In the last few years of her life, my siblings and I had reached the point where we knew it was time to move our elderly widowed mother into a residence for seniors. Already showing signs of dementia and no longer safe to remain on her own in her large home, she had become increasingly miserable. She didn’t want to change anything, however, and we worried that she would hate this disruptive move into her new two-bedroom assisted living suite.
So we were thrilled shortly after her first week there when she excitedly told us about the nice new people she’d already met, all of the fun group activities scheduled each day, and the red blouse she had picked out to wear to the annual Valentine’s Day party that the staff were organizing later that week. She seemed to be happier and more alert than she had been in a long time.
Preventing social isolation is particularly important, not just to those moving into seniors’ homes, but to every aging Baby Boomer no matter where we happen to live – and particularly because of the startling link between social isolation, loneliness and an increased risk of cardiovascular disease.
A U.K. study published this year in the cardiology journal Heart reported that poor social relationships were associated with a 29% increase in risk of heart disease, with no differences noted by gender.(1) That’s a risk comparable to smoking 15 cigarettes a day.
In fact, researchers compared the influence of social relationships on mortality with other well-established cardiac risk factors like physical inactivity, obesity, anxiety or job strain. They concluded that people with poorer social relationships are at increased risk of premature death.
What’s the difference between being socially isolated and being lonely? Academics consider social isolation to mean having few social contacts, whereas loneliness means feeling unhappy about the social relationships you do have.
But surprisingly, loneliness and social isolation are not associated ONLY with those who live alone.
A study released by the National Academy of Sciences in 2013 found that elderly people living in large households or in residential care homes like my mother’s, although surrounded by other people, can actually be more likely to report loneliness than older people who live on their own.(2)
I’m reminded here of a friend’s story of visiting her frail elderly mother living in a care home, as she did several times a week. All visitors had to sign in at the front desk upon arrival, and my friend was shocked to see that the last name on the visitor sign-in book that morning was her own – from her last visit two days earlier. Of the 200+ elderly residents in that building, not one had had a family or friend visiting since then.
Conversely, it is quite possible, researchers concluded, to be socially isolated but not lonely. Some people who live on their own or even in remote places may not ever feel or report loneliness, as lead author Dr. David Steptoe explained:
“An individual may be lonely in a crowd, and socially contented while alone.”
These finding are similar to other research I’ve written about (here and here) about the effect of being married on heart patients. Each reinforces the truism that there are few feelings of loneliness worse than being lonely within an unhappy marriage. And in fact, such unhappiness can be downright dangerous to your heart health. See also: When being married makes being sick worse
A University of Rochester study, for example, predicted that 83% of happily married women will still be alive 15 years after cardiac bypass surgery, versus only 28% of women in unhappy marriages.(3) This 2012 study, published in the journal Health Psychology, suggested that supportive spouses may help by encouraging healthy behaviours, like regular exercise, healthy eating or quitting smoking – each one critical to longterm survival from heart disease.
This is particularly applicable for women. A married woman’s overall health can be significantly threatened by trouble at home, according to researchers at the University of Utah.(4)
Women respond to unhappy marriages by being three times more likely to develop metabolic syndrome – a cluster of serious cardiac risk factors like high blood pressure, high LDL (bad) cholesterol, high blood sugar, and excess body fat around the waist that are linked with increased risk of heart disease. Meanwhile, happily married women face a significantly lower risk of developing metabolic syndrome than their unhappily married counterparts. And happy marriages may just provide a powerful reason for women to “stick around so they can stay in the relationship that they like.”
We might imagine social isolation as a lack of contact or ties with close family or friends, community involvement, or access to necessary services. In Dr. Steptoe’s study, it appears however that even when sharing these three criteria, those who take an active role in maintaining health and independence as they age are actually less likely to feel isolated and more likely to feel that their community is a good one to grow old in compared to those who don’t take that active role. And those who spent very little time with friends and family, or at enjoyable social events, were more likely to die regardless of income or health status.
It’s not clear, said Dr. Steptoe in a radio interview for NPR’s Morning Edition, why social isolation and loneliness are linked to mortality. But one possibility is that having other people around has practical benefits as you get older. He explained that having others around may push you to go see a doctor if you are having symptoms like chest pain, for example.
When Statistics Canada surveyed Canadians for their 2009 Community Health Survey on Healthy Aging, the results were interesting.
