Almost half of older adults experience loneliness. It can be harder to maintain social connections as we age, especially if we’re retired, dealing with illness, or living alone.
On this episode of Aging Forward, we talk with clinical social worker Kileen Smyth about the power of experimentation, and what we can do to stay positive, stay engaged, and make meaning in our golden years.
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Read the transcript:
Dr. Chen: This is “Aging Forward,” a podcast from Mayo Clinic about geriatric medicine and the science of healthy aging. Each episode, we explore new ways to take care of ourselves, our loved ones, and our community so we can all live longer and better.
I’m Dr. Christina Chen, a geriatrician and internist at Mayo Clinic in Rochester, Minnesota. In this episode we’re talking about making Golden connections. Or dealing with loneliness as we age. Our guest this episode is Kileen Smyth, a clinical social worker at Mayo Clinic in Rochester, Minnesota. Welcome to the show, Kileen.
Kileen Smyth: Thank you, Christy. Love it.
What makes working with older adults rewarding?
Dr. Chen: First let’s talk about the people you work with – what do you enjoy most about working with the older adult population?
Kileen Smyth: Honestly, they’re amazing. Older adults have a lot of lived experience and they have a lot of wisdom to give. They’ve dealt with burdens, they’ve savored blessings. I feel like they’re fierce. Sometimes they’re more open to being vulnerable and real.
Oftentimes they have the courage to grow, they’re ready to be more alive than ever before. There’s a spirit that is really amazing when you tune in to a lot of our older adult population.
Dr. Chen: Your work is so important because I was looking at some of the statistics and the background is that 43 percent of older adults experience loneliness.
Kileen Smyth: Yes.
Dr. Chen: Worse over the pandemic, it’s gotten a little bit better, but this increases the risk of depression and dementia by 50 percent. It adds to the risk of cardiovascular disorders. From your observation, Kileen, what are the most common causes of loneliness?
What are the main causes of loneliness in older adults?
Kileen Smyth: I would say some of the contributors to loneliness oftentimes are our own self critical thinking. Our unwillingness to reach out to another, our sense of fear of being a burden when we might be an asset. A loss of interest in doing things. You quit doing things, you quit moving, you quit paying attention to others. You stop learning about life.
There are certainly isolating tendencies when you’re living alone, there’s some racial disparities, there’s lots of challenges people run into. Some people love that dose of solitude, which is a chosen time alone, but the loneliness is when we’re thinking about and fearing moving forward. Loneliness is created by a lot of avoidance of taking any action.
How is loneliness different from social isolation?
Dr. Chen: What’s the distinction between loneliness and social isolation?
Kileen Smyth: In my opinion, loneliness comes often from a busy mind. We’re going so fast and we don’t even realize that we’re not feeling connected. But we can also be busy in our mind and alone. Social isolation is when we’re disconnected from others altogether. Often of our own making. A couple of years ago there was an epidemic of social isolation when COVID came out, and people are still learning to reconnect with each other.
What are the signs of loneliness versus depression?
Dr. Chen: Sometimes I have a hard time distinguishing loneliness and the clinical onset of depression because it seems like it’s so closely interrelated. It seems like it’s a separate entity even in some ways where it’s a mindset of self-criticism and not wanting to be part of society anymore. Do you feel like that happens over time due to all these changes that happen in life? For example, going through health issues, going through retirement, losing loved ones? Does that create more of that mindset you were talking about earlier?
Kileen Smyth: I’m not sure if it creates more of that mindset. Some people have a little wiring for depression, so there’s that biological. Some people, there’s environmental circumstances and that contributes for sure. When it gets to depression, there’s a change, there’s a shift. That’s where people become maybe more irritable or maybe, really start changing their behavior and where people get lost in their own little bubble, and it goes to a deeper place for a lot of people. With clinical depression, sometimes you need a little more, but it’s a continuum.
Are there different types of loneliness?
Dr. Chen: We talked about distinguishing loneliness from depression, but are there different types of loneliness?
