Melissa Harris-Perry: Welcome to The Takeaway. I'm Melissa Harris-Perry. Because of the sheer size of their generation, baby boomers have driven the cultural, political, and marketing realities of our country since their births following World War II. As they age, so too does the country. Back in 2018, two years before our lives were upended by a deadly global pandemic, the US Census Bureau released a report titled The Graying of America. It pointed to a crucial demographic reality that "Within two decades, older adults are projected to outnumber kids for the first time in US history."
Now, back then researchers and commentators pondered what this aging population could mean for the American economy, healthcare system, and family life. Then in 2020, the coronavirus pandemic swept across the globe, and the overwhelming majority of lives it claimed were the lives of older adults. In December 2021, The New York Times reported that 1 in 100 older Americans had died from the virus. 1 in 100. Just by a point of comparison, for those of us under 65, the rate was more like 1 in 1,400, and it wasn't just physical illness and death that was caused by the virus.
As the pandemic forced quarantines, shutdowns, and social distancing, many older people were plunged into deep isolation and loneliness. Seniors long have been vulnerable to the effects of bereavement and loss. Empty nests, shrinking social circles, and fewer working hours can leave even the most healthy older adults at risk for depression and anxiety. The CDC estimates that about 1 in 5 people who are 55 or older experience some type of mental health issue. Most commonly anxiety, depression, or bipolar disorder.
As we're marking May as Mental Health Awareness Month, we wanted to check in with older adults. The challenges they are facing, and the tools and techniques for wellness that they're employing in these still challenging times. I sat down with Dr. Carla Perissinotto, a professor in the Division of Geriatrics at the University of California at San Francisco. She studies the effects of social isolation and loneliness on older adults.
Dr. Carla Perissinotto: It's very fascinating because I think the pandemic has put this idea of loneliness and isolation right in front of us because we have all experienced it to some degree or another. Yet loneliness or the opposite, the need to connect, is really a fundamental human need. What happened during the pandemic and with older people, or in general what happens with loneliness as we age, is that our risks of having complications from loneliness are so much greater as we get older because our reserve and our ability to bounce back from insults to our body and our mind and spirit is just harder.
I think this really has highlighted, unfortunately, the fact that we're incredibly ageist. It was astounding to me as a geriatrician and palliative medicine physician that it took our country and frankly the world quite a bit of time to actually recognize, for example, that older adults were presenting differently with COVID, and that we were doing immense harm potentially to older adults to isolate them for months on end. Even though we were protecting them theoretically from COVID directly, we likely have impacted their lives in really long-term ways by this forced isolation. Not to say that we could ignore the pandemic and what was going on, but there are some nuances there that we really need to think about.
Melissa Harris-Perry: Can you say a little bit more about-- When you talk about that capacity for resilience, for bouncing back, on the one hand we don't want to overstate that in children because children and young adults can experience long-lasting traumas, but I certainly know, even just in aging, even prior to the official designation of senior that the muscles stay sore longer. It is harder to be resilient.
Dr. Carla Perissinotto: That's exactly right. I think one example that often can be a little bit more understandable for people is for an older adult who gets hospitalized for one day, it can take up to a week to recover from that one day of hospitalization. Why is that? It's because our systems in our body have just been working for longer, and so it takes us a little bit more time to recover.
I think that what we're now dealing with, and we saw this firsthand and you may have seen this in your mother, but people that underwent prolonged isolation and prolonged loneliness had declines in their physical functioning, had declines in their cognitive function, and some died directly as a consequence of that loneliness and isolation. I don't think we're talking about that enough.
Melissa Harris-Perry: What's the connection between loneliness, which we began with, and depression and anxiety? They're separate constructs, but are they related, and how?
Dr. Carla Perissinotto: They're absolutely related and they're absolutely different constructs, so thank you for pointing that out. Interestingly, in some research that I conducted in 2012, the majority of people who reported feeling lonely some of the time were not depressed. That is important to say that loneliness is not a clinical diagnosis. It is an experience, it's an emotion. It is an event, for example, but it is not a clinical diagnosis, up until this point. You can also be, of course, depressed and lonely. They are related and they can be risk factors for each other, meaning that if you're lonely you can be at risk for depression, and similarly if you're depressed you can be at risk for loneliness.
Melissa Harris-Perry: Talk to me about how you treat loneliness.
Dr. Carla Perissinotto: One of the challenges that we're faced right now with is that we all want simple solutions and simple answers. We want to be able to say, "Mom, go to the senior center and all will be fine for your loneliness," but really if we look deep into the causes of loneliness there's many different causes. There's many different risk factors. We really need to look underneath it all and try to understand what is driving that. For example, to put things simply, I may have a patient who's lonely because they used to be able to get out of their home and actually go to visit their friends.
