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Loneliness is as lethal as smoking 15 cigarettes a day

By Kelly Klund, LPN
Resourse Nurse, Empira

You have held on through this pandemic and tried to do the right things: you get eight hours of sleep a night, you eat your bright green and orange vegetables, you drink eight glasses of water a day, and you hold doors open for strangers and then POW!!!!!!! You read a blog and learn that loneliness is as lethal as smoking 15 cigarettes a day. As a former smoker I can tell you that smoking 15 cigarettes a day makes you feel like garbage. As a person who was separated from many of the people who are important to me during the height of the Covid-19 pandemic I can tell you that felt like “garbage” too. I get the parallel, but I don’t think that you need me to tell you that the loneliness we have all suffered over the last year because of the lockdowns and quarantines has taken its toll on our mind, body and spirits.

Empira dug into the effects of loneliness and learned some startling facts about the price we pay when we are lonely. The biology of loneliness can accelerate the buildup of plaques in our arteries, help cancer cells grow and spread, and promotes inflammation in the brain leading to Alzheimer’s disease (Social isolation, loneliness in older people pose health risks, 2019). If we experience prolonged periods of loneliness we are more at risk for poor decision making, depression, anxiety, at a higher risk for stroke, we have higher rates cardiovascular impairment, more complaints of chronic pain, and a tendency to fatigue more easily. There is a 50% increased risk to develop dementia and a 26% increase in mortality. Loneliness can kill us, loneliness is just as lethal as smoking 15 cigarettes a day!

Here is the interesting thing about loneliness, it is subjective. Alone ≠ loneliness. According to Cacioppo, loneliness is defined as a state of mind characterized by a dissociation between what an individual wants or expects from a relationship and what that individual experiences in that relationship.

Before we can understand the totality of the impact that loneliness has had on us it is important that we understand the different types of loneliness that we may have been feeling:

  • Personal or intimate loneliness is the absence of a significant person (spouse/ partner, pet) who provides emotional support and affirms one’s value as a person. Did you have to quarantine in your home away from your loved ones? Was it hard?
  • Relational loneliness is the absence of a sympathy group. This is usually about 15-50 people who regularly interact with one another. Examples: Card group, prayer group, immediate family, coworkers. This is a group that you meet with who are going through the same things that you are. Did you cancel family gatherings or suddenly start working from home?
  • Collective loneliness is the absence of a network. Your network is made up of 150-1500 people, who provide support just by being together as part of the same group. Examples: Church family, extended family, organizational memberships. Did your church stop in-person services, did your concert or sporting event tickets get cancelled?

In order to avoid some of the negative mind, body and spirit risks associated with loneliness we must first do some quiet, introspective evaluation. Where in our lives have our expectations about our relationships not been met, either because of forced distance from lockdown or quarantine, or because of other factors in our lives that may have existed or been exacerbated because of Covid?

Knowledge is power, and now that we have learned about the different types of loneliness we may be experiencing it is important that we see some ways that we may respond to address them.

  • Personal or intimate loneliness – what is the “Next best thing”? Can you hug a pillow with your loved ones perfume or cologne?
  • Relational loneliness – Zoom happy hours have replaced the after work get together, and many movie streaming companies have develop the ability to have “watch parties” so people can watch movies together, but from their separate homes. With the CDC relaxing guidelines, is there are small group of your friends and family that can now safely gather?
  • Collective loneliness – Can you join in online events? Most of our Church services are now streamed, many community organizations have moved their meetings to ZOOM or “live” broadcasts. I personally, am much more likely to attend services at home, on the couch in my PJ’s than I was before Covid when services were in person. Some of my favorite performers have hosted free online concerts that can be cast to your living room television and although not in person, I can watch along with other people like we were all together in an arena, without the long drive home.

Addressing your loneliness may require a bit of creativity. Just like many smokers ditched that nasty habit to better their health, I challenge you to take care of your mind, body and spirit and tap into your creativity to connect with the things and people that are important to you.

