I haven't dug into all the sources, but I think there's a potential confounder here, or maybe even reverse causality. The author seems to assume causation when the studies only indicate correlation. E.g. the first link says "chronic loneliness increases mortality risk" but the actual source says "actual and perceived social isolation are both associated with increased risk for early mortality".
So for example, it's possible that if you already have chronic illness, a disability, or any other kind of health issues, you're more likely to have higher social isolation and therefore be more lonely, in addition to having a higher mortality risk. There's an outside variable (your health) that is correlated with both (loneliness and mortality), but that doesn't necessarily mean that loneliness causes mortality. If this were the case, we could defend claims like "autism increases mortality", because we already know that autism increases social isolation.
Poor health increasing social isolation isn't even a hard casual path to argue. Common health problems can physically restrict how often and how long one leaves the house: people on oxygen can only travel as far as their supply and weakened lungs can take them, or people with bowel disorders might be reluctant to be do anything without easy and discrete bathroom use, people with visible symptoms might be embarrassed and avoid socializing.
The loneliness-associated protein study linked in TFA doesn't seem to control for health status. So preexisting conditions may have affected the correlations.
Yes, this seems blindingly obvious to me. Maybe because I have chronic health problems myself. Perhaps those blessed with good health are blissfully ignorant.
When you are chronically ill, socializing falls pretty rapidly down your list of priorities.
And don't forget that physical loneliness, that is, actually being alone, eliminates one major feedback source that something could be wrong with your health, or a source of immediate aid if e.g. you go into cardiac arrest.
Maybe the researcher above touches on these things, but more generally, there should be a standardized probability and statistics exam for ALL aspiring scientific researchers, and a high score should be the minimum cutoff. The influence that a statistically flawed study can have over our collective futures is too dangerous.
> The influence that a statistically flawed study can have over our collective futures is too dangerous.
An even bigger danger: with all of the flawed / p-hacked / over-hyped studies, the public (and the legislature) will start to believe that NO science is real.
It worries me how much argument there is over things I consider to be facts. And how much effort goes into undermining science when it is not in the corporate interest (eg cigarette manufacturers funding “inconclusive” studies).
The first source I clicked into was a meta-analysis of randomized clinical trials.
What you say sounds true about chronic illness and isolation. These researchers are looking at research done using actual interventions and real results.
What should they do to analyze this more than RCTs and then meta-analysis of RCTs?
Another huge factor is probably lack of feedback loop. Its surprisingly easy to press on by yourself through various health issues until its too late. However someone around you might say you look pale recently you should see doctor as an obviously contrived example.
My dismissive but practical take is "well yeah there's nobody in the room to call an ambulance when you have the heart attack you'll most likely have", which mindfulness classes and support groups don't help with. There's practical benefits to having people around.
There was a funny statistical artifact I read once (well, for some value of 'funny') that home was a terrible place to have a heart attack, because people are willing to 'just lie down and see how I feel' rather than in a restaurant or movie theater where an ambulance will be called.
Or related: there's no one to nag you about going to get that funny ache checked out. Men particularly are notoriously reluctant to go to a doctor for various reasons but a worried partner might persuade them.
By these statistics there aren’t enough healthy people to provide care for those that are less healthy
The challenge here is that healthy people don’t desire to be around unhealthy people.
Society provides no incentive or social benefit for otherwise healthy people to be around the unwell to call the ambulances. Even as a nurse, hospice worker or caregiver, the pay/benefits are non existent for the amount of emotional and physical labor needed for care.
I once did a course with a paramedic on basic aid. We were discussing choking, which is a condition that really needs a 2nd party to intervene. Someone asked what to do if you live alone (with no close neighbours) - the answer was essentially ‘good luck’
>Recent meta-analyses examining 2.2 million individuals across 90 cohort studies reveal that social isolation and loneliness trigger measurable biological cascades comparable to traditional disease risk factors.
