How connection heals and loneliness harms your health - Prof Brian Lawlor

Thanks very much. It's a great pleasure to be here, a privilege to be here and I'm looking forward to learning from you. So I'm going to be talking about loneliness, social connection, and health. But I'm really interested in finding out more about this from you. During the talk I'll tell you a little bit about the work. When I was in St. James's, I worked in the community, not this community. I was telling my great friend here, she's 85 and we're here at a marvelous party to celebrate your 85th birthday. I don't really know this area very well. I mean, I know the St. James's catchment area very well, but I think there's similar aspects to who you are, what you are, what you do, because I think it's all about the community. And I think community is communing, coming together, isn't it? And I think that's what we're all about here. And I think that's so important for our brain health and for our mental health. And we're going to be talking a lot about that today. So I just wanted to start because I think there's four C's about being well, about being healthy. Community, which you are. Connection, which is really what we're doing today. Creativity, you know, we're celebrating creative brain week this week and that's one of the reasons that we're here. And creativity is such an important part of being human and connecting. But also, I think one of the most important C's is about caring. And I get the sense that this is a very caring community. You care about one another. You care about your community. And I'm very interested when we get into this conversation about hearing a little bit of the history of what you've done together because I understand it's incredibly impressive here what you've done in the Docklands. So the four C's. People need people. The community is where change happens. And I believe that's the case here. Creativity connects us to ourselves and to others. And just by virtue of being a community and being here, you are being creative. And I think you know keep this meeting going because I want please do because it is creative practice. It is wonderful. It is wonderful to see it. I'm delighted to see it. So caring works through the community connection and through creativity. So the four C's, but we'll come back to that because I think that's who we are and why we're here.

So loneliness is a difficult topic to talk about. I mean, if I were to ask you who's lonely here, who would be rushing to put their hands up? Do I feel lonely? I mean, it's not an easy topic to talk about, is it?

Absolutely. But my point is that people don't necessarily admit to being lonely. They should. It's a subjective feeling. But it's okay to be lonely. People are frequently lonely, but it's hard to talk about it. It's hard to talk about it. And that's what we're going to be talking about. But most importantly, it's about we're talking about how loneliness can affect your health, how it can harm your health, but most importantly, how connection, how community can improve your health, can heal you. So, let's start off with a little bit of participation. I just want to ask you some questions. So I want to ask you a little bit about how you feel today. Now you don't have to put your hands up but just this is a kind of a question you can ask yourselves. Okay. Ask yourself: do you feel in tune with the people around you? Yes or no? And you know, does it feel like a little or a lot? Okay. Do you feel in tune with the people around you? Second question. Do you feel you've got a lot in common with the people around you? Okay. Do you think your interests and ideas are shared by people around you? Just take a mental note. That's three questions. Yes or no? People, I'm sure it's going three out of three. Many of you going three out of three so far. Maybe not. Do you feel left out? Are there people here who really understand me? Okay. Do you feel people are with you? Are there people here that you can talk to? I think that's probably true. There's certainly people you can talk to. Are there people here that you can turn to? So, these are really important questions. I haven't used the word loneliness here at all, have I? Haven't mentioned loneliness. But if you scored or said yes to any of these questions, there's a high likelihood or chance that you might feel lonely. These are items from a scale that we use to measure loneliness called the UCLA in California loneliness scale. So it's a clever way of asking questions without saying put your hands up. Do you feel lonely or not? This is a way of trying to understand if people feel lonely or not because you can see how it is about connection to self, to people around you, to be able to talk to one another, to communicate with one another. But most importantly to feel understood because that's really what loneliness is about. Can you, do you have somebody that you can talk to that you feel you believe that understands you that you are connected to? So we'll come back to this.

So I think this is a wonderful quote from an American author called Kurt Vonnegut. And this is what I'm going to try to talk to you about today. And he asked the question back in the 50s. What should young people do today? And there's a few young people back here. They're Atlantic fellows. So what should you do today with your lives today? And there's many things that young people can do with their lives today. But he said that the most damning thing is to create stable communities in which the terrible disease of loneliness can be cured. So there's a lot in this because stable communities, and again I'm very interested in hearing from you about this community and how stable it is and how stable it can be and can become. Trinity is in this community. The terrible disease of loneliness. Is loneliness a disease? Some people would say it's not a disease. Some people would say it is a disease. We'll have a conversation about that. And is it a terrible disease and can it be cured? So, we're going to talk about all aspects of this and hopefully you'll be able to provide me with some of the answers as well. How can we create stable communities? I think I've got a sense I can learn from you about this. So this is what we're going to cover. What's loneliness? Although I think you've got a feel for it already. There's an epidemic of loneliness out there. Have you heard about this? That there's a huge epidemic of loneliness. We're just coming off the back end of the pandemic as well. Talk a little bit about that so you can understand it. But there is an epidemic of loneliness out there. But who is affected? Do you think it's older people?

It affects everybody. So, what about loneliness and health? How does it affect our health, our well-being, and particularly our brains? I mean, does loneliness affect your brain and your brain health? We'll talk about that. And can we cure loneliness at the community level? So what can we do? What can you do? And actually what are you doing? And I think you're here today. So you're doing a lot to cure loneliness at the community level and at the individual level. So social connection, people need people and it's really part of our innate biology. This social connection, the drive for social connection, the drive to get out here, to communicate, to talk to people. And when people feel isolated or excluded or disconnected, there is this almost biological drive. It's innate. You feel this pain. It's an aversive feeling. It's uncomfortable. This pain of loneliness, not nice. And that drives you to connect. So you have this circle or cycle here of isolation, exclusion drives you towards connecting because you want to avoid the pain of loneliness and that we're wired that way. Humans are wired that way. There's a condition called social craving. Have you heard of social craving? Well, you've heard of food craving, right? So if I take you and I bring you away for about 10 hours and you don't get any food to eat, right? And then I show you pictures of people eating nice food. What happens to you? You start to crave. You crave because you're hungry. But if we start looking at your brain, we show that your brain particularly lights up. When you're food craving, there's a particular part of your brain over here in the midbrain, little blue dot there that we're showing there, but there what we call these dopamine neurons. It starts lighting up and firing because you're craving food. That's food craving. But social craving, if I take you, put you on your own for 10 or 12 hours, totally isolate you, you're on your own, and then I come along and I, again, it's not a nice thing to do. I show you all these pictures of people in Unit 18 having a good time, interacting, joking, having fun. You start to crave that social connection. Your brain has the same activity as if you were craving food. There's this social craving. If you remember in lockdown, it's not so long ago. If you remember when we were locked down, you were totally isolated. And then you remember that Christmas when it was lifted, what happened? People, they had such social craving. They got together. So, and of course, COVID spread like wildfire because the social craving in their brains was driving the connection. It's real. Interestingly, those people and a lot of them were older people who were lonely to start with, they had less social craving because their brains had adapted not necessarily in a positive way, but in a negative way. They didn't have the same degree of social craving that non-lonely people had.

