Loneliness & a Small Social Network Predicts Mortality in Elderly

[Dean Pomerleau]

All,

 

Loneliness and social support are things we don't talk about much around here and (speaking for myself) are things we may not pay enough attention to in general, both for their direct impact on quality of life (i.e. social engagements are an important part of what makes life worth living for many people), and for their instrumental benefits (i.e. loneliness and one's social network size seem to have a pretty dramatic impact on longevity).

 

Regarding this second, instrumental benefit of a strong social network on longevity, I found that there are several recent studies similar to [1]. It followed 600 men and women who were 70+ at baseline for 18 years, measuring at several time points their self-reported loneliness (i.e. how frequently a person feels lonely) and their social network, which was characterized as follows:

 

ocial networks were measured by using four separate indicators including: marital status (married = 1,

unmarried = 0), number of children, contact frequency with children and with

friends, with scores ranging from 0 (do not meet at all) to 4 (almost everyday),

and household size (number of people residing with the respondent).

 

What they found regarding self-reported loneliness was:

 

Mortality was higher among lonely men compared to those who were not lonely (46.9% and

34.3%, respectively) and among lonely women (58% and 48.4%, respectively).

 

Here are the four survival curves for lonely/not-lonely men/women over the 18 years of followup from the full text:

 

 

As you can see, women outlived men (no surprise) and both lonely men and women died significantly sooner than their not-lonely peers. Regarding the impact of one's social network on mortality, they found:

 

[T]he variables that were found to significantly predict mortality among men were

health status (self-rated health and co-morbidity), functional status (ADL), and

social variables (marital status and size of household), suggesting that mortality

was higher among those who were in poorer health and impaired functional

status, were unmarried, and lived in smaller households. Among women only

economic status was found to significantly predict mortality, suggesting that

mortality was higher among poorer women.

 

In short, for men in particular, a feeling of loneliness, being unmarried and living alone appear to be predictors of early mortality. These results raise two questions in my mind:

 

      1) How and to what extent does the practice of CR impact one's social network and feeling of loneliness?

 

Given that some of us eat strict and unusual diets, and eat at unusual times/intervals, it seems pretty plausible that this could (and in fact does, in my case) serve to isolate us to some degree from family and friends, who typically don't follow the same dietary habits. Eating together serves such an important social function in all cultures, it would seem almost inevitable that eating differently will impact one's relationship with others. Such an increase in social isolation could lead to loneliness, and the possibility of increased mortality - perhaps even negating the longevity benefits of CR. On the flip side, I'm pretty convinced from personal experience that CR can contribute to increased psychological resilience and a sense of well-being, which could counterbalance the negative influence of increased social isolation and reduce one's sense of loneliness.

 

      2) To what extent can 'virtual' social networks, like connecting with other CR practitioners on this forum, make up for lack of direct social contact and reduce feelings of loneliness. 

 

Over the years I've found engaging with other folks from the CR Society through these forums and before that the CR mailing list, to be quite psychologically rewarding, producing a feeling of camaraderie,social connectedness, and a sense of being helpful to others, that would seem to me to be potentially beneficial substitute for direct face-to-face social connects. But I've never really been a very social person (e.g. I've always felt uncomfortable at parties), and so may be somewhat biased in this regard.

 

I'd be interested in engaging with others on this topic   and hearing what you think the net impact CR has had on your social network and feelings of loneliness vs. connectedness.

 

--Dean

 

Note: I debated whether to post this to "General Health & Longevity" or "CR Practice". I'm starting it in General Health & Longevity, since in general loneliness had nothing directly to do with CR. But I'm hoping others will engage in a discussion of how CR impacts one's social life and feeling of loneliness, in which case I'll move the thread to "CR Practice".

 

-----------

[1] Int J Aging Hum Dev. 2011;72(3):243-63.

Loneliness, social networks, and mortality: 18 years of follow-up.

Iecovich E(1), Jacobs JM, Stessman J.

Full Text via Sci-hub.io: http://ahd.sagepub.com.sci-hub.io/content/72/3/243.short

We examined the influence of changes in loneliness and social support networks
upon mortality during 18 years of follow-up among an elderly cohort and
determined the gender-specific nature of this relationship. The study is based on
data collected from the Jerusalem Longitudinal Study (1990-2008), which has
followed a representative sample of 605 community-dwelling elderly people.
Subjects were randomly selected from an age homogenous cohort born 1920-1921 and
were aged 70, 78, and 85 when data were collected at baseline in 1990 and at
follow-up in 1998 and 2005. All-cause mortality from age 70-88 was determined
according to the National Death Registry. Sense of loneliness was found to be
stable among the majority of the respondents. Loneliness among men was found in
bivariate analyses to be a risk factor for mortality. Although multivariate
analyses found that loneliness was not a significant predictor of mortality,
nonetheless several social network factors (marital status at the baseline and
living arrangements) were found to predict mortality among men. Loneliness and
solitude among elderly men can be a risk factor of mortality. The findings imply
that attention should be given to this high risk group.

