Two recent studies published in the Archives of Internal Medicine, a journal of the American Medical Association, have found loneliness to be associated with higher risks of cardiovascular disease, loss of independence, and death.
However, the extent of association may depend upon how loneliness is measured. One study, by researchers at Harvard, found that living alone was associated with a higher risk of cardiovascular disease for age groups between 45 years and 80 years, but after age 80, in fact those living alone showed a lower incidence of cardiovascular disease — perhaps indicating that if you are living alone after age 80, you may be in better health than others your age.
The second study, by researchers at the University of California in San Francisco, suggests that feelings of loneliness are a more accurate predictor than living alone is of a person’s risk of losing independence and dying – especially for people age 60 and older. And, in fact, the study found that many who are not living alone actually report feeling lonely.
This study found that those who reported a high level of loneliness feelings showed a significantly greater disability — loss of ability to perform activities of daily living independently — and a 45% greater risk dying after six years of observation than those who did not report feeling lonely.
Both studies were published in the July 23, 2012 online issue of the Archives of Internal Medicine, a journal of the American Medical Association.
The Harvard Study — Found Living Alone Associated with Higher Risk of Cardiovascular Disease between Ages 45 and 80
In the first study, researchers at Harvard Medical School followed nearly 45,000 adults from 44 different countries, aged 45 and older. All were at risk of or had atherothrombosis (heart disease). About 19% of the participants said they lived alone.
Over four years, the researchers tracked the participants’ health, and measured incidence of cardiovascular events (heart attack, stroke or other heart-related problems), with the objective of investigating whether living alone was associated with increased mortality and cardiovascular risk.
Findings and Conclusions
The researchers found that overall those who lived alone were significantly more likely to die from heart attack, stroke or other heart-related problems during the four-year study period than those who lived with others.
However, when the findings were analyzed by age group, the study authors reported that the risk of dying was highest for people who were 45 to 65 years old and lived alone. Study participants in that age group who lived alone were 24% more likely to die during the four years of the study than those in the same age group who lived with spouses or others.
People aged 66 to 80 who lived alone had a 12% higher risk of death during the study period than participants in that age group who were living with others.
However, study participants over age 80 who were living alone were actually 8% LESS likely to die during the four year study period that those over age 80 who were not living alone.
The authors suggested that the age-related differences may be explained by other factors that typically accompany living alone at these different ages. For example, for those over age 80, living alone may actually be an indicator of stronger health and independence than others of that age who are not able to live on their own may have.
In addition, given that living alone is much less common for middle-aged people, it may be that living alone at that age may be an indicator of the potential presence of depression, stress on the job or in relationships, loneliness and a poor support system — all factors that may negatively affect health.
It may also be that those living alone are less likely to have someone to remind them to take their medications, eat properly, or get regular preventive physical exams.
This condition of living alone “should send up a little red flag that maybe this patient needs a little bit more attention,” one of the study authors, Deepak L. Bhatt, MD, MPH, who is a cardiologist at Brigham and Women’s Hospital in Boston and an associate professor at Harvard Medical School, told WebbMD.
“Maybe we need to be a little more careful that this patient really does go to fill their prescription,” or gets to regular checkups or is able to buy and eat healthy meals, Dr. Bhatt said.
The University of California Study — Found Subjective Feelings of Loneliness Among those Age 60 and Older to be Associated with Higher Risk of Disability, Loss of Independence, and Death
In the second study, Dr. Carla Perissinotto, an assistant professor of medicine at the University of California, San Francisco, and colleagues, studied 1,604 people, who had an average age of 71 years, and all of whom were over the age of 60. Fifty-nine percent were women; 81% were white, 11%, black, and 6%, Hispanic; and 18% lived alone.
In this study, the researchers measured loneliness not by whether the participants lived alone, but rather by their responses to a questionnaire designed to measure their feelings of aloneness. The questionnaire included three questions: does the participant (1) feel left out, (2) feel isolated, or (3) lack companionship. If the participants answered “often” or “some of the time” to any of those questions, they were considered lonely. If they responded “hardly ever” to all three questions, they were not considered lonely.
