1 in 7 American adults live alone
COVID and social isolation is part of our lives. During COVID, it became easier to recruit patients for clinical trials. Like increased online shopping during social isolation of COVID? How do deal with patients who are home alone and in a clinical trial?
But — somehow, that seems only part of the story. What happens after a person at home joins a clinical trial. What happens if they are home alone?
In her book, “Alone Together” Sherry Turkle says that social networks are more like mutual isolation networks that detach people from meaningful interactions with one another and make them less human. Listen to her talk on TED. It’s fascinating and may change the way you think about phones and social media.
Increasingly, individuals in developed and developing countries are living away from extended family or friends. There is substantial epidemiological evidence that social isolation may alter neurohormonal-mediated emotional stress, influence health behavior and result in cardiovascular (CV) risk.
Can patient-oriented social networking sites such as patientslikeme.com help mitigate the risk of disease by connecting people and are those online transactions a substitute for listening, real friendships and really revealing ourselves to each other?
In this article, Danny Lieberman, founder of flaskdata.io, discusses risk, risk mitigation and how we can use digital technology to help us discover and get most of the human connection in clinical research and clinical care.
(Flaskdata.io is a Digital CRO – specializing in patient adherence in decentralized clinical trials.
Living on your own is something that we all dream about when in high school.
Living alone is great when you’re a 20 or 30 something with its social and economic benefits, but as people get older, living alone carries growing risk from social isolation.
The degree to which people are integrated with others may be as strongly predictive of incident myocardial infarction (MI) and coronary heart disease (CHD) survival as smoking, elevated cholesterol levels, and hypertension.
A recent article in the Archives of Internal Medicine Living Alone and Cardiovascular Risk in Outpatients at Risk of or With Atherothrombosis reports on research by Jacob Udell et al on whether living alone is associated with increased mortality and cardiovascular risk.
What is atherothrombosis?
Atherothrombosis is the major cause of acute coronary syndromes (ACS) and cardiovascular death.
It is the leading cause of mortality in the industrialized world.
Atherosclerosis is a diffuse process that starts early in childhood and progresses asymptomatically through adult life. Later in life, it is clinically manifested as coronary artery disease, stroke, transient ischaemic attack, and peripheral arterial disease.
See http://eurheartj.oxfordjournals.org/content/25/14/1197.full
If you are age 40 to 60 and live alone, your CV system is at high risk
The prevalence of living alone increases with age. Among participants aged 45 to 65 years, 66 to 80 years, and older than 80 years, 13.6%, 19.8%, and 34.6%, were living alone, respectively.
Living alone is also associated with an increased prevalence of CV risk factors, including hypertension, kidney failure, obesity, heart failure and smoking.
The risk of death from acute coronary syndromes for people who live alone, peaks in middle-age and dramatically goes down for people who lived alone who are over 80.
In participants 45 to 65 years of age, among whom living with others was more common, living alone was associated with a significantly higher risk of all-cause and CV mortality compared with participants living with others.
Although the prevalence of living alone nearly tripled among those over 80 years, living alone was not associated with a higher risk of mortality in the oldest participants.
Thus, living alone at a younger age may be a marker of a stressful psychosocial situation, such as job strain or isolation, with adverse neurohormonal effects on the CV system, that may have more impact in youth to influence health behavior and wellness.
Can social networking mitigate the risk of living alone?
With the ubiquity of Facebook, Twitter and social media sites like stumbleupon.com, it is natural to ask — does social networking for healthcare applications can mitigate the sense of isolation and therefore mitigate CV risk factors by connecting people who live alone with other people?
Despite the old proverb, misery loves company, the answer is probably not.
The popular patient site, patientslikeme.com extolls the wonderfully supportive aspects of the online patient community. Of course they do, they have to promote their web site.
MIT Professor Sherry Turkle believes otherwise
Social networks detach people from meaningful interactions with one another
In her book, “Alone Together” Sherry Turkle says that social networks are more like mutual isolation networks that detach people from meaningful interactions with one another and make them less human. Listen to her talk on TED. It’s fascinating and may change the way you think about phones and social media.
We expect more from technology and less from each other
CV risk for people living at home is real but it cannot be mitigated by logging on to Facebook or tweeting or exchanging messages on a patientslikeme.com forum. The little “sips” of conversation we have on social media are not a substitute for a real meeting or phone call and a complete conversation between two people.
In the case of people living at home, the necessity is real friendships and real interactions with real primary care teams.
Digital technology enables real interactions with real primary care teams.
People who are at risk of cardiovascular (CV) disease need connections with real people who are also healthcare providers (and not just meaningful users tapping data into their Federally approved EHR systems…).
There is the demand side (the patients and people that live alone) and the supply side (the healthcare providers that can help people be healthier but are already stretched too thin).
Digital technology based on private social networking for healthcare, is a tremendous force multiplier for primary care teams. A nurse can work with 100 home-alone people / day instead of 5. A front-line paramedic can screen queries from 300 people/day and connect them to a specialist as warranted.
Healthcare delivery using digital technology to people who live alone is cheap, because we eliminate office costs, travel costs and many of the IT costs by making the most of mobile and private networking technology without having to carry the cross of electronic medical records and government mandated data sharing.
When a nurse, or paramedic or specialist has the time to explain things, patients feel respected and they remember the encounter as a positive experience and are more likely to take the nurse/paramedic/physician advice.
Most people do not live alone out of choice and in order to get to a higher level of social interactions and friendships, they need to take it step by step — especially if they are middle-aged and set in their ways.
It’s best done face-to-face, but if you are home alone and at risk, with low access to a healthcare provider (like many people in poor neighborhoods/countries) — mobile access and a digital connection may be that first step towards a higher level of social interaction and eventually friendship.
This was first published on Medium at Can digital mitigate the risk of living alone
