Being Lonely: One Size Does Not Fit All

By Chuck Dinerstein, MD, MBA — Sep 02, 2020
Loneliness, if you follow the media, is a problem of old age. It worsens one by one, as you lose your companions. Yet at the same time, it seems to be a problem of adolescence, too, as youngsters tries to find their peeps. So loneliness can affect any age, and a new paper suggests the sources of loneliness change over time.
Image courtesy of Qu Ji on Pixabay

While there are many ways to define loneliness, the researchers, studying a cross-section of adults in the Netherlands, settled on this: 

“loneliness occurs when there is a discrepancy in the person’s social relationships; second, it is a subjective experience and third, loneliness is a stressful and unpleasant feeling.”

It is that stress that links poor health outcomes and loneliness? 

While loneliness is age-related, the researchers took a lifespan perspective, trying to identify “age-normative” behavior and goals, that when not met, resulted in that lonely feeling. They made use of a national health survey administered every four years to adults living independently, age 19 to 65. With a response rate of about 25%, their sample was roughly 26,000 individuals. They were broken down into three age categories or “bins,” young adults, 19-34, early middle age 35-49, and late middle age 50-65. 

The groups were evenly distributed between males and females, the majority employed, without “financial imbalances” (making ends meet), and living with two or more persons. The young were less likely to be married, the late middle age more likely to complain of health issues. Most individuals talked to their neighbors, friends, or family more than twice a month. They seem pretty “normal.”

In each age group, more than two-thirds had a moderate or high risk of depression or an anxiety disorder.” 

Overall, 44.3% experience loneliness, the percentage rising with age group. Of course, which came first, anxiety/depression or loneliness is a chicken-egg kind of problem.

  • “Across all three age groups, the strongest association with loneliness was found for those who often felt excluded from society.” Several factors were at play for all age groups so that while they may reflect universal criteria for psychological health, the emphasis on specific aspects varied with age.
  • Educational level was a factor for young adults, no surprise here as those are the years many are pursuing educational goals. Ethnicity and friendships were also heightened factors for these adults, “emphasizing the importance of turning to friends for role socialization and leisure activities.”
  • Employment status was a factor in early middle age, again one of those consistent milestones of life. Who wouldn’t be following their career goals at that age? Ethnic identity continued to play a role, although not as high as for the younger adults. 
  • Connection to family was important, and its importance increased with age as we moved through our child-bearing and rearing years, as we lost our parents, and as some faced divorce. As the researchers write, “individuals of those ages identify themselves through their relationships with family members.”
  • Financial imbalance’s effect diminished with age. The researchers hypothesized that this reflected the lower-cost of increasingly home-based activity.
  • Perceived health was a factor for those in late middle age; caregiver responsibilities seem to weigh more heavily on the young.

The study has limitations, not differentiating social from emotional loneliness, not measuring the “quality” of relationships, and as with any cross-sectional study, not demonstrating causality. But those restrictions should not prevent us from applying an admittedly broad brush. We are social creatures, and there are stages to our lives, reflecting our personal or the aggregated expectations of society. “If an individual perceives life events as non-normative for his or her age, loneliness may manifest.”

As with continue to learn to live with COVID-19, we might well apply this lens of loneliness to what we see around us. In those terms, lots of partying by the young may be reckless or endangering, but is also one of that age-group’s social drivers. Working at home may make it more difficult to climb that career ladder and may lead to psychological distress in both early and late middle age. While social distancing may, on the one hand, be easier for those older individuals with comfortable homes and surroundings, the inability to connect with family across generations may make it much harder. 

The psychological stress of COVID-19 is becoming more evident with time; social creatures do not do well with social distancing. But how, and in whom, this social stress manifests varies, just like loneliness. That feeling of “being excluded” varies across our life span.

 

Source: Age differences in demographic, social, and health-related factors associated with loneliness across the adult life span: a cross-sectional study in the Netherlands. BMC Public Health DOI: 10.1186/s12889-020-09208-0

 

 

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Chuck Dinerstein, MD, MBA

Director of Medicine

Dr. Charles Dinerstein, M.D., MBA, FACS is Director of Medicine at the American Council on Science and Health. He has over 25 years of experience as a vascular surgeon.

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