Kileen Smyth: When I think about loneliness I think about emotional loneliness. There’s relationship loneliness. There’s social loneliness. When we have a desire for close friendships, sometimes there’s a collective loneliness. There’s perceived loneliness, objective loneliness. There are so many kinds of loneliness, but it’s taking time to see what I need to be different?
Loneliness is often something that goes on, in my opinion, in our minds. It’s the way we’re looking at things. It’s oftentimes a more rigid way of seeing the world and one of the avenues out is to become more flexible in our thinking. But sometimes a step back is required to realize what I want to do now because sometimes people are so busy, they haven’t taken a second look at their lives.
How do you assess loneliness in older adults?
Dr. Chen: We need a lot more awareness behind loneliness and social disconnectedness. It’s so easy to fall into that depression phase. When you meet these older adults, how do you assess where they’re at in life?
Kileen Smyth: You get curious about what’s been meaningful in their life. You get curious about what they value now and have valued in the past. I certainly, especially with loneliness, ask who they’re connected to now and what has changed or shifted. Because while there’s some amazing readiness to grow, some people have slowed down and started to judge themselves critically, and the inner critic for everyone can get huge. But sometimes when people are in that shift or change of life, there’s a question about what am I good at now? Who do I matter to now? I always ask about who they could connect with, who they have connected with, who they might want to connect with. Neighbors, friends, family, and who they need to not connect with for their own health and well-being, who they need to reduce connecting with to continue to grow and be who they want to be.
What are the signs of loneliness in older adults versus younger individuals?
Dr. Chen: What if I am concerned about a loved one who may be at risk for loneliness – what are some signs that I should be looking for and how might those be different from signs that a younger person might exhibit?
Kileen Smyth: Oftentimes some people can be really busy in their loneliness. That goes for young people too— staying busy and avoiding opening up to the feelings that are associated with loneliness. Sometimes people are reactive and become a little angrier and more irritable. Sometimes underneath that umbrella of loneliness can be sadness and fear and uncertainty. I think that connecting with others, even if you’re not doing an activity, but having the courage to be out and around others can make a positive difference for people to realize I am a part of the world.
Sometimes even thinking or sending loving kindness to people in the world. Even if you’re only watching TV, if you can’t get out of your home immediately because you’re recovering from something. Sometimes it’s the mindset that somebody is using that gives you a clue as to them being lonely. Can someone be lonely and not realize it? Absolutely.
How can caregivers support their own mental health while caring for loved ones?
Dr. Chen: How would you assess that?
Kileen Smyth: I would probably ask questions, and then I might notice someone’s defensiveness when I’m asking questions. I would be more curious about what someone says. I think oftentimes people who don’t have access to their own feelings, they might be lonely. A woman by the name of Marianne one time talked about the value of slowing down to notice what you bring forth. If you don’t bring forth what is within you, you might not know who you are. Having access to feelings.
Feelings are part of the joie de vivre, the joy of life. But some people grew up in situations in life and they’re living longer, and nobody ever expressed loving kindness or care. Feelings scare people. I would ask lots of questions and notice the responses in their face, in their body, in people’s demeanor. Then I would be curious about what brings them alive. What gives you life? What could give you life? What might you be willing to experiment with investigating?
Dr. Chen: Can you give me some examples of what questions you ask? Just a sort of universal question that opens up the conversation, that allows them to talk and feel safe to express all that to you.
Kileen Smyth: It’s usually in the moment, but I often ask the question, who or what has been meaningful to you in the past? And who or what is meaningful to you now Asking the question about what it is they value, and getting curious about helping them explore. I might throw out an array of values for them to consider and then taking time for them to think for a moment.
Dr. Chen: I bet your treatment and management plan really depends on what their answer is, because everyone’s different, all their values and what brings them meaning is different, and that’s how you kind of encourage them and empower them in a positive direction by taking that information that you’ve gathered and directing it in a direction where they can find more value out of what they lost.
Kileen Smyth: Absolutely. It has to be individualized, and it has to be meaningful to the person who’s engaging in something.
How important are routine and structure for preventing loneliness and burnout?
