Loneliness Is a Health Matter: The Evidence, and What Actually Helps

In 2023 the Surgeon General of the United States wrote that a lack of social connection “can increase the risk for premature death as much as smoking up to 15 cigarettes a day.” Three years earlier, a National Academies committee had reached a comparable conclusion about older adults. Neither treated loneliness as a private sorrow to be borne with good manners; both treated it as a risk factor.

For a widow, the question is rarely whether you miss the person you married. It is whether what you feel is loneliness, grief, depression, or something as mechanical as untreated hearing loss. After reading, you should be able to tell them apart, choose one or two responses worth trying, and raise the subject with your doctor so that it produces a plan rather than a pleasantry.

Isolation, loneliness and solitude are three different things

The Surgeon General’s advisory defines social isolation as “objectively having few social relationships, social roles, group memberships, and infrequent social interaction,” and loneliness as “a subjective distressing experience that results from perceived isolation or inadequate meaningful connections.” Solitude, “a state of aloneness by choice that does not involve feeling lonely,” is not a problem at all.

The first two often come apart. The National Academies committee observed that “social isolation and loneliness often are not significantly correlated.” In the National Institute on Aging’s words, “you can feel lonely while being with other people.”

Both errors are available to a woman of means. A full diary of trustee meetings, advisers and household staff can conceal loneliness, because none of those relationships was built to carry what a marriage carried. A quiet life in a house you love, deliberately chosen, may simply be solitude. The test is whether the contact you have meets the need you feel.

What the Surgeon General’s 2023 advisory concluded

Our Epidemic of Loneliness and Isolation covers adults of every age. Its central findings, quoted as written:

• “Loneliness and social isolation increase the risk for premature death by 26% and 29% respectively.”
• Poor or insufficient social connection is associated with “a 29% increased risk of heart disease and a 32% increased risk of stroke.”
• “Chronic loneliness and social isolation can increase the risk of developing dementia by approximately 50% in older adults, even after controlling for demographics and health status.”
• “In recent years, about one-in-two adults in America reported experiencing loneliness.”

The advisory concludes that the research together suggests “a likely causal association between social isolation and a variety of poor health outcomes, including death.” It also reports “evidence of a dose-response relationship”: each increment of connection corresponds to lower risk. You need not rebuild a social world in a season. Each added strand counts.

What the National Academies found about older adults

The 2020 consensus report, Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System, is narrower and more cautious. It states that “approximately one-quarter (24 percent) of community-dwelling Americans aged 65 and older are considered to be socially isolated,” and that 35 percent of adults aged 45 and older and 43 percent of those aged 60 and older report feeling lonely. Social isolation “has been associated with an approximately 50 percent increased risk of developing dementia.”

On mortality it drew a careful line, calling the evidence linking social isolation to premature death “robust” while finding that the evidence for loneliness “does not yet approach the cumulative weight” of the evidence for isolation.

The committee judged the evidence for specific interventions “mixed,” noted that “different intervention approaches may be needed for social isolation versus loneliness,” and held that respecting “an individual’s own decisions regarding his or her life is essential.” You may decline a well-meant plan that does not suit you.

Loneliness is not depression, though each can lead to the other

Loneliness is a feeling about connection. Depression is a medical condition with diagnostic criteria: the National Institute of Mental Health states that “a person must have symptoms most of the day, nearly every day, for at least 2 weeks,” one of which “must be a depressed mood or a loss of interest or pleasure in most activities.”

The two feed each other. The Surgeon General’s advisory notes that depression is “often characterized by social withdrawal,” and cites a review in which the odds of developing depression were “more than double” among adults who often feel lonely.

Depression can be harder to see in later life. NIMH notes that older adults “may report a lack of emotions rather than a depressed mood,” and that some medications and conditions, such as thyroid disorders, can produce the same symptoms. Our guide to when grief is not easing sets out when mourning needs clinical attention. Feeling better after company does not rule depression in or out. If low mood, loss of interest or another symptom persists or disrupts daily life, tell a clinician rather than trying to diagnose the cause from one good or difficult evening.

