From Alzheimer’s to heart attacks, loneliness in seniors has serious health effects
“I’m painfully lonely,” Joe* says matter-of-factly. Despite having a brother he talks to regularly, the 69-year-old still feels isolated.
After a heart attack several years ago, he signed up for a telephone reassurance program offered through the Calgary Seniors Resource Society. The program matches volunteers with elderly people and they regularly call each other, often every day. “I decided it would be good, largely for the sake of my cats, if somebody were checking in on me every day just to make sure I was okay,” says Joe, who was matched with a staffer at the society.
But the program has become much more than that to him. “We talk about my physical health, my mental health, which isn’t great – for a long time I was talking about my anxiety. She’s very empathetic, and I really feel that I’m talking to somebody who listens to me,” he says.
It hasn’t fixed Joe’s loneliness – what he really needs to do that, he says, is to find a girlfriend. But it does help. “Sometimes I just need somebody to listen to me and maybe give me some advice, and she’ll do that, she’s very supportive. It’s very important to me that she’s in my life.”
The number of isolated seniors like Joe is growing as families move further apart, people live longer and the baby boomers age. Rates of loneliness and isolation follow a U-curve, peaking in early adulthood and old age, with reports suggesting that about 20% of older adults are somewhat isolated. “Right now we’re kind of running this strange experiment where we’re one of the first generations that isn’t naturally living intergenerationally,” says Sally Guy, Director of Policy and Strategy for the Canadian Association of Social Workers. “So far, it’s creating some terrible situations for seniors.”
At the same time, loneliness and isolation are increasingly seen as not just social issues, but as public health ones as well, as research has connected them to depression, heart disease and more. These factors affect the overall risk of death at rates similar to smoking or inactivity.
The provinces and federal governments met this fall to discuss challenges facing seniors, including the problem of social isolation and loneliness in the elderly, and these topics have been the target of a multitude of smaller projects across the country as well. Yet it’s difficult to reach those who are isolated – partially because there’s still a strong stigma around it.
“People will say that they’re lonely in therapy, but they will not say it publicly,” says Ami Rokach, an instructor in the department of psychology at York University and loneliness researcher. “The elderly are very aware of their social standing, and they need to kind of get into their role: I’m doing well, I look well, I dress well. Loneliness doesn’t fit into it.”
“These people are largely hidden,” agrees Samir Sinha, director of geriatrics at the Sinai Health System and the University Health Network Hospitals. “But when we actually understand the scope of the issue, we realize this is something we should address.”
Which seniors are most likely to be isolated?
This problem is actually two separate issues: social isolation, which is a lack of social contact or participation in social activities, and loneliness, a more subjective feeling of isolation or disconnectedness. It helps to picture them as a Venn diagram, with many people also falling into both categories, explains Sinha. The causes and effects of both loneliness and social isolation are largely intertwined.
Both are more likely in seniors. The National Seniors Council report on social isolation pointed out that being over 80 is a risk factor – which is the same age where the majority of people live alone. And the risk continues to increase as you get older. “While up to about 5% or 10% of people 65 to 75 years old are lonely occasionally, up to 80% of those 85 and up report they are lonely,” says Rokach. “They may be widowed, and their social networks and social support is shrinking, because their friends die or because they have limited mobility, and their peers may be as limited as they are.”
The other risk factors are fairly diverse, with isolation and loneliness hitting people in very different situations. Not having transportation available, not living near family or being childless, and having a low income are predictors. Health also has an impact, as people who have a disability, those in long-term care centres, and those who have lost their sight or hearing are also more likely to be isolated.
People in minority groups are also vulnerable, including people who are indigenous or LGBTQ, and immigrants. Even elderly parents who live with their children and even grandchildren may be isolated if they’re immigrants and don’t know the community well or speak English or French, says Sinha. “They may not know anybody in the community, they can’t communicate well, and really during the day, the adults are at work, the kids are at school, they’re on their own.”
The health effects
There is increasing evidence social isolation and loneliness significantly affect health. Loneliness has been associated with higher blood pressure and other cardiovascular risks, like higher cholesterol levels. A 2016 meta analysis found that poor social relationships increase the risk of heart disease by 29%, and the risk of stroke by 32%.