PMID: 21834390

 

 

 

 

[gracezw]

Dean, I am very interested in this topic. Thank you for all your thoughts and information. I have learned a lot.

I am a new member. There have been good amount of social connections for me after separating food from the events. I regularly meet people for reasons other than foods. Taking a walk, jogging at the track, going to volunteer at a local educational farm, going to organized, docent-led hikes, going to a zen meditation center, sitting and chatting in my friends’ living rooms while politely turning down food offerings, and etc.

I have been doing my best to meet friends at healthy eating places including whole foods and salad bar restaurants.

[gracezw]

Also, I posted about looking for other local members to meet. I haven’t gotten any reply yet. I live in San Jose area, California.

[Dean Pomerleau]

Hi Grace! I've been following your discussion with Brian over on the chitchat forum.  Let me take the opportunity to welcome you to the CR forums!

 

I too try to center social my social interactions around activities other than food, but food is so central to socialization in our culture that it isn't always easy. I'm sorry you haven't gotten connected with others practicing CR in your area. Unfortunately CR practitioners (as opposed to just healthy eaters or people dieting for weight loss) are relatively few and far between. I don't personally know of any around San Jose, but given the prevalence of engineers in that area, I wouldn't be surprised if there are some  . I'm from near Pittsburgh.

 

If you haven't noticed yet, we've got a conference coming up this spring in Tucson. That would be a good opportunity to meet CR folks in person. But in the meantime these forums and the CR Society Facebook Group are you best bets for connecting with other folks practicing CR.

 

If you have any specific questions, feel free to post them to the appropriate forum here!

 

--Dean

[gracezw]

Dean, thanks a lot for your kind words! I really appreciate them!

I am scheduled for doing my workout. This is a quick post. I will say more later.

I guess the study in your post is on people who eat a normal, high calorie diet. Being social helps them live longer compared with other people who eat the same diet.

I don’t have a study to show you. But from what I know, Taoist and Buddhist monks who eat mostly plant-based diet and  spend most or much of time in solitude or in meditation live long lives.

[Dean Pomerleau]

Grace,

 

But from what I know, Taoist and Buddhist monks who eat mostly plant-based diet and  spend most or much of time in solitude or in meditation live long lives.

 

Monks living a long time wouldn't surprise me, but they generally enjoy a rich social network (the Sangha as the Buddhists call it), and while some of them restrict calories, many eat a normal (sometimes pretty crappy) diet composed of alms given them by laypeople. At least the Buddhists monks make it a practice of being grateful for and eating whatever they are given. So it doesn't seem like they are generally a very good model for what we practice!

 

--Dean

[Sthira]

I think there's a distinction between solitude and loneliness. I love being alone -- solitary -- much of the time, and often feel loneliest with other people. I don't understand the science indicating people live shorter lives if they're not part of a "rich social network." Entangled in a rich social network sounds lonely to me. I mean, it's not that dislike people. I love people! But I'm an introvert, and I'd rather just be by myself in a quiet corner, happy. People and maintaining relationships require a lot of work, and time and energy and the dizzy drama ups and the drama downs. Some people are totally cool and awesome, but everyone I know is so busy with work, school, family, and all of us are completely captivated by our gadgets.

 

Being alone is fun. I do what I want, when I want, and no one cares if I'm on CR or not, no one cares if I'm vegan or not, no one cares about what I eat or when. Eating meals with others has rarely if ever felt like a bonding social experience for me. Rather, eating meals with others mostly feels awkward and uncomfortable.

 

Of course sometimes I get very lonely just by myself -- so when those moments strike, then I go get surrounded by people to remind myself why I enjoy solitude. Sometimes when alone I yearn to be in a great relationship; then, once in a great relationship, I find myself yearning for solitude. Haha -- the human condition is so damned tricky!

 

Some of my married friends confide to me that they're very lonely, despite their beautiful marriages, families, their bursting social networks.

 

"If you are afraid of loneliness, do not marry."

Anton Chekhov

[Dean Pomerleau]

All,

 

I found an even better meta-analysis [1] than I discussed above (which was just a single study) of the link between social relationships and mortality. It found:

 

Across 148 studies (308,849 participants), the random effects weighted

average effect size was OR = 1.50 (95% CI 1.42 to 1.59), indicating a 50%

increased likelihood of survival for participants with stronger social

relationships.

 

That seems like a pretty strong effect, to put it mildly. To illustrate its magnitude, the authors made this handy chart comparing the percentage mortality decrease associated with engaging in various health-promoting activities, including the first three which are measures of social relationships:

 

 

 

As you can see, according to their data, the benefits of cultivating strong relationships are right up there with quitting smoking, and double that of exercise and avoiding obesity.

