Loneliness and Social Isolation: What to Do About It
For a number of years, I worked at a local nonprofit agency that helped alleviate social isolation among older adults in our community. We recruited volunteers to serve as “friendly visitors” who would spend at least one hour per week visiting an isolated older adult. The friendly visitors served to bring the outside in for older adults who might not have regular human interaction, offering companionship and a window to the outside world.
Most of our older adult clients had friendly visitors. It was the most popular service we offered. Our clients were mostly individuals of low income, and we offered services specifically to address poverty as well. While those services had income eligibility requirements, friendly visiting was one service we did not restrict for socioeconomic reasons. We understood that loneliness and isolation can affect anyone regardless of their income or social status.
Studies have found that in Britain and the United States, about one-third of older adults age 65 and older live alone. In the U.S., half of older adults age 85 and older live alone.
A 2012 study found that more than 40 percent of older adults experience loneliness. The study asked more than 1,600 participants over a six-year period to identify feelings related to loneliness: feeling left out, feeling isolated and feeling a lack of companionship. Individuals who identified as experiencing these feelings some of the time or often were identified in the study as being lonely.
While researchers have long identified the psychological factors surrounding loneliness and isolation, the 2012 study was unique because it connected physical health with loneliness. In following the study participants over time, the researchers found that participants who identified as lonely were more likely to have decreases in functional ability in their activities of daily living, in tasks involving their upper extremities, in their mobility, and in their stair-climbing. Risk of death also was a factor: nearly 23 percent who identified as lonely died within the six-year study period.
Importantly, by making the connection between loneliness and physical health, researchers also have found that the underlying causes of loneliness aren’t strictly due to social isolation.
What Causes Loneliness?
- Lack of family interaction
We might assume that older adults should have family involved in their lives, but a reality is that many don’t. An older adult might not have had children, or even if they did, the older adult might not have relationships with them. Older adults and their adult children also may live at such a distance that frequent face-to-face contact is not possible.
- Outliving friends or other relatives
Older adults in their 80s or 90s may have outlived their long-time friends and other relatives. It also is possible for older adults to outlive extended family, such as cousins, nieces and nephews, leaving them without family connections. This is particularly a concern for those who don’t have adult children.
- Health problems (hearing or vision loss, mobility, chronic health conditions)
Health issues also can contribute to isolation and loneliness. Hearing loss presents a barrier in communication for older adults and the people around them. It’s possible for an older adult with hearing loss to feel isolated even while in a group. As other members of the group participate in conversation, the person with hearing loss may struggle. Vision loss can affect communication and independence. Mobility problems can influence an older adult’s confidence in leaving home and managing safely. Chronic health conditions may require ongoing treatment that complicates leaving home. Oxygen tanks, mobility aides such as walkers or wheelchairs, and other needs may make it difficult for an older adult to manage in the community.
As much as retirement might seem like a positive event—one that we work toward and anticipate happily, it may bring unexpected social isolation. The daily presence of coworkers and colleagues quickly evaporates with retirement. Daily water cooler and break-room chats disappear along with routine workplace interaction.
- Loss of spouse or partner
The death of a spouse or partner represents an immediate and painful loss for an older adult. A partnership that may have existed for nearly a lifetime may be suddenly lost, leaving the surviving spouse alone at home and in life.
- Lack of transportation
Some of the losses already mentioned may compound and affect availability of transportation. In our culture in the U.S., few things symbolize freedom as much as driving. The idea of getting in the car and going wherever we want is inextricably connected with independence. For an older adult, losing a spouse might mean losing transportation, if the surviving spouse doesn’t drive. Health and mobility conditions may affect driving, so it may be limited to daytime hours or not at all. For individuals who no longer drive, the options are to rely on family or friends or to seek transportation providers.
Some older adults are uncomfortable with what they perceive as a dependence on friends and family for transportation. Community or private transportation providers might seem like a viable option, but they’re not always as workable as they might seem. Often, transportation providers require rides to be scheduled in advance, which affects the convenience of the service. It may be difficult to get a ride quickly for an impromptu lunch date or other outing with a friend. Additionally, some services may require riders to ride in the same van as everyone is picked up and dropped off in different locations. This can result in lengthy, hours-long van rides that can be exhausting.
