For years, Linda Fried has offered older patients who complained about being alone what seemed like sound advice. "Get out and find something that matters to you," she said.
But his well-intentioned advice did not work most of the time. What the patients really wanted was a close relationship with people close to their hearts, the satisfaction of social roles and the feeling that their lives were valuable. And it was not easy to find.
We need "new societal institutions that give meaning and purpose" to the lives of the elderly, Fried said recently at a committee of National Academies of Science that studies the loneliness and social isolation of older people. (Fried is a geriatrician and dean of the Mailman School of Public Health at Columbia University.)
The deliberations of the group take place in a context of increasing interest for the subject. Four investigations conducted by Cigna, AARP, the Kaiser Family Foundation, and the University of Michigan examined the extent of loneliness and social isolation among older adults during the Past year. And health insurers, health care systems, senior housing operators and social service agencies launch or develop initiatives.
In particular, Anthem (an American health care company) is planning to implement a lone leniency program under its Medicare Advantage program developed by its subsidiary CareMore Health, said Robin Caruso, head of solidarity at CareMore.
UnitedHealthcare puts health browsers at the disposal of Medicare Advantage members at risk of social isolation. And Kaiser Permanente has launched a pilot program that will lead isolated and isolated older adults in its North West area to community-based services, and plans to move it later to other areas, said Lucy Savitz, vice-president of the community. health research at Kaiser Permanente Northwest.
The effectiveness of these programs and others remains to be seen. Few of them have been rigorously evaluated, and many assume that increased social interaction will go a long way towards alleviating the distress of older people who do not have meaningful relationships. But this is not necessarily the case.
"Ensuring loneliness is not just about having random human contact, but about the quality of that contact and the people you are in contact with," said Vyjeyanthi Periyakoil, associate professor of medicine at Stanford University School of Medicine.
A unique approach will not suit older adults, agreed with other experts. Instead, varied approaches that recognize the different degrees, types, and root causes of loneliness are needed.
Types of loneliness
Loneliness comes in different forms that call for different answers. According to a well-established framework, "emotional loneliness" occurs when a person feels the lack of intimate relationships. "Social loneliness" is the absence of satisfactory contact with family members, friends, neighbors or other members of the community. "Collective solitude" is the feeling of not being valued by the community at large.
Some experts add another category: "existential loneliness", or the meaning that life lacks meaning or purpose.
Carla Perissinotto, Assistant Manager of Clinical Programs in Geriatrics at the University of California, San Francisco, recently reflected on the different types of loneliness because of her mother, 75-year-old Gloria. Widowed in September, then forced to stay home for three months after hip surgery, Gloria became deeply lonely.
"If I were a clinician and I was telling my mom:" Go to a senior's center, "that would not advance me on the fundamental problems: my mother's sorrow and her feeling, since she's not from this country, welcome here, given the political situation, "Perissinotto said.
What helped Gloria is "talking and giving a voice to what she's going through," Perissinotto said. In addition, friends, former colleagues, family members and some friends from Perissinotto High School gathered around Gloria.
"She has the feeling of being an integral part of her community and that is what is missing from so many people," Perissinotto said.
"Look at the elderly people around you who have experienced a major life transition: a death, the diagnosis of a serious illness, a financial setback, an operation that puts them at risk," she said. . "Think about what you can offer as a friend or colleague to help them feel valued."
It is important to listen to older adults and to know the type of loneliness they experience before attempting to intervene. "We need to understand what drives someone's loneliness before suggesting options," Perissinotto said.
Basic causes of loneliness
One of the root causes of loneliness may be the perception that other people have rejected you or do not care about you. Frequently, people who feel lonely express negativity or reject others because of perceived rejection, which only reinforces their isolation.
In a review of interventions to reduce loneliness, researchers at the University of Chicago indicated that interventions that address what they call a "maladaptive social cognition" – mistrust of others, negativity and expectation rejection – are generally more effective than those teaching social practices. skills or promote social interactions. Cognitive behavioral therapy, which teaches people to recognize and question their assumptions, is often recommended.
Relationships that have become disappointing are another common cause of loneliness. It can happen to a spouse become inattentive with time, adult children or friends who live remotely and who are rarely in contact.
"Finding how to promote quality relationships for single seniors is a delicate task," Holt-Lunstad said. "Although we have decades of research in relational sciences that help characterize quality relationships, there is not much evidence on effective ways to create these relationships or to intervene" when problems arise.
Other contributors to loneliness are easier to approach. Some examples: A person who has lost the feeling of having significant connections with other people due to hearing loss – the most common type of disability in older people – may be encouraged to use a hearing aid. Someone who can no longer drive and has stopped coming out of the house can get help for transportation. Or someone who has lost a brother or sister can be directed to a grief program.
"We need to be very strategic in our efforts to help people, what they need and what we are trying to accomplish," Holt-Lunstad said. "We can not just run programs on people and hope something is better than nothing."
She recommends that seniors mentally evaluate how lonely or socially isolated they feel. Do I feel excluded? How are my relationships supportive? Then they should examine what underlies any problem. Why do not I meet up with friends? Why did I lose touch with people I talked to once?
"When you identify these factors, you can then think about the most appropriate strategies to ease your discomfort and manage the obstacles that hinder you," said Holt-Lunstad.
O GET HELP:
If your mental health or that of someone else worries you, the best place to get help is your GP or your local mental health provider. However, if you or another person is in danger or you put others in danger, call 111.
If you need to talk to someone, the following free support lines are available 24/7:
LINE OF DEPRESSION: 0800 111 757
LIFE LINE: 0800 543 354
1737 Need to talk? Call or text 1737
SAMARITAINS: 0800 726 666
YOUTHLINE: 0800 376 633 or text 234