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Should Loneliness Be the Next Vital Sign?

Doctors should check with older adults, who are particularly vulnerable

By Shannon Halloway

(This article was provided through The OpEd Project, whose mission is to increase the range of voices and quality of ideas we hear in the world.)

older man sitting alone in a cafe
Credit: @WR36 via Twenty20

Loneliness can lead to premature death and development of chronic conditions such as cardiovascular disease, diabetes and depression, but health care providers aren’t doing enough to determine who is suffering.

Recently, former U.S. Surgeon General Dr. Vivek H. Murthy warned that we face a loneliness epidemic that crosses all ages, races and socioeconomic groups. Loneliness, a consequence of social isolation, negatively impacts every aspect of health, causing a state of heightened inflammation, as if the body is fighting an infection, illness, or injury.

Although any person is at risk for loneliness, certain populations — including new parents and older adults — are particularly vulnerable. Like checking blood pressure or a pulse for a snapshot of health, loneliness needs to be recognized as a vital indicator of wellness.

Unasked Questions About Loneliness

So why aren't primary care providers regularly questioning patients about loneliness? Surely, if loneliness is associated with poor health outcomes, and even death, a few precious minutes of an annual visit should be devoted to the topic. In fact, practices that spend more time asking questions about social support have better patient health outcomes, including improved quality of life and fewer hospitalizations.

Unfortunately, this rarely happens. At my postpartum appointment as a new mother just over a year ago, I received the obligatory questionnaire regarding postpartum depression. However, I was not asked a single question about feelings of loneliness or about my current level of social support.

Isolation Among Older Adults

Loneliness is an even larger problem in the rapidly growing older adult population. Over one-third of older adults report loneliness, which may be due to social isolation. Over 6 million adults 65 and older have a disability that requires assistance in order to leave the home, and over half of older adults live alone. Lonely older adults may stop eating or getting dressed and become housebound, increasing the risk for frailty and injury.

As a nurse who conducts research with older adults, I can easily identify those who are experiencing loneliness. They often make frequent appointments or phone calls just to chat, or they send long letters.

At Rush University Medical Center, we currently have a pilot study of patients from the Rush Heart Center for Women. Participants are women over the age of 65 who take part in a nurse-led walking program. A part of the program is a monthly group meeting to talk about how to overcome barriers to walking and other health topics. These meetings serve as social engagements for the participants.

One participant recently sent a note to my team saying she was “filled to the brim" with support and camaraderie. Although the focus of our research is on walking to improve various aspects of health, one of the most profound outcomes are the relationships that form during a stage of life notorious for high levels of loneliness.


Obstacles to Group Programs

Unfortunately, in the research world, we’re moving away from interventions and health behavior programs that encourage in-person social interaction.

In-person group programs, such as our team’s walking program's group meetings, are very expensive compared to phone calls or online communities with less patient engagement. Just six group meetings led by a nurse can cost nearly $150 per patient versus about $20 for personal phone calls. Moreover, group programs aren’t always accessible for those with physical limitations or people who live in rural locations.

With developing technology, online communities strive to meet the social needs of users with fancy avatars and real-time communication on a range of devices. Although these online communities may decrease loneliness in some older adults, others note the importance of physical presence and body language for emotional support, which online communities lack.

There is evidence that online communication stifles the human experience, which may limit the health benefits. MIT Professor Sherry Turkle, author of Alone Together, explains that technology allows tight control over one’s image, limiting vulnerability and emotional connectedness crucial for proper development of relationships.

Let’s Explore Solutions

Simply put, online or virtual programs may not address the ill health effects of loneliness. We need the in-person human contacts to garner the benefits of social relationships that are so critical to health.

It’s time for health care providers and researchers to realize that strategies to combat loneliness are worth the investment. We need to be open to exploring less costly in-person strategies, such as hybrid online/in-person programs or utilizing free community spaces for meetings.

But most of all, we need to start recognizing and acknowledging this crucial health issue.

Shannon Halloway, Ph.D., R.N., is a postdoctoral research fellow at Rush University College of Nursing studying preventive health behaviors in older adults and a Rush Public Voices Fellow. Read More
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