Joanne Roe is 81 years old and has lived in the same three-bedroom house in Southern California for 60 years. The house is where she and her late husband, Kenneth, raised nine children. Roe fondly remembers stepping over futons and mattresses to get to the front door and being a part of lively dinners filled with conversation and camaraderie.
“We would have discussions about how they were doing in school and their friends,” she recalls.
Today, the only conversations Joanne hears are between detectives Briscoe and Curtis. “I’m a Law and Order junkie,” she says. “I’ve got the TV on 24/7. I can tell you what the next comment is going to be out of somebody’s mouth, I’ve seen the episodes so many times.”
Roe suffers from an array of physical ailments, including neuropathy in her left foot and chronic back pain. Though she does light housework and cooks for herself, she’s been largely sedentary since she had a stroke three years ago. All day, every day, she sits in her brown easy chair, listening to the fictional detectives, judges, and public defenders while she pores over adult coloring books.
“I get up. Take my pills. Have my breakfast. Sit in my recliner 90 percent of the day coloring,” she says.
“My life is inside four walls.”
Roe may be alone inside those four walls, but when it comes to the painstaking loneliness she confronts on a daily basis, she has plenty of company. What’s more, a growing number of health care providers and delivery systems have begun to understand such loneliness as more than an abstract idea; rather, it is a condition with an undeniable negative effect on health.
A groundbreaking study in the July 2012 issue of the Archives of Internal Medicine found that 43 percent of older adult participants reported feelings of loneliness. That study further indicated that people 60 years and older who reported struggling with loneliness faced an increased risk of mortality compared with participants who do not report being lonely (22.8 percent versus 14.2 percent).
Since then, research conducted among Medicare and Medicaid patients served by CareMore Health, the organization in which I work, has bolstered the idea that loneliness can negatively affect one’s health. Our internal research shows that lonely patients are less likely to take their medications or show up for appointments—behaviors that usually result in chronic conditions going untreated and worsening over time. Similarly, a research perspective published in the Oxford Research Encyclopedias in 2017 by a behavioral medicine researcher at St. George’s, University of London, concluded that people who feel lonely are more likely to suffer from coronary artery disease, declines in motor function, frailty, and other physical and cognitive function conditions.
The increase in loneliness and its attendant health risks has not gone unnoticed in nonmedical sectors. Writing in the Harvard Business Review in 2017 on work and loneliness, physician and former U.S. Surgeon General Vivek Murthy noted, “During my years caring for patients, the most common pathology I saw was not heart disease or diabetes; it was loneliness.” Noting that rates of loneliness in the United States have doubled since the 1980s, Murthy called the condition “a growing health epidemic” and pointed to research showing that “loneliness and weak social connections are associated with a reduction in lifespan similar to that caused by smoking 15 cigarettes a day and even greater than that associated with obesity.”
Given that the deleterious effects of loneliness are being recognized and identified, what is to be done? I don’t know of any physician who can write out a prescription for friendship. Moreover, the root causes of loneliness often are cultural in nature. In Roe’s situation, her children are scattered in communities around the country.
“I don’t have a circle of friends because Ken and my work were my life,” she explains matter-of-factly. “We didn’t need anybody except each other.”
Several new initiatives, however, suggest paths that can help patients like Roe become less lonely while improving their health. In 2017, CareMore Health appointed a chief togetherness officer to oversee our efforts to address loneliness and isolation among the senior population that we treat. An initiative we launched, the Togetherness Program, assessed our patient base of more than 80,000 patients and identified 2,000 lonely seniors—more than 700 of whom elected to participate in the program and are enrolled in an intensive intervention that includes weekly phone calls, home visits, encouragement, and connection to community-based programs.
For example, twice a week Roe gets a call from a volunteer with the program. Those calls, says Roe, are the high point of her days. “You don’t know how that feels unless you’ve been alone without anyone to talk to, she says. “And then you have somebody that doesn’t know you from Adam call and make you feel like you’re important. It just brings joy. It makes me feel that I have a friend.”
The value of such initiatives was further underscored when, after a 2017 report showed that more than nine million people in Britain often or always feel lonely, Prime Minister Theresa May appointed that country’s first Minister for Loneliness who is tasked with developing programs to increase social connectedness among the country’s people. In June of this year, the May government announced £20 million in funding to help isolated people and those suffering from loneliness. Much of those funds will go toward community programs like Shared Lives, a home-sharing program that matches pensioners struggling with loneliness with young people needing somewhere to live, and Men’s Sheds, communal spots where retirees and unemployed men can come together to socialize and participate in activities like woodworking and electronics repair.
Back in Southern California, if you ask Roe about her health, she’ll tell you, “I’m basically in good health. I don’t have any serious medical problems.” A newcomer looking at her chart might disagree. But she says that despite the back pain, the neuropathy, the bladder infection, the creaking knees, and the carpal tunnel in her left hand, the twice-weekly calls she receives from the CareMore Health volunteer “picks up my mood and makes me happy. And when you’re happy, you’re not bawling your eyes out.”
Sometimes, as clinicians, we’re baffled by a patient’s symptoms. Yet, Roe’s words remind us that those of us in the health care community not only should treat loneliness as a clinical condition, we must.
Sachin H. Jain, MD ’06, is an adjunct professor of medicine at Stanford University School of Medicine and president and CEO of the CareMore Health System, a health care delivery organization.