Media Briefings

Loneliness and longevity in older adults

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A quarter of Americans aged 65 and older are socially isolated, and those over age 50 are at greater risk of becoming lonely. Earlier this year, the U.S. Surgeon General released an advisory calling loneliness and isolation urgent public health threats. SciLine’s next briefing covered the latest research on the links between social connections and physical and mental health for older adults, including studies that show loneliness in this age group can adversely affect heart function, cognitive health, and even lifespan. Three panelists made short presentations and then took questions on the record. 

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Introduction

[00:00:23]

RICK WEISS: Hello, everyone, and welcome to SciLine’s media briefing on loneliness and longevity, where we’re going to look into one of the nation’s really most pressing mental health and public health issues, the current epidemic of sorts of loneliness and social isolation in the United States. And we’re going to do that today, with a particular emphasis on the elderly, the nation’s fastest growing demographic age group. I’m SciLine’s director Rick Weiss. Welcome! For those of you not familiar with us, SciLine is a philanthropically funded, editorially independent free service for reporters, based at the nonprofit American Association for the Advancement of Science. Our mission is simply to make it as easy as possible for you, as reporters, to include scientist sources, and scientifically validated information in your news stories. Whether those stories are about a topic in science, or simply about goings on in your community, where a little dose of scientific research about those topics will help strengthen your story. And of course, in our view, almost any story can be made better by adding some scientific research results that are relevant to the topic you’re talking about.

A couple of quick logistical details before we get started. We have three panelists today, who will make short presentations of up to about seven minutes each before we open things up to Q&A. To ask a question, you can do so during their presentations, or afterwards, by going down to the Q&A icon at the bottom of your Zoom screen. Simply hover over that Q&A button and insert your name, the name of your publication and your question, and include information about who you’d like that question posed to, if you care. A full video this briefing is going to be available probably within an hour or so up on our website after this briefing. And a transcript with timestamps will be available a day or two after that. If you need raw video faster than that, just get in touch via that Q&A prompt, and we will get you something as immediately as possible at the end of this briefing today. You can also use the Q&A box to ask SciLine staff if you’re having technical issues of any kind.

Okay, I’m not going to give full introductions for our three speakers today. That would be too time consuming with all their bona fide’s, and it is all located on our website on the media briefings page. I just want to tell you that we will hear first from Julianne Holt-Lunstad, who is a professor of psychology and neuroscience, and director of the Social Connection and Health Lab at Brigham Young University. And she’s going to get us up to speed on some basic concepts and some of the research that’s drawn links between loneliness and isolation on the one hand, and mental and physical health outcomes on the other. Second, we’re going to hear from Dr. Ashwin Kotwal, an assistant professor of medicine at UCSF. And he’s going to focus on the process of assessing loneliness and isolation in older adults, and some of the approaches that clinicians are taking to address this mental and physical health issue. And finally, we’re going to hear from Dr. Karen Fingerman, a professor of human development and family sciences, and director of the Texas Aging and Longevity Center at UT Austin, who will talk about some of the research that has deepened our understanding about the health benefits of social experiences, how family and friends, and sometimes technology, can mitigate the effects of loneliness, especially, again, late in life. Okay, so let’s just get started with the presentations and overview. Dr. Holt-Lunstad?

Social connection and health

[00:04:09]

JULIANNE HOLT-LUNSTAD: Thank you so much. I’m just going to quickly take a moment to get my—pull my slides up. Well, thank you so much. I really appreciate this opportunity to speak to you all. I want to start by asking you to imagine a new treatment that could increase your survival by as much as 50%. It also can reduce your risk for cardiovascular disease by 29%, and stroke by 32%. It can reduce your likelihood of developing depression and dementia. In fact, it also can increase your immune responses to vaccines and to viruses. And in fact, it also comes with few side effects, and actually can increase your well-being. Well, now, of course, everyone would want to invest in that. And what I’m actually referring to is social connection. And although it’s not a new treatment, everyone should invest in their social connections. And I hope to share some of the reasons why.

So, one of the truisms in life is that people often don’t appreciate what truly matters until it’s taken away. And so while it’s clear that the global pandemic brought greater awareness to the importance of our social connections for our well-being, it’s clear that this is not a new issue. There is decades of scientific evidence documenting not only influences on our emotional well-being, but significant influences on our survival and longevity. But concerning trends began before the pandemic, and so getting back to normal is not going to be enough. And the urgency of this public health issue has resulted in international and national efforts, including the recent Surgeon General’s Advisory, which I was the lead scientific editor on. A Surgeon General’s Advisory is quite noteworthy, because it’s a public statement that calls the American people’s attention to an urgent public health issue, and provides recommendations on how it should be addressed. And the most prominent of these, of course, was on smoking, that led to significant societal change. But advisories are reserved for significant public health challenges that need the American people’s urgent attention.

