Loneliness in the Elderly and How to Prevent It
Loneliness is a serious problem for today’s seniors. Mon Ami takes stock of the epidemic of elderly loneliness, along with ways to ameliorate it.
The Loneliness Epidemic Among Seniors
Anywhere from a quarter to just over a third of American seniors suffer from loneliness. In September of 2018, an AARP survey found some 35% adults aged 45 or older reporting loneliness and social isolation. This acute loneliness epidemic presents a serious concern for community and personal well-being and for public health. As the HRSA points out:
“As a force in shaping our health, medical care pales in comparison with the circumstances of the communities in which we live. Few aspects of community are more powerful than is the degree of connectedness and social support for individuals.”
According to a recent study by Julianne Holt-Lunstad, loneliness and social isolation can be as physically damaging as smoking 15 cigarettes a day. Nothing is harder for the children of aging parents, or the friends and loved ones of elderly adults, than to watch on helplessly as the ones they care about struggle with a vicious cycle of increasing solitude and depression. That’s why now more than ever, it’s important to understand the causes of loneliness in the elderly and to be aware of all the methods available for addressing them.
Defining Loneliness and Social Isolation
To fully understand the nature of the problem, it’s useful to clarify just what the terms “loneliness” and “social isolation” mean. It is not always true that people who are often alone will experience loneliness: a person can be socially isolated in a crowd and socially contented while alone. That said, Holt-Lundstad defines social isolation this way:
“Living alone, having few social network ties, and having infrequent social contact are all markers of social isolation. The common thread across these is an objective quantitative approach to establish a dearth of social contact and network size.”
Loneliness is related to this phenomenon, but it’s also distinct:
“. . . loneliness is a subjective emotional state. Loneliness is the perception of social isolation, or the subjective experience of being lonely, and thus involves necessarily subjective measurement. Loneliness has also been described as the dissatisfaction with the discrepancy between desired and actual social relationships . . .“
Social isolation is often a predictor of loneliness, and it’s for this reason that these terms are discussed in this article as being closely linked. The nature of loneliness in particular makes it necessary to look for solutions that address not just the number of social contacts a person has, but also the quality of their relationships.
“The Loneliest Generation”
There’s some divergence in the public image of who constitutes today’s “loneliest generation,” with some studies identifying “Generation Z” as the most affected group even as other outlets place the focus on the many Americans who are aging alone. While it’s important to have an accurate statistical picture of the phenomenon, it’s also arguably the case that what matters most is not to get too bogged down in the question of who is most affected. For that matter, it’s also important not to get wrapped up in arguments about whether loneliness is or isn’t increasing over time, or whether it’s an “epidemic” in the strictest sense of that term. What’s far more important is to recognize that loneliness is a serious contemporary problem for Americans in general — not to mention other countries around the world — and that addressing the specific problems faced by seniors is a key part of this overall picture.
It’s Even Worse for LGBT Seniors
Rates of loneliness are substantially higher among LGBT seniors than they are among non-LGBT seniors: an alarming 49% of LGBT seniors report feeling lonely or isolated according to AARP’s survey. Histories of discrimination (and the fear of discrimination), a frequent lack of children to help them in old age and general disparities in their access to financial security, health services, transportation and housing all contribute to a tougher old age and greater risk of loneliness. It’s worth keeping in mind that all of the effects of loneliness in the elderly discussed here are on average felt even more keenly and in greater numbers by LGBT seniors.
Coverage In the Media
The issue of loneliness among seniors has generated a variety of kinds of coverage in recent years. Often these are targeted on local programs focused on alleviating loneliness, some of them centered around public health initiatives in various countries and others decidedly more quirky (such as a trial initiative involving robotic pets). At other times, the focus is a bit broader, on larger issues that are purported to be pivotal to loneliness, such as articles noting that at least a third of seniors are effectively left out of the internet age and claiming this is a contributor to social isolation. (An approach that presents a bit of a conundrum, since the internet itself is frequently argued to be a contributor to social isolation.) Overall, the media coverage of elderly loneliness indicates a rising awareness of the issue, but also the absence of a real consensus on how to approach it.
