June 6, 2021

The Silent Epidemic of Our Times

By Kenneth Ring, Ph.D.

I recently read a very touching story about a woman named Virginia, who is 92 years old, and her cat, Jennie. She adores her cat who is almost always nearby. She likes to look at Jennie’s green eyes. She likes that Jennie is with her in the morning when Virginia wakes up. And sometimes when Virginia feels sad, she just sits in her soft armchair while Jennie rests on Virginia’s stomach. She nuzzles, purrs, stretches and just does her cat-like things.

Talking to an interviewer, Virginia said, "I can’t believe that this has meant as much as it has to me." When she dies, she thought she might bring Jennie with her. 

Jennie is a robot.

I came across this vignette in a recent article in The New Yorker that was written by Katie Englehart, the author of the book, The Inevitable, which I featured in my previous blog. In the article, she was addressing a problem that two English researchers, writing in The Lancet, had characterized in the following way:

Imagine a condition that makes a person irritable, depressed, and self-centered, and is associated with a 26% increase in the risk of premature mortality. Imagine too that in industrialised countries around a third of people are affected by this condition, with one person in 12 affected severely, and that these proportions are increasing. Income, education, sex, and ethnicity are not protective, and the condition is contagious. The effects of the condition are not attributable to some peculiarity of the character of a subset of individuals, they are a result of the condition affecting ordinary people.

The condition to which these authors are referring, as you might have guessed, is loneliness. And, as we also now know, this condition is particularly acute among the elderly,  which is why caregivers have been interested to see whether providing them with robot pets will help to alleviate their loneliness. In fact, as a number of researchers and scholars have recently pointed out, the pervasiveness of loneliness among the old in America has now reached what the Surgeon General, Vivek Murthy, was frank to call an "epidemic." But in contrast to the pandemic we have all been through for the last year and half, this has mostly been a silent epidemic. The plight of the elderly, despite suffering unduly from the pandemic and dying in much greater numbers than younger people, did not receive the kind of sustained attention that we gave to families having to cope with children underfoot or workers who had lost their jobs.

This is understandable, of course. As a society, we no longer venerate the old, assuming we once did; all too often, we simply abandon, forget or ignore them. To be sure, individual family members usually continue to care for their elderly loved ones when they can. And we have all heard horrific stories of the contagion of COVID and resultant deaths that plagued our nursing and other old age homes during the first year of the pandemic. But as a society, we no longer provide the kind of social welfare net that permits most older people to continue to live out their lives in relative comfort in the company of other family members.

There was a time, of course, when, even in America, many people lived in extended families, either in the same house or nearby in the same neighborhood. In those days, when grandma became old and frail and could no longer hear well, she would still be cared for, and could still enjoy the loving company of her family. These days, however, grandma is usually shipped off to a nursing home to live among decrepit and often demented strangers, who cry out piteously during the night and during the day often sit, vacantly, strapped into their wheelchairs. This happened to my mother, too, when she had become old (I was living in Connecticut then while she, who had never flown, had to remain in California). During those years, I would continue to visit her as often as I could arrange to come out to California, but every time I had to leave her in her bed alone and without friends or other family, I felt a wracking guilt.

But even when older people can continue to live in their own homes, they are often left alone, and when that happens, they can suffer from acute loneliness and feelings of abandonment. And more and more of our elderly do live alone now – more than ever – as a result of the modern way of family life which has seen the rise of isolated nuclear family settings at the expense of extended family networks. Statistics show that nowadays almost 30% of Americans over the age of 65 live by themselves, most of them women.  And during the period when COVID raged, this isolation, as we all know, was even more of a torment to the old and to their families who could no longer see and comfort them. How many of these elderly died, alone and afraid, without a hand to hold? One can only shudder when one imagines people dying in this way. How many tears have been shed by their helpless family members? Perhaps you were such a person or knew others who had to endure such emotional and traumatic distress.

Even before COVID struck, however, the deleterious effects of isolation among the old were evident to researchers. Let me take just a moment to acquaint you with the range and severity of some of these effects.

To begin with, 43% of the elderly in America complain about being lonely. According to Englehart, loneliness can "prompt a heightened inflammatory response, which can increase a person’s risk for a vast range of pathologies, including dementia, depression, high blood pressure, and stroke." To amplify this point, consider the following statistics that come from a book dealing with the effects of social isolation in older adults:

•  Social isolation has been associated with a significantly increased risk of premature mortality from all causes.