Okay. What do you think of that fact? It's America, not Ireland. Do you think it's true that about a third of people, this is America, have two or fewer friends? Do you think that's true in Ireland?

No. It's not true for you guys, but you know, this is the way the world is going, believe it or not. Friends, you know, friends that you can connect with, friends that you can communicate with, friends that you can rely on, confidants, you know, with the rise of social media and all that and what's happening, you know, people are having fewer friends even in Ireland. So, society is disengaging more. This is what's happening in the United States, you know, and often times these patterns that happen in United States happen here in Ireland or in Europe, you know, a little bit later. It could be five, it could be 10 years, but social engagement of friends, companionship is plummeting in young Americans and also if you look at diverse populations, Black Americans, it's happening even more. So this is a trend in a different part of the world. I hope that it won't happen to the same extent here. But I think there are signals or indications that it is happening. And this leads me to tell you a little about this epidemic of loneliness. There's no doubt that there is an epidemic of loneliness and social isolation out there. And we have it here in Ireland as well. So why is this happening? Why do we have an epidemic of loneliness in Europe, in Ireland, in Australia, in the US? Well, one thing that's been happening over the last couple hundred years is that people are living alone more. There is a rise since the industrial revolution. There is a rise in one-person households. You see this happening yourselves. Look at your children, your grandchildren. Are they, a lot of them are living? Well, it's hard now at the moment in terms of trying, maybe they're coming back living with you now, but boomerangs. Yeah. But in general, I think people are trying to live on their own more. Okay. And that probably is driving up loneliness levels. So this is getting, in the US, the same trends in Europe, you know, single-person households, but also people are in single-person households. They're living alone, not necessarily getting married, they're having children later. People are deciding not to have children. So these are trends that are happening around the world. People are living longer, there's more widows, more divorce, more separations. But also there's this drive for individualism. If you remember in the old days that people kind of lived together, did everything together. There was a much more collective society. It's all changed. It's all changed. And this is true for both high and low income countries. It's not just in Ireland. You know, this is happening in Africa. It's happening in India. It's happening everywhere to a greater or lesser extent. And we know that if you live in an individualistic society, which is the way we are going, people report more loneliness. So that's a little bit about the epidemic of why is it happening? And I think there are many factors out there that are driving it and some of them are kind of stoppable, some of them are not stoppable.

So I just now want to talk a little bit about loneliness, isolation and health. And when I was in medical school, when I was in school, I'm sure when you were in school, did you ever hear that social connection was good for your health? No one ever taught me that in medical school. No. Ever. And if you look at mainstream psychiatry, geriatric journals, medical journals, the connection between loneliness and poor health or social connection and health, it's really not talked about or taught very much. So I mentioned you I was a psychiatrist in St. James's Hospital looking after older people and we did studies looking at people living in the community over the age of 65 and we studied thousands of people and we were looking at depression and anxiety but also looking at loneliness but I got involved in this because I had this sort of light bulb moment because a GP referred a patient to me, a woman, she was a widow, she was probably in her 70s and for the last two years the GP said she has this depression and she was living on her own and GP said and he said I tried lots of different things, medications, we tried psychological treatment, you know, therapy, nothing seems to work. So she came to see me and a little bit into the conversation, you know, it became clear to me that there was, it wasn't, you know, there was depression but it wasn't straightforward depression, there was something else going on. And I said to her, you know, because we had been beginning to look at loneliness, I said are you lonely? And she stopped and she kind of looked at me kind of strangely for a while and then she kind of said, she said you know what, you're right. And she talked about her husband and they had done everything together, they'd been married for 40 years, everything together, the same friends, the same contacts, everything was, they were sort of almost dependent on one another. And when he died, her whole life was totally turned upside down because he was everything to her, she was everything to him and you know, she didn't have that confidant, that person to talk to anymore. And yes she grieved and she got depressed, but she wasn't really able to come out of her grief or her depression because of this loneliness and what we call emotional loneliness. And really when we started talking about the loneliness and she began to understand it, she began to do something about it because up until then she hadn't been able to do anything about it. And she started to try to reconnect with family, with friends, with her community and overcome and get through the loneliness, that emotional loneliness, her depression improved, no medication. But it was through an understanding of this emotional loneliness which she hadn't really understood or come to terms with. And for me that was a light bulb moment because it kind of underscored for me the importance of the connection, how loneliness was harming our mental health but the importance of working that through and the connection and it encouraged me to do more work in this area.