Dr. Chen: Right.
Kileen Smyth: Now I might encourage a little experimentation because some people don’t know what they’re not doing. We might play with coming up with some ideas of what might help, you move a little bit out of loneliness or what might help you explore some bigger connections.
Dr. Chen: Can you share any stories behind that? Anything that comes up, top of your head, as the success story of where you’ve been able to guide someone through that exercise?
Kileen Smyth: Well, one of the things I’m thinking about is our senior vitality group. It’s a group we started to help reduce isolation and loneliness. It’s for people who are over age 55, that are ready to grow, mentally, emotionally, physically, spiritually, or in any other way.
Recently in our senior vitality group we sent people out to find a resource that they didn’t know about. They then shared in the group with each other what they found. Well, several people have found out 125 live this phenomenal resource in Rochester, Minnesota to be the place to go. But we’re just scared to go because I don’t want to be around too many people.
I don’t like small talk. I don’t like doing these things, and so people have gone to this place with the sole purpose of, “I’m just going to go and swim and leave.” Well, one woman recently went, she was just going to swim and leave, but she had met somebody in the pool who said, “Oh, you ought to come to this other class with me tomorrow that’s after swimming,” and so she did, and she went to a Tai Chi class.
This woman said, “I would have never gone to anything named Tai Chi. I ended up going and then I went again” and I love that! She was telling our whole group that we all needed to be doing Tai Chi and we’ve had you come in and teach Tai Chi to our senior vitality group, which is so phenomenal.
Dr. Chen: You’ve remembered it.
Kileen Smyth: Oh yeah. It was lovely. Seriously, like that’s one of the success stories. But sometimes actually, even having people reach out and write a note or send a text right in session to someone they care about. I said, “Why don’t you do that now?” Sometimes I invite people to do something a little more in the moment and they might get a text back immediately, and a tear will come to the eye because they have wanted to connect with their grandson forever, but they just didn’t take that one minute to send a text.
Dr. Chen: It just seems like people need a little bit of a push to do something. Then once they do it, it’s like, this is great. I enjoy it. I didn’t realize I would, but this was actually quite meaningful.
Kileen Smyth: I think we all need a push at some times or an invitation. Sometimes people just need to slow down and do it at their own pace and investigate something and learn from it. But it might even be that they go into Walmart and back because being around other people can help you feel like you’re part of the world.
It’s a little more engaging when you’re meaningfully involved in doing something with others. But sometimes there’s little steps you have to take to get there.
Dr. Chen: Is that a strategy that you coach to caregivers, for example, who are taking care of a loved one who’s at risk of loneliness? Is that something that you share with them too?
Kileen Smyth: Absolutely. Caregivers often get lonelier than anyone realizes because they are sheltering so much. Other people might be coming over to see the loved one or not coming over, but sometimes the caregiver is maybe doing their job or doing everything and not even realizing in their busyness how isolated and how they’ve cut themselves off of the other things in their life that made a positive difference.
When it comes to caregivers, I really encourage extreme self-care and extreme self- compassion. I probably have encouraged more caregivers to blame me as if I’m their mother, and they might be 85 years old, but you need to get out of the house and we need to help you build up the capacity to get out of the house.
What are we going to do so that you can leave your home on a regular basis? It might be a little “mother, may I” baby steps by having someone come over and meet with your loved one in the home, not because your loved one needs it, but because you can’t leave the home til you know somebody’s going to be with your loved one, that your loved one will trust. That happened a lot in hospice too. I really feel like caregiver stress is so underrated.
Dr. Chen: You must be doing both things at the same time, helping the patient, but also if they’re accompanied by caregivers, you’re assessing their needs, their stress levels, their burden and almost coaching both at the same time of a different set of things that they should be doing.
Kileen Smyth: Or could be doing. I try to look for what else is possible and I try to invite them to consider what else might be possible and it might take a little time and a couple of conversations to go there, but I really feel that opening up the doors a little bit to bring others in and to give caregivers a break is so important.
