Memento Mori and the Physiology of Relationships

 

    Working with hospice patients and spending time with people at the end-of-life is critical to my passion for healthcare. One key element I have witnessed is the necessity of social relationship, especially approaching death. Here, I aim to assess the physiology behind relationships and reflect on the ethics of how providers and people in general can build better relationships with people who are dying.

 

    The connection between social interaction and health is best linked through physiology. The benefits of positive social relationships are improved immunity, endocrine, cardiovascular function, mental health, and lower stress response. Social support also inclines people to be more compliant in their treatments. Important to understanding how relationships influence health is people's sympathetic nervous system (SNS). Chronic SNS activation leads to higher HRs and BPs. Overtime, these contribute to risk for CVD, CHD, and Diabetes. However, with support groups, people can lower their chronic SNS. Relationships that help can in part be measured by levels of hormones like oxytocin and vasopressin. Oxytocin has been shown to play a key role in social attachment, maternal care, and social cues. With proper levels of oxytocin, people also have lower levels of anxiety, and perform better. Vasopressin levels also appear to be involved with pair bonding, social recognition, and aggression. Higher levels make people more likely to cooperate and connect. Low socialization leads to both low oxytocin and vasopressin. The combination of these physiological shifts without social interaction increases morbidity and mortality. In short, low socialization risk is as notable as that involved with obesity, smoking, hypertension, or a sedentary lifestyle.

 

    With this in mind, we can imagine how people who are in dying can benefit from social interaction. The actual statistics for visitors at nursing homes or other care facilities are not clear. However, it is easy to interpret how raised anxiety levels at end-of-life could be moderated by connection. Likewise, the agitation and lack of cooperation often seen in dementia or memory care patients could be mediated by vasopressin increases. I have encountered countless older adults without families or with families who live far away. This lack of social connection is unjust and should be addressed as future providers. As compassionate professionals working to cultivate a culture that equity, we ought to embrace end-of-life care through collaborating with palliative physicians and at the very least making intentional connections with patients in their final days. While the elderly tend to be my area of passion, perhaps as we approach the holidays, we can reach out to someone lonely to improve their health and ours. Especially with COVID, our need for socialization (for our future health and well-being) is critical. 

Umberson, D., & Montez, J. K. (2010). Social relationships and health: a flashpoint for health policy. Journal of health and social behavior, 51 Suppl(Suppl), S54–S66. https://doi.org/10.1177/0022146510383501

Ozbay, F., Johnson, D. C., Dimoulas, E., Morgan, C. A., Charney, D., & Southwick, S. (2007). Social support and resilience to stress: from neurobiology to clinical practice. Psychiatry (Edgmont (Pa. : Township)), 4(5), 35–40.

Gaugler J. E. (2005). Family involvement in residential long-term care: a synthesis and critical review. Aging & mental health, 9(2), 105–118. https://doi.org/10.1080/13607860412331310245

Brunnlieb et al. (2016). Vasopressin increases cooperative behavior. Proceedings of the National Academy of Sciences, 113 (8) 2051-2056; DOI: 10.1073/pnas.1518825113