Why loneliness really can harm your health... and how a coffee morning could be just the medicine many of us need
WHAT should we do to stay healthy and live a long life? I’m sure most of you can list all the ‘dos and don’ts’ just like that: don’t smoke, drink less, exercise regularly, eat healthily and get enough sleep.
But how many of you mentioned the dangers of loneliness?
Loneliness isn’t just a wishy-washy side note that makes people more prone to being depressed. It’s a silent killer that’s claiming the lives of many thousands of people every year.
A study last year by the European Commission’s Joint Research Centre (JRC) showed that Ireland had the highest levels of loneliness in Europe, with 20 per cent of respondents reporting feeling lonely.
Loneliness was something that was hardly ever discussed when I was at medical school, but it’s now widely acknowledged we have to tackle it if we’re to improve people’s health.
Modern medicine is geared up to help patients when they become ill — but what we often fail to do is treat the underlying reasons for why patients become ill and ‘fall over’ in the first place. And that’s where loneliness comes in.
I see its effect on a day-to-day basis, in my work in A&E — regularly treating patients who’ve had a stroke or heart attack soon after retirement.
I remember one particular case vividly: a mechanic in his early 60s who hadn’t lived the healthiest of lives — smoking and having a daily fry-up with his colleagues, and without a spouse to keep on at him about his expanding waistline and alcohol intake.
BUT he was happy — he bantered with his work colleagues and often went out with them in the evenings. However, after he retired, he lost his social connections.
On the face of it, he became healthier: he wasn’t going out in the evenings so his alcohol intake fell, and he had fewer fry-ups.
And without the social pressure of his colleagues smoking, he gave that up, too. But he was lonely — very, very lonely.
One morning, three months after his retirement, he suddenly couldn’t move his right arm and couldn’t get his words out.
He managed to knock on his neighbour’s door, and they called an ambulance.
In A&E, the diagnosis was obvious — he’d had a major stroke.
Despite treatment, he never regained the use of his arm or his speech. He went from being an expert mechanic to a nursing home resident in a year.
The retirement effect was not just a coincidence.
In 2012 a study by public health experts at Harvard Medical School in the US, involving more than 5,000 people aged over 50, revealed that being retired was associated with a 40 per cent higher risk of having a stroke or heart attack compared with people who were still working.
Was post-work loneliness to blame? There is a lot of good data to show that this is the case.
In a major review, published in the journal Heart in 2016, researchers at York University looked at the data from 23 papers (with more than 35,000 participants). They found that loneliness led to a 29 per cent increase in the risk of a heart attack and a 33 per cent increased risk of a stroke.
More recently a study in Lancet Public Health last year showed that those who were lonely had a 12 per cent higher chance of being admitted to hospital with an infection than those who were not lonely.
Last year the World Health Organisation declared loneliness a pressing global health threat, with the US surgeon general saying that its effects were comparable with smoking 15 cigarettes a day, and greater than either obesity or lack of exercise.
And loneliness is spreading, thanks to the lockdowns and a change in social norms created after Covid, with the rise in working from home and binge-watching box sets on days off rather than working in groups and socialising.
The mechanism for how loneliness increases the risk of premature death is incredibly complex but, essentially, it triggers our stress response, leading to increases in blood pressure.
This stress response also affects chemicals in the body, called cytokines, which cause inflammation, a known cause of premature ageing.
In my mind the evidence linking loneliness to poor health is very powerful.
But the evidence we have is from observational studies, where you monitor a factor, such as loneliness, and see the impact further down the line (for example, on death rates).
And others in the medical profession are less convinced by the evidence linking loneliness and illness, with the argument that the correlation could just be a coincidence.
The only way you can actually prove that loneliness causes medical problems is through a type of trial called a randomised controlled study, where one group of patients gets a treatment and another gets a placebo and you see the impact.
It works well when you are testing drugs, for example. However, it’s much more difficult to do this type of trial on something as complex as preventing loneliness.
More importantly, it’s much far harder to fund this type of trial as there’s no profit for drug companies. So the evidence base, in terms of randomised controlled studies, for tackling loneliness is not as strong as it could be.
HOWEVER, the proof that addressing it has an impact on health is mounting up. A few weeks ago I met with Jeremy Welch, a GP. He is a passionate believer in the importance of social interactions on people’s health and was especially worried about what was happening to his patients post-lockdowns. He managed to persuade colleagues to use some of their available ‘medical’ budget in a unique way — by getting all their patients aged over 65 who were lonely to engage in social activities to see if this could improve their health.
He appointed Anne Williams as lead nurse for the health and wellbeing team; they contacted 10,000 patients over 65, getting them to fill in a survey to find out if they were lonely.
Those who said they were (a third of the people surveyed) were invited to join a weekly exercise programme for three months arranged by Anne’s team and all in local community settings.
In the first year, there were more than 10,000 attendances at these classes, with the key factor being people met for tea and coffee after, and then, those who wanted it, were given information on other social activities available in the area, such as gardening clubs, dance clubs and choirs.
After this intervention, there was a 13.6 per cent reduction in the GP appointments for this group of patients.
