Loneliness is an experience that has been around since the beginning of time but we all learn to cope. Loneliness is personal and can occur when people are surrounded by others even when this individual is with their spouses and children. Loneliness must not be confused with a chosen isolation or solitude. It must be defined by one’s level of satisfaction with their connectedness, or their perceived social isolation. In most cases this occurs during life transitions such as the death of a loved one, a divorce or a move to a new place. And, this becomes a problem when it is chronic. This arises when individuals either don’t have the emotional, mental or financial resources to emerge and satisfy their social needs or there is an inadequate or non-existent social circle that can provide these benefits. If these needs are not met the major negative health consequences of loneliness can set in. Countering the health and social costs of loneliness and isolation must be seen as a community responsibility.
Any person living alone could be at risk for loneliness—but those who are in their 80s or older are especially vulnerable. Religious institutions may be the most widespread source of social support for older adults and should continue to treat older members as congregants even when they can no longer attend services. The lack of social support is associated with depression, which, if severe and untreated, is associated with increasing disability, loss of weight, disturbed sleep and thoughts of suicide or actual suicide. Social isolation results in an absence of opportunities for social engagement and mental stimulation, activities that are thought to keep the brain in good condition and reduce the risk of dementia.
Enlisting friends and older neighbors in a walking group can provide both social contact and safe exercise. For younger persons living in the neighborhoods, reaching out to an older adult around holidays or if the person has not been seen for a while takes little time but can be quite rewarding for both parties i.e. in deliberation between generations. For families it is also important to recognize the warning signs and act when a member is at risk of isolation. Making efforts to include the person in family events, this will enrich the event and will be well worth the extra effort to arrange the transportation.
The toll of social isolation
There is evidence linking perceived social isolation with adverse health consequences including depression, poor sleep quality, impaired executive function, accelerated cognitive decline, poor cardiovascular function and impaired immunity at every stage of life. In addition, a 2019 study led by Kassandra Alcaraz, PhD, MPH, a public health researcher with the American Cancer Society, analyzed data from more than 580,000 adults and found that social isolation increases the risk of premature death from every cause for every race (American Journal of Epidemiology, Vol. 188, No. 1, 2019). Only prisoners, whether political or criminal have documented in many a book about prolonged periods of social isolation. Winnie Mandela the movie and Castaway acted by Tom Hanks are prime examples.
And, perhaps, in the absence of actual human contact our brains may manufacture social experiences in an attempt to preserve our sanity. It has also been known of people who have lost loved ones to shut themselves off from the outside world rarely leaving the home. The loneliness and isolation, coupled with high levels of stress and unchanging sensory stimulation, may produce the same biological conditions that trigger a “visit” from the recently departed. Widows, especially have been known to express such visitations. Presences can range from a vague feeling of being watched to seeing a seemingly real person. Could it be a god, a spirit, an ancestor, or a personal acquaintance?
Intervention
Social relationships, given the mobile nature of our society, frequently are maintained at a distance through telephone contact, email, and social media when physical contact is not practical. Interventions relying on technology to reduce isolation may be better than no intervention at all, but they are not the same as in-person visits. A large cohort study has recently revealed that different methods of contact are not equal in reducing feelings of loneliness and depression. These investigators found a higher risk of depression in those with less than once-a-month face to face contact with children, family, or friends.
People with once or twice-a-week contact had the lowest rates of depression. (Teo et al., 2015). In the developed world and in a few pockets of geography in the developing countries there is an increasing amount of evidence that pets, especially dogs and cats, are associated with health benefits and reduced mortality. For the older person living alone, especially in our villages, dropping in once in a while also provides opportunities for new relationships, for shared meals, for group activities. Taking action on this specific action on contact surpasses any kind of medications to relieve stress.
However for individuals who have grown hopeless, pessimistic and negativistic, their lack of ability to act may be the result of a depressive illness that would benefit from counseling, psychotherapy and perhaps medication. An understanding that social isolation is a significant risk factor to health, of similar magnitude to obesity and diabetes, may be persuasive for sufferers who are able to increase social contact with others, either in person or through social technologies. It is also challenging to distinguish social isolation and loneliness from one another; not all who are isolated are lonely and not all who are lonely are alone. In this article, we continue by exploring meaningful options at intervention.
Conclusion
There is the need to literally “keep in touch.” Different dimensions of social i.e. “ties” relationships does have different implications for one’s health. The boundaries between social isolation and loneliness are often blurred, although they can be conceptually categorized within a relatively small number of domains. The options mentioned earlier are essential to the understanding of the links between social relationships, isolation and health; to identify people in need of help and to design appropriate prevention and intervention strategies. This article is written for all and sundry and hopefully conceptual clarity elucidated can support one’s intervention development and evaluation. The range of interventions required to address different problems should be in relation to people’s social relationships.
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