Respondents were asked how often in the past 12 months they had participated in eight different activities. Here are some examples of frequent participation at least weekly for the following:
- family or friendship activities outside the household
- religious activities such as services, committees or choirs
- sports or physical activities with other people
- other recreational activities involving other people, including hobbies or games
Frequent participation was also classified as at least monthly for activities typically done less often:
- educational and cultural activities involving other people such as attending courses, concerts or visiting museums
- club or service organization activities
- neighbourhood, community or professional association activities
- volunteer or charity work
Not surprisingly, as the number of social activities and interactions increased, the likelihood of respondents reporting positive self-perceived health rose, and their likelihood of reporting life dissatisfaction decreased.
The number of social activities in which individuals frequently participated was strongly and significantly related to each of the health and well-being outcomes, independent of age and sex. Even when socio-demographic and health characteristics were taken into account, the relationships between social participation and health and wellbeing measures persisted.
The truth, however, for many aging adults is that there can be significant barriers that may keep many people socially isolated.
The most commonly mentioned obstacles to participating in more social activities with other people were:
- a health limitation (33% of men, 35% of women)
- claiming to be too busy, more so among men (28%) than women (16%)
- personal or family responsibilities (1 in 10 seniors)
- the cost, location or availability of activities (reported by 4% to 9%)
- women were more likely than men to report not wanting to go alone to an activity (17% versus 9%)
- women were also more likely than men to report transportation problems traveling to an outing (11% versus 4%)
Ironically, not participating in social activities with others because of a health limitation may well be a factor that actually makes health worse, as the Stats Can report concluded:
“People who are not healthy may still benefit from social participation, perhaps more so. It is also likely that there are reciprocal effects between social participation and health and wellbeing, such that better health allows for greater social participation, which, in turn, improves or maintains health, allowing for the maintenance or increase in the level of social participation.”
In other words, enjoying our time socializing with other people can make us feel better, which means we’ll be more likely to want to do more of it, which will make us feel even better. The less we enjoy these times, the worse we will feel. Arranging social time on a regular basis does require time and effort, but arguably, not as much time and effort as failing health requires.
Here’s how Dr. Steptoe’s team summarized our cohort of aging Baby Boomers when it comes to the reality of maintaining those important social contacts:
- 9% of seniors say that they often feel trapped in their own home
- 6% of older people leave their house once a week or less
- 30% say they would like to go out more often
17% of older people surveyed have less than weekly contact with family, friends and neighbours
- 11% have less than monthly contact
- 49% of all people aged 75 and over live alone
- 41% of people aged 65 and over feel “out of touch with the pace of modern life”
The types of social activities asked about in this report did not include the internet or social media, but other studies suggest that seniors’ use of the internet tends to be for personal communication(5), which has also been associated with lower levels of loneliness and isolation.
(1) Cardiac risk factors and prevention: Original article: Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart. heartjnl-2015-308790. Published Online 18 April 2016. doi:10.1136/heartjnl-2015-308790 et al.
(2) Andrew Steptoe et al. Social isolation, loneliness, and all-cause mortality in older men and women. Proceedings of the National Academy of Sciences of the United States of America. March 25, 2013.
(3) King, Kathleen B.; Reis, Harry T. Marriage and long-term survival after coronary artery bypass grafting. Health Psychology, Vol 31(1), Jan 2012, 55-62. doi: 10.1037/a0025061(4) Nancy Henry, Tim Smith. University of Utah. Presented to the 2009 American Psychosomatic Society’s annual meeting, Chicago.
(5) Sum S, Mathews RM, Hughes I, Campbell A. Internet use and loneliness in older adults. Cyberpsychology and Behavior 2008; 11(2): 208-11.
Q: What kinds of social activities in your life help make you feel less isolated? What challenges have you overcome to make those activities happen?
- Little social support: a big gap for younger heart patients
- How our girlfriends can help us get through the toughest times
- Who will take care of you at home if you’re seriously ill?
- Does getting older mean getting happier?
- Caring for elderly parents: why daughters pay a heavier toll than sons
- When being married makes being sick worse
- When you live with a serious illness – and a bad marriage
- Marriage triples our bypass surgery survival rates – but only if it’s happy
- Depressed? Who, me? Myths and facts about depression after a heart attack
- I don’t want to talk about it…