Lonely, older adults are nearly twice as likely to use opioids to
ease pain and two-and-a-half times more likely to use sedatives and
anti-anxiety medications, putting themselves at risk for drug
dependency, impaired attention, falls and other accidents, and further
cognitive impairment, according to a study by researchers at UC San
The study found that just over half of 6,000
respondents in a nationally representative survey of seniors living
independently were not lonely, while 40% were moderately lonely,
and 7% were highly lonely.
The proportion of seniors in
each group who had prescriptions for opioids and anti-anxiety
medications and sedatives, which included drugs like Valium, Xanax,
BuSpar and Ambien, correlated with their degree of loneliness, according
to the study, which publishes in JAMA Internal Medicine on June 26, 2021.
a misconception that as we age, we become more withdrawn and less
sociable," said first author Ashwin Kotwal MD, of the UCSF Division of
Geriatrics and of the San Francisco VA Medical Center. "In fact, older
people are more socially active than other age groups and frequently
play major roles in their communities. When older people are not
socially active, we need to recognize that there's a problem."
researchers used data from the National Social Life, Health and Aging
Project, a population-based study of health and social factors, and
checked each participant's medications if they were used "on a regular
schedule, like every day or every week." The participants' average age
was 73; 46% were male, and 84% were white (7% were
Black and 6% were Hispanic).
The researchers found that 6% of the non-lonely group used prescription opioids, versus 8% for the moderately lonely group and 11% for the highly
lonely group. For anti-anxiety medications and sedatives - which
includes anti-cholinergic drugs, like Valium, Unisom and tricyclic
antidepressants, which have been associated with a higher risk for
dementia - 9% of the non-lonely group used them, versus 13% for the moderately lonely group and 23% for the highly
Similar patterns were found with antidepressants and
NSAIDs, prescription and over-the-counter painkillers that may cause
ulcers and bleeding in long-term use by older adults. The highly lonely
group was also more likely to be on 5 or more medications - 58% versus 46% for the non-lonely participants.
Replacing Prescriptions with Social Contact
advocates for fewer prescriptions of psychotropic drugs for older
adults who are lonely, and in its place "social prescribing" to local
resources in the community. This can be done by "link workers," based in
primary care practices or within the community, with connections to
amenities like senior centers, exercise classes, grief groups or
He notes that the pandemic has taken the
stigma out of loneliness, giving older adults an opportunity to discuss
their feelings in clinic. Asking patients what might help can be a good
first step to referring them to programs that might fit their needs.
don't want to pathologize loneliness. Most people experience loneliness
at some point in their lives, but when experiences of loneliness
persist for many months or years, it can cause physiologic changes, such
as a ramped-up stress response, sleep problems, and even heart
disease," said Kotwal. "And, a lack of social contact can erode our
social skills, making it more difficult over time to connect with others
and creating a vicious cycle."
De-Prescribing a Challenge for Patients in Distress
Although physicians are well aware of the dangers of prescribing medications
that should not be used in the long term, Kotwal noted that it "takes
time and effort to de-prescribe," and switching a drug that acts
promptly with one that may take several weeks to have an effect may be
very challenging to patients in distress.
In busy practices with
complex patients, contraindications may not come to light until a
patient is suddenly hospitalized, said Kotwal. "It's only then that we
might find out that a patient's prescriptions include Valium and he's
been taking it for more than 20 years."
A recent previous study,
also led by Kotwal, found that in the last 4 years of life, 19% experienced social isolation, 18% were lonely and 5% experienced both social isolation and loneliness. Factors
associated with loneliness included female gender, pain, incontinence, and cognitive impairment.
Source: News Release
University of California, San Francisco (UCSF)
July 26, 2021