The holidays can be the best of times or the worst of times. High-energy celebrations, the emphasis on good tidings of joy and reunions with families and friends can bring happiness and comfort, but they can have the opposite effect on people feeling isolated and alone, especially older adults.
“This season can be particularly difficult for older adults who don’t have as many social connections, or are hindered by physical limitations, because of all the messaging around us that emphasizes activity and connectedness,” said Sonja Rosen, MD, chief, Section of Geriatric Medicine at Cedars-Sinai.
The Surgeon General of the United States has described loneliness and isolation as an epidemic affecting 50 percent of the population and associated with a higher risk for cardiovascular disease, dementia, stroke, depression, anxiety and death.
“Loneliness and isolation, part of what we call ‘social determinants of health,’ are established risks for poor health and early death, especially for aging adults. The health risks are equivalent to smoking up to 15 cigarettes a day,” said Cedars-Sinai geriatrician Allison Moser Mays, MD, MAS. “But we also know that being more socially connected can actually decrease the risk of mortality by as much as 50 percent.”
Hearing loss, memory impairment, the inability to drive safely and other functional changes that can come with age impact the desire or ability to attend holiday gatherings and can exacerbate feelings of loneliness and anxiety.
“We see a lot of our patients not want to go out as much because they are unable to communicate well,” said Mays, an assistant professor of Medicine. “Large gatherings of family or friends or just going out to a restaurant with others can be very stressful if they are straining to hear or have difficulty following conversations. They may prefer to stay at home and isolate rather than feel out of place or anxious.”
Grief and loss can also be significant drivers of social isolation and loneliness as people age.
“This can be a particularly difficult time of the year for anyone who has experienced loss or who doesn’t have that sense of community they wish they had,” Mays said. “And that really is what defines loneliness-not having the social connections that you want.”
Geriatricians at Cedars-Sinai routinely discuss loss and grief during patient visits and can provide referrals to social workers or grief support groups.
“If you know that an individual is feeling lonely, if they’ve shared that they wish they weren’t so alone and want help, then see if there are hurdles that are keeping them isolated, such as lacking transportation or feelings of grief and loss,” said Rosen, a professor of Medicine. “Find out what you can do to help them.”
Ways to support older people during the holiday season
Initiate: Check in more often with older family members and friends and gently ask how they are doing and offer support. A phone call can go a long way in nurturing connectedness.
Invite: Consider inviting them to smaller, more intimate, gatherings if functional limitations are an issue. Welcome them without pressuring them to fit into your plans.
Listen: Actively listen when they want to talk, even if it is a difficult conversation.
Accommodate: Discuss an activity or simple pleasure they would enjoy rather than insisting they participate in planned events.
Grieve: Loss is felt deeply during the holidays. Pay attention and let them know you are there to listen. Meet them where they are and do not force activities they may be anxious about.
Cedars-Sinai’s Leveraging Exercise to Age in Place (LEAP) is an evidence-based exercise program proven to decrease loneliness, social isolation and the fear of falling in older adults.
“We’ve found that purpose-driven activity is a good way to form community,” Mays said. “In our LEAP program exercise classes, some of the participants were only coming 40 percent of the time, but they still felt they had a sense of community and connection to the class.”
Loneliness and social isolation do not have to be the theme of this holiday season.
“A lot of people are embarrassed to ask for help,” Rosen said. “They’re embarrassed to be alone. But they need to know that most of us struggle with the same things at one time or another. We are all part of the same community. There is help and comfort, and we can be there for one another.”