Dr. Chen: Then following that routine, which was kind of our next question is, the importance of routine and structure not just for aging loved ones, but for the caregiver too. They may have two completely separate routines, but how does that play into preventing loneliness, depression and caregiver burnout?
Kileen Smyth: I love that you said structure and routine, because I think those are two major antidepressants. I think exercise, structure and routine, interpersonal connection, time in nature, and learning something new, but structure and routine are key and you can build in little mini things for structure. It can be as simple as waking up at the same time everyday, and not hitting the alarm. Getting out of bed, going and doing one thing, whether it be putting the socks together, or making one phone call to one person a day, or making the coffee.
I would say if people can do one thing at least every morning and every afternoon, at a basic level, that is the start of a routine. Having some structure and routine in your day so you break it up is really critical. When people do the same thing hour after hour, after hour, the enjoyment diminishes, the value diminishes, whether you’re watching TV or looking at a video game or just sitting and doing nothing, people’s happiness diminishes if you do the same thing over and over again.
How can introverts maintain social connections?
Dr. Chen: Seems like there needs to be a balance between what you can do, but also sprinkling in newer things. Not doing things in a mundane way where you have nothing else to look forward to except the same thing. Try new things, but the social connection piece is there needs to be some sort of routine in the day to offer that social connection.
Kileen Smyth: For everyone, if you can find a way to socially connect or to plan, even a social connection. Because maybe you’re not able to go out all the time, but really if you can think about it, if you can imagine it, if you can feel connected, if you can even practice gratitude for the people that are in your life, or the people that you encountered at the quick trip yesterday.
You can even take time to slow down and be grateful for who you are connected with, that you might not even pay attention to all the time.
Building social connections is so huge and that is where it’s amazing some of the folks that are moving from isolated situations where they were busy in their own home, always cleaning things and always doing things. I know one woman who moved into assisted living. She’s like, “I’ve never been so disinhibited in my life!” Having people to go and do things with that you don’t always have to go do things with. But what a gift.
Dr. Chen: How about for people who just don’t really like to socialize? I get this question a lot, “I’m an introvert. I don’t like to go out and meet new people and do things. This is just how I’ve always been. That’s my personality.” I feel like even the most introverted of introverts need some connection. How do you encourage those personality types?
Kileen Smyth: Well, I invite them to consider trying something. I also have to say sometimes you just need to honor that people might need to be a little more alone. But introverted people, a lot of them actually do like to be around people. They just don’t want to have to be managing the people or be the life of the party.
Sometimes an introvert can go in and just be in a situation where others are gathered, and not feel alone even though they are alone. Going to explore even walking down the aisles at target or going to a rotary club meeting, or going where they’re showing cars. Actually going and being around a group of people, where you don’t have to be talking all the time can be very life giving. For some people, the art is finding out where I can do that?
Dr. Chen: It does increase, I think. I would classify myself as an introvert. I love being around people. I enjoy spending time with friends and going to parties. But once that karaoke machine comes out and people start dancing, I’m out. I can’t be around this chaos, but I share that story all the time too, that it’s important to be around people. Because I think we’re by nature, social creatures.
Kileen Smyth: Connection.
Dr. Chen: Yes.
Kileen Smyth: We all need some sort of connection. I think that’s in our DNA.
What is the Senior Vitality Group and how does it help reduce loneliness?
Dr. Chen: I’d like to move on to talk a little bit more about what you do. You’ve led such a great senior vitality group over the years. I’m sure you’ve shared a lot of skill sets and coping mechanisms. What do you teach in these senior vitality groups? How do you structure these support groups? What’s the magic behind that?
Kileen Smyth: Well, the most magic is the courage it takes people to say yes and come to a group. It is the people in the group that make the group.
What advice would you give to older adults hesitant to seek help for mental health?
Dr. Chen: Yeah.
Kileen Smyth: Every time it’s very different. But we do have some structure. Because we have a topic we’re focused on every one of the eight weeks of the group. We might talk about aging 101 and we might have some fun cartoons and statistics and then people have some homework or practice every week. They come back and they identify one thing they like about aging and one thing that’s difficult about aging. The conversations are rich.