•  Social isolation has been associated with an approximately 50 percent increased risk of developing dementia.

•  Loneliness among heart failure patients has been associated with a nearly four times increased risk of death, 68 percent increased risk of hospitalization, and 57 percent increased risk of emergency department visits.

•  Poor social relationships (characterized by social isolation or loneliness) have been associated with a 29 percent increased risk of incident coronary heart disease and a 32 percent increased risk of stroke.

Of course, old age in itself is hard enough to endure for most of us oldsters, quite apart from the dangers, physical and emotional, of isolation, which I have just briefly adumbrated. The so-called "golden years" are really just the olden years when sentiment is absent and the reality of life as one ages is bereft of any illusory euphemism. Growing old is scary enough when one contemplates the prospect and then the reality of increasing decrepitude, loneliness, illness and then, finally, dying and death. If you have the misfortunate of living long enough, you may even find yourself not only alone but without anyone any longer knowing who you are and what you have been in your life. This is probably the most terrifying kind of existential isolation.

I remember when I was in my early eighties and was writing some (mostly) humorous essays about my own vicissitudes of aging that I eventually collected into a little book I puckishly called Waiting to Die, I had one of those moments of anticipatory existential fright. This is what I wrote at the time:

One day long ago I had a shocking realization. I received a new credit card whose expiration date was November, 2023, when I would be almost 87 years old. Surely, I thought, I would expire long before that. But, then, a horrible thought occurred to me: What if I don’t?! What if I live to 86? Honestly, before seeing that card, I had never imagined such a thing. No, no! Will I still be walking on this road toward death, still waiting to die, for years to come? What a ghastly thought.

I realized I’m not afraid to die; I’m now afraid of living too long!

At that time, I could still half-joke about such a prospect, but now that I am halfway to 86, it seems that some of my fears may no longer be a laughing matter!

A few years ago, the well-known physician, Ezekiel Emmanuel (you have probably seen him often interviewed on television where he became a frequent commentator on the pandemic), wrote a now famous piece in The Atlantic, which he provocatively entitled, "Why I Hope to Die at 75." In it, he reflected my own thinking, but took the time to lay out his reasons. This is how his article began:

That’s how long I want to live: 75 years.

This preference drives my daughters crazy. It drives my brothers crazy. My loving friends think I am crazy. They think that I can’t mean what I say; that I haven’t thought clearly about this, because there is so much in the world to see and do. To convince me of my errors, they enumerate the myriad people I know who are over 75 and doing quite well. They are certain that as I get closer to 75, I will push the desired age back to 80, then 85, maybe even 90. I am sure of my position. Doubtless, death is a loss. It deprives us of experiences and milestones, of time spent with our spouse and children. In short, it deprives us of all the things we value.

But here is a simple truth that many of us seem to resist: living too long is also a loss. It renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived. It robs us of our creativity and ability to contribute to work, society, the world. It transforms how people experience us, relate to us, and, most important, remember us. We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic.

Exactly. Which is why I argued in my previous blog that people should have the right to terminate their own lives. Emmanuel would not choose to do that, but many people who no longer wish to live doubtless would if they could do so peacefully. Who, when young, dreams of getting old? Instead, we pretend it won’t happen to us. I never really thought it would happen to me either. But one day, after I had turned 81, I realized that my time had come.

Right now, even though I live alone (and have for many years – it’s easier for us introverts), I am lucky to have a loving girlfriend, now nearly 80 herself, who is able to spend some time with me as well as a caretaker who can assist me when I need someone to go grocery shopping or do errands for me. But my three children all live far from me, and I would never want to burden them with my care if one day I should find myself alone in this world. But who knows – it may be that I will eventually be one of those people I have been writing about -- on my own, sick and feeling forlorn, lost in my dotage, just waiting to die. Knowing what I have learned about the effects of isolation, I am not keen on spending my last days like this, even if I should have a robot cat to keep me company. 

Of course, old age needn’t be a drag or a seemingly unending series of tribulations and sorrows. It’s important to keep things in balance after all. As Emmanuel implies, old age can also be rewarding and full of pleasures, including sex. I have an old girlfriend, now well into her 80s, who frequently writes me about her deeply satisfying sex life with her husband. And there are certainly people in their nineties who are happy still to be alive and able to enjoy life.

