Abstract
Social isolation and loneliness (SIL) has been deemed an epidemic, with reports indicating dramatic increases in prevalence over the past decade. Despite the growing recognition of SIL as a public health crisis, current interventions remain insufficient to address the need. Occupational therapy practitioners are well positioned to screen for and address SIL, and preliminary evidence suggests that individual and group-based occupational therapy interventions hold promise in reducing SIL. The three aims of this Health Policy Perspectives column are to (1) describe the SIL epidemic in the United States, (2) analyze the strengths and limitations of current initiatives, and (3) identify occupational therapy interventions and approaches that may be integrated into current efforts to combat SIL in the United States.
This Health Policy Perspectives column describes the epidemic of social isolation and loneliness in the United States, analyzes the strengths and limitations of current initiatives, and identifies occupational therapy interventions and approaches that may be integrated into current efforts to combat the issue.
Social isolation—defined as the objective condition of having limited social connections or infrequent interaction with others—and loneliness—a subjective experience of feeling isolated or lacking meaningful relationships—are significant public health concerns (National Academies of Sciences, Engineering, and Medicine [NASEM], 2020). These issues affect a substantial portion of the U.S. population, with approximately 24% of community-dwelling adults age 65 and older being identified as socially isolated and 43% of those age 60 and older experiencing loneliness (Barnes et al., 2022; Cudjoe et al., 2020; Perissinotto et al., 2012). Social isolation and loneliness (SIL) has emerged as a public health crisis, prompting the Office of the Surgeon General (2023) to call for meaningful action to address its impact on health outcomes and health care costs. Despite this recognition and urgency, current interventions to address SIL have been deemed insufficient in their scope, design, rigor, and sustainability (NASEM, 2020). Occupational therapy is a potential solution. Occupational therapists are trained to use a strengths-based approach, skillfully analyze various activities and barriers to performance, and then deliver meaningful and person-centered interventions (American Occupational Therapy Association [AOTA], 2012; Mahesh et al., 2024; Royal College of Occupational Therapists, 2019). Occupational therapists are positioned to address SIL while actively rebuilding patterns of social engagement, which could improve quality of life and reduce health care utilization (Cowen et al., 2024; Nakashima et al., 2023; Roberts et al., 2020). In this column, I highlight the challenges surrounding SIL in the United States and suggest potential avenues for integrating occupational therapy services into current initiatives.
Social Connection and Disconnection
Community, belonging, and togetherness are essential components of social connection. Social connectedness is recognized as a core dimension of individual flourishing, health, well-being, and survival (Smith et al., 2023). One’s social connectedness can be considered as both the sum and the quality of all their relationships and roles—with respect to family, friends, religious group members, colleagues, and neighbors (Holt-Lunstad, 2018). It comprises all the interactions that can occur within one’s lived environment: in homes; neighborhoods; workplaces; schools; grocery stores; and through digital media, such as Facebook, Instagram, and other social platforms. Despite living in a society where the potential for connection is easily accessible, reports of SIL have been rapidly increasing, with the average time spent alone increasing from 285 min/day in 2003 to an alarming 680 min/day in 2023 (Danvers et al., 2023; Kannan & Veazie, 2022). In examining this trend, one must consider the impact of the COVID-19 pandemic, including the fact that the primary strategy for managing the spread of COVID-19 (prior to vaccinations) was social distancing. Places of worship, businesses, and workplaces all reduced their in-person content or hours, which led to widespread social isolation. Although the goal was to keep people safe and healthy, an unintended consequence was increased mental health concerns across various populations (Menezes de Sousa et al., 2021). It is important to understand that even after the pandemic restrictions related to physical distancing lifted, the 20-year trend of increasing social isolation has continued, highlighting the growing disconnect between individuals and their communities.
