Loneliness and Seniors: Can Redefining What Independence Looks Like Help?

As I stood in the checkout line at a local candy store, an elderly gentleman ahead of me was talking with the cashier. Even after his transaction was complete, he continued the conversation, not wanting to break the human connection. After he left, the clerk told me that the man's wife of 50 years had recently died. He was a longtime customer and if there was no one in the store, he would stay and talk for a long time, sometimes breaking down into tears. "You are his family now," I told the cashier.

This brief encounter offers a small window into the issues of social isolation and loneliness among older Americans. Scientists distinguish between the two conditions. Social isolation is defined as living alone, while loneliness is defined as the subjective and distressing sensation of being alone. It's possible to be lonely even while being surrounded by others. On the other hand, not everyone who lives alone is lonely.

Social Isolation and Loneliness: Contributors and Consequences

It seems that longevity is a recipe for social isolation and loneliness. Researchers believe that between one third and one half of elderly individuals suffer from social isolation and loneliness. Major contributors to social isolation and loneliness include:

• The death of a spouse

• The changing nature of close relationships – such as when a spouse or partner develops dementia or Alzheimer's disease

• Separation from family

• Loss of mobility and lack of transportation

The physical effects of social isolation and loneliness are profound. The National Institute on Aging suggests that these phenomena are correlated with high blood pressure, heart disease, obesity, and weakened immune systems to mention a few. Scientists also believe that social isolation and loneliness can actually contribute to both cognitive decline and Alzheimer's disease. The Cacioppo Evolutionary Theory of Loneliness hypothesizes that loneliness launches both behavioral and biological processes that contribute to early death in individuals, no matter their age.

Combatting Loneliness: Is the Desire for Independence the Enemy?

Many older people fear a loss of independence. For some, independence is closely tied to having a car and driving. For others, independence means continuing to live in their homes. Yet as we age and live longer, safe driving becomes less attainable. Without adequate transportation, living at home in suburban or rural areas can become almost like a prison.

I recall that my parents were insistent that they stay in their home, after my Dad had a stroke and began the descent into vascular dementia. My mother, who suffers from glaucoma, had stopped driving years before. My Dad was no longer able to drive (even though in his own mind, he was convinced he could). They relied solely on home health aides and me to get them out and about. My Dad attended an adult day program at the local senior center which gave him an opportunity to interact with others. Yet, my Mom refused to participate in other activities at the Senior Center. She became practically a prisoner in her own home – the place where she insisted she wanted to live.

Fast forward to the present, my Mom now lives in a skilled nursing facility which has a diverse activity program. She happily goes to activities from morning until late afternoon. At home she felt that she couldn't go to church – now she attends a weekly Bible study and Sunday worship service. Each Tuesday, Mom goes to a watercolor class. She's found a new interest in bell ringing.

This makes me wonder if family members need to start conversations early with their loved ones about their definition of independence. As people age, traditional narratives around independence no longer work. With my parents, I saw that their view of "independence" led to loneliness and I'm certain it affected their physical health.

Is it possible to redefine independence in ways that combat loneliness? Accepting new types of resources, such as transportation services, community activities, or even moving to places that provide more support, can help older individuals create new ideas about what it means to be independent and also healthy.

Tips for Addressing Social Isolation and Loneliness

Addressing social isolation and loneliness among seniors is both a local and a global challenge. Caregivers may want to consider the following actions, if they feel their loved ones are experiencing isolation:

• Try to determine the root causes of their loneliness. In some happy instances, loneliness is aggravated by an easily solved problem: hearing loss. Investing in hearing aids can help older individuals participate in conversations more easily and not feel embarrassed about continually asking people to repeat themselves.

• Identify community resources that might help. Consult with your local council on aging to find out what sort of transportation resources are available, as well as senior center programs that promote social interaction.

• Explore why your family member may be resistant to activities that could increase social interaction. Common reasons include fear of rejection or distrust of strangers. If your family member is apprehensive, for instance, about taking the town's senior bus to the grocery store or doctor's office, see if you can accompany them the first time. The same goes for senior center activities – perhaps bring your family member there and explore the options together.

• Have a conversation about what being independent means to your loved one. In a non-emotional way, explain the health issues that are caused by loneliness. Discuss how our views of independence change over time.

On a more global level, communities can take steps to address social isolation and loneliness among their older populations. Many towns have strong Councils on Aging. In addition, the "dementia friendly" and "age friendly" community movements are gaining momentum.

I recently ran into the director of the adult day program in my town and told her about the gentleman in the candy store. She said our town is focused on becoming an age friendly community and businesses would be encouraged to share information about the Senior Center and other resources with customers like him. This gives me hope that loneliness in our communities can be recognized and addressed.

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