Face-to-Face Social Participation Nourishes Quality of Life

Staying socially active promotes self-reliance and well-being as we age.

Posted Nov 24, 2016

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As people across the United States of America come together to celebrate Thanksgiving with family and friends... new research confirms that face-to-face social participation is highly beneficial to someone's quality of life. The Macmillan Dictionary defines 'Quality of Life' as, "the enjoyment of life at a basic level, which includes being happy and healthy, rather than having lots of money." 

According to a wide range of research, the two cornerstones of Thanksgiving—gratitude and social connectedness—are an unbeatable combination for combating depression while improving self-reliance and quality of life, especially as you age. 

The latest November 2016 findings on the benefits of social connectedness were published this week in the Journal of the American Geriatrics Society. (To read more about the benefits of gratitude, check out my Psychology Today blog post, "Small Acts of Generosity and The Neuroscience of Gratitude").  

For the most recent study on the benefits of social participation, a team of researchers from Nara Medical University in Japan were curious to identify if participation in social activities could improve an older adult's ongoing ability to perform the Activities of Daily Living (ADL).

The ability to perform the simple activities of daily living—such as bathing, dressing, shopping, preparing simple meals, doing light housework, going to the post office, etc.—are a fundamental aspect of an older adult maintaining his or her independence and quality of life.

Increasingly, the decline of elderly adults' ability to perform daily life activities is a growing public health concern in countries with a critical mass of rapidly aging populations. When older adults begin having trouble managing their daily activities independently, quality of life often deteriorates. And, someone's risk of falls, hospitalization, and mortality increases.

Therefore, identifying practical ways to improve someone's ability to perform ADLs for as long as possible needs to be a top priority. The good news is that social activity and participation were found to create a dynamic upward spiral of increased mobility, more positive outlooks on life, and the desire to take better care of oneself.

There are four reasons that might account for the link between social activities and the sustained ability to perform life's daily activities:

  1. Participating in social activities means that you are physically engaging in society.
  2. Social participation provides emotional support, laughter, and levity.
  3. Participating in social activities makes you feel as if you matter to a community which provides a sense of meaning and belonging.
  4. Social activities help relieve the angst of perceived social isolation.

Taken together, these factors provide inspiration and motivation for older adults to maintain their ability to function. Public health advocates and healthcare professionals should take note of older adults' social activity and make face-to-face social participation a top priority to increase the likelihood of someone's long-term well-being and independence throughout his or her lifespan.

We Must "Tend-and-Befriend" for Our Individual and Collective Well-Being

In the mid-twentieth century, a handful of American researchers began studying the lifestyle habits of indigenous populations and tribes in remote regions of the world who had remained untouched by industrialization. They were trying to identify which fundamental lifestyle habits were associated with human longevity and good health.

Legendary scientists such as Alexander Leaf of Harvard Medical School and René Dubos of Rockefeller University discovered that among other lifestyle choices, strong social bonds seemed to protect indigenous cultures from illness and helped them live longer. Dubos was a world-renowned microbiologist, author of the 1969 Pulitzer Prize-winning book So Human an Animal, United Nations Ambassador, environmentalist, and humanist who coined the phrase, "Think Globally. Act Locally."  

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There are two definitions of humanism—one is believing in the “values, characteristics, and behavior that bring out the best in human beings.” The other is an innate “concern for the needs and well-being and interests of all people.” The Three Musketeers’ maxim “One for all, and all for one” sums up the collectivism of the humanist philosophy and reinforces the importance of our social connectivity. Celebrating diversity and avoiding the "us" against "them" divisiveness of ingroups versus outgroups is at the heart of humanism. 

In the early 1960s, other doctors in the U.S. began to notice that residents of Roseto, Pennsylvania had an unusually low rate of cardiovascular disease. Roseto residents—who were identified as having a close-knit Italian-American heritage throughout their community—experienced a minuscule number of heart attacks. In fact, Roseto men over 65 had a death rate that was half the national average.

Although members of the Roseto community didn’t eat a particularly healthy diet, the researchers identified that the sense of social security and wholehearted human bonds within individual homes and throughout the community were the secret to Roseto residents' lower rates of stress, heart disease, and mortality.

The health benefits of social connections became known as "The Roseto Effect." Sadly, as the traditional social structure in Roseto dissolved in the later-twentieth century due to technological advances, modernization, and other socioeconomic shifts...cardiovascular disease and heart attacks grew in tandem.

How could our minds and bodies possibly adapt at a neurobiological level to all of the technological changes that have occurred in the past two decades?  The ways we engage with one another socially continues to evolve at hypersonic speed. Remember: Text messaging, email, and the internet were first commercialized for use in 1995. Facebook was founded in 2004. The iPhone was introduced in 2007.

Technological advances of the twenty-first century have forever altered the way we socialize. The changes in how we interact socially may be causing the cohesive fabric of our social tapestries to deteriorate. For many, there is no safety net to protect against the feeling of isolation created by living in a digital age. Sherry Turkle writes about this phenomenon in her seminal book Alone Together: Why We Expect More from Technology and Less from Each Other.

Perceived Social Isolation Can Lower Life Expectancy

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In recent years, researchers at the University of Chicago have found that the chronic perception of social isolation increases a person’s chances of premature death by 14 percent. The impact of perceived loneliness on premature death is almost as strong as the impact of living in poverty—which the researchers found increased the chance of dying early by 19 percent. In an unexpected finding, the researchers found that the impact of perceived social isolation has double the impact of obesity on early death.

