Behavioral Interventions for Social Connectedness in Older Family Caregivers: A Call to Behavioral Medicine

Kathi L. Heffner, PhD^✉; Kimberly Van Orden, PhD^✉; and Jaime M. Hughes, PhD^✉; Aging SIG

With the expected growth of family caregivers driven by population aging, it is important that feasible and principal-driven behavioral interventions are available that can effectively promote caregivers’ social engagement and connectedness, and reduce health risks. The science of developing, testing, and deploying such interventions is in its infancy, in part because the potency of disconnectedness as a contributor to poor health and declines in well-being has only recently been widely acknowledged as a significant public health problem.^1,2 The SBM scientific community is poised to substantially advance our understanding of effective intervention targets that can impact social connectedness. SBM is a partner of the Science of Behavior Change (SOBC), an NIH Common Fund program established to identify key mechanisms underlying successful change in health behaviors like diet and exercise.³ SOBC researchers, which include many SBM members, have identified self-regulation, interpersonal and social processes, and stress reactivity and resilience as central to health behavior change. The field is ripe for application of these principles to increasing social engagement, which is less well-studied as a health behavior, but yet increasingly recognized as a critical contributor to health.

Caregivers of a family member with dementia are particularly vulnerable to poor mental and physical health. They report higher levels of stress and depressive and anxiety symptoms,^4,5 faster aging-related cognitive decline,⁶ and experience worse physical health outcomes. ^4,7 Social disconnection – that is, social isolation and/or feelings of loneliness -- is a common experience among family caregivers,^8-10 with estimates indicating that up to 80% of caregivers will report feeling socially disconnected due to caregiving responsibilties.¹¹ A lack of social connectedness is associated with a wide range of negative health outcomes, similar to those observed in caregivers, including Alzheimer's disease (AD),¹² and psychological morbidity.¹³ In fact, social disconnectedness carries mortality risk comparable to or greater than other well-established factors, including smoking, body mass index, and physical activity.¹⁴ On the other hand, meaningful, quality relationships and feelings of belonging, critical indicators of social connectedness, are associated with physical and mental well-being.^15,16 The increasing morbidity and mortality among caregivers is likely a function of the more proximal health risks evident among caregivers, including a lack of social engagement and connectedness.^8-10,17

Applying SOBC-identified mechanisms to the science of social connectedness intervention development suggests multiple potential targets. For example, interventions that can reduce or help individuals regulate negative emotions, like anxiety or anger, or stress reactivity in response to interpersonal interactions, may be effective for increasing social engagement and feelings of connectedness with others. Aligned with SOBC mechanisms, improvements in social processes themselves drive healthy behaviors, underscoring the impact of social engagement as a target for subsequent improvement in other domains, like diet and exercise.

We implore behavioral medicine researchers to apply their expertise in behavior change to advancing innovative, mechanism-driven interventions to improve social engagement, particularly in family caregivers. As Co-Directors of the National Institute on Aging-funded Rochester Roybal Center for Social Ties and Aging Research, our mission is to support the advancement of behavioral interventions that impact social connectedness in caregivers of a family member with dementia. Our Roybal Center belongs to the Research Centers Coordinating Network (RCCN), an interdisciplinary network of NIA-funded research centers, and a partner of the SOBC. Funding and mentoring opportunities for early stage and new investigators exist within our own and other centers of the RCCN to conduct pilot work that can move development of behavioral interventions for social engagement and connectedness along the translational continuum. ¹⁸ We also highly encourage established investigators to apply their expertise to advancing social engagement for health and healthy aging.

Meeting the challenges of behavioral interventions in older family caregivers stretches far beyond aging-focused centers and interest groups. Developing, testing, and spreading effective interventions will depend upon interdisciplinary collaborations in aging, population health, intervention science, and policy, to name a few. SBM members, with their depth and expertise, are well poised to be a leader in this area. Resources for more information:

Rochester Roybal Center for Social Ties & Aging Research: https://research.son.rochester.edu/rocstarcenter/

Research Centers Coordinating Network: https://www.rccn-aging.org/

Science of Behavior Change, NIH Common Fund: https://scienceofbehaviorchange.org/

 

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