At the 1976 Democratic National Convention, Hubert H. Humphrey said, “The ultimate moral test of any government is the way it treats three groups of its citizens."
"First, those in the dawn of life — our children, " he added. "Second, those in shadows of life — our needy, our sick, our handicapped. Third, those in the twilight of life — our elderly."
At the time, he said that Republicans had "failed this basic test of political morality." But as a former psychiatric visiting nurse and now as a researcher working with family caregivers of persons with dementia, it's a test that many of us are failing.
That is because loneliness is a broad societal problem that affects not only Americans, but everyone on the globe, as social isolation becomes widespread with an aging population.
Six million Americans 65 and older live alone in their communities, are homebound because of medical or emotional conditions or lack access to transportation. Many of these adults become physically isolated and emotionally lonely, contributing to what many call the loneliness epidemic.
Recent research indicates that loneliness and social isolation are risk factors for depression, impaired cognitive performance, dementia progression, compromised immune system, cardiovascular disease, hypertension, stroke and an overall increased mortality risk.
Take my elderly neighbor, Mary: we first crossed paths when she was walking her dog, and we smiled at each other, nodded and went about our business.
Soon after that, on a weekend evening, I noticed she had not picked up her newspaper that day, so I knocked on her front door. She was surprised but grateful that someone cared enough to check on her; few other people ever had. We remained friends for a decade, until she passed away.
Her circumstances are far too common. As a psychiatric visiting nurse in the mid-90s, I had the privilege to work with many older adults confined to their homes or apartments because of physical and/or mental health limitations. In many cases, apart from the occasional Meals-on-Wheels volunteers, I was the only other human being they interacted with over the course of each week.
My presence ensured that they maintained a degree of safety, medication adherence and, if necessary, that they would be connected with further medical care before a crisis ensued.
But not every elderly person living along can count on having a nurse used to working with older adults living on her block or coming by the house. And, according to recent U.S. Census Bureau data, the population of adults 65 and over will grow from 49.2 million in 2016 to 78 million by 2035. As the number of older adults increases at such a fast pace, so will the needs for addressing their health care needs, including those created by loneliness and isolation.
According to recent reports, a few major health care providers across the U.S. are already defining loneliness and isolation as social determinants of health. These providers are taking measures to connect their clients through basic measures such as home visits, phone contacts and providing transportation. The hope is that preventing and combating loneliness and isolation in older adults may prove cost effective.
Many of the connecting strategies to combat loneliness, though, rely on technology. While online messaging, voice and video chatting and social networking are effective ways to connect, not all older adults in the U.S. and globally can afford or have access to the Internet. In 2017, a Pew Research Center Survey found that only four in 10 seniors in the US owned a smartphone, only about half of them subscribed to high speed internet services and only one-third accessed social networking platforms such as Facebook or Twitter.
Low tech programs are out there, but they're mostly volunteer-based — like The Little Brothers-Friends of the Elderly, a non-profit volunteer agency with eight chapters across the United States. Volunteers visit those who are homebound, organize holiday and birthday celebrations, and even plan mini-vacations.
Many organizations are just beginning to launch self-assessment and awareness campaigns to bring attention to the problem of social isolation in older populations. The AARP Foundation, launched Connect2Affect in 2016, collaboration with organizations such as the Gerontological Society of America, United Healthcare, Give an Hour and the National Association of Area Agencies on Aging. The goal was to increase understanding of the complexities of loneliness and isolation in older adults, raise awareness of the public health implications, and rally resources to create evidence-based interventions.
Other nations are addressing the loneliness epidemic directly through policy initiatives.
In 2017, The Australian Coalition to End Loneliness enlisted the combined efforts of academic, not-for-profit, national, local and community-based resources to raise awareness, advocate and create evidence-based interventions to eradicate loneliness.
And in the United Kingdom, a recent report by The Jo Cox Commission inspired the Prime Minister Theresa May to pledge the equivalence of $23 million to tackle loneliness that afflicts an estimated 4 million British older adults. Earlier this year, May charged the Minister for Sport and Civil Society to include loneliness under its auspices, naming Tracy Crouch its Minister of Loneliness.
Medicare spends a reported additional $6.7 billion per year to treat the health problems of persons with limited social connections.
In the absence of a national plan endorsing the older adult loneliness epidemic in the U.S., millions simply rely on volunteer-based, charitable organizations to address a serious problem with severe public health implications. Or they will have neighbors, like Mary did, who are able and willing to visit them and check on their well-being.
Relying on individuals to be their neighbor’s keeper may indeed be a moral test for the individual but, as Humphrey opined four decades earlier, it is also a moral imperative of government and policy makers to create policies, standards and frameworks to care for those who have paved the paths before us.
I am willing to check on people I understand may need my help; I see it is not only as a kindness, but as my social responsibility. In the broader picture, how we as a nation address the needs of our elderly is a reflection of our humanity. This is difficult political test as well, and one that must be passed and passed on, not passed over.