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Shay Jacobson, RN MA NMG LNCC CLNCP
Martha Kern

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Social isolation can be deadly.

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A 2012 study in the Proceedings of the National Academy of Sciences shows an association between loneliness and mortality, placing what used to be perceived as a relatively benign social problem on a par with smoking in its impact on lifespan, and even worse than obesity in this same regard.

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The number of seniors living alone is estimated to be 11 million and growing. While living alone does not in and of itself guarantee social isolation and loneliness, it is most certainly a risk factor.

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The Hard Wiring
Ours is a social species. It is theorized that our basic urge to survive has inspired a natural tendency to live among others and form social connections. Our ability to form these social connections is, in fact, credited with our emergence as a dominant species. We are evidently hard-wired to fare better in circumstances where we can rely to some degree on other people.

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There are some important differences between loneliness and isolation. External isolation is often brought about by life events, such as the loss of a spouse. Widowhood may render us alone, at least in terms of household composition, without necessarily making us lonely. If we have strong social support, people on whom we can rely for comfort and assistance, and social connections that we enjoy, we may avoid an internal sense of loneliness.

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Loneliness stems from a lack of meaningful and sustained contact with family or the wider community, and is generally perceived in a negative way. Much has been written over time about “being alone in a crowded room”. A lack of true connection to other people, perhaps in spite of frequent exposure to others on a superficial level, often leads to feelings of isolation, hopelessness and a negative outlook on the future. How we feel about being alone may influence the extent to which it impacts our health.

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The Influence on Health
Studies show that older, isolated individuals have higher rates of breast cancer, high blood pressure, heart disease and other chronic diseases. It has also been demonstrated that isolated seniors are more likely to smoke, be sedentary, and have poorer diets. It is difficult to say if loneliness caused these poor lifestyle choices or if people predisposed to unhealthy behaviors are also somewhat inclined to have fewer meaningful social connections.

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There may also be a link between social isolation and alcoholism/addiction. Often, years of alcohol abuse or drug addiction will result in estrangements from family and friends. Some alcoholics or heavy drug users tend to withdraw from the community owing to a desire to indulge freely and without the negative judgments of others. The alcohol or drug of choice becomes the only “friend” with whom they are comfortable.

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Loneliness Isn’t New….But It May Be Worse
A number of social factors have changed over the past few decades and they may each contribute to the overall problem of isolation and loneliness.

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Fifty years ago, for example, it was far more common for female heads of household to stay at home rather than work in the community. Not only were these women the primary caregivers for children, they were also largely available later in life, when the older members of the family began to need help. Seniors who could no longer care for themselves might move in with an adult child’s family, a transition made possible and practical by the presence of someone in the home all day to manage their needs.

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Over the course of the last few decades, it has also become more common for American adults to remain unmarried or to remain childless regardless of marital status (In 1960, 72% of all adults ages 18 and older were married; today just 51% are). Contributing to a higher incidence of social isolation, too, is the increased prevalence of geographic separation from adult children who have perhaps moved for an educational opportunity or job, placing them miles away from aging parents.

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Due to medical advancements, people live much longer than they did in the past. The longer we live, the greater the number of chronic diseases with which we might contend, and the higher the likelihood that we cannot drive at some point in our lives. There is, on average, an interval of ten years for women where they are alive and cannot drive, and an interval of six years for men. An inability to drive is known to interfere with the formation and maintenance of social connections outside the home.

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Risk Factors for Isolation
Aside from these social changes of the past few decades, there are a number of other factors that strengthen the prospects of loneliness and/or social isolation. These include:

  • Living alone
  • Being female, primarily because women tend to outlive their husbands;
  • LGBT status – these individuals are likelier to live alone, be unmarried, have no children and to have experienced social exclusion or estrangement from family over time;
  • Ambulation/Transportation issues – an inability to drive and/or reliance on canes, walkers and scooters, might make outings in the community difficult and infrequent. Darkness and bad weather also tend to discourage older people from venturing out.
  • Self-consciousness – encroaching cognitive deficits, hearing loss, incontinence and colostomy can all undermine confidence in social situations and foster an overall tendency to withdraw.
  • Psychiatric issues – behavior issues stemming from psychiatric problems often trigger alarm in those who do not understand psychiatric impairments. People who look or behave a little differently are excluded and avoided in many social contexts.
  • Being a caregiver – if a senior is the primary care provider for a spouse or adult disabled child, they are at much greater risk for social isolation. An inability to find suitable relief care providers often prompts these individuals to stay home, limiting their social spheres and opportunities.
  • Hoarding – the shame associated with hoarding behaviors often leads to estrangements from family and voluntary withdrawal from a community that does not understand the issue.
  • Relocation – moving to a new environment, even a communal setting full of people, can do little to allay loneliness in a person who is introverted or accustomed to being alone.

