What Keeps Me Up at Night

April 9, 2020

Photo Credit: Dmitry G / Public domain

Many older adults struggled with loneliness and isolation long before this pandemic began. How are they faring now, and what’s being done to help them?

Listen to the full episode below or scroll down for the transcript and more information.

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Wendy Hohl: What’s going to happen? What if I get it? How do I know?

Dan Gorenstein: A lot of us have those same questions swirling around our heads these days.

WH: If I fall in my backyard…who’s going to find me?

DG: For seniors living alone contracting COVID is just the start of their worries.

WH: Who’s gonna miss me right now? And that scares me.

DG: It’s Thursday, April 9th.

Today, from the Annenberg Studio at the University of Pennsylvania, what doctors, nurses, and policymakers are doing to alleviate the impact of loneliness on isolated seniors, who are more cut off than ever before…

I’m Dan Gorenstein…this is Tradeoffs.

Carla Perissinotto, MD

Carla Perissinotto, MD

Carla Perissinotto: The research I did several years ago determined that, solely by feeling lonely, you’d have an increased risk of dying and you’d have an increased risk of losing your independence.

DG: Carla Perissonotto is the associate chief for clinical programs in geriatrics at UC San Francisco.

She cares for older patients and, for the past decade, has studied how loneliness affects their health.

DG: There’s a lot more conversation about loneliness and isolation. Help us understand, as people who may haven’t thought much about this issue until being trapped in our own homes, do those two words mean the same thing?

CP: They’re related, but they mean different things. So loneliness is really the subjective feeling of being isolated. You would say it’s a discrepancy between your desired relationships and your actual relationships. So you want 10 friends and you only have five and you’re distressed about that gap. Social isolation is really about the number of contacts you have with others and how that affects you.

What’s happening right now with COVID is that there’s probably both going on. What we know about the research is that we presume that these things can be additive. So we know that over long periods of time this can affect your health, but we don’t know what that time period is, right? So we don’t know—is a week enough for it to cause health effects? Is it a month? Is it the amount in a week? Those are the big unknowns, which is why I think this is such a critical time, because we’re enlisting these pretty severe measures to protect health while potentially affecting health at the same time.

DG: Carla says the research pretty clearly shows the same people most likely to be harmed by COVID are the same ones at risk for loneliness and isolation.

But concrete solutions are hard to come by.

It’s difficult not knowing how to help, when you know there’s so much need.

DG: So, Carla, how are you sleeping these days?

CP: Depends on the day…so what keeps me up at night is our patients who have never used technology, who are visually impaired, who are hearing impaired or low income, who don’t have Internet…One of our patients who is in an assisted living, who is surrounded by people but still feels incredibly lonely. And because suddenly her family can’t come to see her, she literally feels abandoned. Because she already has dementia, it feels like no one’s coming to see her. No one cares about her. I mean, that is devastating.

DG: The woman who lives in assisted living—let’s call her Maria—what does the research tell us about the impact feeling abandoned like this could have on Maria?

CP: Potentially, could she have had worsening dementia because of her loneliness? And is her cognition going to get worse because of this distress of now feeling abandoned? The second thing is that if she doesn’t have family and other people who are coming in to see her and socialize daily or weekly, she’s at pretty big risk of losing her function, meaning is she going to some of her muscle mass in a matter of days and be at greater risk for falls and of getting more frail? And so those are the active things that are worsening her health while we are theoretically improving her health by reducing her exposure to COVID.

DG: Carla was a coauthor on a National Academies report published in February summarizing what we know—and don’t know—about loneliness in seniors like Maria. It also made some recommendations. One of them: Doctors and nurses should regularly ask seniors questions, like whether they have a caregiver or easy access to food, to help identify and support those at risk for isolation. While some clinics and hospitals are doing this work, Carla says it’s really just ramping up.

CP: What’s hard is that really from a population health standpoint, we should already have this information and know who of our patients are at risk. But informatics has lagged behind because we do not focus on older people as a country. We are incredibly ageist and we forget about them and now suddenly we’re in crisis where we need to about know about this and we’re trying to catch up.

DG: Beyond better identifying who is at risk, Carla also supports other solutions like giving seniors easy to use tablets…

Sfx: Phone ringing

DG: and connecting them to programs like this one…

Jimmy: Friendship Line, this is Jimmy. How are you today?

DG: The Friendship Line (800-971-0016) is a 24-hour crisis and counseling line for older adults and younger people with disabilities feeling suicidal or just sad, and lonely.

Jimmy: I’m glad you gave us a call.

DG: It’s housed at the Institute on Aging in San Francisco.

DG: In the months leading up to COVID, the Line averaged about 18,000 calls per month. Half come from California—the other half from around the country. More than 50% of the Line’s callers live alone.

