Loneliness and social isolation are significant risk factors that precede the first occurrence of coronary heart disease (CHD) or stroke.¹ In meta-analysis of 16 longitudinal datasets, poor social relationships increased the likelihood of CHD by 29% (pooled relative risk 1.29, 95% CI 1.04-1.59) and stroke by 32% (pooled relative risk 1.32, 95% CI 1.04-1.68) for both genders.¹ Similarly, a meta-analysis of 70 prospective studies of 3,407,134 participants (mean age = 66 years) reported the likelihood of all-cause mortality was increased by 26% (OR = 1.49, 95% CI = 1.38-1.70) for reported loneliness, 29% (OR = 1.83, 95% CI 1.27-2.63) for social isolation, and 32% (OR = 1.51, 95% CI = 1.32-1.74) for living alone.² Healthcare providers may need to consider a patient's psychosocial wellbeing in the fight against CHD and stroke.

The National Social Life, Health, and Aging Project, analysis of Wave 2 data from 2010-2011 indicated health in older adults is associated with a social network, and marriage provides protection against health decline.³ Older adults at greatest risk of death are those without family or close friends who live alone. Is it possible older adults with a satisfying social network may have a lower risk of CHD and stroke?

Married older adults with a social network are at decreased risk for general health decline.³ According to the United States Census in 2014, there were 39,833,000 single adults 50 years of age and older,⁴ but reportedly only 14% of eligible older adult singles were actively dating.⁵ Efforts to address social isolation and loneliness are needed to reduce the risk of CHD and stroke. How often do healthcare providers consider an active dating or social life as a strategy to decrease cardiac risk in elderly patients?

A New York Times⁶ article that emphasizes friendship as the antidote to the detrimental effects of loneliness is supported by a systematic review of benefits of group interventions, support, and activities, such as a foster grandparent program.⁷ Websites, such as LeadingAge⁸ and Pioneer Network,⁹ that provide resources to address the challenges of staying active while aging can be beneficial sources for both professionals and patients.

Similar to the risk factors of smoking, hypertension, hypercholesterolemia, and obesity, loneliness and social isolation pose significant health risks. Yet loneliness and social isolation are typically unrecognized cardiac risk factors. Medications and invasive procedures treat CHD and stroke, but if older adults remain socially isolated and lonely, the capacity to experience the full benefits of these treatments may be limited. Healthcare providers can consider loneliness and social isolation along with traditional risk factors. A few brief conversational questions about social activities, connection with family and friends, and personal relationships can quickly reveal if a patient is lonely or social isolated. Routinely screening for significant others and social support in older adults may be indicated as our understanding of aging patients with cardiovascular disease evolves.

References

1. Valtorta NK, Kanaan M, Gilbody S, Ronzi S, Hanratty B. Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart 2016;102:1009-16.
2. Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci 2015;10:227-37.
3. Wong JS, Waite LJ. Marriage, social networks, and health at older ages. J Popul Ageing 2015;8:7-25.
4. United States Census Bureau. Families and Living Arrangements: America's Families and Living Arrangements: 2014: Adults. Table A1: Marital status of people 15 years and over, by age, sex, personal earnings, race, and Hispanic origin. 2014. https://www.census.gov/hhes/families/data/cps2014A.html.
5. Brown SL, Shinohara SK. Dating relationships in older adulthood: a national portrait. J Marriage Farm 2013;75:1194-202.
6. Span P. Loneliness can be deadly for elders; friends are the antidote. The New York Times 30 Dec 2016. https://www.nytimes.com/2016/12/30/health/loneliness-elderly.html.
7. Dickens AP, Richards SH, Greaves CJ, Campbell JL. Interventions targeting social isolation in older people: a systematic review. BMC Public Health 2011;11:647.
8. The Trusted Voice for Aging in America. Leading Age. http://leadingage.org/.
9. Resources and Links. Pioneer Network. https://www.pioneernetwork.net/Resources/Resources/.

Keywords: Adult, Aged, Coronary Artery Disease, Health Personnel, Hypercholesterolemia, Hypertension, Loneliness, Marriage, Obesity, Risk Factors, Social Isolation, Social Support, Stroke, Geriatrics

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