Driving Awareness: Former US Surgeon General Vivek Murthy
One key figure in driving public awareness of loneliness has been Vivek Murthy, former US Surgeon General and the first to label the issue an “epidemic” during his tenure from 2014 to 2017. He recounts his journey toward awareness of the larger issue this way:
“. . . I was really taught about this subject by people all across the country in the United States, who, when I visited their communities, would tell me stories of their struggles with addiction and violence, and with chronic illnesses like obesity, with mental illnesses like anxiety and depression. What was often unsaid were these stories of loneliness, which would take time to come out. They would not say, “Hello, I am John Q, I am lonely.” What they said was “I have been struggling with this illness, or my family is struggling with this problem,” and when I would dig a bit it would come out.
“Then I started to surface the topic more deliberately. I started to ask people about loneliness. What I found was that after an initial pause, the stories would come out. And everyone had a story to share, whether it was about themselves or someone else.”
Murthy has played a critical role in putting forth the argument that, while there isn’t as yet the kind of supporting data on loneliness that exists for the study of ailments like diabetes or heart disease, there is still a strong case to be made that it is prevalent, common, and robustly associated with a wide range of other illnesses. He has further made the important point that “we start this effort to address loneliness by asking ourselves what can we do in our own lives in our own homes, and our own neighborhoods, to help make people feel connected.”
Worries About Aging Parents: What Can You Do?
If you’re worried about an aging loved one who may be struggling with loneliness, and wondering how best to support them, you’re far from alone. The issue is becoming more and more commonly expressed and discussed and provides an occasion for relatively frequent advice listicles in the media. The approach taken here is to start from the ground up, to identify the causes of the loneliness epidemic and go from there to suggest practical ways you can support your loved ones.
What’s causing the Loneliness Epidemic?
Loneliness for seniors tends to have numerous contributing factors rather than a single cause. According to the aforementioned AARP survey, for example, it correlates strongly with lower incomes, the contraction of one’s social network and turning to isolated activities such as watching television or surfing the internet in order to cope. Further major indicators of loneliness are discussed below.
Grief: The Loss of Friends, Relatives or a Spouse
One of the most powerful drivers of loneliness in the elderly is grief. The loss of friends and loved ones is something that takes place throughout one’s life, but as these losses mount with old age and combine with the host of physical and mental changes and possible impairments that come with the territory, the impact of grief can grow more profound. As Psychology Today puts it:
“Those who lose a spouse at this time in their life are particularly vulnerable to dying from a cardiac event. Grief can also be associated with the loss of self and the person we used to be. Even if we are fortunate to have family around us, we can still mourn the loss of those our own age that knew us and understood us.”
Even the physical impact of grief is different for the elderly. Stress, one of the most powerful products of grief, can render the body’s immune system more vulnerable to disease and opportunistic infections. It can indirectly increase the risks from dementia and contribute to anxiety, depression and other ailments.
Age Segregation & Living Alone
Living alone can lead to social isolation, making it a major risk factor for loneliness. A recent report from the National Poll on Healthy Aging found that of seniors living alone, 60% felt a lack of companionship and 41% felt isolated. Combined with this is the fact that most American seniors live in communities that are age-segregated from younger generations and the enlivening cross-generational friendships that can result from being in contact with younger people. One recent study in Aging & Society found that just 6% of adults over 60 report discussing important questions with non-family members under the age of 36. The lack of age-integration can have a negative impact on building meaningful, fulfilling social networks, as the authors of that study explain:
“Age integration at the level of personal networks is relevant because network members play an important role in integrating individuals (of any age) into the larger society. Through network members, information and ideas are shared, new ways of thinking and living are discussed, and advice is exchanged. Network members exchange social, emotional, material and informational support that promotes well-being. Through networks individuals are recruited into social movements and organisations, which provide further opportunities for developing personal bonds . . . Thus it is likely that older people whose personal networks lack younger members may be excluded from full participation in the society in which they live.”
