Troy Johnson's dad died last year and now he's worried that his mom, 79, will be lonely. So he and his wife try to visit regularly and he and his brother coordinate their schedules to make sure one can be there for her if the other one is swamped.
Johnson, of Centerville, faces a common family concern: How to step in and provide companionship and help to an elderly parent who might feel lonely or isolated. He knows his mom needs help with some tasks. And he doesn't want her to be lonely.
According to new research, his worries are well-founded. Loneliness and social isolation are as dangerous to one's health as obesity, researchers at Brigham Young University found. All three can kill.
The BYU study is reported in Perspectives on Psychological Science.
"The public is very aware of common physical health indicators and risk factors," said Tim Smith, professor of counseling psychology and one of the study's authors. "Everyone understands that diet, exercise, smoking, alcohol use and obesity pose risks. Well, it turns out social isolation is just as predictive of death."
In earlier research, Smith and the study's lead author, Julianne Holt-Lunstad, associate professor of psychology, found loneliness poses substantial risk of death — similar to smoking 15 cigarettes a day or being alcoholic. The new study says the risk surpasses that posed by obesity and the researchers note that a lot of people are endangered.
More people live alone than at any time in human history, according to demographers and social scientists — a claim backed by U.S. Census figures. Smith said that experts look down the road and predict that America is cruising toward a loneliness epidemic in about 30 years.
The coin has two distinct sides, though. While social isolation and loneliness create a real health risk, having strong relationships improves health, Holt-Lunstad and Smith said.
Markers of social isolation
A recent Current Population Survey from the U.S. Census Bureau shows the increase in people who live alone, a steady progression from 5 percent in the 1920s to 27 percent in 2013, notes The Washington Post.
The research shows that older people are lonelier than people who are pre-retirement age. Their social networks have shrunk and they tend to be more isolated, Smith said. Older people leave the workplace where many have built a social network and they miss the daily contact. Their children may not be nearby or around often. A spouse's death can create a huge loss of companionship.
Researchers looked at 70 previously published studies on loneliness and isolation, involving a total of 3.5 million people. They considered three aspects: loneliness, social isolation and living alone. Studies don't generally look at the three together.
Living alone, having few social ties and little or infrequent social contact are all markers of social isolation. Loneliness is subjective, the perception of being socially isolated.
"They may be correlated in some cases, but each one of them is significant in terms of predicting mortality, suggesting they are all important," said Holt-Lunstad. She said the size of the effect on health is comparable to severe or morbid obesity.
One's living situation can raise concerns, but not tell the whole story, she added. "It's certainly possible to be living alone but have other social connections. Someone could be socially isolated but prefer to be alone. And it's also possible to be around a lot of people and still feel lonely."
She said the factors are all important but not necessarily interchangeable. Her best guess is that someone who is both socially isolated and feels lonely carries the greatest risk, but more study is needed. The researcher also pointed out that the effect on longevity is similar even for those who prefer to be alone.
For their analysis, the researchers controlled for socioeconomic status, age, gender and pre-existing health conditions. One of the measures used was the UCLA Loneliness Scale, where respondents rate themselves on 20 measures. It is a well-accepted measure and can show that even people who deny being lonely sometimes score off the charts as actually being lonely.
Previous research has prompted action and the BYU researchers hope their findings will, too. For example, the government in the United Kingdom has changed its social policy and invested in solutions to geriatric isolation, Smith said. Programs emphasize being social and helping each other, using tools like an awareness campaign that included catchy billboards.
One of the U.K. government's messages is that retiring to the countryside may not be the best idea for the elderly, Smith said, because "people overlook that most of our life satisfaction is around relationships."
How to help is situational and one needs to know what an individual deals with, said Holt-Lunstad. "If it's social isolation, increase social contact. The perception of loneliness is a little bit trickier. There you're needing to help modify someone's cognition, the way they think about life and isolation. ... Strategies are different if one faces social isolation rather than loneliness."
Technology has improved the ability to stay connected in many ways, including real-time video chats over great distances. But the authors warn that people will be hard-pressed to replace the warmth of in-person interaction with technology.
"It's so easy to get caught up in a schedule," said Johnson. "I hope you'd say you love this person so much you want to be there for them. But life's busy and we sometimes have to schedule time."
His wife Rachel occasionally nudges him that it's been a while if he gets too caught up in other things and hasn't seen his mom. He and his brother serve as "rodeo clowns," he said, one distracting their mom from the fact the other's been too busy recently.
Someone else's isolation is an "awkward situation and nobody's trained, so we all muddle through," he said. "But you hope everybody'd step up."
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