Isolation

Definition

Isolation in the context of senior health usually refers to social isolation rather than to the medical practice of isolating persons with contagious illnesses. Social isolation has been defined by the Cornell Institute for Translational Research on Aging (CITRA) as “the lack of access to social support and the lack of meaningful social relationships , roles, and activities.” As this definition suggests, social isolation should not be confused with solitude, living by oneself, or loneliness. Solitude refers to being apart from others, whether for a short period of time or longer, and is usually self-chosen. People of all ages often need solitude in order to focus on work or to rest; many believe that solitude is an important precondition for artistic or scientific creativity. Some people may go on periodic religious retreats in order to deepen their spiritual life through a period of solitude; thus it is not being alone in and of itself that defines a person as socially isolated.

With regard to living by oneself, a senior may live alone in a house or apartment and still have frequent contacts with friends and family members or participate in various community activities. Loneliness, on the other hand, is an emotional condition that may affect a person without regard to age or to his or her living situation. Loneliness is usually understood as an internal sense of emptiness or hollowness, of feeling cut off and disconnected from others; it is stronger and more painful than a simple desire for the company of another person. It is thus possible for someone to feel lonely even though they are sharing a household with several other people.

Description

Social isolation in the senior population has become a concern to health care professionals and policy makers since the 1960s, when gerontology (the branch of medicine dealing with older adults) first emerged as a separate specialty. The aging of the so-called baby boomer generation has intensified this concern, particularly because a number of studies have linked social isolation to an increased risk of physical and mental illnesses ranging from heart disease and cancer to depression and panic disorder .

Effects of social isolation

The connections between social isolation and these various diseases and disorders are still not fully understood as of 2008, although there is general agreement that the effects of social isolation depend on the amount of control a senior has over his or her living situation. That is, a senior who is in good physical and mental health and can participate in social activities when they wish to is less likely to feel socially isolated than someone who has mobility problems or is in the early stages of dementia.

One theory maintains that social isolation in and of itself produces stress on the body, leading to a lowkey version of the fight-or-flight reaction that raises the risk of physical illness if it persists for long periods of time. Conversely, social contacts with others supposedly reduce emotional stress and its long-term effects on health. Some animal studies have been cited in support of this theory.

A second theory maintains that social contacts are beneficial to a senior's health because other people influence the senior's attentiveness to self-care and compliance with medical recommendations. Friends and family members can also discourage smoking , excessive drinking, and other behaviors that are harmful to health. A variation on this theory maintains that social contacts improve a senior's access to other sources of companionship or help, such as medical referral networks or support groups of various types, thus multiplying the number of the senior's contacts with others.

Causes of isolation

Most of the research that has been done on social isolation among the elderly has been done among seniors living in large cities rather than in small towns or rural areas. To some extent this focus is the result of the special problems facing seniors in crowded urban areas. A study that was done by CITRA on seniors living in the New York City area identified several causes that contribute to isolation among older adults:

• Demographic changes that have increased the number of seniors living alone. As of the early 2000s, seniors are the age group in the United States most likely to live alone; 28 percent of Americans over 65 live by themselves. Three times as many women as men live alone. Over time, older Americans have becomes less likely to live with a relative other than a spouse—a change brought about by a combination of the rising divorce rate since the 1960s, the baby boomers' preference for smaller families, and increased geographical mobility. Although most seniors have at least one adult child, they may live hundreds of miles away from him or her. While living alone does not indicate by itself that a senior is socially isolated, it is thought to be a risk factor for eventual social isolation.
• Role loss. As a senior gets older, he or she is likely to lose one or more of the roles that connect him or her with others, such as husband or wife, employer or employee, friend or neighbor. It is also harder for seniors to make new friends as their friendship circle is narrowed by death or as former neighbors move away.
• Differences between men and women. Although women are more likely than men to be widowed and not remarry, they are also more likely to maintain social networks as they age. Men tend to rely on their wives to maintain their social networks and may have serious difficulties finding social support after a wife's death. A Swedish study of older men with prostate cancer reported in 2000 that nine out of every 10 patients in the study had only their spouse to confide in, and eight out of every 10 single men had no one they could call on for social support. The authors of the study concluded that gender has to be taken into account in evaluating a senior's social isolation.
• Health problems. Seniors with physical disabilities, cognitive decline, or mood disorders are more vulnerable to social isolation.
• Poverty. Of all seniors living alone and below the poverty line, 34 percent have no contact with friends or neighbors for two weeks at a time, and 20 percent have no phone conversations with friends or family.
• Language difficulties. Some seniors, particularly in large cities, are recent immigrants with poor command of English. A study published in 2007 reported that elderly Chinese in the United States are vulnerable to elder abuse as well as social isolation because of their language difficulties.