So what is loneliness? It's subjective. You know you can't tell if somebody is lonely or not unless they admit it to you. It's subjective. It's unpleasant. It's painful. It's essentially not being happy or dissatisfied with your social relationships, the quality of your social relationships. Now, it's very different to being on your own, voluntary solitude, just being on your own. It's very different. You know, you decide to be on your own, that doesn't mean you're lonely. However, if you're socially isolated and have poor connection, poor network, you know, you're more likely to be lonely, but you may not be lonely. But you can also be lonely in a crowd. So, you can have lots of family, lots of friends. And my patient, she had plenty of friends. She had family, but she didn't have the emotional connection with her husband. So, she was lonely. So, she was lonely in a crowd of people. So, you can be isolated and lonely, but you can be isolated and not lonely and vice versa. So there are two different types of loneliness we talk about. I've been referring a lot to emotional loneliness which is where you don't have the confidant. You have this person that you're really connected to, you know, and with that type of emotional loneliness, you tend to be prone to sometimes mistrust and be a little bit suspicious of contact with people. You can be hypervigilant. It can be a difficult condition, the emotional loneliness, and it can be long-standing, it can stay with you for quite a while. Social is a little bit different, this is where there's a lack of social integration or embeddedness. So for example, you know, if we have people here, Atlantic fellows who come to Ireland from different parts of the world, so they come to Dublin and so there's a lack of embeddedness, they're disrupted from their connections and they can be socially lonely. But that can improve over time and circumstances. But of course, as you can imagine, you know, I'm giving you this distinction between emotional and social loneliness but often times they both coexist, you can have both types of emotional and social loneliness together but generally what happens is one form of loneliness predominates. And if I was to ask you which type of loneliness would you least like to have, what would you say?

Emotional loneliness. You're absolutely right. Emotional loneliness is the, it's a tougher one. It's a tougher one. So there are thinking and feeling parts to loneliness and the feeling part is just unpleasant. It's painful feeling. The thinking part is what is kind of a little bit distressful and I think it's a very important point. If you have been lonely or feel lonely, you know, you have, I think appreciating this sense of mistrust is important because you've got to bridge to make the connections and I think it's important as a health care professional or a doctor you're dealing and working with people who are lonely. You sometimes have to realize this to work across the mistrust, that hypervigilance because you can't just say to them look, you know, you're lonely why don't you go to Unit 18. You know, you have to build a relationship, you have to understand it's not that easy for a person if they have emotional loneliness to actually just upsticks and go down to Unit 18 because there is this mistrustful hypervigilance because the loneliness causes that. Here the risk factors for loneliness is not entirely surprising. So being widowed, living on your own, having a physical disability or people with physical disability are more likely to develop loneliness. Having a poor social network, I'll talk a little bit more about social isolation, but if you have few contacts, you know, you're more likely to develop loneliness. Women seem to have more risk at loneliness. Interestingly, lower socio-economic status. So people living in very impoverished poor areas are more likely to experience loneliness. So there's a social determinant of loneliness. Any caregiver and we saw this a lot during COVID, you know, people who were looking after people living with dementia, looking after people living with mental health issues. If you're a carer you can often feel very isolated and excluded and it can be tougher. So loneliness can be an accompaniment of people who are in a caregiver status. Having a mental health problem is associated with increased risk of loneliness. So talk a little bit about that moment. Retirement. I've just retired. I've just retired in December.

Oh, interesting. It's an interesting comment and I think so because loneliness, it depends, you know, if you look at the data, loneliness can accompany your retirement but often times it doesn't, in fact people's connections can build. So it's put in there but I agree with you, I don't think it's a big risk factor. I'm telling that myself anyway at the moment, so that's why I'm here today. Okay, thank you. Bereavement, that's another, you know, obviously as I talked about my patient, I mean not surprisingly, particularly, you know, if you have a bereavement and you lose somebody that you love, you're very close to, your confidant, of course, loneliness is very important. Stereotypes, I mean, you know, it's not just older people, younger people, it's very important that we understand this. There's younger people right across the life course, everybody can get lonely and very important that we don't stereotype. And this is where you see there are different peaks in terms of loneliness and often around life transitions, your children, your grandchildren, this can happen, transitions age 30, 50 to 60, and again over age 80. Talk a little bit about that later because some of this may be related to cognitive impairment, the development of cognitive impairment and cognitive decline. Measure, how we measure loneliness, again, it's not something we can see, you know, we have to ask people how they feel. Like depression, how do you measure depression? How do you know if someone's depressed? You only know if someone is depressed if they tell you. You have to ask them, are you depressed? Are you lonely? That's one way to measure loneliness. But there are other scales, and you've actually in your heads completed some of the UCLA loneliness scale, which is probably one of the most commonly used loneliness scales, but we measure loneliness that way. So, how common is it? It's pretty common. But a third of people will say they feel lonely sometimes or often. That's quite a lot, isn't it? Often about 10%, one in 10 people will say I'm lonely a lot of the time and up to 5 to 10% of people will have a significant level of loneliness that would impair their impact on their quality of life and on their functioning. That's not insignificant. Now acute versus chronic, I think it's, you know, there are state and trait aspects. So basically you can have transient or situational type loneliness, you know, as you can imagine, people moving from one part of the country to the other, one city to another, one country to another, bereavement, I keep talking about retirement, I shouldn't be using the word, becoming a carer, COVID-19. But when there's chronic loneliness, being lonely all the time, more likely to be emotional. And that's the type of loneliness that really impacts on your health, your mental health, and your physical health. This was an interesting study where they looked at older people longitudinally over the age of 50 and looking at mortality. So people, like, loneliness does kill people. So if you are chronically and emotionally lonely over time you're more likely to die compared to if you're not lonely or if you've had situational loneliness that kind of has come and gone. Okay. So loneliness can kill people.

