Living solitary lives: It’s an underrecognized health crisis
In the wake of Christmas, as we gather to ring in 2024, I recall my patients who spend this “most wonderful time of the year” alone: the middleaged woman with depression, unable to visit her daughter in another state; the younger man with lung problems on the verge of homelessness.
The contrast between reality and the Norman Rockwell version of the seasonal festivities can be especially stark for those who spend the holidays in solitude. But the negative impacts of loneliness and social isolation on health aren’t limited to the weeks between Thanksgiving and New Year’s.
Both have been linked to higher rates of mental illness, dementia, infections and cancer deaths. They increase the risk of heart disease and stroke by an estimated 29 percent and 32 percent, respectively. Disconnection can raise the risk of dying early as much as daily smoking. From a neuroimaging standpoint, social exclusion and loss look similar to physical pain.
As a family physician, I’ve seen patients without a support circle struggle to make meaningful progress. I recall the middle-aged man trying to get sober after years of heavy drinking, a Spanish-speaking single mom with chronic back pain.
The patients who do well are often the ones with strong family ties: the older couple with five adult children living nearby, the elderly woman with COPD who came to every medical visit with an attentive daughter or grandchild.
Rates vary, depending, in part, on how survey questions are asked, but loneliness is common. A survey earlier this year by the University of Michigan showed that 34 percent of adults ages 50 to 80 had felt isolated from others some of the time (29 percent) or often (5 percent) in the past year. A Gallup survey from February indicated that 17 percent of U.S. adults felt lonely “a lot of the day yesterday.” An 80-year cohort study,
The Harvard Study of Adult Development, followed over 700 men – and later their spouses and descendants – throughout their lives. Study leaders Robert Waldinger and Marc Schulz concluded that having healthy, fulfilling relationships was the most important predictor of longevity and happiness.
We’ve faced setbacks in recent years. The rise of social media – which sometimes replaces meaningful inperson interactions and contributes to feelings of inadequacy and depression – has created barriers, especially for younger generations. Widespread isolation during the COVID-19 pandemic, which reduced even brief “micro-moments” of connectivity (conversations with a bus driver or store clerk, for example), increased feelings of loneliness. We have yet to recover.
Healthcare providers would do well to take a broad view of health, encouraging patients to prioritize relationships. We should support initiatives in schools, workplaces, and neighborhoods that provide opportunities for people to connect.
When I was in medical school in the mid-1990s, my study partner and I would sometimes debate which disease was the worst. Among parasitic infections, was it visceral leishmaniasis (spread by sand flies) or Guinea worm disease? One could cause fever, and anemia. The other could cause painful blisters – with worms.
What I’ve since realized as a physician is that the worst disease isn’t based on the diagnosis, but on the conditions surrounding the patient. Those who are alone, fighting an illness without friends or family, suffer the most.
Doggett is a columnist for Public Health Watch, a nonprofit news organization based in Austin. She is a family and lifestyle medicine physician at UT Health Austin’s Multiple Sclerosis and Neuroimmunology Center and senior medical director of Sagility. She is the author of a new memoir, “Up the Down Escalator: Medicine, Motherhood, and Multiple Sclerosis.”