A recent New York Times article described a 77-year-old retired gardener in England who had not spoken with another human being in more than six weeks. He told the reporter through tears that he felt “very lonely, and bored.” Recent budget cuts prevented him from taking the bus to the grocery store. Younger people, including his own son, had left town for better jobs in larger cities.
I see this loneliness regularly in my geriatric cardiology practice in New York City. New York is the opposite of the sparsely populated English countryside; 1.6 million people live in the 23 square miles that make up the island of Manhattan, and another 2.3 million (like myself) commute there every day to work. While New Yorkers are not physically isolated, the city can still be an exceptionally lonely place — especially for the over 1 million older adults who live there.
During routine office encounters, many of my older patients tell me they have nobody in their daily lives: no spouse, no children, no close friends. They might be able to name an emergency contact — a neighbor whom they scarcely know, or a distant relative. But nobody checks in with them on a daily, or even a weekly, basis. From a basic human perspective, this loneliness matters: We are fundamentally social creatures. From a health perspective, emerging literature shows that loneliness carries an increased risk of many poor health outcomes, including coronary heart disease and stroke, independent of more traditional risk factors.
Many of my older patients lived through some the most iconic periods in American History–the Great Depression, World War II, Civil Rights — and through all of this they never planned on being alone. It just happened. The death of a spouse might have tipped the balance. Or sensory impairments prohibited regular conversations with friends (for example, think about how difficult it is as a physician to communicate with someone who’s hearing impaired).
Other physicians have written poignantly about loneliness and social isolation; Dr. Dhruv Kullar wrote an emotional piece in the New York Times in 2016 about “How Social Isolation is Killing Us.” He used the example of a hospital inpatient with a terminal illness, who had no immediate family or close friends to call at the end of his life. Dr. Kullar wrote, “A great paradox of our hyper-connected digital age is that we seem to be drifting apart.”
Most of cardiology is straightforward: aspirin and lipid-lowering therapy for coronary disease, diuretics for heart failure. Some decisions are nuanced–especially in geriatric patients — which keeps practice interesting. But cardiologists (and I would argue, most medical professionals) are ill-equipped to deal with the epidemic of loneliness among our older patients. This epidemic is likely to worsen in the next 20 years, driven by the confluence of an aging society, smaller families, and even the societal balkanization created by technology.
The crisis of loneliness calls out for solutions, but as with any complex problem there is no easy fix. Researchers have tried numerous interventions, including pairing lonely older people with volunteer companions, creating peer support groups, and animal therapy, with varied degrees of success. Technology companies are developing socially assistive robots (and even robot pets) that may have benefit in specific settings such as nursing homes. Forward-thinking cities are laying out ambitious plans for their older residents: for example, in 2017 the New York City comptroller issued a blueprint for “Aging with Dignity” that included investing in more senior centers and increasing the number of age-friendly neighborhoods (with tangible changes like more benches, safer street crossings, and buddy systems to help provide companionship for seniors).
In the meantime, I struggle with how to counsel my lonely patients. I ask about resuming an activity that may give them meaning. (I have found champion bridge players and professional singers among my patient panel.) Often I’ll put in a referral for a visiting nurse assessment; this identifies those who qualify for a home aide to assist with their daily activities and to provide companionship. Clinic itself provides some degree of socialization, and I so I try to ensure they have regular visits. I may call distant family members (if there are any) to let them know my concerns.
It’s been over 50 years since the Beatles’ “Eleonor Rigby” brought the plight of lonely older people to a popular audience of millions. The lyrics are heartbreaking, and the song is considered one of their best works. Since that time, the epidemic of loneliness among older adults has only increased. This problem will ultimately require system-wide solutions. But in the meantime, as physicians, we can recognize the problem, bear witness to others (including policymakers), and advocate for our lonely patients by taking small steps to improve their lives.
John A. Dodson is a cardiologist.
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