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Naina Limbekar, MD, MPH. Neurology

What is Loneliness and Social Isolation in the Elderly?

Loneliness and social isolation is a growing epidemic both at a national and global level. Research from the National Academies of Science, Engineering, and Medicine (NASEM) shows that about one out of every three adults aged older than 45 feels lonely and one out of every four adults over age 65 feel socially isolated. As scary as these numbers are, they are only projected to get worse over time.

As medical technology continues to advance, we expect that there will be a higher age expectancy for most of us living in developed countries. However, with aging comes living with chronic illness and this may not always equate to a good quality of life. And experiencing loneliness and social isolation can further dampen our health often leading to a dangerous vicious cycle further worsening loneliness and poor well-being.

What is the difference between loneliness and social isolation?

Most of us desire emotional and physical connection to others, this is one of the most integral parts of being human just like our needs to eat, drink, and sleep. When we feel lonely and isolated, we lose our sense of self and what it means to a community.  Most generally accepted conceptual models agree that loneliness is a negative subjective or emotional feeling that can occur even if there are other people around you. Whereas, social isolation refers to the negative effect of being objectively and physically isolated from others. Both are pretty dangerous.

Why are the elderly particularly vulnerable?

Over the past few decades, there have been many societal shifts that have led to the elderly feeling more lonely and socially isolated.  These include reduced intergenerational living, increased geographic distances between children, parents, and siblings, lack of mobility due to disability from chronic conditions, loss of loved ones,  retirement from work, lack of financial resources and transportation, and not to mention the COVID pandemic which as likely exacerbated all of these factors.

As a neurologist, most of my patients fit the elderly category and are lonely and socially isolated.  Many of them report not engaging in meaningful conversations with another human for weeks, some for even as long as a month and this was even occurring before the pandemic. Many have accepted that this is part of aging, but it doesn’t have to be, and there has been a greater call to action to address this in the medical and greater community at large as research is showing that loneliness and isolation have both tangible and significant adverse health impacts.

An elderly man socially isolated from his family

How does loneliness and social isolation impact our minds and body?

Experiencing loneliness and social isolation results in stress responses in our brain and body. This stress response activates the sympathetic nervous system, or also known as the “fight or flight response”,  which programs our bodies to increase levels of cortisol which is also known as the “stress hormone”.  When we experience loneliness and isolation for long periods of time,  we enter a state where our body loses the checks and balances needed to keep inflammation at bay. As a result, this constant state of low-grade inflammation serves as a breeding ground for the development of other diseases by causing havoc on our blood flow through the walls of our arteries coursing through our heart and rest of our body, the integrity of our brains, and the ability of our immune system to respond to threats.

Here are a few facts regarding the effects of loneliness and isolation on health:

• You are at an increased risk of dying by 26% if your experience loneliness

• Loneliness increases high blood pressure, coronary heart disease, stroke,  and is worse for you than obesity

• Loneliness is akin to smoking 15 cigarettes a day

• Loneliness and social isolation increases risks of cognitive decline and dementia

References:

Valtorta, N.K., Kanaan, M., Gilbody, S., Ronzi, S. and Hanratty, B., 2016. Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart, 102(13), pp.1009-1016.

Hawkley, L.C., Thisted, R.A., Masi, C.M. and Cacioppo, J.T., 2010. Loneliness predicts increased blood pressure: 5-year cross-lagged analyses in middle-aged and older adults. Psychology and aging, 25(1), p.132.

Holwerda, T.J., van Tilburg, T.G., Deeg, D.J., Schutter, N., Van, R., Dekker, J., Stek, M.L., Beekman, A.T. and Schoevers, R.A., 2016. Impact of loneliness and depression on mortality: results from the Longitudinal Ageing Study Amsterdam. The British Journal of Psychiatry, 209(2), pp.127-134.

Courtin, E., & Knapp, M. (2017). Social isolation, loneliness and health in old age: a scoping review. Health & social care in the community, 25(3), 799-812

Cacioppo, J.T. and Cacioppo, S., 2014. Older adults reporting social isolation or loneliness show poorer cognitive function 4 years later. Evidence-based nursing, 17(2), pp.59-60.

Cacioppo JT and Cacioppo S. The growing problem of loneliness. Lancet 2018;391(10119):426.

Cacioppo JT and Cacioppo S. Older adults reporting social isolation or loneliness show poorer cognitive function 4 years later. Evidence-Based Nursing 2014;17(2):59-60.

THE AUTHOR

Naina Limbekar MD MPH, Co-Founder and Chief Medical Officer of Reviving Mind, Sleep Neurologist, and Assistant Professor of Neurology at BUSM/BMC.

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