SIL has been linked to negative mental and physical health outcomes, including lower health-related quality of life and functional mobility as well as an increased risk for heart disease, stroke, Type 2 diabetes, depression, anxiety, addiction, suicidality, and dementia (NASEM, 2020). Most concerningly, socially isolated individuals have a 33% higher risk of death compared with socially connected peers (Naito et al., 2023), underscoring the urgency of targeted interventions. Certain populations, such as low-income adults; older adults; people with chronic illness and disabilities; individuals who are lesbian, gay, bisexual, transgender, queer, or questioning; rural residents; individuals with psychiatric or depressive disorders; previously incarcerated individuals; and victims of abuse have been identified as being at increased risk of SIL (Office of the Surgeon General, 2023).
The financial burden of SIL, along with the associated comorbidities, is also substantial. Medicare alone is estimated to spend $6.7 billion annually on health impacts related to SIL (Flowers et al., 2017). Shaw et al. (2017) found that socially isolated individuals incur an additional $1,644 in Medicare spending per beneficiary each year. Despite this increased utilization of health care services, socially isolated individuals experience a 31% higher risk of mortality. More recent studies have reinforced these findings, showing that socially isolated Medicare beneficiaries are more likely to visit the emergency department and face an increased risk of inpatient hospitalization—further driving up health care costs (Bartley et al., 2024; Mosen et al., 2021; Pomeroy et al., 2024).
Beyond the health care sector, SIL also affects workplace productivity. Stress-related absences linked to social disconnection cost employers an estimated $154 billion annually (Bowers et al., 2022). These widespread consequences extend beyond individual health, straining the public health infrastructure, escalating health care expenditures, and exacerbating existing health disparities. There is an urgent need for interventions to confront this growing public health crisis that are not only meaningful and sustainable but also equitable and scalable.
Current Policies and Interventions
Federal Initiatives
The Office of the Surgeon General (2023) identifies SIL as a public health challenge that requires urgent attention, emphasizing that addressing these issues is critical to improving health outcomes and reducing health care costs. Some examples of national legislative policy that may support SIL-reduction efforts include the Older Americans Act of 1965 (OAA; Pub. L. 89-73) and the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA; Pub. L. 110-343). OAA’s primary purpose is to provide funding for services that target older adults, such as community-based initiatives like Area Agencies on Aging (AAAs). Although many AAAs include programs that support social connection, the OAA legislation itself does not explicitly mandate, or fund, programs whose primary purpose is to address SIL. The MHPAEA ensures parity between mental health and physical health benefits. Although this act is important for reducing barriers to mental health and substance use disorder treatment, it, too, does not directly address the role of social isolation in mental health outcomes (Internal Revenue Service, 2024). Expanding these legislative frameworks to include funding for social connection programs could significantly reduce associated health risks and economic burdens.
Additional federal initiatives related to SIL include Medicare, Medicaid, and Healthy People 2030. Both Medicare and Medicaid offer pathways to address SIL through funding home- and community-based services and care coordination. Through the Accountable Health Communities model, Medicare and Medicaid are evaluating whether identifying and addressing beneficiaries’ social needs—through screening, referrals, and community navigation—can lower health care costs and reduce utilization. As of April 2022, 28 organizations were participating in this initiative, with most locations on the East Coast (Centers for Medicare & Medicaid Services [CMS], 2025). In 2023, CMS also expanded support for underserved populations by introducing new billing codes and payments for services that address social needs affecting health care. These updates include reimbursing caregiver training in specific cases and funding community health integration services, such as care coordination, person-centered planning, and connecting clients to social resources. This was the first time services involving community health workers were reimbursable under the Medicare Physician Fee Schedule (CMS, 2023). Medicaid further supports reducing SIL through programs such as the Medicaid 1915(c) waiver, which enables states to fund nonmedical services, such as transportation, adult day programs, and nutrition supports, which can foster engagement for older adults and individuals with disabilities (CMS, 2025).
Also at the federal level, the framework outlined by the U.S. Department of Health and Human Services in Healthy People 2030 can be used to support the inclusion of SIL content in health professional education. Although the framework’s goals and objectives are not formal educational standards, they can influence curricula by reflecting national health priorities (NASEM, 2020). The current edition articulates a broad vision in which all people can experience health and well-being across the lifespan, with an emphasis on reducing SIL by promoting strong community contexts (Office of Disease Prevention and Health Promotion [ODPHP], n.d.-a, Vision section, para. 1) with an emphasis on reducing SIL by promoting strong social and community contexts (ODPHP, n.d.-a, overarching goals, para. 1; ODPHP n.d.-b).
