Americans prize self-reliance and independence; they are as intrinsic to our cultural identity as Mickey Mouse and the Liberty Bell. But studies show that going it alone can negatively affect health, especially when we’re isolated by circumstance rather than by choice.

As Maslow’s hierarchy of needs showed decades ago, humans are hard-wired for connection. We need friendship, intimacy, trust, acceptance. We thrive on receiving and giving love and affection. When we feel detached physically or psychologically, however — when we’re disconnected from family, friends, and community — isolation takes hold. And even though technology and social media may provide a sense of connectedness for some, there’s no substitute for real-life, in-person connection.

For older adults — one in five of whom is affected by social isolation — the absence of a shoulder to lean on or a hand to hold, of someone to count on in times of stress and need, can be crushing. What’s more, it can have alarming emotional and physical effects.

Along with its cousin, loneliness, isolation is associated with a higher risk of mortality in older adults. Higher blood pressure, increased susceptibility to the flu and other infectious diseases, greater risk of heart disease, earlier onset of dementia — all are linked to social isolation. One study shows that the health risks of prolonged isolation are equivalent to smoking 15 cigarettes a day.

Isolation is also a major risk factor for depression. “I have been alone for 20 years. I am 60 and it gets very depressing during the holidays,” says Tami C., a Facebook user. Her work is stressful, and her co-workers are “mostly young kids who have nothing in common with me.” She adds, “I miss having someone to talk to about work and problems or just someone to watch a movie with. It is difficult to make new friends and I dread dying alone.”

Apart from its effect on individuals, social isolation hurts society overall, and communities in particular. A November 2017 report by the AARP Public Policy Institute found that Medicare spent an estimated $1,608 more per year for each socially isolated adult age 65 or older than it did for those who had more typical levels of social contact. The additional spending, according to the report, is “comparable to what Medicare pays for certain chronic conditions, such as high blood pressure and arthritis.” Moreover, when older members of the community withdraw, taking with them their knowledge, perspective and talents, everyone is diminished.

A Link With the Outside World

In light of these physical, emotional and financial costs, several organizations have begun exploring ways to solve the isolation conundrum. AARP Foundation recently joined with Gerontological Society of America, Give an Hour, the National Association of Area Agencies on Aging and UnitedHealth Group to create Connect2Affect, a collaborative effort to help end isolation and build the social connections older adults need to thrive. Connect2Affect’s website features tools and resources to help users determine isolation risk and reconnect with local communities.

These and other organizations are exploring ways to harness emerging technology and new applications of existing marketplace solutions that may reduce or prevent isolation. There is, for example, an ever-growing universe of hands-free, voice-controlled devices and capabilities that may help older adults stay connected and fend off isolation.

One of the more challenging aspects of this work is that there’s no single cause of isolation in older adults. The normal processes and transitions that can come with age — changing physical and brain health, untreated hearing or vision loss, difficulty walking, and life events like loss of loved ones and retirement — increase the risk for isolation. So does living alone. Another Facebook user, 80-year-old Eldonna B., commented that she suffers from several health conditions that keep her at home and on her own. Her description of her situation is heartbreaking. “Loneliness is a terrible thing. [My] tablet is my link with the outside world.”

There are other factors at play that have little to do with the physical act of aging. Environmental, societal and economic conditions that contribute to poor health outcomes — known as social determinants of health — often converge, straining social connections even further.

If you’re a low-income older adult from a disadvantaged population — a person of color, LGBTQ+, an immigrant, a refugee, or someone who lives in a rural area — you likely confront barriers, such as reduced access to services or culturally appropriate care, that can intensify isolation. The burden of society’s marginalization becomes even greater when you’re trying to explain a medical issue to a doctor who doesn’t speak your language or understand your health care needs. It may seem easier to just stay home.

If there’s no mass transit where you live, and you can’t afford a cab or a ride-hailing service, then getting to the senior center, a doctor’s appointment or the grocery store becomes an insurmountable problem.

If you’re caring for a loved one with a chronic condition, dementia, or other illness, the demands and pressures of caregiving can be overwhelming. Many caregivers find it difficult to break away and take time for themselves; they become detached from their social support networks and the emotional sustenance friendships bring.

Independently or in combination, these factors have a negative impact on health. When you can’t leave the house, get the care you need, or talk to other people, the sound of isolation can be deafening.

The Language of Connection

There is, however, a growing interest in solving social isolation. The national conversation may be in its infancy, but one thing is clear: family members and neighbors are a crucial part of the mix. They’re usually the first to recognize signs of isolation — even if they don’t know how to interpret them, or what they can do to help.

Although there are no visible “symptoms” of isolation, there are some signposts. In addition to statements like, “I don’t talk to many people” or “It’s too hard to get anywhere,” an isolated older adult may appear bored, disinterested, and withdrawn. Personal hygiene may fall off, along with healthy eating and nutrition habits. In some cases, there may be obvious home disrepair, clutter, or hoarding. Some seniors may be isolated and not realize it. Others may be aware of their isolation but don’t feel comfortable talking about it.

Experts advise listening, asking questions, and helping seniors get what they need to maintain connections with neighbors, family, and friends.

“Listening means more than just hearing the words an older adult has to say,” explains Lisa Marsh Ryerson, president of AARP Foundation. “It means tuning in to their concerns, their fears, and their needs. It means giving them space to talk without rushing in to fix the problem — or, worse, dismissing it.”

Through careful listening, a family member might learn that “I don’t call because I don’t want to bother you” really means, “I’m afraid I’m not important to you.” An expression of anger or frustration, such as “I don’t like the home care aide you hired for me,” may mean, “I feel like I no longer have control over my world.” Asking thoughtful, nonjudgmental questions — “I’ve noticed you stopped going out with your friends as much. Is there something that’s keeping you from being able to do that?” — can bring issues to light, with the answers serving as a guide to finding solutions.

As our awareness of social isolation has grown, so has our understanding of what can be done to ease it. Studies have identified a variety of actions and resources that can be effective in getting an isolated person out of the house and back into the community.

Senior centers and community centers offer activities, volunteer programs, and other opportunities for social interaction. Exercise and falls prevention programs can be especially helpful for keeping older people active and confident in their ability to safely navigate the world. Providing or paying for transportation to the senior center or other social activities can be the gentle push an isolated person needs to venture back into society.

Untreated hearing or vision loss can play a major role in isolation. Ensuring that loved ones have regular vision and hearing tests and talk with a healthcare professional about possible solutions to hearing or vision loss may ease this burden and restore confidence.

Even a short visit with a neighbor or family member can have mental health benefits for a person at risk of isolation. Making time to visit with an isolated relative or arranging visits by others can ease feelings of loneliness and improve their sense of connection. Where visits aren’t possible, technologies like Skype and FaceTime are invaluable for to staying in touch with loved ones who live far away. Helping an isolated senior learn to use one of these formats can re-establish vital connections to those they can no longer visit in person.

Our aging population faces challenges every day, but feeling alone doesn’t have to be one of them. As we learn more about isolation and the factors that contribute to it, we can continue to seek solutions that help senior loved ones feel valued and get back out into the world. Ensuring the continued health and quality of life of our most vulnerable seniors is good for them, good for their families, and good for our society as a whole.