 

So are we introverts doomed?!

 

On that note Sthira wrote:

 

I think there's a distinction between solitude and loneliness. I love being alone -- solitary -- much of the time, and often feel loneliest with other people. I don't understand the science indicating people live shorter lives if they're not part of a "rich social network."

 

Very well said. I agree that one can be alone but not lonely. Some people seem to need frequent social interactions to feel happy and fulfilled, while other, more introverted folks find happiness in other things, and can be uncomfortable with too much social engagement / interaction.

 

I think CR, by making one more emotionally resilient, and at the same time requiring a degree of discipline that few others exhibit, may encourage a degree of independence that makes a solitary lifestyle more enjoyable and appealing. Or perhaps its just that CR attracts free and independent thinkers, character traits that correlate with being introverted, self-reliant and self-reflective (self-absorbed?!).

 

That, coupled with the psychopharmacological effects of CR, such as increased dopamine release/sensitivity, may make simple, solitary activities more rewarding for CR folks than they do for the general public.

 

Having read further, I think the best interpretation of the literature on the link between social networks, loneliness and mortality is the following.

 

First, a significant part of the effect may result from reverse causality. People who are sick and more likely to die are likely to be less gregarious, and so naturally have a smaller social network, rather than the other way around.

 

But beyond that, there appear to be two causal pathways from a sparse social network to mortality. The first is the pragmatic support pathway. If someone has few financial resources and lives in a country without a strong socioeconomic safety net (like the US), than having a sparse social network can lead to increased mortality because without friends and family, there will be nobody to assist you when/if you become sick or disabled. The second is the loneliness pathway - for certain personality types, having a sparse social network will lead to loneliness, which in turn results in anxiety and depression, which lead directly to unhealthy physiological responses (e.g. high blood pressure, inflammation, suppressed immune system), as well as less diligent self-care (e.g. sedentary lifestyle, eating badly, substance abuse etc.), all of which will increase one's risk of dying.

 

But if one has a small but supportive social network, or the money to buy assistance when it becomes necessary, one can avoid the negative effects of a sparse social network via the first pathway. And if one has a resilient, self-reliant, introverted personality, the solitude of a sparse social network won't lead to loneliness, and so the negative cascade of the second pathway won't get off the ground.

 

So as introverts we aren't doomed to an early death, despite all the hype we see in the media about the correlation between strong social relationships and health/longevity.

 

--Dean

 

--------

[1] PLoS Med. 2010 Jul 27;7(7):e1000316. doi: 10.1371/journal.pmed.1000316.

 

Social relationships and mortality risk: a meta-analytic review.

 

Holt-Lunstad J(1), Smith TB, Layton JB.

 

Author information: 

(1)Department of Psychology, Brigham Young University, Provo, Utah, United States

of America. julianne_holt-lunstad@byu.edu

 

BACKGROUND: The quality and quantity of individuals' social relationships has

been linked not only to mental health but also to both morbidity and mortality.

OBJECTIVES: This meta-analytic review was conducted to determine the extent to

which social relationships influence risk for mortality, which aspects of social 

relationships are most highly predictive, and which factors may moderate the

risk.

DATA EXTRACTION: Data were extracted on several participant characteristics,

including cause of mortality, initial health status, and pre-existing health

conditions, as well as on study characteristics, including length of follow-up

and type of assessment of social relationships.

RESULTS: Across 148 studies (308,849 participants), the random effects weighted

average effect size was OR = 1.50 (95% CI 1.42 to 1.59), indicating a 50%

increased likelihood of survival for participants with stronger social

relationships. This finding remained consistent across age, sex, initial health

status, cause of death, and follow-up period. Significant differences were found 

across the type of social measurement evaluated (p<0.001); the association was

strongest for complex measures of social integration (OR = 1.91; 95% CI 1.63 to

2.23) and lowest for binary indicators of residential status (living alone versus

with others) (OR = 1.19; 95% CI 0.99 to 1.44).

CONCLUSIONS: The influence of social relationships on risk for mortality is

comparable with well-established risk factors for mortality. Please see later in 

the article for the Editors' Summary.

 

PMCID: PMC2910600

PMID: 20668659

[gracezw]

Hi Sthira, thank you for your post. It is really nice to get to know you!

I agree too that one can be alone but not lonely.

I visit two Zen meditation centers in my area. I visit one of them once a week to hang out with people. The Zen master asks his followers to devote 2 to 3 hours everyday on sitting and walking meditation while trying the best to eat vegan foods for better health. I ignore much of the master’s rules because they are arbitrary and not science based. But I like his idea of cultivating the constant state of calmness and focusing on doing all the right things for health.

