You say you want to be alone? Think again. Researchers have found that older people with fewer human contacts are more likely to die -- even if they're happy in their solitude -- than are people with richer social lives. The study adds to the debate over whether loneliness, social isolation, or some combination of the two leads to higher mortality.
Social isolation is an objective condition in which people have little interaction with others. Loneliness, on the other hand, is an emotional state felt by people who are dissatisfied with their social connections. "Someone who's socially isolated is likely to be lonely, and vice versa, but that's not completely the case," says epidemiologist and lead author Andrew Steptoe, of University College London.
To tease apart the effects of being alone versus just feeling lonely, Steptoe and his colleagues examined data from 6500 Britons aged 50 and up who had filled out questionnaires assessing their levels of loneliness. The researchers also tabulated the subjects' contacts with friends, family, religious groups and other organizations to gauge their social connections. Then they counted how many subjects died over a seven-year period.
The most socially isolated subjects had a 26 percent greater risk of dying, even when sex, age and other factors linked to survival were accounted for, the researchers reported online Monday in the Proceedings of the National Academy of Sciences. They then tweaked their model to determine whether the connection to death was due to the fact that isolated people are often lonely. It wasn't.
The researchers then explored the connection between loneliness itself and death. Intense loneliness also appeared to raise the risk of death by 26 percent -- until the team took into account a host of other factors linked to survival, including wealth, education and the presence of health problems. Once their impact had been accounted for, the scientists discovered that loneliness on its own didn't make people more vulnerable to death.
The researchers suspect that older people who have few social ties may not be getting the care they need. No one is urging them to eat right or take their medicine, and in a crisis no one is there to help.
"There are plenty of people who are socially isolated but who are perfectly happy with that," Steptoe says. "But even then we should be trying to make sure there's enough contacts with them so that if something does go wrong . . . they're going to be advised and supported." Even those who are content to be alone, he says, should have some regular contact with other people who can encourage and check on them.
Other researchers praise the new work as rigorous and well-controlled. But they say it's far from clear that social isolation, not loneliness, is always the real culprit when it comes to increased mortality.
Other studies, including an analysis of older Americans led by John Cacioppo, a psychology professor at the University of Chicago, have shown a link between loneliness and a higher death rate. Cacioppo suspects that the discrepancy between his study and the new research could lie with cultural differences between Steptoe's British subjects and Americans. "The culture of the stiff upper lip may mean people are answering somewhat differently . . . than they do in America," he says, adding that Britons and Americans may define friends differently, too.
Health psychologist Bert Uchino, of the University of Utah, lauds the new study for its large sample size and its direct comparison of social isolation and loneliness, but he says that researchers are still far from understanding how those two factors affect one another and other health-related behaviors.
"They've done a really good study here," Uchino says. "I just don't think it's going to be the final word on the issue."