Report Outlines Strategy for Combating Senior’s Social Isolation and Loneliness

Published in the Woonsocket Call on March 1, 2020

Nearly one in four older adults residing in the community are socially isolated. Seniors who are experiencing social isolation or loneliness may face a higher risk of mortality, heart disease and depression, says a newly released report from the National Academies of Sciences, Engineering and Medicine (NASEM), a Washington, D.C.-based nonprofit, nongovernmental organization.

For seniors who are homebound, have no family, friends or do not belong to community or faith groups, a medical appointment or home health visit may be one of the few social interactions they have, notes the NASEM report released on Feb. 27, 2020. “Despite the profound health consequences — and the associated costs — the health care system remains an underused partner in preventing, identifying, and intervening for social isolation and loneliness among adults over age 50,” says the report.

“I’m pleased the AARP Foundation sponsored study by NASEM confirms the connection between social isolation or loneliness and death, heart disease and depression for older adults. It also finds that the health care system and community-based organizations have a critical role to play in intervening,” says AARP Foundation President Lisa Marsh Ryerson.

“We also know social isolation, like other social determinants of health, must be addressed to increase economic opportunity and well-being for low-income older adults,” says Ryerson.

Addressing Social Isolation and Loneliness

The 266-page NASEM report, “Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System,” undertaken by the Committee on the Health and Medical Dimensions of Social Isolation and loneliness in Older Adults, outlines five goals that the nation’s health care system should adopt to address the health impacts of social isolation and loneliness. It also offers 16 recommendations for strengthening health workforce education and training, leveraging digital health and health technology, improving community partnerships, and funding research in understudied areas.

Although social isolation is defined as an objective lack of social relationships, loneliness is a subjective perception, say the NASEM report’s authors. They note that not all older adults are isolated or lonely, but they are more likely to face predisposing factors such as living alone and the loss of loved ones. The issue may be compounded for LGBT, minority and immigrant older adults, who may already face barriers to care, stigma and discrimination, the report says.

Social isolation and loneliness may also directly result from chronic illness, hearing or vision loss, or having mobility issues. In these instances, health care providers might be able to help prevent or reduce social isolation and loneliness by directly addressing the underlying health-related causes.

“Loneliness and social isolation aren’t just social issues — they can also affect a person’s physical and mental health, and the fabric of communities,” said Dan Blazer, J.P. Gibbons professor of Psychiatry Emeritus and professor of community and family medicine at Duke University, and chair of the committee that wrote the report in a statement announcing the its release. “Addressing social isolation and loneliness is often the entry point for meeting seniors’ other social needs — like food, housing and transportation,” he says.

Providing a Road Map…

The 16 recommendations in this report provides a strategy as to how the health care system can identify seniors at risk of social isolation and loneliness, intervene and engage other community partners.

As to improving Clinical Care Delivery, the report calls for conducting assessments to identify at-risk individuals. Using validated tools, health care providers should perform periodic assessments, particularly after life events that may increase one’s risk (such as a geographic move or the loss of a spouse).
The NASEM report also recommends that social isolation be included in electronic health records (EHRs). If a patient is at risk for or already experiencing social isolation, providers should include assessment data in clear locations in the EHR or medical records.

It’s important to connect patients with social care or community programs, too. The NASEM report notes that several state Medicaid programs and private insurers already has programs that target the social determinants of health. These programs can be more intentionally designed to address social isolation and loneliness of the older recipients. Health care organizations could also partner with ride-sharing programs to enable older adults to travel to medical appointments and community events, the report recommends.

The NASEM report also suggests that as more evidence becomes available, roles that health care providers are already performing — such as discharge planning, case management and transitional care planning — can be modified to directly address social isolation and loneliness in older adults. The report also details other interventions that the health care system might consider may include mindfulness training, cognitive behavioral therapy, and referring patients to peer support groups focused on volunteerism, fitness, or common experiences such as bereavement or widowhood.

Strengthening health professional education and training can be another strategy to combating the negative impacts of social isolation and loneliness. The NASEM report calls for schools of health professions and training programs for direct care workers (home health aides, nurse aides and personal care aides) to incorporate social isolation and loneliness in their curricula. Health professionals need to learn core content in areas such as the health impacts of social isolation and loneliness, assessment strategies, and referral options and processes, say the report’s authors.

