— Tech may help but it cannot constitute the whole solution
by Neil Baum MD
The epidemic of loneliness poses a grave threat to public health, just as obesity, social media, or substance abuse does. Occasional loneliness is usually not problematic, as almost everyone experiences loneliness from time to time. However, chronic loneliness is associated with depression, anxiety, and declining physical health.
Approximately 46% of Americans experience loneliness some or all of the time. And the American Psychiatric Association reports that 33% of U.S. residents are lonelier today than before the pandemic. In 2023, the surgeon general, Vivek Murthy, MD, MBA, estimated that the mortality impact of being socially disconnected is even greater than that associated with obesity or physical inactivity.
While some studies find that younger generations report feeling more lonely than older generations, loneliness can affect anyone of any age. Nearly one-third of U.S. adults ages 45 and older report feeling lonely, and the population of lonely people over age 45 has grown by 5 million in the past 8 years. Some lonely patients describe a situation where a physician’s monthly home visit was their only human contact. Both men and women are equally prone to it.
I’d like to focus on loneliness among our older patients, as forming new social connections can become challenging as friends and partners pass away. One option for managing loneliness is artificially intelligent (AI) chatbots. But are they enough to replace the human connection?
The Impacts of Loneliness on Health
Millions of people who live with sparse human contact are more likely to become ill, experience cognitive decline, and even die early. Research indicates that loneliness is a powerful emotional state that urges lonely patients to seek social connections. Isolated or lonely senior have a 50% increased risk of developing dementia, a 30% increased risk of incident coronary artery disease or stroke, and a 26% increased risk of all-cause mortality. Studies suggest that the health effects of loneliness are equivalent to smoking up to 15 cigarettes a day — and we all know the harmful effects of smoking.
Loneliness can also put more strain on our overburdened healthcare system. Older people who are socially isolated or lonely are more likely to be admitted to the hospital or to a nursing home.
Identifying Loneliness
Isolation and loneliness often go together. Four signs of social isolation include loss of interest in activities; lack of personal hygiene; poor nutrition habits; and significant clutter at home.
There are screening tools to help identify loneliness in our patients. The UCLA Loneliness Scale uses 20 items to measure a person’s subjective feelings of loneliness and isolation. Participants rate whether they often, sometimes, rarely, or never feel that they have companionship, for example, or need company.
Solutions for Managing Loneliness
Once we’ve identified signs and symptoms of loneliness in our patients and conducted a screening, the next step is to offer support. Tech is one option.
Chatbots, or AI companions, offer synthetic interactions with lonely patients. This technology can engage in sophisticated conversations with people to offer them a potential coping mechanism to the epidemic of loneliness. After all, talking about one’s problems to an active listener in psychotherapy can be effective in bringing relief. A lonely patient can ask their AI companion questions, and it will respond in a natural, believable way, just like a human would respond.
One study found that AI companions successfully alleviate loneliness on par with interacting with another person and more than some other activities, such as watching YouTube or TikTok videos. Longitudinal studies confirm that an AI companion reduces loneliness over a week of interacting with the chatbots. The most significant reduction in loneliness occurred on the first day, followed by steady decreases in loneliness on subsequent days.
One potential explanation behind the success of chatbots is that they make lonely patients feel heard. Feeling listened to is essential to alleviating loneliness because one of the primary sources of loneliness is the perceived lack of social and emotional support. Just as important as feeling heard, AI companions can express empathy for patients suffering from loneliness.
AI companions actively listen, allowing lonely patients to express their feelings and concerns without fear of judgment or interruption. (Let’s not forget that the average doctor interrupts a patient after just 11 seconds during the doctor-patient encounter!) AI companions can also learn about patients’ unique needs and preferences, tailoring their responses and interactions to support lonely patients.
Beyond just the tech-human interaction, AI companions may be able to help patients connect with local support groups, community resources, or mental health professionals to expand their human-human interaction.
The take-home message is that technological solutions may be part of the solution to alleviating loneliness, but they cannot constitute the whole solution. Physicians need to screen for loneliness just as they do for depression, incontinence, diabetes, and hypertension. Once loneliness is identified, there are options for helping our patients who suffer from loneliness. Physicians can help lonely patients become socially connected — beyond scrolling on Facebook or TikTok.
Neil Baum, MD, is a urologist in New Orleans, the corporate medical officer of Vanguard Communications, adjunct professor of Clinical Urology at the Tulane University School of Medicine in New Orleans, and the author of Marketing Your Clinical Practice-Ethically, Effectively, and Economically, 4th Edition.