So, what is loneliness? I hear it colloquially used very broadly, and often used as a catch-all term for all forms of lacking social connection. But there is a more specific definition of loneliness. It is specifically a subjective distressing feeling, resulting from a discrepancy or unmet need between an individual’s desired and actual level of connection. And it’s important to note that both loneliness, specifically, and the larger issue of lacking social connection are important. And of course, the public perception is that isolation and loneliness are the result of the pandemic. And yet, we have evidence of these concerning trends from the American Time Use Survey, that goes back two decades. So, for example, we see time spent in isolation has significantly increased, household and non-household family, time spent with them, has significantly decreased. Similarly, time spent engaging with friends and others in our community, and companionship have also significantly decreased over the past 2 decades. And there’s some evidence to suggest that some of these trends go back even farther. So, it’s not surprising that according to some estimates, roughly 1 in 2 American adults report experiencing loneliness. Further, data from 1.3 million texts, obtained from the National Crisis Line, reveal the number one source of crisis was relationships. And so this really underscores the need to pay attention, not—to the quality of these relationships, because 1 in 3 was related to relationship stress or dysfunction, while 1 in 5 was related to absence of human contact. So, it’s important to note that this goes beyond loneliness, and that all aspects of social connection have been linked to both health and longevity. And so our attention needs to be paid to all aspects of this. Social connection is clearly underappreciated. It’s often seen as nice to have, but not essential. And yet, it’s a critical—it’s critical for individual and population health, well-being, community safety, resilience and prosperity. But unfortunately, far too many people lack social connection in one or more ways compromising these benefits. The stems from the widely-accepted that—note that humans are fundamentally a social species. This social need is reflected in our neurobiology, that can shape our thinking, behavior and functioning.

So, for example, evidence points to dysregulation across multiple biological systems when various social needs are not met. And if sustained over time, this dysregulation can develop—lead to the development of disease and compromising our longevity. This has been linked to physical health outcomes, including cardiovascular disease, stroke, type two diabetes, mental and behavioral health, including depression and anxiety, suicidality and addiction, as well as cognitive health, including cognitive decline, dementia, and specifically Alzheimer’s disease. There’s also evidence linking this to economic health outcomes, including billions in healthcare spending, lost productivity. And according to one estimate, 154 billion due to workplace absenteeism and lower quality of work. Some of the strongest evidence is related to longevity. So, for example, lacking social connection is on par with other well-known risk factors for mortality. Now, I do want to note that this is—this comparison is across indicators of lacking social connection, and is not specific just to loneliness. And while all aspects of social connection have been linked to health and longevity, some may be stronger predictors than others. So, for example, one large national study found that social isolation is the stronger predictor of physical health outcomes and mortality, while loneliness is a stronger predictor of mental health outcomes.

And finally, going back beyond or going beyond health outcomes, several studies also document the importance of social connection in times of crisis. And the ability to mobilize resources via one’s social connections can be a matter of life and death. And so communities where people know one another are better prepared for, respond to, and recover more quickly from natural disasters than those with lower levels of social connection. And so as extreme weather patterns become more frequent, connected communities are going to be crucial to weather these kinds of environmental crises as well. So, to conclude, this is an issue that affects us all. We all need social connection at all ages, although young, particularly—may be particularly vulnerable. None of us is immune to lacking social connection. We can all face barriers, but some groups more so than others. And finally, this is simply a human issue. And so I thank you for your attention, and turn the time over to the next presenter.

[00:12:59]

RICK WEISS: Thanks, Dr. Holt-Lunstad. Great introduction. And I think a really convincing case for starters, that this is, as you said, not a nice-to-have, but a critical-to-have for proper physical and mental health. We’re going to go over now to Ashwin Kotwal.

Loneliness and social isolation among older adults

[00:13:16]

ASHWIN KOTWAL: Great. And yes, thank you, Dr. Holt-Lunstad for a great introduction to this topic, and I will be building off a lot of those concepts. I’ll share my screen. All right. So, I’ll be discussing loneliness and social isolation among older adults. I have a few disclosures. So, Dr. Holt-Lunstad gives a really nice overview of the definitions of these concepts. I also think about loneliness and social isolation as markers of our social health that have emerged in recent years, that really give a good picture of whether people are meeting their social needs adequately. So, loneliness being the subjective feeling of lacking connection to other people. People who are lonely may have a desire for more relationships, or at least more satisfying social relationships. And a popular phrase is, “You can feel lonely in a crowded room.” Right? So, people may be surrounded by friends, family, or even be married, and still feel lonely. Social isolation is a related, but distinct concept as indicated by this Venn diagram, of having objectively few social relationships. They may have so few social roles, group memberships or infrequent social interaction. And I really think of this as a complete or near complete lack of contact with society. One key point I’d like to make is that loneliness and social isolation are not unique to older ages. As Dr. Holt-Lunstad just mentioned, this affects us all.

In recent years, we’ve noticed that young people may be particularly vulnerable. And I want to counter some of the ageist stereotypes that are prevalent of older adults kind of being locked away in their rooms, not engaging with the rest of society. In fact, many studies indicate that older adults tend to be more engaged with community groups, and quite participatory compared to other age groups. And yet, there are unique considerations that can disrupt how older adults cope with loneliness and isolation. And there are unique considerations when we consider the health impacts. So, first, what goes along with aging that can impact how we cope with loneliness and isolation. There are a number of important losses, which predict these experiences at older ages. That can include the death of—death of a spouse, or the death of or other loss of relatives and friends. Some of these relationships are incredibly—incredibly meaningful and difficult to replace, or people don’t want to replace those relationships at all. Changes in living arrangements, or institutionalization, where people move from their homes of decades, to communities that may be less familiar. And, of course, health issues, deteriorating physical health, then impaired mobility, which can make getting to social activities more challenging. Impairment in vision or hearing, or even multiple sensory loss, and reduce social activity, or really reduced opportunities to engage socially for—with community activities that may not be adapted to older adults. And so just to summarize, social isolation and loneliness impact health along many different aspects of well-being for older adults.

As mentioned earlier, people who are lonely or isolated can have a higher mortality or shorter lifespan than we would hope. And it greatly impacts quality of life. Right? So, older adults have a greater likelihood of loss of independence. That includes functional impairment, frailty, and being more relegated to their home, or being homebound. They’re more likely to require nursing home assistance. This was just demonstrated in a recent study published in 2023 in the Journal of the American Medical Association. And they can have poor quality of life. Loneliness is associated with higher levels of pain, depression, fatigue, poor sleep, and the cluster of these symptoms. Older adults who are lonely tend to have higher use of medications with adverse side effects, including benzodiazepines, opioids, and antidepressants. And of course, cognitive impairment can be a big downstream impact of loneliness and isolation.

