Social Isolation and Loneliness in Older Adults Opportunities for the Health Care System (2020) / Chapter Skim
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5 Mediators and Moderators
5 Mediators and Moderators
Pages 91-106
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From page 91... ...
Rather, the following sections summarize the current evidence concerning a few key mechanisms that exert critical roles in explaining the association between social connections and health outcomes. Then the chapter identifies and summarizes the evidence for several variables that have been identified as potential plausible moderators.
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FIGURE 5-2 Possible mechanisms by which social connections influence disease morbidity and mortality. SOURCE: Holt-Lunstad and Smith, 2016.
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MEDIATORS: BEHAVORIAL, PSYCHOLOGICAL, AND BIOLOGICAL MECHANISMS The mechanisms by which social connection -- or the lack thereof -- affects the development and course of disease have been elucidated by a robust and growing evidence base. Much of this evidence emerged in the context of examining the protective effects of social relationships and social support; however, this work relates specifically to both social isolation and loneliness.
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Sleep influences a variety of physical health conditions, including cardiovascular disease, weight gain and obesity, diabetes, and metabolic syndrome, and poor sleep has been associated with an increased mortality risk. Multiple studies have demonstrated a robust association between social
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Thus, being socially isolated and lacking social support significantly reduces medical adherence, which may partially explain poorer health outcomes. Psychological Pathways As noted in Figure 5-2 there are several potential psychological pathways by which social connections influence morbidity and mortality.
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Several studies have linked social support to lower rates of depression and greater subjective well-being. For example, one study found that that depression increased as in-person social contact decreased and that individuals with lower rates of in-person social contact had "a significantly higher probability of clinically significant depressive symptoms 2 years later" (Teo et al., 2015, p.
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. Strong evidence also links greater degrees of social support to cardiovascular functioning that confers lower risk for disease (Uchino, 2006)
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Inflammation Chronic inflammation has been linked to diseases such as heart disease, stroke, some cancers, and autoimmune disorders, so it is possible that there is a common pathway underlying the broad health effects of social connection on multiple disease outcomes. In particular, a meta-analysis of 41 studies (including more than 73,000 participants)
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population to assess the prospective association of both structural and functional dimensions of social relationships (social integration, social support, and social strain) with objectively measured biomarkers of physical health (C-reactive protein, systolic and diastolic blood pressure, waist circumference, and body mass index)
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was associated with higher risk. This provides strong evidence that social relationships influence health and longevity via these risk markers.
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Demographic Factors Demographic characteristics including gender, SES, and ethnicity all may influence the relationship between social connections and health outcomes. Gender Examining the larger literature via available meta-analytic data indicates that the protective effect of social relationships and the risks associated with social isolation broadly and with loneliness and living alone specifically were similar for men and women (Holt-Lunstad et al., 2010, 2015)
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Race and Ethnicity The majority of epidemiological studies do not report effect sizes for social isolation, loneliness, social support, or other aspects of social connection that are broken down by race or ethnicity. Therefore, researchers have not been able to adequately examine this factor meta-analytically.
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, women with small social networks and low levels of social support and small networks had a significantly higher risk of mortality (Kroenke et al., 2013)
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A lack of social connections has been linked to higher levels of inflammation, which may point to a plausible biological mechanism for the association of social isolation and loneliness with a variety of negative health outcomes. • Social isolation and loneliness have been linked to decreased quality of sleep, which itself can influence a variety of physical health conditions, including cardiovascular disease, weight gain and obesity, diabetes, meta bolic syndrome, and increased risk for mortality.
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• Understanding both the negative and the positive attributes of social re lationships is needed to fully understand how these relationships impact health. • Decreasing social isolation may not reduce risk if attention is not paid to the quality of the relationships; thus, indicators of quality need to be included in assessments.
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