For years, Linda Hawthorne, MD, 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-meant advice didn’t 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’t easy to find.
We need “new societal institutions that bring meaning and purpose” to older adults’ lives, Hawthorne recently told a committee of the National Academies of Sciences investigating loneliness and social isolation among older adults. (Hawthorne is a geriatrician and dean of the Mailman School of Public Health at Columbia University.)
The committee’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.
Notably, Anthem Inc. is planning a national rollout to Medicare Advantage plans of a program addressing loneliness developed by its subsidiary CareMore Health, according to Robin Caruso, CareMore’s chief togetherness officer. UnitedHealthcare is making health navigators available 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.)
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 Trevor Winchester, MD, 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 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.
The distinction matters because people who are sometimes lonely don’t necessarily stay that way; they can move in and out of this state. 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.
People who are severely lonely are at “high risk,” while those who are moderately lonely are at lower risk, 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. When AARP asked adults who participated in its survey last year, “How often do you feel lonely or isolated from those around you?” 4 percent said “always,” while 27 percent said “sometimes.” In the University of Michigan’s just-published survey 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.
“If you compare loneliness to a toxin and ask, ‘How much exposure is dangerous, at what dose and over what period of time?’ the truth is, we don’t really know yet,” Winchester said.
Why it matters: 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 with others, strengthening social bonds. More often than not, it’s 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.
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, neighbors 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 Novak, 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, Tracy. Widowed in September, then forced to stay home for three months after hip surgery, Tracy became profoundly lonely.
“If I were a clinician and said to my mother, ‘Go to a senior center,’ 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,” Novak said.
What’s helped Tracy is “talking about and giving voice to what she’s experiencing,” Novak continued. Also, friends, former coworkers, family members and some of Novak’s high school buddies have rallied around Tracy. “She feels that she’s a valuable part of her community, and that’s what’s missing for so many people,” Novak said.
“Look at the older people around you who’ve had a major life transition: a death, the diagnosis of a serious illness, a financial setback, a surgery putting them at risk,” she recommended. “Think about what you can offer as a friend or a colleague to help them feel valued.”
Why it matters: listening to older adults and learning about the type of loneliness they’re experiencing is important before trying to intervene. “We need to understand what’s driving someone’s loneliness situation before suggesting options,” Novak said.