Loneliness is a risk factor for functional decline and early death in adults over age 60, according to aUniversity of California, San Francisco study published in July. More than 43 percent of the 1,604 participants reported that they often felt left out or isolated or lacked companionship. In the six-year follow-up period, more than half of the self-identified lonely people had difficulty with basic housekeeping and personal tasks. They also had a 45 percent greater risk of dying earlier than older adults who felt more connected to others.
The majority of lonely people (62.5 percent) were married or living with others — an indication that feeling lonely and being alone are not the same. “It’s not the quantity but the quality of your relationships that matters,” said Dr. Carla M. Perissinotto, a geriatrician who led the study. “You can’t tell who may be feeling lonely. It’s not just a little old lady living all alone.”
The study did not investigate why people said they felt lonely, Dr. Perissinotto added. “Is loneliness biological?” she asked. “Is it socially mediated — meaning are lonely people simply not caring for themselves or not interacting with the health care community? What are the mechanisms at play and what are some practical interventions? That’s where the research needs to go next.”
The health effects of loneliness should not be ignored, she added. “Lonely people aren’t taking the extra step of talking to their doctor or their kids,” she said. “If you don’t talk about it, nobody’s going to know.”
Other studies have found that over time chronic loneliness is associated with high blood pressure, coronary heart disease, a diminished immune response, depression, sleep difficulties, cognitive decline and dementia. So far, researchers do not understand how loneliness harms health and accelerates aging, said Louise C. Hawkley, a psychologist at the University of Chicago. She has written several papers on loneliness with a colleague, John T. Cacioppo, based on a large, long-term study of Cook County residents.
Chronically lonely people — estimated at 20 percent of the population and as high as 40 percent of adults over age 65 — may have problems because of the way they think about other people, Dr. Hawkley said. “Rather than look for signs of acceptance from others, lonely people are on alert for signs of rejection,” she said. “If you are afraid that others won’t accept you, you may come off as aloof or critical. Then, people become more careful around you, so a self-fulfilling prophecy or a loneliness loop develops.”
Cognitive behavior therapy focused on identifying and reframing negative social thoughts may help those with a sense of social isolation, she added.
The research comes at a time when one-third of Americans ages 45 to 63 are single, a 50 percent increase since 1980. Divorce among midlife and older couples is also rising, with one in four adults over age 50 splitting up, threatening connections to friends and extended family. Relocation, illness and retirement are common events in later life requiring a conscious effort to rebuild a social network, said Dr. George E. Vaillant, a professor and psychiatrist at Harvard Medical School.
“In the same way you exercise, pay your taxes and eat a healthy diet, you need to start replacing friends as soon as you lose them, particularly around retirement age,” said Dr. Vaillant, author of the coming book “Triumphs of Experience: The Men of the Harvard Grant Study,” based on one of the longest studies of aging in the world. Begun in 1938, the study has tracked the physical and emotional health of 268 Harvard students (several dozen of whom survive, all in their 90s); Dr. Vaillant led it for more than four decades.
The study shows that relationships are the key to healthy aging, said Dr. Vaillant, who advised cultivating younger friends for their energy and fresh perspective. “You must have somebody outside yourself to be interested in — not hobbies or crossword puzzles or your stock account — but flesh and blood,” he said. “That’s why volunteerism is so important — the only way to stop thinking of your own unique wonderful self is to think of others.”
But self-centeredness wasn’t the problem for Richard Anderson of Arlington, Va. The 67-year-old became a volunteer for the Well Spouse Association, a support group, after long serving as primary caregiver for his wife, who died in 2004 after decades of having a debilitating illness.
From caring for his wife, Mr. Anderson learned that sickness itself could be isolating. “As an illness progresses, friends have a harder time relating to you,” said Mr. Anderson, an academic librarian at Georgetown University. “And if there is no possibility of a cure, some people can’t handle it and drift away.”
After reaching out to the group, he met spousal caregivers with whom he stayed in touch. “Even though you do lose long-term friends during an illness, it’s still possible to make new friends who will accept your situation for what it is,” said Mr. Anderson, who has since remarried.
By ELIZABETH H. POPE