By Amanda Gardner
MONDAY, June 18, 2012 (Health.com) — Loneliness and isolation can affect your quality of life—and maybe your quantity of life, too. According to a pair of studies published today in the Archives of Internal Medicine, living alone—or even just feeling lonely—may increase a person's risk of premature death.
One study followed nearly 45,000 people ages 45 and up who had heart disease or a high risk of developing the condition. Those who lived alone, the study found, were more likely to die from heart attacks, strokes, or other heart complications over a four-year period than people living with family or friends, or in some other communal arrangement.
The risk was highest in middle-aged people, just 14% of whom lived alone. Solo living increased the risk of heart problems and early death by 24% among people ages 45 to 65, and by only 12% among people ages 66 to 80. And there was no association at all in people age 80 and older, a group in which living alone is common.
More research is needed to confirm these findings, but in the meantime it may not be a bad idea for doctors to ask heart patients about their living situation, says senior author Deepak L. Bhatt, M.D., a cardiologist at Brigham and Women's Hospital, in Boston.
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Living alone "could be a little red flag that [a] patient may be at a higher risk of bad outcomes," Bhatt says.
Why is living alone potentially harmful? Especially among the middle-aged, a demographic in which living with a spouse or partner is the norm, living alone may be a sign of social or psychological problems, such as relationship trouble, a weak support system, job stress, or depression—all of which have been linked to heart disease.
But living alone could affect health in more immediate ways. For instance, people who don't have a spouse or other family member keeping an eye on them may be more apt to skip their medications or ignore the warning signs of heart trouble, Bhatt says. (Indeed, a 2011 study found that men who have heart attack-related chest pain tend to get to a hospital sooner if they're married or living with a partner.)
Previous research has shown a "very consistent relationship" between a lack of so-called social support and poor health, but measures such as social support haven't always been consistently defined, says Emily M. Bucholz, M.P.H., a medical student and doctoral candidate at Yale University, in New Haven, Conn.
"Living alone, in and of itself, could stand for many different things," says Bucholz, who coauthored an editorial accompanying the studies. "Does it mean you lack companionship? Or is it that there is no one there to help you out with medications? Does it have to do with mobility or nutrition?"
Next page: Is loneliness a form of stress?
The second study suggests that actual feelings of loneliness and isolation, and not just practical matters such as medications, do play a role in health.
The six-year study, which focused on people age 60 and older, found that men and women were 45% more likely to die during the study if they reported feeling lonely, isolated, or left out. They were also 59% more likely to have difficulty with everyday tasks such as dressing and bathing, an important measure of overall health in older people.
Lonely people—a full 43% of the study population—weren't necessarily living alone, however. The link between loneliness and poor health held even after the researchers took into account living situation, depression, and a wide range of other factors, suggesting that feelings of loneliness or isolation might independently damage health in some way.
Some experts view persistent loneliness as a form of stress, for instance, and in previous studies it has been linked with inflammation and other processes that can damage blood vessels. These biological factors, along with social factors, may help explain the new findings, says lead author Carla M. Perissinotto, M.D.
"Feelings of being lonely could cause an inflammatory state," says Perissinotto, an assistant professor of geriatrics at the University of California, San Francisco. "At the social end, those who feel lonely may be less likely to engage with the healthcare community or the community at large, and therefore have less self-care."
Although it's too soon to say how—or even if—loneliness and isolation undermine health, the authors of both studies encourage doctors to discuss living arrangements and feelings of loneliness with their patients. The conversation may provide a clue that patients aren't sticking to their medication, or an opportunity to suggest ways to alleviate loneliness.
Even just raising the issue can be beneficial, Perissinotto says. "Acknowledging it can go a long way," she says. "People feel like they're not ignored."