Links between Loneliness and Dementia

OK guys, this is me stepping out into the world of blogging for the first time. I hope you like it….

A couple of months ago Alzheimer’s Disease International (ADI) produced their annual report focusing on risk factors and dementia. The report reflects a shift in research and public policy from cure to prevention. The report takes a life course view, identifying a number of factors over a person’s life that may increase the chances of developing dementia. The risk factors of developing dementia are wide ranging but are influenced by our age, lifestyle, the environment we live in, as well as the genes we have. Whilst the genes we have are not modifiable, many of the other factors are. By modifying risk factors, such as vascular risk factors we may be able to reduce the risk, severity and progression of dementia. The ADI report makes for very interesting reading, however I was disappointed to find that it did not give psychological factors the prominence that it deserves. This may be because of the difficulties researching a subject that has so many complex variables, or perhaps the dominance of the medical model in society.

In my social work days I observed many individual’s develop dementia following a life event e.g. the death of a partner, or another form of loss sometimes material or physical. This has always made me curious as to the relationship between how we feel and the onset of dementia. Similarly in my training and consultancy work I often feel moved by the powerful impact good emotional care has on an individuals’ wellbeing. The impact is far reaching, often not only impacting on their emotional wellbeing but also their physical health. Many studies have concluded this correlation, e.g. one study showed that narrative self-disclosure can significantly improve wound healing (Wienman 2008). This has led me to spend the last few years reading widely around the subject, in trying to understand the links it has taken me deep into the realms of neuroscience, biology, psychology and sociology and the complex and fascinating world of psychoneuroimmunology (PNI). It is through my explorations I discovered an interesting body of research on loneliness and its impact on wellbeing, and in particular its relationship with dementia.

Social isolation is used to describe the absence of social contact, whereas loneliness is the dissatisfaction with the quality and/or quantity of social relationships. Loneliness is a subjective experience. You may live alone but not feel lonely, therefore social isolation and loneliness are not one in the same thing. Cultural factors may also influence the prevalence of loneliness; whether there are extended families or cultural attitudes and expectations about living alone.

There is a growing amount of generic research showing that loneliness is harmful to your health. One study claims that loneliness and isolation has a greater impact on mortality rates than obesity (Holt and Lunsted 2010). Loneliness could also increase the risk of high blood pressure (Hawkley et al 2010), and has also be linked to more rapid motor decline (Wilson RS et al 2010). Similarly, and unsurprisingly there have also been a number of studies exploring the impact of loneliness on our mental state; individuals who are lonely are more prone to depression (Cacioppo et al, 2006). Depression may be a major risk factor to developing dementia (Byers et al 2013), and some researches have hypothesized that depression may even be an early part of the pathology of dementia, while others maintain that the links between loneliness and dementia are independent of depression (Holwerda et al 2012).

There have also now been a number of studies researching the link between loneliness and dementia. The AMSTEL study (Holwerda et al 2012) concluded that individuals that have feelings of loneliness have a 64% chance of developing dementia. In this research several interesting strands have been explored:

Could loneliness be a behavioural reaction to early cognitive decline impacting on our ability to maintain social relations? Social cognition can be impaired early both in Alzheimer’s and Frontal Temporal dementia. This also may be the case in vascular dementia, dependant on where the incident is in the brain.

Could it be that when someone is living alone they have less access to social stimulation and sensory engagement which may lead to physical changes in the brain, reducing cognitive reserve?

Could it be related to certain personality traits, for example there are a number of research studies linking neuroticism to increased mortality rates (Huppert 2009)?

Could there be a more novel neurobiologic mechanism involved? This is certainly what my money is on. We don’t understand the links properly yet, but we know they are there.

Prolonged psychological distress will create a physical response along the HPA axis. HPA axis, put simply is that distress causes the body to release cortisol which can be lead to a number of physical responses impacting on vascular, immunologic and metabolic systems. Some studies have looked at the relationship between cortisol and onset of dementia (Schrijvers et al 2011) and found no correlation. However there have been a number of studies linking cortisol to hippocampal damage (Lupien et al 1998), the hippocampus is where our memory is. Whatever the biological process psychological distress is not good for wellbeing, however, the level of distress may be mediated in some way with an individuals’ personality, specifically one’s ability to be resilient. Resilience is a quality that can be developed. One of the main personality types is neuroticism, and these are individuals who have a tendency to experience negative feelings more, and may be less resilient when dealing with emotional distress.

Loneliness exists all over the world, and poses significant challenges to the health and social care systems. However, as social isolation and loneliness are not one in the same thing, this may not necessarily correlate. Similarly, a person may live within a care facility, or receive home care support services and still feel lonely. This highlights that it is the quality not the quantity that service providers need to consider.

As a training provider I plan to tackle this through several strands;

Consider how we can encourage better relationships with our clients in the training we deliver; by tackling stigma head on and encouraging individuals to reflect on their assumptions. By encouraging people to develop better communication skills, to recognise the difference between sympathy and empathy. By recognising the negative role that power can play on destroying a persons’ self-esteem.

Through our leadership programmes, I plan to enable people to think creatively as how they leverage their resources to create better outcomes. This will include using technology to support communication and connection.

To educate the individuals I train about the relationship between how we feel and our physical health. To argue that this is why we need an integrated model of care.

Sec 2 of the Care Act 2014 talks anout Preventing, Reducing and Delaying Needs, a primary prevention includes the need to ‘reduce loneliness or isolation (e.g. befriending schemes or community activities)’, it is essential to include prevention in our Care Act training as a way to ensure that providers are aware that social isolation has a negative effect on recovery and renablement.

Safeguarding training now focuses on the 6 key principles of Empowerment, Prevention, Proportionality, Protection, Partnership and Accountability. As an integral preventative measure within safeguarding, loneliness and its negative outcomes is explored when considering proactive safeguarding strategies.

Caroline Bartle