Staying connected

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costumePhoto: Mark Epstein, Centre for Better Ageing.

“Our friends and families literally keep us alive,” writes gerontologist Prof Rose Kenny, who heads TILDA, an ongoing study on ageing in Ireland. So far, the study has shown that social engagement is protective against poor physical and mental health in older age—and that the converse is true. Loneliness is toxic, and it kills.

Relationships and happiness

The Harvard Study of Adult Development has come to the same conclusions. Also known as the “Harvard Happiness Study”, it has followed thousands of participants, some since as far back as 1938.

Initially two groups of men (724 in total) were selected—one from among Harvard sophomores and a comparison group from Boston’s poorest suburbs. They agreed to participate in questionnaires, interviews, blood tests and brain scans, which were conducted every two years. The results were astounding. Heathy longevity in participants was unrelated to neighbourhood, social and economic position, but to the quality of their relationships.

A full range of their academic papers can be found on their website, but study lead Dr Robert Waldinger has described some key findings as:

  • Warm relationships: People with strong social connections are happier, physically healthier, and live longer. Conversely, loneliness is detrimental to both mental and physical health. 
  • Quality relationships: The quality is more important than quantity. Having many friends does not count as much as having friends that can be relied upon. While warm committed relationships are protective of good health, high-conflict intimate relationships can be worse for health than being single.
  • Brain health: Strong relationships can preserve memory function as people age.
  • A mid-life predictor: Satisfaction in relationships at mid-life is a better predictor of health age at 80 than physical indicators, such as cholesterol levels.
  • Social fitness: Relationships need continuous effort to stay healthy and strong. Social fitness is just as important as physical fitness.
  • Mood regulators: Positive connections provide mental and emotional stimulation and boost mood. While positive contact with friends and family are important, even casual contacts such as talking to strangers, make a difference. Conversely, social isolation is a mood buster.

Relationships and social engagement are subjective terms. Much scientific research has explored how their absence impacts on health and well-being. Objective measures of loneliness have been developed, and given the scale of this growing social problem, loneliness has been the topic of many studies.

Photo: Elliot Manches, Center for Better Ageing

An epidemic of loneliness

In the UK, loneliness is a frequent visitor. According to Age UK, 2.6 million UK adults say they are always, or often lonely and more than a million older people say they go for over a month without speaking to a friend, neighbour or family member. The situation is similar in many other high-income countries, where a recent review found approximately a quarter of the over 60s experienced loneliness.

Fay Bound Alberti, in her insightful book The Biography of Loneliness, describes loneliness as a cluster of emotions, rather than a simply defined state. It may include anger, rage, self-pity, shame, sorrow and jealousy.  Far from being a universal human condition, her research shows that loneliness is a modern phenomenon, and the word only became common English usage in the early 19th century, peaking at the end of the 20th century. She concludes that loneliness is a product of transitions in the nature of home, work and values that occurred during the industrial revolution.

“Loneliness as a modern social affliction has grown up in the cracks, in the formation of a society that was less inclusive and communal and more grounded in the scientific medicalised idea of an individual mind, set against the rest,” she writes. “Loneliness thrives when there is a disconnect between the individual and the world, a disconnect that is so characteristic of neoliberalism, but not an inevitable part of the human condition.”

karaokePhoto: Centre for Better Ageing

 Loneliness and health

A swathe of recent studies has shifted our understanding of loneliness from an inevitable consequence of modernity to an epidemic with serious health and social consequences. For example, a large-scale US study in 2020 found that loneliness was associated with a 40% increase in dementia risk; and a 2015 review demonstrated that social isolation, loneliness and living alone were associated with an average of 29%, 26%, and 32% increased likelihood of mortality, respectively.

Another more recent systematic review of 114 studies found that loneliness had a medium to large effect on all health outcomes, with the largest effects being on “mental health” and “overall well-being”. Other research, investigating the biomedical impact of loneliness has found that that loneliness and social isolation trigger chronic inflammation and raise stress hormones in the body.

Studies also shows that lonely brains are different: they are rewired for introspection and hypervigilance to threats.

Seeing loneliness as a clinical or biomedical problem inevitably suggests it can be medicated out of existence. Indeed, a trial with the drug pregnenolone has shown some success but had negative side effects. Ironically, the researcher Dr Stephanie Caccioppo, abandoned the trial when she found she could manage her own loneliness (after the death of her long-time partner) through exercise and lifestyle interventions.

busPhoto: Peter Kindersley, Centre for Better Ageing.

What is to be done?

Governments are beginning to take loneliness seriously.  In 2023 the US Surgeon General told a press conference that loneliness poses health risks equivalent to smoking 15 cigarettes a day and published an advisory on the healing effects of social connection and community.

In 2017 the UK appointed a commission to investigate ways of reducing loneliness, which resulted in the appointment of a Minister for Loneliness and the publication of a loneliness strategy. Central to this was a £30 million fund to tackle loneliness and boost volunteering in 27 of the UK’s poorest areas.

Many other advanced industrial countries have awareness campaigns and strategies to combat loneliness. Some of these, like the Netherlands, were launched after headline-grabbing stories about old people dying alone and lying undiscovered for long periods of time.

How tackling loneliness fares on the current crowded agenda of social ills can only be guessed at. But what is clear is that loneliness, like many threats to health in older age, is a structural issue that can’t be legislated or medicated away.

The moral of the tale: staying socially connected may be one of the most effective ways to grow old with health and grace.

tablegroupPhoto: Elliot Manches, Centre for Better Ageing

References