Mdm L, in her 80s, had always been the heart of her family. During the weekends, her home would be filled with the lively chatter of children and grandchildren.

She would buy and prepare ingredients from her regular market stalls and gather the family around the kitchen table to wrap dumplings.

But after a fall at home, she suffered from a hip fracture that changed everything.

Suddenly, she became homebound and dependent on a helper to supervise her every move. She was instructed not to stand for many weeks, which kept her from her usual marketing and cooking.

Her once bustling kitchen fell silent and her cheerfulness turned into forlornness and self-pity. Over the span of a few years, she became increasingly cynical, isolated and even forgetful.

As her house-call doctor, I wondered: could she be suffering from “loneliness”?

It was obvious that isolation has had an effect on her physical and mental health. Unfortunately, this trend among elderly patients is not limited to my practice. Loneliness is increasingly common in many ageing societies. Its health consequences have been deemed a serious public health concern, triggering authorities across the globe to pump in money to address this problem.

The UK Government launched the Know Your Neighbourhood Fund with up to £30million to target chronic loneliness in 27 local communities in England. In South Korea, local authorities announced in October 2024 that they will spend almost US$327million to address loneliness. How does loneliness warrant such budgets?

WHAT IS LONELINESS?

We have been taught that loneliness is simply being alone, or being in a state of solitude. But loneliness is actually a subjective emotional state characterised by feelings of isolation, emptiness, and a lack of social connection.

For example, a retired teacher may experience loneliness in a crowded hawker centre, while a hawker may not feel lonely surrounded by familiar faces in his bustling workplace.

Loneliness is a common human experience, yet its experience can vary from person to person, depending on the context. Just like the weather or any other emotions, it may be experienced intermittently or in waves.

However, in contrast to loneliness being a state of mind, a disease is a medical condition that affects the structure or function of a person’s body.

It may present with physical signs and symptoms, and can be explained by physiological changes in one or more organ systems. For example, a person with a disease like pneumonia (a lung infection) would typically have difficulty breathing and suffer from fever.

The diagnosis can be supported with an objective physical examination with a stethoscope, and further confirmed with blood tests or X-rays. These criteria are applicable, regardless of gender, occupation or mental state.

Similarly, dementia may be diagnosed with various symptoms like forgetfulness and confusion, alongside a low score in cognitive tests and further supported with brain imaging. In both of these diseases, there are bodily changes that can be examined and investigated.

Is loneliness a disease then?

Loneliness has been explored extensively by academics and has even been studied in some medical journals. There are various attempts to define its heterogenous nature, using questionnaires that include social and emotional aspects, but its effect on specific physiological functions has yet to be found.

As such, the state of loneliness cannot yet be defined as a formal disease. However, it does not negate the fact that loneliness has profound and longstanding effects on a person’s health, and its impact on the masses is the reason why leaders are urgently acting upon it.

Also, there are ways to address this loneliness “epidemic” that is taking over ageing societies.

THE HIDDEN DANGERS IN LONELINESS

Numerous high-quality studies have consistently linked loneliness to a variety of negative health outcomes. Most measure loneliness using verified questionnaires like the Dejong Gierveld Loneliness Scale. Thereafter, these results are compared to their actual health outcomes.

Research from the Brigham and Women’s Hospital found that loneliness can increase the risk of death by 50% in older adults.

Loneliness was associated with a 29% increase in risk of heart attack and a 32% increase in risk of stroke, based on a study published in the Journal of the American Heart Association. Granted, these statistics may be lower than that of established causes and chronic illnesses like cigarette smoking, high blood pressure and diabetes, but the implication on each individual is that there is a strong correlation between loneliness and cardiovascular outcomes.

Apart from cardiovascular risk, the British Medical Journal even published a study which found that loneliness was associated with a 40% increased risk of dementia.

Another mental health link established found loneliness to be a robust predictor for depressive symptoms in older adults, based on a study done in Shanghai over a 6-month period. These staggering results illustrate how this social and emotional state is invariably linked to many different negative health outcomes, and is something that cannot be ignored. How then does one break free from loneliness?

BREAKING FREE FROM ISOLATION

Addressing the issue of loneliness requires a multi- pronged approach. Older adults can make use of a variety of elder-friendly recreational spaces to convene and connect. Currently, centres like active ageing centres, senior activity centres and day care centres are designed to engage older adults at various degrees, depending on their level of independence or cognition.

For example, older adults who have interest in karaoke, cooking and exercise programmes can enjoy these group classes, while others who are less mobile may partake in simpler arts and craft activities.

These seemingly simple activities may go a long way in creating shared experiences with others and promoting social connections, as long as they are recommended for the right people.

In the Age UK programme, more than 530 people were assessed within 6-12 weeks, and of those who identified as “often lonely”, 88% of these people said that they were less lonely following support and interventions.

Such activities are commonly labelled as “social prescription”, and can be recommended by family physicians, geriatricians or community nurses during healthcare touchpoints. Unlike a disease where there are tablets that can be prescribed, social prescription is a non- pharmacological approach that connects people with community resources which promote overall health and well-being. While

there is currently not enough research to show that these programmes directly affect cardiovascular health and mental health, there have been positive impact on patients’ lives.

A 2019 pilot at Bright Vision Community Hospital yielded positive outcomes – patients who were referred to and linked up with community services like Senior Activity Centres reported improvements in their quality of life.

As a result of its success, other community hospitals have also taken up this endeavour to tackle the issue of loneliness.

A FUTURE WITHOUT LONELINESS

While loneliness may not be a disease in the traditional sense, it is a serious public health issue that requires attention and intervention. Promoting more avenues for social connections through various activities has the potential toreduce loneliness and improve health outcomes.

By understanding the hidden dangers of loneliness and taking proactive steps to address this “epidemic”, I am hopeful that there will be more opportunities for people like Mdm L to thrive.

Back in Mdm L’s home, I noticed a framed picture of her singing karaoke. She smiled and told me, “I used to love singing Chinese classics. My favorite is ‘Tian Mi Mi.’” When she began spontaneously to sing for me, I noticed a spark of joy return to her eyes – something I had not seen in a long, long while.

Her music brought a moment of connection and happiness to an otherwise mundane and lonely day.

Author

  • Family Physician
    MBBS, MMed (FM)

    Dr Smily Lock is a certified Family Physician who underwent training in a wide range of specialties from Paediatrics and Geriatrics to Emergency Care and Ambulatory Care under the SingHealth Family Medicine Residency Programme.

    Upon earning her certification in NUS Masters in Medicine (Family Medicine) in 2021, she served in the public polyclinic system in both Respiratory Medicine Workgroup and Remote Care Workgroup.

    She previously worked in a digital health startup, as Head of Healthcare Solutions, overseeing the company’s Home Programmes as well as its first physical clinic. Dr Lock is currently working as a freelance Family Physician, with a keen interest in home-based geriatric care.

    She is motivated by the trust and continual relationships with patients to provide the most holistic form of care.

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