Why Death Risk Increases with Social Isolation

You are listening to Boomers Today with your host Frank Sampson. Welcome to Boomers Today. I’m your host, Frank Samson. Of course, each week were bringing important and very useful information on issues facing baby boomers, their parents, and other loved ones.

And as I do on every one of our shows, I thank all of you, and I thank all of you because our listeners are growing each and every day and it’s because of you. You’re sharing many of our individual shows or the entire theories of podcasts with friends and family, and because of you, our listeners are growing. So thank you, so much. So many of you listen to the show on various podcast stations like Apple Podcasts, Spotify, iHeartRadio, Audible, some of you just ask Alex and Siri to take it Boomers Today, and some of you go to our website at Boomersdayradio dot com an a lot of different ways to listen to it.

So again, thank you so much. And I do know why you’re sharing our show with friends and family is because we have the best guests, and I’m not going to disappoint you. Today we have with us doctor Crystal Sinay, who is a general internal medicine physician implementation scientists and a professor of Medicine at UC San Diego, where she also serves as Chief Administrative Officer and Associate Chief Medical Officer for Health Equity. A nationally recognized health services and health equity researcher, she focuses on cardiovascular health, social and structural drivers of health, and patient and family centered care.

She has led federally funded research studies and published extensively on interventions and reduced disparities and prove chronic disease outcomes. So, doctor Sine, thank you so much for joining us on Boomers today. I really appreciate it. Oh, thank you so much for having me, Frank, I’m excited to talk about this topic.

Yeah. So what we’re going to talk about is something that sure we both feel is just so important and affecting so many people, not only around the country but around the world. And that’s social isolation. You know, when when people know that I’m in the senior care industry, I always say it’s the biggest challenge today for the elderly in my opinion.

So, you know, social isolation and loneliness are you know, you know, associated with increased risks of premature death. Even all right, So talk to us just about about how social isolations affecting individuals, their families, and our communities. Yes, thank you, Frank. So I just want to start by making a very bold statement, but one that is true, just to really impress upon your listeners how important this is.

Social isolation kills. It really does. And you mentioned that it’s associated with premature death, and it’s from all causes of cardiovascular disease, which is something that I’m particularly interested in. We know that heart disease is the number one cause of death in the US, and so when we think of social isolation and loneliness being major risk factors for heart disease, that really tells us and drives home the point that these conditions really do lead to death and they do kill.

So they don’t just make people feel bad, but they really are bad for your health. And so a lot of my research and others research has shown that social isolation, which simply is just not having enough meaningful connections to others. So that can be determined by few contacts with people, whether that’s by contacts in person, contacts by phone. Now we’re moving into people doing a lot of things online, so that’s a new way to connect with people.

But what we know is that many people do not have sufficient meaningful and that’s a very key word, meaningful connection with others, and that actually is very bad for your health. Right. So every year, I want to get your opinion of this. Every year now the ARP and other organizations come out with these studies, and these studies say, oh, we surveyed all these people, eight percent or ninety something percent of the people want to live the rest of their life at home.

And listen, I have great respect for ARP, I really do. I think it’s a crazy study to spend money on because I could tell you we all know people would rather live at home. Yeah, okay, but my question to you is even though they do, that doesn’t mean they should right talk to us about that. Yeah.

I think it’s wonderful if people are able to live at home. But I think what is more important is that wherever they live, that they’re connected with others in meaningful ways. And I make that distinction because we know that sometimes connecting with people online or in ways that are I will say that we are non traditional, at least previously there were less traditional ways is not as meaningful for people. For getting the benefits out of connection that we hope people have.

And so, whether you’re living at home, which is great if you have the h if you have the resources in terms of the support that you need to live at home, that is wonderful. But what’s more important is that wherever you live, you’re connected to others in meaningful ways that you are able to get the benefits of the connection, whether it’s social support through tangible means, people helping you, you know, get food, get access to the grocery store, taking you places, whether it’s practical support again, helping you with medications. We know many people as they age are taking medications. Whether it’s someone who’s helping you with your medications, whether it’s informational support, someone who can help you understand the mass of information that’s being drawn at us every day.