The NASEM report warns that there are ethical Implications for using Health Technology to reduce social isolation and loneliness. Technologies that are designed to help seniors — including smart home sensors, robots and handheld devices — might intensify loneliness and increase social isolation if they are not easy to use or attempt to substitute for human contact. Moreover, the report found that 67 percent of the current assisitive technologies in dementia care were designed without considering their ethical implications. Developers of technology should properly assess and test new innovations, taking into account privacy, autonomy and the rural-urban digital divide.

The NASEM report says that more research is need because of evidence gaps and calls for more funding of studies to determine the effectiveness of interventions in clinical settings; to develop measures to identify at-risk individuals; and identify trends among younger adults as they age (such as use of technology and economic trends) that may inform how the health care system should target social isolation and loneliness in the future. More research is also needed to identify approaches and interventions that best meet the needs of LGBT and ethnic minority populations.

The National Academies are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.

For a copy of the NASEM report, go to http://www.nap.edu/catalog/25663/social-isolation-and-loneliness-in-older-adults-opportunities-for-the .

Comic Robin Williams’ Death Puts Spotlight on Depression, Suicide

Published in Pawtucket Times, August 15, 2014

Last Monday evening, millions of Americans were shocked to hear that 63-year- old Robin Williams died from an apparent suicide. While it was well-known that he had a history of severe depression and years of alcohol and drug addiction, we were stunned by the unexpected tragic news. publically, Williams had it all, fame, fortune, loyal friends, and fans in every corner of the globe. But like millions of Americans he suffered in silence trying to slay his personal demons when he went into substance abuse treatment.

The sudden death of this Oscar-winning actor, recognized as America’s comic genius, squarely puts the spotlight on depression, a mental illness that commonly afflicts tens of millions of Americans.

DDepression Becomes a Public Conversation

Within the first 48 hours of Williams’ suicide The Samaritans of Rhode Island saw an increase in calls from people concerned about loved ones and friends, says Executive Director Denise Panichas, who expects to also see an increase in visits to her Pawtucket-based nonprofit’s website. Last year, its website received more than 50,000 visitors.

Panichas says, “William’s death reinforces the fact that suicide knows no boundaries, it being a relentless demon afflicting both rich or poor, and those having access to therapy or medical care and those not having it.

According to the Woonsocket resident, William’s suicide has raised the awareness of suicide prevention in a way that millions of dollars in public health announcements could never have done. “William’s movies as well as his dedication to community service resonate with multiple generations, says Panichas, stressing that his six plus decades had value “which will live on.”

Williams substance abuse problems also highlights the need for more awareness as to how addictions can be a risk factor for depression and suicide, states Panichas, who observes that throughout the country, in ever city and town, budgets for substance abuse treatment are being decimated, she adds.

“Promoting wellness and preventing addictions will always be a big challenge but we must do more if we want to see a decrease in suicides,” says Panichas.

Panichas expects the death of Williams, an internationally acclaimed movie star, will have an impact on fundraising for suicide prevention or addiction and depression prevention programs. She has seen an increase in donations from Rhode Islanders as well as from around the country. .

“One donor gave a donation in memory of “Mork”. The donations coming in may be small but every one counts toward keeping our programs available to the public,” says Panichas, noting that over the years public funding has “been drying up.” The Samaritans of RI is using more creative fundraising structures, like crowdfunding (www.crowdrise.com/samaritansri2014) and other social venture sites to create new revenue streams for her nonprofit, she adds.

An Illness That Can Affect Anyone

Lisa B. Shea, MD, Medical Director of Providence-based Butler Hospital, Providence, learned of William’s suicide by a CNN alert on her IPhone. To the board- certified psychiatrist who serves as a clinical associate professor at Brown University’s Alpbert Medical School, “it was tragic but preventable.”

Shea, a practicing psychiatrist for 20 years, notes that people who have suicidal thoughts, like Williams, are struggling with mental health disorders. “Their thinking can get very dark and narrow and they believe they have no options,” she says, oftentimes feeling like a burden to others. “It does not matter who you are mental illness can strike any one regardless of their wealth and fame,” she says.

According to Shea, the public’s interest in William’s tragic death sheds light on the fact that people can get help and it begins with taking a positive first step. “People with suicidal thoughts, who feel “intensely tortured and can not see any way out of their situation, can benefit from supportive therapeutic relationships, medications, and getting support from family and friends who can push them into getting professional help,” she says.

Shea calls on Congress and Rhode Island state lawmakers to positively respond to the William’s suicide by providing increased funding to create access to treatment and prevention programs and to support mental health research.

Finally, Shea says that there are a number of tell-tale signs of a person expressing hopelessness who may be thinking of ending their life. They include statements made by someone that others are better off if he or she were not around; excessive use of alcohol and/or drugs; not taking care of yourself; and giving away personal items. When these occur, talk to the person telling them that you care about them and are concerned for their well-being.

