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The outbreak of COVID-19 or Coronavirus has spread fear much more virulently than the disease itself although older adults being at high risk of mortality from coronavirus certainly have much to fear. Self-isolation as a method to reduce transmission risk may not be an optimal response to the coronavirus threat for very old adults because social isolation and loneliness have been shown to be detrimental to the physical and mental well-being of seniors. Isolating seniors amid such high tension can only serve to heighten the risk to their mental and physical health. Social isolation and loneliness are prevalent among the elderly because their social networks tend to shrink in later life due to losses of friends, family or from age related functional loss. As whole communities retreat into isolation to ease concerns about acquiring coronavirus, the vulnerable elderly living in near isolation will be forced to deal with fears of dying or media reports of impending doom all alone. What an alarming development!
All gatekeepers to the elderly should increase urgency to help seniors stay connected socially during the coronavirus crisis. What seniors in later life need more than ever are peers sharing similar feelings of distress about coronavirus who can band together and help each other through this most difficult period. Gatekeepers to the elderly are reminded that social isolation and loneliness though not the same, are widely recognized among health experts as a cause of poorer health among the elderly. Social isolation is measured objectively by the number of contacts we have which can drop sharply as we age.1 Loneliness is measured subjectively as the difference between one’s desired and achieved levels of social connectedness which can increase as we age.2
In fact, published studies on the effects of loneliness and social isolation on health, show that seniors living in near isolation are at much higher risk to develop chronic loneliness, sleep disturbance, depression or anxiety and may experience worsening symptoms of geriatric conditions such as cognitive impairment, frailty, heart or respiratory diseases. 3A recent report by the National Academies of SCIENCES, ENGINEERING + MEDICINE, February 2020, found that social isolation and loneliness can cause serious health issues, including an increased likelihood of early death, dementia and heart disease to name a few. Interestingly, research has revealed that being isolated for a prolonged period causes premature mortality and has the equivalent effect on health as smoking 15 cigarettes a day.4
Seniors lack reserves to cope with the high levels of stress particularly those who lack good social supports. Gatekeepers to the elderly should know that in a November 2015 study, researchers identified how loneliness and perceived social isolation triggers heightened fight-or-flight stress responses, depressive symptoms and ultimately premature death. 5What happens is that when we feel stress, our natural response is to run or fight but how many of our vulnerable elderly population have enough resilience to fight a threat whereas, many seniors confronted with a threat will run not literally, but by withdrawing more into their heads, thus causing them to be even more isolated.
National Institutes on Aging grant recipient and researcher Dr. John T. Cacioppo, former director of the Center for Cognitive and Social Neuroscience at the University of Chicago was a principal researcher in November 2015 study described above and he along with his wife Stephanie Cacioppo have been pioneering studies on the effects of loneliness and social isolation on older adults for some time. The Cacioppo’s have identified what they term is an Evolutionary Theory of Loneliness, ETL, which lays out a case for why loneliness or perceived social isolation signals danger to emotional health, prompting those affected to want to increase socialization as a threat response and the case for why many seniors fail to take proper steps to reduce or cure loneliness. 6John Cacioppo in a statement to the University of Chicago said on the subject:
“physical pain is an aversive signal that alerts us of potential tissue damage and motivates us to take care of our physical body. Loneliness meanwhile is part of a warning system that motivates people to repair or replace their deficient social relationships”.7
What the Cacioppo’s have learned in their exhaustive research is that while the feeling of loneliness produces an emotional pain that motivates people to want to increase social connectedness, it also produces a short-term reflective action of heightened self-centeredness for self-preservation purposes such that as we become more self-centered, we tend to get locked into a feeling of being more socially isolated.8 This unhealthy feedback loop in what the Cacioppo’s called the reciprocal influences between loneliness and self-centeredness, is a root cause of the mental and physical illnesses that arise from chronic loneliness.
