Loneliness can creep into your life at any age. But it's a more common problem among older adults, who can easily become isolated and detached from friends and family.
Loneliness is a subjective feeling, separate from a clinical condition like depression. But researchers are finding that loneliness is linked to serious health risks for seniors.
For some, loneliness – a feeling associated with emptiness, desolation and social disconnectedness - comes and goes. When it becomes a feeling that never leaves you, it begins to affect your health.
It may sound strange to consider that a subjective feeling has a physical manifestation. But researchers are building solid evidence that loneliness is linked to a decline in an older adult's ability to do every day activities, and may eventually lead to a premature death.
One of the most recent studies on the subject was led by Carla Perissinotto, MD, an assistant professor of medicine at the University of California – San Francisco. She found that older adults who identify as “lonely” had a 59 percent greater risk of decline and a 45 percent greater risk of death.
Dr. Perissinotto works with older adults who are still living in their homes, but may be heading towards a loss of independence. “I'm interested in trying to improve older adults' quality of life and promote independence,” she told dailyRx.
“I've been interested in understanding the other factors outside of traditional medical risk factors – those being hypertension, high blood pressure, cholesterol, and diabetes,” she said. “What other things are going to affect their health, negatively or positively?”
For her study, she used data from the Health and Retirement Study, a national survey that collected data from over 1,000 older adults. She focused in on a few questions.
“We define loneliness by asking if three questions: if they felt left out, if they felt isolated, or if they lacked companionship,” explained Dr. Perissinotto.
She was surprised by the results. “Amazingly, out of 1,604 people, 43 percent of the population reported feeling lonely,” she said.
She continued, “This is not a small number. It means that there are many around us who we don't even know are feeling lonely.”
Interestingly, being lonely didn't necessarily mean that the person was living alone. Only 18 percent of the population said they lived alone.
Dr. Perissinotto looked at how loneliness affected those people over a six year time period. Between 2002 and 2008, there was a 59 percent increased risk that a person who felt lonely would lose their ability to do activities of daily life independently, including bathing themselves, feeding themselves, and being able to go to the bathroom alone, among others.
Identifying as lonely was also a powerful predictor of death during the time of the study. There was a 45 percent greater risk of death among those who were lonely.
It's tempting to explain away these statistics as things that are likely to happen as one ages. But Dr. Perissinotto explained that she was able to link health outcomes to loneliness independently of other health risks.
“We looked at the number of chronic illnesses, age, and socioeconomic status,” she said. “When we took factors out of the equation that usually affect health, loneliness was still a strong predictor of functional decline and death.”
But how does a feeling make an impact on physical health? Other scientists, noticing the correlation between loneliness and physical decline, have studied the biological effects of loneliness on the body.
John Cacioppo, PhD, is a leading expert on loneliness. He's a social psychologist at the University of Chicago in Illinois who began his studies back in 1988, after reading one of the first papers about how social isolation increases mortality.
Like Dr. Perissinotto, Dr. Cacioppo also believes that loneliness is separate from depression or other mental health conditions. In his research, he's found that chronic loneliness has demonstrable impacts on the cardiovascular, immune, and nervous system.
One of Dr. Cacioppo's studies found that loneliness puts the body into a state of alert. Their arteries tighten, raising blood pressure and forcing the heart to work harder. Over time, loneliness wears on the cardiovascular system.
Dr. Cacioppo and his co-investigators also found that lonely people have elevated levels of stress. These can be seen in “biomarkers” in the saliva and urine.
Stress points to impacts on the nervous system. Dr. Cacioppo thinks that it is a signal for people to change their behavior in relation to their social ties. When they don't, it becomes dangerous.
In another small study, Dr. Cacioppo looked at the immune system response to loneliness. Lonely people tended to have more activity in genes that promoted inflammation and less activity in genes that stopped inflammation.
They also had less activity in genes that respond to viruses – meaning that the immune system wasn't as prepared to fight off disease. These biological findings may explain Dr. Perissonotto's dramatic results.
From a social perspective, loneliness may be at historical highs among older adults in America because the family structure is changing. Traditionally, parents and grandparents have been closer to an extended family network. Now, older relatives might live thousands of miles away from family.
“As we prepare for the silver tsunami, we have to think differently about how we care for older people,” said Dr. Perissonotto, referring to the wave of baby boomers who are now approaching these aging issues.
“The vast majority of Americans can't afford retirement facility and long term care,” she said. There are limited options for families who are trying to care for aging relatives on a limited budget.
That's why it's valuable, from a public health perspective, to keep people independent as long as possible. Taking steps towards decreasing loneliness and creating social connections is part of a healthy lifestyle choice.
So what can you do if you think someone you care about might be lonely, and how do you tell?
“If someone is refusing social engagement, not coming out of house, or looking disheveled - those could be signs of loneliness,” said Dr. Perissonotto. “It's really urging us look around us and not ignore older adults who are distressed.”
“I think people are afraid of asking these questions because they don't know what to do or what's the answer,” she continued. “Just letting someone know you are hearing them, they are not invisible and they are not alone - that can make a big difference.”
She said it is helpful to check in with family members more often and try to find ways to engage them again. There are usually community resources that can encourage social interaction – such as senior day centers, or even hotlines to put someone in touch with a listening ear.
If you are feeling lonely, Dr. Perissonotto advises that you bring it up with your physician. If they don't know how to help you, ask to be put in touch with a social worker who has a better idea of what resources are available for you.