Effect of loneliness on longevity: Pre- and post-COVID-19 updates

 Highlights:

• Social interaction is an evolutionary component critical for growth, survival, and the lifespan
• Loneliness affects people of various age groups, causing manifestations like troubled sleep, reduced immune functionality, and chronic activation of the stress response
• Social isolation was recognized as a problem before the COVID-19 but only received significant attention during the pandemic
• Loneliness led to the emergence and development of business sectors, like "family rental" and telehealth services
• Research has highlighted that loneliness is a contributor to shortened longevity

Introduction

Homo sapiens+ (modern humans) are a social species with a high level of organization, where they usually live together and form relationships with others. Sociality is a term that describes a group of people living together in an organized society, where interaction plays a role in growth and development. At the most basic levels, relationships are essential for survival. For example, infants are entirely dependent on their parents, and without having a parent-child bond, their survival chances are minute. Research has stressed the importance of social interaction not only for early life stages survival but also for lifespan and longevity.

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Sociality is one of the reasons we exist!

Social interaction has been one of the pillars for survival and evolution until reaching the modern age. This is because the said processes require tradeoffs that favor energy conservation to focus on more critical processes, like cognitive development (1). In other words, social interaction has given us the capacity, as a species, to establish a herd that offered protection, which in turn, helped us establish societies. The opposite of social interaction is loneliness (social isolation).

The literature highlights that loneliness has genetic, perceptual, and cognitive components (1, 2). Further research revealed that transient feelings of loneliness (defined as isolation extending for minutes, hours, or days) could induce mild negative physiological consequences, like changes in cortisol levels (1). However, most of these effects are temporary and tend to resolve upon dissipation of the causative factor.

The negative impact of loneliness

Loneliness is defined as perceived and not objective social isolation. In other words, people can have a relatively solitary life without feeling socially isolated and vice versa (3). There are groups of people who prefer solitude; they are known as introverts (people with a low preference for social interaction and activity) (4). This is important so as not to mix solitude with loneliness.

The impact of loneliness has been recognized as a problem, and its effects have been investigated in research for decades (5, 6). Some researchers have even described it as a disease (7). Its physiological and psychological impact across all age groups has been recognized. In this context, the literature highlights that the impact of loneliness on children and adolescents can be seen across different outcomes (1). For example, the said groups are often found to suffer from depression, reduced sleep quality, poor general health, and less control over negative habits and behaviors like eating.

In older groups, the said effects persist, and new ones emerge, like increased tendency to visit doctors due to physical complaints, increased use of emergency rooms, and cognitive decline. In addition, those people suffer from impaired immune function, increased levels of circulating inflammatory mediators, and early mortality (1). The aforementioned factors predispose those individuals to reduced lifespan due to increased rates of cardiovascular disease, alcoholism, and Alzheimer's disease, among other conditions (8).

Loneliness as a public health problem before the COVID-19 pandemic

As discussed previously, loneliness is not a new challenge that has emerged recently but has been present for decades. The literature has indicated that loneliness is a problem that does not only affect the elderly, as it is widely believed (9). A US study conducted well before the COVID-19 pandemic has found that loneliness is perceived as a serious issue for older adults by 61% of those in the age group between 18–34-years old, 47% of those between 35–64 years, and 33% of those aged 65 years and above. In a similar context, evidence suggests that up to 30% of middle-aged and young-old adults and about 45% of adolescents and young adults report suffering from loneliness (9). Among the reported reasons for loneliness include an increased proportion of solitary living, higher divorce rates, and reduced size of kinship network.

The negative effects of loneliness on physiological and psychological parameters have been established in pre-pandemic meta-analyses. For example, a 2018 meta-analysis of 35 studies that assessed over 77 thousand participants from 35 studies found that loneliness was linked to increased mortality risk (8). The study attributed the increased mortality rate to age-related conditions, like cancer and cardiovascular death. The psychological burden associated with loneliness was highlighted in another pre-pandemic meta-analysis, which found that social isolation was linked to an increased risk of depression (10). According to research, depression has been found to correlate with accelerated cellular aging, where it was linked to premature brain deterioration and the development of conditions like dementia, atherosclerosis, and others (11, 12).

The impact of social isolation during and after the COVID-19 pandemic

Based on the previous, loneliness has been a longstanding problem, but it did not receive enough coverage until the pandemic hit hard. In March 2020, the World Health Organization declared the novel coronavirus a global pandemic. This led governments to implement social distancing measures to prevent the disease from spreading (13).

