Background: Social isolation and loneliness (SI+L), two largely silent social determinants of health (SDOH), are associated with negative health outcomes such as the increased risk of cardiovascular disease, higher rates of depression, increased hospital readmissions, and increased use of healthcare services. SI+L are also common, with one in five US adults reporting feelings of SI or L. At LAC+USC Medical Center, a 600-bed safety net hospital and Level 1 trauma center, we have found 42% of our hospitalized patients feel socially isolated, 26% feel lonely, and 20% feel both SI and L. Despite the high prevalence rate and the associated adverse health outcomes, we currently do not systematically address SI+L. But in order to reduce SI+L, we first need to better understand it in our patients.

Purpose: We aim to understand the characteristics of SI+L in our hospitalized patients and the resources needed to address it.

Description: We interviewed over 60 patients on the medical-surgical units of LAC+USC. Our interview tool consisted of a 2-question screen to assess for SI +L presence, an 11-question validated tool (Berkman-Syme Social Network Index, BSNI), and 3 open-ended questions assessing barriers and resources needed to reduce SI+L. Patients identified barriers to connectedness and requested resources. We then categorized barriers and resources into 4 major themes: Physical/Lifestyle, Enabling Resources, Interpersonal Support, and Health Care & Supportive Services. Our patients reported physical health/lifestyle issues and lack of enabling resources as the two major barriers causing SI+L (Table 1) with physical disability and behavioral health issues being the most common minor themes identified. Interpersonal Support was the most common resource requested; direct support from family/friends/long term relationship was the highest prioritized minor resource theme (Table 2). Health Care and Supportive Services were the least requested resource from our patients.

Conclusions: Based on this qualitative analysis of both the perceived barriers and needed resources for our hospitalized patients, we have learned that reducing SI+L isn’t a “one size fits all” task. Rather, it requires an individualized approach. Using this research and a human-centered design approach, we are developing an enhanced referral process that will link patients to resources at a co-located wellness center to create personalized interventions to address SI+L in our patients.

IMAGE 1: Barriers & Underlying Mechanisms Driving Loneliness/Isolation Identified by N=60 Patients.

IMAGE 2: Resources Needed by Patients to Alleviate Loneliness/Isolation (as identified and prioritized by patients by N=60 patients).