Doctors asked to consider loneliness in senior health assessment

More research is needed to define the link more clearly, but physicians should be mindful of patients’ social support.

By Carolyne Krupa — Posted July 2, 2012

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Most people struggle with feelings of loneliness from time to time, but new research shows that those emotions can have negative health consequences for older people.

Loneliness is associated with declining health, decreasing mobility and death in people 60 and older, according to an Archives of Internal Medicine study published online June 18.

The study highlights the need for physicians to take the time to get to know their patients beyond their obvious physical health, said Carla M. Perissinotto, MD, lead study author.

“If we focus only on blood pressure, we really are missing a lot of what is going on in someone’s life,” she said.

Researchers evaluated six years of data on 1,604 people 60 and older and found that 43% were classified as lonely. Compared with other study participants, those individuals were more prone to have their mobility decline, lose upper body strength, have trouble climbing stairs and decrease their daily activities. Loneliness also was associated with an increased risk of death, the study said.

Primary care physicians who treat older adults should screen them for loneliness. If a patient is at risk, doctors should know where to refer them to get help, such as a social worker or a local organization that serves the elderly, Dr. Perissinotto said.

Reducing the risks for these patients is particularly important with the aging of the population and high costs associated with disability. The number of people 65 and older is projected to grow from 39.6 million in 2009 to 72.1 million by 2030, according to the Dept. of Health and Human Services’ Administration in Aging.

Measuring social support

A separate study of 8,594 adults 45 and older found that those between age 45 and 65 who live alone have significantly increased risk of mortality — and particularly cardiovascular-related death — than those who don’t live alone. That study also was published online June 18 in Archives of Internal Medicine.

In both cases, researchers explored the impact of social support on health. It’s a concept that has generated a lot of debate in the medical community, said an accompanying commentary by Emily M. Bucholz, MPH, and Harlan M. Krumholz, MD, both of Yale University School of Medicine in New Haven, Conn.

“The difficulty with using social support as an epidemiologic variable arises when trying to define it,” the commentary said. “Social support encompasses many concepts and can be defined several ways.”

However, loneliness is a negative feeling that is worth addressing with patients, even if it had no health implications, the commentary said.

Other studies have looked at many different social factors, such as whether a person’s religion affects their health, said Jim Pacala, MD, president of the American Geriatrics Society. While determining whether a person lives alone is easy to assess, loneliness is less concrete.

“Loneliness is less of a medical type of concept. I just think it doesn’t enter the medical mindset,” said Dr. Pacala, associate professor and associate head of the Dept. of Family Medicine and Community Health at the University of Minnesota Medical School.

Dr. Perissinotto, a geriatrician and assistant clinical professor at the University of California, San Francisco, emphasized that loneliness isn’t the same as depression or living alone. Just because a person is lonely doesn’t mean they are clinically depressed. Likewise, being alone and being lonely are two separate things. Someone can live alone but not feel lonely, while someone who is married may feel alone, she said.

Most individuals who felt alone in the loneliness study lived with someone, and most were not depressed.

“It’s not just the frail lady who lives by herself,” Dr. Perissinotto said. “It could be your neighbor who is married or your grandmother who you see every Christmas.”

Finding out whether a patient is lonely can be as simple as asking them. For the study, participants were asked if they felt left out, or isolated or lacked companionship. They were classified as lonely if they answered “some of the time” or “often” to any of those questions.

As a primary care physician, Dr. Perissinotto said she understands that it can be challenging to balance all the things a physician needs to discuss with a patient during a limited patient visit.

“It’s really quick; it doesn’t take much time,” she said. “I think some physicians are afraid to ask the question. When you ask these questions you are potentially opening up a can of worms.”

Dr. Pacala said more research is needed to clearly define the links between social factors and health, but such research helps physicians think beyond a patient’s physical health.

“It is a good reminder to health care providers that, particularly in older adults and frail older adults, that this is something that we need to be mindful of — is these social constructs and how they bear on overall health,” he said.

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The health risks of loneliness

People who are lonely are at an increased risk of functional decline and death compared with those who aren’t lonely, a study says. Lonely individuals showed higher declines in a variety of areas:

Functional measure Lonely Not lonely
Activities of daily living 24.8% 12.5%
Upper extremities tasks 41.5% 28.3%
Mobility 38.1% 29.4%
Stair-climbing 40.8% 27.9%
Death 22.8% 14.2%

Source: “Loneliness in Older Persons, A Predictor of Functional Decline and Death,” Archives of Internal Medicine, published online June 18 (link)

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External links

“Loneliness in Older Persons, A Predictor of Functional Decline and Death,” Archives of Internal Medicine, published online June 18 (link)

“Loneliness and Living Alone: What Are We Really Measuring?” Archives of Internal Medicine, published online June 18 (link)

“Living Alone and Cardiovascular Risk in Outpatients and Risk of or With Atherothrombosis,” Archives of Internal Medicine, published online June 18 (link)

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