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Loneliness and Isolation: Modern Health Risks
“We live in a society in which isolation is commonplace. In the impersonal climate of industrial society, even more people obviously suffer from a sense of loneliness—the loneliness of the lonely crowd. Understandably, the intense wish emerges to compensate for this lack of warmth with closeness. People cry for intimacy.
The Unheard Cry for Meaning, Viktor Frankl
Written more than two decades ago, the foregoing quote is even more relevant nowadays. One need only consider certain demographics to see how widespread isolation is today in America.
In 1900, for example, it was unusual to find people living alone, and relatively common to see large households: only 5% of households in 1900 consisted of people living alone, while 20% had seven or more people. Over the course of the century, the proportions reversed: 26% of households in 1998 consisted of only one person; 1% had seven or more. [24] By 2010, it is estimated that 31 million Americans will be living alone, up from 24 million in 1995. [25] Among the elderly, in 1995, 32% of all people older than 65 years lived alone. [26] Nearly half —45%—of women 65 years and older were widowed, and 70% lived alone. [12]
“Of course, living alone doesn’t necessarily mean that someone is lonely, but I think we can justifiably say that for a significant proportion of our society, loneliness is simply a fact of life,” said Dr Meston. “This is especially true for the elderly, but it also cuts across all age groups. I don’t think that as a society we quite realize the seismic change that is going on or that many people in our country are grappling with the painful realities of isolation and loneliness.”
The Impact Of Loneliness On Health
In his book Love & Survival: The Scientific Basis for the Healing Power of Intimacy [27] , Dean Ornish, MD—best known for directing clinical research demonstrating that comprehensive lifestyle changes may begin to reverse heart disease—describes the isolation he finds when he lectures around the country. He asks his audience how many of the following statements are true:
  • You live in the same neighborhood in which you were born and raised, and most of your old neighbors are still there.
  • You’ve been going to the same house of worship for at least 10 years, and most of your fellow congregants from 10 years ago are still there.
  • You’ve been at the same job for at least 10 years, and most of your coworkers are still there.
  • You have an extended family living nearby that you see regularly.

"Living alone doesn’t necessarily mean that someone is lonely, but I think we can justifiably say that for a significant proportion of our society, loneliness is simply a fact of life."
– Dr Meston

In a typical audience of several thousand people, only a few raise their hands. “And that’s not just in San Francisco or New York or Los Angeles, but also in Ames, Iowa, or Omaha, Nebraska, the heart of the heartland. Fifty years ago, most would have been able to say yes [to these statements],” Dr Ornish writes.
Panelist Dr Schnarch said that Americans have not always been as lonely and isolated as they are today. “It’s only since the industrial revolution, with mass movement to cities, that the tight bonds people had with family and community began to weaken and people thus began to develop a heightened sense of isolation. In recent decades, especially after World War II, isolation has only intensified as it’s become commonplace for people to move out to suburbs or away from the towns and cities in which they grew up,” he said.
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Loneliness may be characterized by three conditions: isolation, such as distance from a romantic partner; feelings of being disconnected—not having close friends; and feelings of not belonging—not identifying with or not being accepted by valued social groups. [28] Loneliness may also be measured (Figure 1). One study examined the differences between lonely and socially embedded individuals that might explain differences in health outcomes suggested that social relationships were associated with positive outlooks on life, more secure attachments, and more effective restorative behaviors. [30]
Loneliness has traditionally been considered a psychological problem, but research conducted in the past few years has suggested a connection between loneliness and health. [31] For example:
  • Loneliness for a romantic partner has been shown to be a significant factor in physician utilization—independent of depression, somatic complaints, and health status. [31]
  • People who are lonely use emergency departments 60% more often than nonlonely people, despite the same level of chronic illness and acuity of illness. [32] (Figure 2.)
  • In a four-year study that controlled for age, physical health, income, and education, elderly people who were extremely lonely were more likely than other elderly people to be admitted to nursing homes over that time period. One of the reasons given for the link between loneliness and nursing home admission was that the extremely lonely sought to enter a nursing home as a way of gaining social contact. [33]
Many things can lead to loneliness across the age spectrum: disability, loss of employment, diminished financial reserves, change in family structure and family member roles, availability of health care, and lack of competitive level of education. The threat of violence; experiencing discrimination; substance abuse; the social pressure to juggle multiple responsibilities such as work, parenting, and caretaking; and frequent geographic moves all contribute to isolating and insulating people from other people.
The Lonely Heart
While loneliness and social isolation are less commonly recognized as important elements in predicting morbidity and mortality from cardiovascular problems, studies have suggested that those conditions have a strong impact on the ultimate fate of people suffering from coronary artery disease as well as of people who have had heart attacks or have been slated for surgical procedures.
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A study that looked at emergency department usage among 164 adults at a Massachusetts hospital found that emergency department visits were more frequent among those who were lonelier. The difference was statistically significant (P<.001).
In one study, lack of emotional support was significantly associated with six-month mortality after an acute myocardial infarction. [4] Additional studies have found that loneliness at the time of surgery may be an important predictor of death at both 30 days and five years following coronary artery bypass grafting [34] and that the recurrent cardiac event rate at six months after an initial myocardial infarction was significantly higher among those who lived alone. [35] Results of a study in Stockholm suggest that lack of social support contributes to the severity of coronary artery disease not only among men, but among women as well. [36]
In a Duke University study, investigators found that patients with coronary artery disease who had low levels of social and economic resources were an important high-risk group among medically treated patients with the disease. [37]
The pathways by which loneliness and social isolation put people at risk for cardiovascular problems are not yet fully understood. However, one way that researchers are evaluating the issue is in recognizing that people who do not have their emotional needs adequately met are more likely to engage in risky behaviors such as smoking, drinking, and overeating. On the other hand, when emotional needs are met, people are more likely to successfully and permanently make the healthy lifestyle changes necessary to reverse heart disease. Recent research tends to lend credence to that line of thought: one study suggested that when emotional needs are being met, people are more motivated to make lifestyle changes that lower heart disease risk. [38]
James Lynch, PhD, author of The Broken Heart: The Medical Consequences of Loneliness, has written, “It is high time for us to develop a more comprehensive physiological perspective, one that will help clarify the cardioprotective nature of community life and loving relationships, as well as the cardioprotective nature of healthy dialogue, and the cardioprotective benefits of our relationship to the rest of the natural, living world.” [39]
In the next chapter, we will explore the ways in which changing demographics are affecting the kinds of relationships we now form and the way these changes may be impacting health.