I used to eat their free vegan lunches, but I don’t now, because they have too many calories.

I visit another Zen meditation center, just for their free vegan lunches, once every two weeks. It is located close to the Costco that I go to. Their lunches have a lot more choices while mostly separating greens and low calorie veggies from other high calorie plants. I really don’t care that much about sitting and meditating for a long time. I like the idea of moving meditation.

I am interested in going to the conference at Tucson. When will the details of the schedule come up? It is OK to be in T-shirts all the time?

My husband is a software engineer. He calls himself a science geek, but anti-aging science is really new to him.

[Dean Pomerleau]

One more, much newer and even better meta-analysis [1] of social isolation, loneliness and mortality by the same authors as the 2010 meta-analysis discussed above (PMID: 20668659) one thanks to Al Pater. In this study, they looked at a much larger set of studies and focused on the opposite side of the spectrum from their previous study - that is, rather than looking at the benefits of a large social network relative to average, they focused on the negative mortality implications of having a smaller social network (or increased loneliness) relative to average. Here is a good summary of what they found from the full text:

 

Cumulative data from 70 independent prospective studies, with

3,407,134 participants followed for an average of 7 years,

revealed a significant effect of social isolation, loneliness,

and living alone on odds of mortality. After accounting

for multiple covariates, the increased likelihood of death

was 26% for reported loneliness, 29% for social isolation,

and 32% for living alone. These data indicated essentially

no difference between objective and subjective measures

of social isolation when predicting mortality.

 

In other words, whether you actual are socially isolated (e.g. living alone), or just feel socially isolated (i.e. lonely), you're about 30% more likely to die during any given time period. 

 

One thing I found interesting in this one that wasn't in the previous meta-analysis:

 

Middle-age adults were at greater risk [my emphasis] of mortality when

lonely or living alone than when older adults experienced

those same circumstances.

 

The authors speculate about four possible reasons for this counterintuitive finding that loneliness when young is worse than when older: 

1. Survivor bias - "individuals who do not die early may be a particularly resilient group, with different social or health characteristics than those who die at earlier ages. "
2. It's "natural" for older, retired people to be less socially connected, and so less stigmatized and likely to result in depression etc.
3. Individuals who are alone or lonely before retirement age may be more likely to engage in risky health behaviors or less likely to seek medical treatment early.
4. it is possible that the different results across participant age are confounded with marital status: Older adults are much more likely to be widows/widowers than middle-age adults.

Overall this study seems to reinforce the previous analysis, but as far as I can tell it doesn't invalid the idea that if someone has enough of a social support system to assist them if they become sick or disabled, and doesn't feel lonely even if relatively socially isolated, than their mortality is unlikely to be elevated, despite what these studies say.

 

--Dean

 

-------------

[1] Perspect Psychol Sci. 2015 Mar;10(2):227-37. doi: 10.1177/1745691614568352.

 

Loneliness and social isolation as risk factors for mortality: a meta-analytic review.

 

Holt-Lunstad J1, Smith TB2, Baker M3, Harris T3, Stephenson D3.

 

PMID: 25910392

 

Full text via sci-hub.io: http://pps.sagepub.com.sci-hub.io/content/10/2/227.short

 

Abstract

 

Actual and perceived social isolation are both associated with increased risk for early mortality. In this meta-analytic review, our objective is to establish the overall and relative magnitude of social isolation and loneliness and to examine possible moderators. We conducted a literature search of studies (January 1980 to February 2014) using MEDLINE, CINAHL, PsycINFO, Social Work Abstracts, and Google Scholar. The included studies provided quantitative data on mortality as affected by loneliness, social isolation, or living alone. Across studies in which several possible confounds were statistically controlled for, the weighted average effect sizes were as follows: social isolation odds ratio (OR) = 1.29, loneliness OR = 1.26, and living alone OR = 1.32, corresponding to an average of 29%, 26%, and 32% increased likelihood of mortality, respectively. We found no differences between measures of objective and subjective social isolation. Results remain consistent across gender, length of follow-up, and world region, but initial health status has an influence on the findings. Results also differ across participant age, with social deficits being more predictive of death in samples with an average age younger than 65 years. Overall, the influence of both objective and subjective social isolation on risk for mortality is comparable with well-established risk factors for mortality.

 

KEYWORDS:

 

loneliness; mortality; social isolation

[Sthira]

Hi Grace!

 

It's nice to get to know you, too! Is Zen meditation the one where a guy walks around with a stick and smacks you if you start drooling?

 

I tried Shambhala for meditation -- they seem a little more chill about it. Twenty minutes seated, ten minutes walking meditation, then another twenty. It's interesting to watch the mind go round and round, recycling thoughts and worries, highs and lows, boredom followed by dopamine releases.

