The
potentially harmful effects of loneliness and social isolation on
health and longevity, especially among older adults, are well
established. For example, in 2013 it was reported based on a research finding that loneliness can impair health
by raising levels of stress hormones and inflammation, which in turn
can increase the risk of heart disease, arthritis, Type 2 diabetes,
dementia and even suicide attempts.
Among
older people who reported they felt left out, isolated or lacked
companionship, the ability to perform daily activities like bathing,
grooming and preparing meals declined and deaths increased over a six-year study period
relative to people who reported none of these feelings. Writing for The
New York Times’s department The Upshot last December, Dr. Dhruv
Khullar, a physician and researcher at Weill Cornell Medicine in New
York, cited evidence for disrupted sleep, abnormal immune responses and
accelerated cognitive decline among socially isolated individuals, which
he called “a growing epidemic.”
As
research moves forward on these topics, scientists are gaining a more
refined understanding of the effects of loneliness and isolation on
health. They are also looking into factors such as who is likely to be
most seriously affected, and what kinds of interventions may reduce the
associated risks.
There are some
surprising findings. First, though equivalent in risk, loneliness and
social isolation don’t necessarily go hand-in-hand, Julianne
Holt-Lunstad and Timothy B. Smith, psychologist-researchers at Brigham
Young University, have pointed out.
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“Social
isolation denotes few social connections or interactions, whereas
loneliness involves the subjective perception of isolation — the
discrepancy between one’s desired and actual level of social
connection,” they wrote in the journal Heart last year.
In
other words, people can be socially isolated and not feel lonely; they
simply prefer a more hermitic existence. Likewise, people can feel
lonely even when surrounded by lots of people, especially if the
relationships are not emotionally rewarding. In fact, Dr. Carla
Perissinotto and colleagues at the University of California at San
Francisco reported in 2012 that most lonely individuals are married, live with others and are not clinically depressed.
“Being
unmarried is a significant risk,” Dr. Holt-Lunstad said, “but not all
marriages are happy ones. We have to consider the quality of
relationships, not simply their existence or quantity.”
As
Dr. Nancy J. Donovan, a geriatric psychiatrist and researcher in
neurology at Brigham and Women’s Hospital in Boston, said in an
interview, “There is a correlation between loneliness and social
interaction, but not in everyone. It may be simplistic to suggest to
people who are lonely that they should try to interact more with
others.”
Perhaps equally surprising
is the finding that older adults are not necessarily the loneliest among
us. Although most studies of the effects of loneliness have looked only
at older people, Dr. Holt-Lunstad, who with colleagues has analyzed 70 studies
encompassing 3.4 million people, said that the prevalence of loneliness
peaks in adolescents and young adults, then again in the oldest old.
According
to Louise Hawkley, senior research scientist at the National Opinion
Research Center at the University of Chicago, “If anything, the
intensity of loneliness decreases from young adulthood through middle
age and doesn’t become intense again until the oldest old age.” Only 30
percent of older adults feel lonely fairly often, according to data from
the National Social Life, Health and Aging Project.
“We
found stronger risks for those under 65 than for those over 65,” Dr.
Holt-Lunstad said. “Older adults should not be the sole focus of the
effects of loneliness and social isolation. We need to address this for
all ages.”
Furthermore, she said,
while it is not certain whether loneliness or social isolation has the
stronger effect on health and longevity, “if we recognize social
connections as a fundamental human need, then we can’t discount the
risks of being socially isolated even if people don’t feel lonely.”
Equally
intriguing is a recent finding suggesting that loneliness may be a
preclinical sign for Alzheimer’s disease. Using data from the Harvard
Aging Brain Study of 79 cognitively normal adults living in the
community, Dr. Donovan and colleagues found a link
between the participants’ score on a three-question assessment for
loneliness and the amount of amyloid in their brains. Amyloid
accumulation is considered a main pathological sign of Alzheimer’s
disease.
In this study, loneliness
was not associated with the extent of people’s social network or social
activity or even with their socioeconomic status. However, in another study
of adults 50 and older, published earlier this year in the
International Journal of Geriatric Psychiatry, Dr. Donovan and
co-authors reported that loneliness was linked to worsening cognitive
function over a 12-year period, whereas initially poor cognitive
function did not lead to increased loneliness.
When
the researchers examined their findings more closely, they discovered
that depression, even relatively mild depression, had a greater effect
than loneliness on the risk of cognitive decline.
“There
is now strong evidence relating greater depressive symptoms to
increased progression from normal cognition to mild cognitive impairment
and from mild cognitive impairment to dementia,” Dr. Donovan and
colleagues reported, citing their findings and those of others. They
suggested that loneliness as well as low-grade and more serious
depression may have similar pathological effects on the brain.
All of which raises the question of how
loneliness and social isolation might be countered to help ward off
cognitive decline and other adverse health effects.
Suggestions
for lonely or socially isolated adults have included taking a class,
getting a dog, doing volunteer work, joining a club and many more.
#Credit: #nytimes
