Loneliness and Social Isolation as Risk Factors for Mortality A Meta-Analytic Review

From the article, Perspectives on Psychological Science, March 2015  vol. 10 no. 2 227-237

Several lifestyle and environmental factors are risk factors for early mortality, including smoking, sedentary lifestyle, and air pollution. However, in the scientific literature, much less attention has been given to social factors demonstrated to have equivalent or greater influence on mortality risk (Holt-Lunstad, Smith, & Layton, 2010). Being socially connected is not only influential for psychological and emotional well-being but it also has a significant and positive influence on physical well-being (Uchino, 2006) and overall longevity (Holt-Lunstad et al., 2010; House, Landis, & Umberson, 1988; Shor, Roelfs, & Yogev, 2013). A lack of social connections has also been linked to detrimental health outcomes in previous research. Although the broader protective effect of social relationships is known, in this meta-analytic review, we aim to narrow researchers’ understanding of the evidence in support of increased risk associated with social deficits. Specifically, researchers have assumed that the overall effect of social connections reported previously inversely equates with risk associated with social deficits, but it is presently unclear whether the deleterious effects of social deficits outweigh the salubrious effects of social connections. Currently, no meta-analyses focused on social isolation and loneliness exist in which mortality is the outcome. With efforts underway to identify groups at risk and to intervene to reduce that risk, it is important to understand the relative influence of social isolation and loneliness.

Living alone, having few social network ties, and having infrequent social contact are all markers of social isolation. The common thread across these is an objective quantitative approach to establish a dearth of social contact and network size. Whereas social isolation can be an objectively quantifiable variable, loneliness is a subjective emotional state. Loneliness is the perception of social isolation, or the subjective experience of being lonely, and thus involves necessarily subjective measurement. Loneliness has also been described as the dissatisfaction with the discrepancy between desired and actual social relationships (Peplau & Perlman, 1982).

[Press release] Losing a family member in childhood associated with psychotic illness

From the 21 January 2014 press release

Highest risk seen in children who experience suicide in close family members

Experiencing a family death in childhood is associated with a small but significant increase in risk of psychosis, suggests a paper published today on bmj.com.

The researchers say that the risks are highest for children who have experienced a suicide in the ‘nuclear family’ (brothers, sisters, parents).

Previous studies have concluded that the risk of adult disease can be influenced by genetics, lifestyle and environmental experience. There is also evidence that maternal psychological stress adversely affects the development of the fetus.

Population studies have so far provided weak support for an association between prenatal maternal psychological stress and later psychosis. Researchers from the UK, US and Sweden therefore set out to examine the association between deaths in the family as a form of severe stress to the individual and subsequent psychosis. Data were taken from Statistics Sweden and the Swedish National Board of Health and Welfare and children born between 1973 and 1985 in Sweden.

Definitions of psychosis were: non-affective psychosis (including schizophrenia) and affective psychosis (bipolar disorder with psychosis and unipolar depression with psychosis).

Exposure periods were divided into ‘any exposure’ (all pre and postnatal); ‘any prenatal’ (prior to birth) and ‘any postnatal’ (birth up to 13 years of age) and further subdivided by trimester (first, second, third) and by three year periods in childhood between birth and 13 years of age (0-2.9 years; 3-6.9 years and 7-12.9 years). If more than one exposure occurred during the study period, priority was given to the earliest exposure.

Death was categorised into suicide, fatal injury / accident and others (such as cancers and cardiac arrests).

Models were adjusted for year of birth, child sex, maternal and paternal age, maternal and paternal nationality, parental socioeconomic status and history of any psychiatric illness in the family.

The final number of children included in the study was 946,994. Altogether, 321,249 (33%) children were exposed to a family death before the age of 13. Of individuals exposed to any death during the study period, 1323 (0.4%) developed a non-affective psychosis while 556 (0.17%) developed an effective psychosis. 11,117 children were exposed to death from suicide, 15,189 from accidents and the majority, 280,172 to deaths due to natural causes.

