Human health is a wonderfully dynamic area of medicine because it encompasses so many sub-specialisations, it is forever changing as patients move through various phases of health from poor to complete health in the space of days, weeks, months, years and one can even transition between different health states in just a matter of a single consultation with a doctor.

There has been an evolution in the definition
of health over the years. Early definitions in keeping with biomedical
traditions of medicine focused on just the functionality of the body and how it
is amenable to disturbances during disease states/illness. Then, in 1948 the
WHO (World Health Organisation) radically altered the definition and stated
that health is the complete physical, mental and social well-being and not
merely the absence of disease or infirmity (a biopsychosocial model)

¹

.
This definition was initially heavily acclaimed and hailed as an innovative
approach to defining the aim doctors should strive to achieve for their
patients and although it seems complete and thorough, the inclusion criteria is
seen to be somewhat broad, vague and immeasurable. In accordance with such a
definition few people around the world would be regarded as completely healthy.
Furthermore, adhering to such a definition could potentially incentivise the healthcare
system

²

. Huber’s definition of health coined in 2011, went a long
way to finding the appropriate conceptualisation of health and is still key in
today’s healthcare practices. It involved a more dynamic approach with the
fundamental theme being resilience, more specifically the capacity for a
patient to absorb disturbance and re-organise, to maintain and restore one’s
integrity and identity

³

.

Leading on from Huber’s definition, it has
been understood that a crucial determinant of a positive health outcome and a
patient attribute which favours resilience is social connectedness; the absence
of which can cause destructive neurological and cardiovascular changes as well
as having a damaging psychological impact

^4,5

.

Maslow’s hierarchy of needs states that upon fulfilment of physiological and safety needs, the third level of human needs is interpersonal and involves feelings of belongingness (the need to be part of a community or social circle)

⁶

. This hierarchy holds true for patients, and their healthcare outcomes; deficiencies within this level of the hierarchy can detrimentally impact health-social anxiety and clinical depression being a chief example

⁷

. The foremost groups of patients that are likely to experience loneliness, neglect, and ostracism are the elderly, hospitalised patients, those with stigmatised conditions, and the disabled. In the USA a systematic study showed that in people over the age of 50 living with HIV/AIDS, positive changes in psychosocial factors such as

loneliness and isolation

resulted in a decreased transmission and improved health outcome, reducing the burden of disease as adherence to HIV medications increased

⁸

.

For the purpose of answering the question on the impact of loneliness on human health and well-being, the focus will be on the

elderly population

as they make up the majority of our population, the UK demographics is shifting more towards an ageing population. The elderly is more at risk of social isolation because of an increase in chronic debilitating conditions e.g. risk of heart disease, stroke, falls and fractures, patients experiencing chronic pain and fatigue. The elderly experience more losses than their younger counterparts, losses in relationships, independence (becoming reliant on family members and carers), mobility, work and income.  Other life transitions afflict the older population which inherently involve a more sedentary and isolated lifestyle including retirement, potential loss of driving capabilities, functional losses e.g. rheumatoid arthritis affecting dexterity and manual handling, age related hearing loss etc. Research conducted by Age UK recently revealed that half a million people over the age of 60 in the UK usually spend each day alone

⁹

. And nearly half (49%) of people over the age of 75 are living alone

¹⁰

. Existing health conditions or impairments in the elderly can lead to a restricted level of independence resulting in feelings of loneliness which inevitably lead to social isolation

¹¹

. A shocking statistic was revealed by a study conducted by Holt-Lunstad et al., 2010 which found that loneliness can be as harmful for our health as smoking 15 cigarettes per day

¹²

.

The impact of social isolation in the elderly is
three-fold, the social impact is that those without a social network are more
likely to participate in risk taking behaviours; studies have shown the use of
alcohol to alleviate the depression, loneliness and anxiety experienced and
patients are less likely to adhere to medical advice

¹³

. The
psychological impact is the increased risk of cognitive decline due to a lack
of social connections. Persistent/chronic loneliness and isolation is what
impacts mental health the most. Impairment in sleep quality triggering memory
dysfunction with adverse changes to hormonal and neural regulation; which in
turn amplified the feelings of vulnerability, anxiety and depression

^{14, 15}

.
The risk of developing Alzheimer’s dementia doubles in those experiencing chronic
self-perceived loneliness

¹⁶

. The English Longitudinal Study of
Ageing has revealed that elderly people that have a social circle and are
engaged with experience greater cognitive stimulation and have lower stress
levels thus see less of a decline in cognition

¹⁷

and have been shown
to be less susceptible to developing dementia

¹⁸

. The physiological
impact of being lonely is multi-faceted as it affects a number of normal
functions including the increase in blood pressure, due to heightened
sympathetic tone with increases in cortisol level (stress hormone) identified. A
number of epidemiological studies have identified that those with a lack of
social support are more predisposed to developing cardiovascular disease. Scarcity
in social support and welfare has been linked to a faster development of
atherosclerosis and a heightened risk of a myocardial infarction or stroke

^19,20,21

.

In the coming years we face a challenge to tackle the
social isolation crisis not just because the life expectancy is increasing but
also globally the number of elderly living with dementia is projected to
escalate to 81 million by 2040, suffering from such a debilitating condition
naturally lends itself towards becoming socially isolated

²²

. The UK
Kings Fund National Statistics Analysis has estimated that the number of people
over the age of 85 living on their own is expected to grow from 573,000 to 1.4
million by 2032

²³

. A qualitative questionnaire study was conducted using
the Manchester Short Assessment of Quality of life/Happiness Index, highlighted
that mental health is negatively associated with day time activities

²⁴

;
having a daily occupation or even just being busy during the day vastly
improves wellbeing and can be beneficial in providing meaning, improving social
relations and boosting self-esteem

²⁵

. Even offering adaptive coping
strategies such as signposting them to social workers or focus groups can be
significantly beneficial to patients suffering with social isolation and
loneliness.

Social isolation should be seen as a
diagnosis which needs be identified both in primary and secondary care by
healthcare professionals. Appropriate training and education needs to be
provided to be able to identify vulnerable patients. The NHS has made strides
with the implementation of care packages for patients upon discharge from
inpatient hospital stay with social care being endeavoured to be put into
place. However, many patients go unnoticed, most times this is due to a lack of
communication and understanding. More effort needs to be made to assess
patients in primary care settings such as during home visits. A strategy needs
to be implemented whereby when a patient arrives for a consultation, the
patient is assessed holistically. Not to just focus on what is physiologically
wrong but to always bear in mind the human dimension, to cultivate a climate of
understanding with the patient and delve deeper into the different dimensions
of patient care, the chief amongst them being social and psychological
well-being; above and beyond anything else, patients always want to feel
listened to

^26,27,28

. A potential strategy for identifying patients
most in need is by implementing a holistic assessment tool into everyday
clinical practice, addressing the physiological, psychological, sociological,
developmental, spiritual and cultural needs of a patient. Once high-risk
patients are identified (for example patients that have experienced a recent
bereavement or have health-limiting conditions) they need to be signposted to
relevant psychological therapy services, support groups and they must be
encouraged to help themselves by doing regular exercise and getting involved in
activities they enjoy.

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• Jackson, J. C., Santoro, M. J., Ely, T. M., Boehm, L., Kiehl, A. L., Anderson, L. S., & Ely, E.
• W. (2016). HHS Public Access,
  
  29
  
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