The unspoken COVID-19 toll on the elderly: Loneliness

Mary Faines just turned 94 years old. For years the tradition has been to celebrate her special day with a festive dinner with her husband, son and daughter-in-law. It took a pandemic to break the long-standing tradition.

“This year was the first time we don't go out and celebrate with a dinner party. That has always been a big treat,” Faines told ABC News.

Faines is one of thousands of older adults who are at higher risk for severe illness from COVID-19 infection. Older adults have been instructed to limit face-to-face interactions with individuals outside their immediate household to protect themselves from the novel coronavirus. COVID-19 has forced many family members to end visits to parents and grandparents or stop visiting older loved ones at nursing homes and assisted living facilities.

The implementation of physical distancing is an essential step in reducing transmission of the virus. But in an effort to flatten the curve, physical distancing may be causing social isolation and loneliness. Although loneliness and social isolation can affect anyone regardless of age, the elderly are particularly vulnerable, especially under the current conditions of the pandemic.

"The frail elderly are particularly at risk because of limited (or impaired) physical mobility, less autonomy, increased vulnerability to infections and immunological depletion, cognitive decline, chronic health conditions, lower injury thresholds and higher recovery times,” said Stephanie Cacioppo, director of the Brain Dynamics Laboratory at the University of Chicago’s Pritzker School of Medicine.

Some older adults may also be at higher risk because their social world becomes smaller and their opportunity to socially connect with others decreases.

Dr. Ellen Whyte, a psychiatrist and the director of geriatric psychiatry outpatient services for UPMC Western Psychiatric Hospital, admits that not all older adults will be affected equally.

“The elderly as a group is very diverse," she said. "Those with more education and resources will come through this social distancing just fine, while those who don't have the ability you engage in tech supported replacements, for example, may feel particularly isolated."

Shirley Strauss, 93, lives alone in Brooklyn. While she remains positive, she admits that the last couple of weeks have not been easy.

"I was able to go out and do certain things, but now I'm stuck in the house and it's like the walls are coming down on me. I am feeling lonely, now it’s the holiday and I can’t see the family and that upsets me,” she said.

Social isolation and loneliness do not always go together. Loneliness, unlike social isolation, is a subjective feeling. According to Lisbeth Nielsen, director of the division of behavioral and social research at the National Institute of Aging, loneliness is the “sense of suffering from being disconnected from other people, which is different than social isolation which is simply not being around other people or not having close connections."

Social isolation could lead to feelings of loneliness. Observational and correlational studies have linked persistent feelings of social isolation and loneliness with higher risk of developing certain mental and physical health conditions like heart disease, high blood pressure, anxiety, depression and even premature death.

"Loneliness also triggers a stress response that there is an imbalance in our social homeostasis," Cacioppo said.

This biological phenomena has been associated with increased inflammation and a hyper activation of the immune system, which, according to experts, contributes to some of the chronic diseases that older adults are already more vulnerable to developing.

The health consequences of loneliness may also manifest as changes in routine and self care.

"Is the person still keeping a routine, getting up at the same time every morning, going to bed at the same time? Do they have food in the house, are they preparing meals, keeping up with bathing?” Whyte said.

“Many of the older people are finding that they are cut off from the types of activity that bring meaning or purpose to their life, communal activities, recreational or exercise or just face-to-face social interactions that they are used to having,” said Nielsen.

Faines, who lives in the University of Pittsburgh Medical Center senior community, used to socialize with her fellow residents in the communal dining hall and her son "used to come three to four times a week to see us, but we’ve been told no visitor or family members and we miss that,” she said.

But experts say there are ways to help older adults combat sensations of loneliness and social isolation and prevent negative mental and physical health consequences.

“Fundamentally we are social creatures and part of what brings meaning to our life is to maintain and foster those social connections and we all need to be creative in finding ways to do that under these difficult situations,” said Nielsen.

Faines said she was upset that she couldn’t see her son in person on her birthday but is grateful for help in setting up a video chat call.

"On my birthday our activity director hooked up her iPad with my son and daughter in law," she said. "We speak over the phone every day but it was wonderful to connect and have that moment looking at each other and talking to each other via the iPad.”

Strauss also values the power of technology to stay connected. She said her family got her a tutor to teach her how to use her computer.

“I use FaceTime and Facebook, I’m into everything," she noted. "I get to keep in touch with friends and relatives, otherwise I really would be lonesome.”

She said that having the ability to FaceTime with her grandchildren and great grandchildren is “like having them right in my house.”

Whyte suggests older Americans set up regular phone calls as part of a daily or weekly routine.

"We can prevent and reverse loneliness with the power of our mind and positive thinking,” said Cacciopo. "Older adults, in fact, have a wisdom that can be protective against loneliness because they tend to value the quality of their relationships over the quantity.”

She said the key is to change expectations and understand that the current situation is temporary.

Faines said she hasn't experienced anything like the coronavirus before.

"Even the wars we’ve lived though were nothing like this," she explained. "This virus has attacked us, but we are trying to keep our spirits up, looking for that brighter day ahead. We have the television on all the time, to see we aren’t the only ones, you can’t help but feel a part of it.”

Cacciopo also said it’s important to focus on the present moment. But focusing attention on the present may be tougher for older adults who sometimes have impaired working memory capacity.

Linda E. Maurice, director of community education and lifelong learning at Nova Southeastern University, is giving older adults the opportunity to continue learning and enriching their minds. Her educational program allows then to continue learning as though they were still in the university. Her students range in age from late 50s to 90s.

"The older adults I work with, I know that they crave a schedule and they crave that socialization,” she said, adding that she believes she can help "them not just physically but emotionally stay healthy.”

Self isolation and quarantine is impacting younger people, too.

Liora Fishman, 24, calls her 98-year-old grandmother, Gloria Koller, her best friend and role model and before the pandemic visited her every other week for as long as she can remember.

"I think something that is so particularly scary about this is that ... we feel helpless -- we have no control of their fates," she said. "Knowing that if, God forbid, she were to get sick, I would not be able to see her, sit next to her, or hold her hand, makes me incredibly anxious. I have to constantly remind myself that in not seeing her, I'm actually doing more to control the outcome for her and the rest of my family."

Fishman is still creating memories with her grandmother even if they can't be physically together.

"One thing my grandma absolutely loves to do is sing," she said. "We've spent plenty of FaceTime calls singing her favorites -- 'New York, New York' 'Diamonds Are a Girl's Best Friend' and '42nd Street.'"

Cacioppo said there may in fact be a silver lining in this crisis.

"We should take this opportunity to learn again what it really means to be social and find new forms of social connection," she said.

Added Cacioppo, "We can grow more united and we may even see more intergenerational cross over and a lot of social connections between grandparents, parents and kids. In these unprecedented times, we need to protect, connect and unite with the elderly more than ever before."

Editor's note: Shirley Strauss is a relative of an ABC News employee.

Eden David, who's studying neuroscience at Columbia University and matriculating to medical school later this year, is a contributor to the ABC News Medical Unit.