Online Therapy for Social Isolation: A Guide for Older Adults

Chances are, you’ve heard the phrase “social isolation” in conversation once or twice since COVID-19 drove the world into lockdown. Already, the condition affected more than 20% of American adults.¹ It’s just that people didn’t talk about it very much.

All that changed soon after March 2020, when nearly everyone experienced a crash course in being physically separated from other people. Suddenly, America’s epidemic of loneliness was big news—and common knowledge.

What's the difference between social isolation and loneliness?

It’s important to understand the difference between social isolation and loneliness. Social isolation is actually having few social relationships, social roles, group memberships, and infrequent social interaction with family, friends, and others. On the other hand, loneliness is someone's own personal view. It’s the distressing experience that results from one’s own perceived isolation or unmet need between a preferred and actual experience. Some people can be socially isolated but not feel lonely, and others who feel lonely may not socially isolated.

“Historically, there’s been this tendency among the general population to think of social isolation both as a rarity and as something that individual people need to figure out how to fix on their own,” explained Kathleen Cameron, senior director of NCOA’s Center for Healthy Aging. “As the pandemic made clear, that simply isn’t the case. Social isolation is very much a public health issue that affects millions of people across the age and demographic spectrum, but especially older adults.”

That issue has only grown alongside collective awareness about it. According to the World Health Organization (WHO), as many as 1 in 3 older adults today report feeling lonely, including in the United States.² And social isolation now impacts 25% of Americans age 65 and older.³ Some of this is due to COVID. But other factors play into it as well.

Effects of social isolation on older adults

The WHO warns that social isolation can negatively impact mortality as much as smoking, obesity, and physical inactivity do.² It reduces longevity and quality of life and can lead to poor mental health outcomes as well.

For older adults in particular, social isolation can increase the risk for:⁴

• Anxiety
• Depression
• Cognitive decline
• Alzheimer’s disease

“Mobility challenges, hearing loss, a lack of transportation, grief—all of these things can prevent seniors from feeling connected to the outside world,” Cameron said.

The good news is that there are proactive steps that older adults can take to reduce the negative effects of social isolation on their mental health. Let’s take a look at what those effects are and how to address them.

Barbara, who lives alone in Buffalo, New York, knows this all too well. Even before COVID-19, a rare autoimmune disorder left this 80-year-old mostly confined to home. Trying to navigate everyday obstacles, including major out-of-pocket prescription expenses, without nearby family and friends to lean on caused Barbara significant anxiety. And once the pandemic hit, she felt completely “overwhelmed with life.”

“Barbara is an example of someone whose physical and mental health were truly at risk because of her isolation,” Cameron explains. “Her situation easily could have led to a downward spiral in both: lacking the emotional reserves to find or apply for financial assistance programs, she could have stopped filling her prescriptions or buying the food she needed to stay healthy.

“Declining physical health leads to declining mental health and vice-versa,” Cameron added. “That’s why it’s so important that isolated older adults have access to the necessary mental health support that they need.”

What are the symptoms of social isolation in older adults?

Fortunately, an outreach worker from the local food bank encountered Barbara during a mobile food pantry event and ultimately helped her apply and qualify for SNAP benefits. Now, Barbara can afford both her groceries and her medications. Plus, she has a new friend at the food bank.

“I’m so grateful someone noticed me,” Barbara said.

Would you notice the signs of social isolation in someone else—or yourself? Barbara clearly was by herself, but other indicators aren’t so obvious. According to a broad range of experts, symptoms of social isolation can include, but aren’t limited to:

• Unusual irritability or conversely, apathy
• Avoiding other people
• Poor self-care
• Increased substance use, such as alcohol and prescription drugs
• Thoughts of suicide

How do you prevent or reduce social isolation in older adults?

Navigating social isolation can seem challenging, especially for older adults—but it’s not impossible.

“Taking steps, even small ones, to reconnect with the outside world can go a long way,” Cameron suggested. “While COVID is still a concern, and we all need to remain careful, there are ways to safely interact with others in social situations now.”

Not sure where to start? Cameron suggests ideas such as:

• Volunteering in the community
• Visiting your local local senior center and participating in a new activity
• Re-engaging in an activity you've enjoyed in the past, like going to the movies and playing cards with friends
• Cultivating a new hobby with others—like mah-jongg or pickleball
• Attending a congregate meal
• Using technology to connect with far-away family and friends

“Each of these activities provides opportunities to rebuild confidence and cultivate old and new friendships,” Cameron said.