Its frustrating, because cohort study experimental designs like these can in principle chip away at reverse causality (i.e. observe loneliness exposure before a cardiovascular disease prognosis, compare difference-in-difference between treatment/control), but the meta-analysis doesnt clearly state whether this constraint was applied. But even a study like this would have issues with medical participation, so that would need to be controlled, preferably with a prospective design.
Having a spouse or friend nag you into going to the doctor is undoubtably a part of the effect, both for the practical side and for the feeling that someone would care if you were ill. (Assuming this is what you mean by "issues with medical participation.")
As an anecdote, I have a couple of elderly family members who did not mellow with age. Instead they became even more toxic and abusive as they approached their 80s. (I have another who was the complete opposite.). The abusive ones hurled curse words as soon as you entered the door; then they "switched" personalities and acted as if nothing happened. I also know of an acquaintance whose son had the similar personality traits even though he's only in his 40s. The son needed a 24 hour a day caregiver because he's mentally challenged. In short there are a whole host of physical and/or mental problems that confound the situation.
>The author seems to assume causation when the studies only indicate correlation.
once I heard Feynmann say in a youtube video that (paraphrasal) "we don't know what causes gravity, we just know that it exists, it's a property of matter"
then I realized, our experiments never show causation, they only show correlation. gravity has 100% (in our experience) correlation to matter. admittedly, that's a pretty good correlation, but for all we know, gravity causes matter. energy too, apparently.
Philosophers have worried for a long time about whether we can actually observe causation.
David Hume was famous for arguing in An Enquiry Concerning Human Understanding that we can't observe it and we instead have a "custom" or habit of expecting effects to follow causes.
> After the constant conjunction of two objects—heat and flame, for instance, weight and solidity—we are determined by custom to expect the one from the appearance of the other.
Religious philosophers have sometimes gone to the extreme of occasionalism, where they've maintained that patterns and regularities in nature were just habits or customs that God chooses to follow:
I was not aware of this, but this actually supports my point, since the reasons in that study seem to be correlated physical comorbidities, so that makes the claim "autism increases mortality due social isolation" both easier to make (as you can misinterpret the stats) as well as less defensible.
Social isolation is also not the same thing as loneliness. The paper recognizes this and gives different outcomes for three distinct categories (social isolation, loneliness and living alone). The blog post mistakenly cites the outcome for living alone as the outcome for loneliness.
If you think things through like that then you can only ever attribute physical, material, biological factors as the only things involved in mapping the causation. In other words, every time we attempt to draw the line to mortality, it gets hacked down as we keep reducing the argument.
We cannot explore the possibilities of truth if we do that, but I can appreciate the due diligence. It’s a tricky subject, but life experience informs many of us that there is something more going on than “I materially feel like shit”.
There is a taboo element to loneliness that isn’t often discussed, and that is “I feel hurt that I can be left alone, or that anyone can be left alone or isolated”. So, while the source of the isolation could be material, the feeling that manifests from it is an actual hurt that one feels from the actual thing (isolation). For example, we may be killing our elders when we isolate them in care facilities.
I can’t say if we have the sense as a society to accept data that suggests this pain can be linked to mortality. Isolation in itself isn’t the killer, it’s the pain of “well how could any society leave anyone alone”, and such a phenomenon can be witnessed in the macro outside of yourself (how can we leave people on the street? Etc).
Loneliness and isolation is often in sequence, after abandonment, or negligence, or unforgivingness (if the person “deserved” the isolating). A phantom, immeasurable pain. And even more painful, to deny it afterwards.
There is considerable evidence that people who live alone are at greater risk of hospital re-admission, probably because they are less able to care for themselves properly.
Of course there is no direct causation between loneliness and death. You don't directly die from lack of social interaction, but you do directly die from lack of food. However, there is a clear causal link between loneliness and habits that increase mortality.
> Of course there is no direct causation between loneliness and death.
Of course there is. If you are alone at home, who calls an ambulance if you have a heart attack or similar condition?
If you are living together with someone, the chance they are arund while it happens is all thats needed to skew the statistics.