No increased risk of psychosis was seen following exposure in any prenatal period. Postnatally, an increased risk of ‘all psychosis’ was associated with deaths in the nuclear family and risk increased the earlier in childhood the death occurred.

Risks associated with exposure to suicide were higher compared with exposure to deaths from accidents which in turn were higher than risks associated with other deaths from natural causes.

The largest risk was seen in children exposed ages 0-3 years and risks reduced as age of exposure increased.

Professor Kathryn Abel, from the Centre for Women’s Mental Health at The University of Manchester, said: “Our research shows childhood exposure to death of a parent or sibling is associated with excess risk of developing a psychotic illness later in life. This is particularly associated with early childhood exposure. Further investigation is now required and future studies should consider “the broader contexts of parental suicide and parental loss in non-western, ethnically diverse populations.”

 

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Research: Severe bereavement stress during the prenatal and childhood periods and risk of psychosis in later life: population based cohort study

 

 

The U.S. Health Disadvantage – Part 2: Possible Causes and Solutions

by Kirsten Hartil 

“Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing and medical care.”

At least according to Article 25 of The United Nations Universal Declaration of Human Rights, so why does the United States, one of the wealthiest countries in the world, have some of the poorest health outcomes compared to other high income countries?

My previous blog, adapted from the Institute of Medicine (IOM) report U.S. Health in International Perspective: Shorter Lives, Poorer Health, described how the U.S. compares in causes of mortality and years of life lost with other high income and OECD countries. Here, as outlined in the report, I explore some of the social determinants of health that may explain this. Social determinants of health, as opposed to biological determinants (biology and genetics), describe the…

View original post 1,307 more words

[Reblog] Longer Old Age but Lower Quality Near the End?

Reblog

(My 80 year old mother is doing well, but she voices concerns in this area from time to time.
These related end of life issues have motivated me to exercise more & volunteer at our local Area Office on Aging…
However, I think there is more we can do collectively, maybe a combination of government and community organizations, and just plain families cooperating more for their most vulnerable members…)

Longer Old Age but Lower Quality Near the End?

http://asourparentsage.net/2012/05/24/9609/

May 29, 2012

A few days ago I added a must read link to Michael Wolff’s New York Magazine article, A Life Worth Ending. It’s an eye-opening piece, detailing long drawn-out decline of his mother. Check it out — it really is a must read.

For our parents there are no easy end-of-life answers. Those of us with older moms and dads still living active and full lives are lucky, but one only has to sit in a Starbucks or linger near the water cooler at work to hear frightening and very sad stories. No one wants to die the long drawn-out way as a helpless invalid,

The single conclusion that I reach is less about my parents lives — we can’t turn the clock back — than it is about my own. At some time in my life, if I reach an advanced age, I need to make some clear and thoughtful decisions about how much medical care I will use … or not use.

Two Quotes from Wolff’s Article  to Make You Want to Read More                         

– By promoting longevity and technologically inhibiting death, we have created a new biological status held by an ever-growing part of the nation, a no-exit state that persists longer and longer, one that is nearly as remote from life as death, but which, unlike death, requires vast service, indentured servitude really, and resources.

– The traditional exits, of a sudden heart attack, of dying in one’s sleep, of unreasonably dropping dead in the street, of even a terminal illness, are now exotic ways of going. The longer you live the longer it will take to die. The better you have lived the worse you may die. The healthier you are—through careful diet, diligent exercise, and attentive medical scrutiny—the harder it is to die. Part of the advance in life expectancy is that we have technologically inhibited the ultimate event. We have fought natural causes to almost a draw.

Related articles

• The Beginning of the End (theamericanconservative.com)

Why Do More People Die During Economic Expansions?

St Annes Nursing Home (Photo credit: Wikipedia)

From the April 2012 brief at the Center for Retirement Research at Boston College

The brief’s key findings are:

• When economic times are good, deaths in the United States increase.

