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Loneliness a Common Health Threat for Older Adults

May 02, 2019

By Carolyn Crist

Loneliness is strongly linked to poor health and risk of death in older adults, but doctors can play an important role in identifying and addressing the problem, researchers say.

In the journal CMAJ April 29, geriatrics experts outline "five things to know" about loneliness in older adults and a three-item questionnaire that physicians can use to get patients talking about how they feel.

"Loneliness is a public health issue that impacts older people from many different perspectives, making it an important cross-cutting issue," said co-author Dr. Paula Rochon of the University of Toronto.

"Loneliness is not something that can be cured by a pill," she told Reuters Health by email. "It is important we investigate different strategies to address this public health issue."

In their article, Rochon and her colleagues emphasize that loneliness is an emotional state of perceived social isolation. It's not a classified disease or mental disorder, and it's separate from other mental states such as anxiety and depression. But it can lead to feelings of desperation, boredom, self-deprecation, hopelessness and a negative attitude toward self and others.

Loneliness is common among older adults and linked to declines in health, the authors note. Past research has tied it to accelerated physiological aging, high blood pressure, heart disease, stroke, heart attack, depression and dementia.

In fact, loneliness can be as harmful to health as other risk factors like smoking or obesity, they write. A 2015 analysis of data from 70 studies with a total of 3.5 million participants linked loneliness to a 26 percent increase in risk of death by all causes. In older adults, the risk increase was 45 percent.

Loneliness is also a large contributor to healthcare use, the authors note. Older adults often seek social contact through healthcare visits, which can boost health spending. In one study, more than 75 percent of general practice doctors in the UK reported seeing one to five patients per day who visited simply because they were lonely.

Although doctors cannot treat loneliness with medication, one solution could be so called social prescribing. Health workers can "prescribe" community resources for social support, such as volunteering, visiting a local museum or art gallery, or joining a home-visiting service.

It's important, though, not to make assumptions about who is lonely, Rochon cautioned. Most adults who identify as lonely live with others, and more than 60 percent are married, she said.

To assess loneliness, she recommends using the Three-Item Loneliness Scale, which asks people: "How often do you feel that you lack companionship?" "How often do you feel left out?" and "How often do you feel isolated from others?"

If patients respond "some of the time" or "often" to two or more questions, they may be considered lonely.

Events that occur later in life can make loneliness particularly potent, especially widowhood, retirement, chronic illness and loss of mobility, said Joanna McHugh Power, a lecturer in psychology at the National College of Ireland in Dublin, who wasn't involved in the article.

"One can feel lonely in the middle of a crowd, even when deeply embedded in their family or community," McHugh said in an email.

Plus, loneliness is a subjective experience that doesn't necessarily match the outward appearance of social isolation, she added. Those who are lonely but socially well-connected face the highest risk for negative health outcomes.

"One of the major issues is that loneliness can be stigmatized and isn't recognized as the holistic problem it is, with effects on physical, mental, emotional and spiritual health," said Dr. Charlotte Jones of the University of British Columbia in Vancouver.

Jones, who wasn't involved with the CMAJ article, created a Walk 'N' Talk For Your Life program in Kelowna, Canada, that encourages older adults to meet with nursing students for socialization, physical activity and health education.

"We should all recognize and acknowledge loneliness in ourselves and around us," she said in a phone interview. "If we raise awareness, then we can help others."


CMAJ 2019.

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