Online therapy can also be an effective tool for older adults who want to overcome feelings of loneliness and isolation.

Online therapy and peer support programs for older adults

NCOA Adviser’s Reviews Team regularly ranks the best virtual counseling sites for older adults based on over 1,000 hours of in-depth research on mental health, substance use disorders, and online therapy.

A variety of these platforms also include group therapy options and peer support programs which, according to Cameron, can feel more comfortable for some older adults than one-on-one counseling.

“Participating in group sessions reinforces that you’re not alone. It also helps forge those human connections that are so important,” she said.

If you or someone you know is interested in trying virtual group therapy, our Reviews Team suggests the following:

BetterHelp
BetterHelp offers dozens of group sessions, branded as Groupinars, each week. Groupinars generally center on a specific topic, such as anxiety, and participants can access recordings of each session after the fact. BetterHelp charges subscribers between $60-$90 each week, billed monthly, and you can cancel at any time.

Talkspace
Talkspace therapists lead group workshops four days per week covering a variety of topics organized into three categories: Parenting, Individuals, and Couples. These sessions are available for subscribers to the Video + Messaging + Workshops plan, which costs $109 per week with no contract required.

Grouport
Licensed Grouport therapists lead focused online group therapy sessions addressing topics such as anxiety, depression, bereavement, chronic illness, and more. Costs range between $25 and $35 per week, billed monthly or quarterly depending on your plan. Members can cancel their subscriptions at any time.

Monument
This platform is an especially good choice for older adults whose social isolation has led to alcohol misuse. In addition to targeted individual therapy, members have unlimited daily access to peer support programs related to sobriety and moderation. Depending on the plan, it costs between $0 - $249 per month to join Monument, some or all of which may be covered by insurance.

Sesh
Sesh exclusively centers around online support groups led by licensed therapists, with hundreds of topics available to explore. You can try Sesh free for two weeks, after which you will pay $30 per individual session or $60 per month for unlimited access. Sesh doesn’t require a contract and you can cancel anytime for any reason.

Are support groups for older adults free?

In general, no. Most online counseling platforms require some form of payment, whether it’s pay-as-you-go or subscription-based. That said, some telehealth therapy platforms offer financial aid or will charge on a sliding scale, based on a client’s ability to pay. NCOA Adviser’s Reviews Team compared the costs of some common online therapy sites.

That said, there may be in-person community support groups offered in your area at no cost. Check with your local senior center, weekly newspaper, or faith community to learn about available opportunities. You can also try typing “peer support groups near me” into your internet search engine.

The bottom line

The COVID-19 pandemic shone a spotlight on social isolation and its negative effects on physical, emotional, and mental health. Many older adults already faced particular risk factors for loneliness and isolation, and lingering lockdowns further exacerbated the problem on a global scale. Today, as many as 1 in 3 older adults report feeling lonely according to the WHO. The good news is that there are effective strategies for overcoming social isolation and rebuilding community connection. For older adults who need or want a little extra guidance and encouragement might consider online group therapy and virtual or community-based peer support programs.

Sources

1. Bianca DiJulio, et. al. Loneliness and Social Isolation in the United States, United Kingdom, and Japan: An International Survey. Kaiser Family Foundation. August 2018. Found on the internet at https://files.kff.org/attachment/Report-Loneliness-and-Social-Isolation-in-the-United-States-the-United-Kingdom-and-Japan-An-International-Survey

2. World Health Organization. Reducing social isolation and loneliness among older people. Found on the internet at https://www.who.int/activities/reducing-social-isolation-and-loneliness-among-older-people

3. The National Academies of Science, Engineering, and Medicine. Social Isolation and Loneliness In Older Adults: Opportunities for the Health Care System. Found on the internet at https://nap.nationalacademies.org/catalog/25663/social-isolation-and-loneliness-in-older-adults-opportunities-for-the

4. National Institute on Aging. Social isolation, loneliness in older people pose health risks. April 23, 2019. Found on the internet at https://www.nia.nih.gov/news/social-isolation-loneliness-older-people-pose-health-risks