So a lot of. Times you can get that type of support when you’re in community. And so again it’s wonderful if that community occurs. In your own home.

However, for we know that the reality is that for many people as they age, that community comes outside of their home. And so again the key is that you’re not alone, you’re not feeling lonely, and we know those are different. You can be around people and still feel lonely, but wherever you are that you feel a connectedness to others. I think that is key to improving and preserving health.

Being at home and sitting in front of the TV alone all day long. That’s not no, that is not a meaningful connection. It’s not a meaningful connection the connection to the television, right, right, So how do we change this? I mean, how do we? I guess doing this on the podcast and trying to educate people, I guess is part of it. It’s educating people.

But how do you deal with a day to day in your own practice? Yeah? So I will say for me, as an you know, primary care internal medicine doctor who has taken care of a lot of patients and including multiple members of the same family. We see this a lot. We see people for whom really coming to the doctor is one of their main sources of social connection and connectedness, and I think one of the very simple things is talking to them. Right, is you need someone in your life that you can talk to that when you’re having a bad day or you’re not feeling your best, that you have someone that you can actually go to and communicate with.

Which again highlights why you know, the TV is not a meaningful connection if that’s the main way you’re spying your time. So as physicians, we see this often. Talking to people is really important. I think it’s also important to share with people.

What we’re doing here is that letting people know that social isolation and loneliness are not just things that you should be ashamed of or feel like you have to hide from people, but it’s something that we should be talking about because of the impacts that it does have on health. And so knowing that someone’s risk of you know, developing heart disease is you know, thirty percent higher if they’re isolated or developing, or you know, being hospitalized or dying rather from heart failure is twenty percent higher, those things are important for us to share with for me as a physician, to share with my patients and my patients’ families, because I hope that it will impress upon them the importance of making sure that their loved ones, or if I’m talking to the person themselves, the importance of this staying in community and staying connected. Another statistic that’s really key is that socially isolated people face two to three times higher risk of death. We know that there’s a higher risk of stroke.

So again, education is really important, but when we get to that practical part of it, it’s thinking about how can you get connection in your everyday life. So whether that’s talking on the phone, whether that’s taking a walk with someone, just having someone that you can talk with about the highlights of your day but also the low lights of your day. We know that not every day is great, and as we get older, we face a lot of changes in our networks. You know, when you retire, you lose kind of that network that you’ve had.

When you start to lose loved ones through bereavement and death, you lose that network. So there are a lot of shifts that happen as we age. But again it’s trying to figure out how can we deepen the relationships that we that remain, even though those might be smaller in number, how can we deepen those or how can we spread those can we get into community. I know, for example, I’ve had people that I know who their doctor’s office will facilitate this.

There are many geriatricians’ offices who will have you know, activities at their office or patients, whether that’s playing bingo or doing arts and crafts or making cards. So I do think it’s also important that for us as healthcare providers, we think about how can we create spaces of connection in our practices so that patients who are lonely and isolated there are many of them, and most a lot of times doctors don’t even realize that, but how can we create spaces and community that our patients can then take advantage of. Yeah, so you know, there are a lot of options out there where people can meet others and be part of the community, you know, anywhere from senior centers you know, or day daycare they need care, uh, to even more independent living if they can, you know, if they can afford it, the independent living, and if they need care assisted living. Uh, there’s you know, it has been a perception that if you’re not at home and you have to go into some sort of a community, it must be nursing and that’s not the case anymore.

But what what are your what are your thoughts there on more of a you know moving in a sense literally, Well, again, the daycare centers, they don’t have to move, they could spend a day there once in a while, but if they were to move into more of a community that has things going on every day, ways to meet people and be involved. What are your thoughts there, Yeah, I think that is a great option, and I think it’s one that people should strongly consider, certainly. You know, we know that there are a variety of different options when you think about places if you wanted to move into a different environment that you could pursue. Uh so, And I think that they’re great for fostering social connection with the activities and just being in a closer, tightly knit community.

