Practical Tips for Addressing Patient Loneliness in Primary Care

Loneliness is a widespread medical issue that negatively impacts the health of patients, families, and communities. Defined as the distressing experience of having perceived inadequate relationships, loneliness is associated with cardiovascular disease, stroke, diabetes, and dementia.^1–4 Loneliness is also associated with a reduced quality of life, increased falls, and functional decline.^5–7 Approximately half of U.S. adults are lonely, and lonely people are 26% more likely to die prematurely.^5,8

In 2023, former U.S. Surgeon General Vivek Murthy, MD, MBA, released a health advisory titled Our Epidemic of Loneliness and Isolation that promoted a national strategy for addressing loneliness.⁹ This advisory called to attention the role of the health care sector in combatting loneliness, including the assessment and support of patients. The advisory highlights the current reality many family physicians experience as we sit across from patients and hear their stories — that loneliness is a pervasive medical issue profoundly worsening the health of our patients and requiring urgent attention and action by the health care sector.^10,11 Family medicine is well positioned to respond to this need, and family physicians can play a critical role in identifying and addressing loneliness.

Risk factors for loneliness include the following:

• Older age,
• Living alone,
• Recent loss,
• Chronic medical or mental health issues,
• Caregiving responsibilities,
• Cognitive challenges,
• Disability status.

While high-risk individuals are priority targets for loneliness screening, a case can be made for routine screening of all patients.

Why should we screen for loneliness?

Loneliness confers risk for morbidity and mortality equal to smoking 15 cigarettes a day.⁹ Just as every patient who comes into a primary care clinic is screened for smoking, they should also be screened for loneliness, according to the former Surgeon General’s report. Many clinicians do not like to screen for conditions that have no treatments; however, emerging evidence suggests that cognitive behavioral therapy (CBT) and social prescribing (discussed below) may help ameliorate loneliness. By screening, we can identify people who are lonely and may be able to prevent some of the excess morbidity conferred by being lonely.¹²

How should we screen for loneliness?

Simply asking “Are you lonely?” may not get an accurate response because people have different definitions of loneliness and patients may underreport loneliness due to the stigma of being lonely. However, asking if someone is lonely may be better than not screening for it at all.¹³