The Health and Safety Risks of Loneliness
Researchers in Britain have determined that loneliness is a public health risk. Throughout England, local governments and the National Health Service have teamed up to create programs to address loneliness. Fire departments are monitoring older adults’ homes not only for fire hazards but also for isolation.
Neuroscientists at the Massachusetts Institute of Technology found an area in the brain that may be responsible for feelings of loneliness. Neuron activity in this area of the brain is linked to depression; however, the MIT scientists found that mice who were isolated for 24 hours experienced a surge of activity in these neurons when they were placed again with other mice, indicating a change associated with resumed peer interaction.
John T. Cacioppo, a psychologist at the University of Chicago, says a barrier to getting help for loneliness is admitting to experiencing it. Loneliness might be perceived as a weakness or a negative, such as a dependence on others, which is not in line with western cultural values. Cacioppo says chronic loneliness affects the body’s level of cortisol, a stress hormone, and can result in higher blood pressure and less blood flow to bodily organs. In addition, loneliness may decrease production of white blood cells, which affects the body’s ability to fight infections. AARP found that the effects of long-term isolation are similar to smoking 15 cigarettes per day.
According to Edwin Walker, U.S. acting assistant secretary for aging at the Administration for Community Living, “Isolation and loneliness are known to be associated with higher risks of chronic disease, heart disease, depression and anxiety, even dementia and Alzheimer’s.” One study suggested that health risks linked to isolation exist in part because no one in the older adult’s life is aware of signs of illness or monitoring when symptoms might be worsening.
In addition to the health risks associated with loneliness, safety issues also should be a consideration. An individual who is isolated and seeking social interaction might be more likely to engage with scammers and others who might abuse or defraud them, says Lisa Marsh Ryerson, president of the AARP Foundation. She says people who have experienced fraud or scams may further isolate themselves due to shame.
Efforts to Reduce Loneliness
Programs already in place in Britain may be a start in addressing loneliness and isolation. For example, The Silver Line, a phone service in Britain, offers a means for older adults to call advisers to talk and connect. Some callers may call multiple times per day while others might call for specific advice. The phone advisers are trained to listen for the signs of isolation and to offer referrals for other services. In the U.S., a similar service called The Friendship Line, is available through the Institute on Aging.
Other programs, such as the friendly visiting service at my former agency, also address loneliness and isolation. A program called Little Brothers, Friends of the Elderly performs a similar visiting function for older adults in San Francisco. The program matches isolated older adults with volunteers who may begin by visiting in the individual’s home but might eventually move toward encouraging more activity in the community.
In addition, AARP recently began a large-scale, national effort to address loneliness and isolation called Connect2Affect. According to the program’s website, the goal is “to create a network that meets the needs of anyone who is isolated and lonely, and that helps build the social connections older adults need to thrive.”
How Do You Know If You’re Lonely?
Identifying loneliness is key to getting help and preventing the long-term risks associated with isolation. It’s important for individuals who are feeling lonely or isolated to understand that interaction is a valid human need—not a negative character flaw signaling weakness.
Connect2Affect offers a self-assessment so individuals can measure their own risk of isolation. If the self-assessment results show an individual is at risk for isolation, they are immediately provided with a list of options that can help, such as community resources, ideas to increase involvement, and other advice. The Connect2Affect website offers a variety of resources that can help. The Friendship Line and your local Area Agency on Aging also are good resources.
What Can You Do to Help Older Adults Who Are Lonely?
One way to help with loneliness is to be aware of the older adults who are around you. Whether they are relatives, neighbors, church members or others, be watchful for the possibility of loneliness or isolation. Is an older adult not participating in activities as much as in the past? Are there changes in grooming, housekeeping or yard maintenance, for example? Is the individual more talkative than expected (indicating a lack of social outlets) or uncharacteristically withdrawn? Are you noticing changes in mobility, hearing, vision or other physical needs?
Being a friendly visitor doesn’t require an agency to coordinate it. If you’re concerned that an older adult might be isolated, ask if you can stop in for a visit or see if they’d like to go out for coffee or lunch. As you act as a listening ear, you also serve as a second pair of eyes to monitor for loneliness, isolation and safety.
A Place for Mom offers an extensive list of 14 ways anyone can help with an older adult’s social isolation, ranging from offering transportation, to encouraging attendance at religious services, to addressing incontinence and promoting meaningful activities.