One of the things that really for me is important and can somewhat be a challenge, is that those places aren’t always accessible to people who have fewer financial means. And so I think that as a as a community and as a country, we have to think about how do we make places like that more affordable for people who may not have the resources. And this really connects with this topic of social isolation because one of the things that we know in terms of the people who are greatest risk of isolation are people who come from sometimes lower income communities, people who are you know, people with disabilities. Of course, that doesn’t mean there have fewer financial means, but people with disabilities and who have multiple chronic conditions, things that people who live in rural areas, right, that’s a major challenge.

And so I think as we think about these other options besides home for places for people to go to be in community, we have to think about how do we make them more accessible to people who actually may be at greater risk of isolation and so in essence, people who need them more. How can we make them more available? But I think that that’s a great option and one that people should, you know, certainly take advantage of. But again, as you said, Frank, just the daycres just even if you you know, the moving is not an option or one that you would like to take advantage of. Even if it is an option, just getting out, going to the daycare and spending a few hours there, just being in community really really helps.

And so I would strongly encourage people to keep that option open and take advantage of it. Yeah, so you know, I know your your specialty is on the cardiovascular side. However, I’m sure you deal with patients and families who’ve loved one maybe has started maybe some cognitive decline, sure, right, maybe early stage dementia, maybe not, maybe MCI my cognitive impairment. For those of you that don’t know what MCI is, but you know in my work that I do, it’s unfortunate.

But then you find when when people start that cognitive decline, it seems like many of their friends, any even even members of the family start to shy away because they’re not comfortable in those situations and how that person may be acting and repeating questions and things like that. Any just any words of wisdom there real to that, to that, because that that kind of cree could create social isolation. Absolutely, it’s a tough one, I know, But any any thoughts you have. There, no, you know, I appreciate you bringing that up.

It’s true. And I you know, as a general intern is so you know, I do a lot of work on the cardiovascular side as a researcher, but as a primary care doctor, I see all adults, you know, all you know people who are you know, adults, and many of them are older adults. And so I do think that the cognitive impairment, and we know that, you know that is sadly a challenge that many people face as they get older and even younger if they have certainly multiple chronic conditions. A lot of times, many of the cardiovascular conditions can lead to cognitive impairment.

And so we see this, and I do think it’s true that a lot of people families have a hard time knowing how to still connect and support their loved ones when they start to experience cognitive impairment or dementia. And I think a few things that. Are helpful are just to remember that one, you know, these aren’t things that people can choose. No one would ever choose to be cognitively impaired or to have dementia.

And so as much as you can, just try to engage with them the way that you did before. And yes there’s the you know, repeated questions and those things, and I know that those things can be very frustrating. And then the family are dealing with the emotionality, their own emotions around you know, a love one changing, and there’s a certain kind of stages of grief that you go through as a family member. I know I’ve certainly gone through that as a family member who’s been a you know, caregiver for older adults, and as a physician, you know, knowing understanding what’s happening, but also it doesn’t change the emotions that you have and kind of the grief reaction that you have and just seeing them change.

But again, as much as you can just try to interact with them, you know, the way that they were and remember them the way that they were, even as you adapt to kind of how they are now. So I think as much as you can maintain communication, maintain conversations. Again, sometimes you have to do that in. Shorter spurts because it is challenging and it is you know, if you have to step away because you realize that you’re getting frustrated or you’re getting upset, do that, but the key is coming back and re engaging and trying to just maintain that connection.

I think it’s really important if people do have family members, that the families can get a plan together like Okay, you know, can you spend time with mom today and maybe I’ll come, you know, in a few days or whatever, to break it up so that the what can be perceived as a burdener can be perceived as emotionally challenging or hard that’s shared among people, so the person the loved one, still gets the interaction that they need, and that the families aren’t overwhelmed. And I think really this highlights kind of one of the groups that’s the greatest at risk are those who really are socially isolated in terms of they don’t have family, they don’t have children, they don’t have immediate family in their alone. And that’s the group that it really is the hardest. They’re the most at risk because they don’t have those connections.

Right right, So, doctor say, we’re going to take a real quick break. I promise just to recognize our sponsor. We come back, certainly, I want you to share more about all the wonderful things you can do you are doing, and how families can learn more what you’re doing. And then I would like to talk about you could give us some thought, you know those people that maybe families are aware that mom or dad or a spouse need social interaction, but that person is kind of pushing away of doing that.