Now I just want to talk a little bit about the difference between loneliness and isolation because they're important. They can happen together but they are distinct and we can measure isolation more objectively. So I have to ask you do you feel lonely and how lonely do you feel? But in terms of isolation I can as a health care professional I can make an assessment with regard to whether you are likely to be isolated or not. Are you living alone? Do you have any friends, family? Who's visiting? How often do you see people? There are ways that I can determine your network and your network size and the frequency of your contact. Okay? And that's the way that we look at isolation. And isolation it's frequently associated with lonely but not always. And very important point I've made it already that loneliness can occur in the presence of a strong social network. And so you know saying well I'm sure everybody is okay that they've got lots of family, lots of, you know, they seem to have lots of contact that doesn't necessarily mean that they're not lonely. So it's very important that you ask a person. So they commonly occur in loneliness, isolation, but isolation, you know, doesn't necessarily mean the person is lonely but isolation is a risk factor for becoming lonely. And but there is overlap in terms of what we measure and how we measure it. So it can be tricky to distinguish. But very important that we do try to determine network isolation and loneliness because the risks to health are not necessarily interchangeable. So they can be additive. So if you are isolated and lonely, that's probably worse for your health than if you're just isolated or lonely. Okay? So it's important to understand about the person network, but also whether they're lonely or not. And also very importantly, when you're trying to help somebody, you know, understanding if they're lonely, but also understanding their network and their contacts, because that's where you're going to look for help and support. You know, you're going to say to the person, well, look, you know, we need to increase your contacts. We need to increase the frequency. We need to try and get contact here, get there, attend, you know, different activities. So, understanding a person's network and their social activities is very very important in terms of how you might try to help that individual.

Okay. So, I just want to talk a little bit more about health. How does loneliness affect your health? And I think there's some surprising facts here. This was a quote from Steinbeck, of Mice and Men, the book back in 1937. I don't know if any of you have read it, but it was a great book about I suppose the Great Recession, you know, California, people, these migrant workers. But this was a quote from him about loneliness in 1937. This is before we know anything about connection and loneliness and health. You know, a guy needs someone to be near him. A guy goes nuts if he ain't got nobody. Don't make no difference who the guy as long as he's with you. I tell you, a guy gets lonely and he gets sick. I mean, isn't it amazing? Here's a writer, a creative is telling us medical facts and you know the literature, it took a while before the scientific literature in science, the publications caught up with this. So the risk associated with poor social relationships is comparable to that of cigarette smoking and other major biomedical and social risk factors. 1988, Science. Now Steinbeck told us this a long time before that. So it's as bad as smoking, right? And probably worse than hypertension and obesity for your health, for mortality. Did you, were you surprised to hear that?

That's a fact. Now, light smoking. What's light smoking? I mean, but I think light smoking is apparently 10 to 20 cigarettes a day. I don't think that's light smoking, but there you go. This is serious, isn't it? How come we don't have a public health campaign around loneliness and health in Ireland? Yeah, we have public health around hypertension and obesity, right? And cigarette smoking. So these are all the bad things associated with being lonely, isolated, increased risk of dying. I showed you that before. Being more frail, heart attack, stroke, sleep problems, increased risk of dementia, increased risk of psychosis, and very much depression. Depression is very much a, loneliness is very much a risk factor for depression. So, what does it do to your physiology? If you are lonely, particularly emotionally lonely on a long-term basis, your blood pressure goes up, your sleep gets fragmented, and these inflammatory markers in your system, in your blood, they go up and not good to have high levels of inflammatory markers because they can aggravate heart disease and other bad things. You also, your stress axis is overactive. So your cortisol level goes up. All these are not good things for loneliness, particularly loneliness and isolation. So what about the brain? Loneliness in the brain, it affects your cognition but also over time, over time we know that loneliness is a risk factor for the development of dementia. It's also associated with depression, psychosis and lack of compassion and empathy. These are very important. So when people are lonely and it's not something that you should blame a person if they're lonely because it's not their fault but also if they're lonely their empathy and compassion levels go down. So it's harder for them to feel compassionate, to feel empathy because of the loneliness. And this brings us to the important point about brain health, you know, and again loneliness and social isolation do impact on your brain health and on your mental health. And really what we should be trying to do with brain health is protecting the brain, reducing risk of the brain. I'll talk about the different risk factors in a moment and building reserve in the brain. And what loneliness and isolation do is they diminish our reserve in our brain so that as we get older we don't have the same ability to counter, you know, pathology, the wear and tear that happens in our brains as we get older. So this is why we think people are at greater risk of developing dementia due to social isolation. They have diminished reserve, cognitive or brain reserve. So we know that if you take a mouse and you isolate the mouse, now mice are, you know, you say, how would you know a mouse is lonely? That's not an easy question. Who wants to try that one? Mice are very social. I mean, I don't know who, well, I hope you don't have mice in your house and we don't have mice here in Unit 18. But they are quite social, but it's hard to tell if a mouse is lonely. But you can isolate a mouse. But what happens to a mouse's brain if you isolate it? Basically, you get, there's a kind of a trophic factor, like a brain fertilizer goes down in the brain when you isolate the mouse. The cortisol level goes up. You've heard about cortisol and loneliness as well. And so it happens in the mouse as well. And also this is what's shown here. The number of nerve cells in a particular part of the brain, the hippocampus, which deals with memory, goes down. So this is what happens in mice, not necessarily men, but it's probably what happens in men. Let me tell you about these Antarctic expeditioners because this is a way we can study what happens to the brains of people when you isolate them and they become lonely. So these were studies done with Antarctic expeditioners. Okay. So they have to go down to the Antarctic and they're in this station and they're pretty much isolated and it's a lonely place to be and they're there for months and months on end. So what they did with these people was they looked at their brains before they went down. So they did a scan, an MRI scan, but then they also measured the brain fertilizer level, BDNF in them, right? And lo and behold, when they compared, you know, the brain size and the BDNF, the brain fertilizer levels before and during and after, what happened was, not surprisingly, when these people were isolated and became lonely, the brain volume decreased, the brain size decreased, and this brain fertilizer level went down just like what happens in the mouse. So, these are real effects. Isolation and loneliness can affect the brain structure and the function over time.

