Addressing Loneliness in Older Adults through Empathetic Conversations, Health and Fitness Classes
The COVID-19 pandemic and social-distancing focused much attention on impacts of social isolation particularly for older adults, but even before the pandemic, loneliness had been increasingly of concern.
As a recent Special Issue on Social Connectedness and Mental Health in the American Journal of Geriatric Psychiatry notes, “While the public has long understood the centrality of social connectedness to well-being, the framing of social isolation and loneliness as public health problems is more recent.” Researchers are looking at the relationship between social disconnectedness and mental illness, effective interventions and prevention.
Past research has found clear association between loneliness and depression; however, the extent of the connection and the cause and effect are less clear. In addition to the link to depression, social disconnection is also linked to anxiety, obsessive compulsive disorder, post-traumatic stress disorder and psychosis. Social disconnection is also risk factor for physical health problems, at a level similar to other known risk factors such as obesity and alcohol consumption.
Several factors contribute to the older adults’ greater risk of social isolation, including retirement, problems with physical function and mobility, hearing and vision issues which may hinder digital connection, and potential loss of spouse or friends as they age. Researchers distinguish between objective social isolation and perceived isolation or loneliness—the difference between being alone and feeling disconnected and alone.
Below are several examples of the potential interventions for social isolation identified in recent research.
A study published in the American Journal of Geriatric Psychiatry found that among older adults, a peer companionship intervention was effective in improving symptoms of depression, anxiety, and feelings of being a burden. Participants received four visits, both in person and by phone, from trained older adult volunteers. The study authors noted that “By improving social connectedness, peer companionship as delivered by community-based social services can contribute to the mental health and well-being of older adults.”
In a commentary in the journal last year, researchers Jo Anne Sirey, Ph.D., and Elissa Kozlov, Ph.D., note that “well-trained peers are an underutilized resource, with growing evidence for their effectiveness at targeting a variety of health conditions” and peer companionship offers an “opportunity to reduce health disparities in minority aging populations and increase access to healthcare and supportive services.”
Home visits focused on problem-solving
Another study looked at the effectiveness of the PEARLS program, a brief, home-based intervention focused on problem-solving and behavioral activation to help low-income older adults living with depression improve social connectedness. The program provided training to community health workers and others from social service safety-net organizations to provide eight one-hour home visits with participants over a four-to-six-month period. They helped participants build problem-solving skills to gain a sense of control over overwhelming issues in their lives and provided information on depression and linkages to other services when needed.
After the series of visits, participants significantly improved on three social connectedness (social interactions and satisfaction with social support; perceived isolation; and loneliness) and experienced decreased severity of depression.
Participation in community exercise and health programming
Participation in community health and exercise programming activity also helped to reduce loneliness and social isolation. In another recent study, participants met with a health coordinator and selected and participated in one session of either Arthritis Exercise, Tai Chi for Arthritis, EnhanceFitness, or a Healthier Living Workshop. Six months later, after participation in a session of the classes, participants reported decreased loneliness and social isolation.
Lay counselors – empathy-oriented phone calls
In a study published in JAMA Psychiatry, researchers found that a four-week empathy-oriented telephone program delivered by rapidly trained lay callers during the COVID-19 pandemic improved loneliness, depression, anxiety, and general mental health. The randomized clinical trial involved 240 older adults receiving services through a Meals on Wheels organization—most at least 65 years of age and all with at least one chronic condition.
Sixteen callers, aged 17 to 23 years, were briefly trained in empathetic conversational techniques. Each called 6 to 9 participants over 4 weeks—daily for the first 5 days, and between 2 and 5 days a week after depending on the participants preference.
The authors conclude: “A layperson-delivered, empathy-oriented telephone call program reduced loneliness, depression, and anxiety compared with the control group and improved the general mental health of participants within 4 weeks.”
- Kahlon, M.K., et al. Effect of Layperson-Delivered, Empathy-Focused Program of Telephone Calls on Loneliness, Depression, and Anxiety Among Adults During the COVID-19 Pandemic: A Randomized Clinical Trial. JAMA Psychiatry. 2021 Jun 1;78(6):616-622. doi: 10.1001/jamapsychiatry.2021.0113.
- Mays, A.M., et al. The Leveraging Exercise to Age in Place (LEAP) Study: Engaging Older Adults in Community-Based Exercise Classes to Impact Loneliness and Social Isolation. American Journal of Geriatric Psychiatry. October 15, 2020. DOI:https://doi.org/10.1016/j.jagp.2020.10.006
- Conwell, Y., et al. Peer Companionship for Mental Health of Older Adults in Primary Care: A Pragmatic, Nonblinded, Parallel-Group, Randomized Controlled Trial. American Journal of Geriatric Psychiatry. Volume 29, Issue 8, P748-757, August 01, 2021.
- Steinman, L., et al. Increasing Social Connectedness for Underserved Older Adults Living With Depression: A Pre-Post Evaluation of PEARLS. American Journal of Psychiatry Volume 29, Issue 8, P828-842, August 01, 2021.