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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 older people, Fried recently told 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 growing interest for the subject. Four surveys (conducted by Cigna, AARP, the Kaiser Family Foundation, and the University of Michigan) examined the extent of loneliness and social isolation in older adults during of the past year. And health insurers, health care systems, senior housing operators and social service agencies launch or develop initiatives.
Anthem plans to launch Medicare Advantage's leniency program, developed by CareMore Health, "said Robin Caruso, Solidarity Manager 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 toward alleviating the distress of older people who do not have meaningful relationships. But this is not necessarily the case.
"Assuming loneliness is not just about having random human contact; it's about the quality of that contact and the people you're in contact with, "said Vyjeyanthi Periyakoil, associate professor of medicine at Stanford University School of Medicine.
A unique approach for all will not work for older adults, have agreed with other experts. Instead, varied approaches that recognize the different degrees, types, and root causes of loneliness are needed.
Degrees of loneliness. The headlines are alarming: between 33 and 43% of older Americans are alone, they proclaim. But these figures combine two groups: people sometimes solitary and people always solitary.
The distinction is important because sometimes people alone do not necessarily stay alone; they can come in and out of this state. And the potential impact of loneliness on health – a higher risk of heart disease, dementia, immune dysfunction, functional impairment and premature death – depends on its severity.
Extremely lonely people are at "high risk," while those who are moderately moderate are less at risk, said Julianne Holt-Lunstad, a professor of psychology and neuroscience at Brigham Young University.
The number of people in the highest risk category is relatively small in the long run.
Four percent said "always" and 27% said "sometimes" when AARP asked, "How often do you feel lonely or isolated from those around you?" To the adults who participated in his investigation last year. In the University of Michigan's recently published survey on loneliness and social isolation, 8% of seniors (aged 50 to 80) said they often lacked camaraderie (an indicator of loneliness), while 26% said this was sometimes the case.
"If you compare loneliness to a toxin and ask" What is the dangerous exposure, at what dose and over what period of time? "The truth is we do not really know yet," Periyakoil said.
Why is it important? Loneliness is not always negative and seniors should not panic if they feel it sometimes.
Loneliness often motivates people to find a way to connect with others, strengthening social bonds. Most often, this is inspired by circumstances that people adapt to over time, such as the death of a spouse, a close family member or a friend; serious illness or injury; or a change of life situation.
Types of loneliness. Loneliness comes in different forms that call for different answers. According to a well-established framework, "emotional loneliness" occurs when someone 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 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 was a clinician and I said to my mother," Go to a senior center, "that would not advance me on the fundamental problems: my mother's grief and her feelings, since She's not from this country, welcome here, considering 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 feels like a valuable part of her community and that's what so many people miss," Perissinotto said.
"Look at the elderly around you who have experienced a major transition in their lives: a death, the diagnosis of a serious illness, a financial setback, a surgical operation putting them in danger," she said. . "Think of what you can offer as a friend or colleague to help them feel valued."
Why does it matter? It is important to listen to older adults and to know the type of loneliness they experience before intervening. "We have 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 noted that interventions that address what they call "maladaptive social cognition" – mistrust of others, negativity and expectation rejection – are generally more effective than those who teach society. 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.
"Understanding 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 how to effectively create these relationships or 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. A person who can no longer drive and who has left the house can get help with 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 achieve," 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.
This column is produced by Kaiser Health News, a non-profit news service. It is an independent editorial program of the Kaiser Family Foundation and is not affiliated with Kaiser Permanente.
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