Loneliness and Social Isolation: Problems and Solutions - San Diego Seniors ...
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Loneliness and Social Isolation:
Problems and Solutions
Dilip V. Jeste, M.D.
Senior Associate Dean for Healthy Aging,
Distinguished Professor of Psychiatry &
Neurosciences,
Director, Center for Healthy Aging
University of California San Diego
Stein Institute for Research on Aging
Center for Healthy Aging
Loneliness vs. Social Isolation
• Loneliness = Subjective distress caused by a feeling
of being alone (perceived isolation)
• Social Isolation = Inadequacy of number of social
relationships (objective isolation)
(Cacioppo and Cacioppo, 2018)
Stein Institute for Research on Aging
Center for Healthy Aging
Pandemics • Traditional pandemics (global epidemics) involve infectious diseases like plague, cholera, flu, and currently, Covid-19 • Behavioral pandemics: Loneliness Suicidality Opioid crisis Stress Stein Institute for Research on Aging Center for Healthy Aging
Modern Pandemic of Loneliness
A silent killer: Loneliness increases
the odds of mortality by 30% - as
dangerous as smoking and obesity
(Holt-Lunstad, 2018)
In the US, 162,000 deaths per year are
attributable to loneliness – more than those
secondary to lung cancer or stroke
(Agency for Healthcare Research and Quality, 2019)
In the UK, a new Minister of Loneliness was
appointed in 2018
Stein Institute for Research on Aging
Center for Healthy Aging
Loneliness Increases the Risk
for Several Diseases
• Heart disease
• Diabetes
• Obesity
• Major depression with suicide
• Opioid and alcohol use
• Anxiety disorders
• Alzheimer’s disease and other
dementias
Stein Institute for Research on Aging
Center for Healthy Aging
US Suicide Rates Increased by 33% in 2 Decades
(1999 – 2017) (CDC Statistics)
6 and Confidential.
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Risk Factors for Loneliness (Lee EE, et al., Int’l Psychogeriatrics, 2019) • Age: 20s, 50s, 80s • Physical illnesses • Chronic work and/or social stress • Homelessness • Socioeconomically disadvantaged groups • Poor social network • Being single or having stressful marital relationship Stein Institute for Research on Aging Center for Healthy Aging
Qualitative Interviews: Problems & Solutions • “It's kind of a grey and incarcerating. I would like to cry out for somebody” • “It was a sense of not being attached, not having very much meaning, not feeling very hopeful” • “I don't know what to do, being lost and not having control” ................................................................................................................. • “If nothing else, I'll go down to the lobby, and I can find somebody down there to talk to, and I can go into the library, and they've got a computer in there ... But I just have to get up and do something” • “I was very introverted and wore my feelings on my cuff and was affected by things a lot ... but learning that I had an impact really made times of loneliness much less, markedly less” Stein Institute for Research on Aging Center for Healthy Aging
Psychosocial Determinants of Health:
Odds of Reduced Mortality
Social Relationships:
Social Relationships:
Social Relationships:
Drug Treatment for
Hypertension
Holt-Lunstad J, et al., PLOS Medicine 7(7): e1000316, 2010.
https://doi.org/10.1371/journal.pmed.1000316
Strategies to Reduce Loneliness
• Physical exercise
• Social engagement
• Healthcare – therapeutic and preventive
• Wisdom and Compassion
(Dilip Jeste, with Scott LaFee: Wiser: The Scientific
Roots of Wisdom, Compassion, and What Makes Us
Good, Sounds True, 2020)
Stein Institute for Research on Aging
Center for Healthy AgingLoneliness and Wisdom/Compassion are Inversely Correlated (r = - .51; N=2,400) (Nguyen, et al., J Clin Psych, 2020) Stein Institute for Research on Aging Center for Healthy Aging
Wisdom: A Multi-Component Trait
Spirituality Empathy &
Compassion
Emotional
Decisiveness Regulation
Accepting
uncertainty & Self-
diversity reflection
Stein Institute for Research on Aging
(Bangen
Center K,Aging
for Healthy et al., Am J Geriat Psych, 2013; Jeste & Harris, JAMA, 2010 )San Diego Wisdom
Scale (SD-WISE)
• Total 28 items, each to be rated on a 1-5 scale (“strongly
disagree” to “strongly agree”)
• Good to excellent psychometric properties
• Examples of items: “It is important that I understand the
reasons for my actions.”
