The silent epidemic of loneliness

It's a bigger risk factor for disease than anxiety or depression, one researcher says

Loneliness is generally thought of as an emotional state—but research suggests it has a biological component that can significantly harm your health, Brian Resnick writes for Vox.

Psychologists often say that our existence as "social animals"—being able to "live, work, and cooperate in groups"—is "the key to our survival," Resnick writes. "But it comes with a tradeoff. Companionship is an asset for human survival, but its mirror twin, isolation, can be toxic."

Studies have found a link between loneliness and heart disease, for instance. And "a 2015 meta-review of 70 studies showed that loneliness increases the risk of your chance of dying by 26 percent," Resnick writes.

Steve Cole, a genetics researcher at University of California, Los Angeles, says "social isolation is far and away the strongest social risk factor out there." But the big question is why.

The biology of loneliness

In 2007, Cole and colleagues published a small study of 14 people that hinted at some answers. The study found that people who suffered from chronic loneliness had cells that were in a chronic "state of fear," Resnick writes.

Specifically, the genes in the cells of lonely people that regulate inflammation were "turned on to a degree not seen in non-lonely participants," Resnick writes. And according to Cole, chronic inflammation is linked to cardiovascular disease, neurodegenerative diseases, and cancer. "That provides one reasonable biological explanation for why [lonely people] might be at an increased risk for these diseases," he explains.

At the same time, the study found that the genes responsible for fending off viral infection had reduced activity in study participants considered to be lonely. This, as Resnick explains, is a confusing dynamic.

While inflammation can be useful to deal with stress in the short term, it's unclear why a lonely person's body would become less willing to defend against viruses. But Cole says inflammation is how the body fights bacteria—and the systems that fight viruses can strengthen bacteria. "So the body makes a choice—and it's all in the name of protecting against bacteria," Resnick writes.

These changes may be at the root of why chronically lonely people have worse health than their peers. But Cole is quick to note that the way the body reacts to loneliness is similar to how it reacts to other sources of chronic stress such as low socioeconomic status. In all cases, stress hormones like cortisol begin a chain reaction that prompts the genetic changes observed in Cole's research. Which along with other studies "suggest people who are lonely are more susceptible to chronic diseases, and less able to fight off immediate threats," Resnick writes.

Fighting loneliness

Luckily for the lonely, other studies by Cole and colleagues have found that harmful cellular changes abate when loneliness recedes. And preliminary research suggests reducing loneliness "reduces the impact of [harmful] cellular changes," Resnick writes.

Unfortunately, Cole says there is only "modest" evidence that interventions can make people less lonely—but the most effective interventions seem to focus on giving people a sense of purpose rather than reducing loneliness directly. For instance, there is a pilot program that aims to make older participants less lonely by matching them with children to "look out for" and tutor, Resnick writes.

Noting that loneliness is a bigger risk factor for disease than anxiety or depression, Cole says his research has convinced him that "there is a huge hidden epidemic of loneliness and disenfranchisement from the human race." And it's an issue that may become more important as the baby boomers become older, reaching a stage of life when loneliness typically increases, Resnick writes (Resnick, Vox, 1/30).

How this hospital supports patient- and family-centered care

 How this hospital supports patient- and family-centered care

With patient- and family-centered care as a strategic priority, Hennepin County Medical Center wanted to improve their HCAHPS scores in areas including nurse communication, medication communication, and hospital rating of nine or ten.

To help reach this goal, Hennepin implemented iRound in 2013 to systematically collect and use real-time patient feedback, using iRound as a "forcing mechanism" to ensure that staff learn about the needs of each individual patient, as well as those of family members. In 2014, Hennepin experienced significant increases in their HCAHPS scores—including one increase as large as 15 percentage points.

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