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As health becomes a greater priority for people, misconceptions and gaps in our knowledge for achieving good health have emerged. One such gap is our ignorance of the detrimental impact of loneliness and social isolation on our physical health. One meta-analytic review found that the effects of loneliness and isolation on mortality is comparable to the impact of well-known risk factors such as obesity and cigarette smoking. This finding is particularly thought-provoking in the context of the lockdown and quarantine measures that were implemented during the Covid-19 pandemic. In this article, which first appeared on Medical Brief, the impact of social isolation and loneliness on cardiovascular and brain health is examined. – Nadya Swart
AHA flags effects of social isolation on cardiovascular and brain health
Social isolation and loneliness are common, and the risk appears high for the young and the old, although for different reasons.
The link between social isolation, loneliness and other social determinants in shaping cardiovascular and brain health outcomes is well established. Nearly one-quarter of community-dwelling Americans ≥65 years of age are socially isolated, while prevalence rates of loneliness are even higher, and more than 40 years of research have documented robust evidence that this lack of social connection, using measures of social isolation, has been linked to increased risk of premature death from all causes, as well as other adverse health outcomes.
Social isolation is defined as the objective state of having few or infrequent social contacts. Loneliness is perceived isolation that is distressing for the individual. Although related, they are distinct constructs that operate through different pathways and have unique downstream effects on health. Individuals can lead a relatively isolated life and not feel lonely; conversely, individuals with many social contacts may still experience loneliness.
Both social isolation and loneliness denote some degree of social disconnection.
Estimates from national surveys conducted in 2018 by the Henry J Kaiser Family Foundation, Association for Advancement of Retired People, and Cigna, noted prevalence estimates for loneliness of 22%, 35% and 47%, respectively. A survey conducted by Cigna described Gen Z (adults 18–22 years) as the loneliest generation, whereas the Greatest Generation (adults ≥72 years of age) were the least lonely or socially isolated compared with middle-aged adults.
Data suggest that social isolation and loneliness may have increased since the start of the Covid-19 pandemic, particularly among young adults (18–25 years of age), older adults, women, and low-income individuals. It is well known that risk for social isolation increases with age because of life course factors like widowhood and retirement.
Notable reasons for increased isolation and loneliness among younger adults are greater social media use, less engagement in meaningful in-person activities, and less experience regulating emotions, so everything is felt more intensely. Moreover, young adulthood is naturally isolating as individuals’ identities are changing and they are learning how to relate to others and their environment.
It is important to examine the impact of social isolation and loneliness on cardiovascular and brain health because social isolation, considered a stressor, has been shown to affect both risk of incident cardiovascular disease (CVD) and cerebrovascular disease, as well as prognosis, once disease manifests.
Risk and protective factors for social isolation and loneliness have been well described. These include predisposing physical health conditions (chronic illness, functional impairments), psychological and cognitive factors (eg, depression, anxiety), and socio-environmental factors (eg, transportation, living arrangements, dissatisfaction with family relationships, pandemics, natural disasters). Some of these factors increase the risk for adverse health effects, whereas others lower the risk.
In addition, there is a bi-directional relationship between risk factors and social isolation or loneliness. For example, depression may lead to social isolation, and social isolation may make an individual more likely to experience depression.
Certain populations are at higher risk for social isolation and CVD based on sociodemographic characteristics such as race and ethnicity, sexual orientation, gender identity, socioeconomic status, and social status (eg, immigrants, incarcerated individuals), or place of residence (eg, rural and under-resourced settings). However, research on health effects of social isolation and loneliness within these special populations is sparse.
This statement seeks to (1) critically review observational and intervention research that examines direct associations and mediating pathways between social isolation, loneliness, and cardiovascular and brain health and (2) highlight, where available, studies of the impact of social isolation and loneliness on cardiovascular and brain health in special populations.
Effects of Objective and Perceived Social Isolation on Cardiovascular and Brain Health: A Scientific Statement From the American Heart Association
Crystal W. Cené, Theresa M. Beckie, Mario Sims, Shakira F. Suglia, Brooke Aggarwal, Nathalie Moise, Monik C. Jiménez, Bamba Gaye, Louise D. McCullough, et al
Published in The Journal of the American Heart Association on 4 August 2022
Social isolation, the relative absence of or infrequency of contact with different types of social relationships, and loneliness (perceived isolation) are associated with adverse health outcomes.
To review observational and intervention research that examines the impact of social isolation and loneliness on cardiovascular and brain health and discuss proposed mechanisms for observed associations.
We conducted a systematic scoping review of available research. We searched 4 databases, PubMed, PsycInfo, Cumulative Index of Nursing and Allied Health, and Scopus.
Evidence is most consistent for a direct association between social isolation, loneliness, and coronary heart disease and stroke mortality. However, data on the association between social isolation and loneliness with heart failure, dementia, and cognitive impairment are sparse and less robust. Few studies have empirically tested mediating pathways between social isolation, loneliness, and cardiovascular and brain health outcomes using appropriate methods for explanatory analyses. Notably, the effect estimates are small, and there may be unmeasured confounders of the associations. Research in groups that may be at higher risk or more vulnerable to the effects of social isolation is limited. We did not find any intervention studies that sought to reduce the adverse impact of social isolation or loneliness on cardiovascular or brain health outcomes.
Social isolation and loneliness are common and appear to be independent risk factors for worse cardiovascular and brain health; however, consistency of the associations varies by outcome. There is a need to develop, implement, and test interventions to improve cardiovascular and brain health for individuals who are socially isolated or lonely.
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