Loneliness & Older Adults Welcome My Intro, OABHI Why talk about loneliness? Loneliness & Older Adults

What is loneliness like for older adults? Loneliness in older adults is as deadly as smoking 15 cigarettes per day, according to the AARP Foundation’s Connect2Affect campaign. Being Alone

Loneliness defined Loneliness is the subjective feeling of being alone It is “the distress that results from discrepancies between ideal and perceived social relationships.” -Cacioppo. U. Chicago 2009 http://psychology.uchicago.edu/people.faculty/cacioppo/jtcreprints/hc09.pdf Not the same as social isolation

Social isolation Defined Social isolation refers to a complete or near- complete lack of contact with society Relates to quantifiable number of relationships

What do older adults say about loneliness and isolation? Campaign to End Loneliness in UK Video talks to people in various geographies and life situations = the universal experience of loneliness Campaign to End Loneliness

Intrinsic: Belonging naturally, essential The existence or absence of any of these things may lead to loneliness, depending on the individual. For some, it may take only one of these things to create loneliness. Intrinsic: Belonging naturally, essential Extrinsic: Coming or operating from the outside Goodman, A, Adams, A, Swift, HJ. Hidden citizens: How can we identify the most lonely older adults. 2015. The Campaign to End Loneliness: London.

Loneliness is not depression Depression defined: According to the Mayo Clinic, depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. It affects how one feels, thinks, and behaves and can lead to a variety of emotional and physical problems, including difficulty completing daily tasks and feelings of worthiness. However…loneliness is a major risk factor for depression. Can someone be lonely and still complete essential daily tasks? Not so for clinical depression.

Loneliness and the risk of Alzheimer’s disease Research shows the subjective feelings of loneliness may be a risk factor for developing Alzheimer’s disease Feelings of loneliness are linked to poor cognitive performance and quicker cognitive decline People who reported being socially isolated but not lonely were not at an increased risk for developing Alzheimer’s disease or another dementia Loneliness is more impactful in the risk for developing Alzheimer’s than is social isolation without loneliness. Tjalling Jan Holwerda, Dorly J H Deeg, Aartjan T F Beekman, et al: Research paper: Feelings of loneliness, but not social isolation, predict dementia onset: results from the Amsterdam Study of the Elderly (AMSTEL). Journal of Neurology and Psychiatry.

Living with Alzheimer’s and Loneliness What do we know about Alzheimer’s disease that may contribute to one’s loneliness? Why might Alzheimer’s disease create loneliness in individuals in early stage? Mid stage? Late stage? We know the desire for social engagement and interaction is still present, regardless of the lack of cognitive ability or change in memory.

Loneliness & the Alzheimer’s caregiver The challenges of caring for someone with Alzheimer’s disease differs from caring for someone with other diseases like cancer or chronic diabetes. What makes it different? How might these differences affect the loneliness of a caregiver? Changes in personality, caregiver guilt, shame, stigma, exhaustion.

risks of loneliness & isolation Nearly 1 in 5 adults over the age of 50 is at risk of social isolation (AARP, Connect to Affect Campaign) Loneliness is as dangerous as smoking 15 cigarettes a day (Holt-Lundstad, PLoS 2010) Loneliness is associated with higher blood pressure and heart disease Subjective feelings of loneliness can increase risk of death from 26% to 45% (AARP, Connect to Affect Campaign) Loneliness can be a factor in suicidality for an individual…

Suicide among older adults In Oregon, 93% of older adults who died by suicide in 2004 had a chronic illness. It has been estimated that 15% of adults over age 65 suffer from persistent and serious symptoms of depression but only 3% are given the clinical diagnosis of depression. In one study, 75% of physicians were found to believe that depression in older persons is a “normal facet of old age.” Programs that reduce certain risk factors such as depression, social isolation, loss of spouse or partner, access to lethal means, alcoholism, and poor physical health and increase protective factors such as social support, coping skills, and outreach can reduce suicide deaths. Source: http://www.oregon.gov/oha/PH/PreventionWellness/SafeLiving/SuicidePrevention/Documents/plan.pdf

We know that… In the month before an individual’s death by suicide: Half saw a primary care provider 30% saw a mental health professional Risk of suicide is highest in the first 30 days following discharge from: An emergency department An inpatient psychiatric unit Zero Suicide, zerosuicide.sprc.org

How loneliness impacts suicidality Two components of thwarted belongingness: (1) loneliness; and (2) absence of reciprocal care – relationships in which individuals both feel cared about and demonstrate care of another Perceived burdensomeness – views oneself as defective and flawed to the point of being a liability to others Not belonging Reciprocal relationships Feeling like a burden All very complex issues when compounded with other health issues, loss, etc.

Suicide prevention in older adults Purpose and meaning in life Consistent and meaningful connection Asking the question Are you thinking about harming yourself? Do you have a firearm? A plan? Restricting access to means Knowing who to call for help

Loneliness Scale 3-Item Loneliness Scale: If you are a provider… Max score: 9 or higher = more lonely http://psychcentral.com/quizzes/loneliness.htm

What can we do to help fight loneliness? Be the connection! Connections are paramount to caring for people who are lonely – assist them with keeping contact with people who are important to them Be as present as possible with people who are lonely Empathize with people’s losses and suffering Resources…

The Friendship Line: 1-800-971-0016 24-Hour Accredited Crisis Intervention Telephone Hotline/Warmline, began service in 1973: Call-In Service – Confidential telephone discussions for people 60+ (their caregivers or younger disabled) who may be lonely, isolated, bereaved, depressed, anxious and/or thinking about death or suicide A caller does not need to be in a suicidal crisis to use the call-in service Call-Out Service – Friendship Line Staff or Trained Volunteers will make phone calls to older adults for emotional support – Referrals can be arranged by calling IOA Connect 415.750.4111 Questions? Mia Grigg, Friendship Line Director, Mgrigg@iaoging.org 415.750.4138 or Patrick Arbore, Founder & Director, CESP – parbore@ioaging.org or 415.750.4133

Local Resources Aging and Disability Resource Center (ADRC) 503-650-5622 Riverstone Crisis Line and Walk-in Clinic 503-655-8585

Say hello! Start Seeing Seniors

Thank you for being the connection! Stephanie Barnett-Herro Clackamas County Older Adult Systems of Care Coordinator sbarnettherro@Clackamas.us