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The High Price of Loneliness

Loneliness stings at any age. But in older people, it can have serious health consequences, raising the risks of an earlier-than-expected death and the loss of physical functioning, according to a study published on Monday.

The report, in the Archives of Internal Medicine, is the largest yet to tease out the impact of loneliness on people in their later years. Geriatricians at the University of California, San Francisco, asked 1,604 adults age 60 and older how often they felt isolated or left out, or lacked companionship. The researchers were attempting to quantify the feeling of loneliness — a sense of not having meaningful contact with others, accompanied by painful distress.

Answers were recorded in 2002 and every two years after through 2008. The number of older adults who reported feeling lonely — just over 43 percent — didn’t change significantly over that period, according to Dr. Carla Perissinotto, an assistant clinical professor at U.C.S.F. and the study’s lead author. About 13 percent of older adults said they were often lonely, while 30 percent said loneliness was sometimes an issue.

What did change over the six-year period was the health status of elderly men and women who felt isolated and unhappy. By 2008, 24.8 percent of seniors in this group reported declines in their ability to perform the so-called activities of daily living — to bathe, dress, eat, toilet and get up from a chair or a bed on their own. Among those free of loneliness, only 12.5 percent reported such declines.

Lonely older adults also were 45 percent more likely to die than seniors who felt meaningfully connected with others, even after results were adjusted for factors like depression, socioeconomic status and existing health conditions.

The emphasis on meaningful connections goes to the heart of what loneliness is and is not. It is not the same thing as being alone: 62.5 percent of older adults who reported being lonely in this new study were married. Nor is it simply a paucity of social contacts. As has been observed many times, people can feel lonely even when surrounded by others if their interactions lack emotional depth and resonance.

Loneliness is about the way people experience relationships subjectively, not the number of relationships they have, expert say.

That isn’t to say that the number of relationships, or what’s known in the scientific literature as “social supports,” isn’t important. In fact, a large body of research has demonstrated that social supports are critical to older adults’ health and well-being, as well as to their longevity. Instead, both social supports and loneliness are important, each separately, each in its own way, even as these components of older people’s lives interact, Dr. Perissinotto said.

Barbara Dane, an 85-year-old jazz and blues singer who lives in Oakland, Calif., has seen this play out in her relationship circles.

“As you get older, you see the world writing you off,” she said, adding, “So you tend to become passive and think, ‘I don’t want to bother anybody.’ You lose contact with your own kind, your tribe. And before you know it, you’re feeling bad.”

“It’s kind of life a self-fulfilling prophecy. Your eyes start to fasten on the sunset, and you start walking toward it.”

An unanswered question is what explains the physical impact of loneliness on older adults. Andrew Steptoe, director of the Institute of Epidemiology and Health Care at University College, London, has been studying this subject. “There is growing evidence that both loneliness and social isolation are related to biological processes that may increase health risk, including changes in immune and inflammatory processes and disruption of the stress-related hormones,” he wrote in an e-mail.

“Practical aspects of human contact may also be important,” Mr. Steptoe continued. “Someone who lives alone may not have anyone around to call for help if they suddenly experience acute symptoms, while a lonely older person may not have others about them to remind or encourage them to take their medications or follow the doctor’s advice.”

A small study published last year in Psychology and Aging offers another clue. In that report, Anthony Ong, associate professor of human development at Cornell University, showed that the blood pressure of older people rises in reaction to some kinds of stress and that loneliness accentuates this response.

“Loneliness may be something that is particularly salient in later life, and we should design interventions that help screen for it,” Mr. Ong said.

Short of that, reaching out more consistently to elderly friends, neighbors or relatives may help, Dr. Perissinotto said. “Sometimes for older people, just realizing that someone is listening and they’re not being ignored makes a difference.”