An Epidemic of Loneliness (Naderi, 4/29/2020)

Such an important topic this week from Dr. Tahereh Naderi: An Epidemic of Loneliness. While she focused her talk on loneliness in elders, her presentation certainly has me pondering a loneliness in my own life-- especially in pandemic times.

What is loneliness? It's subjective: it's your own perception of the lack of interaction
What is social isolation? An objective lack of meaningful and sustaining communication and/or interaction.

Risk factors for loneliness include: older age (esp >80), poor subjective health and self-reported functioning, large number of chronic illnesses, impaired hearing, functional disability, lack of mobility or motor decline, hopelessness, depressed mood, psychiatric morbidity (e.g. depression), quality and quantity of social interactions, living arrangements, low SES, and race.

2 in 5 Americans report they sometimes or always feel their social relationships are not meaningful.
1 in 5 Americans feel lonely or socially isolated
In the past decade, average household size has decreased leading to 10% increase in people living alone, 28% of older adults live alone
Over the past 2-3 decades, the average size of our social networks has declined

The impact of loneliness is real:

• greater risk of cognitive decline and dementia
• lower self esteem and limited use of coping mechanisms
• increase in personality disorders, schizophrenia
• increase in risk for depression
• predictive of suicidal ideation and behavior
• increased substance use (especially alcoholism)

And what about quarantining?

Data following the SARS health crisis in China in 2003, found that quarantining had particular impact on healthcare workers even after restrictions were lifting including:

• low social contact
• avoiding enclosed public spaces
• not returning to work
• long term behavioral changes such as excessive hand washing

Isolation can exacerbate feelings of anxiety, anger, and pre-existing symptoms, can increase one's risk of developing PTSD, and interrupt treatment for substance use disorders. 

Dr. Naderi reminded us (we need to keep hearing this) that social distancing DOES NOT equal social isolation.

Also, guess what? There is an antidote to loneliness: social connection. Social connection actually makes people healthier!

• A meta-analysis including >300K people concluded that greater social connection is associated with a 50% reduced risk of early death
• In studies of the "blue zones" (regions in the world with the greatest concentration of centenarians), social connection is a component of 4 of the 9 of the power principles. The power principles are the 9 lifestyle habits that seem to be associated with longer, healthier, happier lives. 

Believe it our note, we can work on increasing or firming up our social connections in several different ways-- through mindfulness and acceptance, increased use of technology (yep, it's true, even for seniors) and intentionally reaching out to others to form community.

• A randomized controlled trial using mindfulness-based techniques was able to reduce loneliness by 22% and increased social interactions in daily life by 2 more interactions per day and one additional person per day!
• The use of technology-- even in seniors-- can effectively decrease loneliness (multiple modalities including email, video conferencing and computer training). 
• Shared activities were effective: gardening, physical activity, visual arts discssion, even animal therapy!!

Dr. Naderi introduced us to the concept of  Moais (模合, Mo-ai):social support groups that form in order to provide varying support from social, financial, health, or spiritual interests. Moai means "meeting for a common purpose" in Japanese and originated from the social support groups in Okinawa, Japan. These have been studies as part of the blue zone studies.

While Okinawan Moais are inherently built in to society, we may have to be more proactive about reaching out and creating ours. If you don't have one, consider taking steps toward forming a Moias. Or identify and strengthen the one you have. 

Dr. Naderi concluded with an quote by Vivek Murthy, internal medicine physician, 19th Surgeon General of the US, who took a particular interest in loneliness as surgeon general:

"The irony is that the antidote to loneliness, human connection, is also a universal condition. In fact, we are hardwired for connection-- as we demonstrate every time we come together around a common purpose or crisis- and even now as we face the global COVID-19 pandemic and resort to physical distancing to reduce the spread of the virus, we are recognizing that we cannot make it through fear, dager, and uncertainty of the current moment without supporting one another. "

Go ahead, close this browser, call that person you've been meaning to call. You won't regret it.