How maybe recommendations you would have for those family members. So when we come back, we’ll talk about that, all right, So do you know anyone who may be concerned about an older driver? Well, Senior Care Authorities Beyond Driving with Dignity program is a facilitated self assessment program for older drivers This program has been designed to serve as a vital tool to facilitate older drivers and their families as they make the appropriate decisions regarding the future of one safe driving career. If the individual is a safe driver, an advisor will provide him or her with strategies on how to remain a safe driver as they progress through the aging process. If driving retirement is the appropriate decision, then the individual and their families are offered possible alternatives, resources, and a specific plan to ensure a smooth and successful transition from the driver’s seat to the passenger seat.

So to learn more, go to www. Dot Beyond Driving with Dignity dot com. That’s Beyond Driving with Dignity dot Com to connect with a senior care authority advisor in your area. We’re back with doctor Crystal Siney, who is a general internal medicine physician and a professor of Medicine at UC San Diego.

And our subject matter is really social isolation, mainly for the elderly we’re talking about. So, doctor Sinay, why don’t you share with our listeners it’s bragging time. Tell me about yourself, all the wonderful things you’re doing and how they could learn more. Well, thank you so much, Frank.

I appreciate that. So yes, So I am, as Frank said at the beginning, I’m a general internal medicine doctor. I am a researcher. I study cardiovascular risk and really social influences on cardiovascular health.

I’m a health system executive, and most importantly, I am a person who really cares about how patients and family members connect with and communicate with their physicians, and how do we strengthen that relationship and that bond, and how to help physicians and health system leaders really pay attention and build systems and structures that support people who are isolated and lonely, and who support the family members. I’m a big proponent of family member engagement and care. I would love you to check out my website to learn more at Crystal Sinay, MD dot but it’s Crystal c R Y S T A L s A c E n E. M AS and Mary DS and David dot com, so you can learn more about me and my work there.

And really, yeah, I just want to give people as much information as I can to help them understand how things like social isolation affects health and how patients and family members can partner together, and particularly how they can improve their relationships with their doctors, and how to make doctors and health systems more compassionate and caring, certainly when for these types of conditions that tend to be under recognized and underappreciated, and we don’t create great systems to help our patients and families when they’re struggling with issues around isolation and loneliness. Right right, Well, thank you for that. That’s great, wonderful. So before we get to the question, I was going to ask ask you what I mentioned before the break.

I would like to go back to kind of the original discussion at the beginning that social isolation could have an effect on coronary heart disease, etc. So I guess my question I was thinking, how do you know that? I mean, it makes sense, but how do we know that? I mean, what kind of studies have been done is to really show that? Yeah, well it’s a great question. A lot of the studies so there have been probably now over four decades of data that has demonstrated that social isolation increases the risk of death, and it’s pretty similar in degree to the risk associated with obesity or smoking and physical activity. So we know that it increases the risk of death and increases the risk of having heart disease.

But a lot of the ways that we know that, the majority of the studies are kind of what’s called epidemiologic studies, but they’re using surveys, So it’s looking at what people say on surveys about their social connections and then we look at whether or not they develop heart disease. And again, cardiovascular disease can be ranged from heart disease to. Stroke, and you know within heart disease there’s heart failure. There are different causes, but we can follow people over time and we actually can do cardiac cathorizations or MRIs of their brain if we’re talking about stroke.

So we have our ways that we tell, just like many of your listeners I’m sure themselves or have loved ones to have heart disease, and the clinical ways that we diagnose those, that’s how we tell the heart disease piece of it. But we ask. People and usually the key is that you’ve asked them in surveys about their social relationships and lots of questions to get at the strength and the types of social relationships and how frequently or whether they’re lonely. We ask those questions, you know, at one time period, and then we follow those people over time and see if they develop heart disease.

And then there are some fancy mathematical and statistical ways to see if that association seems to be true and if it holds up. But the interesting thing is that there have also been studies done in animals where you know, you look, put them by themselves or whether they’re in community with other animals, and we kind of see very similar patterns. So we can also see within. Animals where they’re where they’re isolated, what those effects are on the body.

