The silent epidemic of loneliness

Across Canada and around the world, we are only beginning to recognize the adverse health impacts of loneliness. A growing body of research has linked loneliness to an increased risk of depression, anxiety, cognitive decline, cardiovascular disease, hypertension and even premature death. Health care professionals estimate the increased risk of death from this condition is similar to smoking 15 cigarettes a day or living with an alcohol use disorder. Loneliness is undeniably a health care issue, although it has not been seen that way until very recently. 

Rates of loneliness have also been growing in recent decades. According to the U.S. Surgeon General Vivek Murthy, rates of loneliness have doubled since the 1980s. While loneliness in Canada cuts across ages and demographics, the most recent estimates from the National Institutes on Aging suggest that up to 58 per cent of adults over 50 have experienced loneliness.  

The urgency and consequences of this widespread condition make it clear: addressing our epidemic of loneliness must be a public health priority. 

Several countries and international organizations have already taken a lead in this movement. The United Kingdom appointed a minister of loneliness in 2018, while the World Health Organization recently established a Commission on Social Connection, calling high-quality social relationships “essential to our mental and physical health and our well-being.”  

In Canada, by contrast, we lack a national strategy, despite convincing appeals from advocates such as the Women’s Age Lab and GenWell. Although such a breakthrough may take time to accomplish, we can start now by changing how we educate new health care professionals. 

In their practices, clinicians see first-hand the impact of loneliness on older adults. However, without adequate training loneliness can be a challenging issue for healthcare professionals to recognize, understand and address. Loneliness is more than just a fleeting emotion. It can be defined as the subjective feeling that our social relationships are lacking compared with what we want them to be. It is a complex, multi-faceted and deeply personal issue connected to other social determinants of health, previously thought to be outside the scope of health care. Despite familiarity with the evidence of the negative health effects of loneliness, health care professionals often struggle with how best to help. This is exacerbated by social stigma surrounding loneliness that can make it feel awkward to discuss it without sufficient clinical experience. 

The Canadian Coalition for Seniors’ Mental Health published the first-ever clinical practice guidelines on social isolation and loneliness in older adults in February 2024. These guidelines synthesize research evidence into 17 practical recommendations that health care providers can use. The guide provides a strong foundation for health care students to begin their engagement with this critical problem among one of the groups most impacted by it. The recommendations, which may be helpful for younger people as well, include targeted screening and a comprehensive assessment followed by potential interventions including social prescribing, psychological therapies, physical activity, animal-assisted therapies, leisure activities and optimal use of technology.  

While health care providers are focused on diagnosing and treating medical conditions, they are also well-positioned to recognize and address underlying social and emotional aspects of their patients’ lives. For example, clinicians may perform periodic assessments at regular appointments that allow them to monitor their patients’ social health and adjust their recommendations as needs and circumstances change. The limited extent of training related to loneliness can impact health care professionals’ confidence and expertise. For instance, a lack of knowledge about the most appropriate tools for screening (and how to interpret results) can lead to a hesitancy to even raise the subject.  

We must heed calls from the National Academics of Science, Engineering and Medicine, the U.S. Surgeon General, and countless others to empower new health care professionals to integrate practical knowledge for preventing, recognizing and addressing loneliness. Entire health care teams, from nurses to health care assistants, physicians and allied health professionals, should be prepared to tackle loneliness head-on. 

We need all hands on deck to make this a reality. Instructors, department heads and credentialing bodies alike must work together to ensure that best practices for the prevention, assessment and treatment of loneliness are systematically included in health care curriculum and graduate competencies. Educators should create and share open education teaching resources that enable others to more easily integrate this topic into their courses. 

We believe it is our responsibility as educators to train the next generation of health care professionals to confidently address the epidemic of loneliness. Together, we can untangle loneliness and weave connection across our many diverse communities.  
 

For more information about the Canadian Coalition for Seniors’ Mental Health or to join its efforts as champions and partners, please email so***************@cc***.ca.