… the best is yet to be. A beautiful notion about the journey of increasing years. We are social creatures and relationships play a key role in protecting and promoting our mental health throughout our lives.
So it is ironic that our advances in technology are creating a modern way of life that is associated with more people living alone, away from extended families, and in states of increased social isolation. For older adults, this is especially true, and with grave consequence, but it doesn’t have to be this way.
1. Where do older adults live? As societies become increasingly industrialized and wealthier, the multi-generational household becomes less prevalent. In 2018, approximately the same number of older adults lived alone as lived with a family member. There is also a significant gender story to be told. Twice as many women over the age of 65 live alone as compared to men, in part because average life expectancy is greater for women than for men and in part because women are less likely to remarry following the loss of a spouse. And the drama only grows with age, such that more than half of women over age 75 are living alone. Women tend to be good at building community so living alone does not mean being socially isolated, but with increased risk for health conditions that affect mobility and memory, living alone does increase risk for social isolation if we are not paying attention.
2. Social isolation and mental illness: Social engagement changes as we age for a variety of reasons, including retirement, relocation for retirement, death of friends and family, and lack of mobility. In the wake of these changes, some individuals are at increased risk of social isolation, a construct that centers on the idea of limited or impoverished connection between an individual and society. My personal operational definition of social isolation is the experience of eating dinner alone day after day. By their own self-assessment, almost 4.3 million older adults in the United States are not satisfied with their social connections and number of friends. In Canada, 20% of older adults do not engage in monthly social activities. Regardless of the causes of isolation for older adults, the consequences can be alarming. Perceived social isolation is correlated with depressive symptoms and with higher levels of overall psychological distress.
3. Social isolation can be deadly: Both social isolation and loneliness are associated with a higher risk of death in older adults. Individuals who are socially isolated have the same risk of death as people who smoke 15 cigarettes a day. While there is no direct explanation for this higher risk of death, people who live alone or lack social contacts may be at increased risk of death if health symptoms develop, because there is less of a social network to prompt medical attention.
4. Social integration and mental health: Social integration, or active participation in community and civic life, is a key factor in promoting mental health for all of us, including older adults. When we are able to spend time in relationships that are meaningful to us, whether it be family or friends, on a regular basis, we report higher levels of overall health and wellbeing. Social integration and connection is especially strongly associated with healthy aging for women. And it is provocative that older adults and individuals with serious mental illness face similar risks of social isolation. Two segments of our population that need greater understanding and accommodation, they also share increased risk for falling out of community and losing a sense of social connection. Considering the school of thought which holds that the goodness of a society can measured by how it cares for those who are vulnerable, around the world, we have a lot of work to do.
5. Health and Aging Policy Fellows Program: With 128 fellows to date, the Health and Aging Policy Fellows Program is all about helping society do better in terms of health and healthcare for all of us as we grow old. Funded by The John A. Hartford Foundation and WestHealth Foundation, Health and Aging Policy Fellows have advanced policies at federal and local levels that touch every aspect of growing older. Our current cohort of fifteen 2018-2019 fellows are working on a diverse range of policy, from support for caregivers of adults with dementia to improvement of geriatric residential care facilities. I have the honor of directing this fellowship program along with Dr. Harold Pincus and have witnessed firsthand the impact that these fellows have had on the lives of older adults. If you are interested in learning more or becoming a fellow, please visit our website.
By 2040, one of every five citizens in the United States will be over the age of 65. Doom and gloom dominate forecasts about our planet and our health. Such catastrophizing is fatiguing and paralyzing. In fact, if we put what we know into practice, if we develop policies that support social integration and mitigate social isolation, if we build communities where the most vulnerable retain their rightful place in society, Robert Brownings’ words will be more than an aspiration. Grow old with me, the best is yet to be.