There is a 45% increased risk of death in people who are lonely compared to not lonely, according to a UCSF study. (Photo: Getty Images)

Do you feel left out? Isolated? Or lack companionship? Answer ‘yes’ to any of these questions and you may be at risk for adverse health outcomes, says Carla Perissinotto, MD, an Assistant Clinical Professor at UCSF.

Perissinotto’s latest study, which found a link between loneliness and serious health problems among the elderly, was the main topic of Wednesday’s Forum with Michael Krasny.

The study, published this week in the Archives of Internal Medicine, followed over 1,600 elderly individuals for six years. These individuals completed surveys that measured whether they felt left out, isolated, or lacked companionship — all of which are components of loneliness.

“We demonstrated that [loneliness] is also a risk factor for poor health outcomes, including death and multiple measures of functional decline,” said Perissinotto. “[There is a] 45 percent increased risk of death in people who are lonely compared to not lonely.”

Perissinotto says medical professionals also need to put more emphasis on the role of psychosocial distress on health. “We cannot continue to ignore the psychosocial distress that our patients are experiencing,” Perissinotto said. “It is, in fact, just as important as traditional medical risk factors.”

According to Perissinotto, medical schools currently emphasize the role of traditional medical risk factors such high blood pressure, cholesterol and obesity and pay less attention to factors such as social support and loneliness. “There needs to be a slight shift where we don’t ignore the traditional medical risk factors but we also incorporate things like loneliness into the general assessment of our patients,” Perissinotto urged.

On a positive note, Perissinotto does acknowledge the existence of health care programs that currently screen for loneliness among patients such as the Bay Area’s Institute on Aging. The institute’s Friendship Line is a phone service that reaches out to elderly individuals and offers a variety of services, including emotional support.

Karyn Skultety, the Director of Clinical and Community Services at the Institute on Aging and another guest on KQED’s Forum, cautions the idea of relying on screens alone. Screens are useful and helpful but should not replace the ability to ask clients questions, she said. “Nothing substitutes real good conversations with someone.”

The two guests also clarified a common misconception over the definition of loneliness itself. “Loneliness is the subjective feeling of isolation, not belonging, or lacking companionship,” said Perissinotto. About two-thirds of her study’s participants who were classified as lonely were married or living with a partner. Skultety added that loneliness is not based on the quantity of friendships, but on the quality and type of friendships.

Skultety added that society does not view careers involving care for the elderly as rewarding. She said  this viewpoint is responsible for the current shortage of medical professionals available to work with older adults. “We haven’t done enough in terms of our spending and choices in our health care system,” she said.

“In our medical schools across the country, geriatrics education is not a focal point. It is not viewed as important,” Perissinotto added. “It is a huge detriment to our future physicians and adults in this country and abroad.”

(Adrian Clark: Flickr)

Back in the days when modern medicine started, around the turn of the 20th century, the practice of medicine was roughly divided into  thirds: diagnosis, treatment and prognosis.

That’s what Alexander Smith, palliative care expert at the San Francisco VA Hospital, told me in an interview. He attributed the approach to the illustrious William Osler, one of the founding professors of Johns Hopkins Hospital, back in the late 19th century.

But things have changed since Dr. Osler ruled in Baltimore. “Prognosis has really waned,” Smith says. “Now in textbooks, there’s just a few lines. The focus is on diagnosis and treatment.”

Smith and a handful of colleagues are trying to refocus doctors and other clinicians on prognosis in older patients. But it looks like he has a long way to go. In today’s Journal of the American Medical Association, Smith and his colleagues assess the efficacy of 16 different ways to measure prognosis. Unfortunately, the authors find that all of them are lacking in one way or another. Failure to consider prognosis is a problem, they argue, because it can lead to poor care.

“Prognosis is a critically important piece of information for decision-making in the elderly,” Smith said. “For most preventive measures, the harms occur up front, but the benefits don’t accrue for years.”

One case in point is the colonoscopy. “There’s an immediate risk of intestinal perforation. It sounds awful and it is. While uncommon, it’s horrific when it happens.” While colonoscopies are great at finding very early colon cancers, that’s what they are, very early. This is where overall prognosis comes in. As people get older, their likelihood of dying with and not of a particular cancer goes up, so why subject patients to screening tests?

This isn’t a question just of a patient’s age, which is what doctors call a “blunt instrument.” A better way to measure prognosis, Smith said, would be to add in other factors, “like what other medical conditions a patient has, what functional status a patient has, like walking, bathing, calculating checkbooks, what cognitive impairment they have.”

Smith and his colleagues have taken the 16 current imperfect tools that measure prognosis and put them together in a new website, www.eprognosis.org, specifically for doctors and other health care workers. The goal is for doctors to use the individual tools and then rate them on usefulness. But doctors should use the information as one tool, in combination with discussions with patients and their patients’ preferences.

Still, Smith stressed that doctors tend to be optimistic when estimating prognosis, and the better they know the patient, the more optimistic they become.

“If a patient has the information, then patients and doctors are more likely to make choices that are sensible. They are less likely to pursue tests and treatments that are likely to be harmful and they can shift priorities to other things like maintaining mobility and independence.”