I've seen this happen in person, to my grandmother. She hitched her identity to the man of the house, even signing checks "Mrs. grandad's name." She was the accountant of their farm along with housewife and cook and chicken tender. He was most of the muscle until he had to relinquish the work to their youngest son, who had moved out and into his own house. She was in relatively good health when grandad died at 76. She suddenly lost her identity, being alone in that farmhouse which she helped build and maintain, it was too full of ghosts to live alone, she moved in with the son. I never saw her smile after that. She died within months.
My great-grandmother was different. her husband died young. she had 50 more years of life after that. She gardened, she sewed, she pickled and canned. She established a strong personal identity and experienced evergreen personal growth. She was a happy woman, cackling all of the time when we'd visit. When she died at 95, it was a surprise, she seemed very alive and healthy shortly beforehand. She died in her sleep, no chronic diseases.
Makes me think that 32% might be traced to psychological/sociological factors.
It sounds like your grandma passed from a broken heart.
My mother in law lost her husband when she was in her early 60s, and I was worried that she would suffer the same fate as your grandma. She sold her house after a few years to escape the ghosts and moved into a condo near me. Her social schedule is jam-packed.
There is so much to be said about having your own identity, hobbies, and passions.
The person she spent her life with died. She could have just been sad and lonely over that, not some lack of "identity".
I've been married for over 30 years and we both have our own independent identities and successes (as well as shared ones). We are still very close and loving. Neither needs the other to live but after so long our emotional involvement with each other is as deep and foundational as the roots of a great tree. Losing her (or her me) would be utterly devastating and how we identify ourselves has nothing to do with it.
Mindfullness as a treatment for loneliness is strange to me. This doesn't actually help with the problem of being alone, it could just make someone be more OK with it.
As someone who spends a lot of time alone, one of my big fears is having a medical emergency, even just choking on food, and dying from something that would be easily avoided had another person been in the house. I've gone and looked up how to give myself the Heimlich maneuver on myself, and play out that scenario in my head all the time... or trying to get to a neighbor's house or just outside where someone might see me. Mindfulness won't help if this is how I meet my fate, actually community and relationships would.
It's quite a rare thing to die by choking. It just doesn't feel like it, which is where mindfulness can help. You do more dangerous things every day like walking (falls) and driving, eating (obesity), and brushing your teeth (gum disease), so if you want to work on prevention it's better to have a head that correctly assesses risk and spends your limited time/money/effort optimally.
But then choking is not the only health emergency when having people around is a plus. Even active people sometimes suffer from heart attacks and having someone being there doing chest compressions or at least calling for help leads to quite difficult health outcomes versus being found hours later. Same goes for strokes…
I think probably the idea is that Mindfulness helps you make peace with yourself and trouble-shoot your personality, both of which could make it easier to make connections with other people.
I think so much of it is our fear of dealing with conflicts and running away. Mindfulness, if it helps us have the courage to talk with people, apologize, forgive, and reconcile relationships with ourselves and others, can probably be super helpful. However, I think a lot of it has us actually move farther away from others, retreating into ourselves and then yeah, if you need someone to take you to the hospital, the relationships aren't there or aren't so immediate to help with that.
I think I feel you and I hope that if something like that were to happen, you would have people willing to offer and give that help and you'd be willing to ask for and receive that help.
Before getting tied up with bureaucratic nonsense my daughter was looking at starting a "borrow a grandma / grandpa" club at her university. The idea was to connect students with elderly people who are lonely, and they could have tea / coffee together. The elderly get to be social with a younger generation, and the younger generation gets to understand the struggles that a lot of elderly people face.
I think that the university was concerned with liability. I still think that it's a good idea.
Did your daughter talk to a few local senior citizen agencies or nursing homes? Last I knew, quite a few of those are interested in "just visit occasionally" volunteers. And if another org (which specialized in seniors) was handling that end of things, the U might not be so hung up on allowing the club.
