Researcher explores connections and interventions for loneliness, cognitive decline in older adults

Human interaction is a biological need that does not diminish with age. In fact, loneliness and social isolation are known risk factors for developing dementia.

Kexin Yu, Ph.D., Assistant Professor in the UT Southwestern Department of Neurology, is exploring the connections between loneliness in older adults and overall cognitive health through the lens of dementia research.

In her work, Dr. Yu explores the pathophysiological and psychobehavioral pathways of chronic loneliness. Data from her work suggest that disruption of isolation risk factors in older adults could potentially change their cognitive trajectory.

Early findings suggest several areas in which loneliness and cognitive health may be linked and how physicians can help older patients strengthen their interpersonal connections, reduce feelings of loneliness, and maintain their cognitive health.

Offer support to reduce brain atrophy, inflammation

Long-term loneliness appears to affect the body in some of the same ways chronic stress does. For example, people who feel isolated may have more systemic inflammation.

“Chronic loneliness can be compared to the body being in a state of famine,” said Dr. Yu, who is completing supervised training toward licensed clinical social worker licensure. “When the body craves human connection but cannot get it, signs of this damage can appear throughout the body.” 

Research suggests that inflammation could explain the association between social isolation and cognitive health in older adults. Loneliness may also reduce cognitive resilience – the brain’s ability to maintain cognitive function despite signs of damage or disease. Older patients who are chronically lonely may experience more cognitive decline than peers who are not lonely, even if they have the same amount of amyloid beta and tau in their brains.

Data from the I-CONECT study, for which Dr. Yu was the principal investigator, showed that socially isolated older adults experience more negative emotions. This may be tied to changes in how their brains process and manage those feelings. For example, the “management system” of the brain (its prefrontal cortex) appears to have less ability to soothe its own “alarm system” (the amygdala). These changes are visible on fMRI and may increase the risk of anxiety or depression.

Research published in AJPM Focus, contributed to by Dr. Yu, shows that strong social cohesion in one’s neighborhood and living environment may help enhance cognitive function.

“We can only do so much as a healthcare system,” Dr. Yu said. “Our arms only reach so far. We require an ecosystem of support organizations to help guide people through the stages of aging and cognitive decline.”

What physicians can do

Clinicians should try to encourage older patients to develop and maintain social connections, and can provide referrals to community organizations that support healthy interpersonal interaction. UT Southwestern collaborates with several North Texas organizations that provide socialization opportunities for seniors, including:

• Little Shepherd Foundation, which serves Chinese immigrants with limited English proficiency.
• Reducing Social Isolation Loneliness Collaborative (R-SILC), a collective of organizations led by the Tarrant County Area Agency on Aging that is invested in building social networks for older adults.
• North Texas Alzheimer’s Disease Research Center at UTSW provides community engagement and services through the Outreach, Recruitment, and Education core.

Suggest affinity groups, technology for enjoying hobbies

The shift in one’s sense of self after retirement is a key driver of loneliness with aging. Many people identify their sense of self with their careers. After retirement, it can be difficult to forge a new identity – and often a new circle of friends – beyond the workplace.

It also can be hard for older people who want to maintain their independence to admit to themselves, or to their doctor, that they are lonely – especially if they don’t want to “burden” loved ones with their needs. This stigma can contribute to an unfortunate cycle: Patients may feel so isolated that they begin to decline offers of social connection from family and friends.

What physicians can do

Clinicians should ask older patients what they used to enjoy doing outside of work and remind them that retirement is a great time to revisit old hobbies and find new interests. There are affinity groups for nearly every activity, which can be a great way for older adults to form new social connections. If geography or mobility are a hindrance, encourage them to use technology to supplement interactions with like-minded new friends.

“Research has shown technology can relieve loneliness, depending on how it is used. It’s not as simple as, ‘Technology is good or bad for your social well-being,’” Dr. Yu said. “It’s a matter of how you use technology in your day-to-day life.”

Dr. Yu’s research found that while the average level of loneliness remained stable while internet use increased from 2006 to 2014, many people reported less loneliness when they used the internet to increase their social contact – not to replace or avoid interpersonal connection. Additionally, data from the I-CONECT trial showed that using video calling can stimulate seniors’ brains and help enhance their cognition.

Countering loneliness in seniors requires an ecosystem of healthcare providers, organizations, and community members. With research as the bridge that links these entities, there is hope for helping aging patients counter loneliness and preventing or managing risk factors for dementia.