June 25, 2025. By Kate Kutzer.

I knocked on the door of the VA exam room with a social needs screening tool in hand.

“Good morning! I’m a medical student here to explore resources that could support you before and after surgery. Is it ok if I ask you a few questions?”

“Of course!” he said, as he greeted me with a sturdy handshake.

Mr. J was a cheerful 72-year-old man with a warm smile on his sun-weathered face. His slightly stooped yet steady posture had a quiet air of dignity. Brimmed by an embroidered Vietnam Veteran hat, his eyes conveyed humility and wisdom. We worked through the set of questions together.

1. Do you live in stable housing? – “Yes.”
2. Have you worried whether your food would run out? – “No, thankfully.”
3. How often do you feel lonely or isolated from those around you? – “Often.”

About 30% of high-risk senior veterans in this clinic screen positive for at least one social need, with social isolation being one of the most prevalent. With each visit, I feel privileged to share such a vulnerable space with patients who trust me to help them with deeply personal challenges. It is disheartening to know that this man has fought for our nation’s freedom, yet we have let him face the challenges of the end of his life alone. In the setting of government initiatives to reduce the workforce of the VA by 80,000 (17.2%) individuals, including 20,000 veteran workers, supporting veterans through social needs screening and volunteering has become increasingly important.

Mr. J was to undergo a right knee replacement, typically an outpatient procedure. However, without help, he would face challenges such as driving home, navigating stairs, preparing food, and managing his pain regimen. Simply experiencing the emotional toll of undergoing surgery is difficult alone. His story is not unique—countless older adults, particularly veterans, find themselves in similar situations, struggling with isolation that extends far beyond the perioperative period. This encounter underscored the impact of social isolation among older adults and veterans—a silent epidemic that threatens their health, well-being, and sense of self.

The Crisis of Social Isolation

Social isolation is not just a personal struggle; it is a public health challenge with far-reaching impacts. Research has shown that loneliness is more than a feeling—it has measurable effects on physical health. It is comparable to smoking 15 cigarettes a day, and has been associated with an increased risk of heart disease, dementia, and stroke, making it a significant yet often overlooked risk factor. The Surgeon General has identified it as a top priority, with about half of adults in the US experiencing loneliness.

The COVID-19 pandemic has only exacerbated isolation and its social, financial, and health consequences for our society. Social scientists argue that fewer connections lead to fewer discussions, ultimately creating distrust and polarization in our communities extending to the political landscape. Moreover, American isolation comes at a financial cost of $6.7 billion in excess Medicare spending annually, stemming from increased utilization of healthcare services, notably hospitalizations and nursing facility care. Socially isolated individuals often lack support systems, leading to delayed medical attention and exacerbated health conditions, resulting in more frequent and prolonged hospital stays.

The Disproportionate Burden for Minorities

Social isolation disproportionately affects minority populations, patients with financial constraints, and those with limited English proficiency. Structural barriers such as systemic inequities, discrimination, socioeconomic disparities, and language barriers contribute to reduced access to community events, resources, as well as healthcare. Studies have shown that social isolation is strongly associated with negative physical and mental health outcomes that disproportionately impact minority populations.⁵

Solutions Are Within Reach

Addressing this challenge requires a multifaceted approach (Table 1). In Congress, a bill currently under consideration titled “National Strategy for Social Connection” was introduced in 2023 and aims to establish an Office of Social Connection Policy within the White House to develop a comprehensive nation strategy to address the issue. Among the Veteran population, many are voicing their support of preserving the PACT Act, which expanded job opportunities for veterans in 2022. Additionally, as outlined in the Surgeon General’s advisory, the Six Pillars to Advance Social Connection offer a national framework for fostering relationships and supporting public health.

Within the healthcare system, promoting social infrastructure, community-based organizations, and interdisciplinary clinics can help rebuild our sense of community. The Geriatrics and Extended Care program at the VA is a strong example of integrated care, offering routine screenings and resources such as home health aides, home-based primary care, and palliative support.

At an individual level, creating a culture that values relationships starts with each of us. We all play a part in supporting our family, friends, neighbors, and colleagues. Checking in with loved ones, volunteering, encouraging intergenerational activities, and supporting trainings for technology and internet utilization can encourage social connection. Additionally, as healthcare providers, we can play a valuable role by screening for loneliness, facilitating community engagement, and connecting older adults with support networks or local activities. Mr. J’s priority after his surgery was getting back to serving the local food bank, an activity that brought him friendship and fulfillment.

A Call to Action, Together

The story of the senior veteran I met reflects a larger truth: connection is not a luxury—it is a human necessity. I learned that excellent patient care requires listening to vulnerabilities and acknowledging the role of human connection in healing. Providing social needs resources is just as important as clinical care, regardless of the specialty. Given that the population of older adults within the United States is projected to rise by almost 50% from 2020 to 2050, it is increasingly important to support older adults and their sense of community, particularly during periods of recovery. Mr. J agreed to receiving information about transportation, the local senior support center, and a postoperative phone call. As an aspiring surgeon, I look forward to nurturing trust and community with every encounter.

Table: Practical Strategies to Address Social Isolation Among Older Adults and Veterans

Level	Strategy	Example Implementation
Policy	Expanded Home- and Community-Based Services	Advocate for legislation and funding that increases access to in-home aides, meal delivery, and volunteer visitation.
	Supporting legislation for older-adult and veteran populations	Support policies such as the National Strategy for Social Connection Bill or the PACT Act which expanded VA job opportunities in healthcare.
Community	Social Engagement Programs	Partner with senior centers, faith-based organizations, and local nonprofits to organize group activities. Employ technology training to promote connection through telephone calls or internet groups.
	Transportation Support	Offer ride-share vouchers or volunteer-driven services to help older adults attend social events and medical appointments.
Clinical	Screening and Post-Discharge Follow-Up	Use brief, validated tools during clinic visits to identify those at risk. Schedule phone calls or home visits to monitor recovery and connect patients to community resources.
	Leverage Technology	Provide user-friendly devices or apps for telehealth, along with basic tech support.
Individual	Encourage intergenerational relationships	Facilitate interactions between older and younger generations through mentorship programs or local activities.
	Volunteer	Promote individual community involvement or help older adults find meaningful volunteer opportunities where they can contribute to their community.

Doximity Profiles

Katherine Kutzer: Doximity, linkedin, twitter

Eden Singh: linkedin.

Thorsten Seyler Doximity, twitter.

Mamata Yanamadala Doximity.

Bio:

Katherine Kutzer and Eden Singh are third-year medical students at Duke University School of Medicine, currently serving as North Carolina Albert Schweitzer Fellows. They support high risk senior veterans undergoing surgery through social needs resource connection for things like food, housing, and transportation.