Evidence
Alert

Loneliness, but not social isolation, predicts development of dementia in older people

Older people who feel lonely and have few close relationships may have an increased chance of developing dementia. Perhaps surprisingly, being socially isolated with few or infrequent social contacts does not seem to predict dementia risk, researchers found.

This study was carried out before the coronavirus pandemic but the findings are relevant now, when the over-70s are socially isolated.  It suggests that those who have supportive social relationships with relatives and carers may be protected from cognitive decline. The quality of their relationships seems to be more important than how often they meet up in person.

People who have social contact may still feel lonely. The study stresses the importance of supportive relationships for people with early stage dementia.

What’s the issue?

Treatments for dementia provide only limited benefit. Understanding and improving prevention and slowing of dementia is therefore important.

Many preventive measures focus on physical aspects such as promoting cardiovascular health. However, social and emotional factors may also be important in the development of dementia.

Previous research has shown that being married is linked to a lower chance of dementia. Less is known about the impact of other social relationships and contact. In this study, researchers explored factors that might translate into interventions to support people at risk of dementia, or in the early stages of cognitive decline.

What’s new?

This study included adults aged 50 and over in England, who are living independently. They are part of the ongoing English Longitudinal Study of Ageing (ELSA) and are assessed every two years.

Researchers looked at data on 6,677 people (3,716 women) with a mean age of 66, from 2004 onwards. Participants were interviewed face-to-face and took cognitive tests. When they were unable to answer questions, carers completed questionnaires.

People were asked about feelings of loneliness and about close personal relationships. They were considered to be socially isolated if they had less than monthly contact with either:

  • children, family apart from spouse or children, and friends
  • social, sports or religious organisations.

Of the group, 220 (3.3%) were diagnosed with dementia during the study period. Those who developed dementia were older, had less education and less wealth at baseline than others. After taking confounding factors like these into account, researchers found that:

  • being unmarried (single, widowed or divorced) increased the risk of dementia two-fold compared to being married
  • being lonely increased the risk of dementia by one-third
  • having 2-3 close relationships decreased the risk of dementia by three-fifths. Having ten or more relationships decreased the risk by two-thirds
  • degrees of social isolation were not associated with dementia in a consistent manner.

Why is this important?

The impact of social isolation and loneliness on cognitive decline in older people may be more complex than has been thought.

Initiatives to tackle social isolation, such as befriending services or provision of social activities, may decrease social isolation. But they may not have an impact on loneliness or the number of close relationships people have. This research indicates that social isolation alone is not strongly linked to the development of dementia. Tackling loneliness may not be as simple as increasing people’s social contacts.

The research findings are interesting now when social isolation is imposed by the coronavirus lockdown. The current social isolation measures are different from the social isolation measured in this study. But study author Andrew Steptoe says that loneliness is strongly linked to a lack of intimate contact, so these results may be relevant for people isolating alone. Health and social care professionals could try to educate the relatives and carers of people with dementia about the importance of maintaining good close relationships.

What’s next?

The study adds to evidence that social and emotional aspects of life can have a major impact on the development of cognitive impairment. It is part of a wider initiative, the Promoting Independence in Dementia (PRIDE) project, which aims to develop interventions to support people in the early stages of cognitive decline. For example, some work suggests that cognitive behavioural techniques may help to reduce loneliness.

The study will inform research into the ways loneliness and social relationships interact with disease processes. It may be that people with supportive social relationships are more motivated to exercise, eat well and participate in cognitively-challenging activities. Biological responses such as stress hormones may play a part in cognitive impairment, and may be affected by feelings of loneliness or the presence or absence of close relationships.

You may be interested to read

The full paper: Rafnsson SB, and others. Loneliness, social integration and incident dementia over 6 years: prospective findings from the English Longitudinal Study of Ageing. J Gerontol B Psychol Sci Soc Sci 2020;75:114-124.

The Promoting Independence in Dementia (PRIDE) project investigating how people can maintain independence in the early stages of dementia

Tips from Join Dementia Research and the NIHR on how to support people with dementia and carers during lockdown

The International Longevity Centre (ILC), a think tank addressing issues on the impact of the UK’s ageing population and how society can best adapt

 

Conflict of interest

The authors declare no competing interests.

Funding

This research was supported by the NIHR and the UK Economic and Social Research Council.

Commentaries

Study author

“I was surprised by the lack of association between social isolation and dementia because our other studies have shown that people with more social contacts seem to have a lower risk of dying over the next number of years. That could be to do with practical aspects of social relationships. Those around you may prompt you to have a persistent cough or breast lump checked out. It’s different if you have dementia or cognitive impairment. We suspect that social contacts have a mixed impact on people, both positive and negative, and it leads to an inconsistent pattern in studies.

Putting the results into practice is difficult. We could increase befriending services, and activities for older people to be involved with, and that would be likely to increase social contact. But to change someone from being lonely to not lonely is a much more personal thing. I don’t think anyone has solved that.”

Andrew Steptoe, Professor of Psychology, Head of Behavioural Science and Health, UCL

Volunteer

“As a volunteer, I am aware of the importance of a weekly event, doing something different with someone with dementia and helping them to stay active, physically and mentally. This research suggests that making lifestyle changes earlier, particularly in relation to isolation and loneliness, might mitigate the risk of dementia. When someone sees their GP, there is not much time to say everything. Peer support volunteers can get to know their likes, dislikes, issues going on now and past issues. They can use the information to make small changes, maybe looking at hobbies and helping to set up groups that could be self-run, such as a chess club. Or encouraging the person to try new activities by going with them so they gain the independence to go safely on their own.

Since lockdown, it has been difficult for volunteers to have contact and people are feeling it. I have made phone calls and sent short emails because some contact is essential with the person, their carer or partner. It is important they have the opportunity to talk about things that are bugging them.”

Justin Greenwood, Side by Side volunteer, Alzheimers Society

Researcher

“This research emphasises the importance of relationship quality and perceptions of loneliness, over the degree of apparent social connectedness, for future dementia risk. It could influence health or social care strategies aimed at improving relationship quality, possibly through greater involvement in the community.

Potential barriers to implementation include the limited visibility of issues like loneliness and perceived relationship quality beyond actual degree of connectedness and designing strategies applicable to different social groups and contexts. Further understanding of the mechanisms linking relationship quality to dementia may help to facilitate design and implementation of interventions.”

Matthew O’Connell, Lecturer in Health Services Research, King’s College London