Loneliness among older adults is often described as an epidemic with serious physical and mental health consequences, including a higher risk for dementia. Some experts say the socially isolating pandemic has the potential to make this epidemic even worse, leading to more memory loss and other cognitive problems among vulnerable older people.

"We know people who are getting old, if they're isolated or socially less stimulated, they tend to develop dementia earlier than others,” says behavioral neurologist Borna Bonakdarpour, an assistant professor of neurology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician. “So when social activities were stopped when we first started to shelter in place, I started getting phone calls from family members that [their loved ones] were declining.”

Bonakdarpour says some patients grew confused or paranoid, including one who “thought the TV anchor they were watching was in the room with them. There are a lot of symptoms developing.”

Loneliness is a particular risk factor for dementia if someone already is developing early markers of Alzheimer's disease in the brain (often well before cognitive symptoms result), says geriatric psychiatrist Peter Rabins, an Alzheimer's disease expert at the Johns Hopkins School of Medicine and author of Is It Alzheimer's?: 101 Answers to Your Most Pressing Questions About Memory Loss and Dementia. “You're kind of adding another problem to it. That can push them over the edge and unmask it."

Rampant loneliness predates pandemic

Loneliness — the subjective feeling of distress caused by feeling lonely, as opposed to the physical state of isolation — was already rampant before “social distancing” became a household phrase this year: Some 43 percent of adults age 60 and older reported feeling lonely in a 2018 survey from the National Academies of Sciences, Engineering, and Medicine that was sponsored by AARP Foundation.

The repercussions are serious: Loneliness has been associated with a wide range of physical ailments, from high blood pressure to diabetes, as well as a weakened immune system — not something anyone wants to experience during a pandemic. A 2015 metanalysis of 70 loneliness studies concluded that over seven years lonely adults had a 26 percent greater risk of non-suicidal death.

A Friendly Voice

AARP Friendly Voice was set up early this year to break through the wall of loneliness made more formidable by social distancing. Friendly volunteers recruited from across the country will call anyone who requests contact. If people are having a crisis — in critical need of food, health care or mental health intervention, for example — they are steered to appropriate help. But more often these calls are just an opportunity to have a relaxed, extended conversation with someone who's friendly and caring. Those seeking a call can reach out to AARP's program through this link: https://aarpcommunityconnections.org/friendly-voices/.

And loneliness among older adults may result in an estimated $6.7 billion in additional federal spending annually, according to a 2017 analysis of Medicare spending data by the AARP Public Policy Institute and Stanford University.

Your brain: ‘Use it or lose it’

How does loneliness result in cognitive decline? Bonakdarpour says, essentially, “It's a use-it-or-lose-it kind of thing.” More scientifically, he explains: “Proteins associated with Alzheimer's disease tend to accumulate in the brain for years, sometimes 20 years. The brain tries to compensate for it with what we call cognitive reserve.” That's the connections between neurons that have been built up by social interactions and other stimulating activities that make the brain more resilient.

"We need to have help people maintain brain health and keep your blood pressure controlled and eat well, but we also need to be stimulating the brain,” Rabins says. “I think of loneliness as a kind of social deprivation. You're depriving the brain of external emotional and social stimulation."

Complicating the issue is that depression often looks like dementia — and one can exacerbate the other: The isolation during the pandemic, Rabins says, “can lead to depression and demoralization, which also then has a negative effect on thinking. It can sometimes be difficult to disentangle."

Fighting back against loneliness

Many concerned people are stepping up to address loneliness during the pandemic, suggesting more telehealth visits and assistance with sensory issues such as hearing loss, a contributor to loneliness; hearing aids or other devices can often help someone with hearing loss feel more connected and alleviate those lonely feelings.

And nursing homes and assisted living facilities around the country are trying to help patients connect with families remotely using programs like FaceTime and Zoom, when they aren't allowed in-person visits due to the pandemic.

Vivek H. Murthy, a former U.S. surgeon general and author of Together: The Healing Power of Human Connection in a Sometimes Lonely World, has been working to encourage all of us to help alleviate loneliness in the people around us, during the pandemic and beyond. Simply showing up and listening to them with our full attention is sometimes all it takes, he told AARP recently. One of the greatest gifts that we can give people is our presence, he said. It can “make people feel seen; it can make people feel that they matter. We don't need to be a nurse or a doctor to provide that kind of healing.”

~AARP