By all rights, Betty Lewis should be a lonely woman.
Now nearly 90, her daughter, grandchildren, and great-grandchildren — whom she’s never met — all live in California. Her friends have died or moved to faraway nursing homes. Health problems mean she can’t get outside without help, and her vision troubles make reading a challenge.
But Lewis, of Brighton, involves herself in public lectures, continuing education classes, sales on eBay, and visits from friends and volunteers for Little Brothers-Friends of the Elderly.
“I’m an optimistic person,” said Lewis, who still laughs a lot and values her ability to put aside unpleasant thoughts. “I think that’s so important for anybody’s survival of a decent, non-unhappy life,” she said.
A growing body of evidence suggests that there could be health consequences for someone like Lewis if she dwelled on the negatives.
Chronic loneliness, it seems, is partly a matter of social isolation and partly a state of mind. Both can potentially drive ill health.
Lonely people over 65 run the same risk for early death as those who smoke or are at least 100 pounds overweight, according to a study published last month in the journal Perspectives on Psychological Science.
Although the exact mechanism isn’t clear, loneliness “activates a whole host of biological systems that appears to be harmful to people’s health,” said Bert Uchino, a professor of psychology at University of Utah, who was not involved in the new study.
A lonely person’s blood pressure tends to be higher and change more as they age; and they are more likely to have high levels of inflammation, which leads to even more health problems, Uchino said.
“Often mental health is a precursor or warning sign that physical health is in danger,” said Laura Kubzansky, a professor of social and behavioral sciences at Harvard’s T.H. Chan School of Public Health. Loneliness is “a really important aspect of people’s lives we should be paying attention to — but it’s not the kind of thing doctors typically ask about.”
Loneliness is particularly problematic among older people, said J. David Creswell, an associate professor of psychology at Carnegie Mellon University. They may have lost loved ones, or their social fabric may have frayed when they left the workforce or the neighborhood where they laid down roots.
Today’s older people are more alone than counterparts of 50 years ago, said Andrew Steptoe, a professor of psychology at University College London.
In the United Kingdom, for instance, more than one-third of people 65 and older live alone; 40 percent say that TV or pets are their main form of company; and 23 percent of men and 15 percent of women have contact with friends or family members less than once a month, Steptoe said.
Social structures that used to help people avoid loneliness in old age, like close extended families, neighborhood groups, and religious institutions aren’t as strong or as readily available as they used to be.
For those whose loneliness is a matter of social isolation the solution, while not necessarily simple, may be more straightforward. For them more human contact may be the solution.
There are others, however, for whom loneliness is harder to resolve as it is partly a function of personality and temperament.
These are people — whether socially isolated or not — who tend to be mistrustful of others, often negative, and feel threatened, said Steve Cole, a professor of Medicine and Psychiatry and Biobehavioral Sciences at the University of California, Los Angeles School of Medicine.
“When we think about loneliness, we think about it in a sad, dejected way — as a quiet emotion,” said Cole. But “this biology is the biology of threat.”
Such a chronically lonely temperament is relatively common, affecting roughly 15 percent to 20 percent of the population, he estimates.
It’s not clear how much of this is inborn, and how much is the result of loss or betrayal, particularly in childhood, Cole said.
Researchers used to think that the obvious answer to loneliness was simply more social activity — making friends, having hobbies, and getting out more, like Lewis does. For years, researchers studied such social activities and couldn’t understand why there were so many people who had some of these things in their lives but still reported persistent feelings of isolation.
But viewing loneliness for these individuals instead as temperament — a constant state of anxiety — suggests a different approach that has been proving more effective in early research.
After an eight-week program of mindfulness in Los Angeles, for instance, a small group of participants reported feeling less lonely and their genes were producing fewer inflammation-triggering proteins, said Creswell, who led the study, along with Cole.
Mindfulness, said Creswell, helps people view their loneliness as merely a fact, rather than something distressing.
“It’s not any type of cure-all,” Creswell said of mindfulness, “but it can be a really helpful tool.”
Loneliness research has helped highlight the problems, Kubzansky said. Now, people need to act on that knowledge and make a difference in the health of those who are lonely.
“This is something that does really matter and we should put it on the agenda,” she said. “We have a lot of smart people who can think about it, but it has to be on the agenda.”