If they cannot go do those things because of mobility impairments, because of lack of transportation, because of stairs in their home, the way for me to address the loneliness is to address those factors directly. Another way might be someone may be experiencing loneliness because they're newly hearing impaired and they're being left out of conversations. If I address their hearing I may help. Another person may be lonely because they have experienced the loss of a spouse or a partner. Well, the way to address that may be through some grief and bereavement counseling. There may be others who have lifelong loneliness because of the way they view themselves as part of the world.
If we address what is often called in the scientific literature maladaptive social cognition, which is really how do we respond to these internal thoughts about ourselves and our inner voice that we can address the loneliness that way? It's much more nuanced and complex, and I think we often try to find simple answers. Sometimes the simple answers will work, though we really have to try to get to the root of the loneliness.
Melissa Harris-Perry: When young people are sad or angry, it feels like we can see from the outside, "Oh, that's an emotion that that young person is having." It does feel like sometimes with older adults when they might be feeling sadness or anger we think, "Ah, wait a minute. Is this the beginning of a cognitive decline?" Every single emotion actually becomes about cognitive functioning. I'm wondering when it's right to be looking to that and when we're overdoing that because older adults also have feelings.
Dr. Carla Perissinotto: Really, really important question, and I think very nuanced in its answer and very complicated in that we, I would say, almost only barely really try understanding cognitive function and cognitive impairment, and the broader term of neurodegeneration. We do know, for example, that anxiety can be for some kind of a prodrome or a precursor to the development of some dementias. We also know that anxiety, depression, and interestingly loneliness can be risk factors for the development of dementia or cognitive impairment.
It is important for us to think ahead, but you're absolutely right. That it is important to think of this as that we're all entitled to our emotions and our experience regardless of our age. We have to not be ageist in our assumptions about that. It's a little bit of both. I wish I had a better answer for you because we actually do unfortunately under-recognize cognitive impairment in the development of dementia, but we are also very quickly to dismiss older adults' experiences and feelings. I think we've seen that in the last two-plus years.
Melissa Harris-Perry: What kind of stigma do older adults face around these issues?
Dr. Carla Perissinotto: So much. So much because I think that, again, it gets back to this initial idea that we're unfortunately incredibly ageist and we don't value older adults. If you also think about some of the risk factors and some of the consequences for loneliness, it's having a sense of purpose and having a positive view of aging. If we live in a society that consistently tells older adults they're not valuable and that they don't have a purpose, and that we can sacrifice their lives to the pandemic, then it's really hard to curb your inner dialogue. Counteract those very loud, external stimuli telling you that you don't matter.
The stigma of getting older is literally being older, and it's also this assumption that you're older and that being lonely is a normal part of aging, which it's not. It's a common experience, but it doesn't mean that it's normal and it doesn't mean that we shouldn't do anything about it.
Melissa Harris-Perry: What are some of the other big pieces around that could affect the mental and emotional health of older adults that are not necessarily loneliness-related?
Dr. Carla Perissinotto: I think the important thing to know about older adults is they're an incredibly heterogeneous group and because our health and our lives and our society manifest in ourselves, in our lived experience, in our history of trauma. I will also say that I have been incredibly humbled by meeting older adults who did not grow up in an era where talking about mental health was acceptable. Did not grow up in an era where we were good at diagnosing mental health conditions. Did not grow up in an era where it was safe to talk about being LGBTQ. Did not grow up in an era where their race or ethnicity was accepted.
What that means is that people's experience and how they present and how that may be manifested in mental health has a long history that maybe has never been uncovered. Whereas you or I, without making assumptions, may have had access to therapy and diagnoses and conversations and more openness, that may not be true for many of our older adults. This may be an opportunity for us to really give space for people to experience that.
I've certainly met older adults, even, for example, let's say with dementia, who have unresolved trauma that is being manifested in complex dementia behaviors. Who are sometimes lonely because they've never been able to be open about their sexual identity. If you know one older adult, you know one older adult, and that does not mean you can make assumptions about others, and I think that is the takeaway. The other takeaway is that we should be privileged to live and work alongside older adults. I love the fact that my almost two-year-old is cared for by a 70-year-old woman who cares for her 100-year-old woman. That is intergenerational love and she loves going there.
I'm so grateful that I am hopefully going to instill some values in her that older people matter and that aging can actually be a beautiful thing.
Melissa Harris-Perry: Dr. Carla Perissinotto. Thank you so much for joining us on The Takeaway.