Adds Melinda Kulish, Ph.D., a Clinical Psychologist/Clinical Neuropsychologist and Instructor of Psychology at Harvard Medical School, “There are also times when depression is not easily recognizable. Some people who are depressed experience it most acutely when by themselves but can appear fine, even quite happy, when they are with other people.”

Kulish explains that, for various reasons, some people feel the need to make others happy. Cheering others up or making others laugh makes them also feel happy.

“But, if that person is suffering from depression, the happiness is fleeting – the laughter ends and they once again feel empty and sad. The cheering up of others is a fix that is OUTSIDE, not inside of them.

“And drugs and alcohol can make them feel better for a time. The high always ends, and when alone, they feel empty and even more depressed,” says Kulish. “There’s really good research to suggest that talking about traumatic and upsetting events leads to much healthier responses. The old idea, ‘I’m just not going to talk about it so it’ll go away’ doesn’t work.”

“It’s a myth that if you ask a person if they are suicidal you will put that idea in their heads,” says Shea.

Feeling Low, a Place to Call

When this happens, “feeling low with nowhere to turn” as noted singer songwriter Bill Withers once said in a public service announcement, there is a place to call – The Samaritans of Rhode Island – where trained volunteers “are there to listen.” Incorporated in 1977, the Pawtucket-based nonprofit program is dedicated to reducing the occurrence of suicide by befriending the desperate and lonely throughout the state’s 39 cities and towns.

Since the inception, The Samaritans has received more than 500,000 calls and trained more 1,380 volunteers to answer its confidential and anonymous Hotline/Listening Lines.

With the first Samaritan branch started in England in 1953, chapters can now be found in more than 40 countries of the world. “Samaritans, can I help you?” is quietly spoken into the phone across the world in a multilingual chorus of voices,” notes its website.

Executive Director Panichas, notes that the communication-based program teaches volunteers to effectively listen to people who are in crisis. Conversations are free, confidential and, most importantly, anonymous.

A rigorous 21-hour training program teaches volunteers to listen to callers without expressing personal judgments or opinions. Panichas said that the listening techniques called “befriending,” calls for 90 percent listening and 10 percent talking. Panichas noted The Samaritans of Rhode Island Listening Line is also a much needed resources for caregivers and older Rhode Islanders.

Other services include a peer-to-peer grief Safe Place Support Group for those left behind by suicide as well as community education programs.

In 2014, The Samaritans of Rhode Island received more than 4,000 calls and hosted more than 50,000 visitors to its website.

The Samaritans of Rhode Island can be the gateway to care or a “compassionate nonjudgmental voice on the other end of the line,” Panichas notes. “It doesn’t matter what your problem is, be it depression, suicidal thoughts, seeking resources for mental health services in the community or being lonely or just needing to talk, our volunteers are there to listen.”

For persons interested in more information about suicide emergencies, The Samaritans website,http://www.samaritansri.org, has an emergency checklist as well as information by city and town including Blackstone Valley communities from Pawtucket to Woonsocket.

For those seeking to financially support the programs of The Samaritans of Rhode Island, its Art Gallery and Education Center is available to rent for special events, meetings and other types of occasions. For information on gallery rental, call the Samaritans business line at 401-721-5220; or go tohttp://www.samaritansri.org.

Need to Talk? Call a volunteer at The Samaritans. Call 401.272.4044 or toll-free in RI (1-800) 365-4044.

For mental health resources, go to http://www.butler.org.

Herb Weiss, LRI ’12 is a Pawtucket-based freelance writer who covers health care, aging, and medical issues. He can be contacted at hweissri@aol.com.

Coping with the Holiday Blues

Published December 14, 2012, Pawtucket Times

Chestnuts roasting in your fireplace, green wreaths with red ribbons and brightly colored lights on decorated evergreen trees may elicit pleasant thoughts about the upcoming holidays; however, these thoughts might just tear open old wounds and bring to the surface bad memories, triggering stress, tension and even depression.

Not every family gathering with your parents, siblings, children, or grandchildren will be as serene as a Norman Rockwell painting. Of course, everyone has heard horror stories involving holiday family gatherings.

Surviving the Stress of Family Visits

Allison Bernier, LICSW, Associate Director of Wellness Employment and Network Services, at the Providence Center, notes that while the holiday season can be a time of family celebration, joy, and companionship for many people, it can also be a very stressful time. “High expectations, disrupted routines, dealing with loss or separation from loved ones, financial strain, and time constraints can all exacerbate anxiety and depression,” she says.

