{"id":5643,"date":"2019-07-30T13:56:55","date_gmt":"2019-07-30T17:56:55","guid":{"rendered":"http:\/\/www.silvercentury.org\/?p=5643"},"modified":"2019-08-03T07:02:22","modified_gmt":"2019-08-03T11:02:22","slug":"loneliness-in-older-adults-its-complicated","status":"publish","type":"post","link":"http:\/\/78.142.243.82\/~silvercentury\/2019\/07\/loneliness-in-older-adults-its-complicated\/","title":{"rendered":"Loneliness in Older Adults: It\u2019s Complicated"},"content":{"rendered":"

As researchers study loneliness in older people, health insurers and other organizations are developing possible solutions. Journalist Judith Graham delves into this complex issue in an article for <\/span><\/i>Kaiser Health News<\/span><\/a> (KHN). It was posted on the KHN website on March 14, 2019. <\/span><\/i><\/p>\n

For years, Linda Fried, MD, offered older patients who complained of being lonely what seemed to be sensible guidance. \u201cGo out and find something that matters to you,\u201d she would say.<\/span><\/p>\n

But her well-meant advice didn\u2019t work most of the time. What patients really wanted were close relationships with people they cared about, satisfying social roles and a sense that their lives had value. And this wasn\u2019t easy to find.<\/span><\/p>\n

We need \u201cnew societal institutions that bring meaning and purpose\u201d to older adults\u2019 lives, Fried recently told <\/span>a committee of the National Academies of Sciences<\/a><\/span> investigating loneliness and social isolation among older adults. (Fried is a geriatrician and dean of the Mailman School of Public Health at Columbia University.)<\/span><\/p>\n

The committee\u2019s deliberations come amid growing interest in the topic. Four surveys (by <\/span>Cigna<\/a>,<\/span> <\/span>AARP<\/a>,<\/span> the <\/span>Kaiser Family Foundation<\/span><\/a> and the <\/span>University of Michigan<\/span><\/a>) 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. (Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.)<\/span><\/p>\n

Assuaging loneliness is not just about having random human contact; it\u2019s about the quality of that contact\u2026 <\/b><\/p>\n

\u2014 Vyjeyanthi Periyakoil, MD<\/b><\/p><\/blockquote>\n

Notably, Anthem, Inc. is planning a national rollout to Medicare Advantage plans of <\/span>a program addressing loneliness<\/span><\/a> developed by its subsidiary CareMore Health, according to Robin Caruso, CareMore\u2019s chief togetherness officer. UnitedHealthcare is <\/span>making health navigators<\/a> available<\/span> to Medicare Advantage members at risk for social isolation. And Kaiser Permanente is starting a pilot program that will refer lonely or isolated older adults in its Northwest region to community services, with plans to eventually bring it to other regions, according to Lucy Savitz, vice president of health research at Kaiser Permanente Northwest. (KHN is not affiliated with Kaiser Permanente.)<\/span><\/p>\n

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\u2019 distress at not having meaningful relationships. But that isn\u2019t necessarily the case.<\/span><\/p>\n

\u201cAssuaging loneliness is not just about having random human contact; it\u2019s about the quality of that contact and who you\u2019re having contact with,\u201d said Vyjeyanthi Periyakoil, MD, an associate professor of medicine at Stanford University School of Medicine.<\/span><\/p>\n

A one-size-fits-all approach won\u2019t 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.<\/span><\/p>\n

Degrees of Loneliness<\/b><\/p>\n

The headlines are alarming: between 33 and 43 percent of older Americans are lonely, they proclaim. But those figures combine two groups: people who are sometimes lonely and those who are always lonely.<\/span><\/p>\n

The distinction matters because people who are sometimes lonely don\u2019t necessarily stay that way; they can move in and out of this state. And the potential health impact of loneliness\u2014a higher risk of heart disease, dementia, immune dysfunction, functional impairment and early death\u2014depends on its severity.<\/span><\/p>\n

People who are severely lonely are at \u201chigh risk,\u201d while those who are moderately lonely are at lower risk, said Julianne Holt-Lunstad, a professor of psychology and neuroscience at Brigham Young University.<\/span><\/p>\n

The number of people in the highest risk category is relatively small, as it turns out. When AARP asked adults who participated in its survey last year, \u201cHow often do you feel lonely or isolated from those around you?\u201d 4 percent said \u201calways,\u201d while 27 percent said \u201csometimes.\u201d In the University of Michigan\u2019s <\/span>just-published survey<\/span><\/a> on loneliness and social isolation, 8 percent of older adults (ages 50-80) said they often lacked companionship (a proxy for loneliness), while 26 percent said this was sometimes the case.<\/span><\/p>\n

\u201cIf you compare loneliness to a toxin and ask, \u2018How much exposure is dangerous, at what dose and over what period of time?\u2019 the truth is, we don\u2019t really know yet,\u201d Periyakoil said.<\/span><\/p>\n

Why it matters: loneliness isn\u2019t always negative, and seniors shouldn\u2019t panic if they sometimes feel this way. Often, loneliness motivates people to find a way to connect with others, strengthening social bonds. More often than not, it\u2019s inspired by circumstances that people adjust to over time, such as the death of a spouse, close family member or friend; a serious illness or injury; or a change in living situation.<\/span><\/p>\n