• Previous research suggests that a likely culprit is poorer health habits tied to greater job demands.

• However, the increase in mortality is largely driven by deaths among elderly women in nursing homes.

• These nursing home deaths may reflect increased shortages of caregivers during economic expansions.

Related articles

• Death Rates Higher In Nursing Homes During Good Economy (nursingassistants.net)

The future of death in America

From the report summary at the Max Planck Institute for Demographic Research

Abstract
Population mortality forecasts are widely used for allocating public health expenditures, setting research priorities, and evaluating the viability of public pensions, private pensions, and health care financing systems. Although we know a great deal about patterns in and causes of mortality, most forecasts are still based on simple linear extrapolations that ignore covariates and other prior information. We adapt a Bayesian hierarchical forecasting model capable of including more known health and demographic information than has previously been possible. This leads to the first age- and sex-specific forecasts of American mortality that simultaneously incorporate, in a formal statistical model, the effects of the recent rapid increase in obesity, the steady decline in tobacco consumption, and the well known patterns of smooth mortality age profiles and time trends. Formally including new information in forecasts can matter a great deal. For example, we estimate an increase in male life expectancy at birth from 76.2 years in 2010 to 79.9 years in 2030, which is 1.8 years greater than the U.S. Social Security Administration projection and 1.5 years more than U.S. Census projection. For females, we estimate more modest gains in life expectancy at birth over the next twenty years from 80.5 years to 81.9 years, which is virtually identical to the Social Security Administration projection and 2.0 years less than U.S. Census projections. We show that these patterns are also likely to greatly affect the aging American population structure. We offer an easy-to-use approach so that researchers can include other sources of information and potentially improve on our forecasts too.

Author’s affiliation
Samir Soneji
Dartmouth College, United States of America
Gary King
Harvard University, United States of America

More on Grief and Loss ( Nursing Notes Blog Item)

More on Grief and Loss « Nursing Notes.

Excerpts from this thoughtful compassionate blog item….

December 2, 2011

More on Grief and Loss

Filed under: Uncategorized — Shirley @ 9:08 pm

As I am personally experiencing some of both, I found this article to be helpful.  I hope to get another guest posting but the author after the holiday season is over, but for now I will post this article she sent me.  I recommend her book and hope you will visit her website for more information about her.

I would like to invite other nurses to guest post here on this blog.  I try to make this blog a place to come and find viable and current information that reflects on the nursing profession as a whole, but most importantly, on the nurse at the bedside.  Any information that I can produce to empower that nurse, to educate that nurse, to give that nurse a voice is what I aim for here on this blog.  If your writings fall into that catagory, I would love to have you guest post.

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   LOSS, GRIEF AND THE WORK-0F-GRIEF: A DIFFERENT PERSPECTIVE

                                                                              By A. Barbara Coyne, Ph.D, MSN

 

Loss: Ever-Present in Living

 

“The hour that gives us life begins to take it away”…Seneca, first century philosopher

In the unfolding spiral of living, loss is inevitable and universal. If we heed the wisdom of Seneca, we know that we experience loss from the moment of birth until our own death. And throughout the subsequent twenty centuries, we have known that grief is the natural companion of all loss. Although much of what we know about grief is rooted in post-death grief, we also know that we experience other losses: we are connected to people, animals and things and when any of those connections break, we grieve and mourn. Some of these “other losses” include but are not limited to: loss of a job or home, friends who move away or choose to no longer be our friends, chronic but not life-threatening health conditions, divorce, separation and, of course, death (of people or beloved animals)….

 

What can we do about death? Reinventing the American medical system

From the 31 May 2011 Eureka News Alert

(Garrison, NY) In a feature article in The New Republic,(subscription only, check your local public library for availability)  Daniel Callahan and Sherwin Nuland propose a radical reinvention of the American medical system requiring new ways of thinking about living, aging, and dying. They argue that a sustainable—and more humane— medical system in the U.S. will have to reprioritize to emphasize public health and prevention for the young, and care not cure for the elderly.