As clinicians, we often care about traditional physical and mental health issues. As a geriatrician and palliative care physician, increasingly notice that loneliness and isolation are, in and of themselves, important to patients and family members. So, in a seminal study that was conducted by Dr. Karen Steinhauser out of Duke University, she actually surveyed patients, who were seriously-ill, family members and clinicians about factors that were important to them, as they were going through serious illness and approaching the end of life. What she found was that individuals and family members care just as much about social needs, as they do about traditional medical and health issues that we tend to prioritize as clinicians. So, things like having someone who will listen, sharing time with close friends, the presence of family, being able to help others. And yet, our work has demonstrated that individuals with serious illness, or approaching the end of life, have twice the prevalence of loneliness, or social isolation. And that that’s even higher for people certain serious illnesses, like dementia, or advanced lung disease, which can be particularly isolating conditions. And so we really need to be aware of this, and start integrating this into our health systems, and the way we approach people’s quality of life.

So, what can we do? Whether you’re a clinician, whether you’re seeing people in your community, or you’re addressing the needs of loved ones, we can all, I think, pitch in to address this epidemic. The first step is if you’re noticing something is off with a loved one, or they’re experiencing a major life or health transition, start a conversation. Ask them how they’ve been feeling lately. I’ve noticed that talking about loneliness or social isolation can sometimes be hard or awkward. There’s a lot of stigma associated with these concepts. So, common phrases I use are, “I’ve noticed a lot of people have been feeling lonely recently. Is that something you’ve been experiencing?” Or, “Do you need help connecting with others?” When people mentioned that they’re lonely, I think that can be a useful starting point for further discussion. Providing space to discuss potential causes, and helping process emotion, can, in and of itself, be therapeutic. Sometimes people are experiencing major life transitions, like the loss of a spouse, that doesn’t have a simple fix. It doesn’t have an easy solution. But simply providing space to show that you care can make a difference. I usually ask, as a second step, to—for an invitation to address these needs. Since it can be really personal, and not everyone wants you involved. But if people are interested in help, you can ask people what they think might help, and invite them to brainstorm. A third step is just being aware of solutions. So, sometimes there’s no immediate solution. And that’s okay. Showing that you care and want to prioritize their social health can make a difference. But it can be helpful to be aware of solutions.

As a physician, there are a number of health factors that we can address, things like vision and hearing, functional needs, getting a walker so that they can make it to their activity. Addressing pain. Incontinence is an incredibly strong predictor of loneliness, which we have a number of clinical interventions. Some may want to be more active, like reengaging with the hobby, more visits or calls from family, joining a local club. And there’s also a number of community programs that are available locally, that it can be helpful to be aware of. Here are just some of the examples that are available in the Bay Area, for example. And lastly, I think we need to consider policy implications here. Loneliness and isolation are common and may contribute enormously to suffering as individuals age and approach the last years of life. Our medical system spends a lot on treatments of disease, even when these treatments are costly and ineffective. So, we need to think about how to prioritize more on spending towards social care, where we might greatly impact quality of life. As a clinician, we’re often on the frontline of witnessing these needs, but addressing them as time-intensive and complex.

So, we need to also think about how we can adequately compensate clinical teams for addressing these complex needs. We’ve learned a lot from the pandemic that community programs can do—can make a huge difference when they have adequate funding, and reasonable coordination from local, state and federal levels. So, I think, overall, this is a great opportunity to pull the right policy and funding levers to make change. So, with that, I will turn it over to the next presenter. Thank you.

[00:22:52]

RICK WEISS: Thank you, Dr. Kotwal. Super interesting to hear, for one thing about older people with medical problems, caring just as much about these quote/unquote, “non-medical issues”, as the medical ones, a great reminder, not just to healthcare providers, but to family members and others. But also I appreciate your focus on solutions. I’ll remind reporters, these slides will be available very quickly after our briefing today for your review. And if you have questions in the meanwhile, you can start putting them into the Q&A box at the bottom. And let’s go over now to Dr. Karen Fingerman.

The health benefits of social experiences

[00:23:24]

KAREN FINGERMAN: Thank you so much. I’m going to take a slightly different perspective on this, and talk a little bit about how different kinds of social ties enhance a sense of belonging or prevent loneliness, and how that emphasis on social ties shifts with age, what’s going on in old age. If you think a little bit about what the social world does for you, why does it matter? Well, we’ve already heard a little bit about social support, that they’re going to help you in a crisis. They’re going to get you to the doctor. They’re going to be there. They’re also emotionally-rewarding. And in that regard, older adults focus more on emotional rewards in their relationships. And that’s partly because they’re reaching the end of life. And whenever you’re reaching the end of something, spending time with people who are emotionally-meaningful increases. So, if you think about a time when you were going to move, right before you moved, you were not looking to go to big parties. You were looking to spend time with the people you already knew and loved. Relationships or social connection also provide novelty and stimulation. We need new things. We need new activities to keep our brains active, to keep ourselves active. And they also ground you in daily life. They make you feel like your day is familiar. You know the people who are going to be there. If we take a look at where we get these resources, in general, our close ties are the ones who—family and friends, the people we have known and invested in, provide us with support. They’re there. They’re the ones who are going to be tangible and practical, and you can confide in them, and you care about them. What we’re going to call “weak ties”, the people who don’t fit in that category, but are still a part of your life, tend to provide the novelty and stimulation.

