PHILADELPHIA -- It has the health effect of smoking 15 cigarettes a day, but it isn't a bad health habit, at least as traditionally conceived: loneliness and social isolation.
"There is a new chronic condition out there called loneliness," said Donato Tramuto, president and CEO of Tivity Health, a wellness company in Franklin, Tenn., at Thomas Jefferson University's annual Population Health Colloquium here. "This is not just occurring in our vulnerable populations ... We have the opportunity to seek out this problem, and we've got to bring the loneliness out of the closet and make this an issue strong enough where we can embark upon change."
Tramuto said he saw this in his own family. "My father died in 1992 and 6 months later my mother passed away," and when Tramuto went into his mother's hospital room, "the doctor said, 'If I could have written down 'Broken heart' [as a cause of death], that's what I would have written down," he said.
Tramuto's company is the owner of Silver Sneakers, an exercise program for seniors that is offered in YMCAs and other fitness centers. Tramuto said he recently visited Silver Sneakers' oldest member, who is 103. The woman, who started going to Silver Sneakers at age 89, told Tramuto she had lost her sense of purpose at age 88, when the special-needs daughter she was taking care of passed away.
"Her story wasn't about bench-pressing 150 pounds ... Her friends introduced her to Silver Sneakers and she made about 75 new friends," he said.
Health insurer Humana also is interested in the isolation issue, said Andrew Renda, MD, MPH, Humana's director of its "Bold Goal" program to improve population health. He cited research showing that 50% of seniors are considered lonely or isolated and 10% are considered severely lonely or isolated -- and healthcare costs in that latter group are an average $130 per month more than those who aren't.
Humana is working to improve both social isolation and food insecurity, Renda said, noting that one in eight Americans -- including 5.4 million seniors -- are food insecure; that has a profound impact on their health, as they are 50% more likely to develop diabetes and three times more likely to be depressed.
"There's a concept that food is medicine [but] it's not yet been embraced by the government," he continued. "Right now food is explicitly excluded as a value-added benefit on Medicare claims. That's something that needs to change, and we aim to change it by generating proof points for interventions."
So Humana officials decided to conduct programs to screen patients for food insecurity and refer them for assistance. In 2016, the insurer conducted a pilot program in south Florida in which "we found ... a two-question food insecurity screener and embedded it into the electronic medical record," he explained. Humana also developed a resource guide and arranged for distribution of food in medical clinics.
"We found that physicians asked questions and patients responded; they screened positive at three times the rate we expected" -- a rate of 45%. On the plus side, "people were receptive to receiving guidance" on federal food aid programs and local food banks, he said.
Humana also developed a toolkit around how to screen for food insecurity in physician clinics. "Any physician can pick up [our] step-by-step guide," Renda added.
Veterans Affairs Secretary David Shulkin, MD, told attendees his department also is interested in social determinants of health.
"The VA definition of health includes physical, psychological, socioeconomic, and spiritual [health] as well," he said. "We really provide things that do talk about social determinants of healthcare.... We teach patients how to do self-care and how to empower themselves; that sometimes includes mindfulness, yoga, or other integrative medicine aspects."