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