So, if you think about during the pandemic, if you happen to be in the lockdown with other people, at the end of the day, you only had so much conversation. “I went into the kitchen and got a snack today.” “Yes, so did I.” You really wanted to talk to someone outside that household, someone who had done something that you hadn’t done that day. In terms of the grounding of daily life, that was the same thing during lockdowns is that we weren’t going out and seeing the barista who knew our order, the guy on the treadmill next to us in the morning when we were working out. And those things were important to us. The weak ties mattered. When you look at the research, even before the pandemic, there was a study that was done on a couple of hundred adults who were 40 in the 1990s, and they were tracked for 25 years. And it turned out that the weak ties—were associated with how many close ties you have, but it was the weak ties that carried the weight on whether or not you were depressed, whether or not you were lonely over the years. My own research has looked at much sort of smaller increments of time. We did a study where we assessed older adults every three hours. We looked at their level of activity using like a fancy Fitbit. We did a variety of different assessments. And what we found, as well, is that when they were with the weak ties, they were more physically-active. There was a greater level of that. And that makes sense because Americans are incredibly sedentary. And to be with a weak tie, you at least have to get out of your chair to answer the door. But more often than that, you have to get up and leave your home.

So, those things went together in our study. We also found, though, that they were in a more positive mood when they had a mix, the close ties being there as well. So, that emotional component. The mix matters. Now having had said that, one of the things that happens, at least right now in the modern world, is that we have a choice of how we’re having this contact. You can have it in person, you can have it by phone, or you can have it digitally; text, social media, e-mail, video chat. Most of the time, when you look at where they’re trying to intervene, you try to use phone calls. People are going to call older adults who can’t get out, or they’re going to train them to use the digital. And an inconvenient truth is that it looks like, at least from what we know that the in-person is what’s really going to carry the weight, and really going to matter to people. So, when we—there’s a study, again, that looked daily for 21 days, and adults over the age of 65. And they found that it was the days that they had in-person contact when they were in a better mood and less lonely. Now, over the course of the whole thing, the people who used digital media, in general, also were less lonely. But having had said that, digital media, often for older adults, is used to enhance the close ties they already have. So, it’s not a substitution. It’s an enhancement. And that’s partly because they’re using it to reach out to their younger relatives, or to friends they already have. And in fact, one of the things that they’re finding—a study that was done during COVID discovered, perhaps not surprisingly, that most older adults increase their use of technology.

I know that the center that I direct, very quickly, we had instructions on how to use Zoom up on our website. Very simplified. We were hoping people over the age of 65 would use it. And that did happen, based on the research. There was a study of 5,000 older adults, who lived in the community, not in nursing homes, and they had at least one person outside their household. And in general, their use of technology did increase. But the people in their 80s showed a decrease in use of technology. And what the researchers are thinking happened is that they were depending on younger people, who came over and kept their technology going. And without them, they could no longer use that technology. And that probably resonates with a lot of us who turn to our grandchildren and say, “Can you come in here? The camera’s not working. And I’m going to be meeting with 60 reporters in a few minutes.” So, and that’s in fact documented in the research literature, and I’m not actually that old. What else do we know? Well, I’ll tell you at the holiday season where you might be thinking about this. Back in the 1990s, I did a study of holiday cards, and this is back in the days when people wrote little handwritten, like, messages to people. They got writer’s cramp. They risk getting a paper cut on their tongue to lick an envelope. They walked up through the snow, and found a blue box and put it in. And so back in those days, but I think it’s still relevant, we got them to fill out a survey for each of their cards. We looked at how much this mattered. And what we’ve found is that these cards made a difference in terms of their sense of belonging at the holiday season, which in many ways is the opposite of loneliness.

So, receiving these, receiving these people, they’ve known for a long time, who might not be a part of their life, the college roommate, who only touches base once a year, enhanced their sense of belonging. And what that tells us is that at the holiday season, very small gestures may make a difference for other people. We don’t know that that can make a difference for stranger. I don’t have those data, and the in-person research suggests that random contact may not, but by the same token, these holiday cards suggest that if you do know the guy on the treadmill next to you, wishing them a happy holiday, bringing some cookies to the barista, or the checkout person that you know, on a regular basis, may, in fact, make a difference. At least that’s what this study suggests. I do have a list of references for you that will be in the slides that may be helpful. And I should acknowledge, just like Dr. Kotwal did, the funding sources that have made a difference in terms of my ability to do the research that I do. Thank you so much. I appreciate the opportunity to speak with you, and to be a part of this very prestigious panel. Thank you.

Q&A


What is being done well in press coverage of these issues, and where is there room for improvement?


[00:31:33]

RICK WEISS: Thanks, Doctor Fingerman. A fascinating presentation, in addition to our briefing here. And I have to say, making me feel better about the fact that even if I only reach out to some of these folks, once a year, with holiday cards, it’s better than not at all. And it really might mean something. So, with that, we’re going to get into the Q&A. Again, the Q&A prompt is at the bottom of your Zoom screen. You can start submitting those. But I always start these briefings with one question from SciLine. And then I want to quickly go around the horn with each of you to ask you to address this question, which is basically, as not so much as professionals now, but as news consumers yourself. As you’ve looked at news coverage of what’s going on in this country, in the domain of loneliness and social isolation, tell us, each of you, something that either you think is being done well and right by reporters, and that you want to encourage, or if you prefer something that has sort of been—you’ve got a bee in your bonnet about, and it’s something that reporters routinely perhaps get wrong, and maybe this is a chance to set them on the right path. And I’ll start with you, Julianne.