Bernier, who has 15 years under her belt employed as a Social Worker, who now provides one-to-one counseling to clients for the past six years, provides common sense tips as to how to survive stress that can be ignited by holiday family gathering.

Fighting holiday blues can be as simple as being prepared for family conflicts and having a specific plan to handle the uncomfortable emotions that may arise, notes Bernier. Creating a list of “potential issues” and “role playing how you will react with people you trust” can be effective ways to survive difficulties that might occur, she says.

“It is okay to know that you don’t have to be happy during the holidays,” states Bernier, stressing “just accept your feelings and the place where you are at.” If needed, just reach out to your network of family or friends or contact a professional, she recommends.

According to Bernier, when expectations are unrealistic, we almost always will fail to meet them. Scale back on your plans, or ask for help Just keep your expectations low and when you visit family or friends, just go and enjoy the social interactions, she says.

If seeing family causes you great amounts of stress each year, it is alright to say no sometimes and celebrate with friends, Bernier recommends. If you don’t want to withdraw from your family gathering because of tension, you don’t have to, she says. “Just keep your visit time-limited,” she recommends, only going for an hour or two rather than spending all day at the event.

The holidays can easily become a source of stress, especially when you’re standing in long lines at the local mall waiting to buy the last available iPad while trying to remember how much money you have left to use on your credit cards. Writing out a gift list along with creating a budget for holiday spending can help decrease anxiety, too, Bernier notes. By setting spending limits you will also reduce the anxiety that comes with reviewing your post-holiday credit card bills.

Maintaining healthy habits can also take the blues out of your holiday, predicts Bernier. Enjoy some eggnog, cheese cake or pastries at a holiday party, but keep the balance by eating healthy foods (smaller portions), drinking alcohol in moderation, continuing to exercise and getting enough rest.

Coping with Holiday Depression

Besides family stress, other factors may well play into bringing on the holiday blues.

During this time of the year, some Rhode Islanders may even feel a little depressed or have suicidal thoughts with the approaching upcoming festive holidays, especially if they have lost a spouse and friends, are unemployed, experiencing painful chronic illnesses, or just feel isolated from others.

If this happens, “feeling low with nowhere to turn” as noted singer songwriter Bill Withers says is a public service announcement, there is a place to call – The Samaritans of Rhode Island – where trained volunteers “are there to listen.” Incorporated in 1977, the Pawtucket-based nonprofit program is dedicated to reducing the occurrence of suicide by befriending the despairing and lonely throughout the state’s 39 cities and towns.

Since the inception, The Samaritans has received more than 500,000 calls and trained more 1,380 volunteers to answer its confidential and anonymous Hotline/Listening Lines.

With the first Samaritan branch started in England in 1953, chapters can now be found in more than 40 countries of the world. “Samaritans, can I help you?” is quietly spoken into the phone across the world in a multilingual chorus of voices,” notes its web site.

Executive Director, Denise Panichas, of the Rhode Island branch, notes that the communication-based program teaches volunteers to effectively listen to people who are in crisis. Conversations are free, confidential and, most importantly, anonymous.

A rigorous 21-hour training program teaches volunteers to listen to callers without expressing personal judgments or opinions. Panichas said that the listening techniques called “befriending,” calls for 90 percent listening and 10 percent talking.

Panichas noted The Samaritans of Rhode Island Listening Line is also a much needed resources for caregivers and older Rhode Islanders.

Other services include a peer-to-peer grief Safe Place Support Group for those left behind by suicide as well as community education programs.

In 2011, The Samaritans of Rhode Island received more than 7,000 calls and hosted more than 50,000 visitors to its website.

The Samaritans of Rhode Island can be the gateway to care or a “compassionate nonjudgmental voice on the other end of the line,” Panichas notes. “It doesn’t matter what your problem is, be it depression, suicidal thoughts, seeking resources for mental health services in the community or being lonely or just needing to talk, our volunteers are there to listen.”

For persons interested in more information about suicide emergencies, The Samaritans website, http://www.samaritansri.org, has an emergency checklist as well as information by city and town including Blackstone Valley communities from Pawtucket to Woonsocket.

Professional Galley and Gift Shop Supports Program and Services

In December 2011, The Samaritans began a social venture, by relocating to the City of Pawtucket’s Arts & Entertainment District, and opening the Forget-Me-Not Gallery and Community Education Center. Through partnerships with Rhode Island’s fine arts and crafts community, “we hope to foster hope, inspiration and commemoration of the lives of our loved ones who have fallen victim to suicide,” stated Panichas.

