(soft piano music) - [Narrator] Coming up on Aging Matters, loneliness and isolation. - I wanna have a say in what goes on and so, I want a sense of autonomy but I also don't wanna be lonesome doing it. - [Narrator] We have a natural need to connect with others, to find happiness in relationships with family and friends but keeping social connections is difficult as we grow older.
- How am I going to live the rest of my life? What do I want? You drive into a community and never connect with anybody, you can drive into your garage, the garage door goes down.
Totally isolated, everything's built for isolation and loneliness, really. (relaxing music) - [Narrator] Many Tennessee adults 65 years and older experience social isolation. According to the Tennessee Commission on Aging and Disability, 28% live alone.
That's almost three hundred thousand people. 14% report rarely or never receiving social and emotional support. 48% of older adults experience loneliness and isolation.
- This is a substantial number of people. We need to address that. - One never thinks about isolation and loneliness until you find yourself by yourself.
- [Narrator] Researchers say loneliness is hazardous to physical and mental health, and can even lead to early death. - Loneliness is more important than diet. It's as damaging as cigarette smoking.
15 cigarettes a day is the equivalent of loneliness, in terms of the medical risk that you put yourself through. - [Narrator] Studies show that feelings of loneliness increase the risk of death by 26% and not always by natural causes. - On an annual basis in the U.
S. , we lose close to seven thousand older adults to suicide. With the baby boomers moving older, our numbers are gonna increase.
- [Narrator] There is an urgent push to find new, reliable ways to measure loneliness and isolation, and to intervene before the damage is done. - We saw big differences in depression, anxiety, better sleep, so what we wanna do is actually correct those things, so that if we can actually reach out to people, maybe we can actually prevent some of those things. (clapping) ♪ I love you ♪ (laughing) (calming music) - [Narrator] Major funding for Npt Reports, Aging Matters, is provided by: The West End Home Foundation, improving the quality of life of seniors through the support of nonprofit organizations in Middle, Tennessee, the HCA Foundation, on behalf of TriStar Health, the Jeanette Travis Foundation, dedicated to improving the health and well-being of the Middle, Tennessee community, and Cigna HealthSpring.
Additional support provided by: Jackson National Life Insurance Company, The Community Foundation of Middle, Tennessee, and by members of Npt, thank you. - Growing older can be an isolating experience. Retirement, the passing of loved ones and friends, a change in health or functional ability all can limit one's engagement with the world.
The problem is that social isolation has grave consequences for health. Studies show it can be just as bad for you as smoking and nearly twice as dangerous as obesity. Hi, I'm Kathy Mattea.
The likelihood of living alone increases with age but is living alone inevitable? Is physical isolation as bad as feeling isolated or lonely? What can we do to prevent ourselves and our loved ones from becoming withdrawn from community?
As our population ages, we need to think about the kind of community we want to live in and what it will take to create it. Join me as we explore the role of isolation and community in our health. Stay tuned.
(emotional music) - This is our anniversary in 2010. We used to do a lot of things but after her illness, we had to curtail some of those things. That's the one reason I decided to go ahead and retire.
- [Narrator] James Trent retired after a 35 year career in the automotive industry. He didn't have a plan but he did have a mission, to be primary caregiver for his wife, Carolyn. - My number one focus was to take care of her.
It just wasn't feasible for me to try to work and take care of her because we didn't have family members here. That's what I enjoyed doing, taking care of this woman who had been in my life for the last 50 years and she had stuck beside me when I was down. (emotional music) - [Narrator] Carolyn died in 2017 and James suddenly found himself with no mission, no plan, and few relationships.
- When she passed, she had friends and families that come around, and they support you, and as the days go by and the weeks, after a while you find yourself alone and that's when the reality sets in. She's not coming back. You're alone.
That's when you find yourself understanding what loneliness is and what isolation is. - [Narrator] Loneliness and isolation are powerful words in our western lexicon. They are the subjects of countless works of art, from popular music, ♪ Would shake me from my slumber.