[00:32:44]

JULIANNE HOLT-LUNSTAD: Thank you so much. I appreciate it. So, one of the things that I really appreciate about what the media has done is to help raise awareness of how important this issue is. And even just looking at the kinds of articles that are out there, loneliness has become something that is now well-recognized as being important for our well-being. The one thing that perhaps could be improved upon is that it’s still primarily seen as just an issue of loneliness, when there are many aspects of social connection that are important that have equal effects on our health and well-being, as well as the public perceptions still seems to view this as primarily associated with emotional well-being. And some of the strongest evidence is around longevity and physical health outcomes. So, really, where we could perhaps do better in raising some of that awareness is recognizing that both isolation and loneliness, and poor quality relationships, and lacking social support, all of these things are important, not just loneliness, and recognizing how important it is to our physical health as well.

[00:34:17]

RICK WEISS: Great. Thank you. Ashwin?

[00:34:20]

ASHWIN KOTWAL: Yes, I’ll echo Julianne’s appreciation for prior coverage. Particularly of the relationship of social connection to health outcomes. I start almost every talk I give to clinicians with the attention that you all have brought to this topic on health outcomes and why clinicians should care. So, I think it’s made an enormous difference in raising awareness in health systems and making this a priority for clinicians across different disciplines. One area that I think could improve is I touched on this a little bit during my presentation, it’s just this concept, a lot of the ageism, that is quite prevalent in our country. And I think recently, I found that media has really helped to counter some of those ageist notions, and I think we can build on that further. Older adults are hugely important contributors to society. We—sometimes during the pandemic conceptualized older adults as victims of the pandemic, of having to be locked in their homes a way, where we needed to go out and help them. But it’s really a two-way street, older adults help their younger children, their grandchildren, get through troubles throughout their lives. When we reduce the opportunities for older adults to—to participate in our communities, it affects us all. And so I just wanted to make, I think we can continue to push that message that we need to be inclusive, and create opportunities for people at all different life stages.

[00:36:10]

RICK WEISS: Thank you. And Karen, thoughts on how media is handling this?

[00:36:15]

KAREN FINGERMAN: Again, I want to echo what the other speakers said that media is doing a really good job. There are a lot of really good stories out there. The thing that—I want to build on what Ashwin just said, and I think that I forgot to mention when I was talking about age differences, is that younger adults tend to be on the whole as a population lonelier than older adults. So, when you just do a survey of the whole US population, you find a much higher rate of loneliness in the young adults. And that was the case during the pandemic. The older adults were coping better. They were less lonely, actually. And some of that is the coping strategies they’ve developed. And so they’ve learned, over time, to adapt to make time alone into solitude, instead of loneliness at times. And I think that builds on Dr. Holt-Lunstad’s point that it’s not just a psychological state connection, being able to deal with time spent, not with other people, actually may improve with age. And that might be an area where there could be some good media coverage on what are older adults, if you will, doing right, that younger adults could learn from. So, that’s kind of the flipside of it. It doesn’t mean, I mean, I think we’ve really brought the case to you that when people are lonely in old age, because of what we’ve talked about with regard to the risk, to the body, if you will, that’s greater in old age. Your body’s more reactive. It’s going to show that result. So, even if the older population is less lonely, they still may be at greater risk, if that makes sense. So, it’s important. But I think it’s also important to consider how incredibly adaptive older adults are, and everything they’ve learned that people can benefit from.

[00:38:02]

RICK WEISS: What an interesting idea that there’s the flipside of loneliness, which is solitude, which sounds, I guess, positive? Can solitude can be healthful—?

[00:38:09]

KAREN FINGERMAN: Yeah, I should be hesitant there, because actually, we’re just beginning to work on that in my lab. And I think that Julianne has talked a little bit—I know, we gave a—she gave a panel that I was moderating. And you talked a little bit about the dangers, also, of time alone. So, I don’t want to send a message that it’s a great thing, but rather just to send a message that older adults are doing things that are adaptive, in some way, because they are showing a better profile than younger adults.


Are there differences between rural, urban, and suburban older adults, in terms of isolation or loneliness?


[00:38:38]

RICK WEISS: Hmm. Great. Maybe we can touch on that more during the Q&A. But why don’t we get started with some questions from reporters? And I’ll start with this one from Liz Seegert, who’s with the Association of Health Care Journalists. “What does the research show on any differences between rural and urban or suburban older adults, in terms of isolation or loneliness?” Does one of you want to start with that?

[00:39:04]

KAREN FINGERMAN: I could comment just a little because I was talking about that digital research. And so whereas digital cannot substitute for in-person, from what we can tell, it can enhance. And so when you look at people on the whole, who say, “I’m using digital,” not in any given moment. When I assess moment-to-moment, in-person was what changed the loneliness. But over 21 days, when they ask, “Have you been using the digital?” And they look at it, it does help. And in the rural areas, I think we know that the Internet is much less accessible. And so you’ve got that as a barrier to what could be an enhancement. So, and then you of course, have other factors that matter. Geographic distance. The presence of your long-term contacts, including family. And those things are—tend to be less in the rural areas. So, that would be a difference or a concern. There are also some social class differences in size of social network. And so being well-off economically also has benefits for social connection. Those things sort of go together. I don’t know what the other speakers know. That’s just—I had that in my notes, because I just was looking at that.

[00:40:23]

RICK WEISS: Other comments on that, urban versus suburban?

