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Every day, Karen Veselka, the town nurse for Lyme and Old Lyme, makes home visits free of charge to many of the older and retired residents of the area.
“A lot of the people are the older population and a lot of times I’m the only person that they see for a while, and I only see them once a month,” Veselka said. “There’s a lot of loneliness and it’s very sad.”
Veselka said many of her patients who are experiencing loneliness or social isolation may stop eating, sleep for large parts of the day or become depressed.
“Lots of them don’t drive so there is nothing to do, just basically sleep,” Veselka said.
Making sense of the problem
Increasingly health professionals and social service providers are considering the toll that loneliness is having on not only the elderly, but the entire population.
“Every two years we do an open call for issues that are heightened across the world. Social isolation bubbled up two years ago,” said Maryjoan Ladden, a nurse practitioner and senior program officer for the Robert Wood Johnson Foundation.
There is nothing new about loneliness and social isolation, but new research is making sense of the dramatic impact they can have on public health.
“There are many contributing factors: people are living longer, widowhood, people are living independently, more people are childless or never married,” said said Kerstin Gerst Emerson, a clinical associate professor in the College of Public Health at the University of Georgia. “In terms of impacts, researchers find it kills you earlier.”
Emerson is not reserved about the devastating effects loneliness can have on an individual’s life, especially once they are already are less mobile or have a chronic illness.
“When someone is lonely they don’t take care of themselves as well, they often don’t exercise,” Emerson said. “This is linked to early nursing home admittance and poorer health outcomes.”
Loneliness and social isolation are now being considered for listing as key social determinants of health, by the World Health Organization, together with access to food, housing and clothing, said Ladden.
“Most important is for people to be aware that social isolation puts people at significant risk for significant health problems,” Ladden said. “We should be aware of the consequences of isolation and understand what we could do to help our neighbors and to help others.”
Two related problems
Loneliness and social isolation are related, but not entirely the same phenomena, explained Emerson. Social isolation is defined by a lack of significant social connections. Loneliness, on the other hand, is harder to define and less tangible.
“Loneliness is interesting especially in public health. It’s tricky to determine if someone is lonely. Sometimes people are totally fine alone and others crave attention,” said Emerson. “It’s about having your social needs met. Do you have a confidant or someone to talk to about your day?”
For individuals that are both isolated and lonely, the problems are only compounded, which is why more problems are evident in older adults.
“I’m sure there are younger people who are lonely, but at least they are more mobile,” Veselka said. And in a semi-rural or suburban area like much of southeastern Connecticut, losing the ability to drive can cut them off from the outside world.
Programs that help
Although there are no government-led efforts on the national level to address the problems of loneliness and social isolation, as there are in other countries, but the issue is beginning to attract the attention of insurance companies.
“Some healthcare companies including Cigna are really starting to put an emphasis on the problem at the national level,” Emerson said.
“Statistically, older adults who were chronically lonely are more likely to go to their physician,” Emerson said. “Physicians would say they just see their primary care because they want to talk. This is incredibly inefficient in terms of cost, a primary care visit, just for a conversation.”
Senior centers and community health centers and organizations also offer programs that at least indirectly address the problem.
“While there isn’t a specific program to address loneliness, we have programs that are definitely targeted at seniors that help them not be isolated and therefore, lonely,” said Deb Monahan, the executive director of the Thames Valley Council for Community Action (TVCCA).
“In addition, we operate the Retired Seniors Volunteer Program which seeks individuals 55 and over who want to volunteer for something in the community. That also addresses seniors who might be alone and therefore isolated.”
TVCCA also provides a “Meals on Wheels” program to 39 towns in eastern Connecticut.
“It’s more than just a meal,” said Marylou Underwood, the chief operating officer for TVCCA and supervisor of the Senior Nutrition Programs. “It’s about conversation. It’s about do you see something different than usual. There are clients who don’t have any family at all or don’t have family in the state so we work with all the resources in the community to help that client,” Underwood said. “Every single day a drive calls in a problem they noticed with a client and we get that client help.”
When Underwood began working at TVCCA 39 years ago, about 75 percent of the meals they served were in the senior center and 25 percent were through Meals on Wheels. Today that ratio has flipped, while the average age of those served has increased to the age of 79.
“It’s easy to forget about this population because you don’t see them,” Underwood said. “We try to keep the program front and center…. We are the connection for the adult children who may not live nearby or may work full time. We are someone there every day to verify if mom or dad really is okay.”