♪ (western music) ♪ Lonely to the grave. ♪ - [Narrator] To the visual. To the written and spoken.
- [Male Narrator] When, in disgrace with fortune and men's eyes, I, all alone, beweep my outcast state. - [Narrator] But isolation and loneliness are often misunderstood and misconstrued when it comes to social and clinical purposes. Experts are working to find the risk and identify the consequences of what is now considered a public health threat.
(western music) - Western countries, in particular, have been looking at this, you know, for several decades as the older population becomes more isolated from the general population. For example, retirement. A lot of times, that really reduces one's social circle.
Of course, the death of a spouse or family members, other friends. Of course, we have environmental factors, which may be living in remote areas, or we don't have adequate transportation, or maybe disability, or health issues. - Loneliness is more of a subjective feeling and it has a lot to do with a person's perceived social contacts and connections compared with what they would want and desire, so that if a person wants social contacts but doesn't really have them, that is understood as loneliness.
- [Narrator] Dr William Petrie is professor of clinical psychiatry at Vanderbilt Medical Center. His patients are mostly older adults. While anyone at any age is at risk for loneliness, Petrie suggests we should pay extra attention to older adults.
- The older population is more vulnerable to this. There's less they can do about it but the fact is, loneliness is a problem even in younger people. - [Narrator] Simply put, social isolation can lead to loneliness, which can lead to health problems, both physical and mental.
- If you are lonely, you will have an increased incidence of heart disease, you will have an increased risk of stroke, increased risk of premature death, and increases dementia, also reduces your cognitive ability. - [Narrator] The root cause is not simply living alone, although that can be a risk factor for social isolation and loneliness, but many older adults live by themselves, aging in place, whether by choice or circumstance. - A lot of older individuals will fight tooth and nail not to come and live with family, or to go into assisted living, or any other sheltered housing.
Also, we have families that live miles and miles apart now. In some cases, that ends up creating isolation or at least a physical separation from family. - [Narrator] Dr Ronald Aday, professor of sociology at Middle, Tennessee State University specializes in geratology.
Studies show that while living alone might put older adults more at risk for fall-related injuries, household accidents, medical mistakes, and other safety concerns, their risk for loneliness is much more complex to determine, and not simply related to living alone. - For some individuals, they may have a real small social network but they may not necessarily feel lonely. They may enjoy being and living in a remote area.
A lot of people do like to live a very private kind of life. We know, also, that we may be isolated even though we live around people. In today's society, we have, you know, neighbors but we may not necessarily know who those neighbors are.
It's not necessarily sometimes the number of people that we have but the meaningful relationships that we have. - [Narrator] In other words, someone can be lonely but not isolated, or isolated but not lonely. (relaxing music) So how prevalent is social isolation?
The AARP Foundation has an isolation team whose focus is to investigate, analyze, and make recommendations related to isolation and loneliness among adults ages 62 to 91. - And we wanted to get some sense of what that really looks like, how many people are we talking about? And so, this survey indicates that most people over 50 don't experience loneliness or isolation, but almost 30% do occasionally feel isolated and experience loneliness, and 20% say that they do that on a regular basis.
This is a substantial number of people. We need to address that. - [Narrator] The study found that certain characteristics are linked to social isolation.
They include physical impairments like hearing loss and lack of mobility, psychological problems like depression and addiction, and a number of social challenges. - A couple of population factors contribute to the feeling of isolation and literally being isolated, and that is non-English speaking groups, and we have literally hundreds of those, right here in the Middle, Tennessee area. The LGBTQ community.
Women, single women, multicultural folks. Any people who may find themselves in a vulnerable situation or not have other people like them around in larger numbers can definitely feel lonely and isolated. (soft piano music) - [Narrator] Being vulnerable to social isolation often leads to feelings of loneliness.
Researchers say men exhibit more characteristics of loneliness but women are more likely to describe themselves as lonely. For example, 80 year old Essie Sappenfield discovered that retirement and relocation were isolating experiences, despite her best efforts. - I moved here from Kansas because of granddaughters and I found this little house, and it was really cute, and I fixed it up, and I took ballroom dancing, and I tried to find a church that I liked.
