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Health

Harvard Study Reveals Chronic Loneliness May Elevate Stroke Risk in Older Adults

Chronic loneliness may greatly increase the risk of stroke in older adults, a new Harvard study shows.

The study, led by the T.H. Chan School of Public Health in Boston, was published Monday in eClinicalMedicine. It’s one of the first studies to look at the link between changes in loneliness and stroke risk over time.

Among adults ages 50 and older, those who endured chronic loneliness had a 56% higher risk of stroke than those who consistently reported not feeling lonely.

However, participants who experienced occasional loneliness did not incur a greater risk of stroke. This suggests that the impact of loneliness on stroke risk occurs over the longer term, the researchers noted.

“Loneliness has been identified as a modifiable risk factor for stroke, which is a leading cause of death and disability in the U.S.,” said the study’s lead author, Yenee Soh, a research associate in the Department of Social and Behavioral Sciences at T.H. Chan.

“Most prior studies examine loneliness at a single time point, yet loneliness can be transient or chronic,” Soh said, adding that “loneliness is not only a public health issue in itself, but also has significant implications for physical health.”

She said “it is important to routinely assess loneliness, as the consequences may be worse if ignored.” In addition, interventions for loneliness should “address the subjective feeling of loneliness and not conflate it with social isolation — lack of social contact with others.”

“The 2023 U.S. Surgeon General’s advisory on social connection highlights loneliness as an epidemic, exacerbated by the COVID-19 pandemic and with widespread consequences for health,” the researchers wrote.

Researchers extracted 2006-2018 data from the Health and Retirement Study to assess the association between changes in loneliness and stroke incidence over time.

During 2006-2008, 12,161 participants — all adults ages 50 and older without a personal history of stroke — responded to questions on the Revised UCLA Loneliness Scale, from which researchers created summary loneliness scores.

Four years later (2010-2012), the 8,936 participants who remained in the study again answered the same questions.

Participants were then classified into four groups based on their loneliness scores across the two time points: “consistently low” (scoring low on the loneliness scale at both baseline and follow-up); “remitting” (scoring high at baseline and low at follow-up); “recent onset” (scoring low at baseline and high at follow-up); and “consistently high” (scoring high at both baseline and follow-up).

The researchers analyzed each group’s stroke risk over the follow-up period in the context of their experiences with loneliness. They controlled for other health and behavioral risk factors, such as social isolation and depressive symptoms, which are closely related but distinct from loneliness.

Additional research delving into both nuanced changes in loneliness over the short-term, as well as loneliness patterns over a longer period of time, may provide more insight into the association between loneliness and stroke risk. More research is also needed to understand the potential underlying mechanisms, the authors noted.

They also pointed out that the study’s findings were limited to middle-aged and older adults and may not be generalizable to younger people.

“It is a very interesting study that highlights a link of ‘the loneliness epidemic’ that we hear so much about lately to a very serious health outcome — stroke,” said Dr. Michael Dobbs, a vascular neurologist and chair of the Department of Clinical Neuroscience at Florida Atlantic University’s Charles E. Schmidt College of Medicine in Boca Raton. He was not involved in the study.

“We need to do more as a society to help address chronic loneliness in individuals,” Dobbs said, adding that the connection between loneliness and stroke is not surprising.

 

He noted that previous studies have linked loneliness to cardiovascular disease — and stroke has many of the same risk factors.

“Loneliness is a normal feeling to have sometimes in life, but chronic loneliness may increase the risk of stroke” based on someone’s lifestyle decisions and behaviors, he said.

“When feeling lonely, it is still important to make healthy choices and take steps to reduce risk of stroke, such as following a good diet and exercising, and taking appropriate prescribed medications.”

Dr. Timothy Farrell, chair of the American Geriatrics Society’s ethics committee, said the study “adds to an emerging body of literature on the association of loneliness with adverse health outcomes.”

Just like obesity and smoking, loneliness is a strong risk factor for adverse health outcomes, and it also may contribute to stroke, said Farrell, who is interim clinical co-chief of geriatrics and associate chief of age-friendly care at the Spencer Fox Eccles School of Medicine at the University of Utah in Salt Lake City.

He noted that this research lends more support for primary care providers to conduct targeted screening for loneliness in older adults before a crisis occurs.

“If we can identify loneliness earlier, we may be able to prevent or delay that first stroke,” Farrell said, considering that older adults who experience loneliness may be less likely to seek treatment or follow recommendations for managing high blood pressure and other stroke risk factors.

“What this study suggests is that it’s the feeling of loneliness that’s important, above and beyond whether people are isolated,” said Shira Gabriel, a professor of psychology at the University of Buffalo, who has studied loneliness.

Gabriel explained that some individuals feel lonely even if a lot of people surround them, while others don’t experience loneliness with limited social connection.

When people don’t have access to family, friends or a romantic partner, it can help to identify with the characters in a particular TV show. Spending time with pets, reading books or attending concerts also may alleviate loneliness in middle age and beyond, Gabriel noted.

“Each person out there needs to find things that make them feel good and connected,” she said.

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