Loneliness And Social Isolation

By Arvind M. Dhople, Ph.D., Professor Emeritus, Florida Tech

                Everyone needs social connections to survive and thrive.  But as people age, they often find themselves spending more time alone.  Being alone may leave older adults more vulnerable to loneliness, which can affect their health and well-being.

                Loneliness is not new, but it does seem to be gaining attention as a social and health concern.  The U.S. Surgeon General recently called loneliness a public health problem on the scale of smoking as damaging to physical health as 15 cigarettes per day.  The COVID-19 pandemic – necessitating periods of physical distancing and changing the way many structure their working lives – has brought the issue of loneliness to the forefront.  The harms to health are clear.  Poor social connections are associated with increased risk of cardiovascular disease, hypertension, diabetes, infectious diseases, impaired cognitive function, depression, and anxiety.  But can loneliness be addressed through a public health approach? 

                The slippery nature of loneliness and how it functions present many difficulties.  Although broadly understood as a negative experience resulting from inadequate meaningful connections, the public health community has struggled to reach a consensus definition.  Loneliness is not the same as alone.  It is not a binary state, and feelings of loneliness are heavily shaped by cultural norms.  This subjectivity presents a fundamental challenge.  How can the measurement of a feeling be standardized?  The comparison with smoking might help to explain the damage that loneliness can do, but it is a poor guide to potential solutions.  There is no product to be taxed or regulated; no obvious pathology to target.  These difficulties are reflected in the low quality of the literature: small trials, short observational studies, and varied definitions.  Simplistic, one-size-fits-all interventions are unlikely to succeed for such a complex phenomenon.       

                Perhaps what is needed is a recognition of loneliness as a product of how societies and the world around us are constructed: “lonelygenic environments”.  Our physical surroundings, dictated by urban planning, can deter social connection if they do not enable interactions and engagement.  Remote work has become more common, making it harder to form meaningful connections with colleagues.  Social media use, with its promises of bringing people together has been associated with increased feelings of social disconnection.  Austerity, poverty, racism, and xenophobia cause inequity and feelings of exclusion.  Societal trends towards individualism, at the expense of collectivism and feeling of belonging, risk increasing feelings of loneliness.  Attention needs to be directed at understanding how these root causes can foster loneliness, and at how to change or dismantle them for the better.

                There is a need to strengthen and broaden our understanding of loneliness.  A recent meta-analysis of data from 113 countries shows that loneliness is a global issue, with problematic levels of loneliness in a substantial proportion of the population in many countries.  But dada are scarce, and suffer from an absence of validated assessment tools.  Improved surveillance and standardized definitions are essential.  Furthermore, contrary to the idea that loneliness and social isolation are issues mostly in older people, loneliness affects people of all ages, and so a life-course approach is necessary to understand and alleviate it.  Efforts to ad loneliness will need to be personalized, given its complexity and heterogeneity.    

                Given all this, loneliness is an issue that needs attention from all of society.  But the health community can have a key role, not least through raising awareness and helping to reduce the stigma around loneliness.  General practice will be important for monitoring and surveillance, as well as delivering interventions, perhaps through social prescribing.  However, the evidence base for interventions is weak, and evaluation frameworks to assess interventions are needed.

                A widespread appreciation of the health dimensions of loneliness is important.  But applying systems thinking, taking a life-course approach, and understanding loneliness as a global issue are all in their infancy.  For now, perhaps the most useful contribution a health professional can make to alleviating loneliness is to have a meaningful interaction with a patient.  Establishing a connection, even if only briefly, could make all the difference.