Published July 13, 2012, Pawtucket Times

“One is the loneliest number that you’ll ever do
Two can be as bad as one
It’s the loneliest number since the number one”

             Three Dog Night’s well-know lyrics on its first gold record may well mirror research findings of a study published last month in the Archives of Internal Medicine by University of California- San Francisco geriatricians.  That is, older persons can be lonely without really being alone because of lack of emotional connect, the feelings of emptiness or desolation being linked to serious health problems and even death.

             The UCSF geriatricians lead by Carla Perissinotto, MD, MHS, analyzed data in the Health and Retirement Study, a nationally representative study by the National Institute on Aging conducted on 1,604 older adults between 2002 and 2008. Researchers limited their analysis to participants 60 and older and the mean age being 71 years.

             Perissinotto notes in her study that it was one of the first studies to examine the relationship between loneliness and functional decline and death.

             “In our typical medical model, we don’t think of subjective feelings as affecting health,” said Dr. Perissinotto, an assistant professor in the UCSF Division of Geriatrics. “It’s intriguing to find that loneliness is independently associated with an increased rate of death and functional decline.”

 Lonely in Relationships

             UCSF researchers say that one of the more surprising findings of the team’s analysis is that loneliness does not necessarily correlate with living alone. The study found 43 percent of surveyed older adults felt lonely, yet only 18 percent lived alone.  

             “We are interested in identifying the different factors that cause adults to become functionally impaired and ultimately at risk for nursing home admission,” Dr. Perissinotto. “The aging of our population and the greater odds of institutionalization make it important for us to think about all the factors that are putting elders in danger, including social and environmental risks,” she noted.

             Researchers at UCSF focused on death and a decrease in the ability to perform daily activities such as upper extremity tasks, climbing stairs, and walking. People who identified themselves as lonely had a statistically significant 59 percent greater risk of decline. For death, 45 percent were at greater risk of death.

             “This is one of those outcomes you don’t want to see because it was terrible to find out it was actually true,” Dr. Perissinotto said. “We went into the analysis thinking that there was a risk we could find nothing, but there actually was a strong correlation.”

            The UCSF Research team believes the impact of loneliness on an elderly patient is different from the effects of depression. While depression is linked with a lack enjoyment, energy and motivation, loneliness can be felt in people who are fully functional but feel empty or desolate.

             The “baby boomer” generation – those born between 1946 and 1964 – represents the largest population growth inU.S.history. Some of them now are part of the 39.6 million population of people older than 65. That number is expected to more than double to 88.5 million by 2050.  As that population continues to expand, Dr. Perissinotto said she hopes to be able to start to integrate social and medical services for elderly patients more comprehensively, and be more mindful of what kinds of social interventions they require.

             Physicians “asking about chronic diseases is not enough,” she said. “There’s much more going on in people’s homes and their communities that is affecting their health. If we don’t ask about it, we are missing a very important and independent risk factor, she says. “We don’t think we can change genetics, but we can intervene when someone is lonely and help prevent some functional decline.” 

             That’s what 85-year-old jazz singer Barbara Dane is trying to avoid as she continues to entertain in theEastBaywell into her 80s.  “When your spouse dies, there’s a missing space in your heart,” says the widow. “You still want to know that someone cares about you. Connection to other people becomes even more important at this point in your life.”

               Dane, who has performed for over 70 years, credits her active social life to her positive outlook on life. She adds, “A lot of people around me are aging, and some are not doing so well,” she said. “Some who never developed social skills are having the hardest time and those are the ones we need to watch out for.”

 Everything is Interconnected

            Phillip Clark, ScD, Professor and Director, Program in Gerontology and Rhode Island Geriatric Education Center, says that these findings are consistent with what gerontologists have been saying for years; namely, that the experience of aging can only be understood by taking into account its physical, social, and psychological dimensions, because they are all interconnected with each other. “When we get older, we find that different parts of our lives and our health are increasingly related to each other,” he says.

             Dr. Clark states, “Although this recent study does distinguish between the research literature on social support and its specific results on loneliness, certainly the two areas share a common insight: that the psychosocial context of aging can either enhance or undermine our health as we get older.”  For instance, having one close friend—a confidante—as we get older can help buffer us from some of the negative effects of the losses often associated with aging. Just one person with whom we can share our joys and sorrows can make all the difference, he adds.

             The implications of this study are clear to Dr. Clark.  Professionals [including physicians] who work with older adults must be attuned to the psychosocial contexts of older adults and ask questions about how they are feeling, not just physically but also mentally.

             Dr. Clark believes it is not normal that we become depressed or lonely as we get older, and things can be done to address these problems so that older adults have a rewarding and healthy later life.

             Herb Weiss is a Pawtucket-based freelance writer who covers aging, health care and medical issues.  He can be reached at hweissri@aol.com.  This Commentary appeared in July 13, 2012 issue of the Pawtuckt Times.