The extent to which seniors tend to be channeled increasingly into seniors-only spaces, particularly through seniors centers, assisted living facilities and nursing homes, just reinforces these challenges.
Loss of Access to Transport & Activities
At least a quarter of seniors don’t drive, with the non-driving share of senior demographics rising with accumulated years. Especially in car-centric communities, the loss of driving ability — or in some cases of the income needed to maintain a car — can lead to isolation, with many of those affected going entire weeks without leaving their homes. The lack of contact with the outside world can also lead to being cut off from activities and social groups people once enjoyed.
The Downward Spiral of Loneliness
Particularly when people are afraid to discuss their loneliness for fear of seeming like a burden, or when they blame themselves for loneliness or feel useless in their communities, isolation can become a downward spiral. Elderly people suffering from loneliness, when that loneliness is reinforced by lack of access to practical transportation, by age segregation and the deterioration of social networks and meaningful social interactions, can come to feel more and more excluded, and as a result, become even less likely to engage in activities that would help to combat their loneliness. This can, in turn, lead to health problems that make breaking out of isolation even more difficult.
Health Impacts: Depression, Dementia & Cardiovascular Health
One of the biggest worries confronting those with loved ones who are suffering isolation and loneliness are its serious impacts on both physical and mental health. Its effect on general mortality is comparable to well-known risk factors like obesity and cigarette smoking, and overall it increases the risk of mortality by 26%. It’s associated with a greater likelihood of coronary disease and strokes, with rising high blood pressure, and with the onset of disability. It’s also associated with substantially higher rates of depression and with a whopping 64% increased chance of the onset of clinical dementia in some form.
Alarming as all this may sound, the good news is that these risks can be mitigated by taking the appropriate steps. Nevertheless, it’s necessary to fully understand the health effects of loneliness in order to convince a loved one, or fellow-members of that loved one’s potential support networks, of the importance of addressing loneliness.
The Relationship Between Loneliness and Depression
Clinical depression, or Major Depressive Disorder, is a serious condition which manifests through a specific cluster of symptoms:
- Negative thinking, including an inability to see positive solutions
- Agitation, restlessness and inability to focus
- Irritability and lashing out at loved ones
- Withdrawal from regular activities and loved ones
- Disturbed sleep patterns (esp. an increase in sleeping)
- Lethargy and exhaustion
- Morbid and suicidal thoughts
- Weight loss or gain
A recent statistical overview in the journal Pyschiatry concluded that loneliness, “a perceived and undesired social isolation,” is “a unique risk factor among the many that are known to contribute to the development of major depressive disorder.” Where social interactions aren’t perceived as meaningful or are attended by a fear of judgment and other “social threats,” where activities are often carried out in solitude and where there is objective social isolation (physical isolation from social groups and support networks), the risk of developing depression increases. Depression, in turn, can rob the affected person of energy, tempt them to lash out at the very people who could help break their isolation and affect their physical health in ways that make it harder to get out of the house and get active.
All these risks apply to people of any age who experience prolonged states of loneliness. In the elderly, though, the higher risk of depression also indirectly increases the danger from another set of maladies collectively referred to as dementia.
The Relationship Between Depression and Dementia
The precise nature of the link between depression and forms of dementia like Alzheimer’s isn’t well understood yet. What is known is that while there isn’t necessarily a direct cause-and-effect relationship, depression is an apparent risk factor for the development of dementia and vice versa. In Britain, for example, a recently-completed study of seniors found that 22% of those who were depressed at the beginning of the study went on to develop dementia (compared with just over 16% of those without depression). The development of depressive behaviors in seniors may indicate early, pre-diagnostic changes in the brain for a person beginning to manifest a disease like Alzheimer’s, or may indicate some other as-yet-unknown link between the two conditions.
