Social isolation and loneliness are gaining increasing attention as risks to health and well-being among older adults worldwide. In the United States, about one-third of Americans aged 60 and over are estimated to feel lonely, and one-quarter of Americans aged 65 and over live alone. Social isolation and loneliness are closely related, but have an important difference: social isolation is used to describe situations where people live alone and have very few social connections, while loneliness is the feeling of being lonely regardless of one’s true level of social connection.
Loneliness, or feeling alone, is often a consequence of social isolation, but there are cases where the two situations do not match up. For example, many people actively seek and enjoy solitude, and would be defined as being socially isolated but not lonely. On the other hand, loneliness, as an affective state, is sometimes more related to a person’s level of mental health or depression rather than his or her actual living situation. As people age, it becomes increasingly common that they are “alone but not lonely”, as reduced social network sizes are often expected and prepared for as people age.
In order to better understand the unique contributions that social isolation and loneliness make to health behaviors as people age, we conducted a study using data from over 3000 English adults aged 50 and over. The aim of the study was to determine the independent associations between social isolation, loneliness, and engagement in weekly physical activity, daily intake of fruit and vegetables, smoking, drinking alcohol, and having an overweight or obese body mass index over a 10-year period during aging. We chose to study these specific health behaviors because they are implicated in risks for chronic conditions such as cancer and cardiovascular disease, as well as all-cause mortality risk. Further, they are behaviors that could plausibly be affected by social connections, such as having friends or family to help encourage positive behaviors and discourage negative behaviors.
We measured social isolation and loneliness based on information given by the study participants during study interviews that were conducted in their homes. Social isolation was defined based on several factors: whether someone had less than monthly contact with children, other family members, and/or friends, whether they lived alone, and if they belonged to any social organizations or clubs. Loneliness was defined based on responses to three questions about feelings of loneliness, such as “How often do you feel you lack companionship?” We used longitudinal statistical modelling to estimate the unique and independent relationships between each of social isolation and loneliness, and consistent engagement in each of the health behaviors over the 10-year follow-up period. We accounted for factors in the analysis that could be common causes of social isolation or loneliness and engagement in health behaviors, including age, sex, ethnicity, socioeconomic status, health status, and depression.
We found that socially isolated older adults were less likely than non-isolated older adults to consistently report engaging in moderate-to-vigorous physical activity or eating five daily servings of fruit and vegetables, and were more likely than non-isolated older adults to be consistently overweight or obese and to smoke at any time point over the 10-year follow-up period. In other words, we found that socially isolated adults were less likely to engage in healthy behaviors and more likely to engage in unhealthy behaviors during aging than non-socially isolated older adults. We also found that loneliness was not associated with any of the health behaviors that we studied, except that lonely older adults were less likely to quit smoking successfully than non-lonely older adults.
The results of this study support the notion that social isolation might lead to non-engagement in healthy behaviors. Social isolation could reduce or remove older people’s sense of obligation to stay well for family or friends, and would mean that someone has no social or emotional support to help them stay engaged in positive healthy behaviors. We were surprised that loneliness was not related to health behaviors, but it might be that actual social connections rather than the feeling of having poor social connections is what matters for healthy lifestyle behaviors. Importantly, our findings reflect the role of loneliness in the absence of depression; other research that considers the effect of depression on health behaviors may very well find different results.
There are important future questions raised by the results of this research. First, future research should examine the relative importance of different types and methods of social connections for health during aging. For example, direct face-to-face contact with friends and loved ones may have very different implications for behavior than online or telephone contact. The social media boom may have strong implications for the health, behavior, and well-being of older adults, who are increasingly connected online. We have not yet begun to unravel the potentially complex effects of social media on health in the aging population. Future research should examine the best possible ways to help isolated older adults to connect and stay connected with others in ways that help them to sustain healthy behaviors and promote their overall health and well-being.
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