The Dangers of Aging Alone

Seniors Who Are at Risk of Suicide, and How the Friendship Line Helps
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The clarion call has recently sounded: Loneliness is an epidemic -- and older people are the hardest hit.

"Loneliness is, sadly, increasing," says Patrick Arbore, director and founder of the Center for Elderly Suicide Prevention and Grief Related Services at San Francisco's Institute on Aging. "And I think that has to do with our reliance on technology. People are much more interested in their iPhones and screens than the person standing next to them -- particularly if it's an older person who is aging in this ageist society."

The physical and psychological perils of the problem have been well studied and well documented. Health risks of loneliness include heart disease, high blood pressure, depression -- even death. And it's contagious. Lonely people tend to push others away, and others hesitate to intrude or simply shun the company of those who seem down and out.

Lonely in a Crowd

In a recent study of people 60 and older by the University of California-San Francisco, as many as 43 percent reported they feel lonely "on a regular basis." And perhaps the biggest surprise: Two-thirds of those who said they were lonely were married or living with another person. That fact flies in the face of the well-meaning friends and family members who urge their loved ones to move to a communal setting to stay happy and healthy.

"Particularly if you are involved in caregiving, it's very important not to make the assumption that all older people are going to be lonely. Make sure you understand that solitude may be what they choose," says Arbore. "But no one chooses loneliness and isolation; that happens because of circumstances."

Changed circumstances may include the loss of a spouse, partner, and friends, as well as sensory losses common to the aging process. And perceptions about older people often add to their isolation. "As people age and their vision becomes poor or they're unable to hear, other people shrink away," Arbore adds. "Nothing is more feared than individuals who have disabilities. We have such a long way to go in our ability to overcome our prejudices against them. That prevents connection, too."

The Friendship Line Connection

Arbore has long been concerned about that lack of connection, which he says links to the high rate of suicide. Among the young, there are 200 attempts to one death by suicide; among older people, there are four attempts to one death. Much of Arbore's life's work has focused on changing that.

"The traditional suicide prevention centers were not able to target older people who were at risk," he says. "People would call in and be greeted: 'Hello, Suicide Prevention Line.' For older people. that's just too much information. They want a conversation rather than a confrontation."

In 1973, Arbore founded The Friendship Line -- a program with a kinder, gentler name operated by volunteers and staff trained in the art of conversation. Targeted to those 60 and older and to younger people with disabilities, it operates as a hotline for callers in crisis and a "warmline" offering a friendly phone connection to those feeling isolated. Its reach is now national, with about 9,000 calls a month -- the only 24-hour, toll-free service in the nation accredited under the strict standards of the American Association of Suicidology.

Friendship Line workers also make regularly scheduled outgoing calls to about 250 clients who are particularly isolated. "We had to do more than just sit passively waiting for people who might be hesitant to call. We had to reach out to them," Arbore says. Many of those called say it's the only human contact they've had all day. Some clients also get calls from Friendship Line workers reminding them to take their medications at specific times. New callers and those who talk of being isolated are assessed on a Loneliness Scale used to track them.

"Older people in general are more reserved and less likely to be direct -- particularly about issues related to depression, bereavement, suicidal ideations," says Arbore. "There's also a cultural barrier, with many older people saying; 'We don't air our dirty laundry.' A big part of the reason the phone is useful is that it offers confidentiality and anonymity because it may be embarrassing to ask for help."

How Caregivers Can Help

Arbore and others note several "loneliness interventions" caregivers can use to help.

Talk about it. Along with all the other stigmas of aging, there is a strong stigma against admitting to being lonely -- or even talking about the possibility. Arbore advocates asking pointed questions, such as, "Will you tell me more about how your loneliness feels?" Or simply, "Would you like to talk with me?"

Spend more time engaging. That may take some patience and perseverance. "Try to understand what that older person is feeling," says Charis Stiles, who oversees and trains 70 volunteers on the Friendship Line. "Their processing might be a little bit slower, so give them gentle time; that may go a long way toward getting them to open up. Don't approach them with judgment, but with curiosity -- not as an outcome that needs to be accomplished."

Assist the person in keeping contact with others. Urge those who are willing and able to combat their own loneliness to lessen their isolation by working, volunteering, adopting a pet, or cultivating or regaining a hobby. Caregivers can often help by searching out leads or securing transportation to an activity.

