Understanding and Reducing Loneliness

Loneliness is feeling

You can avoid loneliness with social connections

Loneliness refers to the discrepancy between expected and actual social relationships. Loneliness is a subjective feeling, while social isolation reflects to objective scarcity or absence of members of a social network. While similar, loneliness and social isolation can lead to different poor health outcomes.

The popular media often portray American adults as getting lonelier. Is this really true? Researchers used data from the National Social Life and Aging Project and the Health and Retirement Study for US adults over age 50 during the period 2005-2016 and found otherwise. Plus, adults from a younger cohort (born from 1948-1963) did not report greater loneliness compared to adults from an older cohort (born from 1920-1947). Increased transportation and communication options available to members of the younger cohort may have offset increased individualism with respect to risk of loneliness. For both cohorts, loneliness decreased from age 50 to about age 76 after which loneliness increased. The increase in loneliness after age 76 may reflect decreases in health and loss of a spouse or partner. Higher self-rated health, living with a spouse or partner (versus living alone), and larger numbers of close family members all predicted lower risk of loneliness. Decline in cognitive function and a greater number of comorbid conditions did not predict loneliness. Adults who remain in good health, live with a spouse or partner, and who cultivate and maintain relationships with family and friends may avoid loneliness in their later years.

Loneliness is linked to adverse health outcomes including cognitive impairment and dementia. A recent study used data from 2,880 participants with an average of 62 years at baseline in the Framingham Health Study Gen 2 cohort. Researchers found that persistent loneliness independently predicted increased risk of dementia and Alzheimer’s disease. During examinations 6 and 7, loneliness was evaluated with one item, “I felt lonely during the past week.” For yes answers, participants were asked how many days they felt lonely during that week. Categories of loneliness included: 1) No loneliness, 2) transient loneliness (reported loneliness at exam 6 but not at 7), 3) incident loneliness (loneliness reported at exam 7 but not at 6), and 4) persistent loneliness (loneliness reported at both exams 6 and 7). Follow-up lasted for an average of 15 years during which time 218 participants developed dementia (of which 177 were Alzheimer’s disease).

Compared to participants with no loneliness, those with persistent loneliness had higher risk of developing dementia (13.4 vs. 7.5 percent) or Alzheimer’s disease (10.6 vs. 6.0 percent). After adjusting for confounding factors, analyses showed that having persistent loneliness predicted 76 percent high risk of developing dementia / Alzheimer’s disease compared to having no loneliness. Curiously, transient loneliness, compared to no loneliness, predicted significantly lower risk of dementia. Perhaps temporary loneliness promoted mental resilience that included greater physical and social integration and engagement. Overall, loneliness may be an independent and modifiable risk factor for dementia and Alzheimer’s disease.

Loneliness can compromise the health of older people. Recent reviews have included mostly studies with cross-sectional designs, yielding relatively weak evidence. A new review included only longitudinal studies (N=34) of participants over age 60 at baseline. The authors of the review commented that the available evidence was broad but weak. Nevertheless, they found relatively good evidence that the following five risk factors predict increased likelihood of loneliness developing during follow-up. They included: 1) not being married/partnered and partner loss, 2) a limited social network, 3) a low level of social activity, 4) poor self-perceived health, and 5) depression/depressed mood and an increase in depression. Presumably different intervention strategies will be required to address the individual risk factors.

Loneliness and social isolation predict a number of adverse health and well-being outcomes. Researchers have developed interventions reduce loneliness and/or social isolation. A recent integrative review of 39 studies found that most interventions had some success in reducing loneliness or social isolation. However, these studies often had low methodological quality. The review identified thee aspects of apparently successful interventions: 1) flexibility to address local concerns and interests, 2) including program users in the design and implementation of the intervention, and 3) engagement in productive activities. Unlike some previous reviews, this review did not find group-based interventions to be superior to individual-based interventions.

A more recent review concluded that interventions to reduce loneliness are largely unsuccessful. The authors identified two causes: 1) loneliness is a multi-dimensional construct, and 2) lack of targeting lonely individuals’ needs and contexts. More specifically, loneliness has several dimensions, for example, emotional and social, which require different inerventions. Different people have varying levels of openness to consider an intervention to reduce their loneliness and differing levels of motivation to stick with the program. The recommended approach to developing loneliness interventions features precision health that involves the right solution (one or more specific intervention techniques), the right person (available personal resources), and the right time (life stage, prior to onset of cognitive and other health impairments).

Chronic loneliness predicts increased risks for developing depression, cognitive impairment, dementia, Alzheimer’s disease, and all-cause mortality. A new study  expands on the concept of loneliness with a Social Relationship Framework that includes six aspects relevant to older adults. These aspects include 1) availability of social contacts, 2) receiving care and support, 3) intimacy and understanding, 4) enjoyment and shared interests, 5) generativity and contribution, and 6) being respected and valued. Ideally, older adults would not experience loneliness if they have the ability and the social and environmental contexts that provide all six aspects in their daily lives. Thus, interventions that help older adults experience the above six aspects would help them avoid chronic loneliness, with potentially major positive personal and public health benefits. Embrace the healthy lifestyle choice, Cultivate Social Connections, to reduce your risk of loneliness and dementia.

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