In 2014, John T. Cacioppo, from University of Chicago—a social psychologist and neuroscientist who studies the biological effects of loneliness—presented his findings in a lecture, "Rewarding Social Connections Promote Successful Aging” at a seminar on "The Science of Resilient Aging" at the American Association for the Advancement of Science (AAAS) annual meeting.

Cacioppo reported that feeling socially isolated from others can increase risk of depression, disrupt sleep, trigger a rise in the stress hormone cortisol, elevate blood pressure, alter gene expression in immune cells, and lower overall subjective well-being.

In a statement to the University of Chicago, Cacioppo said, "Retiring to Florida to live in a warmer climate among strangers isn't necessarily a good idea if it means you are disconnected from the people who mean the most to you."

From a public health perspective, Cacioppo emphasizes that shifts in the population demographics should make the importance of social connectivity and the detrimental impact of loneliness on someone’s well-being a top priority in coming decades. He said,

"We are experiencing a silver tsunami demographically. The baby boomers are reaching retirement age. Each day between 2011 and 2030, an average of 10,000 people will turn 65. People have to think about how to protect themselves from depression, low subjective well-being and early mortality."

In December 2015, Cacioppo et al. published their findings showing that perceived social isolation is linked to a dramatic increase in the stress hormone cortisol, hardening of the arteries (which leads to high blood pressure), inflammation in the body, and can diminish executive function, learning, and memory.

These findings suggest that perceived social isolation leads to fight-or-flight stress signaling. According to the researchers, the "danger signals" activated in the brain by feelings of social isolation and loneliness ultimately affect the production of white blood cells. The resulting shift in monocyte output may perpetuate loneliness and contribute to its associated health risks.

In future studies, the team plans to continue their research on how loneliness leads to poor health outcomes and how these effects can be prevented in older adults. Cacioppo offers some common-sense advice for simple ways that people from all walks of life can counter the consequences of loneliness such as: taking part in family traditions and making an effort to participate in face-to-face social activity more regularly.

Cacioppo identified three core dimensions of connectedness linked to healthy relationships that people of all ages can focus on to reduce potential feelings of loneliness:

  • Intimate Connectedness: Comes from having someone in your life that you feel reaffirms the essence of who you are.
  • Relational Connectedness: Comes from having face-to-face contacts that are mutually rewarding.
  • Collective Connectedness: Comes from feeling that you're part of a group or collective that extends beyond your individual existence.

Any type of social network and sense of belonging can benefit your health. However, research shows that we need face-to-face contact and intimate human connections to engage biological systems that have evolved for millennia to preserve our psychological and physical well-being.

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Face-to-Face Socializing Reduces Your Risk of Depression

Another 2015 study found that the mental health benefits of regular face-to-face social interactions—especially among older adults—reduces someone’s risk of depression. The findings were published online in the Journal of the American Geriatrics Society.

The Oregon Health & Science University (OHSU) researchers found that having limited face-to-face social contact nearly doubles someone's risk of having depression. Interestingly, study participants who made the effort to regularly connect with family and friends in person were much less likely to report symptoms of depression, compared with participants who only texted, emailed, or spoke to friends and family on the telephone.  

In a statement to OHSU, Alan Teo, lead author and assistant professor of psychiatry at Oregon Health & Science University said,

"Research has long-supported the idea that strong social bonds strengthen people's mental health. But this is the first look at the role that the type of communication with loved ones and friends plays in safeguarding people from depression. We found that all forms of socialization aren't equal. Phone calls and digital communication, with friends or family members, do not have the same power as face-to-face social interactions in helping to stave off depression."

Study participants who met with family and friends face to face at least three times a week had the lowest level of depressive symptoms (6.5 percent). Participants who met up just once every few months, or less frequently, had an 11.5 percent chance of depressive symptoms compared with those who had even less frequent social contact.

The researchers found that among adults aged 50 to 69, frequent face-to-face contact with friends and family reduced depression significantly across the board. However, people who were 70 years of age and older seemed to benefit more from in-person contact with family members.

These findings make a strong case for the importance of face-to-face socializing that occurs during holiday gatherings with friends and family. But, also serve as a reminder that each of us should make an effort to have face-to-face social participation with friends and family 365 days a year.

John Cacioppo emphasizes that it isn't just solitude or physical isolation that is detrimental to your quality of life; but rather, the subjective perception of social isolation or feeling ostracized that is most disruptive. Many people living alone are quite happy being loners and aren't necessarily “lonely” when alone. Feelings of loneliness and perceived social isolation are subjective and malleable.

That being said, anyone can reduce his or her feelings of perceived loneliness by consciously making an effort to stay socially active and seeking face-to-face social participation on a regular basis.


Tomioka, K., Kurumatani, N. and Hosoi, H. (2016), Association Between Social Participation and 3-Year Change in Instrumental Activities of Daily Living in Community-Dwelling Elderly Adults. J Am Geriatr Soc. doi:10.1111/jgs.14447

Alan Teo, M.D., M.S. Does Mode of Contact with Different Types of Social Relationships Predict Depression Among Older Adults? Evidence from a Nationally Representative Survey. Journal of the American Geriatrics Society, October 2015

Steven W. Cole, John P. Capitanio, Katie Chun, Jesusa M. G. Arevalo, Jeffrey Ma, John T. Cacioppo. Myeloid differentiation architecture of leukocyte transcriptome dynamics in perceived social isolation. Proceedings of the National Academy of Sciences, 2015; 201514249 DOI: 10.1073/pnas.1514249112

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