If you are older and alone, join a group – for your heart’s sake

The pandemic, in many cases, contributed to the growing epidemic of loneliness and isolation among older Americans, and there is new evidence that it may be as bad for your physical health as your mental health.

A recently published 8-year study of nearly 58,000 American women between 65 and 99 years old found those reporting isolation and loneliness had higher rates of cardiovascular disease, including strokes, coronary heart disease and death. Among other things, the study found that:

• For participants with high scores for loneliness, the risk for a cardiovascular incident increased 5 percent.
• For those with high scores for social isolation, risk increased by 8 percent.
• For women who scored high for both social isolation and loneliness, risk ranged 13 to 27 percent.

The study was published Feb. 2, 2022 in JAMA Network Open and was funded by grants from the National Institutes of Health. It drew data from questionnaires participants filled out for the period from March 2011 to March 2019. The women involved had no previous history of stroke, heart attack or coronary heart disease.

The researchers wrote that while men and women experiencing isolation and feelings of loneliness may be more likely to turn to poor health choices, such as smoking tobacco, excessive alcohol consumption, not exercising enough and eating a bad diet, all of which can contribute to cardiovascular disease, isolation and loneliness by themselves may harm the body. They distinguished loneliness as not synonymous with being alone, as people can feel lonely even when surrounded by others.

“When people are lonely and isolated, it results in chronic stress,” said Psychiatrist Cathy Perkins, MD, director of the psychiatric emergency services team at Cape Cod Hospital in Hyannis, commenting on the study. She was not involved in the study.

A 2020 report by the National Academies of Sciences, Engineering and Medicine identified the groups at higher risk of loneliness as including minorities, immigrants, and lesbian, gay, bisexual and transgender people. Dr. Perkins said the COVID pandemic exacerbated problems stemming from social isolation and loneliness, particularly among seniors and adolescents.

She said older adults dealing with isolation and loneliness remains an important issue on Cape Cod. Many people choose to retire here, away from family and their former communities where they had established ties. Their spouses or partners may die or fall seriously ill, leaving them to cope by themselves.

“They just struggle more,” she said. “I’d say 50 percent of families are not local.”

The stress caused by loneliness and isolation may affect cardiovascular health by raising blood pressure, stimulating inflammation and causing atherosclerosis (plaque buildup on artery walls), according to the study. Dr. Perkins said stress can affect mood by decreasing the neurotransmitters dopamine and serotonin and increasing production of the hormone cortisol.

The researchers noted their results follow other work depicting social isolation and loneliness among older adults as a public health problem. They cited a 2020 report by the National Academies of Sciences, Engineering and Medicine that said social isolation affects about 25 percent of Americans 65 or older not in long-term care facilities. Loneliness is an issue for middle-aged and older adults. The report said 35 percent of adults 45 and older, and 43 percent of adults 60 and older, report being lonely.

More Concerning Effects

According to the Centers for Disease Control and Prevention, studies have found that in people 50 or older:

• Social isolation or loneliness from poor social relationships or lack of them increases the chance of heart disease by 29 percent and stroke by 32 percent.
• Social isolation raises the risk of dementia (which includes Alzheimer’s disease) by 50 percent and may be as dangerous as obesity, smoking and lack of exercise as a factor in causing early death.
• Loneliness increases rates of anxiety, depression and suicide, and, in heart failure patients, it raises the risk of emergency visits to hospitals by 57 percent, chance of hospitalization by 68 percent and risk of dying by almost 400 percent.

Mobility issues, declining brain skills and other health problems can add to the difficulty of older adults maintaining social contacts and managing their daily lives, including juggling schedules for multiple prescription medications, Dr. Perkins said.

The psychiatric team of physician assistants and nurse practitioners Dr. Perkins leads in the hospital’s emergency department sees 15-25 patients a day, she estimated. Of these, about half are 65 or older. The team intervenes in cases displaying suicidal ideation (thinking about killing yourself) or symptoms of depression, anxiety and confusion. After assessing a patient, they may try to reach a family member to learn of any ongoing issues, recommend assistance from Elder Services of Cape Cod & the Islands or Visiting Nurse Association of Cape Cod, or make a referral to a local therapist, if the person doesn’t have one.

“Sometimes the patients don’t recognize the services available,” Dr. Perkins said.

To combat loneliness and isolation, she suggested older adults:

• Plan ahead for the likelihood of needing assistance as they age.
• Try to maintain supportive contacts with relatives, neighbors and friends.
• Stay socially involved through hobbies, going to religious services, exercise activities or offerings at their town senior center.

Family members “should also take a moment to measure their availability and what more they can do for their elderly relatives, Dr. Perkins said.