By this measure, 43% of the participants were classified as feeling lonely. Surprisingly, nearly 63% of those who reported loneliness were not living alone and were married or had a partner.
The researchers followed up with the participants every two years for a six-year study period. At each follow-up, the researchers evaluated the extent of any functional decline experienced by the participants. The researchers used four measures to determine extent of functional decline: (1) increased difficulty in handling the activities of daily living (ADL’s) — including ability to dress themselves, bathe, eat, walk and climb stairs, (2) difficulty in an increased number of upper extremity tasks, (3) decline in mobility, or (3) increased difficulty in stair climbing.
The researchers also noted the number of deaths among study participants that occurred during the six-year study period.
Findings and Conclusions
The researchers found that the study participants who reported feeling lonely were significantly more likely to suffer a decline in ability to function independently over the study period, according to all four of the measures used, than were their counterparts who did not report feelings of loneliness.
By the end of the six-year study period, the researchers reported, “Lonely subjects were more likely to experience decline in ADLs (24.8% vs 12.5%; adjusted risk ratio [RR], 1.59; 95% CI, 1.23-2.07); develop difficulties with upper extremity tasks (41.5% vs 28.3%; adjusted RR, 1.28; 95% CI, 1.08-1.52); experience decline in mobility (38.1% vs 29.4%; adjusted RR, 1.18; 95% CI, 0.99-1.41); or experience difficulty in climbing (40.8% vs 27.9%; adjusted RR, 1.31; 95% CI, 1.10-1.57).”
And, the self-reported lonely participants were 45% more likely to die by the end of the six year study period than their counterparts who did not report feelings of loneliness.
The authors concluded, “Among participants who were older than 60 years, loneliness was a predictor of functional decline and death.”
These associations held even after the researchers controlled for other factors that could influence the health outcomes, such as a previous diagnoses of depression or other medical conditions that could account for declining health.
“I was surprised by how strong the relationship actually was,” Dr. Perissinotto, the lead study author, told Time Healthland.
Hypothesizing as to how loneliness feelings may contribute to a functional decline in health, researchers note that “feeling isolated can trigger changes in brain chemicals and hormones that can increase inflammation in the body, for example, which can exacerbate conditions like heart disease and arthritis,” as reported by Time Healthland. “Loneliness may also lead to other problems — poor sleep, depression, a disinterest in one’s own health care — which can in turn contribute to disability and early death.”
The authors found that the predictive indicator of health decline was the presence of subjective feelings of loneliness, not merely whether a person lives alone. They found that 63% of the study participants who reported feeling lonely were in fact married or otherwise not living alone.
Dr. Perissinotto, the study author, told Time, “I think that from a public health and policy level, we are doing a disservice by not asking [people] about their subjective feelings of loneliness.” “We focus on their diabetes control and treating their hypertension, but are we missing something that may be more distressing to patients and have more of an impact on their health?”
Dr. Perissinotto urges doctors who treat the elderly to ask their patients about their feelings. “We are trained to ask about a patient’s physical environment to assess how they are functioning, but we aren’t traditionally taught to ask about things like their feelings of loneliness,” she says. “It’s challenging, but it deserves more delving into, and that should be the next step to addressing loneliness and its impact on health.”
“If we can actually target this, I think we have the potential to make a lot of difference,” Dr. Perissinotto said.
For more information on the importance of Social Interaction & A Sense of Connection With Others for wellness, see the HelpingYouCare™ resource pages on Social Wellness: Social Interaction & A Sense of Connection With Others.
For more information on diet, exercise and other lifestyle factors that promote wellness and prevent diseases, see the HelpingYouCare™ resource pages on Wellness/ Healthy Living for Seniors & Caregivers, including:
- Diet & Nutrition: Physical Wellness;
- Exercise: Physical Wellness;
- Sleep, Hygiene, Quit Smoking & Other Healthy Practices: Physical Wellness;
- Activities to Preserve Mental Acuity: Intellectual Wellness;
- Social Interaction & A Sense of Connection With Others: Social Wellness;
- Other Areas of Wellness: Emotional, Ethical/ Spiritual & Vocational Wellness; and
- Examples of Healthy Aging: Stories of Inspiring Seniors.
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