We are social creatures and our connection to others enables us to survive and thrive. However, as
we age, many of us are alone more often than when we were younger, leaving us vulnerable to social
isolation and loneliness. Social isolation and loneliness do not always go together. About 28 percent o
older adults in the United States live alone, but many of them are not lonely or socially isolated.1 Some
people feel lonely despite being surrounded by family and friends. The late John T. Cacioppo, PhD,
former neuroscientist at the University of Chicago, collaborated with his wife, Dr. Stephanie Cacioppo
and was known for the Cacioppo Evolutionary Theory of Loneliness. Dr. J. Cacioppo wrote that
loneliness is the discrepancy between what you want from your relationships and what you actually
have. Older adults can be isolated but not lonely, and feel lonely even though they are not isolated.
Research shows that social isolation and loneliness impact health and mortality at the same
magnitude as high blood pressure, obesity, and smoking.2 Researchers affirm that loneliness is more dangerous to our health than obesity; it’s the equivalent of smoking 15 cigarettes a day.3 Fortunately, there are ways to counteract these negative effects.
However, throw the covid-19 pandemic unprecedented social and physical restrictions into the mixand we have the perfect “Catch 22” conundrum. (A catch-22 is a paradoxical situation from which an individual cannot escape because of contradictory rules or limitations. The term was coined by Joseph Heller, who used it in his 1961 novel, Catch 22. Wikipedia). The physical distancing and stay at home restrictions imposed globally in response to the covid-19 pandemic have proved effective. However, we must pay attention to the potential harms and strive together to mitigate the impacts of social isolation on our most vulnerable populations. As Dr. S. Cacioppo says, “As a social species, we are accountable to help our lonely children, parents, neighbors, and even strangers in the same way we would treat ourselves. Treating loneliness is our collective responsibility.” 4
Understanding the health and lifestyle effects of social isolation and loneliness will help us develop
strategies to counteract them while adhering to covid-19 precautions.
- Immune System: Loneliness may alter the immune system to promote inflammation, which is
necessary to help our body heal from injury, but inflammation that lasts too long increases the
risk of chronic diseases. People who feel lonely may have weakened immune cells and may
have trouble fighting off viruses, which makes them even more vulnerable to some infectious
diseases. Loneliness can accelerate the buildup of plaque in arteries, help cancer cells grow
and spread. It can promote different types of wear and tear on the body. Loneliness can
stimulate the white blood cell inflammatory response, which feeds back to the brain and makes
us irritable, suspicious, prone to negative emotions and fearful of making new friends.
Loneliness is also associated with disrupted sleep, which can affect immune function, glucose
regulation, cardiovascular risk, dementia risk, mood and daytime function (Louise Hawkley et al.,
2010).
The National Institute on Aging-supported research shows that having a sense of mission and
purpose in life is linked to healthier immune cells. - Physical Activity: Social Isolation is associated with morbidity from chronic disease and higher
all-cause mortality. Smoking, reduced physical activity, and increased sedentary time play a
role in increased risk of disease. It is recommended that older adults have 150 minutes of
moderate intensity aerobic activity, or 75 minutes of vigorous intensity activity each week.
Weight-bearing activities and punctuating sedentary time with light activity are recommended. Even activity durations below this are associated with 22% reduction in all cause mortality, improvement in functional ability, and reduced risk of falls. Maintaining routine physical activity is challenged during covid-19 precautions as social networks (walking with neighbors) and access to leisure facilities (like YMCA) are reduced.5 - Mental Health/Lifestyle Habits: Isolation and spending a lot of time alone puts us at risk for
unhealthy lifestyle habits: poor diet, lack of physical activity, smoking, and increased alcohol
use. The risk factor for depression is associated with poor social relationships and loneliness.
Depression can increase platelet clumping/aggregation (making our red blood cells “sticky”);
this increases our risk for heart attacks by 29 % and strokes by 32%. Investigators found that
depression increased mortality rate by 24 %. Increasing social networks and having more
friends over time showed a reduction of 29% in mortality risk per year.
Depression can be mediated through physical activity outside of the home. Enforced social
isolation during the covid-19 epidemic is different than isolation occurring in normal
circumstances. A recent rapid review of the impact of quarantine in disease outbreaks found
links to anxiety, depression and symptoms of post-traumatic stress with some evidence that
these could persist long-term. 6 Negative outcomes were associated with quarantine for over 10
days, fears relating to infection, frustration and boredom, and lack of information and supplies.
The studies were not focused on older adults and tended to involve quarantines less than three
week, well under the duration of our current covid-19 restriction measures.
Social Isolation mitigation strategies/Social Connection opportunities:
Working for a social cause or purpose with others who share your values and are trusted
partners puts us in contact with others and helps us create a greater sense of community. Ironically
covid-19 precautions and restrictions afford us the opportunity to step outside our comfort sphere
and reach out to others, even if only “virtually”. Modern technology makes it easier than ever to
communicate, stay in touch, and help out an older member of the family, neighborhood, or community.
We can teach others how to use a simple voice or video or chat applications. Persevere and make sure
you and other members of the family stay in touch as often as possible, and that you stay connected to someone you reach out to during this difficult time. Even if you cannot visit in person, the phone conversation will help someone feel better after a conversation. Keep in mind that that there will be
Social Isolation mitigation strategies/Social Connection opportunities:
Working for a social cause or purpose with others who share your values and are trusted
partners puts us in contact with others and helps us create a greater sense of community. Ironically
covid-19 precautions and restrictions afford us the opportunity to step outside our comfort sphere
and reach out to others, even if only “virtually”. Modern technology makes it easier than ever to
communicate, stay in touch, and help out an older member of the family, neighborhood, or community.
We can teach others how to use a simple voice or video or chat applications. Persevere and make sure
you and other members of the family stay in touch as often as possible, and that you stay connected to
someone you reach out to during this difficult time. Even if you cannot visit in person, the phone
conversation will help someone feel better after a conversation. Keep in mind that that there will be
issues with digital access and ease of use with 47 % of those over 75 years old who have not had social
media/internet experience.7
Interventions relying on technology to reduce isolation may be better than no intervention at all,
but they are not the same as in person visits. There is increasing evidence that pets, especially dogs and
cats, are associated with health benefits and reduced mortality. We don’t have definite evidence yet,
but it is very likely that social interventions provided at relatively modest costs will have significant cost
savings in public health. Social media and telephone contacts at the very least provide a safe, humane
approach to a common cause of suffering in older adults.8
Submitted by,
Carol Kuhn, MD
June 14. 2020
Additional resources to check out: “12 minute video: Val Walker: 400 friends and no one to call:
https://www.youtube.com/watch?v=VnHkNgTk3GM
1 Social Isolation, loneliness in older people pose risks. National Institute on Aging. April 23, 2019
2 Singer, Clifford. Health Effects of Social Isolation and Loneliness. Journal of Aging Life Care. Spring 2018
3 Darling, Lynn. Is There a Cure for Loneliness? AARP The Magazine. December 2019-January 2020
4 Social Isolation, loneliness in older people pose risks. National Institute on Aging. April 23, 2019
5 Beaney, Thomas. The effects of isolation on the physical and mental health of older adults. The British Medical
Journal. April 2020
6 Brooks SK, Webster RK. The psychological impact of quarantine and how to reduce it: rapid review of the
evidence. Lancet. March 2020
7 Beaney, Thomas. The effects of isolation on the physical and mental health of older adults. The British Medical
Journal. April 2020
8 Singer, Clifford. Health Effects of Social Isolation and Loneliness. Journal of Aging Life Care. Spring 2018
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