Growing old often means also growing lonely
Seniors need specific social supports to combat feelings of isolation and loneliness, experts say
For years, Linda Fried offered older patients who complained of being lonely what seemed to be sensible guidance. “Go out and find something that matters to you,” she would say.
But her well-meaning advice didn’t work most of the time. What patients really wanted were close relationships with people they care about, satisfying social roles and a sense that their lives have value. And this wasn’t easy to find.
We need “new societal institutions that bring meaning and purpose” to older adults’ lives, Fried recently told a committee of the National Academy of Sciences investigating loneliness and social isolation among older adults. (Fried is a geriatrician and dean of the Mailman School of Public Health at Columbia University.)
The panel’s deliberations come amid growing interest in the topic. Four surveys ( by Cigna, AARP, the Kaiser Family Foundation and the University of Michigan) have examined the extent of loneliness and social isolation in older adults in the past year. And health insurers, health-care systems, senior housing operators and social service agencies are launching or expanding initiatives.
The effectiveness of these programs and others remains to be seen. Few have been rigorously evaluated, and many assume increased social interaction will go a long way toward alleviating older adults’ distress at not having meaningful relationships. But that isn’t necessarily the case.
“Assuaging loneliness is not just about having random human contact; it’s about the quality of that contact and who you’re having contact with,” said Vyjeyanthi Periyakoil, an associate professor of medicine at Stanford University School of Medicine.
A one-size-fits-all approach won’t work for older adults, she and other experts agreed. Instead, varied approaches that recognize the different degrees, types and root causes of loneliness are needed.
DEGREES OF LONELINESS
The headlines are alarming: Between 33 and 43 per cent of older Americans are lonely. But those figures combine two groups: People who are sometimes lonely and those who are always lonely.
The distinction matters because people who are sometimes lonely don’t necessarily stay that way. And the potential health impact of loneliness — a higher risk of heart disease, dementia, immune dysfunction, functional impairment and early death — depends on its severity, said Julianne Holt-lunstad, a professor of psychology and neuroscience at Brigham Young University.
The number of people in the highest risk category is relatively small, as it turns out.
Four per cent said “always” and 27 per cent said “sometimes” when AARP asked, “How often do you feel lonely or isolated from those around you?” to adults who participated in its survey last year.
Loneliness isn’t always negative, and seniors shouldn’t panic if they sometimes feel this way. Often, loneliness motivates people to find a way to connect, strengthening social bonds.
TYPES OF LONELINESS
Loneliness comes in different forms that call for different responses. According to a well-established framework, “emotional loneliness” occurs when someone feels the lack of intimate relationships. “Social loneliness” is the lack of satisfying contact with family members, friends, neighbours or other community members. “Collective loneliness” is the feeling of not being valued by the broader community.
Some experts add another category: “existential loneliness,” or the sense that life lacks meaning or purpose.
Carla Perissinotto, associate chief for geriatrics clinical programs at the University of California at San Francisco, has been thinking this recently because of her 75-year-old mother, Gloria. Widowed in September, then forced to stay home for three months after hip surgery, Gloria became profoundly lonely.
“If I were a clinician and said to my mother, ‘Go to a senior centre,’ that wouldn’t get at the core underlying issues: my mother’s grief and her feeling, since she’s not a native to this country, that she’s not welcome here, given the political situation,” Perissinotto said.
What has helped Gloria is “giving voice to what she’s experiencing,” Perissinotto said.
Also, friends, former co-workers, family members and some of Perissinotto’s high school buddies have rallied around Gloria.
“We need to understand what’s driving someone’s loneliness situation before suggesting options,” Perissinotto said.
ROOT CAUSES OF LONELINESS
One of the root causes of loneliness can be the perception that other people have rejected you or don’t care about you. Frequently, people who are lonely push others away because of perceived rejection, which only reinforces their isolation.
Cognitive behaviour therapy, which teaches people to recognize and question their assumptions, is often recommended.
Relationships that have become disappointing are another common cause of loneliness. This could be a spouse who has become inattentive over time or adult children or friends who live at a distance and are rarely in touch.
“Figuring out how to promote quality relationships for older adults who are lonely is tricky,” Holt-lunstad said. “While we have decades of research in relationship science that helps characterize quality relationships, there’s not a lot of evidence around effective ways to create those relationships or intervene” when problems surface.
Other contributors to loneliness are easier to address. A few examples: Someone who has lost a sense of being meaningfully connected to other people because of hearing loss — the most common type of disability among older adults — can be encouraged to use a hearing aid. Someone who can’t drive anymore and has stopped getting out of the house can get assistance with transportation. Or someone who has lost a sibling or a spouse can be directed to a bereavement program.
“We have to be very strategic about efforts to help people, what it is they need and what we’re trying to accomplish,” Holt-lunstad said. “We can’t just throw programs at people and hope that something is better than nothing.”
Assuaging loneliness is not just about having random human contact; it’s about the quality of that contact and who you’re having contact with.
This column is produced by Kaiser Health News, a non-profit news service. It is an editorially independent program of the Kaiser Family Foundation and is not affiliated with Kaiser Permanente.
For the Washington Post