Okay. So I just want to talk a little bit more about loneliness and depression because I always go back to that patient I had, the widow. This was data from St. James's around the catchment area. And what we found was that again this is very important about loneliness being a risk factor for depression that as the level of loneliness goes up, these are older people over the age of 65, the prevalence of depression went right up, shot up as well. Okay, very high levels of depression when there was very high levels of loneliness. And what we're showing here between the red and the blue is that if you have a good network, it did buffer it a little bit. It dropped it down. So it's good to have a social network. Even if you are lonely, but loneliness does increase the risk of developing depression. It also, loneliness predicts hopelessness which is not a good thing because people feel they feel hopeless. They despair and is a risk for suicide. But very interestingly what we found was that depression in widowhood was linked to a higher prevalence of loneliness. So just like the widow I described to you, that you're more likely to get depressed if you lose somebody that you love if you're lonely. That's why it's so important to tackle the loneliness and maybe let us think about maybe there's a way if you could, you might be able to prevent depression related to bereavement if you address loneliness. So these are things to think about and I think that one of the discussions I would have had with that patient was, you know, the talks about, you know, obviously when you are in relationships and in community it's good to diversify, it's good to have lots of different connections, do different things, have different interests, not put all your eggs in one basket as it were because that could be a helpful preventive. It's just good advice for everybody. Psychosis and loneliness. I mean, I mentioned to you about mistrust and hypervigilance being part of loneliness. And this relationship probably goes both ways. That people who have psychotic illness are more likely to be lonely. But also if you have loneliness, you may be more likely to develop a psychotic illness. And we know that from experiments. If you take people like ourselves, you know, you can experimentally change the level of mistrust, you know, you can do this in a room. But if you reduce, you can reduce loneliness by decreasing these paranoid feelings, you know, in people. So there does seem to be this relationship. And I do believe that maybe if at a community level and a population level, if we were able to address loneliness, we might be able to decrease the risk of people becoming or developing psychotic illness. And community and connection can be very very important and maybe actually be able to prevent mental illness like depression or psychosis. I mentioned to you that you know people who are lonely have reduced empathy and reduced compassion and this is very difficult for people when they feel lonely and this is why it's important to address loneliness because lack of empathy, lack of compassion, it interferes with relationships. And I did, I mentioned to you about the risk of developing dementia from loneliness but also if people who are lonely it does affect their cognition, their processing speed, how fast they think, how quickly they think, how accurately they think. And also in older people, you know, people who are lonely versus those who are not. If you're lonely, the cognitive decline can be more rapid. The other point I want to make about loneliness though is that sometimes older people, particularly over the age of 80, if they develop loneliness, it's possible that there could be some memory or cognitive changes happening as well. So you know, it's...

People who develop dementia can be lonely and isolated. It can be a stigmatizing illness, and loneliness is associated with the development of dementia, but also sometimes the actual underlying dementia process may be causing some of the loneliness, particularly in people over the age of 80. So it's an interesting and important relationship.

But very importantly, and we do believe this in the Global Brain Health Institute, that social engagement, the sorts of things we're doing today, is a modifiable risk factor for dementia. So there are things we can do to prevent dementia, to prevent cognitive decline. This is one of them: community connection. And it's a very, very important one to start early and to keep up.

I mentioned about COVID-19, which is kind of a horrible natural experiment in social isolation. What happens when you restrict people? It really caused a huge amount of anxiety, depression, and distress. But in terms of loneliness, this is what happened in Ireland. I'm not sure whether you've seen these data before, but in 2018, before COVID, how many people said that they were lonely almost or all or most of the time? This is census data: about 4%. Right? Look what happened then. April 2020, do you remember back to April 2020? It was just sort of really, you know, St. Patrick's Day, they were just sort of heading into it: 7%. By November, 14%. So it just shows you what isolation restrictions can do.

This is again 2018 and then November 2020. But I just want to show you again where the biggest jump in loneliness was during COVID and who was most affected. Who would you have predicted?

Younger people. You're absolutely right. There's the younger people. Yeah. Absolutely. You're absolutely right. So, look here. This is where it was in 2018. This is 18 to 34, right? Can hardly see it: 3%. 2020, November 2020, 26%. What a jump. There's a big jump in the 45 to 64. Well, interesting. Okay. Less so in the up to 70, but we're not showing data over the age of 80 where I think, again, for people, particularly those people who have dementia, cognitive impairment, I think it was a huge issue, which I'm showing you here.

And this is what happened in terms of people living with dementia, their carers, and I'm sure many of you will remember this: people who have dementia, with the social restrictions, isolation, there was an increase in behavioral and psychological symptoms. It accelerated the cognitive decline. It had a huge impact on their cognition. This just shows you one example of what happened to people who were relatively stable and then fell off the grid, as it were. And for all of us, this is an interesting study which showed you what the effects of lockdown had on your cognition, on your memory. And these were people from the ages of about 18 to 75 who were doing memory tests on a daily basis on a computer. And what it showed was that when they were in the restrictions in lockdown, cognition went down and then after the restrictions were lifted went back up and then down again and back up again. So these are real effects. These are real effects.

So it's loneliness and social isolation, but loneliness in particular is bad for your brain, bad for your brain health. It could be a marker of decline, particularly in people who are much older. And that's really why it's so important to do what we're doing to try and address loneliness and social isolation because it's good for your body. It's good for your brain.

This is where I want to kind of go now for the last part of the talk. I mean, are we keep going? You okay? Yeah. Okay. How do we target loneliness? And I really want to talk about the bottom of the pyramid. And this is the part where you're going to teach me about how you do it. The base is primary. How do we prevent loneliness at the population level, at the public health level, you know, not necessarily when people are lonely and we want to... there are forms of therapy, there are interventions, social prescribing, there are things we can do for people at risk or people who are lonely and that's very, very important. But for people who are... how do we prevent society, how do we prevent everybody becoming lonely? How do we connect our society more than it is? What are the things we should be doing or can be doing that actually can improve? And I think from what I heard earlier, and it was only a very brief conversation, I think a lot of things that have been happening in this area actually will and can prevent isolation and loneliness happening in this community.

So there are many social determinants of health and brain health, and these are all social determinants also of loneliness. So the social community context, in terms of a determinant of health. So what social community context means, you know, high levels of unemployment, housing instability, financial worries, drug misuse there. So that can actually impact health and brain health in a community, but also can drive up loneliness as well. Low levels of education as a social determinant of health, socioeconomic status, poor quality neighborhoods, poor housing stability, poor built environment. These all increase illness but also impact on loneliness and health. And healthcare access. That's really important in terms as a social determinant of health. So how do you address loneliness at a community level? So you have to build the right social infrastructure where people can connect, and I'll give you some examples of that in a little while, mostly from Japan because they've been dealing with this issue for longer than we have because they have a very large aging population who are very lonely and they have had some sort of innovative type solutions, but I think people here are actually innovating as well. How do you make it easier to connect and to trust people, right?

