Editor’s note: This is the second article in a series on how loneliness and isolation are affecting seniors at home. It stems from writer Diane Eastabrook’s participation in the 2021 Age Boom Academy, a free training fellowship of the Columbia Journalism School and the Mailman School of Public Health.
With Americans increasingly aging in place, social isolation and loneliness could become as dangerous to seniors as diabetes, heart disease and stroke. Last year, the National Academy of Sciences reported 40% of people over age 65 said they were lonely; 25% said they were socially isolated.
It’s a problem care providers and caregivers will need to address, according to geriatrician Carla Perissinotto, M.D. She has researched social isolation and loneliness among seniors and encounters it frequently as the director of the Care at Home program at the University of California San Francisco, which offers home-based primary care to people 65 and older.
McKnight’s Home Care Daily Pulse talked to Perissinotto about how caregivers can identify at-risk patients and help them.
McKnight’s Home Care Daily Pulse: When you go into a patient’s home, how do you assess whether he or she might be suffering from loneliness?
Perissinotto: There are a couple of ways to do this and one is quite informal. You have a conversation and ask them about how they feel about their social connections and their loneliness. Clinically, there is a questionnaire that we often use. One that has been commonly used in the United States is the UCLA Three Item Loneliness questionnaire. It can be done very quickly. You ask someone if they feel left out, if they lack companionship, if they feel isolated and how often they feel that.
McKnight’s Home Care Daily Pulse: This sounds like this is something that could be used by any caregiver?
Perissinotto: Absolutely. One of the recommendations that came from this report last year from the National Academy of Sciences is to have different people who interact with older adults be able to conduct these assessments.
McKnight’s Home Care Daily Pulse: Once the caregiver asks those questions, how should he or she proceed?
Perissinotto: A big part of asking the questions is it makes it a safe place to talk about [loneliness] and it helps to remove the stigma. So, this is OK to talk about and this is something important for your well-being. Then, based on that you can say, “Hey, I’m worried that you might be experiencing loneliness. Have you thought about this? Is this something that you want to do something about?” And some people may not want you to do anything. As an aside, as a geriatrician, it’s fascinating. One of the reasons we get into trouble with older adults is that we do things to people all of the time. I’ve noticed some of my patients tell me things that are going on because they want me to be aware, but they don’t want me to do anything about it. So we sometimes rush into solutions before finding the cause and finding out if someone wants to do anything about it. Then it’s working with the person to find out what may work.
McKnight’s Home Care Daily Pulse: There have been a lot of virtual programs to connect seniors since the pandemic. Do they help?
Perissinotto: We are trying to study exactly that: are these [programs] effective for whom and in what modality. To your point, all these Zoom modalities came out and we have no idea if they work. We have thought that some of them work, but we don’t know for whom. There’s been a long-time friendly visitor program and there is telephone outreach. We have anecdotal evidence that some of these work, but we don’t have really good scientific evidence that these work.
McKnight’s Home Care Daily Pulse: How often should a caregiver broach the subject of loneliness with a patient?
Perissinotto: We actually don’t know the right amount of time. During the pandemic when things were changing so rapidly, I think it was important to check in on this on a monthly basis. But when things are in a pretty steady state, I think twice a year is helpful.
Coming Wednesday: How technology — from electronic pets to tablets — is bridging the gap between loneliness and social connection.