Types of Loneliness<\/b><\/p>\n

Loneliness comes in different forms that call for different responses. According to a well-established framework, \u201cemotional loneliness\u201d occurs when someone feels the lack of intimate relationships. \u201cSocial loneliness\u201d is the lack of satisfying contact with family members, friends, neighbors or other community members. \u201cCollective loneliness\u201d is the feeling of not being valued by the broader community.<\/span><\/p>\n

Some experts add another category: \u201cexistential loneliness,\u201d or the sense that life lacks meaning or purpose.<\/span><\/p>\n

Carla Perissinotto, MD, associate chief for geriatrics clinical programs at the University of California-San Francisco, has been thinking about the different types of loneliness 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.<\/span><\/p>\n

We need to understand what\u2019s driving someone\u2019s loneliness situation before suggesting options.<\/b><\/p>\n

\u2014 Carla Perissinotto, MD<\/b><\/p><\/blockquote>\n

\u201cIf I were a clinician and said to my mother, \u2018Go to a senior center,\u2019 that wouldn\u2019t get at the core underlying issues: my mother\u2019s grief and her feeling, since she\u2019s not a native to this country, that she\u2019s not welcome here, given the political situation,\u201d Perissinotto said.<\/span><\/p>\n

What\u2019s helped Gloria is \u201ctalking about and giving voice to what she\u2019s experiencing,\u201d Perissinotto continued. Also, friends, former coworkers, family members and some of Perissinotto\u2019s high school buddies have rallied around Gloria. \u201cShe feels that she\u2019s a valuable part of her community, and that\u2019s what\u2019s missing for so many people,\u201d Perissinotto said.<\/span><\/p>\n

\u201cLook at the older people around you who\u2019ve had a major life transition: a death, the diagnosis of a serious illness, a financial setback, a surgery putting them at risk,\u201d she recommended. \u201cThink about what you can offer as a friend or a colleague to help them feel valued.\u201d<\/span><\/p>\n

Why it matters: listening to older adults and learning about the type of loneliness they\u2019re experiencing is important before trying to intervene. \u201cWe need to understand what\u2019s driving someone\u2019s loneliness situation before suggesting options,\u201d Perissinotto said.<\/span><\/p>\n

Root Causes of Loneliness<\/b><\/p>\n

One of the root causes of loneliness can be the perception that other people have rejected you or don\u2019t care about you. Frequently, people who are lonely convey negativity or push others away because of perceived rejection, which only reinforces their isolation.<\/span><\/p>\n

In a <\/span>review of interventions to reduce loneliness<\/a>,<\/span> researchers from the University of Chicago note that interventions that address what they call \u201cmaladaptive social cognition\u201d\u2014distrust of other people, negativity and the expectation of rejection\u2014are generally more effective than those that teach social skills or promote social interactions. Cognitive behavior therapy, which teaches people to recognize and question their assumptions, is often recommended.<\/span><\/p>\n

Relationships that have become disappointing are another common cause of loneliness. This could be a spouse who\u2019s become inattentive over time or adult children or friends who live at a distance and are rarely in touch.<\/span><\/p>\n

\u201cFiguring out how to promote quality relationships for older adults who are lonely is tricky,\u201d Holt-Lunstad said. \u201cWhile we have decades of research in relationship science that helps characterize quality relationships, there\u2019s not a lot of evidence around effective ways to create those relationships or intervene\u201d when problems surface.<\/span><\/p>\n

If you feel lonely or isolated, take stock of your situation and of any underlying problems. <\/b><\/p><\/blockquote>\n

Other contributors to loneliness are easier to address. A few examples: someone who\u2019s lost a sense of being meaningfully connected to other people because of hearing loss\u2014the most common type of disability among older adults\u2014can be encouraged to use a hearing aid. Someone who can\u2019t drive anymore and has stopped getting out of the house can get assistance with transportation. Or someone who\u2019s lost a sibling or a spouse can be directed to a bereavement program.<\/span><\/p>\n

\u201cWe have to be very strategic about efforts to help people, what it is they need and what we\u2019re trying to accomplish,\u201d Holt-Lunstad said. \u201cWe can\u2019t just throw programs at people and hope that something is better than nothing.\u201d<\/span><\/p>\n

She recommends that older adults take mental stock of the extent to which they feel lonely or socially isolated. Am I feeling left out? To what extent are my relationships supportive? Then, they should consider what underlies any problems. Why don\u2019t I get together with friends? Why have I lost touch with people I once spoke with?<\/span><\/p>\n

\u201cWhen you identify these factors, then you can think about the most appropriate strategies to relieve your discomfort and handle any obstacles that are getting in the way,\u201d Holt-Lunstad said.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

For years, Linda Fried, MD, offered older patients who complained of being lonely what seemed to be sensible guidance. \u201cGo out and find something that matters to you,\u201d she would say.<\/span><\/p>\n

Read more Loneliness in Older Adults: It\u2019s Complicated<\/span> ›<\/span><\/a><\/div>\n

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