SOCIAL ISOLATION OF THE ELDERLY AND REDUCED BRAIN VOLUME

After the age of 60, there is usually a period of important changes in the life of the elderly.

Creation — Jane Portela

There are many occurrences in the lives of people in this age group and they often happen at the same time. Physical changes, physical limitations, reduced independence, illness, retirement, and loss of loved ones (widowhood, for example) are some of them.

At this stage of life, the feeling of loneliness emerges and even becomes quite acute.

The recent pandemic imposed mandatory social distancing for this group of people, considering the high risk of contagion and worsening of COVID-19 symptoms and determining social distancing was considered the best strategy to protect these elderly people.

However, loneliness in old age was already a clear problem even before the new coronavirus pandemic.

And what causes loneliness in old age?

In older age groups, according to publications by researchers at the University of Chicago, social isolation can increase the risk of death by 14%. Loneliness can generate a situation of high stress capable of reducing the production of leukocytes with a decrease in the body’s defense to fight infections. Thus, the social isolation of the elderly can contribute to the reduction of their immune response.

There is no doubt that frequent access to news or untrue information can aggravate the stress of these elderly people by triggering repeated situations of anxiety.

Loneliness and social isolation can increase the risk of heart disease by 29% and stroke by up to 32%, according to a study conducted by researchers at the University of York. The increase in blood pressure and cholesterol levels, the decrease in cognitive capacity, and the worsening of depressive conditions can be enhanced by social isolation and loneliness. These conditions may also be accompanied by loss of appetite and sleep disturbances.

Now, a new publication (Neurology, July 12, 2023) has emphasized that social isolation in older individuals would be associated with reduced brain volume in regions associated with memory. On the other hand, the association between social isolation and reduced brain volume could be, at least in part, mediated by depressive symptoms.

Researcher Toshiharu Ninomiya, MD, Ph.D., professor of epidemiology and public health at Kyushu University in Fukuoka, Japan, suggests that efforts should be made to reduce the social isolation of the elderly.

It is noteworthy that there are several studies indicating that social interaction is beneficial in preventing cognitive decline and the onset of dementia. And, in contrast, recent epidemiological studies have shown that social isolation is associated with a risk of cognitive decline and dementia.

Is there a correlation between these two topics: cognitive decline and dementia?

Some studies have already shown that social isolation is related to depressive symptoms in older adults, and late-life depression has been associated with brain atrophy.

To investigate the possible correlation between social isolation and brain atrophy, as well as the role of depression as a potential mediator, nearly 9,000 citizens aged 65 years or older were included in a national cohort study on dementia (Japan Prospective Studies Collaboration for Aging and Dementia (JPSC-AD)).

Participants in this study were recruited from eight research sites in Japan, and each had an initial MRI between 2016 and 2018 (those diagnosed with dementia at baseline were excluded). The frequency of social contact was categorized as every day, several times a week, several times a month, or rarely.

Study participants also answered questions about medical history and treatment, antihypertensive or antidiabetic medications, exercise, current alcohol consumption, and smoking habits. Fifty-seven percent (57%) of the participants were women and the mean age was 73 years.

Total brain volume was smaller in those with a lower frequency of social contact versus those with a higher frequency (67.3% vs. 67.8%). Less social contact was also associated with smaller volumes of several areas of the brain: temporal lobe, occipital lobe, cingulate, hippocampus, and amygdala.

White matter lesion volume increased with fewer social interactions, from 0.26% in the most social group to 0.30% in the minimal contact group.

Cognitive function was higher in participants who had daily social contact compared to those who had less contact (28 vs 27 in the Mini-Mental State Examination; P < 0.001). Scores between 25 and 30 are considered normal.

Depressive symptoms were lower in the daily contact group compared with the infrequent contact group (P < 0.001). Mediation analyses indicated that depressive symptoms could represent only 15%-29% of the observed associations.

Results also showed that socially isolated participants were more likely to have diabetes and high blood pressure, and were more likely to smoke and be physically inactive.

Researcher Ninomiya commented that “the detailed mechanism of the relationship between social isolation and brain volume is still unclear.” That investigator added that more research is needed to see if the findings would apply to people in other countries.

At the same time, Alexa Walter, Ph.D., and Danielle Sandsmark, MD, Ph.D., of the University of Pennsylvania, Philadelphia, noted that isolation has been linked to many adverse health outcomes, including increased risk of heart disease, stroke, and premature death. These researchers stressed that “Given these findings, future work considering social health factors in the context of neurological diseases is an important area of ​​research to consider. Furthermore, other existing longitudinal studies may allow us to better understand these relationships within populations and inform public policies to address these issues”.

Until then, we can remember that “isolation does not have to be the same as a state of loneliness”.

Many seniors, by choice or not, live alone but can be connected by their family and friends, without changing their daily routines. Social interaction can persist through contact via phone calls or video calls. This can help this age group.

Many studies emphasize the importance of face-to-face contact, which is the primary path to a positive intervention in isolation.

We can conclude that “isolation, regardless of other factors, is capable of negatively influencing health outcomes, satisfaction, and well-being”.

We need to keep in mind that social isolation is potentially preventable.

The expansion of the role and social function of the elderly needs to be reassessed. Elderly people need to be included in the dynamics of cities.

Ageism is still a reality today. Discriminatory practices carried out against a person based on their age need to be fought.

References

• HIRABAYASHI N et al — Neurology, July 12, 2023
• WALTER AE; SANDSMARK D — Neurology, July 12, 2023
• BOCK MA et al — Neurology, October 14, 2020
• BEZERRA PA et al — Acta Paul Enferm 2021, 34: eAPE02661
• BENDER E — Medscape July 25, 2023