Be mindful that ageism often plays a hampering role. Arbore says he was reminded of that recently when giving a talk on loneliness to a group of older people. "Half of those in the crowd said that no one had reached out to them -- and they didn't reach out to others because they feared being rejected."

Help develop community support. While resources to help curb isolation have been slow to surface, more have appeared in recent years, including "Friendly Visitor" programs run through churches, community centers, and nonprofit groups. The local Area Agency on Aging should be able to provide leads to local help.

Keep it real. While some hail the advent of computers and other technology as a way for older people to combat loneliness, Arbore winces at the mere mention.

"You can't have an in-depth or meaningful conversation in a text message," he says. "No emoticons capture the essence of empathy or replace the human voice, nor can they make a true human connection. That's what we're trying to do with the Friendship Line."

Barbara Kate Repa

Barbara Kate Repa, a lawyer and journalist, has devoted her career to editing and writing about legal issues for consumers. See full bio

over 3 years, said...

There is also the old adage - "if you want to have friends, be one!"

over 3 years, said...

So many excellent points made by groldorph. I would add also, that if you have a dog and walk with them, they can often by a starting point for a conversation.

over 3 years, said...

I wish the article touched on what to do when Mom decides EVERYONE of her friends is a horrible person and doesn't want to interact with anyone She would rather carry on conversations with invisible people about events that never happened.

over 3 years, said...

This article touched a nerve. Thank you.

over 3 years, said...

I am 85 and a recent widow (less than a year). I've lived alone for the last 6 years because my husband was living in the dementia unit of Assisted Living. For 12 years before that I took care of him at home. When he was well, he traveled a great deal, for 2-3 weeks at a time, for business, so I was often alone. I have never been lonely, maybe because I am an only child and learned early on what to do when I was alone. I've always had friends but never depended on them to keep loneliness away. I read, no glasses needed; I drive; I play Bridge; watch TV; email friends & family. I am always very busy doing things I enjoy. I have 3 adult children, all married & 10 grandchildren and they keep in touch and visit when they can. I have a number of friends my age and none complain of loneliness. I think keeping busy is the secret!

over 3 years, said...

This article makes very good points! groldorph also makes a good suggestion as well. If you can't walk, sit out on your porch, smile and wave at people that drive by. Another benefit of being outside is also getting more Vitamin D, which many of our loved ones are, as well as us caregivers, are deficient in. My Dad likes to be alone, but is never lonely. He watches his digital picture frame to remind himself of the joyous 93 years of life he has had, and a caregiver quietly watches, and sometimes talks with him about his life. There are also those that are the opposite - TV has to constantly be on, if someone's there they need to talk incessantly, get lonely even if someone is there that they enjoy talking to. The world is made up of many people.

over 3 years, said...

I would suggest that, anyone who is able, to go outside, regardless of the time of year, just dress appropriately as you are able, go outside. Go for a walk, shuffle if you wish, walk in whatever manner you feel is appropriate for your situation. Appear to be an approachable person.. If you have them, wear clothes that do not make you look too weird for others to feel comfortable visiting with you because of your clothes. But, no matter how you dress, dress how you wish, but, think, how you are dressed will, at least to some degree, will influence who might wish to talk with you. Smile. Especially with your eyes. People love to see someone smile. Smiles are a much higher vibrational frequency than is a frown, a sour expression, a scowl, or other, other than inviting facial expressions or body language. But, again, no matter how you look, if you make almost any effort at all, (or at least this happens to me all of the time,) someone will begin talking to you. That other person might just say "Hello", "how ya dooin?" or some other greeting, and you can, from that simple start, begin a conversation with some other person. Sometimes it is fun to be the one who approaches some other person who is also out walking around. Mayhap you may not wish to "walk around", still, go outside, sit in a public place, sit in a relatively or even extremely isolated location. Where you sit will, in many ways, influence who might find themselves in your presence and wish to converse with you. You alone might know what sort of person you may wish to interact with. If you like to go to any particular type of environment, out of doors, planetariums, museums, parks, malls, down-town shopping areas, or what ever sort of place you wish or enjoy hanging out at and if you are receptive to it, you will meet someone with whom you will find some common ground with and with whom you, if you both make any effort at all, should be able to become friends with someone you previously knew nothing about. Try it, if works wonders for me.