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Building connections to fend off the health effects of loneliness

September 1, 2018

By BETSY TAYLOR

A growing body of evidence indicates that loneliness is a risk factor harmful to health, so much so that scholars and care providers report a "loneliness epidemic" and call for concerted efforts to build social connections as a means of protecting a person's health.

Health care organizations offer a number of programs to combat social isolation, such as communal meals, friendly visitor programs and therapeutic interventions. (See below).

Building Connections
Jennifer Murphy, The Esquiline's director of Life Enrichment, presents Roosevelt Hoskins of East St. Louis, Ill., with a gratitude journal at a "Sole to Soul" lunch on his 60th birthday. Looking on at the Caritas Family Solutions office in Belleville, Ill., is George Taylor, 67, also of East St. Louis. The Esquiline organizes the lunches to build social connections and combat loneliness.

Pulling together data from multiple studies, Julianne Holt-Lunstad, a Brigham Young University professor who has led meta-analyses with other researchers on loneliness and its effects, writes in the Public Policy & Aging Report: "More than one third of adults over age 45 report being lonely, equating to over 42 million older adults who experience chronic loneliness. Even among those who are married, over 30 percent of relationships are severely discordant.

"Further, the majority of American adults do not participate in any kind of social group. Less than half of adults participate in a local religious group, and less than a quarter of adults participate in a social club, community group, sports league, or other local group. Taken together, this data suggest that a significant portion of the population, and older adults in particular, may be socially isolated/disconnected."

She goes on to say: "The overall magnitude of effect of social connection can be benchmarked against other well-established lifestyle risk factors. Lacking social connection carries a risk that is comparable, and in many cases exceeds that of other well-accepted risk factors, including smoking up to 15 cigarettes per day, obesity, physical inactivity, and air pollution."

Making connections
"I'm very lonely," says George Taylor, 67, of East St. Louis, Ill. He describes difficult times years ago that still hit him hard emotionally, including the death of his brother and his spouse within days of one another. He relocated back to southern Illinois a couple of years ago, and he says it can be tough to make new friends. "You're set in your ways; most adults have their own lives."

Taylor is attending the "Sole to Soul" lunch in June at Caritas Family Solutions in Belleville, Ill. The program derives its name from "sole" for the fish, and "soul" for the spirit. Others noted the lunches are designed for sole participants, with a tagline of "arrive alone and leave in community."

The lunches are for people age 60 and up and are hosted by The Esquiline, a continuum of care community for seniors located on the grounds of the National Shrine of Our Lady of the Snows in Belleville. They are staffed by employees and volunteers of The Esquiline. The meals are offered through a partnership between the AgeSmart Community Resources nonprofit and The Esquiline.

Each lunch features a different health care or wellness speaker, with some variety in the locations where the monthly lunch is offered to increase geographic reach. Some venues host more than one lunch, and participants may attend multiple lunches.

Building Connections
Betty Staley, left, Bill Hitchcock and Marlene Don Vito get regular visits from volunteers in the Caring Neighbors program. The volunteers provide companionship and help with chores. The program, which helps seniors age in place, is based out of St. Jude Medical Center in Fullerton, Calif.

At this lunch there are more than 20 participants who are enrolled in a job readiness and employment program for those 60 and older based out of Caritas Family Solutions. The group enjoys grilled chicken and salad and sings "Happy Birthday" to one of their own. Jennifer Murphy, the Esquiline's director of life enrichment, gives the man a gratitude journal made by an area artist. Murphy talks about how reflecting on gratitude and writing about it in the journal can help promote positive feelings.

The day's speaker, Donna Heierman, directs Memorial Senior Care, an outpatient counseling program in Belleville for people age 65 and older who are coping with depression or anxiety. The program provides transportation and includes a mental health assessment, individual and group therapy and a shared hot meal, to allow for conversations and socialization to combat loneliness.

Taylor says he may give those group sessions a go.

At the Caritas Family Solutions center luncheon, attendee Pamela Jean Williams, 66, of Belleville, contributes to the discussion, describing the family, work and community involvements that keep her busy and connected to others. She asked a friend to the gathering, a woman who, Williams says, has increasingly withdrawn from others. Williams knows that staying home and ignoring her usual social connections isn't healthy for her friend. "She said no, but I'm not giving up."

Friendly visitors in California
Karyl Dupée is clinical supervisor of senior services and community care navigation for the Caring Neighbors program based out of St. Jude Medical Center in Fullerton, Calif. The medical center is part of Providence St. Joseph Health. Dupée says for an older adult loneliness can be a kind of "gateway drug" that leads to other problems. Loneliness sets the stage for the potential for elder abuse, for greater fall risk, for a person not taking their medications or taking them incorrectly, she says. The lonely are at greater risk for depression and deteriorating physical health.

The Caring Neighbors program background checks and trains volunteers — there are currently about 75 volunteers working with the program — and matches them to an older adult, whom they will visit at home. Clients often are referred to the program by physicians or other clinicians or pastors. Dupée asks the older adult if a volunteer can come visit. About 100 adults 65 and older, most of whom are in frail health, spend an hour and a half to three hours each week with their volunteer.

Dupée says it's rare that someone acknowledges loneliness off the bat. She tells clients that they've been paired with a volunteer who can help them age safely at home. Volunteers carry laundry up or down stairs and retrieve items from high shelves. They can assist with bill paying and perform light housekeeping tasks. Volunteers run errands. They'll accompany a client on a walk or play a board or card game.