Patrick Arbore: Particularly during a crisis like we’re in today, the people that really carry the burden of that often are poor people, often are frail or sick, particularly older women, who are often just kind of discarded.

Patrick Arbore, EdD

Patrick Arbore, EdD (Photo Credit: Kellie Charlton)

DG: Patrick Arbore is the founder of the support and counseling service.

He and his staff and their volunteers are slammed right now.

Demand is so great, no one has had time to confirm what Patrick estimates is a 50% spike in calls.

He also says the very nature of the calls has changed as people camp out at home.

PA: People are much more anxious and scared about what’s going on, and the feeling of panic is really much more intense.

DG: Even though he’s done this work for more than 40 years, Patrick says the intensity of some recent calls sticks with him. He thinks of one woman who is 89.

PA: And she said I can’t bear the thought that I would die alone. And she said, that’s what really terrifies me. And and I could just feel her and I can feel it now…there’s just panic and this fear. And she said, as much as you are here for me on the phone, Patrick, you can’t tell me that I’m going to be safe. And you might not be able to be there in the hospital if I actually came down with the virus, and I may die in that hospital alone.

DG: And she’s right. That’s right. There’s not much you can do.

PA: It’s very real, you know, and that’s the thing about Friendship Line is that we don’t try to pretty things up. This is, you know, the way things could happen. But right now, it’s not happening. And then we’ll encounter them again tomorrow and we’ll talk through that again tomorrow.

DG: Another person Patrick has been speaking to is 69-year-old Wendy Hohl.

Wendy Hohl: My sleep has not been perfect, you know.

DG: Wendy’s been talking to Patrick weekly for six years now. He’s helped her through a lot including grieving the loss of her husband and adjusting to life after retirement. Now they’re working on ways to stay positive and get through anxious days and nights.

WH: I have a list. Spending a lot of time with my dog.

Sfx: Dog collar jingle

I talk to one of my longest friends of over 50 years. And she’s also the one that’ll send me a YouTube that lightens up my day.

Sfx: “Islands in the Stream” song

DG: Wendy’s friend sends lots of upbeat music videos…

WH: I keep those YouTubes and I go revisit them. If I have to revisit them in the middle of the night, I do that. If I get up and have to have a cup of tea.

Sfx: Tea kettle whistle

WH: I try to do that to keep my head straight.

DG: The loneliness is sharp enough that Wendy, with prodding from Patrick, is asking for help in new ways.

WH: I just asked my daughter this morning if she would have a daily check-in thing. I never do that with my kids. They are busy. They have their lives. And now I’ve got to ask them to check in with me, even if it’s just an emoji.

DG: Statewide, Governor Gavin Newsom sees the importance of services like Friendship Line even though the evidence they work isn’t robust. Last week, he launched a resource hotline for seniors sheltering in place and called on Californians to do their part.

Gov. Newsom: So neighbor by neighbor, we’re asking people to make 5 calls to our seniors to check in not just for wellness checks related to food and medicine, but the deep anxiety people are feeling being isolated and home.

DG: Wendy, for sure, agrees there’s value in phone calls. It’s her chats with Patrick…a little help from Dolly Parton and Kenny Rogers…that gives her hope, and has her looking forward to her post-pandemic wish list.

WH: Going out for coffee with a friend. Going to a movie. Oh, my gosh. I love movies. To be together with my two daughters and their boyfriends. To physically hug someone, physically hug someone and not be afraid.

DG: I’m Dan Gorenstein, this is Tradeoffs.

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Episode Resources

Research on Loneliness and Social Isolation

Social Isolation and Loneliness in Older Adults (National Academies of Sciences, Engineering, and Medicine, 2020)

Managing Loneliness (NIHCM, 2020)

Loneliness and Social Connections: A National Survey of Adults 45 and Older, 2010-2018 (AARP, 2018)

Reporting on the Impact of COVID-19 on Loneliness and Social Isolation

How Loneliness from Coronavirus Isolation Takes Its Own Toll (Robin Wright, New Yorker, 2020)

Newsom Asks Californians to Check on Seniors During Coronavirus Outbreak (Katie Orr, KQED, 2020) 

Coronavirus Will Also Cause a Loneliness Epidemic (Ezra Klein, Vox, 2020)

Episode Credits


Carla Perissinotto, MD, Associate Chief for Geriatrics Clinical Programs, University of California, San Francisco

Patrick Arbore, EdD, Director and Founder, Friendship Line and Center for Elderly Suicide Prevention and Grief Related Services

Wendy Hohl

Music composed by Ty Citerman, with additional music from Checkie Brown, Podington Bear, Lobo Loco, and the Brothers Gibb. 

This episode was reported and produced by Leslie Walker, and it was mixed by Andrew Parrella.

Additional thanks to:

Tom Baker, Emily Tsanotelis, Mia Grigg, James Whelan, the Tradeoffs Advisory Board…

…and our stellar staff!