Although the government provides services that benefit millions of Americans, these programs are not without limitations, and their futures are uncertain. Of note, the One Big Beautiful Bill Act (2025; Pub. L. 119-21), which passed in July 2025, includes approximately $930 billion in Medicaid cuts over the next decade. Provisions in this bill could result in 11.8 million people losing health insurance coverage. This means that vulnerable populations will likely lose access to care.
Nonfederal Initiatives
To complement federal policies and initiatives, several states and private organizations have launched initiatives to combat SIL. For example, AARP (formerly known as the American Association of Retired Persons) has partnered with several national organizations—including the Gerontological Society of America, Give an Hour, the National Association of Area Agencies on Aging, and UnitedHealthcare—to launch Connect2Affect, a campaign platform aimed at reducing SIL (Connect2Affect, 2023). This platform seeks to create a comprehensive network of resources that can support people experiencing SIL by increasing awareness of its health and social impacts, providing access to services and training materials, and fostering opportunities for meaningful connection. Public education and resource dissemination are essential first steps in promoting change, but the effectiveness of digital education and interventions in reducing SIL is uncertain and inconsistent (Hansen et al., 2024; Shah et al., 2021). To complement AARP’s efforts, efforts to address contextual and systemic factors will likely be needed (NASEM, 2020).
AAAs are local or regional organizations in the United States that coordinate and deliver services to support older adults, adults with disabilities, and their caregivers. Although they were established by the OAA, states have control over programs to meet the unique needs of their communities; reports indicate that 98% of AAAs have a program or activity that specifically addresses the need for social engagement, including wellness checks, memory cafes, book clubs, technology training, meal delivery, transportation, and group wellness activities (USAging & Scripps Gerontology Center at Miami University, 2023). Although AAAs have a broad scope, access to services varies greatly, especially in rural areas. For example, New York State has 59 AAAs, whereas Wisconsin has only three (National Association of Area Agencies on Aging, 2017).
When considering existing public and private initiatives, the scope of therapy services, and current legislative frameworks, three primary challenges emerge: (1) limited programmatic reach, (2) constraints related to funding and resources, and (3) insufficient legislative support to strengthen the effectiveness of existing initiatives. These limitations underscore a critical gap in our national response to SIL, and they indicate that at the national level, the United States is underequipped to maintain pace with the scale and the urgency of the SIL epidemic. Without stable funding, guaranteed access to services, and robust community infrastructure, public and private efforts to combat SIL will be fragmented and ineffective. If policymakers continue to reduce essential services, the urgency to adopt more comprehensive, integrated, and preventive approaches grows. This highlights the need to recognize and leverage the distinct role occupational therapy can play, not only in screening for SIL and in addressing modifiable risk factors for SIL but also in contributing to scalable, client-centered solutions that support population health and health equity.
Occupational Therapy as an Integrated Solution
Occupational therapy is uniquely positioned to complement broader societal, legislative, and health care efforts aimed at reducing SIL. As professionals who support individuals across the life course in engaging in meaningful and health-promoting activities, occupational therapists frequently work with populations most at risk for SIL (Collins et al., 2020). Occupational therapy interventions naturally align with strategies to foster social participation, community integration, and self-efficacy—factors closely linked to reducing isolation and loneliness. The Occupational Therapy Practice Framework (AOTA, 2020) supports group- and activity-based approaches as within the profession’s scope, enabling occupational therapy practitioners to design interventions that target both social and functional goals.
