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Loneliness, Chronic Illness, and Growing Older

How can older adults with chronic illness handle depression and loneliness?

"Pray that your loneliness may spur you into finding something to live for, great enough to die for." Dag Hammarskjold

The mental and physical burden of loneliness can be extreme, especially for older adults. Usually defined as the perception of being isolated from significant others, whether friends or family, people feel lonely because of the gap between the kind of social relationships they would like to have and the ones they see themselves as having. Since nobody's life is ever truly perfect, we all feel lonely from time to time, though the feeling is usually manageable and temporary.

Still, there are numerous studies showing the link between loneliness and the development of health problems, as well having a shorter lifespan. Along with depression and other psychological problems, chronic loneliness can also lead to sleep problems, hypertension, an impaired immune system, and the breakdown of the body's endocrine system.

The problems associated with loneliness often grow worse with time due to the natural health problems that come with age. As a result, loneliness is frequently a chronic problem in older adults due to increasing health problems which can make it harder for them to stay socially active. Age-related medical issues can also lead to greater psychological distress, including depression, and this can lead to people feeling even lonelier. Medical problems such as arthritis, cardiovascular disease, or cancer, can make many older adults feel more disabled and helpless.

Growing older can also lead to a reduction in social support networks, whether through the death or illness of friends and family members, or through major life changes such as divorce or retirement. Losing this kind of emotional support can have a devastating impact on the ability of older adults to cope with stress. In many life-span developmental theories, old age is often the time when older adults are especially vulnerable to loneliness which, along with the strain of coping with chronic illness, could cause them to sink into a downward spiral of depression and despair from which they may never recover.

Along with the challenges that come with age however, there are also effective coping strategies that can help protect older adults and keep them from sinking into this downward spiral. According to the motivational theory of lifespan development proposed by Jutta Heckhausen and her colleagues, people can cope with stress life changes by engaging in either goal engagement strategies or self-protective strategies to build up a sense of control over their lives.

Goal-engagement involves expending time and energy to accomplish specific goals, whether through learning new skills or learning to compensate for health problems that may keep them from familiar activities. Using goal-engagement strategies also means finding the motivation to overcome obstacles instead of sinking into apathy or feeling helpless.

This in turn leads into the need for self-protective strategies to cope with the stress that can come with life changes. By recognizing the difference between attainable and unattainable goals, older adults can mentally prepare themselves to handle emotional distress, whether by reassuring themselves about their ability to accomplish realistic goals or by "disengaging" themselves from goals which are no longer attainable. As people grow older, accepting physical limitations and learning to compensate for them can be an important part of living well, even with chronic illness.

As one example, older adults who develop serious heart problems may become afraid of engaging in any sort of physical exertion, including sex, for fear that what might happen. Learning to accept these limitations and finding ways to work around them, whether by starting new hobbies that are less physically exhausting or finding new ways to do enjoyable activities can be an important part of staying active. Along with learning to attain health-related goals, it is also essential to overcome the low self-esteem and feelings of depression that can lead to becoming more isolated.

Overall, the kind of control strategies we use are going to change with time and our physical ability to handle what is happening to us. It can also mean the difference between an active life and sinking into isolation. But how effect are these strategies going to be? A new research study published in the journal Health Psychology presents the results of an eight-year longitudinal study looking at the link between chronic illness and feelings of loneliness in older adults. Conducted by Carsten Wrosch of Concordia University and a team of fellow researchers, the study used information taken from the Montreal Aging and Health Study (MAHS).

Beginning in 2004, the MAHS studied two hundred and fifteen adults, aged sixty and older, to learn how they cope with common, age-related problems. The study was conducted with repeated assessments every two years from 2004 to 2012. Because of people dropping out due to health problems or other reasons, only one hundred and twenty-one participants were included in the final analysis. On average, participants were seventy-one years old when the study began. The participants completed questionnaires on loneliness, health, demographic factors, and lifestyle choices. Personality factors such as self-esteem, neuroticism, and optimism were also measured.

To measure health engagement control strategies, participants completed a questionnaire with items such as : "I invest as much time as possible to improve my health;" "When I decide to do something about a health problem, I am confident that I will achieve it;" and "When a treatment doesn't work for a health problem I have, I try hard to find out about other treatments." Health-related self-protective strategies were measured through items such as "Even if my health is in very difficult condition, I can find something positive in life;" "When I am faced with a bad health problem, I try to look at the bright side of things;" and "When I find it impossible to overcome a health problem, I try not to blame myself.”

What the researchers found was that perceived loneliness increased steadily over time and most participants reported having at least one chronic illness. Both of these findings matched what has been reported in previous research studies and suggest that there is a direct relationship between aging and loneliness as well as chronic illness. Not surprisingly, chronic loneliness was highest for older adults with a history of health problems.

Though the trend towards greater feelings of loneliness as we grow older appears strong, especially if we develop chronic health problems as well, it is still possible to protect ourselves. Based on the results of this study, using self-protective strategies to cope with health problems seems to help people with chronic illness deal with the emotional distress linked to loneliness. By reappraising their lives in positive ways and recognizing that they are not responsible for their illness, older adults can adapt to new health threats as they occur.

Positive reappraisal is especially effective in helping people to recognize that they are still capable of enjoying life in spite of their health problems. It also provides them with the confidence to try new things and develop new hobbies that can help them stay socially active. By avoiding self-blame, older adults can also protect themselves from the depression and feelings of helplessness that are often seen in chronic illness.

While self-protective strategies appear effective in dealing with loneliness, health-engagement strategies may not be as useful. Still, health-engagement strategies can also play an important role in managing health though this can change over time as health problems become more severe.

Overall, the researchers found that self-protection strategies can work well in curbing loneliness even when differences in personality, amount of actual disability, or depression were taken into account. These study results can have important implications for how older adults with health problems can manage loneliness and depression. It also demonstrates the need for teaching effective coping techniques to manage the psychological problems linked to living with chronic illness. While many older adults experience greater problems in emotional well-being as they grow older, learning to live with inevitable health problems is the key to a long and productive life.

We are currently looking at one of the largest demographic shifts in history with one out of every three Americans being fifty years or older. One out of every eight Americans is now considered "old" and make up 12.9 percent of the total population. By 2030, one out of every five people will be sixty-five or older and our health care system will be strained to the bursting point (and beyond) caring for them.

With the rising number of older adults living in the community, it is more essential than ever that we explore different forms of psychological training to help them to stay active as long as possible. Helping older adults manage their own physical and emotional health represents a vital investment in the future.