How can we avoid turning our concern about elder loneliness into a fad that will eventually recede from public view without any workable strategies to address it?
When the rock group Three Dog Night released its hit song about loneliness in 1968, it was hailed as a poignant and mournful riff on the breakdown of romantic relationships.
Now, 5 decades after the song hit the airways, its opening line—“One is the loneliest number”—has become an unofficial theme song for what’s being described as the “crisis of loneliness” among older Americans.
That crisis brings with it a lot of research and news articles about the downsides of elder loneliness.
Late last year, The Wall Street Journal (WSJ) labeled baby boomers as “The Loneliest Generation,” and cited research by Harvard University, Stanford University, and AARP showing that the lack of social contacts among older adults costs Medicare $6.7 billion a year.
A related WSJ article in February mentioned an unidentified research study showing that loneliness is “worse for health than obesity or inactivity, and is as lethal as smoking 15 cigarettes a day.”
In 2012, an analysis of the Health and Retirement Study by researchers at the University of California San Francisco found that people who identified themselves as lonely were at 59% greater risk of decline and at 45% greater risk of death.
Other studies focus on similar consequences of loneliness, including more severe cold symptoms, higher risk of dementia, and post-operative mortality after coronary bypass surgery.
Loneliness is such a big issue in Great Britain that Prime Minister Theresa May recently appointed the country’s first-ever Ministerial Lead on Loneliness and announced £20 million in funding to support efforts to tackle loneliness.
IS LONELINESS BECOMING A FAD?
Clearly, loneliness is an issue we can’t ignore. But how exactly should we focus on it? And how can we avoid turning our concern about elder loneliness into a fad that will eventually recede from public view without any workable strategies to address it?
There are several steps we could take to avoid that scenario.
First, we need to be careful that our studies of loneliness are robust, and that the data they provide about the incidence and impacts of loneliness among older people are reliable.
Second, practitioners must learn how to discern which studies on loneliness are reliable and which ones are being touted in the media simply because they lend themselves to attention-grabbing headlines.
I recommend you approach each study with a healthy skepticism. After all, loneliness is extremely difficult to measure. Take a second look at any article that tries to convince you otherwise. And don’t be afraid to question how researchers concluded that loneliness was more lethal than cigarette smoking.
Third, it’s important to understand that being alone, or living alone, doesn’t necessarily mean you’re lonely. Many people actually enjoy being alone and would never think of describing themselves as lonely. On the flip side, it’s quite possible that, due to psychological circumstances, someone could be lonely even if they are surrounded by people all the time.
The bottom line: loneliness is a personal experience and the study of it doesn’t always lend itself to easy generalizations.
FOCUSING ON SOCIAL ISOLATION
Personally, I’d like to see researchers and reporters focus on social isolation among elders, rather than loneliness.
If I’m socially isolated, it suggests that I can’t control my lack of access to other people. Some people might be happy to live alone, but could still run the risk of becoming socially isolated because they can’t get out of the house and engage with others when they want to.
Socially isolated elders are often dealing with extenuating circumstances like frailty, disability, lack of transportation, or other circumstances that they don’t have the power to change. Maybe they live in a remote rural area and have no nearby neighbors. Maybe they’ve moved to a new locale and are having trouble establishing new social connections.
This type of isolation was a concern among baby boomers participating in a LeadingAge survey conducted by NORC at the University of Chicago earlier this year. Among other things, researchers asked 1,200 older adults aged 60-72 how concerned they would be about becoming socially isolated or feeling lonely if they needed help for basic living activities. We found that people with higher incomes are less concerned than individuals with lower incomes about becoming socially isolated and lonely.
ONE POSSIBLE SOLUTION
The higher rate of concern about social isolation among individuals with lower incomes really caught my attention because it dovetails with an area of work on which researchers at the LeadingAge LTSS Center @UMass Boston have focused for more than a decade.
The LTSS Center serves as a national catalyst for the development, adoption, and support of an approach that uses affordable senior housing as a platform for coordinating health and supportive services for older adults. We recently concluded a yearlong study on potential financing options for this service-enriched housing model.
One critical feature of service-enriched housing is its ability to provide a variety of opportunities for residents to interact with one another, engage in meaningful activities with younger people in the wider community, participate in local causes, pursue lifelong learning, or simply have fun together. The housing community makes these opportunities available on-site or provides transportation to them. That way, no one who wants to participate is excluded.
A key to the success of these housing-based social engagement initiatives is that they give older people choices about how, and how often, they will engage with the world around them. The level and method of engagement will be different for every person. And those differences are respected.
Can service-enriched housing cure loneliness? Maybe not for everyone. But it has the potential to give more people the opportunity to choose engagement over isolation. And that’s a step in the right direction.
Robyn I. Stone, DrPH, is senior vice president of research at LeadingAge, and co-director of the LeadingAge LTSS Center @UMass Boston. Her widely published work addresses long-term care policy and quality, chronic care for people with disabilities, the aging services workforce, affordable senior housing, and family caregiving.