The significance of this for depression linked to loneliness is not necessarily that loneliness in itself will cause dementia. Rather, it’s that depression caused by loneliness could well obscure or conceal the onset of dementia, because it becomes difficult to know whether signs of major depressive disorder are the result of social circumstances or of some kind of deeper cognitive change. For that reason alone, simply for the purpose of being able to clearly identify the signs of dementia early on, it’s well worth it to take steps to address depression caused by loneliness to avoid its clouding the diagnostic picture.
The Relationship Between Loneliness and Cardiovascular Health
Loneliness was identified as a risk factor for cardiovascular disease as early as 1992, when a study showed a 32% higher incidence of mortality from coronary heart disease among unmarried people lacking a confidant than among patients with a spouse or partner. More recent studies have shown that loneliness and social isolation correlate strongly with risks of heart disease, stroke, hypertension and high blood pressure. The behavioral changes associated with loneliness, combined with its direct stress-related impacts on the nervous system (and other regulatory systems of the body), accelerate these kinds of risks. This is what’s behind the common claim that loneliness is “as lethal as smoking 15 cigarettes a day.”
Depression & Loneliness Can Be Contagious
It may seem counterintuitive, but depression and loneliness can be surprisingly contagious conditions. People suffering from depression, for example, exhibit a “tendency to interpret events negatively, to feel hopeless or helpless when [encountering] challenges, and to brood over negative events and feelings.” Being in prolonged personal contact with such people, either living with them or through one’s social network, can render those attitudes infectious. Loneliness, too, spreads through a similar contagion process:
“Another recent study examined the spread of loneliness within social networks over time and found that loneliness spreads through a clear contagion process. People who had contact with lonely individuals at the start of the study were more likely to become lonely themselves by the end of it. The researchers even found a virulence factor. The closer someone was to a lonely person, the lonelier they reported themselves to be later on.”
It takes careful awareness of this danger, a willingness to check and correct one’s own negativity and an overall drive to seek out positive connections in order to avoid this kind of contagion. Fortunately, these will often come naturally to those who are taking proactive steps to manage loneliness.
Proactive Steps to Managing Loneliness
Now that we’ve identified the causes and effects of the loneliness epidemic comes the obvious question: what can we do to manage its effects and help ensure a better quality of life for at-risk seniors? It’s widely agreed across a range of systematic studies, such as the AARP study linked earlier in this very article, that taking proactive measures to fortify yourself against loneliness is the best approach.
Active seniors tend to feel less lonely. Moderate exercise three or four times a week correlates with loneliness rates from 6 – 9% lower than among those who don’t exercise. The opportunity for intimate contact and partnership also has a major impact on loneliness: seniors who are able to enjoy sexual intimacy once a week or more are 12% less likely to be lonely than those who enjoy such contact only once a month, and 21% less likely to feel lonely than those who are celibate.
Seniors who enjoy healthy sleep patterns and get from five to eight hours of sleep per night are 25% less likely to be lonely than those who get four hours or less sleep in a night. They’re also 7% less likely to be lonely than those suffering from a sleep disorder.
Regular Social Contact
The “one conversation a day” principle is frequently cited as a way of staving off loneliness, and AARP’s data tends to support that claim. Seniors who know their neighbors and have friendly relations with them, and who are also regularly in touch with other friends and family through texting or video conferencing, enjoy substantially lower rates of loneliness than those who don’t have those kinds of regular social inputs.
Access to Transportation
Where possible, the data on loneliness indicates it should be a priority for seniors to seek out places that will offer diverse transportation possibilities. Where the elderly have access to a wide set of options including public transportation, ride-shares, taxis and the occasional transportation support of friends or family, they are much more mobile and enjoy considerably lower rates of loneliness.
Volunteering and Civic Engagement
Getting involved in the community as a volunteer or through engagement with civic or religious groups is another major way to stave off loneliness. Seniors who did not volunteer during the year were 12% more likely to register as lonely on the AARP study than those who were able to volunteer.