What about intergenerational contact and community participation? Is there much intergenerational contact here?

Because that's, I think, hugely important. You know, not having older people in one part and younger people in another part. I mean, you have to have a mix. Intergenerational contact is really important for brain health, but also to combat loneliness. Volunteering.

It's very strong. It's really, really hugely important. Volunteering, prosocial. It's very good for your brain. We did a study there, you know, a number of years ago where we took people who were lonely, at least learning, and we had a befriending, a volunteer befriending trial. It was a randomized control trial and so 10 weeks they had a volunteer going in with the person and then the other group didn't get the volunteer. And what do you think happened? Was there a benefit to the person who was being visited?

They were less sad. But what about the volunteer?

Because they got a lot out of it. So volunteering, huge, important. Third spaces. Have you heard of third spaces? We're talking about third spaces.

No. Yeah.

Chatty bus stop. Okay. I like that. Have you got a chatty bus stop here?

Well, maybe that's a great idea. I think, you know, because...

Turbo gob. Well, turbo gob is better than a chatty checkout. Yeah. But a chatty checkout is, you know, it's a kind of a Dutch experiment where they, you know, you have two checkouts. You've got, you know, I don't know if it's Lidl or you have two checkouts. One is the kind of fast one and then the chatty checkout is where you actually, you purposely go into the checkout, the slow one because you're going to end up talking to somebody.

No. No. That's just so that's another problem, isn't it? So anyway, these are... we're going to talk about solutions now very soon. Okay. So we've talked about this in terms of, you know, look, connection, you can improve, you can heal. By social connection you decrease depression, improve your sleep, emotional and cognitive health. You know, if you're not lonely and not isolated, you're much more likely to take care of your health, your diet. Stress and inflammation go down. But also very interesting, when people are not lonely and not isolated, they're more likely to be compliant with medication. One of the things when people are lonely and isolated, they take on these very poor health behaviors. They might smoke more because they're on their own. They might drink too much. They kind of sit around, don't exercise. They don't, you know, when you're lonely and isolated, what about eating?

People, I don't know, well, people don't really look after, they don't take an interest in shopping for the food. They don't take an interest in cooking for themselves because they're on their own, because they feel lonely. But if you're not lonely and isolated, you're more likely... there's a relational aspect of eating, isn't it? I mean, eating is not much fun eating on your own, is it?

That's one of the reasons why people who are alone or isolated, they actually don't look after their diet. So you can build a stronger brain. We call this kind of neuroarchitecture, building a stronger brain. And this is by looking at your environment. And this is what I'm curious about, Unit 18 and your community. Would you say that your environment here, your community is an enriched environment for your brain? Is there enough sound, color, contrast, and natural light? Yeah. I mean, I walk around there by El Valentino and looking at the water, the space, it's actually quite attractive, right? I mean, I think it's quite... you don't feel enclosed. You don't feel locked in, right? Is your environment, is it challenging and change, is there the potential to challenge and change you? I mean, you want physical, sensory, and cognitive and social stimulation. You want stimulation. You want things to challenge you because we know that that improves your brain plasticity. That's what protects you. It's the challenge, change. It's cognitive and socially stimulating. It's not sitting passively, you know. It's kind of being challenged, doing something new.

So passive design is not enough. It's about, you know, putting things in place that force you or kind of encourage you to connect. So I noticed there are some kind of seating areas around by the water.

There's some walking areas that probably there are spaces where people can connect and have a chat, you know. Intergenerational, I think, is key. That sounds like you've got that covered. The volunteer is covered. The chatty checkouts, go up. It's on the cards maybe. We got to look at the self-checkout maybe. I don't know. Fun activities. Arts, creativity, culture, and community. You have an artist in residence here now. Angie, she's still here. They've got an artist in residence here, which I think is fantastic. I mean, and I know you have other activities here as well, but I think having an artist in residence, what a resource. I mean, look around you. This sort of stimulation, the activities, that creativity that connects you, it's part of your community.

Safety. Is this safe? Is it a safe community? Do you feel... because one of the things when we did studies with older people, these were done, but security was a big issue for people, you know, going out at night time, you know, feeling safe. That's important because otherwise you can isolate yourself in your own home and not connect with people even though there are third spaces, there are places you can connect and chat and talk, you don't feel comfortable going out. So it's important, security is important, light is important, these aspects of design are crucial but they're important. Is it safe out front there?

Hit and miss, maybe something to think about, you know. So, but I think this is again, we're not just talking about ideas, we're talking... this is the evidence, okay? The best evidence is there's walkability, good overall quality of the environment, greening, good housing options, good transportation. All of these things are important to combat loneliness and isolation. I think the transportation around here is pretty much, is pretty good, right? The buses and so spaces that enable visiting, natural spaces, community spaces, walking, cycling when you can socialize, that's already important. This is the evidence that particularly, certainly at the community level. So it sounds like you're covered there as well.

And again, this is an important study. It came from, this has been done in Canada but also in Australia which shows you that, you know, if you green the area, urban greening has a potential to decrease loneliness particularly in people who live alone. Greening, I wasn't... I saw the park there, there is a park that's kind of almost like a Georgian park, right?

