Loneliness and population health

May 31, 2019 / By Private: Katie Christensen

 “During my years caring for patients, the most common pathology I saw was not heart disease or diabetes; it was loneliness … loneliness was often in the background of clinical illness, contributing to disease and making it harder for patients to cope and heal.”

   -Vivek Hallegere Murthy, 19^th Surgeon General and founder of the non-profit Doctors for America.

Consider the following:

• A groundbreaking 2010 study from Brigham Young University found that weak social connections can shorten a person’s life by 15 years—roughly the same impact as smoking 15 cigarettes a day.
• Research presented at the American Psychological Association’s annual convention last year showed that greater social connection corresponds with a 50 percent decrease in the risk of early death.
• Social isolation or living alone can be more harmful to a person’s health than obesity.

What is loneliness?

The National Institute of Health questions its classification as a disease:

“Loneliness is not necessarily about being alone. Instead, it is the perception of being alone and isolated that matters most and is a state of mind.”

As I suspect we all understand, loneliness is not the same as being alone. There can be joy  in being alone with our thoughts, but I suspect we have all had moments where we wished we had some interaction and experienced feelings of loneliness. 

If it’s a disease, what are its origins?

In recent years, loneliness has been more commonly referred to as an evolutionary manifestation, comparable to pain. Ultimately, we yearn for human interaction, and this trigger prompts a response. Just as we may go to the doctor if we are in pain, we seek ways to console our lonely feelings.

“Loneliness may feel like it has no redeeming features, but it may have evolved as an aversive state that, like hunger, thirst, and pain, promotes behavior change to increase the likelihood of the survival of one’s genes.”

But what if we don’t console ourselves in healthy ways?

History shows that we were not always efficient in our treatment of infection in health care (e.g. bloodletting!); We may find ourselves in a similar situation today.  . Sometimes lonely feelings are addressed through unhealthy social networking, through alcohol and drugs, damaging relationships or harm to oneself. Perhaps these feelings are not addressed at all, and this misery prevents us from using coping skills and can cause lack of follow-through on a plan of care. To that end, loneliness  and may be one of the most important social determinants of health. Loneliness could be the largest contributor to the development and progression of chronic conditions.

If it’s a disease, can I code it? 

ICD-10 offers a few options to classify a patient in this manner, several in the Z60.X code range (Z60.2 – Problems related to living alone, Z60.4 – Social exclusion and rejection)

Does loneliness make you sicker?

The lonelier you feel, the sicker you feel, but  is it just perception? No—loneliness actually does make you sicker. Its presence raises a person’s risk for a wide range of chronic conditions such as cardiovascular disease, cancer and depression, which contribute to poor outcomes and the total cost of care.⁵

Once we know about it, then what?

Capturing the patient’s condition and subsequently risk-adjusting for that condition may represent one of the more progressive strategies to managing population health. Not just managing the populations which have already been to the hospital/ED following acute on-set, but going after those members earlier to prevent the acute on-set. We can’t address loneliness if we don’t know about it.

Strategies for addressing loneliness will likely involve collaboration with community-based provider organizations and applying current population health methodologies to social determinants since they contribute to overall health. 

We learned not to bloodlet to address infection, and we can learn to put new models in place to more effectively address loneliness. Loneliness isn’t just an undesirable way to live. It can kill you.

Katie Christensen is a healthcare consulting manager within the Population and Payment Solutions group of 3M Health Information Systems.