COVID-19 fundamentally influenced various aspects of life. Results from a recent study during COVID-19 revealed that compared to the period prior to the pandemic, severe loneliness increased from 6% to 21% (14). Other studies showed that physical activity decreased by more than 50% in terms of steps taken per day, from an average of 10,000 to 4,600 (15). In addition, the time spent performing physical activities decreased by about one-third from 4.4 hours to 2.9 hours. The same study found that screen time more than doubled to over 5 hours per day (excluding screen time for class or work). The latter increase in time encouraged parasocial interaction (a one-sided relationship that people form with television characters and celebrities) (16). The risk of clinical depression in the same population increased from 32% prior to the pandemic to 61% during the COVID-19 period, representing around a 90% increase (15). Similar results were obtained across many studies exploring the impact of COVID-19 on different age groups and aspects of life (17-21). All these results demonstrate how the pandemic augmented the effects of an existing public health challenge.

Loneliness is a booming business opportunity

As mentioned earlier, loneliness has been a longstanding issue that we did not fully appreciate until the lockdowns due to COVID-19. For example, loneliness in Japan has been a problem well before COVID-19 lockdowns. This led to the emergence of “family rental" services, where you can hire a husband, a mother, or a grandson (22). Other services where you can rent a friend have also been mentioned (23).

Other business sectors have also grown during the pandemic, including telehealth (the use of electronic information and communications means to provide long-distance health care services) and virtual care (24). Telehealth services are diverse, ranging from monitoring (like wound healing) to high-risk patient management (like people with chronic conditions with mobility difficulties). These services have seen growth during the COVID-19 pandemic, as people sought virtual access to health care (24). There are a number of reasons for the success of these services, including accessibility, ease of use, and availability. In addition, in times like the pandemic, they minimize the exposure risk for both the health care professional and the service seeker. An example of telehealth service providers who saw growth during the pandemic is Cleveland Clinic, which went from 2% of outpatient visits done through telehealth to 75% (24). Examples of telehealth's limitations include insurance reimbursement challenges, regulatory framework, and others.

Online exercise classes have seen growth, with lockdowns limiting physical activity during the pandemic (25). These kinds of activities were recommended by numerous reputable organizations, like the US Centers for Disease Control and Prevention, the National Health Service, and the World Health Organization. Some of them have also endorsed certain online exercise classes (25). Digital home exercise programs appealed to many users, as found in an international survey involving over 15,200 participants (26). Exercises included in the survey included resistance, cognition, relaxation, balance, and flexibility training. The survey found that about 7 in every ten individuals expressed interest in virtual home-based exercises, of which about 90% said they were willing to exercise at least three times per week (26). It is important to highlight that these numbers only reflect the interest and do not report actual participation. In addition to the previous, businesses like supermarkets have also established “chat checkout” where customers can engage in conversations to battle COVID-19 loneliness (27). Moreover, companion chatbots, like Replika, have recently gained traction, providing a form of support for those suffering from loneliness (28).

Loneliness and longevity: Connecting the dots

The literature mentions that social interaction plays a role in physiological regulation, such as stress response (a factor that influences many bodily systems and the aging process) (29). Evidence from research highlights that individuals who are socially isolated are more likely to die earlier (30). The effect of loneliness on longevity is mediated by many mechanisms, like chronic activation of immune, neuroendocrine, and metabolic systems (29). These pathways influence many age-related disorders, like cardiovascular and neuroplastic diseases, causing accelerated biological aging (29, 31). The said pathways are highly affected by inflammatory mediators, which tend to activate as a result of accumulating effects of chronic stress that results from loneliness (29).

Tips

There are certain tips you can give to your clients to help them stay connected and ease the stress of loneliness, including (3, 32-34):

• Maintain social connections by spending time with the family and utilizing technology to remain in touch, like social media platforms. Also, engage in community and faith organizations.
• Raise pets, like cats and dogs, as they were found to increase social and physical activities, providing multiple benefits.
• Perform physical exercises and mental activities, like mindfulness practice, walking, listening to music, and reading.
• Manage emotional and psychiatric symptoms by paying attention to signs like irritability, anger, compulsive behavior, anxiety, sleep disturbance and refer to specialist care when needed. There are also call centers that provide support for people suffering from loneliness.
• Highlight that solitude is not always bad, as having some time off can motivate people to reconnect with others, relocate for a scenery change, or engage in new social relations.

Conclusions

Social interaction plays a pivotal role in our existence. The literature highlights its importance for longevity as results demonstrate that people who are socially connected tend to live longer, as seen in residents of the blue zones (35, 36). Loneliness, the opposite of social interaction, has been linked to many diseases and is known to affect people of different age groups. It has also been shown to play a role in biological aging and longevity. Before COVID-19, loneliness was recognized as a problem but only received enough attention when the pandemic hit. Today, it remains a public health challenge that requires prompt actions, as positive outcomes can improve the quality of life for those suffering from it.

References

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