Dolly, a senior who lives alone, looks forward to playing bridge for several hours with her friends every day. That is, until COVID-19. With shelter-in-place and recommendations by the Centers for Disease Control and Prevention for older adults to stay home, Dolly hasn’t had any social interaction for more than two months and feels it is taking a toll on her mental health—citing feelings of loneliness and bouts of depression during this time.
Dolly isn’t the only one feeling socially isolated and lonely. While COVID-19 has amplified it, even before the crisis more than one-third of adults aged 45 and older felt lonely, and one in five Americans said they felt lonely or socially isolated. Living alone can be one of the contributing risk factors for loneliness, and according to the U.S. Census Bureau, 28 percent of older adults live by themselves.
“Loneliness became a ‘hot’ topic due to COVID-19. The reason people now openly discuss it is that we can ‘blame’ the virus for our loneliness, and that eliminates the stigma usually connected to loneliness,” said Dr. Ami Rokach, clinical psychologist and author of Loneliness, Love and All That’s Between.
According to the National Academies of Sciences, Engineering, and Medicine (NASEM), loneliness is the feeling of being alone, regardless of the amount of social contact, while social isolation is a lack of social connections. It is important to note the distinction: Social isolation can lead to loneliness in some people, while others can feel lonely without being socially isolated.
The Impact of Social Isolation and Loneliness on:
Mental Health Month
While social distancing and shelter-in-place are helping flatten the pandemic curve, there are unintended implications on mental and cognitive health. According to the Kaiser Family Foundation, about 45 percent of adults in the United States say worry and stress related to the pandemic are having a negative impact on their mental health.
Coincidentally, May is Mental Health Month, an observance in the United States since 1949 to bring awareness and to provide practical tools to care for mental health. It is an especially important present-day reminder to take care of one’s mental health as people may experience higher levels of stress, loneliness,* and depression during this time, which can lead to higher risks of health problems such as dementia.
While there haven’t been many studies on the short-term effects of social isolation and loneliness, a recent report from NASEM indicated that “high levels of loneliness, infrequent social contacts and low-level group participation” was associated with about a 50 percent increased risk of dementia.
And in a 2018 Florida State University College of Medicine study, loneliness was shown to increase the risk of dementia by 40 percent.
Additionally, loneliness increases the risk of depression, and failure to treat depression is estimated to account for 4 percent of dementia occurrence.
As people age, the likelihood of becoming socially isolated increases due to loss of loved ones, lack of family, loss of social contacts due to retirement, and declining health. According to the AARP Public Policy Institute, social isolation among older adults will cost Medicare $6.7 billion in federal spending annually. The AARP seeks to raise awareness and to highlight the risk factors for loneliness and social isolation with their fact sheet.
The Importance of Social Interaction and Staying Connected
Studies show that social interaction (and other modifiable lifestyle factors such as getting enough sleep, exercise, and eating a healthy diet) can prevent the risk of dementia globally by 35 percent. And research showed that dementia prevention was even greater in low-income countries: India (41%), China (40%,) and a sample of Latin American countries (56%).
It is important for people to regularly engage in meaningful social interaction to maintain their brain health at all ages. A study conducted by Dr. Lisa Berkman of Harvard University found that socially active individuals experienced less decline in memory. Those with the highest sociability reported half as much memory loss compared to those least social. Despite factoring in other demographics like age, gender, race, and health, the statistics remained unchanged.
If shelter-in-place continues, and physical social gatherings or activities are not a possibility, there are many other ways and virtual activities available to feel connected, less lonely, and improve cognitive health. Jonathan Kanter, director of the Center for the Science of Social Connection at the University of Washington encourages video chats and calling regularly to check in with friends and family. The National Institute of Health determined that just 10 minutes of daily social interaction increases performance on cognitive assessments and can give an important cognitive edge as we age.
I am a huge proponent of connecting with friends and loved ones to improve cognitive health. However, it is important to note that just because a person is surrounded by people does not mean they will feel less lonely or that the likelihood of dementia decreases. For both boxes to be checked, individuals must be engaged and participate in social activities outside of the family, so just living with family members does not provide the right type of social interaction to assure cognitive benefits.
However, we are in extraordinary circumstances right now, so use technology as an alternative to make those meaningful connections: Set up dinner dates with your friends or cook healthy meals together via video conferencing. It is also important to reframe one’s thinking. Instead of seeing it as social isolation or feeling lonely, view it as an opportunity for introspection and a time to experience new things when we couldn’t before or perhaps took it for granted.
When the COVID-19 dust settles and we return to our normal lives, it is important to keep up with connections we’ve made and to remain socially engaged—whether it is joining a bridge club, volunteering in community groups, or traveling to meet new people and try new experiences. Humans are social creatures and it is inherent to our cognitive and mental health to connect with one another, now and later, to enrich our lives and help us get through the tough times.
Contact your healthcare provider or a mental health worker if you or someone you know needs support or someone to connect with.
*In a 2017 meta-analysis co-authored by Julianne Holt-Lunstad, Ph.D., a professor of psychology and neuroscience at Brigham Young University Professor, loneliness was found to be as detrimental to one’s health as smoking 15 cigarettes a day, and twice as harmful to physical and mental health as obesity. Social isolation can increase mortality by 29 percent.
Hsiao, Y. H., Chang, C. H., & Gean, P. W. (2018). Impact of social relationships on Alzheimer’s memory impairment: mechanistic studies. Journal of biomedical science, 25(1), 3.
Savikko M, Routasalo P, Tilvis RS, Strandberg TE, Pitkala KH. Predictors and subjective causes of loneliness in an aged population. Archives of Gerontology and Geriatrics. 2005;41:223–233. https://link.springer.com/article/10.1007/s12603-020-1323-6#ref-CR2
Angelina R Sutin, PhD, Yannick Stephan, PhD, Martina Luchetti, PhD, Antonio Terracciano, PhD, Loneliness and Risk of Dementia, The Journals of Gerontology: Series B, , gby112, https://doi.org/10.1093/geronb/gby112
Lupien SJ, McEwen BS, Gunnar MR et al. (2009) Effects of stress throughout the lifespan on the brain, behaviour and cognition. Nat Rev Neurosci 10, 434-445.
Geerlings MI, Gerritsen L (2017) Late-Life Depression, Hippocampal Volumes, and Hypothalamic-Pituitary-Adrenal Axis Regulation: A Systematic Review and Meta-analysis. Biol Psychiatry 82, 339-350.