Why loneliness can really harm your health… and how a coffee morning can be just the medicine many of us need

What should we do to stay healthy and live a long life? I’m sure most of you can easily list all the ‘do’s and don’ts’: don’t smoke, drink less, exercise regularly, eat healthy and get enough sleep.

But how many of you have mentioned the dangers of loneliness?

Loneliness isn’t just a lame side note that makes people more susceptible to depression. It is a silent killer that claims the lives of many thousands of British people every year.

Last week, new figures from the British Heart Foundation showing that premature deaths from heart disease had risen made front-page news.

There was widespread shock that the number of people in England dying from cardiovascular diseases, such as heart attack and stroke, was the highest annual total since 2008.

Clearly a number of factors are at play here – experts pointed to waiting lists and the Covid effect. But this trend had already started before Covid and, in my view, it coincides with a rise in the number of people reporting being lonely (with almost four million in Britain saying they are chronically lonely).

Loneliness was something that was barely discussed when I was in medical school, but now it is widely recognized that we need to address it if we want to improve people’s health.

Modern medicine is designed to help patients when they get sick – but what we often don’t do is treat the underlying reasons why patients get sick and ‘fall over’. And that’s where loneliness comes into play.

I see its effect every day, in my work in the emergency department, where I regularly treat patients who have had a stroke or heart attack shortly after retirement.

I remember one particular case vividly: a mechanic in his early sixties who had not led the healthiest life: he smoked and had a daily chip shop with his colleagues, and without a husband who kept nagging him about his growing waistline and alcohol consumption. intake.

But he was happy: he joked with his colleagues and often went out with them in the evenings. However, after he retired, he lost his social connections.

At first glance, he became healthier: he no longer went out in the evenings, which reduced his alcohol consumption and resulted in fewer fry-ups.

And without the social pressure from his smoking colleagues, he also gave up. But he was lonely, very lonely.

One morning, three months after his retirement, he suddenly became unable to move his right arm and could not utter his words.

He managed to knock on his neighbor’s door and they called an ambulance.

At the emergency room the diagnosis was clear: he had suffered a massive stroke.

Despite the treatment, he never regained the use of his arm and could no longer speak. Within a year he grew from an expert mechanic to a nursing home resident.

The pension effect was not merely a coincidence.

In 2012, a study by public health experts at Harvard Medical School in the US, involving more than 5,000 people over the age of 50, revealed that retirement was associated with a 40 percent higher risk of stroke or heart attack compared to people who did. still works. Was loneliness after work the cause? There is a lot of good data showing that this is the case.

In a major review published in the journal Heart in 2016, researchers from York University looked at data from 23 articles (with more than 35,000 participants). They found that loneliness led to a 29 percent increase in the risk of heart attack and a 33 percent increase in the risk of stroke.

More recently, a study in Lancet Public Health last year found that those who were lonely had a 12 percent higher chance of being hospitalized with an infection than those who were not lonely.

Last year, the World Health Organization declared loneliness an urgent global health threat, with the US surgeon general saying its effects were comparable to smoking 15 cigarettes a day, and greater than obesity or lack of exercise. And loneliness is spreading, thanks to lockdowns and a change in social norms post-Covid, with the rise of working from home and binge-watching on days off rather than working and socializing in groups.

The mechanism by which loneliness increases the risk of premature death is incredibly complex, but essentially it triggers our stress response, leading to a rise in blood pressure.

This stress response also affects chemicals in the body called cytokines, which cause inflammation, a known cause of premature aging.

In my view, the evidence linking loneliness to poor health is very strong.

But the evidence we have comes from observational studies, where you monitor a factor like loneliness and see the impact further down the line (on mortality rates, for example).

And others in the medical community are less convinced by the evidence linking loneliness and illness, arguing that the link could simply be a coincidence.

The only way you can actually prove that loneliness causes medical problems is through a type of study called a randomized controlled trial, where one group of patients gets a treatment and the other gets a placebo and you see the impact.

It works well if you test medications, for example. However, it is much more difficult to conduct this kind of test on something as complex as preventing loneliness.

More importantly, it is much more difficult to fund these types of studies because there is no profit for pharmaceutical companies. So the evidence base, in terms of randomized controlled trials, for tackling loneliness is not as strong as it could be.

However, evidence is mounting that tackling it has an impact on health.

A few weeks ago I met Jeremy Welch, a GP and senior partner at Mythe Medical Practice in Tewkesbury, on the edge of the Cotswolds.

He believes passionately in the importance of social interactions for people’s health and was particularly concerned about what happened to his patients after the lockdown.

He managed to convince colleagues to use part of their available ‘medical’ budget in a unique way: by getting all their patients over 65 who were lonely to undertake social activities to see if this could improve their health .

He appointed Anne Williams as lead nurse for the health and wellbeing team; they contacted 10,000 patients over the age of 65 and had them complete a survey to find out if they were lonely.

Those who said so (a third of people surveyed) were invited to take part in a weekly exercise program for three months, organized by Anne’s team and all in local community settings. The first six sessions were free, then each session cost £3.

In the first year there were over 10,000 attendees at these classes, the key factor being that people met for tea and coffee afterwards, and those who wished were then given information about other social activities available in the area, such as garden clubs, dance clubs and choirs.

After this intervention, the number of GP visits for this group of patients fell by 13.6 percent. This compared with an 8.6 percent increase in GP appointments for similar people in a neighboring town. It’s too early to see the impact on stroke and heart attack rates, but I have no doubt it will be positive.

This type of medicine – holistic and tackling potential problems before they happen – is key to improving our patients’ outcomes and preventing the NHS from imploding due to unsustainable demand.

“It’s just common sense,” Jeremy told me. ‘Just ask one of your grandparents. . . one stitch in time saves nine.’

@drrobgalloway