They are surrounded by hundreds of other people. They have a large menu of group activities: cards, tennis, art classes, and theater outings. How could anyone living in a vibrant senior community be lonely?

But they are, according to a new study by researchers at UC San Diego’s medical school.

The scholars assessed residents of an independent living facility in San Diego County and found 85% have moderate to severe levels of loneliness, a complex condition that mounting evidence links to higher risks for heart disease, dementia, elevated blood pressure, depression and premature death.

“Loneliness rivals smoking and obesity in its impact on shortening longevity,” said Dr. Dilip Jeste, a geriatric neuropsychiatrist who led the research team.

The small study, published online in the journal Aging and Mental Health, is part of a nationwide push to better understand what happens to people as they get older, and to improve their outcomes. It comes as the population of older Americans is growing. The number of those who are at least 65 went up 34% from 2007 to 2017, according to the Census Bureau, and now totals almost 51 million.

By 2030, it’s projected to be 73 million, more than 20% of the total U.S. population. Specialists refer to the group as a “silver tsunami” because it’s expected to wash over many aspects of society: health care, housing, transportation, technology.

The concern about loneliness, which some have labeled a public health epidemic, is not limited to the United States. Two years ago, the United Kingdom appointed a minister for loneliness after government research showed that millions of people often or always feel lonely. Some 200,000 older people in Britain said they had not had a conversation with a relative or a friend in more than a month.

Researchers are diving into the differences between social isolation (the objective reality of living alone) and loneliness (the subjective feeling of distress). They know that not everyone who lives alone is lonely, and not everyone who lives with others isn’t. But they don’t yet fully understand why.

They are exploring various risk factors, including genetics and the loss of loved ones. They are studying the biological and behavioral processes triggered by loneliness. And they are identifying ways to intervene when someone is lonely.

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Jeste is a leader in all this, particularly as it pertains to seniors.

Born near Bombay, educated there and in the U.S. (Cornell and George Washington), he focused initially on general psychiatry and schizophrenia, a diverse group of psychotic disorders that was generally understood to worsen over time. But his research showed that older people with it got better (think mathematician John Nash in “A Beautiful Mind”). That fascinated him, as did another study that showed people get happier as they age, and he settled into a career in geriatric neuropsychiatry.

Now nearing 75 himself, he has no plans to stop work anytime soon, especially when he sees a silver lining in the massing clouds about loneliness.

“It’s a major problem,” he said, “but we can do something about it, both on an individual level and a societal one.”

Not one-size-fits-all 

Jeste’s team believes the new study is the first to look at loneliness in senior housing communities. It focused on 30 people in one particular facility in the San Diego area who are part of a larger, five-year project to assess the residents’ physical, mental and cognitive health.

They range in age from 67 to 92. Two-thirds are women and 90% are white and had at least some college education. None has been diagnosed with dementia.

They live in a place with a wide variety of amenities and activities. There are afternoon socials and happy hours. Art classes and bingo. There’s a wood shop, a golf-putting course, gardening plots and a theater.

“Social isolation is not an issue there,” Jeste said, “and yet they feel lonely.”

Each of the participants was interviewed for about 90 minutes to explore why. Several attributed their loneliness to declining physical health and the deaths of spouses and friends. It was getting harder for them to visit people they know who are still alive. They acknowledged the widespread options to interact with other residents, but said they still feel empty and sad. They talked about not having any purpose in life.

“Loneliness is subjective,” Jeste said. “Different people feel lonely for different reasons despite having opportunities and resources for socialization. This is not a one-size-fits-all topic.”

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Dr. Melissa Gerald, a program director at the National Institute on Aging, said the study demonstrates that “making opportunities available for older adults to interact with others may help some people overcome loneliness, but this may not be a solution for all. As loneliness represents a complex set of emotions, combating this problem will require a multi-pronged approach.”

Although only 30 people were involved in the study, the finding that 85% experienced moderate to severe loneliness “underscores the widespread nature of this problem,” she said.

Susan Valoff, a licensed clinical social worker and vice president at Windward Life Care, a San Diego geriatric-health consulting service, said her experience with clients dovetails in some ways with the study’s conclusions.

“You can live amongst other people and still feel lonely,” she said. “It can be a rude awakening for some people when they move into a facility. They are used to being in their own homes, setting their own schedules, and now someone else is making the decisions. The loss of control contributes to loneliness.”

At Stellar Care, a facility for about 100 seniors in the El Cerrito neighborhood of San Diego, executive director Linda Cho said loneliness is a concern because of its impact on physical and mental health. Her facility tries to combat it by getting people out of their rooms as often as possible and by offering a variety of activities geared to different levels of physical and cognitive impairment.

“Sometimes the one-size bingo won’t do,” she said. “Meeting their needs at their level is very important.”

Wisdom as antidote 

The new study also opens a window into another part of Jeste’s research. It concerns wisdom.

For centuries, wisdom was a philosophical or religious concept. In the 1970s, scientists started looking into whether it is biologically based, and in the decades since have written hundreds of papers exploring where in the brain certain wise behaviors might originate.

Not everyone agrees on the definition of wisdom. It is a complex personality trait. Jeste and his team reviewed all the research papers and identified the six most common components — decisiveness, emotional regulation, self-reflection, tolerance for divergent views, compassion, and the ability to advise others.

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Then they came up with The San Diego Wisdom Scale, a set of 24 statements that people are asked to agree or disagree with on a five-point scale. (Sample statements: “I remain calm under pressure.” “I tend to postpone making major decisions as long as I can.”) The scores are tabulated to determine how wise someone is.

So what does this have to do with loneliness?

Jeste’s research shows that people who score high on the wisdom scale aren’t lonely. And vice versa.

Evidence of that appeared in the new study at the senior-living facility. Several who experienced strong loneliness appeared unable to regulate their emotions. Others talked about how they proactively warded off loneliness by doing something helpful for someone else, or how they had come to accept the physical limitations that come with aging.

“They didn’t use the word wisdom,” Jeste said, “but they were describing the components of wisdom.”

He thinks that points the way forward for possible interventions. Senior-living facilities might look into activities that encourage empathy, emotional regulation and the other parts of wisdom, he said. They can explore ways to make residents feel again that their lives have meaning.

Cho, at Stellar Care, called the study interesting and said it identified traits “that we know allow people to endure difficulties with better outcomes,” including compassion. “Another characteristic of seniors who are less lonely and who seem to be happier, based on my experience, is the need to remain relevant. Often, our residents may not want to participate in a certain activity, but they are often willing to help by assisting with the preparation or assisting other residents.”

Jeste said the popularity of senior homes is likely to increase as the number of older Americans grows, which makes understanding their loneliness even more important.

“It is a growing public health concern, and it’s important that we identify the underlying causes of loneliness from the seniors’ own perspectives so we can help resolve it and improve the overall health, well-being and longevity of our aging population,” he said.



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