By Megan Hays, PhD, ABPP, FAACVPR

As the holiday season approaches, many of us are reminded of the importance of connection, whether that’s through family gatherings, sharing meals with friends, or even small moments of kindness in our daily routines. But for many older adults, especially those living with chronic heart and lung conditions, this time of year can magnify feelings of loneliness and isolation.

Loneliness has emerged as a public health epidemic in the United States, with about half of adults reporting feelings of loneliness.¹ Loneliness is the subjective distressing feeling of being alone or separated. Social isolation, on the other hand, is characterized by having few social relationships or infrequent social interactions. Both can take a serious toll on health. In fact, research shows that the health risks of prolonged loneliness are comparable to smoking up to 15 cigarettes a day² — with increased risks for heart disease, stroke, dementia, depression, and premature death. Poor social health is more predictive of mortality than physical activity or BMI.³

For patients already navigating the challenges of heart or lung disease, loneliness can worsen outcomes and make recovery feel harder. As cardiopulmonary rehabilitation professionals, we are in a unique position to notice, assess, and help our patients strengthen their social well-being alongside their physical health.

Spotting Loneliness in Your Patients

Loneliness isn’t always obvious. Some patients may openly share that they feel isolated, while others may mask it behind small talk or by downplaying their feelings. A few simple questions can help open the door:

• “Who are the people you enjoy spending time with outside of rehab?”
• “What does your support system look like right now?”
• “The holidays can feel different for everyone. What do they feel like for you these days?”

Tools like the UCLA Loneliness Scale⁴ or the Berkman-Syme Social Network Index⁵ offer structured ways to assess loneliness. But often, it’s as simple as listening with curiosity and noticing when a patient hints at disconnection, especially if they live alone, have mobility challenges, or mention losing friends and loved ones.

Why Rehab Is a Natural Antidote

Cardiac and pulmonary rehab programs already provide something powerful: routine, consistency, and community. Patients come at set times, see the same staff, and often exercise alongside the same group of peers. This structure can help reduce isolation and create opportunities for meaningful connection.

Rehab can serve as more than just a medical intervention; it can be a social lifeline. Staff can encourage patients to:

• See rehab as “their place” to not only work on health but also connect with others walking a similar path
• Celebrate small group milestones (birthdays, progress updates, holidays) to build community
• Model empathy and genuine care, reminding patients that they are seen and valued

Practical Tips for CR/PR Staff

Here are strategies you can use in day-to-day interactions:

1. Normalize the Conversation

Bring up loneliness as you would other risk factors. Saying something like, “Many people with heart or lung conditions tell me they feel more isolated, especially around the holidays. What has your experience been like?” helps patients feel less alone in their experience.

2. Encourage Quality Time

Coach patients to focus on face-to-face connection when possible. Suggest simple steps: turning off the TV during meals, calling a friend, or inviting a neighbor for coffee. Even short interactions can build a sense of belonging.

3. Help Them “Keep Showing Up”

Consistency matters. Encourage patients to attend group sessions regularly or get involved in community groups that reflect their interests (e.g., faith-based communities, knitting circles, senior centers, etc.). The more they show up, the more familiar and comfortable it feels.

4. Promote Authenticity

Patients who feel they can be their true selves are more likely to form deep, supportive connections. Encourage self-disclosure at a pace that feels safe; sharing stories, struggles, or victories during group rehab often sparks bonding.

5. Explore Creative Social Prescriptions

Suggest activities that combine social connection with health benefits: walking groups, volunteer programs, or even virtual support groups for those with mobility limitations. The key is pairing connection with meaning.

A Season of Connection

The holidays are a perfect time to remind patients (and ourselves!) that connection is medicine. Small steps, like calling an old friend, writing a holiday card, or attending a group exercise session, can ease loneliness. For clinicians, simply asking and listening can be the spark that helps a patient feel less invisible.

Loneliness is not just a personal issue — it’s a public health issue, with real consequences for heart and lung health. But the flip side is also true: connection heals. Cardiac and pulmonary rehab teams are uniquely positioned to help patients reclaim not just their health but also their sense of belonging.

Key Takeaways for Rehab Professionals

• Loneliness equals risk: Its impact on health is as harmful as smoking 15 cigarettes a day.
• Ask the questions: Use simple, compassionate questions or validated tools to spot loneliness.
• Rehab is community: Leverage the group setting as a natural source of connection.
• Practical strategies work: Encourage quality time, regular participation, and authentic connection.
• Holidays are a hotspot: Anticipate that loneliness may peak and proactively support patients during this season.

This holiday season and beyond, let’s remember that connection is medicine. By keeping loneliness on our radar and fostering connection in every patient interaction, we’re not just improving rehab outcomes; we’re giving patients the chance to truly live longer, healthier, and more meaningful lives.

Megan Hays, PhD, ABPP, FAACVPR, is Interim Enterprise Chief Well-being Officer, Medical University of South Carolina (MUSC).

REFERENCES

1. U.S. Department of Health and Human Services. (2023). Our epidemic of loneliness and isolation: The U.S. Surgeon General’s advisory on the healing effects of social connection and community. Office of the U.S. Surgeon General. https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf
2. Holt-Lunstad, J., Robles, T. F., & Sbarra, D. A. (2017). Advancing social connection as a public health priority in the United States. American Psychologist, 72(6), 517–530. https://doi.org/10.1037/amp0000103
3. Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: a meta-analytic review. PLoS medicine, 7(7), e1000316. https://doi.org/10.1371/journal.pmed.1000316
4. Russell, D., Peplau, L. A., & Cutrona, C. E. (1980). The revised UCLA Loneliness Scale: Concurrent and discriminant validity evidence. Journal of Personality and Social Psychology, 39(3), 472-480.
5. Berkman, L. F., & Syme, S. L. (1979). Social networks, host resistance, and mortality: A nine-year follow-up of Alameda County residents. American Journal of Epidemiology, 109, 186–204.