In May, the Surgeon General, Dr. Vivek Murthy, released a General Advisory sounding an alarm about a growing public health concern: loneliness. The press release for the Advisory didn’t mince words in its headline, which referred to the “Devastating Impact” that the “Epidemic of Loneliness and Isolation” is having in the United States.

The problem—which dates back to pre-pandemic times, when about half of all adults in the U.S. reported experiencing some degree of loneliness—has at least in part been attributed to the increased aging of the population. Older people are at high risk for loneliness due to declining health and the death of partners, family members, and friends, which often increases social isolation. But it’s not just older folks who are affected; more young people are experiencing loneliness today as well.

To untangle some of the complexities of loneliness and potential ways to overcome it, we spoke with Carla Perissinotto, M.D., M.H.S., professor of medicine in the Division of Geriatrics at the University of California, San Francisco, about the increasing focus on this public health issue, both for older adults and for young people of the social media generation. She has published many papers on loneliness and is a member of a National Academy of Sciences committee that published a consensus study report in 2020 on social isolation and loneliness in people over 50. (Her responses represent her opinions alone, not those of the National Academy of Sciences.)

Wellness Letter: Is loneliness the same as social isolation?

Dr. Carla Perissinotto: No. Loneliness is the subjective feeling of being alone or isolated; or it’s the discrepancy between actual and desired relationships. Social isolation is something quantifiable in terms of the number of relationships or contacts someone has with others. This is why you can still feel lonely even while surrounded by other people. 

WL: Can you explain more why older people are especially at risk for loneliness?

CP: There are many factors that place older adults at higher risk of experiencing loneliness, including the loss of a spouse or partner, a life transition (such as moving or retirement), and other changes, such as hearing or visual impairment, that can make it hard to feel connected to others. So there are certainly greater risks for loneliness as we age. Older people are also at greatest risk for the health consequences of loneliness [see below], in part because of changes in our physiological reserves with aging. In essence, when you are younger, you may be better able to “bounce back” quicker, or you have more time to undo the health consequences, or more time to build back social connections. On the other hand, some researchers argue that rates of loneliness in older adults aren’t actually increasing, as they are in younger people, but that we are just more aware of it and asking older people about it more.

WL: How are younger people affected?

CP: New reports and research suggest that teenagers and young adults are also at high risk—and potentially at higher risk for loneliness than older adults. We don’t completely understand why, but there is some concern that the overwhelming use of social media is changing how we form and maintain relationships. An article in The Atlantic a few years ago that looked at cell phone use in young people found that teens who spent more time each day on their “screens” visiting social networking sites than actually seeing their friends in person were more likely to report being lonely much of the time. 

WL: Why is loneliness being discussed as a public health problem in addition to a personal issue?

CP: It’s starting to be considered a public health problem because of the large number of people affected—43 percent of a nationally representative sample of community-living adults over age 60 reported experiencing loneliness in a study I published in 2012—and because of the many adverse health effects that are associated with loneliness. Research has shown that people who are lonely have a higher risk of cardiovascular disease, Alzheimer’s dementia, worsening diabetes control, loss of independence, and even death compared with those who are less lonely. This can be independent of whether or not they are actually socially isolated; that is, the feeling of aloneness itself is the risk factor. One hypothesis is that there’s a heightened stress response when people are lonely, and that this affects the immune system, which ultimately affects many of our bodily systems. 

WL: What causes loneliness—and why is it becoming more problematic?

CP: There is no one cause, and the reasons can be different for different people, depending on their circumstances. There are many ways that someone can become lonely. As mentioned earlier, it could be life changes, physical changes, and, for some, lifelong traits in terms of how they cope with changes in relationships and how they view these changes. Other examples: I have patients who want to connect with others, but they can’t get out of their homes because of stairs, so they feel really lonely. Others have recently lost a lifelong partner, and this is devastating. And still others want to connect, but their hearing impairment makes it hard to, even on the phone.

We don’t really know why loneliness is becoming more problematic, but we do know that our lives are becoming more complex. For example, while technology and social media can be amazing tools to connect with others, some experts think that they are preventing us from forming real relationships because we are using them as a substitute for in-person relationships. Dr. Vivek Murthy, the U.S. Surgeon General, has talked about loneliness as an epidemic that is affecting not just our health but our work performance. 

WL: Are certain people more likely to be lonely?

CP: In my research, women, older adults, people of lower socioeconomic status, and marginalized populations were more likely to be lonely. It’s hard to understand why; we need to understand this better. Interestingly, the majority of people who reported feeling lonely were living with others, and over 60 percent of people who were lonely were married. Marriage and partnership tend to be protective against loneliness, but these findings show that you can still be lonely even when married. 

WL: Aside from talking with a counselor or therapist, what practical advice can you suggest for ameliorating loneliness?

CP: Delve in and try to get a better understanding of why you may be lonely. Be open about it—you’d be surprised that when you admit it and talk about it, there are others like you. Be bold: Take a risk and make that phone call or actually see someone in person rather than sticking to texts or emails. Be mindful about how loneliness affects your health. Researchers have written about how we focus on maintaining our physical health, but we don’t do enough to take care of our social health. This includes being resilient and helping others. By helping others, we are often helping ourselves in the process. We also have to think about some of our own negative thoughts about aging, how we perpetuate this in ourselves, and how as a society we view aging. Combating ageism is probably one of the most powerful steps we can make in changing how we view and experience loneliness.