This compared with an 8.6 per cent rise in GP appointments in similar people in a neighbouring town.
It’s too early to see the impact on rates of stroke and heart attack, but I have no doubt it will be positive. This type of medicine — holistic, and tackling potential problems before they occur — is the key to improving patients’ outcomes and stopping the health system imploding from unsustainable demand.
‘It’s just common sense,’ Jeremy told me.
‘Ask any of your grandparents... a stitch in time saves nine.’
a rider but his focus, which he credits to his training as a psychologist. Oran is now completing his additional MA in sport and performance psychology, which has been ‘enormously helpful’ in his competitive racing.
‘What gives you an edge is cognitive endurance and attention focus, especially when it come to navigating a route like Dakar,’ he says.
‘If you think about running a marathon or doing an Ironman, the path in front of you is very predictable. You’re not going to run off a cliff, you’re not going to run down a waterfall, or off the ledge of a sand dune. That’s not the case here. The environment and the terrain is constantly changing and completely unpredictable. You constantly have to be focused and on edge to react to everything that’s happening.’
While Oran says he could be reaching speeds of up to 160km an hour some days covering huge amounts of ground, the most challenging part of the competition is the diverse off-road terrain, chosen especially to hamper the participants.
‘There’s massive geographical differences in the stages — some parts you are traversing soft sands, then some of the biggest rocks and boulders, rivers, waterfalls and everything in between,’ says Oran. ‘They really find the most difficult, unique situations.’
There are bikes, car, buggies and trucks all competing at Dakar, and Oran says at times even the traffic can get to you. On the second last day of the event, he was knocked over by a car — not that it slowed him down much.
‘Ah yeah, I was a bit battered and bruised, but nothing that wouldn’t stop me going again next week,’ he laughs. ‘I knew the importance of finishing this year so I didn’t want to physically push too much to be in a position [to be placed].
‘Luckily, I got away without having any significant injuries or accidents, which is really, really good,’ he says, before adding that last year, at the Dubai International Baja, a two-day qualifying race for Dakar, he broke his back in two places. ‘Then I had to finish the day as well, which was quite difficult,’ he says. ‘But after that situation, it just made me realise how much I wanted this and wanted to go after it.’
Nothing — even a broken back or the risk of death — stopped Oran from achieving his dream, but he does admit that his injuries ‘definitely slowed him down for a few weeks’.
‘I spent time in hospital and then I had to pick up the pieces, rebuilt myself and kept on going,’ he says, adding that at this point he’s a little made of metal, resulting in him setting off alarms at airports. ‘Sure it’s all part of what I’m doing. Then when I get to an event like Dakar and complete it, it’s worth it.’
Oran answers carefully when asked is he ever worried about losing his life doing the thing he loves most of all.
‘The one amazing thing about Dakar is that it’s an extremely dangerous sport, but it’s done in an extremely safe manner. The level of equipment and technology that they have invested in has saved an incredible amounts of lives,’ he says, referring to the rally’s mandatory airbag system, essentially an inflatable patch that ‘blows up like the Michelin man’.
‘If you press a button on your navigation, the helicopter will be with you in five minutes,’ he says. ‘I think if you really look into a lot of the incidents of injuries, nine times out of ten, it’s human error — someone’s been overtired, they’ve been pushing themselves too hard.
‘I think a lot of times people get caught up with their ego. They lose their self-regulation and think they can push in an area where they shouldn’t push. So I think it’s going to be impossible to completely eradicate human error. I think it’s a case of trying to be super-aware of where you are, what level of energy and concentration you have, to mitigate any safety issues or concerns.’
For now, Oran is taking a quick breather before returning to training and preparation for the second world championship round in Abu Dhabi at the end of February — a race he has done twice before, so is quite confident about.
‘Then there’s a round in Portugal, one in Argentina and finally Morocco,’ he says.
When asked if he fancies his chances completing them all, he says: ‘That’s the dream.
‘Portugal and Morocco are quite achievable, but Argentina is still a bit of a wild idea, but I’ve had wilder ideas that have come through so...’
For Dakar success — and indeed success in any gruelling event — Oran is of the belief that sleep, training and nutrition are the pillars of success, not to mention the power of psychology, particularly in motorsport.
‘When everything is going against you, it’s about being able to make the correct decisions. In sports psychology training and performance, we’ve been able to replicate the situations and use skills like visualisation and emotional regulation that are essential for endurance. It’s to prepare for when you’re in the thick of it, and still be able to perform at the highest level.’
Oran is the perfect example of someone who has never given up on his dream, and you just know he loves being on a bike as much now as he did when he was seven years old. No matter what, he’s willing to take the risk — and not just for the thrill.
‘It’s the freedom, the sense of presence,’ he explains. ‘I’ve no choice but to be focused completely on that moment, not thinking about what happened last night or what’s going to happen in 30 minutes. The level of calmness that brings, to be so present — it’s almost therapeutic.
‘I hope my story inspires someone to write a book, or to run a mile, or to start painting or go into acting — to do whatever that dream might be.’
‘A lot of times people get caught up with their ego’