Or, "we're adults, just do it". The U can't actually stop of-age students from volunteering for local organizations, or joining churches, or playing soccer in a city park.
Old people's homes are very welcoming to ANYONE willing to spend time with the residents. No need to join a club: pick up the phone or stop by and ask if they would like your time. I guarantee the answer will be, "When can you start?"
Maybe a scheduled get togethers of a retirement home group with a that student org either at the home or the university could work. That way it's easier to have a person trained to chaperone, a more controlled environment, and reduced general overhead for planning.
Liability that one of them will don a Robert De Niro grin and say, “hey kid, wanna get out of here?” and the youth will oblige by lowering the roof on the GT and cranking up Deep Purple’s Highway Star as they peel rubber from beneath the pastel peach awning, thousands of foot pounds of torque expressing a shared joy in a cloud of smoke and a squeal of delight.
Holy... That just unlocked a memory. When I was a 10 y.o. kid and a member of Young Pioneers organization in the late Soviet Union, we had a routine elderly care assignment. There was literally a task "to help N lonely elderly people next week"! We were split in pairs and provided with a list of addresses of nearby "targets" and a general guidance on what this help may constitute, like helping them with groceries, walking a dog, house cleaning, etc. And I remember there was a nice old lady who were treating us with tea and pies, and showing us some old photos, and who we then visited few times outside of the assignment just because she welcomed us and we liked it there. For me it was just some secondary quest that I barely registered and completely forgot about until now, but now I wonder if it was a big deal for her
> A liability for having tea with elderly citizens?
In their homes? It's a mountain of liability. The elderly tend to be a combination of paranoid and senile.
The first time they misplace a checkbook or forget some valuable was already given to some grandchild they'll accuse the most recent new guest in memory of stealing.
And that's just one of an infinite number of possibilities having spent zero time dwelling on it.
There's a lot of aspects here, such as where they would meet up, etc. If it's on school property and something happens, for example. Additionally there are restrictions for clubs operating off-campus. I don't know, it was seemingly more complicated than any of us had anticipated.
There's plenty of programs that do just that in the US, so maybe the university just didn't want to deal with the liability if someone else already is (if it was a US university, of course).
How much is related to people suffering a medical emergency and nobody being around to help? vs. How much is the actual emotional impact of loneliness?
It doesn't even have to be medical emergencies that go unnoticed. There are other declining health metrics that an independent observer might notice that a person is not aware of or is unwilling to confront. If there's no one to say "you might want to get that checked out", you probably won't get that checked out!
No mistake, almost all of us can refer to an anecdote of an elderly relative dying soon after their spouse. It can be both tragic and, in hindsight, romantic. But really, the consequences of loneliness are often and unfortunately quite practical.
Its anecdotical (though, I guess, there is plenty of data for that), but often people (especially men) don't visit a doctor early enough. It takes their partner (of friends, kids) to prompt them to get checked.
Medical emergencies might be a cherry on the cake - but let's not forget that most diseases are not instantaneous - and sooner these are cached, less harm.
I saw an analysis that demonstrated this clearly by replacing loneliness with population density. Effectively you could see the same mortality effect for people who live out in the sticks.
This is a very valid question. I have had a few close calls where I afterwards wonder what would have happened if I had hurt myself seriously. Chances are, no one would have paid attention in days.
Aside from a formal study, _feels_ right (for what that's worth). The healthiest people I know are generally happy and have people around who care of them and they care for. I swear the social parts of life are what keep the elderly going, in my experience.
I swear the social parts of life are what keep the elderly going, in my experience.
I could've sworn there was a paper, (or maybe just an article? can't remember), a long time ago about the community on a Mediterranean island somewhere? The thesis was that people there were living abnormally long lives because of the Mediterranean style food they ate, and how socially active and interconnected they were in old age.
It's the social equivalent of ultra-processed food. Hyper-palatable and habit-forming, you always crave more. You end up (socially) both overfed and malnourished.
