In “Eleanor Rigby,” Paul McCartney sings of an elderly lady waiting perpetually for visitors and the isolated priest who buries her. Despite this memorialization of “all the lonely people,” we shouldn’t assume that loneliness is a normal stage of life. Nor is it just a ‘bad mood.’ Chronic loneliness – affecting roughly 1 in 3 seniors – is a medical condition associated with depression, increased inflammation, elevated risk of heart attacks, poor health behaviors, worsened sleep, and premature death. These public health concerns have compelled US Surgeon General Vivek Murthy to issue an 82-page advisory on the dangers of loneliness.
The Eleanor Rigby dilemma is commonplace. When a person outlives their spouse, adult children have moved away, friends have passed, and health adversities set in, establishing and maintaining social ties can be difficult. Now imagine Eleanor was one of the 6.7 million Americans over 65 living with Alzheimer’s disease. Cognitive issues can further hinder socialization. Whether a person with Alzheimer’s lives at home or in an assisted facility, they are at risk of loneliness and associated conditions. What can we do to help?
This article will discuss the difficulties combating loneliness in Alzheimer’s patients, available treatments, and new robotic companion animal technology.
Treating loneliness in Alzheimer’s patients
Myriad resources are available to seniors experiencing loneliness, such as senior classes, meetup groups, dial-a-rides, keeping a pet, and other social activities. But for those suffering from dementia, loneliness is substantially more difficult to address. Some complicating factors include:
- New social bonds are more difficult to establish and retain.
- Sufferers may not remember social interactions, so they won’t necessarily reap the mental health benefits of engagement.
- The behavioral and psychological symptoms of dementia (BPSD) – affecting approximately 97% of dementia patients – can limit social engagement. Symptoms of BPSD, such as hallucinations, agitations, aggression, depression, and apathy, may strain interactions with healthcare 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.
Having more people around
Most Alzheimer’s patients live at home, relying on the aid of an unpaid caregiver – typically 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 rendered unable to work outside the home. To make matters worse, many caregivers report loneliness themselves due to social isolation and stress. A paid caregiver can help keep a dementia patient in the home longer and provide relief to family caregivers. However, professional caregivers cost money, and a national shortage of workers means that finding and retaining competent caregivers may be a constant struggle.
At assisted living and nursing homes, people with dementia depend on staff for socialization. Theoretically, employing more staff per resident should help alleviate loneliness, but facilities generally operate at the minimum ratio. Memory care has a higher staff-to-resident ratio, though this is prohibitively expensive for most families, costing up to $10,000 per month. Healthcare experts predict that acute staffing shortages in this field – amplified by the pandemic – will only worsen over the next decade.
It seems logical that living in a group setting would be more social. For cognitively-typical seniors in relatively good physical health, community living can stimulate social engagement and reduce boredom. However, individuals with moderate or severe dementia cannot easily converse with their neighbors or participate in group activities. To establish and nurture bonds with others, they will require extensive help from caregivers.
Emotional attachment for seniors
Younger adults may have multiple responsibilities that anchor them to the community, such as caring for school-aged children and holding a job. But empty nesters past retirement often feel unneeded and unrooted. For cognitively healthy seniors, caring for a grandchild or a live animal can imbue a sense of purpose. These activities are considerably more difficult for dementia patients, who may not be up to the task. Alzheimer’s patients report extensive 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 unsafe for the patient or the animal. A sizable 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 leads to 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.
Emotional support objects
Fortunately, a senior with dementia can enjoy similar benefits to live animal ownership with an “emotional support object.” Some patients enjoy interacting with a stuffed animal or baby doll. By caring for another someone or something else, individuals can reclaim a sense of purpose. However, most dementia patients are unable or unwilling to form an emotional bond with a motionless toy.
An animatronic or robotic animal can foster better emotional bonds. For example, an interactive robotic fur seal named Paro ($6000+) has delighted people with dementia across the globe 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 furless robotic Aibo dog ($2900) has also been shown to help those with severe dementia by stimulating communication.
These robotic animals can help combat loneliness, BPSD symptoms, and foster engagement with others. As an added benefit, caregivers and other staff enjoy the positive interaction. When a patient smiles, everyone else in the room will feel happier, too.
A looming healthcare crisis
The loneliness epidemic is a pressing public health crisis with severe consequences. According to the Surgeon General, “the harmful consequences of a society that lacks social connection can be felt in our schools, workplaces, and civic organizations, where performance, productivity, and engagement are diminished.”
Not only does loneliness lead to multiple harmful health outcomes, but chronic loneliness is linked to an increased risk of dementia. So, does Alzheimer’s cause loneliness, or does loneliness cause Alzheimer’s? Possibly both.
A significant healthcare crisis looms as Baby Boomers age, which will contribute to a rise in Alzheimer’s cases. Combined with a 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 are responsible for ensuring that America’s seniors don’t end up like Eleanor Rigby. They deserve more.
Photo: :shapecharge, Getty Images