Loneliness is a common emotion when someone feels alone, separated from others or unsupported and distressed. It’s often transient. But loneliness that becomes persistent causes accelerated aging with multiple health consequences, including conditions that lead to death. Studies, including one published in March by Brigham Young University researchers, suggest that loneliness, isolation and living alone can be as threatening to health as cigarettes, excess alcohol and obesity.
The danger of loneliness is especially acute in later life when social resources decline and illness accumulates, which can have an impact on independence. The simple reality from birth to old age is that we need one another to regulate not only our emotions but our bodies as well. Not all people who live alone will describe themselves as lonely. But when living alone leads to social isolation there are health consequences.
The Emotional Impact of Loneliness
On the emotional side the perception that social support is inadequate is associated with depression, which, if severe and untreated, is associated with increasing disability, loss of weight, disturbed sleep and thoughts of suicide or actual suicide. Loneliness can also lead to a self-defeating sense of hopelessness and helplessness that can perpetuate isolation. It can become a vicious, unrelenting cycle.
The Physiological Effects of Loneliness
Loneliness is also associated with problematic changes in the cardiovascular, hormonal and immune systems. The result is a chronic counterproductive inflammatory state which damages the heart, reduces one’s capacity to resist infection and promotes loss of bone and muscle. Loneliness is also associated with frailty, a condition of old age when independence is minimized and vulnerability approaches its maximum.
Social isolation results in a lack of opportunities for social engagement and mental stimulation, activities that are thought to keep the brain in good condition and reduce the risk of dementia. Obviously, declining health and loss of independence can be the cause rather than the effect of loneliness and isolation. But for decades the health status of older adults has improved just as the number of seniors living alone has increased fivefold. The scientific term for this phenomenon in which an increasing percentage of older adults have experienced an increase in the active life span is “compression of morbidity”. This means that the period of disability in old age is being compressed to the end of the life span. And the majority of those living alone have learned to optimize the social resources they have left. Nonetheless the absolute number of persons living alone means an increase in the number of those vulnerable to loneliness, social isolation and their undesired effect on health. As a result, loneliness, social isolation and living alone are a greater threat to health and well-being than the other way around.
Loosening the Grip of Loneliness: Engagement vs. Isolation
If this is true—and the evidence is compelling—what should older adults, their family members and their communities do to combat loneliness? For the individual, feelings of loneliness can serve as motivation to get connected or reconnected and to find an environment that offers opportunities for contact, for stimulation, for belonging. If one’s social network has shrunk due to death, geographic changes or “lost contact,” one should take greater advantage of the members who remain. One cannot maximize the network but it can be optimized. The computer can be a means of maintaining contact through Skype, email and video conferencing with friends and family. However, the blessing and curse of computer socialization is that it is sedentary and largely home-bound.
Enlisting friends and older neighbors in a walking group can provide both social contact and safe exercise. For younger persons living in apartments or neighborhoods, reaching out to an older adult around holidays or if the person has not been seen for a while takes little time but can be quite rewarding for both parties. For the older person living alone, an independent-living or assisted-living apartment also provides opportunities for new relationships, for shared meals, for group activities. The key element is to take action, which is better than an antidepressant to lessen the stress of loneliness. But for persons who have grown hopeless, pessimistic and negativistic, their lack of ability to act may be the result of a depressive illness that would benefit from counseling, psychotherapy and perhaps medication.
Family Members: Look for the Early Signs
For families it is also important to recognize the warning signs and act when a member is at risk of isolation. Here are three things a family member can do:
- Make an effort to include the person in family events, which will be well worth the extra effort to arrange for transportation.
- Schedule a phone call or videoconference on a regular basis rather than leaving the contact to chance.
- Recruit other family members to do the same. Some older people avoid making the call for fear that they will be perceived as a burden, interfering with the younger relatives’ busy lives.
Easing Loneliness: It’s Everyone’s Responsibility
Countering the health and social costs of loneliness and isolation must be seen as a community responsibility. Any person living alone could be at risk for loneliness—but those who are in their 80s or older are especially vulnerable. Religious institutions may be the most widespread source of social support for older adults and should continue to treat older members as congregants even when they can no longer attend services. This is especially the case following bereavement.
Transportation and home-care health programs are critical to reducing isolation and promoting social contact. We also need more peer-to-peer support programs to promote the sense of older adults taking care of one another. Affordable independent-living and assisted-living options are also important as social policy to reduce isolation and its negative health consequences. Loneliness and social isolation among older adults are among the best examples of why social policy and health policy cannot be separated in later life.
It is a cliché to say that what we put in place for older adults today will serve us tomorrow. In actuality, lessening the risk of loneliness and isolation for older adults today is one of the best ways to prepare for old age tomorrow.
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Nice post! One question: do you think the negative health effects of loneliness are independent of depression, or are most of the effects mediated by depression (which has been linked to obesity, diabetes, etc.)?
“… accelerated aging with multiple health consequences, including conditions that lead to death …” May I suggest that loneliness is “in the eyes of the beholder” too. I knew a “senior” when I was young who engaged in long-distance correspondence chess, i.e. he wrote letters back and forth to remote corners of the world to play chess with people he likely never met before nor ever would. He had a few chess boards for each ongoing game set up on a sideboard and received a letter with the next move, then sent his chosen move back etc. That obviously went on for years yet to everyone else he seemed like a staunch recluse. So my suspicion is that it is an inner mechanism that makes people lonely (or not). Some Tibetan monks sit in a walled-up dark cave for decades, being fed through a small hole in the ceiling, and never feel lonely nor meet an early death. So maybe the seeds for this are planted in early childhood and not something that “happens” to one person later and not to another?