Addressing the Habits of Loneliness: How to Re-engage Lonely Residents with the Community

The pandemic highlighted the effects of loneliness on seniors and the overall prevalence of loneliness in senior care settings. Loneliness can impact everything from resident life expectancy to staff turnover. Reducing resident loneliness should be an essential priority for senior care communities. By addressing the habits of loneliness, senior care communities can re-engage lonely residents with the community.

Understanding Loneliness in Senior Care

Adam Greene, CEO and co-founder of Klaatch

Understanding loneliness starts with understanding the emotional toll of isolation. “Loneliness is the difference between your desired level of connection and the actual connections that exist in your life,” says Adam Greene, CEO and co-founder of Klaatch. In contrast, social isolation refers to the physical state of being alone.

“It’s important to understand that loneliness is brought on by loss,” Greene explains. That loss might be the loss of someone, like a family member or spouse, but it can also refer to the loss of identity that’s brought on by retirement, mobility or other impairments.

Additionally, a move into a senior care setting is often precipitated by something. That movement isn’t always voluntary. “Often, you’ve lost your network, you have to get to know all these new people, and you don’t feel great about yourself,” says Greene. “It’s a perfect situation for someone to become lonely.”

The Effects of Loneliness on Senior Care Residents

The effects of loneliness are not only profound, but they are also contagious. “There are well-documented facts of loneliness doubling the risk of getting a dementia diagnosis, increasing the likelihood of stroke by 32%, and increasing the risk of heart attack by 29%,” says Greene. “But one of the things that loneliness does is send a signal from your brain, changing your personality and behavior.”

Much in the way that people can become “hangry,” getting unusually angry when they’re hungry, loneliness sends the same kind of signal. “Rather than making you angry, it makes you self-protective, self-centered, and distrusting,” says Greene. “We also find that people lose their ability to empathize, and they’re focused on themselves.

This behavioral change is rooted in the evolutionary theory of loneliness. “When we lived in caves, being alone was inherently dangerous,” Greene explains. “We needed to be self-centered to survive, but in the modern world, those behaviors push people away when you need them. We call these the habits of loneliness.

Loneliness is a cycle and can be exacerbated by the habits of loneliness. “Just when you want and need people, you end up pushing them away because loneliness generates these behaviors,” says Greene. “When you say ‘I prefer to be alone,’ you’re really rejecting the other person before they have the chance to reject you. You lose the ability to accept deviance, or people who are different than yourself. You narrow your ability to get along with different kinds of people. This shows up in functional MRIs. You can see how the brain is rewiring itself to protect itself from these kinds of emotional strains.”

These behaviors can affect not only physical health, but also one’s ability to enjoy life. “The impacts go to the heart of who we are as people,” notes Greene.

Loneliness impacts more than individual residents, too. “Can you imagine if you had a number of lonely older adults behaving this way and you were on the staff? It’s really hard,” Greene says. “I understand why the extraordinarily high levels of turnover exist in senior living. If you deal with lonely, difficult, distrusting people all day long, that might make you want to change jobs. Fixing the loneliness situation has the ability to transform a community in profound ways, including at the staffing level, length of stay, and occupancy level.”

Identifying the Habits of Loneliness

The evolutionary theory of loneliness was developed by John Cacioppo of the University of Chicago. According to the theory, people developed habits of loneliness because those habits helped keep us alive.

Behaviors of loneliness include distrusting the actions of others, a lack of empathy for others, constantly speaking about oneself, having a lack of confidence, pursuing solitary activities, and more.

“You’ll see people talk a lot about themselves,” says Greene. “They tell the same stories over and over again. They will reject people and tell people that they would rather be by themselves. When they do that in a systemic way, they very often have the TV on all day long, which is like having company without having company.”

The habits of loneliness are reinforcing, meaning the more one performs the behaviors, the more they withdraw. “It becomes a self-reinforcing cycle, and it’s true of young people, too,” explains Greene.

Loneliness is still stigmatized for many people, especially among older adults. “The attitude is that it’s a social deficiency, but it’s not about that. These behaviors are just like when you’re hangry, and you don’t necessarily have control. The way you fix hangry is you feed the person. The same thing is true with these habits.”

Greene explains that it’s possible to identify people who are at a high risk of being lonely using tools such as natural language processing, which can be performed via a phone call. By analyzing conversations, it’s possible to identify people who are very likely to be lonely, and to evaluate how lonely they are.

“Short of that, you can identify habits of loneliness,” he says. “Not everyone’s loneliness is the same. Some people retire, lose a spouse, or have incontinence. All of these different ways that people become lonely manifest themselves somewhat differently. It’s not just someone looking forlorn.”

Supporting Residents Experiencing Loneliness

Residents who are profoundly and persistently lonely may benefit from cognitive behavioral therapy to help them reconnect. It’s important to establish trust and make the person feel seen and heard. “Talk to them, let them talk about themselves, and reinforce that they’re seen and heard, and that they matter,” Greene recommends. “There are techniques to do this using the person’s name regularly and repeating back what they’ve said.”

Greene also recommends bringing people into small, coach-led peer-to-peer groups. The groups need to be structured so that everyone gets seen and heard, since lonely people will naturally try to dominate a conversation. This is easier to accomplish in small groups. “As people start to reconnect, you really want to bring the other residents into the mix,” Greene explains. “If the community has to do all the lifting, that’s really hard. It really makes a difference if the residents support themselves.”

He also suggests several ways that senior care communities can make it easier for someone who is lonely to re-engage with the community:

• Pair large group activities with small group activities. It’s hard to get to know people in large groups, so take the time to stop, break into smaller groups, and give the groups a prompt to facilitate engagement, such as “Tell us something we might not know about you.”
• Make it easier for people to match faces and names. It’s awkward and uncomfortable if you run into someone and don’t remember their name. Take a photo of each resident and post it with their name in an accessible place, so people can easily find out others’ names for the next time they run into them.
• Create opportunities where people can get to know each other. Ambassador programs, where a current resident introduces a new resident to others, is one example. Greene suggests expanding these programs so that if a resident is lonely, people in the community can step in and help to reconnect that person.

How to Reduce Resident Loneliness

Loneliness often goes undetected because it’s easy to assume that a person is just difficult or that they simply like to be alone. “We think the missing piece is identifying these loneliness behaviors,” he says. “Once you identify them, you can start to think about what to do about them. Klaatch offers several workshops and trainings to help teach people how to think about loneliness in light of these behaviors.

Greene notes that it’s important to carefully evaluate loneliness programs. “We’re not an intervention provider, and we recommend all kinds of programs,” Greene notes. “Don’t get taken in by thinking all these people out there saying they have loneliness solutions actually have loneliness solutions. There are a lot of good services out there around the loneliness issue, but they don’t necessarily make people more connected.”

Greene encourages anyone considering a loneliness solution to ask hard questions. What kind of people does it make less lonely? How do you know it’s effective? And how would you know in your community if it’s working? “You want to do things that will actually bring people together and make the community stronger,” he says. “If you’re trying to solve this problem, then let’s find interventions that work in your community.”

Paige Cerulli

Paige Cerulli is a contributing writer to i Advance Senior Care.