As the coronavirus pandemic unfolded and concerns arose about the increased risk of infection facing older Americans, another worry came to the forefront: social isolation. This concern is of a long-term nature, and almost as insidious as the virus itself.
In a very literal sense, stay-at-home orders and social distancing were not what the doctor ordered for those 65 and older, many of whom have already been left to fend for themselves by circumstances such as the death of a spouse and/or friends, geographic distance from acquaintances and/or adult children, cognitive impairment or other disability. And it has been shown that isolation (defined by National Academies of Science, Engineering and Medicine as “the objective state of having few social relationships or infrequent social contact with others”) and loneliness (“a subjective feeling of being isolated,” whether among people or not) can lead to devastating health outcomes for seniors.
Isolation is, in fact, on par with smoking as a risk factor for mortality, and has been shown to cause or exacerbate such conditions as Alzheimer’s disease, obesity, diabetes, high blood pressure, heart disease, neurodegenerative disorders and even cancer. Moreover, pioneering psychotherapist Frieda Fromm-Reichmann (1889-1957) long ago concluded that loneliness lies at the root of all mental illnesses.
Now, faced with a pandemic, seniors have been presented with the ultimate Catch-22: They are required to engage in the sort of behaviors that can be detrimental to their health. No longer are they free to connect with fellow seniors at meetings and clubs. No longer are they able to see familiar faces in an adjacent pew at a religious service. No longer can the more active among them meet up at a gym or health club. Much of the country has shut down, and as a result too many seniors are shut off.
CareMore Health CEO Sachin H. Jain, M.D., MBA, has taken note, writing the following recently: “There has never been a time where we should be more worried about loneliness and social isolation — and its attended consequences suicide and depression.”
Certainly various grassroots attempts are being made to bridge the gap. The New York Times noted that in the case of a Manhattan YMCA, staffers have taken it upon themselves to regularly reach out to the 650 seniors who normally attend programs held at the facility. The same piece took note of other measures being taken in various corners of the country, such as those delivering Meals on Wheels to shut-ins in Atlanta, and lingering afterward to chat with seniors — while remaining six feet away, of course. Or, of those in the entertainment industry keeping tabs on their elderly brethren in Southern California; or the mother and daughter doing the Times crossword puzzle every morning via FaceTime.
But will these efforts diminish as quickly as the threat of the virus, while the deep-seated issue of isolation remains? Many have gone so far as to call it a public health crisis, and studies back that up: A landmark 2012 study concluded that 43 percent of those over 60 felt some degree of loneliness. And of those, their chances of losing independence increased by 59 percent and the mortality rate jumped by 45 percent, when compared to the population at large.
So the question becomes, what to do?
First, it’s important that concerned family members not make any assumptions about lonely seniors. There is no one-size-fits-all solution for this issue. Rather, loved ones would do well to “delve into some uncomfortable conversations about what’s driving the loneliness, what’s missing from the person’s life and how can we actually individualize an approach to mitigating that loneliness.”
Maybe a senior is lacking in social skills, and needs individual or group therapy to make the necessary improvements. Or maybe it’s simply a matter of creating more opportunities for connections by enrolling in programs at a senior center, attending religious services or volunteering. And obviously there are cases, depending upon need and desire, where a senior will thrive in an eldercare facility. There are, after all, always people of the same age, round-the-clock care, and activities to stay engaged.
Beyond that, there are several telephone-based programs that have shown promise in combating isolation. They include the Friendship Line, a 24-hour-a-day hotline that also features a Call Out service, and Senior Center Without Walls, which affords access to 70 groups and programs. (The latter program is also offered online.)
In addition, there are in-person visitation programs like those offered by AgeWell Global, where senior volunteers make in-home visits to those who might be experiencing mobility issues, and Little Brothers, Friends of the Elderly, which operates in several U.S. cities.
The Department of Aging and Adult Services outlines options available to seniors, as does AARP’s Connect2Affect program and the National Center for Creative Aging. Then there is the matter of technology helping to alleviate feelings of isolation, such as social robots and voice-activated assistants. Studies to date are inconclusive about their effectiveness in decreasing loneliness, according to the Times, and one study showed that only 26 percent of those 65 and older feel confident using tech. That is, however, likely to change in the not-too-distant future, given tech’s prevalence and the facility younger generations possess in their use of it.
The coronavirus pandemic has brought us to a troubling juncture in our history, while at the same time exacerbating a long-standing crisis among seniors. It is one that already demanded our attention; now it demands that much more. The solutions are there, if we know where to look, but increased vigilance and creativity will be needed to make them a reality.
Joel Landau is the founder and chairman of The Allure Group, a network of six New York City-based skilled nursing facilities. He has also served as a member or an adviser on the Medicaid Managed Care Advisory Review Panel (MCCARP), NYS DOH Preventative Health and Health Services Block Grant, NYS DOH Task Force on Long Term Care Financing, and the Brooklyn Chamber of Commerce.