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February 2018
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Adding Life to Years
by Dr. Larry Weiss
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Elder Loneliness is Linked to Death and Disability 

Dr. Lawrence J. Weiss
Larry Weiss

Loneliness is a complex and usually unpleasant emotional response to isolation. It is also a very common, though normally temporary, consequence of a breakup, divorce, or loss of any important long-term relationship. In these cases, it may stem both from the loss of a specific person and from the withdrawal from social circles caused by the event or the associated sadness. It typically includes anxious feelings about a lack of connection or communication with others, both in the present and the future. As such, loneliness can be felt even when surrounded by other people. The causes of loneliness are varied and include social, mental, emotional and physical factors. I hate to think of anyone being lonely. But I’ve generally considered loneliness a sad, temporary situation, not a serious threat to a person’s health. However, studies suggest that, among older people, feeling lonely may substantially impair their day-to-day ability to function and even increase risk of death.

It has been estimated that approximately 20 percent of the total U.S. population feel lonely. In the UK research shows half a million people more than 60-years-old spend each day alone without social interaction and almost half a million more see and speak to no one for 5 or 6 days a week. Chronic loneliness can be a serious, life-threatening health condition. It has been found to be associated with an increased risk of stroke and cardiovascular disease. Loneliness shows an increased incidence of high blood pressure, high cholesterol, and obesity. Loneliness is shown to cause anxiety, depression, digestive problems, heart disease, sleep problems, and weight gain.

Loneliness appears to have intensified in every society in the world as modernization occurs. The amount of this loneliness appears to be related to greater migration, smaller household sizes, a larger degree of media and internet consumption, among other issues. Loneliness has shown the largest increases among seniors and people living in low-density areas. Seniors living in suburban areas are particularly vulnerable, for as they lose the ability to drive, they often become "stranded" and find it difficult to maintain interpersonal relationships. The UK Prime Minister has even appointed a "Minister for Loneliness" in a drive to tackle social isolation in Briton, a problem for 9 million in their country.

Back in 2012 researchers at University of California, San Francisco analyzed data from the National Institute on Aging’s Health and Retirement Study for 1,064 people ages 60 and up. In addition to information about their physical health and medical conditions, socioeconomic status, living conditions and such factors as depression, they looked at the answers given to three questions about loneliness: how often do you feel left out, feel isolated or lack companionship. People were deemed lonely if they responded "some of the time" or "often" to any of those questions; they were considered not lonely if they responded "hardly ever" to all three.

The results were that 43 percent of those surveyed were deemed lonely. After controlling for confounding factors (including depression), loneliness was associated with a nearly 60 percent increased risk of functional decline (loss of ability to perform everyday tasks such as bathing and feeding themselves, climbing stairs, walking, etc.) during the sixyear follow-up period than the folks who were not deemed lonely. Loneliness was linked to a 45 percent higher risk of dying during the follow-up period. Those findings are even more impactful given that just 18 percent of the people surveyed lived alone – and nearly 75 percent were married.

The authors note that physicians don’t typically ask their patients whether they feel lonely and acknowledge that making such a conversation a routine part of a checkup would add yet another burden on already time-strapped doctors. But they still argue in favor of instituting loneliness screening because their findings were so dramatic. I ask you, have you ever been asked about loneliness from your medical doctor?

Clearly loneliness impacts a number of serious physical and mental health outcomes. Additional studies have demonstrated that in middleaged and elders loneliness is associated with increased mortality, blood pressure, reduced physical activity, and depression. Loneliness also affects cognitive function and increases the risk of developing latelife dementia. At the cognitive level, perceived isolation diminishes executive function and might lead to a lack of engagement in sensory and cognitively stimulating activities (e.g., playing games or other leisure activities). At the biological level, loneliness may cause chronic inflammation, impair immune function, and dementia.

Loneliness may also influence cognition through other mechanisms, such as cardiovascular and metabolic diseases, as well as unhealthy behaviors (e.g., physical inactivity, smoking, and sleep problems). Physical health consequences of loneliness may represent a main potential bridge between loneliness and cognitive decline.

Because cognitively impaired individuals may have difficulties in maintaining friendships, communicating with others, and participating in social and leisure activities, loneliness could also be regarded as a consequence of diminished cognition.

Given that some specific cognitive domains (i.e., executive function, verbal fluency, and memory) were significantly correlated with loneliness it is more likely that loneliness and cognition have mutual effects on each other, as does depression. In addition, because cognitive impairment may result in difficulties in decision making for effective self-management of diseases and keeping healthy lifestyles, physical health can be exacerbated by impaired cognition via increasing the severity or incidence of physical conditions. Physical disabilities due to worsened health would further limit individuals’ ability to take part in social activities and in turn cause loneliness.

Given the tremendous harmful impact that loneliness has on us, what can we do to combat it? Here are some suggestions: Talk to people, whether you like them or not; Volunteer; Attend meetups, Go to a movie; Identify the cause of your loneliness; Read a novel; Travel to a new place to explore; Exercise; Listen to music; Laugh (I have certainly talked about this previously); Learn something new, take a class; Create something new; Or think about all that you can be thankful for – Express gratitude.

Clearly we need to treat loneliness seriously and explore our own ways of "adding life to years".

Lawrence J. Weiss, Ph.D. is CEO of the Center for Healthy Aging. Dr. Weiss welcomes your comments on this column. Write to him at larry@addinglifetoyears.com or c/o Center for Healthy Aging, 11 Fillmore Way, Reno, NV 89519.