitted to a hospital and needed oxygen) or persons with a weakened immune system (immunocompromised) due to a health condition or medication may transmit virus for a longer time after infection. This may warrant extending isolation up to 10 days or using a viral test to determine when to end isolation. Consider consultation with your medical provider and infection control experts.

Vaccinated persons (even vaccinated persons who have received boosters or additional doses and are considered up to date) should continue to follow all DPH guidance to protect themselves and others and should follow isolation guidance above if positive for COVID-19.

Much of what we know about the causes and effects of social isolation and loneliness comes from the groundbreaking research of the late John T. Cacioppo, Ph.D., former director of the Center for Cognitive and Social Neuroscience at the University of Chicago and an NIA grantee.

In another NIA-funded study, researchers are trying to understand the differences between social isolation and loneliness and how they may influence health. They are also trying to identify potential interactions between genes and the environment of older adults affected by social isolation and loneliness.

Using data from twin studies, Dr. Pedersen and researchers found that both social isolation and loneliness are independent risk factors, and that genetic risk for loneliness significantly predicted the presentation of cardiovascular, psychiatric (major depressive disorder), and metabolic traits. Family history does not strongly influence this effect.

Beyond genetics, understanding social determinants of health, and the role of social and interpersonal processes in healthy aging and longevity, is another research direction at NIH. Scientists are beginning to apply this framework to research on social isolation and loneliness.

These structural obstacles included fear of being robbed, distrust of neighbors, limited availability of appropriate services, dilapidated surroundings, and limited meaningful and positive relationships. Having few friends or family members attuned to their concerns was another factor exacerbating social isolation. Study participants expressed a desire to be socially integrated, an idea that runs against the prevailing assumption that isolated older adults are alone by choice.

Cole SW, Capitanio JP, Chun K, et al. Myeloid differentiation architecture of leukocyte transcriptome dynamics in perceived social isolation. Proceedings of the National Academy of Sciences USA. 2015;112(49):15142-15147.

Everyone needs social connections to survive and thrive. But as people age, they often find themselves spending more time alone. Being alone may leave older adults more vulnerable to loneliness and social isolation, which can affect their health and well-being. Studies show that loneliness and social isolation are associated with higher risks for health problems such as heart disease, depression, and cognitive decline.

Loneliness and social isolation are different, but related. Loneliness is the distressing feeling of being alone or separated. Social isolation is the lack of social contacts and having few people to interact with regularly. You can live alone and not feel lonely or socially isolated, and you can feel lonely while being with other people.

Older adults are at higher risk for social isolation and loneliness due to changes in health and social connections that can come with growing older, hearing, vision, and memory loss, disability, trouble getting around, and/or the loss of family and friends. 041b061a72