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

2. 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

3. 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
Not the same as social isolation

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

5. 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

6. 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 The Campaign to End Loneliness: London.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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…

12. 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:

13. 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

14. 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.

15. 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

16. Loneliness Scale 3-Item Loneliness Scale:
If you are a provider…
Max score: 9 or higher = more lonely

17. 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…

18. 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
Questions? Mia Grigg, Friendship Line Director, or Patrick Arbore, Founder & Director, CESP – or

19. Local Resources Aging and Disability Resource Center (ADRC)
Riverstone Crisis Line and Walk-in Clinic

20. Say hello!
Start Seeing Seniors

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