It just felt like there wasn't a place for me. I have a spiritual advisor and so, I was talking to her, and I said, you know, I've got my house all fixed up just like I like it and I'm still lonesome. - [Narrator] Sappenfield also encountered an unexpected cultural barrier to making social connections.
- There are career women but they're doing their career, and there are married women who are busy with their families, and then, there are married women who don't want you anywhere around their husband. (laughing) - [Narrator] Sappenfield's humor hints at an important trend among older Americans that impacts isolation and loneliness. Older women outnumber older men by a ratio of five to two by age 85 and most older men are married, but most older women are not.
- As we have people living longer and longer, they're more vulnerable to medical illnesses which limit their ability to connect with people and ability to get about their communities. People over 85, which is the largest growing segment of our entire population, and especially the women, they outlive the men, they are the ones that end up with this problem of loneliness. - The link between loneliness and poor health is well established but how it occurs is less clear.
- We think that there are mechanisms that operate through the endocrine and other systems, and particularly stress hormones play a factor. Cortisol, epinephrin, norepinephrine. We think that loneliness increases stress-activated feelings and there are other inflammatory factors that have been studied, so what you've got is this subjective symptom of loneliness which causes medical illness and death.
- The risk extends to those who take care of older adults, caregivers. - A lot of times, people don't realize that they are isolating themselves because they figure, I've got somebody in the home, I'm talking to them, but if they look at their lives before they were in the caregiving situation and think about all the times they went out of the house for lunch with friends and activities with their faith community, being able to go to the grocery store and not have to be home within an hour. - Whatever she needs to do, if she can just come.
I have a big meeting that morning I have to go to. - [Narrator] An untimely phone call puts Cindy Lumpkin in a tailspin. - I just got a telephone call that I won't have somebody to stay with Mom tomorrow.
It's like, oh no, what am I gonna do? I've got these meetings I've gotta go to. Now I've gotta figure out how we're gonna handle all of that.
- [Narrator] Lumpkin is primary caregiver for her mother, Lorene. - So, she's been living with me since she was 78 and she's 101, now, and it's her body that's going, not her brain at this point in time. She gets worried when she can't remember somebody's name and I'm thinking, oh Mom, that's a daily occurrence with me.
- [Narrator] A couple of years ago, Lorene's body started to decline and both women are feeling the impact of that change. - When she first moved in with me, it wasn't about being a caregiver. She did a lot of things like the laundry, a lot of the cooking, even though I cooked some, too, so it was kind of a great, mutual relationship.
- We've had lots of laughs and tears. (laughing) She has taken such good care of me. - I do, sometimes, feel isolated because you don't get to go out and do things with friends and now, I've become a homebody just like her.
- I sometimes feel like I'm an old burden because I always have to have somebody with me and it sorta ties her down. - The guilt that caregivers can feel because they're leaving that person is, it's enormous. - I get so concerned for her health, I don't think about my own.
I don't sleep as well and so, therefore, my body gets run down, and then I get sick, and I can't take care of her like I need to take care of her because I'm not feeling well. I have thought, well what if something happens and I have to have surgery, and I'm laid up for two months? Who's gonna take care of either one of us?
- [Narrator] Researchers say between 40 and 70% of family caregivers experience symptoms of depression, which can be linked to isolation and loneliness. (soft piano music) - Caregivers don't realize they were socially isolated until they're not in that caregiving situation anymore, ready to go back into the world, and their friends may have moved away, the groups they participate in change. (soft piano music) - [Narrator] There is growing interest and necessity for tools to identify and measure loneliness in older adults.
One of the most common and widely used is the UCLA Loneliness Scale, a 20 item test that asks participants to rate statements like, there is no one I can turn to, my interests and ideas are not shared by those around me, I can find companionship when I want it, people are around me but not with me. - These are the scales that have helped us understand the strong relationship between loneliness and these medical outcomes like premature death, heart disease, stroke, Alzheimer's disease, and memory loss. - If the loneliness creates, especially, a mental health reaction in terms of depression, in many cases, they may not eat, they may not go out socially, and that sort of thing, so it reduces their overall quality of life.