Cacioppo, S., Grippo, A. J., London, S., Goossens, L., & Cacioppo, J. T. (2015). Loneliness. Perspectives on Psychological Science, 10(2), 238-249.
Galambos, C., & Lubben, J. (2020). Social isolation and loneliness in older adults: A national academies of sciences, engineering, and medicine report. Innovation in Aging, 4(Supplement_1), 713-713.
Holt-Lunstad, J., Smith, T., & Layton, J. (2010). Social relationships and mortality risk: A meta-analytic review. SciVee.
O’Donnell, E. [Woman on window ledge with cigarette].
Social isolation, loneliness in older people pose health risks. (2019). US Department of Health and Human Services – NIH National Institute on Aging.
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Shoot It To Me Straight Doc…

Written by Kelly Klund
Clinical Educator & Program Specialist

My Uncle Harry is more than an uncle to me. As I grew up fatherless and lived with my grandparents, Harry has been an uncle, a brother, a father figure, and most importantly, my friend.

Early this fall, as Harry planned an upcoming fishing trip, he wasn’t feeling quite up to par. Believing he was in fairly good health, he was admitted into the hospital for what was supposed to be a routine gall bladder removal. Unfortunately, the surgery did not end up being routine as expected. During the surgery, the doctor saw the need to biopsy his liver. The result was a diagnosis of end stage liver cancer. Harry was given a prognosis of two months to live without treatment and “maybe double that” if he chose palliative chemotherapy. Receiving this shockingly straight forward prognosis felt like a semi-truck had smashed straight into the heart of our family.

Coincidently, I was preparing for Empira’s next grant: ResoLute (Resident empowered solutions on Living until the end). One of the cornerstones of ResoLute is truthful prognostication. As my professional and personal lives collided, I summoned the courage to ask my Uncle Harry if I could interview him, asking some tough questions about how he felt knowing he was facing the end of his life.

During our interview, Harry said it was most important he knew the truth about his prognosis. He told me he looked at the doctor and said “Shoot it to me straight doc”. The prognosis was devastating, but the physician’s honesty gave him a sense of urgency around the work that was left to do, the relationships he had to heal, the affairs he had to get in order, and the things he had left to say.

Karen Hancock did a review on discussing prognosis in advanced life-limiting illnesses and stated “many health professionals express discomfort at having to broach the topic of prognosis, including limited life expectancy, and may withhold information or not disclose prognosis. Reasons include perceived lack of training, stress, no time to attend to the patient’s emotional needs, fear of a negative impact on the patient, uncertainty about prognostication, requests from family members to withhold information and a feeling of inadequacy or hopelessness regarding the unavailability of further curative treatment”, (Karen Hancock et al., 2007).

Another supporting journal publication by Fallowfield, Jenkins, and Beveridge discuss how deceit hurts even more than a painful truth could hurt. They state, “Ambiguous or deliberately misleading information may afford short-term benefits while things continue to go well, but denies individuals and their families opportunities to reorganize and adapt their lives towards the attainment of more achievable goals, realistic hopes and aspirations” (Fallowfield, Jenkins, & Beveridge, 2002).

In his book “Being Mortal” Atul Gawande says, “The chance to shape one’s story is essential to sustaining meaning in life” (Gawande, 2014). For our family, truthful prognostication has given Harry the opportunity to shape to his story. We are thankful for the time to do the undone, and for knowing the time to plan the next fishing trip is NOW.

If you or a loved one had a life limiting illness would you value truthful prognostication or in the words of Scarlett O’Hara subscribe to the belief that “I can’t think about that right now. If I do, I’ll go crazy. I’ll think about that tomorrow.”?





Fallowfield, L. J., Jenkins, V. A., & Beveridge, H. A. (2002). Truth may hurt but deceit hurts more: communication in palliative care. Palliative Medicine, 16(4), 297-303. doi:10.1191/0269216302pm575oa

Gawande, A. (2017). Being mortal: Medicine and what matters in the end. New York, NY: Metropolitan Books, Henry Holt and Company.

Hancock, K., Clayton, J. M., Parker, S. M., Wal der, S., Butow, P. N., Carrick, S., … Tattersall, M. H. (2007). Truth-telling in discussing prognosis in advanced life-limiting illnesses: a systematic review. Palliative Medicine, 21(6), 507-517. doi:10.1177/0269216307080823