Research suggests social isolation
and feeling lonely may rival obesity as a threat to people’s health.
By Barbara Sadick ContributorSept. 6, 2018, at
9:56 a.m.
The Loneliness Effect on Public Health
Ten years ago, following the deaths of her parents and
husband, Sally Hayward moved from Florida, where she'd become increasingly
isolated and lonely, to Kenosha, Wisconsin, to be closer to her brother. He put
her to work picking up his grandchildren from school, and she began to feel
useful and connected. But as her osteoarthritis and diabetic neuropathy
worsened, she became wheelchair-bound, stopped driving and retreated to her
apartment in a complex for senior citizens with disabilities.
Hayward, who had also been diagnosed with
depression and bipolar disorder, found her mental health declining. She only
left her apartment for medical appointments, spending most days alone. She lost
her desire to do anything or meet anybody. She ate unhealthy food, rarely got
dressed, and would only collect her mail at midnight when she was certain
nobody in her building would be awake.
Then she got a lifeline.
A staffer at Kenosha Area Family and Aging
Services, an organization for which she had been volunteering, alerted Hayward
to a virtual program being launched in her community that connects older adults
around the country by phone. Modeled on Well Connected, an initiative out of
the San Francisco Bay Area, the program was
affording people like Hayward telephone access to about 75 programs including
support groups, general chat groups and various other educational subject
groups run by specially trained volunteer participants.
These days, Hayward is leading weekly
meditation and chat sessions. "Not only do I have new telephone
friends," she says, "but I no longer feel constantly sad, lonely and
useless."
Feeling sad, lonely and useless is more than
just an emotional quagmire for millions of Americans. Researchers now contend
that social isolation and loneliness may represent a greater public health
hazard than obesity or a near pack-a-day smoking habit.
And the problem is growing. An AARP loneliness
study published in 2010 and now being updated reported that approximately 42.6
million U.S. adults ages 45 and older were suffering from loneliness. A 2018 Cigna survey indicates that Generation Z,
adults between ages 18 and 22, may be the loneliest group of Americans.
Additionally, census data reveal that more than one-fourth of Americans live
alone and more than half are unmarried, with marriage rates and the number of
children per household steadily declining.
It's clear that being alone and unhappy about
it "are risk factors for early illness and death that need to be discussed
more openly and for which solutions must continue to be developed," says
Lisa Marsh Ryerson, president of the AARP Foundation.
Yet unlike heart disease, physical activity
and smoking – which are national public health priorities – social isolation
and loneliness have gotten relatively short shrift in this country, says Carla
Perissinotto, a geriatrician at the University of California-San Francisco. (The U.K., by contrast, recently appointed a minister of loneliness to lead a far-reaching
initiative addressing the problem.)
"Policy in this country doesn't support
this kind of concern," Perissinotto says, "because many health care
workers believe that social factors have nothing to do with medicine."
A Social Species
So why exactly is loneliness bad for health?
Humans are a social species with an innate biological drive to connect,
explains Dolores Malaspina, professor of psychiatry, neuroscience and genetics
at the Icahn School of Medicine at Mount Sinai in New York. Human survival, she says, depends on
connectedness, with feelings of loneliness serving as a biological signal to
socialize.
But the brain's wiring for socialization can
malfunction, leading people to feel isolated and bereft. In fact, Malaspina
says, evidence shows that feelings of loneliness can begin in infancy, though
treating the resulting depression "can restore the ability to connect and
alter the brain's circuitry."
Julianne Holt-Lunstad, professor of psychology
at Brigham Young University, says no age group is
invulnerable to the effects of social isolation and loneliness. Her analysis of
existing research finds that the health toll of loneliness is stronger for
those under age 65 than for the older set, contrary to what stereotypes may
suggest.
Social media may help explain why rates of
social isolation and loneliness are climbing among youth, as popular platforms
blur the lines between appearing – and actually feeling – connected, says
Joshua M. Smyth, a researcher in the department of biobehavioral health at Pennsylvania State University.
On the other hand, social media interactions,
texts, emails and
photos
from loved ones can improve self-esteem, quality of life and feelings of
connectedness, says Amy Gonzales, assistant professor in The Media School at Indiana University–Bloomington.
Holt-Lunstad and colleagues have found that
those who are more socially connected have a 50 percent reduced risk of early
death relative to those who are less socially connected. But studies show that
meaningful, high-quality relationships have the greatest protective health
effect. (Note: A person can have few social connections and not be lonely or
have many connections and still be lonely.)
The Fix
Despite the lack of a coordinated government
response, private programs like Well Connected, which now reaches people in 38
states, are beginning to heighten awareness of and address America's loneliness
problem.
The UnLonely Project, a program led by Harvard Medical School internist Jeremy Nobel,
is evaluating the use of creative arts to help participants explore their
feelings about loneliness and bond with others by sharing their stories online
and in person. The project includes the UnLonely Film Festival, a collection of short
films that deal with loneliness and have educational components. Additionally,
the project partners with various senior centers, health systems, workplaces
and schools to offer in-person programs that have shown promise in reducing
isolation and improving health outcomes.
Hospitals and health systems may be best
positioned to make a real difference, both by shedding light on the problem and
partnering with community organizations to offer solutions, Nobel says. But to
date, few offer programs for the isolated and lonely.
One that does: CareMore Health, a health care
delivery system serving 150,000 Medicaid and Medicare patients in 10 states,
helps Anthem Medicare Advantage patients reconnect socially through referrals
to community centers and senior-focused fitness centers.
Becoming 'Unlonely'
It's important to resist the pull of inertia
and connect regularly with people who share similar interests, psychologists
stress. Social groups centered around activities, like walking clubs, exercise
classes and community choirs, for example, can make it easier to engage with
peers.
Other avenues? Schedule a time each day to
call a friend; take a class to learn something new; volunteer to deepen a sense
of purpose. Lonely children and teens can make natural connections through
school and community centers when encouraged to pursue interests such as chess,
drama, art, running and other sports, says Rockville, Maryland, psychologist Mary Alvord.
When people give in to the urge to hide away,
Alvord says, they lose the opportunity to gain encouragement and reinforcement
in the world. Planning activities – and forcing oneself to follow through – is
crucial.
Feeling connected, she says, directly affects
quality of life.
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