It also contributes to depression, stress, anxiety and anger, and increases vulnerability to elder abuse. It increases the risk of cognitive decline, and has a significant effect on the risk of getting Alzheimer’s disease, with a 2000 Lancet study showing that being isolated is connected to a 60% rise in the risk of dementia and cognitive decline.
And all of this combines to have a significant effect on mortality. In fact, not having social support is just as likely to hasten death as smoking, obesity or inactivity, according to a 2015 meta analysis that found that social isolation increased the risk of death by 29%. It measured the effects of loneliness independently, and found that it also substantially increased the risk of death, by 26%.
There are limitations in the research in this area, however, including the fact that the way researchers measure social isolation or loneliness tends to vary, so it’s hard to compile data from different studies. It’s also difficult to study the impacts of isolation and loneliness on people who are ill, because of the difficulty in controlling for the fact that their illness could be impacting their ability to socialize, rather than the other way around.
It’s clear, however, that socially isolated seniors also use the health care system more – they’re four to five times more likely to be readmitted to hospital. Because they have less support in the community, they also stay longer in the hospital and need more support to stay in their homes.
“When you look at the highest users of our health care system who are older, they tend to be characterized by this Bermuda triangle: having multiple diseases, having problems with their functional abilities, and being socially isolated,” says Sinha. For that reason, he screens his patients for what he calls social frailty, usually asking a simple question: Do you have a family member or friend you can call upon to help you with a basic task like getting a prescription?
“If people don’t have access to those supports, it can put them at significant risk,” he explains.
Promising programs target seniors’ isolation
The research around this seems to have caught the attention of the government. The National Seniors Council, a group that advises the federal government, declared social isolation its priority in 2013. And a meeting this September of the federal, provincial and territorial ministers responsible for seniors also looked at social inclusion. Meanwhile, in the UK, the Campaign to End Loneliness has raised awareness of the problem to policymakers, as well as helping non-profits provide solutions.
For some seniors, increasing programming or transportation services can help. Edmonton is doing that through the Pan-Edmonton Group Addressing Social Isolation (PEGASIS), which includes seven local non-profit groups and is funded by the federal government. Its initiatives include English as a second language programs, drop-in events and telephone reassurance services.
In BC, new workshops from the BC Centre for Elder Advocacy and Support will bring together immigrant seniors over 50 to try to reduce isolation. And in Ontario, the Elderly Person Centres are a great – though under-publicized – resource, says Sinha, offering everything from yoga to afternoon tea. In Toronto, projects like Kipling Acres combine a daycare with a seniors’ residence, offering natural moments for intergenerational connection.
Increasing availability and awareness of such programs is important, according to the World Health Organization’s report on creating age-friendly cities. It also points out the importance of accessibility, both for people with disabilities and in terms of making transportation available.
There’s little literature on whether or not these interventions work, but a 2005 review found that some were effective, namely group programs that included education or training, and social activities that target specific groups, such as widowed people or caregivers. The effectiveness of home visits and befriending programs, on the other hand, was unclear.
It’s also important to remember that not everyone who is lonely is isolated. “When we talk about coping with loneliness, we need to think about, what is the cause? Is it because the person really has no one who gives a damn about them? Or are they the kind of person who for all their lives felt disconnected and unimportant?” asks Rokach, pointing out that he’s spoken to many seniors who go out to events but don’t talk to anyone or make connections through them.
That group would probably benefit more from mental health services than from increased access to classes. An analysis of interventions to reduce loneliness analyzed the effects of improving social skills, boosting social support, creating more opportunities for social contact, and addressing negative thoughts about oneself. It found that changing those thoughts was the most effective, through interventions like cognitive behavioural therapy.
For Joe’s part, he’s joined a number of local clubs, from a men’s group to his newest program, a choir, to try and reduce his isolation. “I’m trying to do more things right now,” he explains. “It doesn’t take care of all my loneliness. But it helps.”
*Name has been changed