An interesting twist on their argument, which would aim to bring everyone’s life expectancy up to an average age of 80 years but give highest priority for medical treatment to those under 80, is that Callahan and Nuland are themselves 80 years old. Daniel Callahan, Ph.D., is cofounder and president emeritus of The Hastings Center and author most recently of Taming the Beloved Beast: How Medical Technology Costs Are Destroying Our Health Care System. Sherwin Nuland, M.D., is a retired Clinical Professor of Surgery at the Yale School of Medicine and author of How We Die and the Art of Aging. He is also a Hastings Center Fellow and Board member.

“The real problem is that we have medicine excessively driven by progress, which aims to rid us of death and disease and treats them as the targets of unlimited medical warfare,” said Callahan and Nuland. “That warfare, however, has come to look like the trench warfare of World War I: great human and economic cost for little progress. Neither infectious disease nor the chronic diseases of an aging society will soon be cured. Cancer, heart disease, stroke, and Alzheimer’s disease are our fate for the foreseeable future. Medicine and the public must adapt it to that reality, one that has mainly brought us lives that end poorly and expensively in old age.”

The article notes that the Affordable Care Act might ease the financial burden of this system, but not eliminate it. It reports, for example, that the cost of Alzheimer’s disease is projected to rise from $91 billion in 2005 to $189 billion in 2015, and to $1 trillion in 2025 – twice the cost of Medicare expenditures for all diseases now.

“We need to change our priorities for the elderly. Death is not the only bad thing that can happen to an elderly person,” the authors write. “An old age marked by disability, economic insecurity, and social isolation are also great evils.” They endorse a culture of care, not cure, for the elderly, with a stronger Social Security program and a Medicare program weighted toward primary care that supports preventative measures and independent living.

Callahan and Nuland point the way to a more sustainable path that reprioritizes the entire system. Among their recommendations:

• improve medicine at the level of public health and primary care, while reducing its use for expensive high-tech end-of-life care;
• shift resources for the elderly to greater economic and social security and away from more medical care;
• subsidize the education of physicians, particularly those who go into primary care, and decrease medical subspecialization;
• train physicians better to tell the truth to patients about the way excessively aggressive medicine can increase the likelihood of a poor death;
• shift the emphasis in chronic disease to care rather than cure;
• conduct a top-down, bottom-up, long-range study of the entire American system of health care, including the training of physicians, with a view toward reconstituting it along systematic lines that take science, humanistic concerns, economics, and social issues into account.

Related articles

• Andrew Reinbach: Health Care Could Kill Us: We Don’t Have to Let It (huffingtonpost.com)
• New at Reason: Ronald Bailey on Health Care Reform (reason.com)

Your Culture May Influence Your Perception Of Death

From the 24 May 2011 Medical News Today article

Contemplating mortality can be terrifying. But not everyone responds to that terror in the same way. Now, a new study which will be published in an upcoming issue of Psychological Science, a journal of the Association for Psychological Science, finds cultural differences in how people respond to mortality. European-Americans get worried and try to protect their sense of self, while Asian-Americans are more likely to reach out to others.

Much of the research on what psychologists call “mortality salience” – thinking about death – has been done on people of European descent, and has found that it makes people act in dramatic ways. “Men become more wary of sexy women and they like wholesome women more. People like to stereotype more. You see all these strange and bizarre occurrences when people think about the fact that they aren’t going to live forever,” says Christine Ma-Kellams of the University of California Santa Barbara, who carried out the research with Jim Blascovich. Particularly, people try to protect their sense of self, by putting down people who aren’t like them or distancing themselves from innocent victims. …..

Related articles

• Perception of death influences one’s action (news.bioscholar.com)
• How You Think About Death May Affect How You Act (Medical News Today)
• The More You Talk About Death, The Less You Fear It, Australia (Medical News Today)