John Prine’s beautiful song “Hello in There” details the story of a man who has lived many years. As the song unfolds, we learn that his wife has died, the kids have moved away, and he has even outlived one son who died in the Korean War.
The chorus speaks to the reality of what it is to be human and to age. Trees grow stronger, rivers wilder, but sometimes old people just grow lonesome. And with each passing day, as time moves ever so slowly, a person left alone simply waits for someone to say, “Hello in there, hello.”
Although Prine wrote the song when he was 22, his insights into one of the more insidious issues of aging rings true. In the United States, the reality of living alone and becoming isolated go hand-in-hand for many seniors. Per Merck Manuels, “Nearly 29% of the 46 million community-dwelling older adults live alone. About half of the community-dwelling oldest old (>85 years) live alone, and about 70% of older people living alone are women, and 46% of all women age >75 years live alone.”
But being alone and isolated does not always equate with the state of feeling lonely. In this post, we’ll make the distinction, then highlight the underlying health impacts and call out some of the signals you can look for as a health care provider.
A Silent Threat
Being able to articulate a sense of loneliness is a two-part problem. Someone can be feeling it, but be unable to explain the “what” and “why” of the experience. And honestly, even uttering that we feel lonely comes with negative connotations that we’re some sort of social failure.
In the fascinating article “Is There a Medical Cure for Loneliness?” over at AARP, author Lynn Darling explains how loneliness is primal. We were built to respond negatively to being on our own. At a cellular level, alarms go off.
Darling details how scientist Steve Cole looked at the white blood cells of people who had expressed dealing with long bouts of loneliness, and discovered that their cells “appeared to be in a state of high alert, responding the way they would to a bacterial infection. It was as though the subject’s body were under mortal assault by disease—the disease of loneliness.” 
This biological response to loneliness makes all the sense in the world given that we are social beings. We need to feel connected and have purpose that is assigned, shared and recognized by others. Loneliness is indeed a disease all its own with a reported impact of nearly one-third of all adults over the age of 45 reporting feeling lonely.
And for older adults over the age of 65, and more reasons people live alone such as the loss of a spouse, plus the onset of health issues like diminished hearing and eyesight, loneliness is at its worst. Loneliness comes more often when people have diminished social contact and are more isolated from daily activities and interactions. This happens more often with older adults.
Is it any wonder that such a notable biological response would impact a person’s physical health, especially over time? Per the Centers for Disease Control and Prevention (CDC), loneliness can impact or cause series health problems, including a 50% increased risk of dementia, a 29% increased risk of heart disease, and a 32% increased risk of stroke.
Look for Signs
Once our white blood cells are ramped up due to that pervasive sense of loneliness, it trickles to our brain and to our thinking, signaling us to be on alert and causing us to draw away further away from others due to lack of trust. Loneliness becomes a loop in our thinking process.
As humans, the disease of loneliness is an issue for everyone, but in a roll as a caregiver for patients there’s an opportunity to be that first-line of defense and help. Look for any of the following changes with someone in your care:
- Expressed sadness or feelings of despair
- Loss of interest in hobbies, socializing or daily activities
- Sleep disturbances or memory issues
- Unexplained aches and pains
- Neglect of personal hygiene and other routines
Resources
As a care provider, you might be the person who most often sees these changes first in a client, and can bring your concerns to the attention of the family members you report to. You can explain that this is something many deal with and there are ways to provide support.
Be prepared to offer a list of resources available to families and seniors. The CDC provides a great list of resources, including Eldercare Locator which is a free national service that helps families and elders find local resources such as financial support, caregiving services, and transportation.
If you work with a professional organization such as Home Health Companions, you’ll also have access to a dedicated team of knowledgeable staff who can help you. Together we can work to destigmatize the disease of loneliness, and by helping others we also help ourselves. When it comes to loneliness, none of us is spared from its impact.
Bibliography:
https://www.merckmanuals.com/professional/geriatrics/social-issues-in-older-adults/older-adults-living-alone#:~:text=In%20the%20US%2C%20nearly%2029,%E2%89%A5%2075%20years%20live%20alone.
https://www.aarp.org/home-family/friends-family/info-2019/medical-cure-for-loneliness.html
https://www.cdc.gov/aging/publications/features/lonely-older-adults.html
https://eldercare.acl.gov/Public/Index.aspx