In Eleanor Rigby, Paul McCartney sings about an old lady who is forever waiting for visitors and the reclusive priest who buries her. Despite this mention of “all lonely people”, we should not assume that loneliness is a normal stage of life. Nor is it simply a “bad mood.” Chronic loneliness—affecting approximately 1 in 3 older adults—is a medical condition linked to depression, increased inflammation, increased risk of heart attack, poor health behaviors, impaired sleep, and premature death. These public health concerns prompted US Surgeon General Vivek Murthy to issue an 82-page advisory on the dangers of loneliness.
Eleanor Rigby’s dilemma is a common one. When one outlives one’s spouse, grown children have moved away, friends have died, and health problems arise, establishing and maintaining social connections can be difficult. Now imagine that Eleanor is one of the 6.7 million Americans over age 65 living with Alzheimer’s disease. Cognitive problems can further hinder socialization. Whether a person with Alzheimer’s lives at home or in an assisted living facility, they are at risk for loneliness and related conditions. What can we do to help?
This article will discuss the challenges of dealing with loneliness in Alzheimer’s patients, available treatments, and new robotic companion animal technology.
Treating loneliness in Alzheimer’s patients
Countless resources are available for seniors experiencing loneliness, such as senior classes, meetup groups, phone walks, fostering a pet, and other social activities. But for those suffering from dementia, loneliness is significantly more difficult to deal with. Some complicating factors include:
- New social connections are more difficult to establish and maintain.
- Sufferers may not remember social interactions, so they may not necessarily reap the mental health benefits of engagement.
- Behavioral and psychological symptoms of dementia (BPSD) – affecting approximately 97% of dementia patients – can limit social engagement. Symptoms of BPSD, such as hallucinations, agitation, aggression, depression, and apathy, can burden interactions with health care workers, family, friends, and other residents.
- Caregivers are already overworked, underpaid and experiencing low morale.
- Other options, such as keeping a live pet, may not be feasible.
To have more people around
Most Alzheimer’s patients live at home, relying on the help of an unpaid caregiver—usually a female family member, such as a wife, daughter, or daughter-in-law. This arrangement can take an emotional and financial toll on the caregiver, often unable to work outside the home. To make matters worse, many caregivers self-report loneliness due to social isolation and stress. A paid caregiver can help keep a dementia patient at home longer and provide relief to family caregivers. However, professional caregivers cost money, and the national labor shortage means that finding and retaining competent caregivers can be a constant struggle.
In assisted living and nursing homes, people with dementia depend on staff for socialization. In theory, hiring more staff per resident should help alleviate loneliness, but facilities typically operate at a minimum ratio. Memory care has a higher staff-to-resident ratio, although it is prohibitively expensive for most families, costing up to $10,000 per month. Health experts predict that acute staffing shortages in the field – exacerbated by the pandemic – will only worsen over the next decade.
It seems logical that life in a group environment would be more social. For cognitively typical older adults in relatively good physical health, community living can stimulate social engagement and reduce boredom. However, people with moderate or severe dementia cannot easily talk to their neighbors or participate in group activities. To establish and nurture relationships with others, they will need extensive help from caregivers.
Emotional attachment for the elderly
Younger adults may have multiple responsibilities that bind them to the community, such as caring for school-age children and holding down a job. But empty nesters after retirement often feel unnecessary and unrooted. For cognitively healthy older adults, caring for a grandchild or live animal can provide a sense of purpose. These activities are significantly more difficult for patients with dementia who may not be able to cope with the task. Alzheimer’s patients report great benefits from interacting with a live animal, such as increased confidence, self-esteem, quality of life, engagement and interaction. With enough help, some sufferers living at home can keep an animal, but in many cases a live animal is impractical and potentially dangerous to the patient or the animal. A significant percentage of assisted living facilities allow pets, but only for residents who can care for the animals themselves. When residents’ health deteriorates (dementia is a progressive disease), this often results in increased responsibility for already overburdened staff. Even worse, residents may be forced to surrender their pets, which can be particularly traumatic for those suffering from dementia.
Objects of emotional support
Fortunately, an elderly person with dementia can enjoy similar benefits to owning a live “emotional support object.” Some patients enjoy interacting with a stuffed animal or baby doll. By caring for another person or something otherwise, people can regain a sense of purpose. However, most dementia patients are unable or unwilling to form an emotional connection with a stationary toy.
An animatronic or robotic animal can encourage better emotional connections. For example, an interactive robotic seal named Paro ($6,000+) has delighted people with dementia around the world and demonstrated mental health benefits. At the opposite end of the price spectrum, Ageless Innovation’s “Joy For All” animatronic cats and dogs ($139) are affordable companions. Sony’s Aibo ($2,900) hairless robotic dog has also been shown to help people with severe dementia by stimulating communication.
These robotic animals can help combat loneliness, BPSD symptoms and encourage engagement with others. As an added benefit, caregivers and other staff enjoy the positive interaction. When the patient smiles, everyone else in the room will feel happier too.
A healthcare crisis is looming
The loneliness epidemic is an urgent public health crisis with dire consequences. According to the Surgeon General, “the harmful effects of a socially disconnected society can be felt in our schools, workplaces and civic organizations, where performance, productivity and engagement are reduced.”
Not only does loneliness lead to a host of harmful health effects, but chronic loneliness is associated with an increased risk of dementia. So, does Alzheimer’s cause loneliness or does loneliness cause Alzheimer’s? Possibly both.
A significant health care crisis is looming as baby boomers age, which will contribute to an increase in Alzheimer’s cases. Combined with the shortage of geriatricians and caregivers, we will soon have more lonely seniors in America. This crisis affects everyone, so we must open our minds to new solutions, such as robotic companions. We have a responsibility to make sure America’s seniors don’t end up like Eleanor Rigby. They deserve more.
Photo: :shapecharge, Getty Images