(Press-News.org) 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 Francisco.
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 percent were moderately lonely, and 7 percent 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.
"There's a misconception that as we age, we become more withdrawn and less sociable," said first author Ashwin Kotwal, MD, of the UCSF Division of Geriatrics and of the San Francisco VA Medical Center.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."
The 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 percent were male, and 84 percent were white (7 percent were Black and 6 percent were Hispanic).
The researchers found that 6 percent of the non-lonely group used prescription opioids, versus 8 percent for the moderately lonely group and 11 percent 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 percent of the non-lonely group used them, versus 13 percent for the moderately lonely group and 23 percent for the highly lonely group.
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 five or more medications - 58 percent versus 46 percent for the non-lonely participants.
Replacing Prescriptions with Social Contact
Kotwal 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 volunteer programs.
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.
"We 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
While 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 four years of life, 19 percent experienced social isolation, 18 percent were lonely and 5 percent experienced both social isolation and loneliness. Factors associated with loneliness included female gender, pain, incontinence and cognitive impairment.
The paper's senior author is Alexander K. Smith, MD, of UCSF and San Francisco VA Medical Center. Co-authors are Michael Steinman, MD, also of UCSF and San Francisco VA Medical Center, and Irena Cenzer, PhD, of UCSF.
For information on funding, please refer to the journal. The authors have no conflicts of interest to disclose.
About UCSF: The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as UCSF's primary academic medical center, includes top-ranked specialty hospitals and other clinical programs, and has affiliations throughout the Bay Area. UCSF School of Medicine also has a regional campus in Fresno. Learn more at ucsf.edu, or see our Fact Sheet.
Researchers from the Institute of Process Engineering (IPE) of the Chinese Academy of Sciences, Beijing Chaoyang Hospital and the University of Queensland have developed a new formulation based on regulatory T-cell exosomes (rEXS) to deliver vascular endothelial growth factor (VEGF) antibodies for choroidal neovascularization therapy.
The study was published in Nature Biomedical Engineering on July 26.
Ocular neovascularization is often associated with age-related macular degeneration, diabetic retinopathy and other ocular diseases, which can cause severe vision loss.
The present treatment for ocular neovascular disease in clinic is intravitreal injection of VEGF antibodies (aV) to block the activity of VEGF ...
BOSTON - In a multi-hospital analysis of individuals who experienced an allergic reaction to their first mRNA COVID-19 vaccine dose, all patients who went on to receive a second dose tolerated it without complications. The research, which was led by allergists at Massachusetts General Hospital (MGH) and is published in JAMA Internal Medicine, indicates that a first dose reaction to COVID-19 vaccination should not keep people from getting a second dose.
Allergic reactions after mRNA COVID-19 vaccinations have been reported to be as high as 2%, with anaphylaxis--a life-threatening whole-body allergic reaction--occurring in up to 2.5 per 10,000 people. ...
Plants, including crops such as rice and wheat, obtain their essential mineral nutrients and water through their roots, making them an important interface between plants and the soil environment. The roots of land plants associate with a wide range of microbes - including bacteria - that are recruited from the surrounding soil and assemble into structured communities known as the root microbiota. These microbial communities are sustained by the plant host, which provides them with nutrients, primarily in the form of organic carbon compounds secreted by the root. In turn, these commensal bacteria mediate multiple processes ...
New York, NY (July 26, 2021) - Researchers have identified a rare class of genetic differences transmitted from parents without autism to their affected children with autism and determined that they are most prominent in "multiplex" families with more than one family member on the spectrum. These findings are reported in Recent ultra-rare inherited variants implicate new autism candidate risk genes, END ...
Bethesda, MD (July 26, 2021) -- There is an urgent need to develop and implement effective screening, diagnosis and treatment strategies for patients with nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), common liver conditions with a rising burden in the U.S. and globally. This is particularly important for the most at-risk patients, those with diabetes and obesity.
As a critical first step, the American Gastroenterological Association (AGA) -- in collaboration with seven professional associations -- convened an international conference of 32 experts to develop a multidisciplinary action plan to improve care for the growing population of patients with NAFLD ...
How do you study a group of organisms with over 300,000 species, dispersed across all seven continents, and with up to 50 times as much DNA content as the human genome?
This is the question posed to biologists studying the evolutionary history of flowering plants, called angiosperms, whose rapid diversification was so convoluted a problem that Darwin referred to it as the 'abominable mystery.'
This month, both the American Journal of Botany (AJB) and Applications in Plant Sciences (APPS) are devoting their July issues to what has recently become a turning point in the way scientists study the relationships among flowering plants. Dubbed Angiosperms353, the initiative combines ...
DENVER, JULY 26, 2021 -- Improving air quality may improve cognitive function and reduce dementia risk, according to several studies reported today at the END ...
The Covid-19 pandemic and the politicization of health-prevention measures such as vaccination and mask-wearing have highlighted the need for people to accept and trust science.
But trusting science isn't enough.
A new study finds that people who trust science are more likely to believe and disseminate false claims containing scientific references than people who do not trust science. Reminding people of the value of critical evaluation reduces belief in false claims, but reminding them of the value of trusting science does not.
"We conclude that ...
DALLAS, July 26, 2021 -- People who are just beginning treatment for high blood pressure can benefit equally from two different classes of medicine - angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) - yet ARBs may be less likely to cause medication side effects, according to an analysis of real-world data published today in Hypertension, an American Heart Association journal.
While the class of blood pressure-lowering medicines called angiotensin-converting enzyme (ACE) inhibitors may be prescribed more commonly, angiotensin receptor blockers (ARBs) work just as well and may cause fewer side effects. Currently, ACE inhibitors are prescribed more commonly than ARBs as a first-time blood pressure ...
DALLAS, July 26, 2021 -- Genomic studies have produced advances in how to calculate and reduce heart-disease risk, however, the benefits don't necessarily apply to people from historically marginalized racial and ethnic groups and Indigenous populations. Efforts must be made to eliminate barriers to increase their participation in genomic research, according to a new scientific statement from the American Heart Association, published today in the Association's journal Circulation: Genomic and Precision Medicine.
"Profound breakthroughs in genetic and genomic science are rapidly improving our ability to prevent, detect and treat cardiovascular ...