The study appeared this month in the Archives of Internal Medicine and focused on a specific population: adults over the age of 60. As study participants were tracked over six years, those who self-reported feelings of loneliness were more likely to experience “functional decline” – i.e. decreased mobility, difficulty with activities of daily living and so on – and also died sooner.
The study piggybacks on another piece of research, also published this week in the Archives of Internal Medicine, that found increased mortality among adults who had heart disease or were at high risk of heart disease and who lived alone.
So does this mean loneliness is a threat to health? Some of the headlines have been blunt in concluding this – “Being lonely can kill you, studies say”; “The grim impact of loneliness and living alone,” to name a few.
But it’s not that clear-cut. Moreover, the studies don’t really explain why there would be an association between loneliness/being alone and decreased lifespan. Are these people depressed, hence not taking care of themselves? Is there no one looking out for their well-being, reminding them to take medications, advocating on their behalf at doctor visits, and so on? Does loneliness have a direct and as-yet undetermined effect on the immune system or the aging process?
There’s a difference between living alone and being lonely. In the study that looked at loneliness as a predictor of poorer health as people age, the authors draw this distinction: “Loneliness is the subjective feeling of isolation, not belonging, or lacking companionship… It is possible for persons who live alone to not feel lonely, while some who are married or living with others will still experience loneliness.”
In fact, the majority of the study participants who reported feeling lonely did not live alone. And most of those who said they were lonely were not depressed.
Given the growing number of Americans who live alone (27 percent of all U.S. households, according to the latest census), this is an area that seems ripe for study.
A number of previous studies have explored the whole issue of social connectedness and whether it has a positive influence on health. The findings have been rather intriguing: Church-going has been linked to better health, as has social support in the form of friendships and regular contact with other human beings. Matrimony seems to be beneficial too, although the benefit is strongest for men and less so for women.
But is this because relationships and social engagement have a direct effect on how healthy we are? It could easily be argued that the people who are socially active and go to church every Sunday are simply healthier to begin with and hence more able to engage in social activities. Conversely, functional decline associated with social isolation among older adults could be a cause rather than an effect; perhaps as people decline, they’re less able to mingle with the rest of the world and are more likely to become socially isolated.
It would also be interesting to know how much of this is tied up in what seems to be an American bias in favor of extroversion and youth. Do we expect people to want and seek out companionship and look for negatives when they don’t measure up? Do we assume loneliness and aging go hand in hand?
Teasing out exactly what’s going on here will probably take much more study. Feeling lonely vs. living alone might be two separate issues with dynamics that need to be considered in different ways. How we perceive purpose and connectedness may matter too; someone who seems to be alone might not feel lonely and might in fact be leading a rich existence that derives meaning from other sources – for instance, the arts, or pets or the outdoors.
The real message may be that psychosocial health deserves far more attention than it often receives.
Last year I wrote a story about a survey conducted by Home Instead Senior Care to identify mealtime challenges for older adults. So what was at the top of the list? The expected answer might have been the practicalities of preparing a meal, or access to fresh fruits and vegetables, or the affordability of quality food. But nope, it wasn’t any of these – what the folks who participated in this survey wanted most was companionship at mealtimes. And this was borne out when I went out and actually talked to some older adults who’d had experience both with living alone and with living in an assisted living facility where they had meals together. Virtually all of them preferred eating with someone else for company.
In the medical setting, these things tend to be assessed briefly or not at all. And indeed, primary care doctors often are so pressed to manage the medical aspects of the patient’s care that they may not have time to ask patients if they’re lonely.
But as the authors of the Archives of Internal Medicine study point out, loneliness for many older people “may be more distressing than their medical diagnoses.” With referral to the right kind of intervention, it might help slow or delay a decline in health for higher-risk individuals, the authors suggest.
Ask patients if they’re lonely, the authors urge. “Ultimately, by asking about psychosocial concerns important to patients, our treatment focus may shift, and we will likely enhance the physician-patient relationship. By identifying loneliness we will be better able to target interventions intended to prevent functional decline and disability.”