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loneliness

Clinical significance: - loneliness accounts for over 80% of association between living alone & psychiatric disorders (depression, anxiety, others) [1] - loneliness is associated with physical & mental health-related quality of life - association with mental health-related quality of life remains after adjusting for both anxiety & depression [17] - primary care providers have increased contact with lonely elderly [17] - loneliness is associated use of NSAIDs, benzodiazepines, antidepressants, & sleep medications, & higher likelihood of polypharmacy [3] Complications: - loneliness is associated with increased all-cause mortality [14] - loneliness is associated with excess risk for premature death, cognitive impairment [4] - cognitive decline is ~20% faster in lonely adults - loneliness is associated with increased risk for myocardial infarction & stroke [10,12] - loneliness is associated with worsening depression & anxiety [12] - loneliness is associated with increased risk of infectious disease [12] - loneliness is associated with functional impairment [12] - loneliness is associated with death from overdose or suicide [12] - loneliness is associated with social frailty - loneliness is associated with increased risk of Parkinson's disease [16] - loneliness is associated with increased risk of cognitive impairment & dementia [18] Management: - if associated with social isolation, assess access to & comfort with using technology for social interaction [4]

Related

living alone social frailty social isolation

General

sign/symptom

References

  1. Jacob L et al. Relationship between living alone and common mental disorders in the 1993, 2000 and 2007 National Psychiatric Morbidity Surveys. PLoS One 2019 May 1; 14:e0215182. PMID: 31042720 Free PMC Article https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0215182
  2. Blazer D. Social isolation and loneliness in older adults - A mental health/public health challenge. JAMA Psychiatry 2020 Jun 3 PMID: 32492078 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2766710
  3. Kotwal AA, Steinman MA, Cenzer I et al. Use of high-risk medications among lonely older adults: Results from a nationally representative sample. JAMA Intern Med 2021 Jul 26; [e-pub] PMID: 34309620 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2782349
  4. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  5. Gardiner C, Geldenhuys G. Gott M. Interventions to reduce social isolation and loneliness among older people: an integrative review. Health Soc Care Community. 2018;26(2):147-157 PMID: 27413007 Free article https://onlinelibrary.wiley.com/doi/10.1111/hsc.12367
  6. Kotwal AA, Holt-Lunstad J, Newmark RL et al. Social isolation and loneliness among San Francisco bay area older adults during the COVID-19 shelter-in-place orders. J Am Geriatr Soc. 2021;69(1):20-29 PMID: 32965024 PMCID: PMC7536935 Free PMC article https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.16865
  7. Ong AD, Uchino BN, Wethington E. Loneliness and health in older adults: a mini-review and synthesis. Gerontology. 2016;62(4):443-449 PMID: 26539997 PMCID: PMC6162046 Free PMC article https://www.karger.com/Article/FullText/441651
  8. Cacioppo JT, Cacioppo S. The growing problem of loneliness. Lancet. 2018;391(10119):426 PMID: 29407030 PMCID: PMC6530780 Free PMC article https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30142-9/fulltext
  9. Fakoya OA, McCorry NK, Donnelly M. Loneliness and social isolation interventions for older adults: a scoping review of reviews. BMC Public Health. 2020;20(1):129 PMID: 32054474 PMCID: PMC7020371 Free PMC article https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-8251-6
  10. Cene CW, Beckie TM, Sims M et al Effects of Objective and Perceived Social Isolation on Cardiovascular and Brain Health: A Scientific Statement From the American Heart Association. J Am Heart Assoc. 2022 Aug 4:e026493 PMID: 35924775
  11. Imai A, Matsuoka T, Narumoto J Older people with severe loneliness have an atrophied thalamus, hippocampus, and entorhinal cortex. International Journal of Geriatric Psychiatry. 2022. Nov 12. PMID: 36394171 https://onlinelibrary.wiley.com/doi/abs/10.1002/gps.5845
  12. Holt-Lunstad J, Perissinotto C Perspective. Social Isolation and Loneliness as Medical Issues. N Engl J Med 2023; 388:193-195. Jan 19. PMID: 36648080 https://www.nejm.org/doi/full/10.1056/NEJMp2208029
  13. The U.S. Surgeon General's Advisory on the Healing Effects of Social Connection and Community. 2023 Our Epidemic of Loneliness and Isolation https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf
  14. Wang F, Gao Y, Han Z et al A systematic review and meta-analysis of 90 cohort studies of social isolation, loneliness and mortality. Nat Hum Behav. 2023. Jun 19 PMID: 37337095 https://www.nature.com/articles/s41562-023-01617-6
  15. Rodham-Clinton H The Weaponization of Loneliness The Atlantic. August 7, 2013 https://apple.news/AcSuBizhzTUmWAKO_XPdUbw
  16. George J Loneliness Tied to Subsequent Parkinson's Risk. Findings support Surgeon General's recent call to improve social connection. MedPage Today October 2, 2023 https://www.medpagetoday.com/neurology/parkinsonsdisease/106592 - Terracciano A, Luchetti M, Karakose S et al Loneliness and Risk of Parkinson Disease. JAMA Neurol. Published online October 2, 2023 PMID: 37782489 https://jamanetwork.com/journals/jamaneurology/fullarticle/2809774
  17. Williams-Farrelly MM, Schroeder MW, Li C et al Loneliness in older primary care patients and its relationship to physical and mental health-related quality of life. J Am Geriatr Soc. 2024 Mar;72(3):811-821. PMID: 38240340 PMCID: PMC10947914 (available on 2025-03-01) https://agsjournals.onlinelibrary.wiley.com/doi/full/10.1111/jgs.18762
  18. George J Loneliness Tied to Alzheimer's and Dementia Risk. Feeling lonely also linked with cognitive impairment that's not dementia, meta-analysis shows. MedPage Today October 11, 2024 https://www.medpagetoday.com/neurology/dementia/112361 - Luchetti M et al A meta-analysis of loneliness and risk of dementia using longitudinal data from > 600,000 individuals. Nature Mental Health. 2024. Oct 9. Not yet indexed in PubMed https://www.nature.com/articles/s44220-024-00328-9
  19. Graham J Older Men's Connections Often Wither When They're on Their Own Nearly one in four men over 75 live alone, leaving them vulnerable to depression and suicide. KFF Health News October 13, 2024 https://www.medpagetoday.com/geriatrics/generalgeriatrics/112348