 

For loneliness, I've since moved onto yoga, and practice that quite a bit. I'm an ex-dancer, so it comes easily and it's fun to flow. The teachers and students are always upbeat and positive, and we gather in hot little rooms for awhile, move together with the breath for an hour or two, like one big organism, then we separate and go our own ways back out into the blue world. Asana and pranayama always relieve my loneliness and awkward shyness. Without fail it's a beautiful experience to just follow the journey of the breath in and out while steadily increasing body awareness. I guess there's a good reason yoga has become so popular in this culture: it unites us in ways nothing else really can, imho.

[BrianMDelaney]

Dean, thanks for raising this important topic. I'm unexpectedly swamped with work but I wanted to share a video on the topic that by coincidence was recently sent to me.

 

 

When I get a breather I'll reflect on some of the important questions you pose (esp. how CR might negatively affect our social lives...).

 

Best,

Brian

 

[gracezw]

Hi Grace!

 

It's nice to get to know you, too! Is Zen meditation the one where a guy walks around with a stick and smacks you if you start drooling?

 

I tried Shambhala for meditation -- they seem a little more chill about it. Twenty minutes seated, ten minutes walking meditation, then another twenty. It's interesting to watch the mind go round and round, recycling thoughts and worries, highs and lows, boredom followed by dopamine releases.

 

For loneliness, I've since moved onto yoga, and practice that quite a bit. I'm an ex-dancer, so it comes easily and it's fun to flow. The teachers and students are always upbeat and positive, and we gather in hot little rooms for awhile, move together with the breath for an hour or two, like one big organism, then we separate and go our own ways back out into the blue world. Asana and pranayama always relieve my loneliness and awkward shyness. Without fail it's a beautiful experience to just follow the journey of the breath in and out while steadily increasing body awareness. I guess there's a good reason yoga has become so popular in this culture: it unites us in ways nothing else really can, imho.

 

Sthira,

Apparently there are many different kinds of Zen meditation. I haven’t experienced that kind you talked about.

I don’t do yoga. I do Tai Chi and Kung Fu as another form  of moving meditation.

[Dean Pomerleau]

Brian,

 

Thanks for posting that video of Susan Pinker (who happens to be the sister of the very smart evolutionary psychologist Steven Pinker).

 

She seems quite convinced from the evidence that face-to-face social interactions are critically important for health / longevity. In other words, she seems quite convinced that my hypothesis is wrong - namely that the study I most recently discussed above (PMID: 25910392), does in fact show that the objective facts of the matter regarding social isolation (e.g. the objective fact that one is living alone) are themselves sufficient to increase mortality, independent of feelings of loneliness. In the segment of video from 16:00-16:40, she says "it [social isolation] does matter, it does affect your immunity, your happiness and your marbles [i.e. cognitive health]". Reading between the lines, she seems to believe humans are inherently social creatures by nature. Therefore without rich face-to-face social interactions we can't / don't flourish.

 

I remain skeptical but open-minded. I acknowledge that there are many people for whom her contention is likely to be true - even if you don't feel lonely you may be more likely to die because you live alone, perhaps as a result of falling without anyone around to help you, or perhaps because you are in denial that your social isolation is causing you psychological distress, which can lead to depressed immunity, increased inflammation, etc.

 

But I still think if one has a sufficient safety net and doesn't feel lonely or depressed by social isolation, but instead enjoys a solitary lifestyle, one can live a long and happy life. 

 

--Dean

[Sthira]

Hermits live for a really long time. Yet no cave studies have been published since hermits throw rocks at peering little notebook clutchers.

[AlPater]

The below paper highlighted to me the importance of not being alone.
 

I was surprised that cardiac arrest accounted for so many deaths,

https://en.wikipedia.org/wiki/Cardiac_arrest#Epidemiology

http://www.cbc.ca/radio/whitecoat/blog/the-downside-of-high-rise-living-1.3408714

The downside of high rise living
By Dr. Brian Goldman

The National Housing Survey says condos are now home to more than 1.6
million households. A large and growing number of seniors live in
high-rises.  Heart disease is the number one killer of older Canadians,
which means the system is handling a growing number of 911 calls from on
high. A study just published in the Canadian Medical Association Journal
says those living arrangements come with a potential health risk.

For those who call 911 from a high-rise, the odds of survival from cardiac
arrest depend on what floor the patient lives. That's the main conclusion of
an intriguing study by a paramedic and doctors with Rescu, a university and
hospital research program in Toronto that focuses on patients who suffer
heart and other life threatening emergencies outside of hospital.
Researchers looked at the 911 records of more than 8200 people in Toronto
who suffered cardiac arrest at a private residence.  Four point two per cent
of the nearly six thousand of them who lived on the first or second floor
survived a cardiac arrest.  Just 2.6% of the 1844 people living on or above
the third floor survived.  A dismal 0.9% of those who resided above the 16th
floor lived; for those who lived above the 25th floor, the chance of
survival was zero.