Companion Care Services
Another great way to combat loneliness in the elderly is to access cross-generational companion services like those provided by Mon Ami. These kinds of services pair up college students — who face their own version of the loneliness epidemic — with seniors to provide social contact and shared activities, the kind of connection that build meaningful relationships over time: the kinds of relationships that can be the best balm for feelings of isolation.
How Children Can Support Their Parents
If you’re worried about an aging relative and want to support them in breaking free from isolation and loneliness, the good news is that you don’t have to feel powerless. There are useful steps you can take that will make a world of difference.
Stay in Touch… Meaningfully
One of the big components of loneliness is the lack of truly meaningful social contact with friends and loved ones. It’s a good idea to follow the common advice to reach out regularly to your aging parents and to visit them in person; but sometimes, despite their best efforts, family members in the course of doing these things can remain so wrapped up in the busy concerns of their own lives, careers, spouses and children that the visit or contact isn’t really fulfilling. For those who are caregivers, it can be even more difficult: the stresses associated with caregiving may leave them feeling overwhelmed, exhausted and themselves vulnerable to depression and loneliness, making it harder for them to provide emotional support to others.
There are, fortunately, ways to get around these problems and go beyond making contact to being really present for your loved one’s needs. Caregivers feeling at risk of burnout themselves can take several kinds of action to mitigate their stress and make it easier to get beyond the tasks of care and focus more on meaningful time spent with their loved one. For caregivers or other family members, there are simple two-minute activities that build a foundation of connection and sharing without placing stress on the participants.
Ultimately, the objective is to try to work out what some of the causes of your loved one’s feelings of loneliness might be and to discuss them. You don’t have to be their therapist, but even just the chance to open up about some of their deeper anxieties can make a great deal of difference.
Seek Out Community Resources & Events Nearby
Most communities have facilities and events tailored to the needs of seniors. If your aging parent tends toward the shy end of the spectrum and isn’t a “joiner,” you can try attending an event with them if it’s practical to do so, or at least encourage them to give it a try if you’re working at a distance. If you’re not able to be physically present but there’s a companion service like Mon Ami within range, that can also be a useful way of bringing the outside world to them.
Don’t Try to Be a Superhero
If you’re a direct caregiver for your aging parent — particularly if you’re an unpaid caregiver — you can be just as much at risk of loneliness and isolation as your parent. Being a caregiver involves a lot of stress and pressure, especially if you try to do everything yourself. There can also be barriers to seeking help: a sense of stigma, for instance, or that one should simply “suck it up”; an inability to recognize the signs of loneliness, isolation or depression; or a feeling of hopelessness that can become a kind of paralysis.
It’s important to be aware of your own mental health as well as your loved one’s, and to keep from giving in to despair or self-blame. When it becomes hard to keep things in perspective on your own, getting an outside perspective from friends and family who understand the signs of loneliness and its related issues can be immensely valuable. Getting their support with caregiving tasks and expenses can be just as invaluable. Overall, one of the best gifts you can give both yourself and your aging parent is being prepared to reach out to friends and other family members and ask for help.
AARP Foundation. Provides an excellent range of resources for seniors and loved ones seeking to care for them, everything from emergency and estate planning to movie recommendations.
Connect2Affect. A general-purpose anti-loneliness initiative, with its own directory of programs and services, run by the AARP Foundation.
Campaign to End Loneliness. A useful “big picture” site on the battle against loneliness in the elderly; a bit UK-centric but with useful information for everyone.
Dr. Vivek H. Murthy, 19th Surgeon-General of the United States. Website of a major advocate for awareness of the loneliness epidemic, with links to his most recent articles and media appearances.
Health Resources & Services Administration. Essential for keeping up to date on federal health initiatives in America.
Veterans Crisis Line. An emergency resource specifically for military veterans feeling anxious or alone and experiencing extreme distress.