Loneliness, loss, and fading resilience in the tarnished golden years: languishing with loss of purpose

The isolation felt by people in quarantine can leave the average person feeling numb and emotionally languished. Recently, I provided a zoom conference on the psychological impact of the coronavirus in November 2021 from my office at Whittier Rehabilitation Hospital in Westborough, MA. It was well attended, largely by people who are psychologically minded and aware of the points I endeavored to make. My target audience was the people who were struggling and vulnerable to decreased coping during covid-19 recovery. I am unsure we hit the mark I was hoping for with the target audience.  The fallout in mental health from the coronavirus is real and it is now recognized as a public health menace among recovering adults. It is now being seen in children and adolescents with growing concern. Just like younger patients, loneliness and social isolation in older Americans are serious public health concerns putting them at risk for dementia and other serious health conditions including failure to thrive, sepsis, malnutrition, addiction, and mental illness according to a CDC report. For many individuals in quarantine, the nightly happy hour started earlier and earlier raising the specter of worsening substance abuse and addiction. The liquor stores were soon to be considered essential services and package delivery became a common source of re-supply. The impact of isolation, emotional loss, and social detachment undermines public and behavioral well-being across the life span. It is a co-occuring illness among illnesses afflicting millions. I see it in my own family as nerves are frayed now almost 2 years in – first noted in the blog post published in May, 2020 (Sefton, M.). In this fourth wave of the virus called the Omicron variant, people are tired of hearing about social distancing, mask mandates, and rising infection numbers. I see it every day.

I have worked with older clients for over 25 years first as a post doctoral fellow at Boston City Hospital – now BUMC. Long before the pandemic, my work at Whittier Rehabilitation Hospital has been to provide support and direct service to patients’ suffering from debility associated with decline in physical health along with the psychosocial needs and changes. All too often, this includes feelings of loss of control and sadness that is palpable in our short conversations. Many seniors feel invisible and the virus exacerbates these feelings. Declining health further instills the loss of purpose and amplifies the stigma of being seemingly infirm. The lack of purpose germinates from the passing of a spouse, close friends who move or have died, food and financial insecurity. It precedes a death wish and it’s associated demoralization. My mother was infected with the coronavirus in mid-April 2020 before the vaccine was introduced. She lived in the same nursing facility where I lost my 93-year old aunt in the first wave of the virus in May, 2020. My mother survived the virus but it has taken a significant toll on her physical and cognitive well-being. We were not permitted to see my mother during her illness and my aunt was alone on May 1 when she succumbed to the virus.

Trauma informed therapy refers to the critical understanding of one’s emotional history and supports the model of early traumatic experience being one underpinning of many mental health outcomes and threatened resilience later in life. These kinds of experiences have an impact on people who have had loved ones die while in lock down across the country and can engender guilt and helplessness. Often, singular front line medical staff are alone with patients who succumbed to the virus – sometimes holding the fading grip of another disappearing life. This heroic act of empathy happens without fanfare or even a moment to process its importance and acknowledgment of the person’s passing.

The cumulative impact of dementia on caregivers

WESTBOROUGH, MA January 20, 2015  Dementia is a life changing affliction for both the patient suffering with the neurocognitive decline and spouse and family members alike. Caregivers have a particular cross to bear – especially those without support. It is a highly stressful role for any spouse that requires both education and support. They are at high risk for burnout otherwise known as caregiver fatigue. For anyone who has had a loved one suffer with this disease “it is like seeing a family member die slowly, daily, withering away into an empty vessel” according to Michael Sefton, Ph.D., Director of Neuropsychology at Whittier Rehabilitation Hospital in Westborough, MA.  “It is very important to obtain a careful and sound neuropsychological assessment of patients’ suspected of having dementia because so many conditions mimic dementia and may be treatable” according to Sefton.

When a caregiver is overwhelmed something must be done to provide emotional respite for the spouse or family member. Caregiving spouses frequently have powerful feelings of guilt, anger, and sadness as a result of seeing a loved one become forgetful, detached, and confused. They can be extremely difficult to managed in the home setting and sometimes require specialized day treatment.  The decision to hospitalize or seek nursing home admission for a family member is an individual one. It is critical to look at the functional change in the afflicted family member and see what placement options make the most sense.  Caregiver fatigue places afflicted patients at greater risk for neglect, battery and abuse than other medically complex cases. It places caregivers at risk for health problems of their own.

Throughout America, physicians and psychologist alike are mandated reporters for cases of suspected abuse – regardless of whether the caregiver is experiencing caregiver fatigue or not. Family members are strongly encouraged to support parents, e.g. respite care for afflicted parent, whenever one is suffering from a severe illness like dementia. Read the post at link below.

The cumulative impact of dementia on caregivers.

Things of importance

WESTBOROUGH, MA November 30, 2014 A patient once said Dr. Sefton “don’t ever grow old”.  At the time I wondered what he meant.  The man was alert, physically fit and had a great support system. We have heard for years that today’s baby boomers are growing older. No kidding, I am one of them.  “People believe human touch and the relationships we forge along the way sustain us into our old age with a sense of well-being”  according to Michael Sefton, Ph.D., who provides neuropsychological testing for older patients.  Along the way the connections we make open our experience and our hearts. As people age, time begins to have greater significance – especially at the end of life. Some people say time moves quicker with age – especially when memory fades. Greater attention to things of importance must include keeping memory and history alive. Ask yourself “what do I value most?”  If the answer in your head is money, job promotion, or things like material objects then priorities may be outright misguided. Next, ask yourself how much dignity you might feel if you suddenly were made to feel irrelevant?  That is how may older Americans feel as they age and enter the “golden years”. Depression and loneliness are highest among people who are older and have become marginalized. This contributes to the inability to participate in their communities adding to feelings of loneliness and increased risk of functional decline and even early death (Singh, A. and Misra, N., 2009).

Cultures everywhere include senior citizens among the things that are valued and respected although this is not universal. Some believe that with age comes wisdom. Here in America, the population of older citizens will grow by a factor of 2 in the next decade or two. No society should discredit those who are older and may be stepping aside to a younger generation.  “Senior citizens, especially those who may be blind, deaf, immobile or senile, contribute less and require more care, which is likely unavailable” according to Discovery Health. The growth of older Americans has far exceed the growth of programs geared to help those in need. Why?

Retirement and aging

For those who are entering the last years of employment a sense of trepidation may confound their decision to retire. The age of retirement has edged upward largely due to financial need. People are constantly speaking out about the need to plan ahead for the retirement years. In a blog I wrote about police officer retirement the success a person feels in retirement depends upon how valued they feel in society (2014).  Many believe that older workers are more reliable and bring a higher level of maturity that benefits employers everywhere.  Others see the older worker as the greeter at the local box store – someone now irrelevant. The impact of this prejudice adds to a high incidence of depression among people over 65. The rate of poverty among older Americans is greater than 15-20 percent, according to Intergenerational Learning Service based in Illinois.  And the rate of grandparent’s who take care of their grandchildren has never been higher.  How is this scenario apt to impact human development for years to come?

A fundamental change in attitude must take place toward people who are aging here in America.  At the same time, a belief in lifelong learning and personal responsibility for health and well-being will give an older person an equal advantage for those who are aged and wish to continue being relevant.

Michael Sefton

REFERENCES

Singh, A. and Misra, N., (2009). Loneliness, depression and sociability in old age. Industrial Psychiatry Journal, Jan-Jun; 18(1): 51–55.

Sefton, M. (2014) https://msefton.wordpress.com/police-service/the-working-chief-a-job-greater-than-the-sum-of-its-parts/. Blog post, taken November 30, 2014.