Why family is the secret to better health outcomes

Strong social networks later in life are not only good for our health, but can also save costs for individuals, families and the public purse

Why have humans, over millennia, felt compelled to be social? For our ancestors, forming social connections was of evolutionary benefit as it improved our chances of both survival and successful reproduction(2). Nowadays, we still feel the instinctual drive to pursue and nurture relationships, and studies have shown that close relationships with family and friends can directly benefit our health(1).

These ancient evolutionary needs have a lasting impact on us today. The bond that we share with others can have a bigger effect on our risk of getting diseases or dying than quitting smoking, with humans feeling actual pain if this fundamental need is not being met(2). The pain is caused by the activation of the body’s stress response, and the release of a hormone called cortisol. This warns us that the body’s stable equilibrium has been disrupted, and we mobilise energy to restore that state. However, chronic activation of the stress response has a negative impact on health(3), and the immune system.

That said, it’s not all bad news – the release of oxytocin and endorphins when we engage in social activity gives us positive reinforcement, increasing our feelings of trust and activating the reward centre in our brain. Feel-good chemicals like serotonin and dopamine are also released, further encouraging us to associate being social with feeling good(3).

If loneliness should motivate us to seek out social contact, why do some people do the opposite?

The activation of the stress response, when someone is lonely, has additional side-effects. It puts the body in ‘fight’ mode, and therefore it can cause someone to be (unconsciously) hyper-vigilant for social threat. An individual in this state will be more likely to place greater importance on any negative social interactions, which can reinforce social withdrawal and further feelings of loneliness(31).


Why is it important to maintain these connections in later life?

Loneliness and social isolation can affect anyone at any time in their life. Older adults, however, often have additional factors to reckon with; health, mobility and memory problems can worsen, impacting their social world(7), the likelihood of losing a partner increases(6), and on top of that, digital exclusion is a growing threat. Those who move into care homes face further disruption to their social network and community(12). For these reasons we must pay particular attention to this group.

Lonely seniors are 40% more likely to get dementia(5), and in the US, 13,200 excess dementia deaths during the pandemic were partially caused by social isolation(17). Likewise loneliness has been associated with factors that increase the risk of cognitive impairment, such as hypertension, obesity and diabetes(5), an increased likelihood of physical(8) and functional decline(9) and of acquiring a disability at a younger age(10,11). In this process, people can start to feel like they have become a burden to loved ones, and therefore the risk of developing depression increases(13).

Additional health problems of an elderly relative can put a lot of pressure on other family members. There’s been a rise in ‘sandwich’ carers who both care for their parents and children; these individuals are usually overstretched, have poor mental health and can struggle financially(14). Additional problems may also increase the cost of care, which is expensive for a lot of families.

Family interaction and health

Many positive health habits – such as diet, physical activity, alcohol consumption(15), hand hygiene(17) and management of health conditions(15) – are more likely to be maintained by individuals with greater social interactions. It’s believed this is down to the influence of those around us, who can have the ability to control our behaviour simply by instilling a sense of responsibility, concern and motivation(15,17). Friends and relatives might also provide health knowledge, which may mean that for someone who is isolated, they might not have come across this information themselves. All in all, close relationships help people to grow and reach their health goals(2).

Family interactions can also be known to improve physical and mental health directly. Social support reduces the cumulative biological toll of stress on the body(15), boosts the immune system and reduces the reactivity of the circulatory system to anticipated and existing stressors(15). The more someone interacts with others, the less likely they will develop dementia(16) or die from a medical condition(15). Interactions foster a sense of meaning and purpose(15); and improve mood, perceived personal control and enhance adaptive coping in more difficult situations. In addition, people who feel more understood and accepted view the physical world as less daunting - such as perceiving a hill to be less steep(2).

But what about those who don’t have family? Around the world, there is a rise in the number of people with no family members. There are two primary reasons for this; one being poorer health in some countries, but improved health in the elderly in others(20). Childlessness doesn’t significantly lead to reduced well-being either(18). This may be because it’s been found that those who lack family have more friends in their immediate networks, and value them more highly(19). Likewise, befriending has been found to reduce feelings of loneliness, depression and improve confidence and physical health, in place of other connections(21,22,23). Therefore keeping in touch with friends is also an important activity to maintain in older age.

A perceived sense of social connectedness serves as a scaffold for the self—damage the scaffold and the rest of the self begins to crumble.

– Hawkley, Louise C., and John T. Cacioppo, 2010(24)

Impact on social care

Perhaps surprisingly, how connected someone is to their family can impact on the social care outcomes detailed in the Adult Social Care Outcomes Framework (ASCOF)(30). For example, increased connection would lead to more service users reporting that they have as much social contact as they would like(30). Likewise, by aiding elderly residents to connect with family to reduce loneliness or isolation, social care workers can improve the resident’s quality of life(30).

Doing this allows people to feel like, or have, greater control over their daily life(15,30). Those who connect with their family members also receive more support and information to allow them to receive self-directed support(25,30).

Finally, elderly people without social connections are more likely to be re-hospitalised(30,26), have a greater number of nursing home stays over their lifetime, and need to use care services more(21,30). When elderly people do need care it has been found that socially-connected service users are more likely to be happy with the care and support they receive(28,30), and more likely to feel safe(29,30).

Why social connections are the secret to better health outcomes

Social connections have been shown to be hugely beneficial for the elderly, with family playing a particularly important role. Close connections with family members, and their involvement in care, can improve their elderly relatives’ health, allowing them to live longer lives of better quality. Connection can reduce reliance on healthcare services, reducing costs for themselves, their families and the public purse. They can gain more control of their lives and enable them to actively take part in their care. It is also very important to note that this alleviates pressure on family members too, which will have long-lasting impacts on the lives and relationships of their loved ones, and their health too(14).

An elderly woman sits in an armchair with a cup of tea.

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According to Eurostat, in the EU, 87 percent of people aged 75 years and over have never been online (2018).

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