There was nothing otherwise different about the patients who reside on
higher floors.  They weren't older or otherwise more prone to heart attacks
than those who live on the first two floors of a high-rise. The only factor
that could explain the difference in survival is the extra time needed by
paramedics to take the elevator from the lobby to the floor where the
patient resides. A previous study by one of the authors found it takes an
extra 90 seconds to reach patients on the third floor or higher.

Even that tiny a difference in response time can have a huge effect on
survival.  In the first ten minutes following cardiac arrest, each
one-minute delay defibrillating or shocking the heart decreases the odds of
success by seven to 10 per cent

Although we're talking high-rise buildings, the conclusions have
implications for smaller apartments and walk-ups. Traditionally, when
researchers talk about response time to 911 calls, they mean the time it
takes from the moment the call is placed until paramedics arrive on the
scene.  Shorter response times mean greater chances of survival.  But those
studies mislead us when they don't count the extra time it takes to reach
the patient.  With high-rises, the delay may be due to the elevator ride.
If the walk-up has no elevator, the delay comes from paramedics having to
carry equipment up several flights of stairs, and have to carry both the
patient and the equipment to the ground floor.

I'm not aware of any published studies comparing survival from cardiac
arrest in office buildings compared with high-rise apartments and condos.
The same issues apply.  Survival depends on how long it takes paramedics to
reach the patient.  I think there's been a greater push in offices than in
apartments to install automatic external defibrillators or AEDs.  These
devices save lives – but only when co-workers are trained to pull them off
the wall and use them. Unlike high rises – which are occupied day and
night – office buildings are occupied primarily during the day. The most
common time of day for cardiac arrest is early morning between 6 and 10 am.
That makes me think a disproportionate number of cardiac arrests take place
at home or en route to work.  Offices got AEDs before residential high-rise
buildings but the gap is closing.

If you are wondering what can be done to increase survival in skyscrapers,
the main thing is to speed things up once paramedics arrive at the lobby of
the building.  As pointed out by the authors, firefighters have a universal
access key that gives them sole access to the elevator.  They suggest that
paramedics get the same access.  As well, they suggest that the
superintendent as well building security be included in emergency alerts so
they can do things like have an elevator on standby when paramedics arrive.

Singapore has mounted a public campaign to enrol fellow residents to act as
first responders, which will close the survival gap by getting help long
before paramedics arrive.  All of these will improve survival.

With more and more Canadians moving to high occupancy buildings, expect
issues of quick access to patients in cardiac arrest to become more common.
It's sensible to take action now to prevent unnecessary harm.


Out-of-hospital cardiac arrest in high-rise buildings: delays to patient
care and effect on survival.
Drennan IR, Strum RP, Byers A, Buick JE, Lin S, Cheskes S, Hu S, Morrison
LJ; Rescu Investigators.
CMAJ. 2016 Jan 18. pii: cmaj.150544. [Epub ahead of print]
PMID: 26783332
http://www.cmaj.ca/content/early/2016/01/18/cmaj.150544.full.pdf+html


Abstract

Background: increasing number of people living in high-rise buildings
presents unique challenges to care and may cause delays for 911-initiated
first responders (including paramedics and fire department personnel)
responding to calls for out-of-hospital cardiac arrest. We examined the
relation between floor of patient contact and survival after cardiac arrest
in residential buildings.

Methods: We conducted a retrospective observational study using data from
the Toronto Regional RescuNet Epistry database for the period January 2007
to December 2012. We included all adult patients (=/> 18 yr) with
out-of-hospital cardiac arrest of no obvious cause who were treated in
private residences. We excluded cardiac arrests witnessed by 911-initiated
first responders and those with an obvious cause. We used multivariable
logistic regression to determine the effect on survival of the floor of
patient contact, with adjustment for standard Utstein variables.

Results: During the study period, 7842 cases of out-of-hospital cardiac
arrest met the inclusion criteria, of which 5998 (76.5%) occurred below the
third floor and 1844 (23.5%) occurred on the third floor or higher. Survival
was greater on the lower floors (4.2% v. 2.6%, p = 0.002). Lower adjusted
survival to hospital discharge was independently associated with higher
floor of patient contact, older age, male sex and longer 911 response time.
In an analysis by floor, survival was 0.9% above floor 16 (i.e., below the
1% threshold for futility), and there were no survivors above the 25th
floor.

Interpretation: In high-rise buildings, the survival rate after
out-of-hospital cardiac arrest was lower for patients residing on higher
floors. Interventions aimed at shortening response times to treatment of
cardiac arrest in high-rise buildings may increase survival.

[gracezw]

 

AlPater, thanks a lot for sharing that. It makes a lot of sense. It is better to have a roommate than living alone.

