Loneliness vs. Isolation: Why Senior Centers Need to Address Both

Lonely man in armchair

Dr. Vivek Murthy is the current Surgeon General of the US. In a recent book, he called loneliness one of the most pressing public health problems in the country. It contributes to alcohol and drug addiction, violence, depression, and anxiety. It’s a serious and growing problem.

That’s even more true for seniors. A meta-analysis in BMC Public Health found that approximately 50% of people over 60 are at risk for social isolation. Likewise, one-third will experience some degree of loneliness later in life.

This is important because isolation can seriously harm your mental and physical health. To stay healthy, seniors need to have meaningful social connections. Senior centers can help, but only if they implement the right programs.

How Isolation Affects Seniors Physically…

First, Isolation can affect your physical health directly.

Seniors who are isolated tend to adopt a “bed-kitchen-sofa” lifestyle with little physical activity. Often, they are stuck inside very small apartments. They move between these three spots without getting much exercise.

Over time, these seniors will lose muscle, known as sarcopenia. They start to eat less, which can cause malnutrition. The overall effects are similar to deconditioning during hospital stays. Seniors lose muscle mass, coordination, and balance and become more physically frail.

Isolation is also associated with hypertension, high blood pressure, obesity, and diabetes. These issues could be the result of that bed-kitchen-sofa lifestyle. But isolation also causes stress, which leads to inflammation and weakens the immune system.

All told, isolation can affect your health as much as other risk factors like smoking or obesity.

And Mentally…

Isolation can also damage your mental health.

The Stockholm Gerontology Research Centre looked into the connection between isolation and dementia. They found that isolation can increase your risk of dementia by as much as 60%. It’s associated with Alzheimer’s disease, increased anxiety, agitation, and depression.

At worst, these problems can lead isolated seniors to attempt suicide. And these symptoms can emerge in people with no prior history of mental health issues. 

Even healthy seniors suffer during isolation. But dementia can make all of these problems worse.

The journal Nature Reviews Neurology published a special issue on neurology and COVID-19. The issue included an article on the effects of the pandemic on people with dementia. Anxiety and depression increased in the whole population. But researchers found that it increased even more among older adults with dementia. That was particularly true for seniors in care homes—another reason seniors prefer to age in place.

The Difference Between Loneliness and Isolation

At this point, it’s worth differentiating between isolation and loneliness.

Social isolation describes an objective state. It refers to how often you interact with people, or how many different people you interact with. Socially isolated people spend less time, less frequently, with fewer people.

On the other hand, loneliness is a personal feeling about whether or not your social needs are being met. Are you close to people? Can you confide in them? Loneliness is more about the quality of your relationships, rather than the quantity.

In other words, a person can be socially isolated but not lonely. And reducing social isolation might not reduce loneliness.

You can think of it like a crowded subway. You can be surrounded by people and still be lonely, if they are low-quality connections.

Isolation and loneliness can each affect someone’s health on their own. Feelings of loneliness can be just as important as actual social isolation.

A study in Amsterdam covered 2,173 seniors. For the seniors who reported feeling lonely, 13.4% developed dementia within 3 years. Among seniors who did not report feeling lonely, only 5.7% developed dementia. This gap persisted even when the researchers controlled for social isolation and other risk factors.

Loneliness can even change the actual brain. In an article from Frontiers in Psychology, researchers looked at how social distancing impacted seniors. Loneliness was connected with decreased brain volume, especially in areas of the brain related to memory. Lonely seniors also had a higher buildup in their brains of the plaque involved in Alzheimer’s disease.

Why Some Seniors Are at Higher Risk

All seniors can become isolated or lonely over time. But seniors with limited English skills are particularly vulnerable. So are seniors who are recent immigrants. Language isolation can lead to social isolation.

For example, in Pennsylvania, 69% of Asian seniors speak a language other than English at home. More than 1 in 4 Asian American households are English-limited. Still, most service providers that help seniors only provide services in English. That effectively isolates Asian seniors from support when they need it most.

Likewise, recent immigrants are joining a new culture. That culture may have different family or community structures. And any new relationships they build will lack depth compared to the relationships they left behind.

The end result of these changes is higher rates of loneliness. A study of immigrants in England found that 24 to 50% of Chinese immigrants reported feeling lonely. The norm for Britain is 8 to 10%.

The difficulties reinforce each other. A study in the journal Aging and Mental Health looked at elderly Korean immigrants. Rates of loneliness were higher for immigrants who had limited English. The same thing was true for immigrants who were less familiar with American culture. It’s just harder to build meaningful connections in an unfamiliar society.

Social institutions like Korean American churches, or care organizations like PASSi, can compensate. According to the researchers, organizations should focus on building stronger social networks.

The Importance of Strong Social Networks

A strong social support network can help seniors avoid the negative effects of loneliness and isolation.

In practical terms, we can turn to our social network for help when we need it. If a senior needs someone to take them to the doctor, or help them with daily chores, they can turn to that network of friends or family.

You can also turn to your social network in emergencies or times of distress, like the death of a spouse. In that way, a social network reduces the impact of stressful events.

Your social network also helps keep your brain active. You talk together, reminisce, go out, and generally live a fuller life. This fits with a “use it or lose it” theory of mental health. The more you use your brain, the stronger it stays. On the other hand, if you don’t use your brain as much, it will grow weaker.

Cognitive Reserve Theory describes this idea in more technical terms. Cognitive reserve is basically extra horsepower in your brain. You can draw on this extra power in times of stress, illness, or declining health. It’s like storing food for winter. You build a cognitive reserve over years through learning, curiosity, and social interaction.

Seniors without a cognitive reserve have no way to make up a deficit, either from age or illness. So their mental health declines more quickly when something goes wrong.

Building Quality Connections in Senior Day Centers

But, you can see why it’s not enough to create any level of connection. Superficial connections can help with isolation, but not loneliness. Seniors, like anyone else, need high-quality social connections to thrive. Not every program promotes those deep connections.

Programs to combat loneliness are usually either one-on-one or in a group setting. When researchers reviewed these programs, they found that the programs that reduced loneliness most effectively share certain features:

  • Are group-based (not one-on-one)
  • Let seniors be active participants in social activities
  • Target specific groups with common life experiences or culture

Social programs for seniors should operate according to those criteria for effective programs. Seniors should be active participants in group programs. And those programs should be tailored to seniors’ specific needs and interests. Ideally, the programs should fit their language and culture as well. That avoids isolating seniors with limited English.

Again, the point is to reduce social isolation and loneliness. You do that by building deep connections and creating a real community.

How Home Caregivers for Seniors Can Help

Certain seniors may not want to participate in group activities. Even then, the right home health aide can still help fight loneliness.

Home care is a very personal thing. A senior who needs care welcomes someone into their home. These caregivers then help them with some of the most intimate activities of daily living like cooking, bathing, and dressing.

As a result, these caregivers are a key part of a senior’s social structure. Any caregiver who comes regularly reduces a senior’s social isolation, since isolation is just a measure of how often you interact with people.

But recall that loneliness depends on the quality of those interactions. If a senior does not share a language or culture with their caregiver, it will be hard to develop more meaningful connection. In other words, a shared language makes it easier to fight loneliness. A shared language leads to better care too.

Get Involved in Your Community

Overall, senior centers or caregivers need to fit the specific populations they want to serve. They should fight loneliness, not just isolation. That means providing activities that fit the unique languages, cultures, and histories of seniors.

At least, that’s our philosophy behind Jubilee Center Adult Day Care. If you or someone you love is ready to get in touch with a new community, you can learn more about our senior day center.

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Penn Asian Senior Services