Surgeon General: “Social connection is medicine”

Loneliness and isolation aren’t synonymous; they have very different definitions. Dr. Cudjoe sought to educate the audience on the difference.

According to the Surgeon General’s 2023 report, loneliness is defined as the perception of social isolation or the subjective, distressing experience resulting from perceived isolation or an adequate, meaningful connection, where inadequate refers to discrepancy or unmet needs between an individual's preferred and actual experience.

He emphasized loneliness may even exist when “someone who has a lot of people around them who may love them, but they don't feel that those connections meet their specific needs.”

That differs from isolation, which he likened to being off in a cave with no contact from others.

According to the Surgeon General and the National Academies of Science Engineering and Medicine’s 2020 Consensus Report, “Isolation is the objective lack of or limited social contact with others,” he said. “It might be chosen solitude.”

While all people are at risk for social isolation, some are more at risk than others, including older adults, unmarried persons, individuals with disabilities, caregivers, new parents, and veterans.

“Social connection is important, and when we aren’t connected, it negatively impacts the health of individuals, their families, and communities,” he said. “In healthcare, we focus on well-established health risk factors like cigarette smoking, blood pressure, and lack of physical activity. But too often, we brush over social relationships in healthcare.”

Cudjoe, a geriatrician, first encountered social isolation and loneliness during home visits with aging patients. The sessions would extend beyond appointment times because patients wanted someone to talk to; they sought meaningful connections in healthcare teams.

“The aging population potentially has more needs or different needs than other populations, and then, because of demographic shifts, marriage rates in our country, childlessness, people living longer and not having their life partner anymore and living alone, potentially, this population has less support, and so we need to tailor strategies for this group.”

His research, published in the Journals of Gerontology, found that one in four people aged 65 and older are socially isolated. That number increased by more than 30% during the COVID-19 pandemic. Research shows that isolation is also linked to a variety of adverse health conditions.

“People with poor social connections have increased levels of coronary heart disease, higher levels of stroke and dementia, depression and anxiety. Isolation doubles the odds that a person will require placement in a nursing home,” according to research Cudjoe co-authored and published in JAMA Internal Medicine.

Isolation also increases mortality by 30%.

“Consider going through one significant health issue like cancer and traveling that road alone,” he said. “That worsens a person’s health. We must modify their experience because if it persists, it’s not good for them and their health.” 

But dealing with social isolation isn’t just for doctors. Cudjoe referenced the Surgeon General’s report, which states we must all play a role in solving this epidemic.

He stressed the words of the Surgeon General: “‘Social connection is medicine,’ and we all have a role to play in that.”

He highlighted areas of the Surgeon General’s report, which calls for a strengthening of local infrastructures, improved public policies that promote connection, language around mobilizing the health sector, and building a culture of connection that exists beyond.

He also stressed the need for intergenerational connections.

“Lessons in resiliency can be learned from past generations, and it’s important that we develop strategies and interventions that are informed by these groups,” said Cudjoe.

Understanding the health consequences of loneliness

For 15 years, Lisa Jaremka, associate professor of psychological and brain sciences at UD CAS, has been researching loneliness and its effects on health.

She defined loneliness as a subjective feeling of disconnection event amidst social contact. She points to circumstances that might increase loneliness, such as moving to a new city or losing a spouse. But the COVID-19 pandemic fundamentally changed all our social worlds.

“We have pretty convincing data that shows loneliness increased during the pandemic,” she said. “Younger adults saw strong increases in loneliness and are now experiencing a loneliness crisis.”

Older adults are also seeing increased rates of loneliness.

“People need to feel loved, cared for, and connected to others; that need is fundamental to being human. We need to feel loved like we need air to breathe and food to eat.

Jaremka’s research shows lonelier adults are more likely to experience pain and depression. Her research also centers on whether loneliness alters immune function.”

“If true, that change in immune function might explain how you go from being lonely one day to potentially developing cardiovascular disease in the future,” she said.

In one study, Jaremka exposed participants to a psychological stressor to see how their immune systems reacted, specifically measuring inflammation.

“In all subjects, inflammation ramped up in response to the stressor—that’s normal. Stress is a very common dysregulator of immune function, but lonelier people had greater immune dysregulation.”

Jaremka believes immune dysregulation could be the mechanism that triggers a variety of adverse health outcomes linked to loneliness. 

To reduce feelings of loneliness, we must change how a person feels.

“We need to help them feel connected to other people, which is difficult,” explained Jaremka. “Simply being in the presence of other people may not be enough to create that feeling of connectedness.”

Consistent empirical evidence to suggest ways to alter that feeling doesn’t exist.

“There have been a lot of different interventions with inconclusive results,” said Jaremka. “What we know doesn’t work -- social skills interventions. We have compelling evidence that lonely people do not lack social skills; they are completely capable of having effective interpersonal interactions.”

Support groups could be one way to reduce loneliness, but not all are created equal.

“These groups provide opportunities for people to create meaningful social connections. But the data show some support groups effectively reduce loneliness while others do not – so the research is mixed,” Jaremka said. 

The 2024 Hayes Symposium concluded with a roundtable discussion moderated by Michael Smith, director of strategic initiatives for CHS. The panel included keynotes Cudjoe and Jaremka as well as Ashley Istenes, senior operations manager for population health at Bayhealth Medical Group; Elizabeth Orsega Smith, professor of health behavior and nutrition sciences in CHS; and Nancy Chipman, director of community outreach and assistive technology for Easterseals Delaware and Maryland’s Eastern Shore. The group discussed volunteering and additional community resources that could help ease the epidemic of loneliness in response to Hayes’ call to action.

“I hope everyone who attended the Hayes Symposium was inspired by new ideas and a desire to further our commitment to make a difference in our communities,” said Hayes.