Wisdom as a potential antidote to loneliness in aging

The population of the world is aging, with the number of adults aged 65 and older expected to double, growing from 420 million in 2000 to an estimated 973 million in 2030 (Centers for Disease Control and Prevention, 2003). In recent decades, there has been growing concern about loneliness across all ages, but particularly in older adults (Anderson and Thayer, 2018). Loneliness (the subjective negative experience of being isolated and having inadequate meaningful connections) and social isolation (the objective state of having few or infrequent social relationships) are serious yet underappreciated public health risks that affect a significant portion of the older adult population. Loneliness is consistently associated with unhealthy aging. It is a major risk factor for not only worse mental health outcomes, such as lower levels of wellbeing and happiness, increased levels of depression, and poorer quality of sleep, but also worse physical health outcomes, including cardiovascular disease, frailty, cognitive decline, and risk of Alzheimer’s disease (Hawkley and Cacioppo, 2010). Strong evidence links loneliness to changes in cardiovascular, neuroendocrine, and immune function as well as to the physiological stress response, such as higher levels of inflammation. Conversely, increased morbidity has been shown to increase loneliness over time (Kristensen et al., 2019). This new behavioral epidemic of loneliness has led to an unprecedented reduction in longevity and contributes to the markedly increasing rates of “deaths of despair,” such as those due to suicides and opioid abuse ( Jeste et al., 2020). In a recent meta-analysis, loneliness was shown to increase odds of mortality by 30% (Holt-Lunstad et al., 2015), and according to Vivek Murthy, MD, the former USA Surgeon General, the reduction in life span associated with loneliness is equivalent to that caused by smoking 15 cigarettes a day and greater than that due to obesity (McGregor, 2017). In the USA, 162,000 deaths per year are attributable to loneliness and social isolation – more than those secondary to lung cancer or stroke (Veazie et al., 2019). Considering the public health initiatives targeted towards curbing tobacco use, obesity, cancers, and other medical morbidities, prevention and intervention efforts and resources to address loneliness fall woefully short. In light of the coronavirus disease 2019 (COVID-19) pandemic, social distancing and selfisolation guidances further exacerbate and escalate the spread of loneliness. The unpredictability of COVID-19 – from uncertain prognoses, shortages of resources for testing and treatment, financial losses, conflicting messages from government leaders and authorities, to the imposition of unfamiliar public health measures – contributes to widespread emotional distress and threaten mental health (Pfefferbaum and North, 2020). This threat is higher for older adults who are at greatest risk for serious complications from COVID-19 and face longer periods of quarantine and isolation. Studies on the SARS-CoV-1 outbreak in 2003 reported that the previous epidemic led to increased anxiety, depression, sleep disturbances, alcohol and substance misuse, self-harm, and a 30% increase in suicides, including among seniors (Yip et al., 2010). This new infectious public health crisis will undoubtedly worsen the ongoing behavioral public health crisis and specifically poses a unique challenge for seniors. As such, the paper by Lutzman et al. (2020) in this current issue is timely. The authors examined a moderated mediation model of physical pain and suicidal ideation in a sample of nearly 200 elderly men. They found that loneliness and social integration significantly mediated the relationship between pain and suicidality in single, divorced, and widowed participants but not among participantswhowere in a relationship or married. The results of this study elucidate potential processes underlying the relationship between physical and emotional distress and provide a biopsychosocial framework for conceptualizing suicidality in elderly individuals. The association between social isolation and health is complex and likely bidirectional. Poor health may lead to social isolation and subsequent loneliness; for example, declining physical and cognitive function among older adults may contribute to limited mobility, reduced independence, and increased barriers to resources and technology to communicate with friends and family. Conversely, loneliness may also increase stress that may affect health outcomes. International Psychogeriatrics (2021), 33:5, 429–431 © International Psychogeriatric Association 2021