 

[Sthira]

AlPater, thanks a lot for sharing that. It makes a lot of sense. It is better to have a roommate than living alone.

Unless your roommate is a psychopath. Ahem.

[Greg Scott]

 

AlPater, thanks a lot for sharing that. It makes a lot of sense. It is better to have a roommate than living alone.

 

Unless your roommate is a psychopath. Ahem.

 

 

Well said Sthira.

 

If you're feeling lonesome, read The Stranger Beside Me by Ann Rule.

[Saul]

Hi ALL!

 

I strongly agree that it's best to live with someone, rather than alone -- I have an ad-lib wife, who I love very much, who is 14 1/2 years youger than I.  She is a Nurse Practitioner, specialized in gastroenterology -- so (maybe partly my influence), advises all her patients to switch their diets to include more fruits and vegetables,

 

 

However, I'f like to bring to your attention one of the resultds of CRONA, in which many of us participated.  We all filled out many forms -- many (if no most) of which were related to our psychological state.

 

The interesting finding was, that a (I think large) majority described themselves as "loners".  (I might even fit into that category -- although married, with a wife who lives with me, and two children (and one grandchild -- aged two months ) in lower Manhattan, I probably have social contact mostly with fellow members (and students) of the UR math dept, where I teach, and, aside from my wife, mostly two local vegan CRONNies, and one female Economist (who is afriend of both my wife and myself).

 

(I'm not counting "electronic friends", such as everyone in this Forum .  I should note that I avoid all social media -- including Facebook, Twitter, etc -- with the exception of Google Plus.  I regard most social media as phishing risks, or worse.)

 

  -- Saul

[Dean Pomerleau]

Hi Saul,

 

Thanks for reminding us of the CRONA CR psychology study. I'd forgotten about that. Here is the reference [1] and a link to the free full text. Here is the relevant passage about social relationships and CR folks being loners:

 

Regarding social relationships, CR participants mentioned on average 2.30 (SD = 2.22) close others, and 19 (70.4%) mentioned two or fewer. Four CR participants (14.8%) mentioned no significant relationships, 22 (81.5%) mentioned no friends, and six (21.4%) described themselves as “loners,” “solitary,” or having little in-person social interaction. Finally, all but one (96.3%) mentioned two or fewer social hobbies. Comparison groups reported similar social profiles but generally indicated higher numbers. Only three (8.1%) mentioned no specific social relations and only two (5.4%) described themselves as “loners,” “solitary,” or having little in- person social interaction.

 

I wasn't one of the participants, but I definitely fit the profile of a loner, despite being happily married, like you. I consider myself very lucky to have her and our daughter. If it weren't for them I'd likely have no (real-world) social life, for all intents and purposes. 

 

--Dean

 

-----------

[1] Appetite. 2014 Aug;79:106-12. doi: 10.1016/j.appet.2014.04.006. Epub 2014 Apr 18.

 

Clues to maintaining calorie restriction? Psychosocial profiles of successful
long-term restrictors.

 

Incollingo Belsky AC(1), Epel ES(2), Tomiyama AJ(3).

 

Free full text: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4198019/

 

To combat the obesity epidemic, interventions and treatments often recommend
low-calorie dieting. Calorie restriction (CR) as a weight intervention, however,
is often unsuccessful, as most people cannot sustain the behavior. Yet one small
group has maintained extreme CR over years - members of the CR Society and
followers of The CR Way. This study examined stable psychosocial characteristics
of these individuals to identify traits that may promote success at long-term CR.
In 65 participants, we measured diet, eating behaviors, and personality traits
comparing calorie restrictors with two age-, gender-, ethnicity-, and
education-matched comparison groups (normal weight and overweight/obese). We
first tested whether the CR group restricted calories without indications of
eating disorder pathology, and second, what crystallized psychosocial
characteristics set them apart from their nonrestricting comparisons. Results
indicated the CR group averaged 10 years of CR but scored lower than comparison
groups on measures of disordered eating (p < .001) and psychopathology (p <
.001). Particularly against overweight/obese participants, CR participants scored
lower on neuroticism (p < .04) and hostility (p < .01), and were stronger in
future time orientation (p < .05). Overall, CR profiles reflected high
self-control and well being, except for having few close relationships. This
study suggests a potential predisposition for successful long-term CR without
disordered eating. Since modifying trait factors may be unrealistic, there may be
psychosocial boundaries to the capacity for sustaining CR. Paralleling a movement
toward personalized medicine, this study points toward a personalized behavioral
medicine model in behavioral nutrition and treatment of overweight/obesity.

Copyright © 2014 Elsevier Ltd. All rights reserved.

