It’s one of the most common difficulties families will face knowing their loved one is not safe at home but getting resistance or an unwillingness to consider moving to a senior housing community from the person who needs it.

By Amanda Gardner, Health.com
updated 5:23 PM EDT, Mon June 18, 2012 CNN.com

(Health.com) — Loneliness and isolation can affect your quality of life — and maybe your quantity of life, too.
According to a pair of studies published today in the Archives of Internal Medicine, living alone — or even just
feeling lonely — may increase a person’s risk of premature death.
One study followed nearly 45,000 people ages 45 and up who had heart disease or a high risk of developing the condition. Those who lived alone, the study found, were more likely to die from heart attacks, strokes, or other heart complications over a four-year period than people living with family or friends, or in some other communal arrangement. The risk was highest in middle-aged people, just 14% of whom lived alone. Solo living increased the risk of heart problems and early death by 24% among people ages 45 to 65, and by only 12% among people ages 66 to 80. And there was no association at all in people age 80 and older, a group in which living alone is common.

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More research is needed to confirm these findings, but in the meantime it may not be a bad idea for doctors to ask heart patients about their living situation, says senior author Dr. Deepak L. Bhatt, M.D., a cardiologist at Brigham and Women’s Hospital, in Boston.

Living alone “could be a little red flag that [a] patient may be at a higher risk of bad outcomes,” Bhatt says.
Why is living alone potentially harmful? Especially among the middle-aged, a demographic in which living with a
spouse or partner is the norm, living alone may be a sign of social or psychological problems, such as relationship trouble, a weak support system, job stress, or depression– all of which have been linked to heart disease. But living alone could affect health in more immediate ways. For instance, people who don’t have a spouse or otherfamily member keeping an eye on them may be more apt to skip their medications or ignore the warning signs of heart trouble, Bhatt says. (Indeed, a 2011 study found that men who have heart attack-related chest pain tend to get to a hospital sooner if they’re married or living with a partner.)

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Previous research has shown a “very consistent relationship” between a lack of so-called social support and poor health, but measures such as social support haven’t always been consistently defined, says Emily M. Bucholz, M.P.H., a medical student and doctoral candidate at Yale University, in New Haven, Connecticut.
“Living alone, in and of itself, could stand for many different things,” says Bucholz, who coauthored an editorial accompanying the studies. “Does it mean you lack companionship? Or is it that there is no one there to help you out with medications? Does it have to do with mobility or nutrition?”
The second study suggests that actual feelings of loneliness and isolation, and not just practical matters such as medications, do play a role in health. The six-year study, which focused on people age 60 and older, found that men and women were 45% more likely todie during the study if they reported feeling lonely, isolated, or left out. They were also 59% more likely to have difficulty with everyday tasks such as dressing and bathing, an important measure of overall health in older people.

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Lonely people — a full 43% of the study population — weren’t necessarily living alone, however. The link between loneliness and poor health held even after the researchers took into account living situation, depression, and a wide range of other factors, suggesting that feelings of loneliness or isolation might independently damage health in some way.Some experts view persistent loneliness as a form of stress, for instance, and in previous studies it has been linked with inflammation and other processes that can damage blood vessels. These biological factors, along with social factors, may help explain the new findings, says lead author Dr. Carla M. Perissinotto, M.D. “Feelings of being lonely could cause an inflammatory state,” says Perissinotto, an assistant professor of geriatrics at the University of California, San Francisco. “At the social end, those who feel lonely may be less likely to engage with the healthcare community or the community at large, and therefore have less self-care.”

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Although it’s too soon to say how — or even if — loneliness and isolation undermine health, the authors of both studies encourage doctors to discuss living arrangements and feelings of loneliness with their patients. The conversation may provide a clue that patients aren’t sticking to their medication, or an opportunity to suggest ways to alleviate loneliness. Even just raising the issue can be beneficial, Perissinotto says. “Acknowledging it can go a long way,” she says.”People feel like they’re not ignored.”