Dr. Carla Perissinotto: Thanks so much for having me.
Melissa Harris-Perry: When we come back we're going to hear from one truly remarkable older adult about how she's learning to live through loneliness and loss. Stay with us on The Takeaway.
It's difficult to lose friends and loved ones as we age, and social isolation can put older adults at greater risk of loneliness, depression, and even physical decline. During my conversation with Dr. Carla Perissinotto at the University of California San Francisco, she talked with us about the importance of addressing loneliness in older people.
Dr. Carla Perissinotto: We think of loneliness as something that is subjective, meaning it is variable from one person to person. I have to define loneliness for myself, but the important part about measuring it, is it allows us to see across people and across time, are we feeling more lonely with certain events? Are we feeling less lonely? If I participate in a program, does it help me get better? It really allows us to really quantify the degree of distress or the degree of loneliness that someone has
Melissa Harris-Perry: Dr. Perissinotto also discussed the role that we all need to play in assisting community members as we age.
Dr. Carla Perissinotto: In February of 2020, the National Academies of Sciences, Engineering, and Medicine came out with a report on the health effects of loneliness in older adults. They specifically highlighted the role of the healthcare system in addressing this. Why? Because we know that people who experience loneliness, especially those who are older, have detrimental health effects. That this is ultimately very costly personally and at a public health and population health level, such that we cannot ignore it. When I think about the we I really think of the whole spectrum of life and of community.
Melissa Harris-Perry: A 2021 study found that participating in long-term programs with people of the same age group significantly reduces loneliness, depression, and barriers to socialization for older adults.
Wanda Dobson: I use the library programs to come together in a community. Peer group in terms of older adults going through the same thing. To just have spaces to address issues like that, particularly struggles and challenges surviving the pandemic.
Melissa Harris-Perry: That's Wanda Dobson. She's 69 years old, and she's been participating in the services for older adults program at the Brooklyn Public Library for the past seven years. She recently began working for the program part-time. The Services for Older Adults Department offers classes and workshops. There's technology training and yoga class. There are also classes taught by professional artists. Things like collaging, watercolors, making jewelry, and writing workshops. That last one is Mrs. Dobson's favorite. When the library shut down during the pandemic, Mrs. Dobson knew it would be important to hold onto that community that had become such a big part of her life.
Wanda Dobson: Being part of a community and having a sense of belonging to a community is very important to me, but that community does not have to be the nine-to-five workplace. It just needs to be active. At this point in life it certainly needs to be about some aspect of fun.
Melissa Harris-Perry: Then in 2020 Wanda Dobson suffered a devastating loss.
Wanda Dobson: Yes, it's been a year and a half. To be pretty much exact, I lost my husband two months short of what would have been our 32nd anniversary. He passed away in what I call the twinkle of an eye. We were in conversation and I stepped away to take care of something, and I came back and he was gone.
Melissa Harris-Perry: Mrs. Dobson and her husband had been inseparable, and she knew it would be bad for her health and her mental health if she was isolated. The library programs, the Zoom calls, the friendships, they all became more important than ever for her.
Wanda Dobson: I used the creative art-making programs at the library to dedicate a whole year from September 2020 to September 2021 to celebrating his life. To move beyond the loss itself. From grieving to healing and honoring those memories.
Melissa Harris-Perry: Then there are the days when it rains.
Wanda Dobson: [sound of rain] My husband loves the rain. He loved listening to the sound of rain. Whenever it rained he wanted everything turned off. He wanted me to not talk. To wait until the rain has stopped. On rainy days, the more recently a couple of days ago maybe, the storm, I used to get at first feel that sense of real strong loneliness, which is like a throb in the heart, and it's just there.
Melissa Harris-Perry: When she has these lonely moments she channels them into creative writing.
Wanda Dobson: Being part of Brooklyn Public Library older adult services is because I'm in a community of peers. We are although very unique and different, our experiences and the challenges and the things that we are facing are so much the same, so we get to share. I can read a piece that was very funny to me. I get so much joy when I'm writing these pieces and I share and I'm laughing or smiling in the beginning, and then somewhere right in the middle my voice cracks and breaks and I can feel that the tears want to come.
Then a second later, because you know you're in that safe space, you're in that supportive environment, you move on. Then you listen, the next one share, and you listen and you embrace the new support. It's just good to know that you're not in it alone.
Yes, I do get lonely. I never feel alone, and I always like to make that distinction.
Melissa Harris-Perry: Now, Mrs. Dobson, she's always been a self-professed social butterfly, but when she was diagnosed with cancer at age 62 she knew she needed to make a big change.