[00:40:26]

ASHWIN KOTWAL: Yeah, I will build on some of those comments. So, rural older adults, not necessarily lonely, and in some cases, incredibly tight-knit communities out in rural areas. However, geographic isolation can lead to challenges, particularly if people have new health issues, which keep them in their home and can make it difficult to access driving or public transportation. I’ve, for example, cared for patients in my clinic who have dementia, and they no longer can drive safely. And that is really challenging if you live in a rural—in a rural environment. Recently, there have been demographic shifts where—where extended families used to live in similar locations and rural situations, but are now moving across the country. That can be hard to adapt. And then lastly, there have been a number of changes in rural communities recently. The closures of a general store, for example, can be really impactful. We were talking about weak ties earlier in Dr. Fingerman’s talk. If you don’t have those places where people can get together, that can make a big difference. We’ve seen hospitals or nursing homes closed in rural situations, which are also really impactful. So, it’s kind of a mixed picture. The last thing I’ll mention is the Internet and Broadband, and those types of things, which can be sometimes some barriers in rural communities. And so we need to be aware of that and make sure we can expand access.


How can older adults who are feeling isolated meet new people?


[00:42:04]

RICK WEISS: Hmm. Great. Question here from Nick Gerbis from KJZZ Public Radio in Phoenix. “Isolation can become a self-feeding cycle, especially as barriers like depression or social anxiety mount. What would you recommend for people who want more social interaction, but have hit a wall or feel like their efforts to meet people are unsuccessful?” How do you meet new people?

[00:42:41]

JULIANNE HOLT-LUNSTAD: Well, I will try to address that, but I welcome input from the others. One thing that I think is really interesting is there was a study done during the pandemic, that showed that 10 hours of isolation was similar to 10 hours without going—or going without food. Showing that we—or suggesting that perhaps there are similar neural signatures, and that we tend to crave social connection. But what this data further showed is that the longer the time that people were in isolation, that craving went away. And so that becomes a real danger, especially as we’ve seen globally, a population that has had to spend significant amounts of time in isolation, that those general biological cravings have waned, and that we’ve also, in our ability to adapt, have become quite comfortable in isolation. And we’ve made it quite convenient. And so it can make it really difficult to make changes. And so suddenly, it’s—it might feel like more work to leave the house and more effort to go to social events. And that can feel challenging and uncomfortable. And it can feel like perhaps it would be easier just to stay home. But we have, as I mentioned, very robust evidence of the risks associated with isolation, even independent of feelings of loneliness. And so we need to be able to get out of that stage. And that’s where I think the real challenge is how do we get out of that? And there are a few recommendations that I can offer, but I certainly welcome the other panelists to chime in, because I don’t want to speak too much. But one way that may help is to—there’s a large literature on providing support or volunteering. And that can feel a lot less vulnerable than asking for help. And so by reaching out to others, and seeing how you can help them, cannot only reduce your own loneliness, but can also begin to start to strengthen those—those social bonds with others, and perhaps get you out of that cycle.


Is there any relationship between the type of housing seniors live in and loneliness?


[00:45:33]

RICK WEISS: That’s a great suggestion. It sounds like from the earlier things you were mentioning, it also might be good advice for people who are on the fence, having been invited to go out and do something, and maybe are thinking, eh, try to get over that, and just go and you’ll be happy you did later. A question here from Ruth Dusseault from Bay City News in Berkeley, California. “Have you seen any research studies on the relationship between types of housing and loneliness in seniors?”

[00:46:10]

KAREN FINGERMAN: Well, if you’re thinking about what they call “CCRC’s”, the continuous care retirement communities—again, gosh, I feel like such a downer, or whatever. No, this is a research that I am not completely current on. So, I’m going back over a decade. But at that time, interestingly, at the university where I worked, the local community, like, that held an apartment for a graduate student to live in, so long as they like ate in the dining room with them, and things like that. And so I was on a dissertation committee, the doctoral student had done that. And of course, the reason people do this is so that they can have the continuity in their social world. And what happened is that when they moved to that assisted living, they lost the social network they’d had. They don’t know exactly why, but it can be very threatening, psychologically, to see your friend begin to decline, it might be affecting you to think, wait a minute, I’m still okay. I don’t want to think about that or go there. And so at each level, they weren’t getting that continuity that they were getting in the community. There are also differences. Right now, the intergenerational households are at their very highest they’ve been in over 100 years in the US. And those do seem to be really beneficial in many different ways. That doesn’t mean that if you—I don’t know what your situation is that you need to invite all your relatives to move into your two-bedroom house, but it is sort of an observation. And again, my knowledge of the literature on those transitions, it may have been improved since then, because as the research came out, facilities really try hard to make things better. You’re nodding, too, Ashwin, so I’m kind of—here, I’ll turn it over to you.

[00:47:57]

ASHWIN KOTWAL: Yeah, that’s great. Yeah, I think there’s a lot of innovative solutions, or some that had been actually in practice for a long time that we’re starting to—to realize they exist. For example, The Village Movement in California, I think, has been really fascinating, and something that’s potentially applicable at a larger scale. I’ve thought a lot about assisted living facilities and nursing homes, as additional transitions in housing that can impact loneliness and isolation. And it’s a little bit of a mixed bag. Right? So, if you’re getting to a point where you’re experiencing new disabilities, new health challenges, where you need to live in an assisted living facility, or nursing home, those may actually reduce barriers to socializing, because those environments are more geared towards activities that accommodate people’s physical or health needs. The same goes with people experiencing dementia, if they—if they’re experiencing cognitive impairments, that are creating barriers to socializing with others, being in a safer environment may actually reduce some of those barriers to interacting with others. Now, that it may come at a cost are a tradeoff, having a harder time leaving those facilities or having less connection to your prior communities. And so I think we need to be mindful about how we can maintain some of those connections, so that people, that transition period is easier, and also people don’t feel completely disconnected from those prior—those prior relationships.


How can journalists identify resources for people who feel lonely or isolated, especially during the holidays?