A growing body of research highlights the success of occupational therapy interventions in reducing SIL across diverse settings and populations. Gonzalez et al. (2023) implemented a mixed-methods, activity-based intervention with justice-involved men reentering the community. Group and individual sessions focused on leisure engagement, coping skills, and self-management strategies, leading to improvements in self-efficacy and emotion regulation and moderate reductions in isolation. Similarly, Kalina et al. (2018) found significant reductions in loneliness among adults with multiple sclerosis after participating in a 12-wk community reintegration program centered on self-efficacy and skill development. Studies involving older adults—who are particularly vulnerable to SIL—also have shown promising outcomes. Mulry and Piersol (2014) reported that 86% of older adults in a Section 8 housing program improved or maintained social participation after an occupational therapist–led group mobility and community access intervention. Papageorgiou et al. (2016) reinforced these findings in their review of interventions promoting social participation among older adults. Hand et al. (2017) further emphasized the role of community-level engagement, identifying dissatisfaction with social activity levels as a primary indicator of SIL in adults age 50 and older and encouraging occupational therapist–led efforts to increase affordable, accessible, and inclusive programming.
Even when an occupational therapist is not the direct provider, evidence from similar interventions supports the potential impact of occupational therapy in addressing SIL. For example, Tran et al. (2023) conducted a randomized controlled trial of a mindfulness-based stress reduction program that significantly reduced loneliness among healthy adults. Although not delivered by occupational therapists, the program’s structure—which comprised group-based mindfulness, reflection, and behavior change—is well within occupational therapy’s scope of practice (Creswell et al., 2012). In addition, Lee et al. (2024) found that poststroke loneliness was strongly mediated by social participation, a domain where an occupational therapist can intervene to support both self-efficacy and connection. These findings demonstrate that even when SIL is not the explicit target of intervention, occupational therapy programs can yield important secondary benefits related to social health. Taken collectively, the literature reinforces that occupational therapy can play a critical role in developing and scaling interventions that promote social connection, emotional well-being, and community integration—key components in the public health response to SIL.
The Path Forward
Given the current scope of the SIL epidemic, and the fact that many occupational therapists are already working with populations at risk of SIL, there is an urgent need for occupational therapists to screen for, and provide interventions to reduce, SIL. If clients are identified as experiencing SIL, then occupational therapists can implement individual or group-based interventions that target the modifiable factors of SIL—such as social participation, health and wellness, fall prevention, and community mobility.
Recent legislative proposals, such as the Social Determinants Accelerator Act of 2021 (H.R. 2503/S. 3039), provide an opportunity for occupational therapy to play a pivotal role in addressing social determinants of health, including social isolation (Aligning for Health, 2025). In addition, federal funding for research through agencies like the National Institute on Aging and the Substance Abuse and Mental Health Services Administration could further the development of evidence-based occupational therapy interventions. However, given the recent changes to federal funding and research initiatives, it is imperative to ensure that research focused on occupational therapy interventions is not sidelined. These changes, along with the passage of the One Big Beautiful Bill Act (2025), threaten to undermine the development and implementation of evidence-based preventive interventions that address SIL.
To effectively combat SIL, it is essential that occupational therapy practitioners feel confident in their existing knowledge and skill sets. Evidence suggests that occupational therapy practitioners are already uniquely positioned to screen for persons at risk of SIL and that their individual and group-based interventions support a decline in SIL. Although at a national level it could be beneficial to incorporate occupational therapy into existing legislative frameworks and initiatives, occupational therapy practitioners can begin to make a meaningful impact immediately. Over the long term, policymakers can ensure a comprehensive approach to combating SIL and promoting community well-being through the inclusion of occupational therapy in public health initiatives. Professional advocacy efforts need to be aimed at policymakers so that funding can be prioritized for evidence-based occupational therapy interventions, especially when considering recent policy changes, and can advance legislation, such as the Social Determinants Accelerator Act of 2021, to address SIL as a critical public health issue.
Footnotes
Acknowledgments
The author thanks Dr. Shu-Fang Shih, Department of Health Administration, College of Health Professions, Virginia Commonwealth University, and Dr. Stacey Reynolds, Department of Occupational Therapy, College of Health Professions, Virginia Commonwealth University, for their help in editing and revising the manuscript.