If it's severe enough, of course, they may even contemplate suicide. (dark piano music) - The one thing that happens when anyone passes away, when it's not a sickness or something like that, everybody asks, what happened? And I'm trying to figure out, in my own mind, what could be so devastating that you would take your life like this?
(emotional music) - [Narrator] Annette Lake believes her father ended his life after retiring from a 40 year career as a truck driver. His health began to decline, he lost independence, and he had to stop driving, which meant he couldn't go to church, the one social connection he maintained. - That was what I observed, him becoming more isolated.
(emotional music) Anytime you have a major change in your life, the older you get, the more difficult it is to manage. - [Narrator] According to the Centers for Disease Control and Prevention, suicide rates increase with age. In 2013, 7215 Americans over the age of 65 died by suicide.
84% were men. The Tennessee Older Adult Suicide Prevention Plan now labels suicide as a public health threat. That designation is reinforced by this fact.
Many older adults who die by suicide have recently visited a primary care physician. 20% on the same day, 40% within one week, and 70% within one month of the suicide. - When we think about our older adults, they're more likely to visit a primary care physician than going to see a mental health physician.
We've got to be able to educate the community of the warning signs. Common suicide warning signs are: Withdrawing from friends, hobbies, social activities. Talking about suicide, death, or being a burden.
Preparing a will or final arrangements. Giving away prized possessions. - I believe that primary care, just as, you know, behavioral healthcare folks should start asking the question: Have you thought about suicide in the last two weeks or have you thought about suicide in the last month or so?
Just as we stand on the scale to find out our weight, our height, it's okay to maybe ask those two questions and see what happens. (emotional music) - What I found in the pockets of the cover of his Bible, I felt like he was reconciling himself to what he felt the Word was saying about committing suicide. - [Narrator] Annette Lake is determined to be better prepared as she ages for the possibility of loneliness.
- It's very important to understand that the mind is part of your physical being, just like your heart, your lungs, your liver. It's the central system for everything that moves within you. If there is something wrong within your mind, it's treatable.
- When physicians and hospitals look at illness, are you lonely is more important than what is your cholesterol and how much are you walking? I think we have to begin understanding and attending to those factors in medical care. - The impact of social connections in preventing early death is documented in a massive research project at Brigham Young University.
It found that being socially connected reduces the risk of early death by 50% and simply thinking about a supportive person lowers stress responses. Social contacts also can reduce healthcare costs, according to AARP Public Policy Institute. It estimates that Medicare spends $134 more, monthly, for each socially isolated older adult than it does for those who have typical social contacts.
(emotional piano music) - If people are already isolated, how do you connect with the people who are going to understand you, who are going to be connected with you? - One solution might be using digital technology to reduce social isolation. - [Muffled Voice] They say, I'm gonna talk to somebody else.
That kinda made me angry and mad. - [Narrator] At Vanderbilt Kennedy Center, researchers are testing a social media platform with people who have developmental disabilities, another high risk population for social isolation. - Our folks already have a greater risk for depression, anxiety, health problems, so what we wanna do is actually correct those things so that if we can actually reach out to people, maybe we can actually prevent some of those things.
The other thing is parents are taking care of these kids. They don't move away, they live at home, so parents are also incredibly isolated, so we think that if we can actually help get the kid more connected socially and reach out, then maybe the parents won't be so stressed. The two-year isolation study was conducted in ten week intervals with small groups of young adults with disabilities, helping them to learn social skills and build social connections.
- So, using some of those de-escalation terms and techniques would probably be really helpful. - Right. - [Narrator] Early results indicate that participants are more socially engaged and Ruth says, this type of intervention could help other populations.