We're an international movement whereby volunteer cyclists pedal passengers around on what is essentially a small couch on wheels. The elderly get out into their neighbourhood while engaging with volunteers in conversation, jokes, and memories. The benefits of even brief but regular social connection are lasting, as we hear from medical professionals and care home workers and the residents themselves and their families.
There's a great TED Talk on it which inspired us to start a local chapter almost eight years ago. We are in high demand and growing so if you're looking for a healthy way to serve others, consider getting in touch with your local chapter (or starting it!)
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So for example, it's possible that if you already have chronic illness, a disability, or any other kind of health issues, you're more likely to have higher social isolation and therefore be more lonely, in addition to having a higher mortality risk. There's an outside variable (your health) that is correlated with both (loneliness and mortality), but that doesn't necessarily mean that loneliness causes mortality. If this were the case, we could defend claims like "autism increases mortality", because we already know that autism increases social isolation.
The loneliness-associated protein study linked in TFA doesn't seem to control for health status. So preexisting conditions may have affected the correlations.
When you are chronically ill, socializing falls pretty rapidly down your list of priorities.
Maybe the researcher above touches on these things, but more generally, there should be a standardized probability and statistics exam for ALL aspiring scientific researchers, and a high score should be the minimum cutoff. The influence that a statistically flawed study can have over our collective futures is too dangerous.
An even bigger danger: with all of the flawed / p-hacked / over-hyped studies, the public (and the legislature) will start to believe that NO science is real.
It worries me how much argument there is over things I consider to be facts. And how much effort goes into undermining science when it is not in the corporate interest (eg cigarette manufacturers funding “inconclusive” studies).
What you say sounds true about chronic illness and isolation. These researchers are looking at research done using actual interventions and real results.
What should they do to analyze this more than RCTs and then meta-analysis of RCTs?
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s... Tackling social disconnection: an umbrella review of RCT-based interventions targeting social isolation and loneliness
The challenge here is that healthy people don’t desire to be around unhealthy people.
Society provides no incentive or social benefit for otherwise healthy people to be around the unwell to call the ambulances. Even as a nurse, hospice worker or caregiver, the pay/benefits are non existent for the amount of emotional and physical labor needed for care.
Its frustrating, because cohort study experimental designs like these can in principle chip away at reverse causality (i.e. observe loneliness exposure before a cardiovascular disease prognosis, compare difference-in-difference between treatment/control), but the meta-analysis doesnt clearly state whether this constraint was applied. But even a study like this would have issues with medical participation, so that would need to be controlled, preferably with a prospective design.
once I heard Feynmann say in a youtube video that (paraphrasal) "we don't know what causes gravity, we just know that it exists, it's a property of matter"
then I realized, our experiments never show causation, they only show correlation. gravity has 100% (in our experience) correlation to matter. admittedly, that's a pretty good correlation, but for all we know, gravity causes matter. energy too, apparently.
David Hume was famous for arguing in An Enquiry Concerning Human Understanding that we can't observe it and we instead have a "custom" or habit of expecting effects to follow causes.
> After the constant conjunction of two objects—heat and flame, for instance, weight and solidity—we are determined by custom to expect the one from the appearance of the other.
Religious philosophers have sometimes gone to the extreme of occasionalism, where they've maintained that patterns and regularities in nature were just habits or customs that God chooses to follow:
https://en.wikipedia.org/wiki/Occasionalism
Are you aware that life expectancy is much lower for peel with autism than the general public?
https://pmc.ncbi.nlm.nih.gov/articles/PMC6713622/
We cannot explore the possibilities of truth if we do that, but I can appreciate the due diligence. It’s a tricky subject, but life experience informs many of us that there is something more going on than “I materially feel like shit”.
There is a taboo element to loneliness that isn’t often discussed, and that is “I feel hurt that I can be left alone, or that anyone can be left alone or isolated”. So, while the source of the isolation could be material, the feeling that manifests from it is an actual hurt that one feels from the actual thing (isolation). For example, we may be killing our elders when we isolate them in care facilities.