So you have enough park, but just really, so I think green, or could it be greener? Could this area be greener? It could be good for your brain health and for loneliness. You're making notes. I hope... The workplace. I mean, some of you may still be working. I'm retired. I keep bringing that up. But people can get isolated and lonely at work, you know, believe it or not, they can be... there's professional loners now. I mean, I was in the hospital, you know, the common room is gone. You didn't meet anybody anymore. You're on your own making difficult decisions. At work, you're on your own. And it's very important to combat professional or workplace loneliness. And this is where, you know, cafes, spaces, lounges, you know, it's really something to think about. There seems to be plenty of coffee shops around here. Anyway, that's... I just want to give you a few examples. Because I know we're probably running out of time, but this is one of a fellow, one of the fellows from GBHI, and she's from Japan, and she developed this concept of... and this is, you know, Japan has a huge problem with aging people living very long lives and, you know, many of them are developing loneliness later in life. So what they're trying to do here is get people together to co-create and co-produce design changes in their own places that they live. So almost like a cooperative. And it sounds a little bit like the type of community you have here. And this helps build community and decrease loneliness. So I think, but the principle of the idea is for people themselves, who are... everybody's in the room, the community is to get together and co-create and co-plan. I heard a lot about how this happened, you know, here, I think, in terms of the development of this area. People did have input and did help with the design. And I think that's really, really important in terms of combating loneliness, making sure that the spaces are there for community interaction.

This was what was called a 'nayatar' in a part of Japan. And it's very interesting what they did in this building was they created, they knocked down a sort of spaces that were barriers. It was a high-rise complex. But what they did was, so if you know, if you go on a small balcony and there's a barrier, you know, you can't see your neighbor, but they knocked down those barriers. So if you went out on your balcony you had to talk to the neighbor.

And also when you came down the stairs and went out of the elevator you came out, you were forced into a space where you would have to bump into people.

And it was intergenerational. Isn't that interesting?

And just very briefly toward the end, we talk about this is a project that we've been involved with. Respond. Have you heard of Respond?

Yeah.

Okay. Well, I'm glad to hear that because I mean we've had a partnership with Respond Now for quite a number of years because we were looking at the whole concept of housing and brain health and loneliness and they're a very progressive organization, really a fantastic organization to work with. But they were building this development down in Ballymun, have you heard of it? And so they partnered with us on the concept of brain health. And the idea was, you know, if we kind of build this development with the principles of brain health in mind, it could be very good for the community and we also thought this would be good in terms of decreasing loneliness and isolation as well. These are intergenerational developments. It's not older people, it's not younger people, it's a total mix of people going down there. It's a phenomenal place. So this is what we were trying to do, but we're really looking at could this actually make an impact on loneliness and isolation as well. And, you know, we looked at, we developed a framework and most importantly what we did with this framework and a lot of the principles we've just talked about, you know, that you obviously understand and know about. We talked about these principles and introduced these principles and we worked with the people themselves. We actually went down and kind of co-created, co-produced with them. I said, 'Well, this is what we think. What do you think? Would this work? What would you like to do?' But we used this framework. And we looked at things like, you know, intergenerational, security, co-creation, the built and the natural environment, integrating with the local services. There was a primary care practice close by, very important for access for people, you know. So all of these things we kept in mind and as we talked with them, it's just interesting what they came up with. And I'm not sure whether, I'm curious about whether you have some of these activities in place. So as part of the co-production process, you know, this is what they came up with: a healthy food program. Do you have a healthy food program here? But it was, you know, I guess it was a kind of a knowledge understanding about what healthy foods are. How do you get healthy foods? Where do you get them? Obviously sometimes healthy foods can't be the cheapest, but they can be. They can be if you get creative. A social walking club.

Okay, you're well ahead. Planting, improving the environment. Do you have a program where you're improving the environment, greening the environment, tidy...

Okay. So I'm speaking to the converted here. And also working with local employers. I mean here you are working with Trinity, I mean and Trinity are looking at greening and horticulture and climate change and all these things. So there's great opportunities for synergies here I would say. That's what we've been doing. It's been projects been going on for the last couple of years. We did baseline assessment. We haven't done the follow-up assessment yet. Can't tell you how successful it is except that people love it and they're all talking about brain health down there, you know, and they're not talking about loneliness. So, something must be working. So, I'm going to finish now. I think people are getting time to go. We ready? So, I'm going to just say look, you know, it's a big epidemic. It's impacting health. We have to do something about it. We can and you are working in terms of adapting the community built environment to mitigate loneliness, enhance, you know, the social... it's the social infrastructure and the physical infrastructure. Social infrastructure is yourselves, it's the community, the commune, and then the physical infrastructure is also important to facilitate the interactions. But it's about, you know, building connections, breaking down the silos, and I think this is an ideal place to do that, it really is an ideal place to do that, and then impact on what you do and evaluate what you do. So this is it: connection heals, loneliness harms. And but you can, we can design a way out of this both at the social infrastructure point of view and the physical infrastructure point of view. So I'm leaving you with this cartoon. Is there a cure for... did you know that loneliness can be cured by listening to others? You can only feel alive and whole when others are listening to you. What do you think of that? Think of what? So, but I hope you are listening anyway. But it all starts and ends with you in the community. So, okay, open for questions. Thank you.

All really good questions. So some, it depends on the GP. I mean, and I think that what I, you know, I said I didn't learn any about, learn about this at medical school or at school. And really the important thing is that we were taught in medical school, you know, taking a social history was, you know, are you single? Are you married? Are you divorced? Do you smoke? Do you drink? That was it. Okay. Social history is much more complex than that. And I think that what we're trying to get across to people and to GPs is that, you know, the social history is so important to understand loneliness and isolation so that because, you know, your treatment and what you're going to say to the individual is going to be so important in terms of what we can do about this. So I think we need to do more. I think we need to at least be more training and education but some GPs obviously are wonderful at picking this up and others, you know, maybe not so good and we need more training and education in this regard, you know. So are there programs that you can refer people to? Yes, there are. I mean there are social prescribing. It's, you know, it's now there is a program within the HSE that you can refer people but it's again it needs to be developed more systematically. So and what you need is for the social prescriber you need a link worker. So I can say to you for example, I mean, you know, I try to find out well what is your interest? What do you really want? So me sending you to the rowing club may not be the right thing. You might want to go to the theater. So but I need a link worker to kind of understand and be able to link you into the service or to connect you to really what matters to you, you know. So and I think evaluation, I mean, I think there we need more studies looking at the evaluation of the impact of social prescribing and other interventions. I mean the study we did a number of years ago, a randomized control trial, there are very few trials out there that have looked at befriending for example and the benefits and we showed there were benefits but we only showed that there were short-term benefits and that's one of the issues about social connection and intervention studies that they're, even if they're well-designed, they're short-term, you know. So, you know, really good questions and this is why, you know, people need to dig deeper in this area but I, you know, I'm positive, but there's a lot of work that needs to be done. And I think it's up to you. I think you go to your GP and say I want to, you know, I guess you want to encourage the GP sometimes to ask more questions about that, you know, and say because it's important to your health and sometimes, you know, it's down to the actual, at the end of the day, the consumer to drive change.