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Chicken and Egg
What cannot be readily gleaned from studies on social isolation and loneliness is the order in which events have transpired. There is always the possibility that personal characteristics or behaviors may have caused the isolation rather than isolation causing the recognized traits. A difficult or disagreeable person may have driven people away early in life rather than having become prickly and unpleasant owing to a lifetime of isolation. In instances where social skills are poor or behaviors inappropriate, addressing the issue of social isolation will be infinitely more complex.

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Interestingly, it has been shown that loneliness is “contagious”. People who lack meaningful connections and an overall sense of belonging are more prone to negative social interactions. These, in turn, impact those with whom they associate. Isolated individuals are also prone to focusing increased attention on negative stimuli (perseverating on what they believe to have been an insult or slight, for example) and may have a tendency to misread social cues.

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It’s Easy to Fix, Right?
The obvious and simple solution to loneliness and/or social isolation would be to put these individuals in social settings and let the rest happen organically. It may not be quite so easy. A person who has been alone for some time may have diminished social skills or may never have had strong social skills in the first place. Approaching new people and initiating conversation is difficult for many people, regardless of age, so merely “planting” a senior in a communal environment may do little to assuage the overriding lack of meaningful social connections.

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Meaning, and its cousin, purpose, play major roles in human perceptions of belonging and contentment. Marrying social opportunities with useful tasks and meaningful connection may go a long way in rejuvenating rusty social skills and building bridges with others.

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If an isolated senior is newly participating in activities at a senior center or has recently been placed in a communal environment like Assisted Living, peer mentoring might create the opportunity for social success. Pairing existing residents with new residents to help acquaint them with the community and encourage assimilation engages and provides benefits to participants on both sides of the equation: The resident mentor has a “job” with purpose, and the new resident has a lifeline to affinity groups and people with similar interests within the community. Resident mentors likely have a better understanding of the building’s social dynamics than staff members, and will perhaps remember well what it was like to be “new”.

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Wherever a lonely senior may live, there are other avenues that may help address the isolation issue:

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Professional Intervention – A Care Manager and/or caregiver represent understanding connections that are both purposeful and social. No matter how difficult a senior may be, professional service providers will stay involved and help. If a given client’s isolation stems from problematic behaviors, professionals will respond with insight, expertise and patience. Professional service providers can also furnish transportation to outings, events and appointments.

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Faith Communities – Many faith communities have organized activities and volunteer opportunities for seniors. Studies have shown that those involved with faith communities tend to have lower mortality rates, and they clearly benefit from having people around them to help in an emergency and watch for changes in health and behavior.

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Technology – Facilitating a senior’s access to a computer and the social avenues it affords can help build bonds with geographically distant family members. Email and other electronic platforms provide a contact point and enable seniors to feel aware of, and included in, family activity.

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The best measure to allay loneliness and social isolation is likely prevention. Awareness of the problem and its serious consequences should serve to make us all better and more vigilant neighbors and service providers. Checking on lone seniors, inviting them out, and linking them with resources, can forestall the loss of meaningful connection and possibly lengthen and enrich lives.

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Resources:
20 Facts About Senior Isolation that will Stun You
http://www.aplaceformom.com/blog/10-17-14-facts-about-senior-isolation/

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Perceived Social Isolation and Cognition
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2752489/

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Sage — The Issues – Social Isolation
http://www.sageusa.org/issues/isolation.cfm

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Senior Centers Reach the Hard to Reach
http://www.ncoa.org/national-institute-of-senior-centers/nisc-news/senior-centers-reach-the.html

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Social Isolation Among Seniors: An Emerging Issue
https://www.health.gov.bc.ca/library/publications/year/2004/Social_Isolation_Among_Seniors.pdf

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Social Isolation Among Seniors, LGBT, Isolation Bad for Your Health
http://www.aarp.org/aarp-foundation/our-work/isolation/info-2012/7-facts-about-social-isolation.1.html

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Fourteen Ways to Help Seniors Avoid Social Isolation
http://www.aplaceformom.com/blog/help-seniors-avoid-social-isolation-8-14-2014/

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You are Not Alone: Six Steps to Reduce Senior Isolation
http://www.aplaceformom.com/blog/9-2-14-reduce-senior-isolation/

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©Lifecare Innovations, Inc.