Loneliness: The New Health Risk

Nobody likes to feel lonely, but new research is showing that it can also be bad for your long-term health. People who are chronically lonely have been shown to experience higher rates of heart disease, diabetes, neurological disorders, and even premature death. Some common problems linked to loneliness include stress, cardiovascular disease (high blood pressure, stroke, heart attack), anxiety, depression, Alzheimer's disease or other forms of dementia, obesity, and substance use. These risks are great enough that the Surgeon General issued a recent advisory statement about loneliness as a risk to health, titled Our Epidemic of Loneliness and Isolation. The Surgeon General issues advisories when there is an "urgent public health issue" for the American people to consider and address; often these have been on mental health topics (e.g., social media and mental health, health worker burnout, or youth mental health). 

Across all age groups, 10-35% of people say that they feel lonely at least some of the time, and for up to 25% of people the loneliness is chronic. The highest rates of loneliness are reported by young adults -- e.g., in college or just out on their own -- followed by the oldest group of adults. Middle-aged and younger-old adults are the least likely to say that they often feel lonely.

The link between loneliness and health outcomes was first described in the literature in 2010, with connections established to more depression, less exercise, and presence of more chronic health conditions, among other factors. Note that there is no clear cause-and-effect, however: People with health problems may feel more lonely, and lonely people may have more health problems. Having a chronic disease can be isolating, and people with deteriorating health may become physically or mentally unable to participate in group activities that they have enjoyed in the past. Serious illness is also associated with taking on the "sick role," a socially recognizable pattern of inactivity and passivity in which people might be less interested in interpersonal interactions and other people may be less likely to invite them to participate in things. On the other hand, some possible ways in which lonely feelings might have an effect on physical health are by way of poor diet, inactivity, disrupted sleep, or mental health problems. People with high levels of loneliness have up to 25% more early mortality, some but not all of which is related to suicide. The rest is due to physical ailments, including higher than average rates of heart disease, hypertension, stroke, and lung disease among lonely older adults.

Despite the uncertainty about causal directions, the Surgeon General's advisory statement notes at least three potential pathways by which loneliness might have a prospective effect on health outcomes:

• A biological pathway, where loneliness increases stress hormone levels, triggers an inflammatory response, and/or leads to greater expression of genes that regulate physiological processes linked to obesity or diabetes;
• A psychological pathway, where loneliness affects people's sense of safety, hope about the future, stress levels, or ability to be resilient in the face of stressors;
• And a behavioral pathway, where loneliness might affect health behaviors like sleep, smoking, unhealthy eating, sedentary living, or medication nonadherence, all of which can contribute to the development and progression of chronic diseases.

These factors can of course co-occur, and some of them might lead to others. Lonely older adults who are also homebound appear to be at particularly high risk for negative health outcomes. This might also suggest that some of the effect of loneliness on health is due to a lack of instrumental social support among older adults with no one to rely on for help completing everyday tasks or coping with emerging health conditions.

What can be done about the problem of loneliness? The Surgeon General suggests working to improve community connection through shifts in policy, building community-level infrastructure, and changing American culture to emphasize social connectedness rather than rugged individualism. This is clearly a tall order! On a more limited scale, nursing researchers have piloted interventions to help rural older adults develop social connections through problem-solving skills and storytelling. The intervention produced benefits for participants' physical health and immunological functioning, along with their mental health and quality of life. And locally at the University of Colorado, some of my nursing colleagues piloted a telehealth program to connect older adults with students in nursing, medicine, and pharmacy; the students themselves benefitted from a better understanding of aging and increased empathy with their patients, while the older adult participants likely benefitted from the social interactions. 

Feelings of loneliness may be particularly acute for many older adults over the holidays. As the U.S. population continues to age over time, health problems associated with loneliness may become more acute. It's important to take steps now to address this issue, not just for mental health reasons but for physical health promotion and chronic disease management as well.