• “I have trouble thinking clearly when I am upset.”
(Jeste DV, et al., J Psychiatric Research, 2020)
Stein Institute for Research on Aging
Center for Healthy AgingCompassion toward Others & Self-Compassion • Gratitude diary • Role playing • Sense of common humanity • Loving Kindness Meditation • Intergenerational activities • Purpose in life • Compassion training Stein Institute for Research on Aging Center for Healthy Aging
PRACTICE POINTERS
• Don’t assume who is or who is not lonely – a person who
doesn’t feel lonely may be socially isolated
• Use short, validated screening measures - e.g., 3-item
loneliness screen
• Consider probable cause of loneliness and focus advice
on relevant mechanism
• Ask the person about their proposed solution, & use local
community resources
• Advocate for your patients and for policies that support
integration of social services
(NASEM Report, 2019)
Stein Institute for Research on Aging
Center for Healthy AgingInternational Community Campaigns Stein Institute for Research on Aging Center for Healthy Aging
Transforming a Lonely, Distressed, and
Polarized World into
Happier, Healthier, and Wiser Society
aging.ucsd.edu
Stein Institute for Research on Aging
Center for Healthy AgingRegional Task Force on the Homeless Funder Convening with Experts on Aging, Health and Homelessness February 2, 2021 Tamera Kohler, CEO
Recent Research on Aging Homelessness
Nationally older adult homeless population is projected to
increase along with the costs to care for them
Adults who became
homeless after age 50
had history of low wage
work, experienced a
crisis (job loss, marital
breakdown, death of
spouse, illness), and low
social support.
Many have adverse life
experiences – mental
health, substance use,
imprisonment, traumatic
brain injury, etc…
Source: Kushel, Margot (2017) Homelessness in
Source: Culhane et al (2019) The Emerging Crisis of Aged Homelessness: Could Housing Solutions be Funded by Avoidance of Older Adults: An Emerging Crisis; Presentation
Excess Shelter, Hospital, and Nursing Home Costs?2020 San Diego Point-In-Time Count
Number of Adults Age 55+ Served in Shelter
and Outreach in San Diego Over Past 3 Years
3,000
2,500
2,000
1,500
1,000
500
0
Q118 Q218 Q318 Q418 Q119 Q219 Q319 Q419 Q120 Q220 Q320 Q420
Persons Age 55+ Served in Emergency Shelter Persons Aged 55+ Served in Street Outreach
Source: RTFH Community Performance Dashboard (Data pulled 1/29/21)Aging Homelessness - the nexus of stigma,
shame, isolation & vulnerability
• Fear of stigma and shame keeps their housing status secret, hindering
their ability to enroll in services, find housing and employment among
their social networks
▫ Personal and economic hardship
▫ Discrimination and exclusion from social networks
• Change in interactions with general society, law enforcement, and
health care system.
▫ Invisible or visible only through negative attention
• Highly vulnerable to acts of violence, harassment, and exploitation
▫ Create fear of public spaces
▫ Loss of possession
▫ Cause extreme social isolation
▫ Exploited for income, medications
• Trigger or worsen mental and physical health issues
▫ Delay or forgo annual and critical healthcare needsInterventions for Homeless Seniors
There needs to be an array of both emergency and permanent
housing solutions that range from low to high intensity models to
meet the needs of seniors experiencing homelessness
Shared
Housing
Prevention and
Diversion Shallow
Subsidy
Low-Barrier
Emergency
Rapid Re-
Shelter
Housing All housing interventions
Medical will need strong connections
Respite Care Senior
to health care services
Affordable
Housing
Permanent
Supportive
HousingQuestions?
Tamera Kohler
Chief Executive Officer
Tamera.kohler@rtfhsd.orgFunder Convening:
Aging, Health and
Homelessness
SHELLEY LYFORD
President and Chief Executive Officer
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