Then the next week might be something about physical wellness. We might do a Tai Chi movement moment in the group, or we might put on a song and move all of our limbs to a fun song where we have people shimmy their shoulders a little bit or something. But we invite them that week to do one thing that gets them moving a little bit more because it’s all relative. Some people can move a lot more than others. Someone will go out and play pickleball and the other person might actually take their walker and go up and down the aisles at the Home Depot.
Dr. Chen: I love that. There are so many functional limitations that get in the way, between joint issues and pain, and the fact that you’re encouraging them just to try any movement. That’s kind of my next question. How do you encourage people who are more functionally limited to maintain social connections and to get out?
Kileen Smyth: We bring a beach ball in and we do a mindfulness exercise where everyone gets a number and they toss it around and call out each other’s numbers to talk about cognitive health and how relearning something and learning new names.
Everyone is able to do it very quickly after we play that little game. We then talk about mindfulness and ways to practice different forms of mindfulness. Whether you’re out forest bathing, or whether you’re wishing people well, or practicing gratitude or just, taking moments to focus and breathe.
We highlight the importance of emotional well-being because so often people haven’t really even learned to name feelings. Feelings are fun and they help us connect. Some of us have tightened up our bodies and become rigid to protect ourselves from feelings, which is kind of a loss.
We might talk about senior fraud and cognitive aging and signs of dementia versus memory loss. One woman said, of course I have memory loss. I know 5,000 people now and I used to, when I was younger, I might’ve known 200 in my graduating high school class. It’s harder to remember everyone. I mean, people are funny.
Dr. Chen: It seems like that group support environment is really what gets them to open up and share, not just what their struggles are, but how they can learn from each other’s struggles and move forward in a positive way. As they’re becoming more aware of what their underlying struggles are. Do caregivers come to these sessions as well?
Kileen Smyth: Oftentimes the people that come are caregivers. Sometimes a caregiver has come with their loved one, which has been welcomed. It’s kind of fun, and during the last session I had to say, “Okay, you two are sitting together too much. So I’m going to sit between you.” The next week I walked in and they were sitting across the table from each other instead of next to each other.
I mean, during one of our sessions, one woman introduced herself and talked about being newer to the community and feeling lonely. She had to leave friends because she wanted to live closer to family, but there was a feeling of loneliness.
I’m sitting at the end of the table and I see another woman rip off a piece of paper, write her name and number down and slip it to her, saying, “I will be your friend. Call me.:
Dr. Chen: Aww. That’s so sweet.
Kileen Smyth: Lots of times people go out and kibitz with each other in the parking lot, and visit. Sometimes having an avenue where people can connect is so helpful.
Dr. Chen: Yes. That’s very true. What advice do you have for older adults who are more hesitant to seek help for their mental health issues? Perhaps they’ve gotten the push that they need and they are aware, but not quite ready to seek help yet. What advice do you have for those individuals who are perhaps on the fence about all this?
Kileen Smyth: My dad used to say, we all have our quiet anxieties and I love that line. My invitation would be to dare to grow because you can grow until the moment you’re in the grave. What I would say is mental health and wellness is an opportunity that you not only do for yourself, but there is a domino effect and it influences your children and their children and your friends and everyone for generations. Having the courage to reach out and say, I need a little help can be remarkable.
Allowing yourself to be vulnerable and real is so enriching. Having the courage to address any mental health challenge will influence other people in your life. Having the chance to also be more self-compassionate, be more connected and in general, be more alive while you’re living. That’s what I think mental health does for people. It allows us to be freer in who we really are.
Dr. Chen: Thank you, Kileen.
Kileen Smyth: Thank you.
Dr. Chen: That’s all for this episode. Hopefully you’re feeling a little more informed, inspired, and empowered. If you have a topic suggestion for a future episode, you can leave us a voicemail at 507-538-6272. We might even feature your voice on the show! For more “Aging Forward” episodes and resources, head to mayoclinic.org/agingforward. Thanks for listening, and until next time, stay curious and stay active.
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