Social isolation and elder abuse

Social isolation is a concern because of its connection with elder abuse ; social isolation of caregivers as well as the abused elders themselves has been identified as a major risk factor for abuse. Such isolation reduces the likelihood that others will intervene to protect the abused elder. In addition, the senior's fear of the consequences of reporting the abuse reinforces his or her feelings of loneliness and helplessness.

Viewpoints

A number of programs and proposals have been put forward to help seniors deal with social isolation.

Public policy measures

Some public policy measures that have been proposed include making demographic analyses of neighborhoods within large cities and targeting those with a high population of vulnerable seniors (based on the number of seniors living alone and the level of their need for services).

Within the medical profession, some doctors have suggested screening seniors in primary care settings for signs of depression and other mood changes that often indicate social isolation. A common instrument used to screen for depression in seniors is the Geriatric Depression Scale, or GDS, first used in 1983 and translated into many different languages. The short form of the GDS consists of 15 questions with yes/no answers; the longer form has 30 questions. The GDS can be used by a senior's dentist, a visiting nurse, or any health care professional who is concerned about the senior's well-being.

Visitation programs

Volunteer approaches to the issue of social isolation in the senior population often take the form of visitation programs. Some churches and synagogues have groups of lay leaders who visit elderly members on a regular basis; in some cases, youth in the congregation “adopt” seniors and visit them on their birthdays and major religious occasions. In recent years, some colleges and universities have started volunteer programs that pair students with seniors living near the school. Many of these relationships turn into long-term friendships. Some organizations that sponsor intergenerational friendships include Dorot, which serves Jewish seniors in the New York City area, and Little Brothers-Friends of the Elderly (LBFE), a group that was started in France in 1946 by Armand Marquiset (1900–1981), a French nobleman who wanted to relieve the suffering of the elderly after the devastation of World War II. The American branch of LBFE was founded in 1959.

Other approaches

Other approaches that have been used with some success in reducing social isolation among seniors are:

• The formation of hobby groups and other interest groups recruited from neighborhoods where the members will see each other outside the group meetings.
• Programs that have some kind of educational component; this feature appears to increase the members' level of interest in and commitment to the group.
• Internet-based programs. One study done in the Netherlands reported that introducing homebound seniors to the Internet helped alleviate loneliness, with e-mail and online chat groups found to be the seniors' favorite activities.
• Pet therapy. A number of studies have reported that caring for a cat or dog not only relieves loneliness for seniors but also leads to forming new social contacts with other pet owners and keeping more active physically. The Delta Society, a group formed in 1977 to study and encourage the human/animal bond, has several of these studies posted on its website.

KEY TERMS

Gerontology —The branch of medicine that deals with the study of older adults and the aging process.

Loneliness —An internal feeling of hollowness or emptiness combined with a sense of being cut off from or estranged from other people. It can affect people who share a household with others as well as those who live alone.

Solitude —The condition or situation of being apart from other people, whether short-term or long-term. It is often self-chosen for the sake of privacy or to rest or work undisturbed.

It is generally agreed, however, that further research is needed in order to counteract social isolation among seniors more effectively. As of 2008, the approaches that seem to work best are those that target specific groups of seniors with clearly defined needs or interests.

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision. Washington, DC: American Psychiatric Association, 2000.

Beers, Mark H., M. D., and Thomas V. Jones, MD. Merck Manual of Geriatrics, 3rd ed., Chapter 15, “Social Issues.” Whitehouse Station, NJ: Merck, 2005.