And so that gives us a sense of how exactly is social isolation actually affecting your health? So what’s happening in the body. But it’s a combination of the physical, you know, the clinical ways that we measure and diagnose heart disease or stroke or and then the surveys that where we ask people. Questions to understand what their connections are. They’re very interesting, very interesting.

So you know, listeners might be listening to this our podcast here and they go, you know what, I my mom, my dad, my other you know, loved one is more socially isolated. I got to do something about it. And they try and they get pushed back and they go, I’m fine, I’ll be fine, I’m good. I just like being at home, you know whatever.

They don’t want to go out, they don’t want to meet people, et cetera. And maybe this is more of a psychological question, but just just your thoughts there, and I’m sure you’re this type of question is brought up to you by families. But any advice you have in those situations. Yeah, it’s interesting because a lot of times that’s one of the ways that that gives you an indicator that they’re isolated.

But I think one of the things that also highlights is that it could be that your loved one is also depressed. There’s a lot of overlap, and we know that they’re not the same thing. Let me be clear with that, But people who are depressed sometimes tend to isolate. But you can be isolated and not be depressed or lonely.

So I think one of the biggest things, and it’ll seem simple, but it’s really important, is to ask questions. Sometimes we know that irritates people and that may be the last thing you want to do. Because you don’t want kind of the wrath, if you will, of people getting annoyed by the questions, but it is good to probe you want to try to understand what’s going on because you might be thinking this person is isolating, and that may be absolutely true, but the question is why are they isolating? Is it some underlying is it depressed or you know, a mental health condition. Is it a physical condition, a health physical health condition that is also causing those those same kind of manifestations.

So you want to try to ask questions as much as you can to really try to understand what’s going on. And then the next thing I would say is you want to check in on that person frequently a lot of times. Again you don’t know is it isolation, is it due to depression, is it due to a health condition, is it due to a combination of those. So I think the consistency in checking in with people is really important because you don’t you know, they may not reveal anything the first time, or maybe even the second time, but if they see you consistently showing up, see that you’re caring and your concerned and you want to understand, I think that helps people open up and be a little bit more honest, and at some point I think you will get some insights into what’s going on.

So I would say, ask questions and be consistent with checking in with people. So I could talk to you for quite a bit longer on this subject matter, but unfortunately running out of time. But I don’t want to finish up, and then you know, you’re thinking, God, I wish Frank would have asked me this. So what is something that maybe I have an ass that you’d like to address? Just finishing up here? Yeah, I just want to share a little bit about why, because I know some people wonder about that humans are wired for connection, and when that connection is lacking, the body interprets as that absence of a connection as a threat.

And so what happens is that the stress hormones in our body rise, inflammation increases, our blood vessels become more vulnerable to damage, and over time, this chronic stress associated with isolation accelerates heart disease and it weakens the immune system. So that’s really how social isolation and loneliness get under the skin. And I bring that out because I don’t want people to think that this is an issue of just oh, we’ll just get over it and move on, and people are weak. Or they’re just sad.

It really does cause physiologic manifestations in the body, and so we have to take this issue seriously. People and family members need to think about it and take it seriously. Clinicians and physicians and other clinicians like myself, we have to think about it. There are ways that it’s been recommended that health systems screen people for social isolation, yet.

Sadly many don’t. So I want you to really think about that, and I want to push any clinicians or health system leaders out here to really push ourselves to do this. We have to ask the question, simple questions that can be powerful to ask our loved ones or to ask our patients, who do you talk to when you’re having a bad day? And so that’s a very. Simple question that can help us get a sense of what’s happening with people.

So again, we have to ask the question. We need to know because connection is not just a nice to have, it’s a medical necessity. So that’s that’s what I’ll leave you with. Great, great, Well, thank you so much for joining us.

Check check it out Crystal Sinay MD dot com. Right yes, that’s it. Okay, great, Thank you so much for joining us. Thank you everybody.

Please be safe out there. Talk to everybody next week. You’ve been listening to Boomers Today with Frank Sampson. To learn more about today’s show, visit Boomerstoday radio dot com and join us next time for another edition of Boomers Today.