Hidden in Plain Sight: Isolation and loneliness were big problems long before Coronavirus

Written By: Marc Rothman, MD

Grandma Sue

Though only 23 years old and not yet finished with my pre-med classes, my Sunday morning routine was already decidedly geriatric in nature. I’d grab a cup of coffee and the New York Times, ride the #2 train into the beating heart of Brooklyn, pick up a hot roasted chicken and plop myself down in Grandma Sue’s kitchen for the next several hours, in the home where she had lived for the last 40 years.

Her around-the-clock aide would return home to spend time with her own family. Grandma Sue and I would eat, she told stories, and I mostly listened. She told stories of growing up before WWII, of becoming a big-boned, red-headed math and history teacher, of colorful relatives and friends over the years. And when something met with her disapproval she’d wag her finger, and in her thick Brooklyn accent, say, “Nothing doin’!”

Alone with Grandma Sue on Sunday’s I learned about perseverance, about listening and about family. And it’s also where I first learned about isolation. Despite caregivers and phone calls, Grandma Sue was largely confined to three rooms, rarely left the home, and saw only two or three people in person for most of the year.

Unveiling the Health Hazards of Social Isolation and Loneliness

In 2020, Grandma Sue’s single-location life and minimal outings are now eerily familiar. COVID-19 stay-at-home orders have given younger generations a taste of what daily life for homebound older persons is often like. While younger folks are experiencing social isolation in a novel, unprecedented way, for older folks this is more common than ever.

Well-recognized across the pond, a 2017 report in the U.K. found that 9-million Brits felt lonely in a significant way, prompting Prime Minister Theresa May to appoint a Harry Potter-esque Minister of Loneliness a year later. In 2018, AARP reported that in the U.S., 8-million people over 50 feel socially isolated, and that number increases daily by 10,000. Former Surgeon General Dr. Vivek Murthy highlighted the pan-generational aspect of loneliness and isolation, at both home and work, and it’s association with health outcomes. An often-cited 2010 study looking at mortality risks and social connections actually found that social isolation posed a higher health risk than smoking, alcohol, and obesity.

In geriatrics, isolation and loneliness are always on our minds. From a chronic disease perspective, isolation and loneliness correlate with increased risks for depression and anxiety, cardiovascular disease and dementia. From a functional status perspective, feelings of loneliness are correlated with a fear of falling among older persons as well, according to a 2017 study. “The profound effects of loneliness on health and independence are a critical public health problem,” said Dr. Carla M. Perissinotto, a geriatrician at the University of California, San Francisco. “It is no longer medically or ethically acceptable to ignore older adults who feel lonely and marginalized.”

Dementia, Loneliness and Isolation

Because depression can sometimes imitate dementia in my patient population, I always consider whether a person has become isolated the first time someone asks me about memory loss. For example, have they recently become immobile due to a medical condition, isolated, alone and now depressed? Did a spouse or daily companion recently pass away?

When people do receive a diagnosis of dementia, they may feel reluctant to talk about it publicly, so they stop engaging. Even with a diagnosis of mild cognitive impairment, people may start to limit their social engagement, anxious about forgetting things in conversation, fearful of getting lost on the way, or just embarrassed about the diagnosis in general. Caregivers who are tending to later-stage dementia patients often become socially isolated themselves.  It’s well known that caregivers often skip medical appointments, give up hobbies, socialize with smaller and smaller circles of friends, all of which can leave them depressed or ill, or worse. Generations of dementia patients and caregivers have cut themselves off from other people. Their world becomes smaller and smaller, a downward spiral of social isolation and loneliness.

Digital Strategies to Combat Social Isolation

Can the recent boom in technology strategies to combat social isolation in the COVID-19 era be adapted for the socially-limited elderly and those with dementia? I am hopeful they can help, despite the digital divide that has so long plagued the access and adoption of digital technologies by older adults. We must continue to push for technologies that are designed with older users in mind, utilizing design principles that are intuitive and non-threatening. We must quit blaming older users for their inability to catch on because of their unfamiliarity and, instead, innovate around their strengths, experiences, and preferences.

Failure to do so can paradoxically lead to an exacerbation of the digital divide, reducing adoption despite what seems like increased access. In her summary report on technology for older adults – 2019 Market Overview – analyst Lori Orlov notes, “While government and insurers see benefits of using technology to help people remain at home, device complexity, price, poor usability, rapid obsolescence combined with lack of standard professional training have created big barriers to broadening [digital technology] usage of an aging population, particularly for individuals aged 75-plus.”

When it comes to loneliness, isolation and dementia, bringing the digital world and seniors together is not enough. The root causes of social isolation and loneliness are broad. Social isolation with loneliness is a multi-faceted construct that requires a holistic solution. That’s why we employ dementia care teams – social workers, disease educators, gerontologists, patient advocates, case managers – to connect dementia patients and their caregivers to senior centers, PACE programs, physical therapy, museums/libraries and community events. The goal is not only to fend off social isolation and caregiver burnout, but to leverage social interaction for exercise, stimulation, even nutrition.

When the world goes back to some semblance of normal, when we turn off our video-conferencing systems and head back to the office, let’s not forget that social isolation and loneliness will remain a problem for our older adults with and without dementia, for their caregivers, and for us all. 

If you need services for your elderly loved one, visit Elder Care Locator or call 800-677-1116. 

The contents and information on DementiaSpring.Org are for educational purposes only and is not intended to substitute for medical advice, diagnosis or treatment.  Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. 

Any opinions expressed about, or endorsements of persons, services or organizations are solely those of Dementia Spring and are not made on behalf of Signify Healthcare or any other entity.

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