PERIODICALS

Brummett, B. H., D. B. Mark, I. C. Siegler, et al. “Perceived Social Support as a Predictor of Mortality in Coronary Patients: Effects of Smoking, Sedentary Behavior, and Depressive Symptoms.” Psychosomatic Medicine 67 (January-February 2005): 40–45.

Dong, X., M. A. Simon, M. Gorbien, et al. “Loneliness in Older Chinese Adults: A Risk Factor for Elder Mistreatment.” Journal of the American Geriatrics Society 55 (November 2007): 1831–1835.

Fokkema, T., and K. Knipscheer. “Escape Loneliness by Going Digital: A Quantitative and Qualitative Evaluation of a Dutch Experiment in Using ECT to Overcome Loneliness among Older Adults.” Aging and Mental Health 11 (September 2007): 496–504.

Helgason, A. R. et al. “Emotional Isolation: Prevalence and the Effect on Well-Being among 50-80-Year-Old Prostate Cancer Patients.” Scandinavian Journal of Urology and Nephrology 35 (April 2001): 97–101.

Lachs, M. S., and K. Pillemer. “Elder Abuse.” Lancet 364 (October 2-8, 2004): 1263–1272, Raina, P., D. Waltner-Toews, B. Bonnett, et al. “Influence of Companion Animals on the Physical and Psychological Health of Older People: An Analysis of a One Year Longitudinal Study.” Journal of the American Geriatrics Society 47 (March 1999): 323–329.

Sharp, Lisa K., and Martin S. Lipsky. “Screening for Depression across the Lifespan: A Review of Measures for Use in Primary Care Settings.” American Family Physician 66 (September 15, 2002): 1001–1008.

Stratton, D. C., and A. J. Moore. “Fractured Relationships and the Potential for Abuse of Older Men.” Journal of Elder Abuse and Neglect 19 (January-February 2007):75–97.

Wilson, R. S., et al. “Loneliness and Risk of Alzheimer Disease.” Archives of General Psychiatry 64 (February 2007): 234–240.

OTHER

Dutton, Audrey. “Visitation Programs Relieve Isolation of the Elderly.

” Columbia News Service, February 14, 2006. Available online at http://jscms.jrn.columbia.edu/cns/2006-02-14/dutton-visitorsforelderly/ [cited March 5, 2008].

Friedman, Michael B., and Kimberley A. Steinhagen. Issues in Geriatric Mental Health Policy. New York: Geriatric Mental Health Alliance of New York, 2004. Available online in PDF format at http://www.mhawestchester.org/advocates/issuesd1004.pdf [cited March 5, 2008].

Geriatric Depression Scale (GDS). Available online at http://www.stanford.edu/?yesavage/GDS.html [cited March 5, 2008]. Page contains links to foreign-language as well as the short and long English versions.

Gusmano, Michael K., and Victor G. Rodwin. The Elderly and Social Isolation. Testimony to the New York City Council, February 13, 2006. Available online at http://www.ilcusa.org/media/pdfs/ElderlyandSocialIsolation.pdf [cited March 5, 2008].

ORGANIZATIONS

Cornell Institute for Translational Research on Aging (CITRA), Beebe Hall, Second Floor, Cornell University, Ithaca, NY, 14853, (607) 254 4336, (607) 254 2903, http://www.citra.org/index.php.

Delta Society, 875 124th Avenue NE, Suite 101, Bellevue, WA, 98005, (425) 679-5500, (425) 679-5539, [email protected], http://www.deltasociety.org/index.htm.

Dorot, 171 West 85th Street, New York, NY, 10024, (212) 769-2850, [email protected], http://www.dorotusa.org/site/PageServer?pagename=homepage_DOROT.

Geriatric Mental Health Alliance (MHA) of New York City, 666 Broadway, Suite 200, New York, NY, 10012, (212) 614-5753, http://www.mhawestchester.org/advocates/geriatrichome.asp.

Little Brothers-Friends of the Elderly (LBFE), 28 East Jackson Boulevard, Suite 405, Chicago, IL, 60604, (312) 786-1032, (312) 786-1067, http://www.littlebrothers.org/.

Rebecca J. Frey Ph.D.