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JUNE 18, 2012, 4:01 PM

By JUDITH GRAHAM

Loneliness stings at any age. But in older people, it can have serious health consequences, raising therisks of an earlier-than-expected death and the loss of physical functioning, according to a studypublished on Monday.The report, in the Archives of Internal Medicine, is the largest yet to tease out the impact of lonelinesson people in their later years. Geriatricians at the University of California, San Francisco, asked 1,604adults age 60 and older how often they felt isolated or left out, or lacked companionship. Theresearchers were attempting to quantify the feeling of loneliness — a sense of not having meaningfulcontact with others, accompanied by painful distress.Answers were recorded in 2002 and every two years after through 2008. The number of older adultswho reported feeling lonely — just over 43 percent — didn’t change significantly over that period,according to Dr. Carla Perissinotto, an assistant clinical professor at U.C.S.F. and the study’s leadauthor. About 13 percent of older adults said they were often lonely, while 30 percent said lonelinesswas sometimes an issue.What did change over the six-year period was the health status of elderly men and women who feltisolated and unhappy. By 2008, 24.8 percent of seniors in this group reported declines in their abilityto perform the so-called activities of daily living — to bathe, dress, eat, toilet and get up from a chairor a bed on their own. Among those free of loneliness, only 12.5 percent reported such declines.Lonely older adults also were 45 percent more likely to die than seniors who felt meaningfullyconnected with others, even after results were adjusted for factors like depression, socioeconomicstatus and existing health conditions.The emphasis on meaningful connections goes to the heart of what loneliness is and is not. It is notthe same thing as being alone: 62.5 percent of older adults who reported being lonely in this newstudy were married. Nor is it simply a paucity of social contacts. As has been observed many times,people can feel lonely even when surrounded by others if their interactions lack emotional depth andresonance.Loneliness is about the way people experience relationships subjectively, not the number ofrelationships they have, expert say.That isn’t to say that the number of relationships, or what’s known in the scientific literature as“social supports,” isn’t important. In fact, a large body of research has demonstrated that socialsupports are critical to older adults’ health and well-being, as well as to their longevity. Instead, bothsocial supports and loneliness are important, each separately, each in its own way, even as these components of older people’s lives interact, Dr. Perissinotto said.

Barbara Dane, an 85-year-old jazz and blues singer who lives in Oakland, Calif., has seen this play out
in her relationship circles.

“As you get older, you see the world writing you off,” she said, adding, “So you tend to become passive
and think, ‘I don’t want to bother anybody.’ You lose contact with your own kind, your tribe. And before you know it, you’re feeling bad.”

“It’s kind of life a self-fulfilling prophecy. Your eyes start to fasten on the sunset, and you start walking toward it.”

An unanswered question is what explains the physical impact of loneliness on older adults. Andrew Steptoe, director of the Institute of Epidemiology and Health Care at University College, London, has been studying this subject. “There is growing evidence that both loneliness and social isolation are related to biological processes that may increase health risk, including changes in immune and inflammatory processes and disruption of the stress-related hormones,” he wrote in an e-mail.

“Practical aspects of human contact may also be important,” Mr. Steptoe continued. “Someone who lives alone may not have anyone around to call for help if they suddenly experience acute symptoms, while a lonely older person may not have others about them to remind or encourage them to take their medications or follow the doctor’s advice.” A small study published last year in Psychology and Aging offers another clue. In that report, Anthony Ong, associate professor of human development at Cornell University, showed that the blood
pressure of older people rises in reaction to some kinds of stress and that loneliness accentuates this response.

“Loneliness may be something that is particularly salient in later life, and we should design interventions that help screen for it,” Mr. Ong said. Short of that, reaching out more consistently to elderly friends, neighbors or relatives may help, Dr. Perissinotto said. “Sometimes for older people, just realizing that someone is listening and they’re not being ignored makes a difference.”

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