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A Great Poverty

By: Marc Evans Abat, MD, FPCP, FPCGMA Great Poverty

Honestly, this topic touched a lot of chords in my heart and spirit.  As I was preparing to write this article, two people came to mind: Mother Teresa and Robin Williams.  Here are quotes from these esteemed individuals that represent so much what loneliness is, especially when you are older:

“Loneliness and the feeling that nobody needs you is the worst kind of poverty” – Mother Theresa

“I used to think the worst thing in life was to end up all alone.  It’s not.  The worst thing in life is to end up with people that make you feel all alone.” – Robin Williams

Loneliness has been defined invariably as an emotion, distressing and painful, in response to isolation or paucity of support or companionship.  By this, it can be surmised the loneliness can happen in the setting of “being alone” or not being in communication with people daily, or “feeling lonely” despite being in a setting where an older person is surrounded by other people, whether with family, friends or co-seniors in a residential facility.

This is a growing problem for the older person, varying from 20% to almost 50% among older persons, depending on the living situation.  On a population level, many, if not most countries, are “aging”, meaning the percentage of people reaching age 60 and up, is increasing.  More elderly persons reach extremes of ages, with many having a fair level of health.  There are also accompanying changes with aging.  One cannot deny that many health concerns start to appear with aging, and these may affect one’s participation in society, and affect their outlook in life.  Aside from major health issues, sensory impairment, including vision and hearing loss, significantly contribute to isolation, both from the side of the patient (“no one pays me attention”) and other people (“it’s difficult to mind him”).

There are many role changes, from previously being the dominant forces in the family, work or community, to taking either a drastically laid back seat or mainly a consultative role.  Family and social dynamics also change.  Children leave the home to start their own lives and may have a much less time to visit or care for their parents.  There may be an inherent difference in interests, priorities, outlook, and perceptions between the older parents, and the younger children and grandchildren, such that sincere and meaningful “relationships” may not be existent despite the proximity of kin. One can argue that technology is now available to bridge relationships with people from across distances.  But the learning curve for these technologies may be quite steep, especially for those not accustomed to these gadgets when they were younger or were not able to learn to use them.  Today’s gadgets are also a one-size-fits-all model such that most of them are difficult to use and manipulate.

Importantly, the loss of previously established relationships like the death of a spouse or close friends may negatively impact an older person and might lead to avoiding the need to establish new relationships.  Living in a residential facility or a nursing home also increases when growing old. However, this does not guarantee the elimination of the perception of loneliness.  Not having meaningful communication and interaction between the residents or with the staff may perpetuate the sensation of loneliness.  Some studies also indicate that loneliness can exist even in situations where both spouses are still alive and together, highlighting the importance of having meaningful relationships.  Mental factors also affect the development of loneliness.  Those unable to accept changes with aging, deny and try to overcompensate (e.g. trying to act “young”), may have difficulty coping with the changes or may become disappointed when their expectations are not meant.  Unique issues also affect the risk of loneliness among groups like the lesbian-gay-bisexual-transgender community.

The feeling of loneliness significantly contributes to depression.  Depression in turns is a known detrimental health factor.  With depression comes negative behavior factors like poor appetite leading to malnutrition, or overeating as a compensatory mechanism.   They may also develop behaviors that make them less sociable and pervade the loneliness.  Disability can ensue from social withdrawal.  Increased alcohol consumption and smoking may also ensue, leading to problems like pulmonary disease, gastrointestinal and liver concerns, and falls.  Suicide risk also increases from the ensuing depression.

How does one avoid being lonely?  It’s a difficult answer and the solution comes from both the person and the factors around him.

  • Developing a positive outlook.  This helps by promoting a better understanding and acceptance of what life offers and the possibilities that it presents despite being older.  This trait extends to enabling older persons to attempt establishing new networks and relationships and to participate in available social activities.  It may be difficult for some to do, especially with their personality traits.  A simple first step is always to smile, even with people you just casually see (e.g. the security guard, the cashier, nurse, etc.).
  • Reach out to people.  Make an effort to meet your friends for snacks or lunch or a game of cards.  Tell your relatives it would make you happy to be with them from time to time.  Join community activities, accept and tolerate the differences between you and the other attendees.  If you are adept or an expert in a particular skill, then try to teach other people.  This is a useful way to reach out to your younger relatives, especially grandchildren.
  • Try to learn simple technology. Some of the elderly religious I’m involved with, are into social media, smartphones and tablets, computers and the like.  They email and talk to friends over the computer.  They even interact with younger students by asking for their help with their gadgets.  A tablet or computer that is set-up well will be more easy to use and acceptable to an older patient
  • Have a pet.  If you feel that human touch is inadequate, a pet dog or cat may be more pleasant for some.
  • Arrange for physical proximity. A nursing home is sometimes not the best solution.  In many situations, caring for the elderly at home, or living in proximity to their residential facility can make a huge difference in the emotional health of an older person.
  • Make it a habit. If you have an older relative living alone or in a residential facility, spend at least once or twice a week having a meal with them, or taking them out for shopping or sight-seeing over the weekend.  Once it becomes a routine for the both of you, it becomes an expected and well-loved event.

Our older relatives deserve to be the richest persons at the twilight of their lives.  Let us not make them poor in spirit.

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