Social Isolation and Loneliness in Older Adults Opportunities for the Health Care System (2020) / Chapter Skim
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2 Evaluating the Evidence for the Impacts of Social Isolation, Loneliness, and Other Aspects of Social Connection on Mortality
2 Evaluating the Evidence for the Impacts of Social Isolation, Loneliness, and Other Aspects of Social Connection on Mortality
Pages 35-48
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From page 35... ...
Loneliness and other aspects of social connection are also emerging potential risk factors for mortality. This chapter considers the evidence for social isolation, loneliness, and other aspects of social connection as potentially causal risk factors for mortality, while Chapter 3 will do the same for morbidity and well-being.
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From page 36... ...
Thus, this chapter begins with an overview of how social factors (e.g., the social determinants of health) , including major social disparities and inequalities, have come to be recognized as major determinants of or risk factors for health and especially how and why social isolation and loneliness have come to be particularly pivotal at this point in time.
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From page 37... ...
attribute the dramatic rise of human life expectancy to the application of biomedical science, clinical medicine, and biomedically based public health. Such an attribution continues to dominate much thinking about health policy even to the present day, though its validity has been increasingly challenged, and most health researchers now agree that clinical medicine, public health, and social changes all contributed to this increase in life expectancy (see House, 2015, especially Chapter 4; McGinnis et al., 2002; McKeown, 1976, 1979, 1988; Szreter, 1988, 1997, 2000)
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From page 38... ...
The identification of cigarette smoking and other negative health behaviors as major risk factors for mortality and morbidity was pivotal to the movement toward a conception of the broader social determinants of health. The recognition of the danger of tobacco was considered one of the 10 greatest public health achievements of the 20th century (CDC, 2001)
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From page 39... ...
. Cassel and Cobb each reviewed a wide range of evidence from humans and animals showing that social connections were protective of health, especially in the face of biological and psychosocial risk factors for disease, most notably psychosocial stress, and both emphasized the ability of social support to buffer or moderate the adverse effects of such risk factors to health across a wide range of health outcomes.
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From page 40... ...
and why these may be causal effects. THE CURRENT STATE OF THE EVIDENCE ON IMPACTS OF SOCIAL ISOLATION, LONELINESS, AND SOCIAL SUPPORT ON MORTALITY As described in Chapter 1, the scientific evidence concerning social isolation and loneliness is based on a variety of different related conceptual and measurement approaches that all characterize related aspects of social relationships.
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From page 41... ...
In sum, more than four decades of research has produced robust evidence that lacking social connections has been associated with significantly increased risk for premature mortality -- and this is strongest among measures of social isolation. Furthermore, in spite of a variety of challenges in the definitions and 1 While social integration can describe high social connection, low scores on measures of social integration (e.g., the Berkman–Syme Social Network Index)
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From page 42... ...
subsequent measurement of both social isolation and loneliness, there is some evidence that the magnitude of the effect on mortality risk may be comparable to or greater than other well-established risk factors such as smoking, obesity, and physical inactivity (which also have their own challenges in terms of determining causality)
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From page 43... ...
The strongest study that contained good measures of both social isolation and loneliness was done in a large nationally representative sample in the United Kingdom, which found that both social isolation and loneliness were associated with mortality when considered independently and with limited control variables. The effect of loneliness though was not independent of demographic factors such as age or health problems and did not increase the risk associated with social isolation.
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From page 44... ...
When social isolation and loneliness are considered together, social isolation has remained a robust predictor of mortality, but loneliness appears more tenuous. Evidence Regarding Social Support and Mortality Social support is one of the three major components of social connection, and it has been extensively studied in relation to health.
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From page 45... ...
A FURTHER NOTE ON SOCIAL ISOLATION, AND SOCIAL CONNECTION MORE GENERALLY, AS A POTENTIAL CAUSAL RISK FOR MORTALITY Substantial evidence supports an association between social connection (across varied measurement approaches) and both better health and a reduced risk for mortality; there is also substantial evidence for an association between a lack of social connection (especially social isolation)
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From page 46... ...
and comparable to or greater than other accepted risk factors. Temporality Does the cause occur ✓ Prospective evidence establishes before the effect?
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From page 47... ...
FINDINGS AND CONCLUSIONS • Social isolation has been associated with a significantly increased risk of premature mortality from all causes. • There is some evidence that the magnitude of the effect of social iso lation on mortality risk may be comparable to or greater than other well-established risk factors such as smoking, obesity, and physical inactivity.
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From page 48... ...
48 SOCIAL ISOLATION AND LONELINESS IN OLDER ADULTS operate with each other in order to inform effective clinical interventions. Therefore, the committee recommends: RECOMMENDATION 2-1: Major funders of health research, including the government (e.g., the National Institutes of Health, the Center for Medicare & Medicaid Innovation, and the Patient-Centered Outcomes Research Institute)
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