Social Isolation and Loneliness in Older Adults Opportunities for the Health Care System (2020) / Chapter Skim
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3 Health Impacts of Social Isolation and Loneliness on Morbidity and Quality of Life
3 Health Impacts of Social Isolation and Loneliness on Morbidity and Quality of Life
Pages 49-62
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From page 49... ...
As described in Chapter 2, studies of all-cause mortality provide compelling evidence of the health impacts of social isolation, and several aspects of social connection have been associated with specific causes of death (e.g., cardiovascular disease, cancer)
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Social connection: an umbrella term that encompasses the structural, functional, and quality aspects of how individuals connect to each other. Social isolation: the objective lack of (or limited)
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As described in previous chapters, the scientific literature concerning social isolation and loneliness draws on a variety of conceptual and measurement approaches that collectively characterize related aspects of social relationships. In the following sections, the committee presents evidence of the effects of different aspects of social connection on health, using the terminology and definitions as described by the individual authors of the cited studies.
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From page 52... ...
. The risk ratios for a weak social network and few social contacts were even stronger after adjusting for the presence of depression, indicating that low social connection has discrete effects on dementia risk that are distinct from the effects of depression (Penninkilampi et al., 2018)
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From page 53... ...
. These studies have found inconsistent and, most often, opposing evidence that low cognitive function leads to subsequent social disengagement or loneliness in population-based cohorts; however, other research has demonstrated that older adults with declining cognitive performance experience disruptions in their larger and more diversified social networks (Aartsen et al., 2004; Ayalon et al., 2016; Donovan et al., 2017; Ellwardt et al., 2015; James et al., 2011; Wilson et al., 2007)
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. A systematic review of this topic included eight cross-sectional studies of adults aged 60 and older and found loneliness to have been associated with depression in seven studies and low social engagement to have been associated with depression in one study (Choi et al., 2015)
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. One German study that sought to compare different measurement approaches found that subjective loneliness and network quality best predicted mental health, whereas network size and living alone best predicted physical and cognitive health (Beller and Wagner, 2018b)
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(See Chapter 4 for information regarding risk factors associated with frailty in older adults.) Several aspects of the structural and functional characteristics of social connection have been associated with newly and previously diagnosed type 2 diabetes mellitus (T2DM)
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However, these effects can be positive or negative. For example, studies have shown that smoking cessation among one's social contacts improves the likelihood that an individual will stop smoking, while living with a smoker or having smokers among one's social networks decreases the likelihood of smoking cessation (Holahan et al., 2012; Lacey et al., 1993; Moore et al., 2014)
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From page 58... ...
In that analysis, elderly adults were found to be 57 percent more likely to experience suicide ideation if they had discordant social relationships, and perceived loneliness along with elderly mistreatment and poorly perceived social support were found to be the measures associated with the greatest effect (Chang et al., 2017)
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From page 59... ...
Other work done in the context of older people's social networks has found social isolation to be associated with decreased satisfaction with one's life, hopelessness, increased risk of depressed mood, and decreased happiness (Golden et al., 2009)
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• Strong evidence indicates that social isolation and loneliness have effects on the risk of cardiovascular and cerebrovascular morbidities. A smaller amount of evidence indicates that social connection has effects on the course of other chronic health conditions, such as type 2 diabetes mel litus, or on health characteristics, such as mobility and functioning in the activities of daily living.
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From page 61... ...
NEXT STEPS AND RECOMMENDATIONS Substantial evidence supports the association of social isolation, loneliness, and certain other indicators of social connection (e.g., social support) with an increased incidence of major physical, cognitive, and psychological morbidities; poorer health-related behaviors; and lower perceived well-being or HRQL.
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From page 62... ...
Therefore, drawing from information in all of these chapters, the committee makes the following recommendation as a strategy to mitigate or eliminate the negative health impacts of social isolation and loneliness: RECOMMENDATION 3-1: 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) , foundations, and large health plans should fund research to im prove the scientific understanding of the links between social connection and health, including the study of risk factors and mechanisms.
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