PMCID: PMC4198019
PMID: 24747211

[Sthira]

I was one of the particilpants, and reading that others in the group also had no friends makes me feel a little less like a loser. Haha... I keep wondering where is my tribe, where are my people, and maybe it's the damn weird CR community. Scattered to the four winds, skinny little rare gypsies gonna make escape velocity ha.

[BrianMDelaney]

I wasn't one of the participants, but I definitely fit the profile of a loner, despite being happily married, like you. I consider myself very lucky to have her and our daughter. If it weren't for them I'd likely have no (real-world) social life, for all intents and purposes.

 

 

Dean, interesting. You "seem" very sociable, both over the phone (that was a while ago, but I doubt it's changed much), and via your e-personality. But that of course doesn't mean that you're not fundamentally a loner.

 

As to one of your key questions -- might CR affect social life in a negative way? -- I'd say the answer is clearly yes. Any kind of "orthorexia" can have that effect. Or to frame it even more broadly: any health regimen can be inflexible enough to have negative effects on one's social life. I know people who decline dinner invitations because it interferes with their (very) late afternoon run.

 

The risk with CR is particularly high, of course. I've built in flexibility in my health regimen, but I still say no to certain events when I know the food won't work for me. Living alone, this is more of a problem than for someone who has the alternative of having a meal with spouse and children at home instead.

 

I'm currently looking into cohousing options. (I think I mentioned that previously, elsewhere.) Most are 10-20% "commune", 80-90% apartment complex. That is, in practice: you have your own kitchen, eat most meals in your own living space (which in some cases is a house, not an apt.), but then there are huge group meals periodically (how often depends on the group). One could join the group meal event and partake in whatever food worked, or one could influence group meal menus, of course.

 

And then there is a common space for just hanging out. The trick, of course, is finding the right group of people to have this arrangement with....

 

- Brian

 

 

 

[Dean Pomerleau]

Dean, interesting. You "seem" very sociable, both over the phone (that was a while ago, but I doubt it's changed much), and via your e-personality. But that of course doesn't mean that you're not fundamentally a loner.

 

Thanks Brian. You'll see (and probably be disappointed) at the upcoming CR Conference that I'm much less gregarious and personable in real life than my on-line personality would suggest. 

 

I agree that without question CR can push one away from many social situations. Eating is such an integral part of human socialization, it is often not easy to engage with others at a social event without eating, and without perseverating on the available tempting foods while not partaking.

 

I'm currently looking into cohousing options. (I think I mentioned that previously, elsewhere.) Most are 10-20% "commune", 80-90% apartment complex. That is, in practice: you have your own kitchen, eat most meals in your own living space (which in some cases is a house, not an apt.), but then there are huge group meals periodically (how often depends on the group). One could join the group meal event and partake in whatever food worked, or one could influence group meal menus, of course.

 

And then there is a common space for just hanging out. The trick, of course, is finding the right group of people to have this arrangement with....

 

That sort of living arrangement sounds ideal, particularly if you can find a group of like-minded, free-thinking individuals with whom you can get along... I've often thought about retiring to a small intentional, health-conscious community along the lines of the arrangements you describe. I'll be very curious if you can find such an arrangement, and how it works out. Are you looking for it in the US, Sweden, or both?

 

I'd also be curious to hear about how the reaction to your practice of CR differs between friends and acquaintances in the US vs. Sweden. Are the Swedes more open to unusual lifestyles than Americans?

 

--Dean

[BrianMDelaney]

That sort of living arrangement [cohousing] sounds ideal, particularly if you can find a group of like-minded, free-thinking individuals with whom you can get along... I've often thought about retiring to a small intentional, health-conscious community along the lines of the arrangements you describe.

 

Well, let's be sure to stay in touch! (As I expect we will anyway.) I'm almost tempted to suggest we and others who might be interested try a sort of minimally scientific test run in Tucson via a 2- or 3-day Airbnb arrangement. (Or someone local hosts us.) Might be more practical to wait to do it at the following conference, though (likely late 2017 or early 2018).

 

Although a hotel is actually in many ways a better model for many aspects of cohousing.

 

That sort of living arrangement [cohousing] sounds ideal, particularly if you can find a group of like-minded, free-thinking individuals with whom you can get along... I've often thought about retiring to a small intentional, health-conscious community along the lines of the arrangements you describe. I'll be very curious if you can find such an arrangement, and how it works out. Are you looking for it in the US, Sweden, or both?

 

Both, but cohousing hasn't caught on here in Sweden.

 

I'd also be curious to hear about how the reaction to your practice of CR differs between friends and acquaintances in the US vs. Sweden. Are the Swedes more open to unusual lifestyles than Americans?

 

Swedes are WAY less open to unusual lifestyles than Americans – on average, but esp. among the sort of educated elites who would be interested in health- politics-based communities. The US is the land of alternative lifestyles par excellence!

 

- Brian