[00:49:36]

RICK WEISS: Great. Here’s a question from Cindy Goodman from the South Florida Sun-Sentinel. “How, as journalists, can we identify resources for people who feel lonely, isolated or depressed, especially during the holidays?” This speaks to I think, part of the new trend in journalism known as “solutions journalism”, where reporters are increasingly, I think, trying to include some useful, practical information for readers. Any categories of help that you might think reporters ought to include in their stories?

[00:50:08]

KAREN FINGERMAN: I do think the literature that Dr. Holt-Lunstad referred to earlier on volunteering is really an area where we’re seeing a lot of good research that—that’s the opportunity. The door is open, and deriving meaning—deriving just being with other people. That’s a really great place to do it. And what I was talking about earlier, those weak ties, those often if you—if you keep going the same week, the same time, those are just going to arise, even if they don’t become intimate relationships. They’re a form of social contact that can be very meaningful.


Does the risk of experiencing loneliness increase during the holiday season?


[00:50:46]

RICK WEISS: We’ve got a few more questions, I want to try to rush through. So, let’s see if we can squeeze a few more in, in the last few minutes. This is from Youri Benadjaoud from ABC News. “There was some mention of holiday cards, but more broadly, how does the holiday season amid friend family gatherings relate to loneliness? Does risk of loneliness increase in this season?”

[00:51:10]

JULIANNE HOLT-LUNSTAD: I’ll just quickly mentioned that, while certainly there’s a lot of media attention, you see images of families getting together. And so if that heightens that comparison level, that may heighten the loneliness for some, but the counter is that there are so many service—services and opportunities that are reaching out to people during the holidays as well. And so at least according to a BBC survey, they found that when they looked at time of year when people feel most loneliness, it actually wasn’t during the holidays. So, perhaps some of those efforts are counteracting some of the other kinds of effects that might otherwise heighten that.


Are there data on the value of solitude and whether it can enhance health?


[00:52:03]

RICK WEISS: Anything else on the seasonality—? Okay. Question here from Sandra Strieby, who’s picking up on I think the earlier point about solitude. She’s a freelance reporter based in Washington State. “Are there data on the value of solitude, and in particular, how much solitude may enhance health?”

[00:52:30]

JULIANNE HOLT-LUNSTAD: So, I guess I’ll jump in and say that there is a lot of interest in solitude, and that is less well understood. But we do know that there is very strong evidence and very robust evidence that spending time in isolation has significant risks independent of loneliness. And so I think the key is, to what extent the—what timing we’re looking at. So, just like loneliness can be adaptive in the short-term, because it helps motivate us to reconnect socially, moments of solitude may be—may be helpful. But when—when more persistent, when time alone is more persistent, and isolation becomes more chronic, that is linked to significant risks.

[00:53:29]

KAREN FINGERMAN: Yeah, this—as you say, the interest is rising. So, we’ve been looking a little at it. I think the point in our research that would dovetail with what you’re saying is that solitude in the context of an active social life can be beneficial. So, for example, we have one study throughout the day that finds that when you’re having conflict in your social world, that having that solitude can help you reset, at least in old age where people are better at sort of readjusting their ideas about conflict, a moment alone. But that—we’re talking about moments alone in the context of an active social world. So, that may be, now again, the interest is just coming up, and I know we’re just beginning to look at it. But we’re looking at it, as you said it, I was realizing, wait a minute, our finding has to do with people who are very social, and then they’re stepping back for a moment, and they’re reengaging. And that might be where it’s beneficial.

[00:54:22]

ASHWIN KOTWAL: One thing I would just add is I sometimes use this question: “Do you need help connecting with others?” And that gives you a sense of is this something that where they’re in a place where they actually want to engage with interventions or community groups, or even a professional and thinking about how to reengage with others? Or is this a more active choice where people are actually taking a step back from their social life to regroup a little bit. But sometimes using that type of question as an invitation can be helpful.

[00:54:53]

RICK WEISS: Mm-hmm. Quick last question and a half here. First of all, Julianne, when you were mentioning the researcher, out this season not being the loneliest of the year, we do have Hilary Brueck, a health correspondent from Insider asking: “When was the loneliest time of year?” Do you know or remember?

[00:55:11]

JULIANNE HOLT-LUNSTAD: I’m sorry, I don’t recall. I just remember that the finding was that it wasn’t highest during the holidays.


What are the biological mechanisms that link loneliness and physical health?


[00:55:19]

RICK WEISS: All right, maybe we’ll be able to follow up on that. I’m going to try to squeeze in one last question here before we wrap, and that’s going to be from Damian McNamara, reporter at Medscape, asking whether we can say anything about the biological mechanisms known to account for this link between lower social isolation and lower levels of physical infirmity, and so on. And I don’t know if Ashwin is a clinician, you might want to have any insights into that, or anyone else about the physical mechanisms. How is this connection being made?

[00:55:51]

ASHWIN KOTWAL: Yeah, I can start although I rely on Julianne’s conceptual diagrams linking loneliness to health. So, I’ll also defer to her. The main ways, I think of it as is loneliness, by definition, it’s emotional distress. And when people are experiencing this stressful experience, over many, many years or even decades, it can lead to stress response in the body, which can activate our—our physiologic stress response, this hypothalamic pituitary adrenal pathway that leads to wear and tear on our body over time, and chronic inflammation, which leads to things like cardiovascular risk, dementia risk, and other chronic illnesses. It can also disrupt our sleep patterns. It can change the way that we’re interacting with our healthcare systems, and receiving healthcare and medications. So, there’s many different pathways, but I really think about that chronic inflammation as the main way that it’s leading to wear and tear on our body.