I can’t say if we have the sense as a society to accept data that suggests this pain can be linked to mortality. Isolation in itself isn’t the killer, it’s the pain of “well how could any society leave anyone alone”, and such a phenomenon can be witnessed in the macro outside of yourself (how can we leave people on the street? Etc).
Loneliness and isolation is often in sequence, after abandonment, or negligence, or unforgivingness (if the person “deserved” the isolating). A phantom, immeasurable pain. And even more painful, to deny it afterwards.
The problem is that this article is overstating the effect on mortality because its not controlling for confounding factors very well.
Of course there is. If you are alone at home, who calls an ambulance if you have a heart attack or similar condition? If you are living together with someone, the chance they are arund while it happens is all thats needed to skew the statistics.
My great-grandmother was different. her husband died young. she had 50 more years of life after that. She gardened, she sewed, she pickled and canned. She established a strong personal identity and experienced evergreen personal growth. She was a happy woman, cackling all of the time when we'd visit. When she died at 95, it was a surprise, she seemed very alive and healthy shortly beforehand. She died in her sleep, no chronic diseases.
Makes me think that 32% might be traced to psychological/sociological factors.
My mother in law lost her husband when she was in her early 60s, and I was worried that she would suffer the same fate as your grandma. She sold her house after a few years to escape the ghosts and moved into a condo near me. Her social schedule is jam-packed.
There is so much to be said about having your own identity, hobbies, and passions.
That was quite common for much of the 20th century.
I've been married for over 30 years and we both have our own independent identities and successes (as well as shared ones). We are still very close and loving. Neither needs the other to live but after so long our emotional involvement with each other is as deep and foundational as the roots of a great tree. Losing her (or her me) would be utterly devastating and how we identify ourselves has nothing to do with it.
As someone who spends a lot of time alone, one of my big fears is having a medical emergency, even just choking on food, and dying from something that would be easily avoided had another person been in the house. I've gone and looked up how to give myself the Heimlich maneuver on myself, and play out that scenario in my head all the time... or trying to get to a neighbor's house or just outside where someone might see me. Mindfulness won't help if this is how I meet my fate, actually community and relationships would.
I think I feel you and I hope that if something like that were to happen, you would have people willing to offer and give that help and you'd be willing to ask for and receive that help.
I think that the university was concerned with liability. I still think that it's a good idea.
https://adoptaunabuelo.org
Or, "we're adults, just do it". The U can't actually stop of-age students from volunteering for local organizations, or joining churches, or playing soccer in a city park.
In their homes? It's a mountain of liability. The elderly tend to be a combination of paranoid and senile.
The first time they misplace a checkbook or forget some valuable was already given to some grandchild they'll accuse the most recent new guest in memory of stealing.
And that's just one of an infinite number of possibilities having spent zero time dwelling on it.
No mistake, almost all of us can refer to an anecdote of an elderly relative dying soon after their spouse. It can be both tragic and, in hindsight, romantic. But really, the consequences of loneliness are often and unfortunately quite practical.
So I guess you have:
bad company < no company < good company
Medical emergencies might be a cherry on the cake - but let's not forget that most diseases are not instantaneous - and sooner these are cached, less harm.
I could've sworn there was a paper, (or maybe just an article? can't remember), a long time ago about the community on a Mediterranean island somewhere? The thesis was that people there were living abnormally long lives because of the Mediterranean style food they ate, and how socially active and interconnected they were in old age.
https://cyclingwithoutage.org/
We're an international movement whereby volunteer cyclists pedal passengers around on what is essentially a small couch on wheels. The elderly get out into their neighbourhood while engaging with volunteers in conversation, jokes, and memories. The benefits of even brief but regular social connection are lasting, as we hear from medical professionals and care home workers and the residents themselves and their families.
There's a great TED Talk on it which inspired us to start a local chapter almost eight years ago. We are in high demand and growing so if you're looking for a healthy way to serve others, consider getting in touch with your local chapter (or starting it!)