Hearing loss: the cause that hides in plain sight

The National Institute on Aging reports that “about one-third of older adults have hearing loss.” Those who cannot hear well “may become depressed or withdrawn from others because they feel frustrated or embarrassed about not understanding what is being said,” which “can lead to social isolation and loneliness.”

Suppose you have begun declining dinners at a favorite restaurant because the room tires you, or leaving meetings unsure what was decided. You may read this as a waning appetite for company. It may be a waning ability to hear. NIA’s warning signs include trouble following conversation when two or more people are talking, and a sense that others mumble.

The National Academies asked clinicians to identify the underlying causes of a patient’s isolation, naming “hearing loss, mobility limitations” as examples, and noted that “several studies suggest that treating hearing loss with hearing aids or cochlear implants may mitigate the effects of hearing loss on loneliness.” NIA says over-the-counter aids “may help people with mild to moderate hearing loss,” and that an audiologist or hearing aid specialist can prescribe aids for significant or complicated loss. A hearing test is the least glamorous suggestion here and possibly the most productive.

What has evidence behind it: groups, service and a real role

No program works for everyone, but there are patterns. The National Academies committee reported that, according to several studies, “successful interventions tended to have certain key features, including the active participation of older adults, having an educational focus, and using a group-based approach.” Reviews disagree on whether groups outperform one-on-one help, though experts consulted for one report the committee cited agreed that the most effective group interventions “target a specific group, focus on a shared interest (or on education), and include the older individuals in the planning process.”

In practice, that suggests three choices:

1. A structured group with a shared purpose. A seminar series, a choir, or a bereavement group; the committee noted support groups for “bereavement or widowhood.” Our guide to choosing a grief counselor or bereavement group explains how to judge one.
2. Service with obligations attached. NIA states that volunteering “helps you feel less lonely and allows you to have a sense of mission and purpose in life, which is linked to better health.” See our piece on putting what you know to use.
3. A role in which you are expected. Patronage can be conducted by check from a distance; a role cannot. A docent’s weekly shift or a standing committee seat answers the advisory’s call to join groups that “foster a sense of belonging, meaning, and purpose,” because someone would notice your absence.

Existing friendships deserve care too; see when friendships change. For local programs, NIA points to the Eldercare Locator at 800-677-1116.

Company can be arranged; belonging has to be built, slowly, in rooms where you are expected back.

When loneliness calls for clinical help

Connection may help loneliness, but persistent distress, changes in functioning, or symptoms of depression also belong with a clinician. Seek help promptly in any of these circumstances:

• Low mood or loss of interest most of the day, nearly every day, for two weeks or more.
• A flatness of feeling, with changes in sleep, appetite, energy or concentration.
• Withdrawal that deepens even when invitations arrive.
• Heavier drinking, which NIMH lists among the signs of depression.
• Any thought of death or suicide. Call or text the 988 Suicide and Crisis Lifeline at 988; in a life-threatening situation, call 911.

NIMH names cognitive behavioral therapy and interpersonal therapy among evidence-based treatments, the latter aiming partly to help people “form social support networks.”

Questions to ask your doctor

Do not wait to be asked. The National Academies recommended that providers “periodically perform an assessment using one or more validated tools,” and named the “loss of a significant relationship” among the life events that raise a patient’s risk, but that is a recommendation, not a requirement, and practice varies. The Surgeon General advises individuals to “be open with your health care provider about significant social changes in your life.”

1. My husband died recently and I am more alone than I expected. Can you screen me for isolation or loneliness with a validated tool?
2. Should I also be screened for depression?
3. Could any medication or condition of mine be affecting my mood or energy?
4. Will you refer me for a hearing evaluation?
5. Is a mobility, vision or transport problem keeping me at home?
6. If therapy would help, which kind, and can you refer me?
7. Does this practice have a social worker who connects patients with community programs?
8. When should we review this, and what should prompt me to call sooner?

This article provides general U.S. educational information and is not medical, psychological, or audiological advice. If you are in crisis, call or text 988; otherwise, discuss your circumstances with a clinician who knows your history.