Longer Life With Less Loneliness

Kerstin Gerst Emerson kept hearing an unusual complaint from doctors she worked with. Elderly patients kept coming to see them without any health problems. They weren’t feeling sick. They were feeling lonely. Dr Emerson, a clinical assistant professor at the University of Georgia’s Institute of Gerontology, did some digging with a health economist and found that adults 50 and older who were categorised as lonely were going to see their primary-care physicians more often than those who weren’t lonely. They published their findings in the American Journal of Public Health in 2015.

“A lot of people have known their doctors for a long time, they know the office staff, and it does become a social interaction,” Dr Emerson says. Numerous studies have documented how loneliness can negatively affect health, particularly among the elderly. Now, one health-care provider is going as far as combating loneliness as a treatable medical condition. CareMore, a California-based subsidiary of Anthem that provides health care to 150,000 Medicare and Medicaid patients across the country, is screening its elderly patients for loneliness. They’ve created a “togetherness” program for those deemed lonely, and they are remodelling their clinics to encourage seniors to socialise, even when not waiting for a medical appointment. Dr Emerson says CareMore’s effort to tackle loneliness is among the first national efforts in the U.S. The United Kingdom and Australia have formed national campaigns or coalitions to end loneliness. U.K. Prime Minister Theresa May even appointed a minister for loneliness earlier this year. At a newly remodelled CareMore clinic in Modesto, Calif., there are large, square tables, colouring books, puzzles and games like chess and backgammon. On Mondays, a patient who plays the guitar often comes to entertain others. “Our care centres are no longer just medical office spaces, they are like community centres,” says Sachin H. Jain, president of CareMore, a subsidiary of Anthem insurance company.

Studies show loneliness is a risk factor for everything from cardiovascular problems and Alzheimer’s disease to diabetes and stroke. “Loneliness is an independent risk factor for death and functional decline,” says Carla Perissinotto, associate chief of clinical programs in geriatrics at the University of California, San Francisco. She is the first author on a 2012 study that found that elderly people who identified themselves as lonely had a greater risk of death and a decline in the ability to perform everyday activities like getting dressed and eating. Other analyses have found that lacking social connections has a similar impact on mortality as smoking 15 cigarettes a day, and that loneliness affects mortality risk more than obesity. “People who are socially isolated or lonely, typically the first thing to go is their level of self-care,” Dr Jain says. “They don’t take their medicines; they don’t eat as well, they don’t exercise.”

About a year ago, CareMore appointed Robin Caruso to manage a program of more than 700 seniors and hopes to recruit more. Her title: chief togetherness officer. CareMore members are screened for loneliness during physical exams and in health assessments when they first join. “That’s one of the most difficult things about this disease,” says Ms Caruso. “These people are invisible.” Once in the program, seniors get regular phone calls from CareMore employees called “connectors,” who check in on them and try to connect them with services for food, transportation and socialisation. Some also get home visits. “One of our goals is to get them reconnected to their health care,” says Ms Caruso. She recalls an elderly patient with a severe mental illness who was lonely. People didn’t want to be around him because he was difficult. Once he started receiving regular phone calls, his behavioural health team says he stopped skipping appointments. He also agreed to try his medications again, which he had been refusing to take. Employees also urge patients to use the company’s free Nifty After Fifty gyms, which are usually attached to their clinics. The gyms include classes like seniors Zumba, chair volleyball and cane fu (kung fu with canes). Patricia Loeb is among those in the togetherness program. The 70-year-old Bellflower, Calif., resident joined in November after a telephone outreach call. Her husband died about 15 years ago, and she lives alone with a part-time caregiver. As part of the program, a social work intern, Sara Santos, visits her at home once a week. “I have some kind of little support behind me to help me and keep me on the right path,” says Ms Loeb. “It’s helpful knowing that somebody is out there that cares. I’m not as depressed anymore.” Before the visits, Ms Loeb, who uses an electric wheelchair, says she didn’t get out of the house much. Now, she’s started going to a nearby Nifty After Fifty gym once a week, where she focuses on mostly upper-body strength-training. She hopes to be able to play chair volleyball soon.

Charlotte Yeh, the chief medical officer for AARP Services, says survey data of Medicare seniors shows that 27% to 29% of them are lonely. The organisation is testing ways to combat loneliness. One method uses animatronic pets that can imitate real cats and dogs with sounds and motions. She notes that one senior who brought an animatronic cat to dinner at a restaurant found people approaching her to ask about it. “It’s a simple toy, but it’s a way to connect with others,” Dr Yeh says. Steve Cole, a genomics researcher at UCLA, says there is genomic evidence showing how loneliness can cause disease. Transient loneliness that occurs from something temporary, like moving to a new city, doesn’t have the physiological and biological effects that chronic loneliness has, he notes. Studies he and others have done show that lonely people have certain more active genes that make the proteins that cause inflammation in the body. That inflammation is often a precursor to chronic conditions and diseases. Research has also found that some genes involved in defending against viral infections are less active in lonely people. Other chronic stressors, like the death of a loved one, cause similar genomic changes, says Dr Cole. “That molecular defence program is running all the time in lonely people,” says Dr Cole. “It’s not just their psychology; their cells are running differently.”

Credit: Sumathi Reddy for The Wall Street Journal, 28 April 2018.