Wanda Dobson: I was diagnosed at a stage three, so two weeks later I was like, "You need to take care of it. You need to focus on that first and foremost; your health." That's when I left the workplace.
Melissa Harris-Perry: I know for many of us our work and our careers, it can be really wrapped up with our sense of identity. For older folks who spend their whole lives making sacrifices for their families and for their work, it was no small decision to step away from her job. Not only that, but Mrs. Dobson also decided to cut back on some of her social activities. Which might sound counterintuitive, but she thought about the relationships that meant the most to her and made the decision to slow down and to reconnect with those meaningful friends through written letters.
Wanda Dobson told us that her health is good right now, but as she focuses on her physical recovery, she also realized that being physically healthy also meant staying mentally and emotionally healthy and engaged.
Wanda Dobson: I found that I needed to replace those 40 hours in the workplace. I went on a desperate search for what I could do. I joined a few senior centers, but I was looking for more than coming together for lunch and playing cards and watching TV. I wanted to continue to be mentally engaged, physically engaged in activities, but things that were fun.
Melissa Harris-Perry: It was through some particularly fulfilling activities that Mrs. Dobson learns something new about herself.
Wanda Dobson: I didn't realize I was creative until I start started being involved in creative arts-making programs. When I look back on my life in terms of doing photo scrapbooking and little art pieces it was a different level of creativity, but as a creative artist, that certainly began in the Brooklyn Public Library.
Melissa Harris-Perry: Mrs. Dobson also realized that her husband, who passed away in 2020, was a creative in his own right. He was a carpenter and a painter who left his mark on their two-bedroom apartment.
Wanda Dobson: When I unlock my door I'm unlocking locks that he installed. I walk into a key rack that he built and hung on the wall, and a scarf rack, and a coat rack for me to hang my coat. He built the shoe rack to put the shoes at the door. The very floor that I walk upon down the hallway and through the living room, he laid plank by plank. The very bed that I sleep in he built. In that sense, I'm never alone because his handiwork I'm surrounded by.
Melissa Harris-Perry: Those peer groups at the library and the creativity they awakened in her help Mrs. Dobson feel connected to him in an entirely new way.
Wanda Dobson: I'm on a journey of healing through faith and creative art.
Melissa Harris-Perry: She's been channeling her loneliness after her husband's death into poetry.
Wanda Dobson: Dancing in the rain by Wanda Dobson. In troubled times like these when I must socially isolate myself from family, friends, and loved ones, I begin my days with affirmations, reminding myself of who I am. That hope is not defined by whatever befalls me. I surround myself with words of inspiration. Positive quotes like "Life is not about waiting for the storm to pass. It's about learning to dance in the rain." I surround myself with music that draws me to my feet and a moment of dancing partner style with me leading and following.
Recognizing that on some days the music will be soft pitter-pattering rain, and on other days strong whistling winds. Every now and then, when darkness like a blackened midnight comes, music will gush upon me like a mighty Russian river that overflows and spills into every fabric of life and spread swiftly like COVID-19. It is then that I must dig deep within and embrace the five senses. I must see the beauty yet still around me. Hear and listen to the quiet sound of peace within the storm. Smell the bittersweet fragrance of change. Taste the clementine of sunset and sunrise, and cling to hope for a better future.
Melissa Harris-Perry: Many thanks to Wanda Dobson for sharing her story and her art with us today, and many thanks to all of you who called to share your stories with us.
Caller: I'm a senior, and if you asked me personally about my mental health before COVID I'd say I'm a well-adjusted mentally stable person. I had a dog that I walked every day. I also went to our senior center once in a while, but then COVID happened. I was overwhelmed by grief and went on antidepressants. I no longer had my little social life. I focus my time on handicrafts like knitting and quilting, and I'm now the old lady sitting on the couch doing handiwork.
Amber: This is Amber from Nashua, New Hampshire. I work with blind and visually impaired veterans at a VA hospital. Most of them are elderly and homebound, and the monthly support groups that we ran as part of our program were truly the social highlight of their month. The pandemic really fractured these life-changing friendships that they forged in the support group with their peers. When you're blind and you're deaf, a phone or a video call just won't do. I try to talk to each veteran nowadays about exactly how they're feeling to remind them that I can connect them with mental health.
Tommy: This is Tommy in Springfield, Oregon. I'm a 72-year-old senior. I have used religion, self-taught psychology, solitude for deep thinking, and even the [unintelligible 00:27:15] unit once for my mental health. I'm a second-generation American, so we tend to use doctors as a last resort. We tend to seek true friendships for our mental needs.
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