Loneliness worse than smoking, alcoholism, obesity: Study suggests primary care clinicians can offer solutions

Loneliness is a significant biopsychosocial stressor with a mortality risk comparable to smoking more than 15 cigarettes a day and more harmful than alcoholism, obesity, and lack of physical activity.

Despite its harmful effects, interventions to address the discrepancy between desired and actual social interaction are few and limited.

In a new study, Regenstrief Institute and Indiana University School of Medicine research scientists Monica Williams-Farrelly, Ph.D., Malaz Boustani, M.D., MPH, and Nicole Fowler, Ph.D., MHSA, identified evidence suggesting primary care clinicians can play an important role in developing and maintaining personal connections for patients experiencing loneliness.

The study found that 53 percent of older adults in the primary care population experience loneliness. Evidence also suggests that when older adults experience loneliness, their physical and mental health related to quality of life are reduced significantly.

"The first and obvious answer for loneliness is for primary care physicians to screen their patients," said Dr. Williams-Farrelly, the study's first author, a Regenstrief research scientist and an assistant research professor at IU School of Medicine.

"Based on the literature and research, loneliness has influences on health that are quite significant and quite strong, so in the same way that we ask older adults: Do you smoke? Or do you measure your blood sugar? We should be inquiring about and measuring loneliness and offering solutions."

Dr. Williams-Farrelly suggests that it is imperative for primary care physicians, nurse practitioners and other clinicians also to provide resources to patients to help address this significant issue.

"The topic of loneliness is more relevant now than ever given the May 2023 U.S. Surgeon General's call to action to tackle the loneliness epidemic," said Dr. Fowler, principal researcher and senior author.

"This research is important because it identifies and suggests evidence for interventions that are necessary for older adults in primary care who experience loneliness. Primary care clinicians should discuss loneliness with their older adult patients and provide resources to help them create meaningful social relationships." Dr. Fowler is also a Regenstrief research scientist, an associate professor, and a director of research at the IU School of Medicine.

An effective intervention, the researchers suggest, is the Circle of Friends concept, which consists of a three-month, group-based, psychosocial rehabilitation model aimed at enhancing interaction and friendships between participants. The model has shown effectiveness in both reducing loneliness and improving health outcomes, including subjective health, cognition, mortality, and lower health care costs.

"As older adults age, they have a lot of changes in their life due to a lot of circumstances—retirement, divorce, or the death of family and friends—making it a little more difficult for them to maintain social relationships. When connections are lost with coworkers or loved ones, it can be jarring," said Dr. Williams-Farrelly. "Older adults need their primary care physicians to screen and suggest effective resources that can allow them to maintain, foster and develop social relationships."

Data was gathered during the COVID-19 pandemic, but the researchers identified a steadily increasing trend in loneliness in this population prior to the global pandemic. The numbers are still increasing today.

"Loneliness may seem simple, but it can be complex to identify and address. It started to become a problem before COVID-19, and then with the national stay-at-home order caused by the pandemic, social contact was being prevented, which exacerbated the problem," said Dr. Williams-Farrelly.

This study used baseline data from the Caregiver Outcomes of Alzheimer's Disease Screening (COADS) clinical trial, supported by the National Institutes of Health's National Institute on Aging grant R01AG056325.

"Loneliness in older primary care patients and its relationship to physical and mental health-related quality of life," is published in the Journal of the American Geriatrics Society.