Since this blog has been grim and uncharacteristically sober (at least for me), suppose we take a moment for a little levity to lighten the mood. One thing that I’ve been struck by is how many comics live to a great age and seem to leave this world laughing, at least figuratively speaking. To take one example, I can choose one of my favorite comics from an earlier era, George Burns, whom you may remember as God since late in life he became famous (again) for playing God in a film with John Denver. I mention him and comics generally because, as I have previously argued in some of my blogs, humor is often the best defense against the trials of aging and the prospect of death.

George Burns died at 100, and like other centenarians, he was asked to explain the secret of his longevity. He was inclined to attribute his success to smoking cigars daily. But there were other factors as well that contributed to his aging well until the end, as witness this obituary:

George Burns died at age 100 on March 9, 1996. Mr. Burns spent his lifetime in show business and created millions of laughs. It is reported that Mr. Burns was buried with three cigars in his pocket, had on his toupee, his ring and watch, which was a gift from his wife, and in the pocket of his suit were "his keys and his wallet with ten 100-dollar bills, a five, and three ones, so wherever he went to play bridge he’d have enough money."

Several years ago, he was asked by an interviewer if he ever considered retiring. "Retire to what?" an amused Mr. Burns asked. "I play bridge for two hours a day to get away from work. Why the hell would I want to retire to play bridge 24 hours a day?" George Burns played bridge every day of his life. He loved bridge. But at 3 o’clock, he could be in the middle of a hand, he’d stand up (and say) "Thank you gentlemen," and go home to take a nap. He used to say: "Bridge is a game that separates the men from the boys. It also separates husbands and wives."

Burns was perhaps one of the best bridge players in Hollywood. Well, if not the best, the funniest.

I loved George Burns, and his raspy voice – from all those cigars, no doubt. He knew how to enjoy himself and when to rest. He also did yoga. We oldsters can all take a lesson from George Burns. Keep laughing and don’t allow yourself to languish – that’s the ticket.

Still, George was the rare exception. Most people suffer when they get very old and often yearn to be free of the burden of living. Nevertheless, even though life is hard for the old and is in end universally fatal, as long as we are still here, we old-timers have to make the best of it. What will help us get through our battles with loneliness if robotic animals aren’t enough?

We are social creatures, and older people, who were so cruelly deprived of that kind of vital contact during the pandemic, are particularly vulnerable to the lack of face-to-face interaction. They can starve psychologically without it, but they can rebound and even thrive again with it.  We must find ways to address the social deficit of the aged in order to forestall, if not completely defeat, the insidious dangers of loneliness.

And social workers and other caregivers have not been slow to realize this. Here’s just one example of this kind of intervention:

The good news is that friendships reduce the risk of mortality or developing certain diseases and can speed recovery in those who fall ill. Moreover, simply reaching out to lonely people can jump-start the process of getting them to engage with neighbors and peers, according to Robin Caruso of CareMore Health, which operates in 8 states and the District of Columbia with a focus on Medicare patients. Her "Togetherness" initiative aims to combat "an epidemic of loneliness" among seniors through weekly phone calls, home visits and community programs.

What can you do? It’s obvious: Visit the old. So what if they just natter and chatter – they matter! Now that the COVID cloud is finally beginning to lift, don’t go out solely for your own pleasure. Do you have a loved one or someone you know who is living alone or in a nursing home? If so, visit them. Even better, bring them a pet, a real pet, not a robot, if they don’t have one. And don’t just visit once. Come back. Help to assuage their loneliness. You’ll be doing a mitzvah. You will be old one day yourself. Sew some good karma while you can. It will come back to you.

Englehart found that many older people whom she visited were reluctant to see her leave. They relished the time with her; they wanted her to come back. As she writes about Virginia:

It was the same with almost every robot owner I met. "I haven’t had anybody to talk to for a while, so chatter, chatter, chatter," Virginia said, when I first called. Near the end of my visit to her home, she insisted that I take a doughnut for the road and told me to come back sometime. She thought she would probably be around, though she also wondered if she would die in the big empty house: "Maybe this is the year."

"Your bags are packed, right?" her daughter-in-law said, laughing.

"Gotta go sometime," Virginia said. When she died, she thought she might bring Jennie with her. She liked the idea of being buried with the cat in her arms.