[00:56:56]

JULIANNE HOLT-LUNSTAD: And I’ll just add that that’s also true, even if we’re not feeling distressed. So, there’s quite a bit of research, just even when we are objectively alone. Because humans, throughout history, have needed to rely on others for survival. And so when we are alone, that’s a very vulnerable place. And so our brains are more active when we are alone. And are—because we have to—we don’t have others to rely on to—to meet the demands of everyday life. And so our brains become more active, and those systems become dysregulated. And so inflammation is one of the pathways that Ashwin—or Ashwin mentioned. But experimental studies have demonstrated this across cardiovascular responses, neuroendocrine responses, immune responses. There’s research looking at cellular aging, and some research that’s diving into gut microbiome. So, there are several pathways by which this occurs. And I think one of the interesting ones that Ashwin mentioned, the inflammation, is a nice one to highlight simply because it helps us understand a common pathway that might—that explains what might otherwise be viewed as very diverse kinds of outcomes. But there are multiple pathways by which this happens, both biologically, as well as behavioral changes as well, including things like sleep, disrupting—changing our eating and activity patterns, risk-taking. So, there—as well as medication adherence. So, there are behavioral patterns as well. So, both biological and behavioral pathways can explain this.


What is one key take-home message for reporters covering this topic?


[00:58:57]

RICK WEISS: All right. I know we’re a minute over, and we’re just going to wrap now. I’m going to ask each of you to take 15 seconds to give the reporters on this line a take-home message, often the best, cleanest, most quotable thing that we get out of interviews in journalism. I want to remind reporters before we wrap up, that as you log off today, you will get a prompt for a survey. It takes literally about a half a minute to do it. It’s so helpful to us, if you will take that half minute and answer three quick questions so we can keep designing these briefings to be most useful for you. And now with just 15 seconds each, if each of you would just give a take-home message what’s the one thing you want reporters to really walk away with after this hour together today. And Julianne, I’ll start with you.

[00:59:41]

JULIANNE HOLT-LUNSTAD: I think what I started with is that it’s critically important that individuals, our country, our nation, the healthcare system, invest in our social connections. It’s critical for our health, our well-being, and the success of our society.

[01:00:01]

RICK WEISS: Thank you. Ashwin?

[01:00:04]

ASHWIN KOTWAL: Yeah, this is a call to action for everyone. So, we’re—if everybody can make a difference, and it starts by having a conversation, destigmatizing these topics, and providing space to help people process what might be really challenging things that they’re going through.

[01:00:22]

RICK WEISS: And Karen?

[01:00:24]

KAREN FINGERMAN: And I think building on what both of the other speakers said is that, I guess what I would convey is, it’s not that hard to not be alone. There are billions of people on this planet, and that contact in a variety of ways that builds familiarity and connection can be beneficial.

[01:00:45]

RICK WEISS: Fantastic. I want to thank our speakers today for just bringing so much information and compassion to this really important psychological and medical topic. As usual, it’s just so great to get a few people together who really know what they’re talking about, and share their knowledge and insights with reporters. We really appreciate that. And thanks to the reporters attending and covering this important topic. We look forward to seeing you again at the next SciLine media briefing. So long!

Dr. Karen Fingerman

University of Texas at Austin

Dr. Karen Fingerman is a professor of human development & family sciences and is the director of the Texas Aging & Longevity Center at the University of Texas at Austin. Her research focuses on social and emotional processes across adulthood, health, and well-being. She oversees The Adult Family Project, which focuses on adults’ relationships with their parents, spouses, grown children, romantic partners, friends, and other social partners across adulthood and into old age. For this project, her team looks at how relationships with family members, friends, and acquaintances change from young adulthood to old age. Dr. Fingerman is also conducting the National Institute on Aging-funded Daily Experiences in Late Life Study examining older adults’ social relationships and physical and cognitive functioning in a daily context.

Declared interests:

None.

Dr. Julianne Holt-Lunstad

Brigham Young University

Dr. Julianne Holt-Lunstad is a professor of psychology and neuroscience and director of the Social Connection & Health Lab at Brigham Young University. She is also the founding scientific chair and board member for the U.S. Foundation for Social Connection and the Global Initiative on Loneliness and Connection. Dr. Holt-Lunstad’s research focuses on the individual and population health effects, biological mechanisms, and effective strategies to mitigate risk and promote protection associated with social connection. Dr. Holt-Lunstad’s research examines the influence of both the quantity and quality of social relationships on long-term health and risk for mortality, and she has found strong evidence that having more and better relationships is associated with better health while fewer and poorer quality relationships is associated with poorer health. As the lead scientific editor for a U.S. Surgeon General’s Advisory and Framework for a National Strategy, her work also focuses on translating evidence into practice and policy.

Declared interests:

None.

Dr. Ashwin Kotwal

University of California, San Francisco

Dr. Ashwin Kotwal is an assistant professor of medicine in the Division of Geriatrics at the University of California, San Francisco School of Medicine. Dr. Kotwal devotes most of his time to research focusing on understanding and enhancing social connections of older adults to improve their quality of life and health care access. Recent work has investigated experiences of loneliness and social isolation among older adults with cognitive impairment and the impact of the COVID-19 pandemic on social well-being. His research interests involve evaluation of community-based interventions to address loneliness and isolation, particularly among older adults with cognitive impairment or approaching the end of life. Dr. Kotwal’s clinical work focuses on advancing telehealth palliative care at the San Francisco VA Medical Center where he has been director of the Outpatient Palliative Care Telehealth Program since 2019.

Declared interests:

Dr. Kotwal is a research consultant for Papa Inc.

Dr. Julianne Holt-Lunstad slides

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Dr. Ashwin Kotwal slides

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Dr. Karen Fingerman slides

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