Daily routine brings with it a quiet loneliness for the elderly, and the holiday season sharpens it further. From neighboring apartments come the sounds of gathering families, while in the homes of many elderly people, the solitude is felt all the more intensely. According to the CBS Social Survey, about a quarter of those aged 65 and older in Israel (26%) feel lonely often or sometimes. Beyond personal distress, this loneliness also carries a heavy financial price tag. At the end of 2023, approximately 1.25 million people aged 65 and older lived in Israel, and according to CBS forecasts, their number is expected to rise to about 2.1 million by 2045.
How much money is involved? In the US, researchers from AARP and Stanford University examined Medicare spending on 5,270 insured individuals over age 65. For every insured person with a sparse social network, the federal program spent about $1,608 per year. About 14% of insured individuals belong to this group, roughly four million people, totaling approximately $6.7 billion annually. The excess cost stems mainly from hospitalizations and stays in nursing care facilities.
This is not the only figure.
In Spain, researchers estimated the cost of unwanted loneliness at approximately 14 billion euros in 2021, about 1.2% of GDP. Of this, about 6.1 billion euros consist of direct healthcare expenses, mainly due to more frequent doctor visits and higher medication consumption.
"This is an acute issue that is often pushed to the margins of headlines, but it holds great significance. The coming decades will be characterized by a continued rise in life expectancy, and the number of senior citizens is expected to grow significantly, making it our duty as a state and a society to prepare strategically," notes Lior Strassberg, CEO of Matav, Israel's largest organization in nursing care for senior citizens.
The hidden health cost of loneliness
When examining what loneliness does to the body, it becomes clear how urgent this preparation is. Behind the heavy financial cost lies actual physiological deterioration. Social isolation is not merely emotional distress; it is a clinical risk factor that accelerates a series of chronic illnesses. According to the US Surgeon General, poor social connections increase the risk of heart disease by 29% and the risk of stroke by 32%. Among older adults, the risk of dementia and cognitive decline surges by about 50%. The damage does not stop at the heart and brain. A meta-analysis examining data from more than one million people found that loneliness raises the risk of type 2 diabetes by 32%. Other studies link it to the development of hypertension, and the World Health Organization also warns of a surge in rates of depression and anxiety.
The damage is also evident in daily function. A British study that tracked about 2,800 people aged 60 and older found that loneliness predicts physical frailty four years later. An American study including more than 14,000 elderly individuals found that within six years, it translates into material difficulties in mobility and performing routine activities. Each of these diseases carries a heavy price tag. In Israel, excess healthcare spending on diabetes patients was estimated at about NIS 3.5 billion annually (2013 figures). Strokes cost the economy about NIS 2.3 billion per year (2018 estimate). As data from the US indicates, a significant portion of the excess cost of loneliness stems from hospitalizations.
The growing cost of caring for seniors
The decline in function among senior citizens has a response in the form of a nursing care benefit. When an acute or chronic illness limits an elderly person's function to the point where they can no longer operate independently, such as walking inside the home, bathing, or dressing on their own, they are defined as needing another person's assistance. This is the point where the National Insurance Institute benefit enters the picture. The benefit is granted to individuals of retirement age who meet an income test and live in their own homes or in assisted living. The primary condition is substantial dependency on the assistance of others in daily activities, such as dressing, bathing, eating, and moving around the house. It is also granted to those who require constant supervision when their condition places them in danger. The level of dependency is determined by an evaluator on behalf of the National Insurance Institute.
Public spending on the benefit has grown significantly in recent years, partly following the 2018 nursing care reform that expanded the circle of eligible recipients. According to the State Comptroller's report, it rose from about NIS 7 billion in 2018 to about NIS 21 billion in 2025. The number of eligible individuals grew from about 180,000 prior to the reform to about 392,000, and their proportion among all individuals of retirement age nearly doubled, from about 16% to about 30%.
"Behind these numbers stand senior citizens who need help to perform the most basic actions," says Strassberg. According to him, assistance within the framework of the nursing care benefit also carries significant additional value, as it provides a meaningful response to coping with loneliness. "The personal bond formed between the caregiver and the patient in working with the elderly, along with her regular presence in the home, is no less important than physical help," he says. "It provides security, companionship, and the feeling that someone sees and cares." Matav, he adds, provides a variety of additional services addressing loneliness, such as day centers, supportive communities, and social clubs, and also operates projects aimed at alleviating loneliness through volunteers who visit for conversation and leisure activities with senior citizens.
Loneliness is also rising on the international agenda. According to the World Health Organization, eight high-income countries have already adopted national policies to strengthen social connection. Three principles recur in most of them: Involvement of all of society rather than a single government ministry, strengthening the research foundation, and cross-sector cooperation. In May 2025, the World Health Assembly passed a first-of-its-kind resolution on the matter. The resolution calls on countries to develop evidence-based policies, programs, and strategies, raise awareness, and promote social connection for physical and mental health. At the same assembly, the organization launched the "Knot Alone" campaign. A month later, a committee of the organization published a global report showing that one in six people experiences loneliness, and it is linked to approximately 871,000 deaths annually. Following the report, the organization called on all countries to make social connection a public health priority.
The number of senior citizens in Israel will continue to grow in the coming decades, and their social connection is part of the preparation for this shift. This is not only a matter of personal welfare, nor merely the fulfillment of the commandment "Do not cast me off in old age." It is also an economic calculation, and the state stands to benefit from it.