- How much can we really move the needle, here? So, for people who are older, I think the idea that if you could connect, and I think things like FaceTime and Skype, and we already know that for some of our older adults, if they can find those ways to connect, maybe there's not somebody face to face. A lot of our folks only have family and paid staff members as their kind of friends but if we can find them to kind of outside of that comfort zone and hook up, and connect with other people, then really we could do those things.
(emotional music) - [Narrator] A recent study found that internet use was associated with lower levels of loneliness among residents of assisted and independent living centers, and encouraging older adults to begin using the internet to communicate with others could help to enhance social contact and decrease loneliness. (soft piano music) - You got it looking easy. Six.
- The more we're learning about isolation, we are realizing that we can do something about it and the quantifiable aspects are things like, are you engaged with a social group at least once a week? Do you have more than three or four friends? Are you continuing to be active in your community?
Are you going to the library and the senior center? Are you staying as involved as you possibly can be? And if not, then we can change that at any point in our life.
(cheerful music) - [Narrator] For some aging adults, the first step in preventing isolation is choosing to live in a community designed and built for bringing people together. It's called co-housing, a concept based on the Roseto Effect, named after a town in Pennsylvania of Italian immigrants whose close-knit lifestyle resulted in lower heart disease and longer lifespans. - There were three generations in a household.
The homes were all along the sidewalk. There were big porches out front. Just highly structured for social connection.
Think about that just for a moment. All of our social ills, addictions, crime, and disease, could be eliminated by the way we build our environment. - [Narrator] Diana Sullivan, a Nashville realtor, wanted to live and grow older in such a community.
She joined with a small group of like-minded residents to create a co-housing community in Germantown, the first in Tennessee, and one of fewer than two hundred in the country. - Well, there are 25 homes and then the common house. That size community really builds empathy, as opposed to a much larger group of people, and co-housing is built both for connection and for privacy, so, yes, there are times when you don't wanna connect with people and you don't have to come to all the dinners.
It's returning back to the natural state of who we are that we need one another. - [Narrator] Those needs are why this community attracted Essie Sappenfield. - Old age isn't a problem.
It's a stage of life and I didn't have any idea that it could be as joyful as it is. I'm happier now than I've ever been. I live in a pretty house and I have a community that supports me and cares.
- Friends. Really, really important and a huge factor in protection from the problems of medical illnesses with lonely people. Now, we can hire people but they aren't friends.
I mean, it may help to have a visiting nurse, a visiting social worker, whatever, but there's nothing like a good friend who comes to see you, and so, how do we create communities where friends can connect, stop by, go to the grocery for them, how are you doing? - Hey you. (laughing) - How you feel?
- Rubbery. (trainer laughing) (cheerful piano music) - When you stop communicating, when you're lying in bed and not getting out of bed, then you know if you're gonna have to do something. The company that I'm keeping, you know.
All the people around you. You just don't come in here and sit, you know. You interact, you're moving, you're doing activities all the time.
(emotional music) - You need some sort of outlet for yourself. Both emotionally, something physically that you can do. - Seeking new environments where we can meet other friends and replace the old ones is a very important part of what we're looking at in the future as people live longer and so, creating those environments where they can come, meet, and experience this is very important.
(soft music) - As Americans live longer, we will need to find new ways to mitigate the pressures of isolation that occur naturally as we age. We all have a role to play in ensuring that no one lives alone or faces loneliness without support. Community is the antidote to social isolation and we all benefit from a community where everyone at every age is included and valued.
For more information and to see all of Nashville Public Television's Aging Matters series, visit our website at WNPT. org/AgingMatters. Thanks for watching.
♪ ♪ - [Narrator] Major funding for Npt Reports, Aging Matters, is provided by: The West End Home Foundation, improving the quality of life of seniors through the support of nonprofit organizations in Middle, Tennessee, the HCA Foundation, on behalf of TriStar Health, the Jeanette Travis Foundation, dedicated to improving the health and well-being of the Middle, Tennessee community, and Cigna HealthSpring. Additional support provided by: Jackson National Life Insurance Company, The Community Foundation of Middle, Tennessee, and by members of Npt, thank you.