At the Forget-Me-Not Gallery, no sales taxes are charged on one-of-a-kind pieces of art work. The gallery also is a retail site for Rhode Island-based Alex and Ani jewelry and other giftware.

For those seeking to financially support the programs of The Samaritans of Rhode Island, its Gallery and Education Center is available to rent for special events, meetings and other types of occasions. For information on gallery rental, call the Samaritans business line at 401-721-5220; or go to http://www.samaritansri.org.

Need to Talk? Call a volunteer at The Samaritans. Call 401.272.4044 or toll free in RI (1-800) 365-4044.

Herb Weiss, LRI ’12 is a Pawtucket-based freelance writer who covers health care, aging, and medical issues. He can be contacted at hweissri@aol.com.

The Best of…Call the Samaritans for a Shoulder to Lean On

            Published on December 24, 2001, Pawtucket Times

             Chestnuts roasting on the fire.  Green wreaths with red ribbons. Soothing Christmas music coming from speakers in shopping malls.  Houses decorated with long strands of brightly colored lights.  Decorated evergreen trees.

            Got the Christmas spirit?  Many do, but many don’t, especially if they are seniors.

           With Christmas tomorrow, not everyone is feeling the holiday spirit.  The  holidays may be a very difficult time for seniors, particularly the elderly who have lost spouses and friends, have painful chronic illnesses or feel isolated or powerless, says Cynthia Barry, M.S.W, executive director of the Mental Health Association of Rhode Island.  At this time “some may feel depressed and even suicidal.”

            Even drinking during the holidays can put seniors at a higher risk of experiencing depression and thinking about suicide, Barry adds.

            Even drinking during the holidays can put seniors at a higher risk of experiencing depression and thinking about suicide, Barry adds.

            But the stigma of mental illness will keep older persons from seeking out needed treatment for their depression or suicidal thoughts, Barry says.  Those who feel that they have a problem with depression should visit their local mental health care, neighborhood health canter, the family physician or even private practitioners re commended by their health plan, she says.

            Carolyn Pellegrino, deputy director of Self Help, Inc., a nonprofit community action agency in the East Bay that provides senior case management to all upper East Bay communities and both Pawtucket and Central Falls, , notes that 60 percent of her older clients usually involve  persons who just worry to those experiencing severe clinical depression.

           “There’s a lot of depression out there,” Pellegrino says, adding that today’s seniors, who grew up in a different era, were told not to dal with their feelings of depression, “just get on with your life.”

          Although depression, like heart diseased, is an illness, seniors will get treated for their heart disease, but not their depression, Pellegrino says.  Oftentimes, a combination of medication and therapy can do wonders about a person’s depression, she states.

          A newly released Public Service Announcement (PSA) tells seniors to seek out another resource to fight the holiday blues.  Last week, WHJJ and B101 played a PSA featuring well-know songwriter Bill Withers who, after singing a few lines of his popular song, “Lean on Me,” urges his radio listeners “feeling low with nowhere to turn to contact The Samaritans.”

        Directed to the lonely, the depressed and suicidal, the PSA is intended to raise the awareness of the existence of The Samaritans of Rhode Island, a nonprofit program dedicated to reducing the  occurrence of suicide by reaching out to the despairing and lonely.

          Denise Panichas, serving as The Samaritans’ interim executive director states the communication-based program, established in Providence in 1979, teaches volunteers to effectively listen to people who are in crisis.  Conversations are free, confidential, most important anonymous.

         A rigorous training program teachers volunteers to feel and think without expressing personal judgements or opinions, Panichas says, noting that the listening technique, called “befriending,” calls for 90 percent listening and 10 percent talking.

          Last year, more than 20,o00 Rhode Islanders called The Samaritans, Panichas said.  The Samaritans, Panichas said.  “It doesn’t matter what the problem is, be it depression, suicidal thoughts, seeking resources for mental health services in the community or being  lonely and just needing to talk,” she said.

          Panichas notes that The Samaritans also offers other needed resources to caregivers and older Rhode Islanders. “We do community education programs and also have our peer-to-peer Safe Place Support Group for those left behind by suicide.

          For seniors who are looking for something to do with their time, the art of “befriending” is something that anybody can do.  Becoming a compassionate listener to someone in need.

         Herb Weiss is a Pawtucket-freelance writer who covers health care, aging and medical issues.  He can be reached at hweissri@aol.com.