Study Finds Link Between Cumulative Loneliness and Mortality

Loneliness has been well-established not only as a public health concern, but also as a significant and common risk in senior care settings. However, a new study sheds light on how serious the implications of loneliness can be.

Esther Cromwell, founder and CEO of the Avendelle Assisted Living Franchise

The study, published in December 2023, included 9,032 patients and included a median follow-up at 10.37 years. The mean baseline age of the patients was 63.99 years, and 17.98%, 9.13%, and 11.84% of participants reported they experienced loneliness at one, two, and three or more times from 1996 to 2004.

In addition to examining the prevalence of loneliness in participants, the study collected data on deaths. The data indicates that participants who experienced loneliness at each of one, two, and three or more time points during the study were associated with a 1.05, 1.06, and 1.16 times higher chance of death compared to participants who never felt lonely. The study highlights the importance of taking measures to address loneliness, and is particularly relevant to senior care communities, where loneliness is prevalent.

The Effects of Loneliness in Senior Care

In addition to the mortality risks outlined in the study, senior care residents may experience other effects of loneliness. Esther Cromwell, founder and CEO of the Avendelle Assisted Living Franchise, explains that loneliness can lead to depression, anxiety, and feelings of isolation. “It can also exacerbate existing health conditions and lead to a decline in physical health,” she explains. “We’ve observed that loneliness can negatively impact a resident’s willingness to engage in activities or interact with others, affecting their overall happiness and quality of life.”

Ameera Bhanji, social worker and member services facilitator for the Goodwin Living at Home program

Ameera Bhanji, social worker and member services facilitator for the Goodwin Living at Home program, notes that older adults who are lonely struggle more with unforeseen circumstances and major life changes, such as medical events or moves, compared to adults who feel satisfied by their level of social interaction. “Lonely older adults often face these hurdles alone, and the very prospect of that feeds into feelings of anxiety and depression,” explains Bhanji. “Loneliness is more than just an isolated experience for some older adults – it’s a cycle that can only be broken by building and nurturing connections with others at every life stage.”

Strategies to Prevent Loneliness

Bhanji takes a proactive approach to help prevent loneliness in seniors. She works to create opportunities for interaction and uses technology to remove barriers like accessibility and transportation that sometimes prevent older adults from being able to engage more. “I encourage older individuals to join a book club like the one I facilitate for Goodwin Living At Home, where we meet monthly over Zoom,” she says. “Goodwin Living At Home also hosts a caregiver support group and a weekly walking group, and I encourage members to attend whether or not they report feeling lonely, because these types of activities can serve as precautionary measures to prevent loneliness.”

Cromwell explains that Avendelle Assisted Living implements various programs, including group activities, social events, and one-on-one interactions to help prevent loneliness. “We encourage family involvement, use technology to connect residents with loved ones, and provide opportunities for residents to pursue hobbies and interests,” she says. “Additionally, we train our staff to be attentive to the residents’ social needs.”

How to Identify and Alleviate Loneliness

Cromwell explains that staff perform regular assessments to identify loneliness in residents. “We also encourage self-reporting and look for signs such as withdrawal from activities, changes in mood or behavior, and decreased communication,” she says.

Bhanji also takes a proactive stance, asking members how they feel about their current social engagement level during each face-to-face interaction. The question gives members a chance to share any feelings of loneliness or isolation. If they identify such feelings, Bhanji asks follow-up questions, including whether the members feel comfortable confiding in someone, whether they have close friends or family nearby, and what activities bring them joy. “I also keep in mind less obvious indicators of loneliness, such as cognitive changes or a low mood. Taking a comprehensive approach like this allows me to both identify loneliness and understand how it shows up in people’s lives,” says Bhanji.

To combat loneliness, Bhanji works to find opportunities to help members strengthen social bonds with those who are already within their reach. “In my interactions with older adults experiencing loneliness, I encourage them to map their existing social circles, including family, friends, neighbors,” she explains. “I facilitate discussions about hobbies, passions and interests that the person can use to connect with those who share similar interests, join social groups, or participate in community activities.”

Cromwell describes how staff develop a personalized plan to address the needs of a resident who is identified as lonely. “[The plan] could include increased social interactions, involvement in specific activities, requested counseling services by 3rd party providers, or facilitating communication with family and friends. Our staff works closely with the resident to ensure they feel supported and connected,” she says.

One Size Does Not Fit All

A blanket approach to addressing loneliness won’t work for every resident. Cromwell highlights the importance of understanding that every resident is unique. “Continuously evaluating and adapting our approaches is key to effectively addressing loneliness,” she says. “We strive to create a community where every resident feels valued, connected, and engaged.”

“Understanding loneliness isn’t as simple as counting friends,” notes Bhanji. “Some people thrive with fewer social connections, while others feel lonely despite being surrounded by people. This ‘threshold’ for fulfillment is tied to an individual’s health, living situation, family and even physical abilities, so it varies and changes with changing circumstances.”

She explains that addressing loneliness is complicated, and creative solutions are often necessary. “While creating social spaces is a valuable step, real progress requires us to think deeply about how we, as a society, treat and interact with older adults,” she says. It’s essential to ask ourselves whether we are creating an environment that nourishes connection. “In what ways do we perpetuate ageism, and how might that impact social connectedness amongst older adults?” Bhanji poses. “Only by confronting our own biases and actively fostering inclusion can we truly build a society where everyone, regardless of age, can feel socially engaged, connected and valued.”

Paige Cerulli

Paige Cerulli is a contributing writer to i Advance Senior Care.