Clients complete a depression survey twice a year and can be linked to mental health assistance. Volunteers tell Dupée or a clinical social worker if the older adult has unmet needs or wants the program can address. For instance, if a person can't afford adult diapers, the program provides them free of charge. At Christmas, participants are asked what they might wish for as a gift. The program has given clients everything from electronic tablets to warm slippers.

Dupée says by catching medical issues and unsafe living conditions, the volunteers can be lifesavers. She's twice dialed 911 for participants who appeared fine at the start of her visits but went into cardiac arrest while she was with them in their homes.

Not alone in feeling alone
In Colorado Springs, Colo., Centura Health's Penrose – St. Francis Health Services has a Healthy Church Initiative that helps faith communities more effectively serve the spiritual, emotional and physical health of their congregations and others. Among its services, it conducts spiritual well-being surveys that give insights across a congregation about health concerns. (Centura Health is sponsored by Catholic Health Initiatives and Adventist Health System.)

John Zondlo, facilitator for the Healthy Church Initiative, says from 2013 to 2016 — the most recent years the surveys were given to large numbers of congregations — 380 people or 18.8 percent of respondents said they suffered from loneliness, and 485 people or 20.9 percent of respondents called loneliness the social condition that has the most impact on their health. (It should be noted that respondents pointed to other issues as greater areas of concern for them. For instance, more people said they suffered from lack of self-esteem, lack of direction or physical pain than loneliness, but Zondlo says the survey helped the initiative determine that loneliness remains a pervasive problem in the congregations it serves.)

The Healthy Church Initiative trains faith community nurses and ministers to recognize and counter loneliness when they make a home visit to a congregant. Social disconnection may lead to or exacerbate physical, spiritual and mental health issues.

Barb Gilliland, visiting pastor/pastoral assistant with Faith Presbyterian Church in Colorado Springs, trained for home visits in a seminar taught by Zondlo. Gilliland says if one of the seniors she visits begins a rather one-sided, long-running conversation, it's a good bet that person is lonely and wants someone to listen to them.

Without the visits, "they have so much to say, and no one to say it to."

» View video of Penrose-St. Francis Healthy Church Initiative’s home visit program

Loneliness cuts across age groups, says Our Lady of Peace therapist

While many programs that combat loneliness are aimed at older adults who spend a lot of time alone, loneliness affects people of all ages.

Loneliness cuts across age groups
Art therapists Nevia Greenwell, left, and Courtney Carter demonstrate an art therapy technique they use at Our Lady of Peace psychiatric hospital in Louisville, Ky.

Cigna, the Bloomfield, Conn.-based health insurer, released national survey results in May of more than 20,000 adults 18 and older measuring their scores on the UCLA Loneliness Scale, a questionnaire to assess feelings of loneliness.

It found that nearly half of those surveyed reported sometimes or always feeling alone or left out, and that those ages 18 to 22 were the loneliest generation, based on the survey.

Nevia Greenwell, an art therapist at KentuckyOne Health's Our Lady of Peace psychiatric hospital in Louisville, Ky., has worked with people of all ages in individual and group therapy sessions for about 15 years at the hospital. (The hospital is part of Catholic Health Initiatives.) "I think for every session I do, loneliness comes up," she says. "It's very prevalent, especially if you're coming with the issues people come here with. They tend to feel extremely lonely and very, very disconnected from the rest of the world which they perceive as happy and well-functioning versus themselves."

Loneliness cuts across age groups
The 12-year-old Our Lady of Peace patient who drew this picture told her art therapist she felt alone, lonely, trapped within herself and unable to trust others.

Inpatient hospitalization programs for children are usually about three weeks at the hospital, with a length of three to seven days for adults in acute programs. From there, patients transition to outpatient programs, which they often take part in for much longer periods of time.

Greenwell works with emotionally struggling children, adolescents and adults, some of whom have survived abuse. She says issues of identity can make people feel lonely, or like they don't fit in with others. Some patients may self-harm, act violently or grapple with eating or substance abuse disorders.

She says often a person's negative view of him or herself contributes to a sense of isolation.

"In my opinion, the age of experimentation with substance use is becoming younger and younger. With the rise of technology and the use of social media, what we're seeing is a greater disengagement and a distancing from empathy. Though we're connecting, it's not in the true way humans were meant to connect," Greenwell says.

She says she sees that manifest in young people who say they can't feel what others feel, who may display aggression, or show a lack of kindness.

She uses play therapy to teach social cues and social skills and to help young children learn to self-regulate. For instance, she may have a toy express anger, to then talk about healthy ways of handling anger with the child.

In group sessions, she works with young children on skills like making eye contact, and how to find and make a friend.

With adolescent and adult patients, she says part of combatting loneliness involves identifying what a person feels shame about and teaching them to either cope with or resolve those feelings of shame. She has patients practice voicing their feelings.

One exercise for adolescents and adults involves using sheets of paper to express about seven layers of feeling. She asks each person to write down the emotion he or she feels the most, the least, the feeling the patient wishes to get rid of, or have more of, and additional questions. Participants then layer the pages to begin a conversation about the connectivity between different emotions.

In another exercise, she asks people to draw themselves alone and then in a crowd, to talk about self-image and then self-identity within a group.

— BETSY TAYLOR

 

Copyright © 2018 by the Catholic Health Association of the United States
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