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Another December

Here we are. The end of the year has arrived; we know this is the time for joy, celebration, and connection with loved ones. Yet, many feel sad or lonesome. Unfortunately, success in life these days does not necessarily include friendships. What is going on? Daniel Cox, writing in the New York Times, stated that we seem to be in some sort of a “friendship recession.” Apparently, there are many opinions as to why this is happening. There is more agreement however of the impact of connection to our mental and physical health. Social isolation and loneliness are being recognized more often as complex clinical and public health problems, particularly in older adults, leading to adverse mental and physical health outcomes.

According to the Survey on American Life, we humans seem to have fewer close friends, we talk to friends less, and we rely on friends less for support. Nearly one half of Americans report three or fewer close friends, while 36% report four to nine. Some of the theories include decreased involvement in religious activities, decreased marriage rate, lower socioeconomic status, having a chronic illness, working longer hours, and changes in the workplace. And, since many of us relied on the workplace for connection, this has worsened the feelings of loneliness and social isolation.

There are some interesting nuances in the data. For instance, African American and Hispanic people seem more satisfied with their friendships. Further, women are more likely to look to friends for emotional support. They put in the work to developing their relationships…even telling a friend that they love them! On the other hand, 15% of men report no close relationships. This has increase by a factor of five over the last 30 years. Robert Garfield, an author and psychotherapist, states men tend to “stash their friendships away;” meaning they do not devote the time to maintain them.

Social isolation is an objective absence or lack of social contact with others, whereas loneliness is defined as an undesirable subjective experience. The terms are distinct, although they are often used interchangeably, and both have similar health implications. Social isolation and loneliness are increasingly common in older age groups. National surveys report that approximately one in four community-dwelling older adults reports social isolation, and nearly 30% report feeling lonely.

Why would the marriage rate have an impact? Well, per the survey data, nearly 53% of those reporting state that their spouse or partner is often their first contact. If you do not have a significant other, then you may more likely feel lonely.

Same impact as smoking or obesity?

Given how common these findings are, primary care providers should consider the health impacts associated with social isolation and loneliness, particularly in older adults. A growing body of research demonstrates a strong link between social isolation and loneliness with adverse outcomes. All-cause mortality is increased to the same extent as that for smoking or obesity. There is more heart disease and mental health disorders. Some of this impact is due to isolated individuals reporting a higher use of tobaccos and other harmful health behaviors. These isolated individuals use more health care resources because they often have more chronic health conditions. At the same time, they report being less compliant with the medical advice they get.

How to address

On the provider side, “social prescribing” is one approach. This is an effort to link patients with support services in the community. This could be using a case manager who can assess goals, needs, family support and make referrals. Doctors often will also refer patients to peer support groups. This tends to work well for those patients with a shared medical problem or condition. The strength of these groups is that patients often are more receptive to ideas from other dealing with a similar condition. Some of these groups now also meet in “chat rooms” or other social media sites.

Catherine Pearson, writing in the Times on November 8, 2022 described four courses of action that all of us can consider in addressing feelings of social isolation or loneliness:

  1. Practice vulnerability. I am talking to myself here as well. Enough with the masculinity or stoicism. It is okay to tell people how you feel about them. Consider joining structured peer-groups for support. Consider sharing your struggles with a friend.
  2. Do not assume friendships happen accidentally or by chance. They require initiative. Reach out to someone.
  3. Use activities to your advantage. Truth is, many of us are more comfortable connecting with others if we are involved in a shared activity. That’s great. It can be a sport, or getting together to fix or make something.
  4. Harness the power of casual “checking-in” via text or email. It may very likely be the encouragement somebody needs today, just to know they are being thought of.

American Perspectives study May 2021

National Academies of Sciences, Engineering, and Medicine. Social isolation and loneliness in older adults: opportunities for the health care system. 2020. Accessed April 21, 2021.

Smith BJ, Lim MH. How the COVID-19 pandemic is focusing attention on loneliness and social isolation. Public Health Res Pract. 2020;30(2):e3022008.

Courtin E, Knapp M. Social isolation, loneliness and health in old age: a scoping review. Health Soc Care Community. 2017;25(3):799-812.

Freedman A, Nicolle J. Social isolation and loneliness: the new geriatric giants: approach for primary care. Can Fam Physician. 2020;66(3):176-182.

Leigh-Hunt N, Bagguley D, Bash K, et al. An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health. 2017;152:157-171.

Due TD, Sandholdt H, Siersma VD, et al. How well do general practitioners know their elderly patients’ social relations and feelings of loneliness?. BMC Fam Pract. 2018;19(1):34.

Veazie S, Gilbert J, Winchell K, et al. Addressing social isolation to improve the health of older adults: a rapid review. AHRQ report no. 19-EHC009-E. Agency for Healthcare Research and Quality; 2019.






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