Yes. Yes. Yeah, it is. But I mean, I guess that's... it's still, it's very... but because of the impact on health it's so important. Yeah. Yeah.

Yeah. I think this is a really, really important point. We have tried to, we've worked with Respond, we have tried to work with some of the policy drivers in this area because, you know, we started the concept of housing and brain health. So I think people don't fully understand the importance of social determinants of health and housing and I mean it's a huge issue right now, you know, and it's getting to be high-rise design, lack of intergenerational, ghettoing, you know, and this is why actually it's very interesting in this community which I'm hearing about is actually it seems like you may have... it's less of a problem here perhaps than in other areas, you know, where but obviously what happened, you know, I think in the 60s, 70s they took people and just moved them out and none of these approaches were thought through or strategic in any way and I think people don't really appreciate the, you know, the evidence that's accruing now about greening, urbanization, spaces, the importance of connection and, you know, I guess we have to, you know, we should look to Japan now and see what the problems are because that's ahead of us and they're really, it's a huge issue for them and they're trying to come up with innovation, you know, but a lot needs to be done. So and I think again, I think change has to be, you know, I think from this community we need to think about it and again, I'm talking with Mary, maybe these are issues, these are things that in Unit 18 that I think the community could help drive, right, and inform, you know, Respond, maybe we get Respond in here. We also were looking at child homelessness, you know, and the Ombudsman and all of them. These are people they want to do things, they want to change but they need help, you know, we all need, you know what it is, but you're spot on, you're spot on.

Yeah, no, again, you're absolutely right. And professional loneliness, worker loneliness, because they don't have the sort of that little chat, that sort of the water cooler conversation, they don't have the support, and they're dealing with multiple issues at home as well. So it is a rising tide. We have also the social media for our children and our adolescents and young adults, hugely driving loneliness. So we have big problems ahead and we also then have, you know, from the effects of COVID, we have a generation mostly young people who have lost out as well. And so these are big issues and there isn't a lot of strategic thinking around this, you know, and again I think it has to come from the community and the collaboration, you know, to look at these problems grassroots to pull, you know, the policy makers in line. But these are excellent questions. I'm afraid I wish I had better answers, but these are excellent questions.

Just going to say on that point, I mean that's been probably been a huge benefit also to the companies if you think about it.

Everybody because...

Yeah.

Yes. Yeah, but again you have to combat that by creating a new community for yourself. But Jay, you've done that and this is, you've created solutions. You've adapted and I think your point about retirement is absolutely accurate and true in terms of meaning in life and purpose is so important and you have to reinvent yourself. And I think what we find, you look at the retirement studies, most of the time when people decide, they have agency, they decide to retire and they decide what they're going to do and how they're going to do it, no problem, they grow, you know. It's really when people are forced out, can't decide for themselves and they don't have purpose. And so purpose and meaning is a huge issue. We talk about loneliness and health and isolation, meaning and purpose are so important for your health as well. I mean, yeah, we haven't... that's a separate talk, you know, but you're spot on, meaning and purpose is so important in life, not just living, it's for your health and your well-being. Yeah.

Yeah, especially that age. So we just have creative brain... there's a... and we have music on the brain as it were with creative brain, but music is a full brain workout. It really helps your brain health but also we know that, you know, music, arts, creativity is very... it decreases loneliness, decreases anxiety, improves mood. So participation in creativity and arts like music is very good for your brain health but also decreases loneliness. And so in fact, you know, people who play a musical instrument also has their brain changes. So they say one of the really good things, you know, as you get older, I haven't, I mean, I'm thinking about it, but I haven't done anything about it, is maybe should I learn a new instrument, you know, learn to play something different. Because your brain can change. Anybody here learning to play a new instrument or learning a new language?

I lived in the north side for a while. It was different.

Yeah. Yeah. Yeah. You're not, as somebody said, you're not retiring from life. So just very rich questions. I mean, the socioeconomic status, I mean, there is just that the evidence is that if you've got very socioeconomically deprived neighborhoods, you know, that there is more loneliness there, you know. So there is a social determinant of loneliness. You know, what the mechanism of that is not entirely clear but there is a relationship. Less money to go for a coffee.

Your other questions were about the rural.

Well, that's a huge issue. I mean, and again that's been that ball that's been dropped, you know. You don't drive and also when people develop cognitive impairment if they were driving they can't drive. So rural loneliness is a big issue and again not just in older people. I mean again farmers, you know, and again probably contributes to mental health issues, that rural loneliness and that lack of connection. So that again, we have to think, you know, about connecting communities and connecting the island, you know, in a more strategic way.

Okay. So I think, I would say it wouldn't be about lobbying. I think it's probably about people getting together and co-creating and co-producing. So what is it? What is it that you want? How do you want to do it? I think my experience in working with, I suppose 40 years when I started working in the area of dementia for example, it was just the doctor, you know, deciding. That's not the case anymore. You know, we talk to caregivers, we talk to patients, we get an understanding, we try to co-create and co-produce. It's really important. I think that's what you can do.

Yeah. But I do think that's what I would do. And but I think, you know, there is potential. I think there's a lot of innovation here. There's potential to drive that, the music. So you say you're a musician. So is music part of what you do here then?

I'm studying music.

Should I know? Should we? I guess it... so I think we'll feel like we've gone plenty over time. It just shows though the level of interest of the amount of questions. So thank you for participating and thank you for the talk.