Loneliness: Another epidemic

Neil Baum, MD

"I think of loneliness as our bodies' signal to us that we need better, more satisfying connections with other people." Eric Klinenberg, New York University

The crisis of loneliness poses as grave a threat to public health as obesity or substance abuse. Millions of people live with sparse human contact, and research tells us that lonely people are more likely to become ill, experience cognitive decline, and die early. Isolated seniors have a 59% risk of overall functional decline and a 30% increased risk of coronary artery disease or stroke incidents. Individuals who suffer from loneliness also bear a 50% greater risk of developing dementia.

According to a recent New York Times article in 2017, 46 percent of Americans experienced loneliness. A study was repeated in 2023, and more than 52 percent of all Americans reported feelings of loneliness sometimes or always. It is interesting that a sizable majority of those aged 18-25 who responded to a survey reported feelings of loneliness in the previous month. The American Psychiatric Association reports that 33 percent of U.S. residents are lonelier today than before the pandemic. In 2023, the U.S. Surgeon General, Vivek Murthy, estimated that social disconnection affects more Americans than obesity or diabetes.

Covid-19 has resulted in large numbers of Americans opting to work remotely. Studies have demonstrated that when we emerge from quarantine, we make less eye contact and conduct fewer conversations with co-workers and friends. This remote work has resulted in a retreat to a digital world that provides everything, even delivering our meals to our homes, we need except meaningful connections.

Some lonely patients describe a situation where a physician's monthly home visit was their only human contact. Loneliness is not confined to older people and can affect people across the age spectrum. Both men and women are equally prone to it.

Nearly one-third of U.S. adults aged 45 and older report feeling lonely. While the findings that 35 percent of midlife and older adults are lonely is unchanged from 2010, the population of lonely people over age 45 has grown by 5 million, from 42.6 million to 47.8 million, in the past eight years.

Loneliness's impact on health

A study of the health threats associated with loneliness demonstrated that feeling lonely results in a 60 percent increased risk of functional decline and a 45 percent greater risk of death. Studies have shown that loneliness is equivalent to smoking 15 cigarettes a day, and we all know the harmful effects of smoking.

Older people who are socially isolated or lonely are more likely to be admitted to the hospital or to a nursing home. Social isolation and loneliness are also associated with higher risks for:

• High blood pressure
• Cardiovascular disease
• Heart disease
• Obesity
• Weakened immune function
• Anxiety
• Depression
• Cognitive decline
• Dementia, including Alzheimer's disease
• Suicide
• Shorten life span

Older people who are lonely or socially isolated may get too little exercise, drink excessive alcohol, smoke, and experience insomnia, which can further increase the risk of serious health conditions.

Identifying loneliness

Isolation and loneliness often go together. Older adults are more likely to experience loneliness due to living alone.

Four signs that your patient may be experiencing isolation.

1. Loss of interest in activities

2. Lack of personal hygiene

Individuals experiencing depression that frequently accompanies isolation and loneliness may be less motivated to maintain personal hygiene.

3. Poor eating and nutrition habits

Skipping meals or medications can be a sign of isolation and depression among seniors.

4. Significant clutter at home

A cluttered apartment or a home in disrepair may be a sign of loneliness,

There are screening tools to help identify loneliness in our patients. The UCLA Loneliness Scale uses 20 items to measure a person's subjective feelings of loneliness and isolation, but it also provides a brief three-question version.(Figure 1) Participants rate whether they often, sometimes, rarely, or never feel that they have companionship, for example, or need company.

Figure 1

Questioning how often they've felt lonely in the last month may start the conversation and demonstrate a caring and compassionate physician.

Older adults regularly use the health care system, allowing physicians to inquire about loneliness.

12 Suggestions for resolving loneliness

Being socially connected has medicinal benefits and is associated with longevity. Here are some suggestions to share with your lonely patients:

1. Avoid isolation

Encourage patients not to be alone all the time. Tell patients to avoid sitting at home alone.

2. Keep busy

Encourage patients to keep busy, which helps them to take their minds off their lonely feelings. Encourage patients to join a group—book clubs, gardening, or playing card games like bridge. Now, they will be mingling with people who have a shared interest.

3. Talk to someone

It is a big step to get patients to admit they are lonely. Encourage lonely patients to find someone—a relative, friend, or therapist—to whom they can reveal, "I'm lonely." This will automatically relieve some of their feelings of loneliness and often boost the lonely person's self-image.

4. Volunteer

Doing something good lifts their mood and releases those happy neurotransmitters like endorphins and dopamine. Volunteering at a charity is a great way to meet people and make lonely people feel worthy and uplifted. Encourage lonely patients to offer a random act of kindness to someone every day, even if it's only a smile.

5. Meet friends

There's a caveat about engaging in social media. Checking someone's Facebook page can put a lonely person under the illusion they are connected. Kindly inform them that just because others can see what they're up to on social media doesn't mean they have the importance of being in touch. Encourage them to make a call or regularly meet a friend face-to-face.

6. Find a buddy

The buddy scheme is fantastic for older, isolated people. Some volunteers buddy up with other older adults to identify their interests and connect them with community activities in their area of interest.

7. Reading

Lonely patients can escape reality by immersing themselves in a good book.

8. Exercise

When you're fit, you feel better about yourself. Exercising releases those feel-good neurotransmitters, and the body reaps the rewards of being physically and mentally active. Encourage a gym membership, a fitness class, or a walking group, which improves their health and allows lonely patients to meet others.

9. Diet and sleep

Everyone, including lonely patients, needs good nutrition and sleep to be happy and healthy.

10. Participate in a religious community

There has been a precipitous decline in the number of Americans of all faiths who attend religious services. Religious communities are places where adults engage with children, stand for moral values, and there is a fusion of moral and spiritual life. Nearly all religious communities welcome new members. This is an excellent opportunity to increase socialization and reduce the impact of loneliness.

11. AI solutions for loneliness

An article on this topic would only be complete by looking into the use of A.I. as a virtual friend or person to help resolve the problem of loneliness. Chatbots can now engage in sophisticated conversations with lonely patients to offer potential coping solutions to the epidemic of loneliness. More research must be done to advise whether these applications effectively alleviate loneliness. These "A.I. companions" are designed to provide lonely patients with synthetic interaction to offer connectivity that isn't available to humans. One study finds that A.I. companions successfully alleviate loneliness on par only with interacting with another person and more than other activities such as watching YouTube or TikTok videos.

12. Get help

If the lonely patient has tried everything but cannot escape those feelings of loneliness, then professional help is the next step. Sometimes, it is necessary to get to the root of the problem to deal with it properly.

Bottom Line: The take-home message is that technological solutions may be part of the solution to loneliness, but they cannot and should not constitute the whole solution. Physicians need to screen for loneliness just as they do for depression, incontinence, diabetes, and hypertension. Once loneliness is identified, we can make suggestions to help our patients find solutions to this common problem. Sometimes, the solution to loneliness is only a phone call, email, or a friendly knock on the door. As physicians, we can help identify the problem and help our lonely patients become socially connected…beyond scrolling on Facebook or TikTok!

Neil Baum, MD, a Professor of Clinical Urology at Tulane University in New Orleans, LA. Dr. Baum is the author of several books, including the best-selling book, Marketing Your Medical Practice-Ethically, Effectively, and Economically, which has sold over 225,000 copies and has been translated into Spanish.