Randy Beckett

The Carpenters’ 1976 hit song “Superstar” got it right: loneliness is such a sad affair. This is especially true for many people living in long-term care facilities. We now know that loneliness is not just sad, however; it is, in fact, deadly. 

Loneliness describes a person’s perceived amount of social interaction. We experience loneliness when our desired quality and quantity of engagement with others is not met. There is a gap between what we want and what we are getting. Loneliness has been described as three related concepts:

  1. Being alone, or the time spent alone.
  2. Living alone, or our household arrangements.
  3. Social isolation, or the amount of social interaction we have with others — both individually and in social groups.

Time reports that more than one third of adults over the age of 45 are lonely. More than 40% of seniors over 65 regularly experience loneliness. With over 6 million people over the age of 65 in long term care, the prevalence of loneliness and isolation is astounding. 

Loneliness is deadly to long-term care residents in several ways. Feelings of loneliness effect the levels of participation in physical activity for older people. The more social support people have, especially from family members, the higher the levels of physical activity. Therefore, people who are getting physical, occupational or restorative therapy are more likely to engage if they have a higher level of social support. Participation in therapy determines recovery and ability to perform activities of daily living. It is also well-established that increased physical activity improves mood and decreases anxiety. A lack of social interaction decreases physical activity and mobility, thus leading to anxiety and depression. Increases in sedentary time are directly linked to increased disease, poor well-being and hastened death. 

According to recent studies, loneliness has significant effects on both physical and mental health concerns. Social isolation increases the levels of stress hormones, such as cortisol, in the body. This response has been linked to conditions such as depression, alcoholism, heart disease, obesity, sleep difficulties, cognitive decline and early mortality. In fact, loneliness increases the likelihood of mortality by 26%. It also increases the probability of developing clinical dementia by 64%.

A recent, widely publicized article from the New York Times referred to loneliness as a “silent killer”. The report suggests that social isolation is more lethal than obesity, cigarette smoking, or high blood pressure. As 1 in 4 Americans now live alone, loneliness is reportedly on the rise.   

So, what can we do? We know that despite family visits, outings, attending activities, and staff interaction, residents still report feeling lonely. 

I suggest psychotherapy. 

Loneliness often leads to feelings worthlessness, inferiority, self-deprecation and distrust. This can lead to negative thought patterns and low self-worth, and only perpetuates the social isolation cycle. This is where psychotherapy comes in. A form of psychotherapy, known commonly as cognitive behavioral therapy (CBT), helps develop new ways of thinking to reduce symptoms of depression, anxiety, stress and loneliness. It also offers support through particularly difficult times such as loss, grief, illness and hospitalization. CBT helps people recognize their negative thought patterns and perceptions and redirects those thoughts. This results in a more positive outlook and behavior changes such as mental well-being and physical activity. Studies have shown that patients do better when medication and psychotherapy are used together, than when either one of them is used alone. 

Loneliness is indeed sad. But changing thought patterns is an effective tonic.