We now know from evolutions in social science that as seniors become disconnected from healthy social support systems during times of great stress, they are prone to run to safety which psychologically, means becoming more self-centered not in a derogatory sense but more out of a perceived necessity for self-preservation. In such situations, the senior is seen withdrawing more emotionally while living with the pain of loneliness, yet unable to do things to alleviate that pain. Unfortunately, in times of great distress, socially isolated seniors who are already dealing with chronic loneliness are forced to process a great level of distress “in their heads” which will lead many to have heightened fight-flight stress responses to that stress.
Aloneness is a form of self-distancing that allows for solitude to build on things like self-confidence or resilience. Many older adults cope well in solitude but due to increasing levels of emotional and physical fragility that accompanies later life, many will not have enough resilience to cope well during times of great distress. The coronavirus has been labeled a Pandemic which term triggers a primal fear of an existential threat to human survival and a lethal threat to all seniors. This current period is unprecedented in modern history and is forcing many seniors to manage very high levels of stress without adequate social supports. Gatekeepers must be prepared to help the vulnerable elderly to resist the urge to self-isolate as their flight to safety and instead facilitate increases in their opportunities for socializing as soon as possible during this crisis.
What all gatekeepers of the elderly should know is that there is strong scientific evidence revealed through a controlled study that when we share a threatening situation with others who find themselves in an emotionally similar situation, we can help each other cope with the threat which can lower the heightened levels of stress that accompanies the shared threat.9 The study performed by Townsend et al, examined groups of people who feared public speaking but were to perform public speaking in front of an audience. The study confirmed the hypothesis that individually, we experience heightened levels of stress in response to greater threats but when subjects of the study were placed in groups and enabled to interact with those who shared a fear of public speaking, the paired individuals experienced reductions in cortisol responses (Cortisol is a catabolic hormone and an end product of activation of the hypothalamic-pituitary-adrenal cortical axis during times of stress) and reported lowered stress levels than did the individuals. 10Thus, while isolation causes stress and poses higher risks to health, connecting with others reduces stress and lowers risk of adverse health issues.
Seniors living alone may recoil at the suggestion that they move into a communal living environment during a contagious virus outbreak. At first blush, it may seem obvious that moving from a single-family home or condominium to a communal living environment would increase the risk of disease transmission. However, in truth, seniors living alone will be exposed to a variety of unknown risks of people depositing viral material for others to pick up and transmit as they grocery shop, eat out or pick up medications at their local pharmacy. Person-to-person contact risk may actually be higher for seniors living in a home than for residents of a senior living community which observes standard anti-germ protocols.
For example, when comparing senior living to home, keep in mind that person-to-person contact can be minimized in the controlled environment of a senior living residence as senior living residents receive all the social supports they need inside the community, are able to self-isolate when they deem it appropriate in the privacy of a comfortable apartment and there is a staff diligently working to reduce the threats of disease transmission. Whereas, seniors living alone will be compelled to go out for socialization, recreation or to shop. Thus, when performing a transmission risk assessment, if seniors take the time to assess global risk to their health and well-being staying home in near isolation versus staying connected with similarly situated residents who help one another address the fears and uncertainties surrounding coronavirus, the prevailing sentiment may be that a move into senior living is a safer choice than staying home.
A move into senior living can reduce the pain and stress which accompanies many seniors who are living alone with inadequate social supports during this most trying time. Stephanie Cacioppo reaffirms the main message of the research efforts discussed above about the effects of loneliness this way:
“when humans are at their best, they provide mutual aid and protection. It isn’t that one individual is sacrificial to the other. It’s that together they do more than the sum of the parts. Loneliness undercuts that focus and really makes you focus on only your interests at the expense of others."11
Stephanie speaks to the essential benefits of senior living. Seniors who have been exposed to chronic loneliness will need to work hard at building new friendships, open up about their fears of the unknown with others and be willing to help others as they cope with their own stress. These self-improvements can be achieved in the social setting of an assisted living community but, whether a move to senior living is the right choice, it is very important for all gatekeepers of the elderly who are living in the community to help them increase social connectedness such as attending a local senior center or a support group.
Resources
In-House Legal Counsel & Founder of Wellness-4 Later Life
