Golden Years Grow Dark for Isolated Elders

It's not surprising that Robert Lyons slipped into depression a few years ago, except that he was among the growing number of elders living alone, who were lucky enough to get the help he needed to pull him out of his deep funk.

The usually upbeat Lyons, 78, watched his parents and all of his siblings—eight of them—die within a few short years. He also lost most of his friends in his circle of army buddies, who had moved to San Francisco in the 1940s and ‘50s, partly to escape Southern segregation.

"It was kind of a dark time for me," said Lyons, recalling his sister's terminal cancer, his two remaining brothers' losing struggles with diabetes, and his own health challenges—lingering effects of a stroke in 1993 and, recently, a broken hip. Family trips to his native Texas, surrounded by nieces and nephews, would be a thing of his past.

"So I guess I went off into this depression thing," he said.

Lone Seniors Double U.S. Rate

Lyons is among the more than one elder in four living alone in the United States, according to a recent report from the Pew Research Center. That's more than double the percentage of Americans of all ages living on their own. The impact of loneliness is even sharper for many immigrant elders, often isolated further by culture and language.

"Adults ages 65 and older who living alone report they are not in as good health and are more likely to feel sad, depressed or lonely than are older adults who live with another person," says the Pew report, released in March.

The Pew researchers found that one quarter of those living solo reported feeling depressed, versus only one in seven older adults residing with a spouse or other person.

African American seniors, such as Lyons, are especially prone to living by themselves (31.7 percent), according to the Pew study, followed closely by whites. Only one in five Latino elders lives alone.

But Lyons counts himself among the lucky. His senior health program at San Francisco's Institute on Aging provided him access to a psychiatrist, who treated him with anti-depressants and talk therapy.

After three years, said Lyons, "It worked because I snapped out of it." He added, "That was a big turn around for me in my life. I kind of got back on track."

According to the Pew study, "Older folks who live alone enjoy fewer benefits of aging" than seniors who live with someone. Those on their own have less time with family, have fewer interests or hobbies and volunteer less often.

The highest suicide rates are for people 65-plus—and even worse for those 85 or older.

Today, Lyons receives daily calls from the Institute on Aging's Friendship Line, a nationally emulated telephone service for suicide prevention and grief counseling. Program counselors call to chat, gauge his mood and remind him to take his medications or help arrange medical appointments in vans suitable for patients with wheelchairs or walkers. Lyons uses both.

Lyons, like many others, enjoys being independent as they age. A self-described "news junkie," he watches hours of public affairs programs and takes advantage of the monthly activities calendar—listing such things as exercise classes, dances and nature walks—for Fellowship Manor, his low-income senior living apartment building run by the Bethel AME Church.

A lifelong loner who was married briefly in his 30s, Lyons is among only 17.9 percent of older American men living on their own, compared with 34.4 percent of senior women.

Asian Elders Isolated

The challenges of isolation and social exclusion are even more difficult for immigrants.

Psychologist Terry Gock, who directs Asian Pacific Family Center in the San Gabriel Valley section of Los Angeles County, said outreach is critical to locating isolated elders.

Not only is language a major barrier to social interaction, Gock said, "You have an older adult who has never driven in this large space, where houses are far apart, and you cannot walk to practically anywhere in Los Angeles. So they become very housebound."

Noting the growing elder population, the mental health center started its Older Adult Supportive and Integrated Service (OASIS) program two years ago. The staff reached out to find isolated elders through community agencies, senior centers and religious organizations.

Gock dispelled the myth that older Asians have low rates of mental health problems. He stressed that clinical depression among Asian elders is often missed by common screening questions that American medical or counseling professionals ask to identify clinical depression, anxiety or other disorders.

"Even if you ask about being sad or depressed--and it's hard to even ask that in Asian languages--they'd probably say no," Gock explained. But practitioners might well get a different answer if, instead of inquiring whether the older person is sad, translating into Chinese the question, "Does your heart not feel good."

Similarly, Gock emphasized that providers might elicit a "no" to a question about whether a senior frequently feels angry. "But they can tell you that their liver is on fire. So, the symptoms a service provider asks about can create a very different picture of what symptoms [Asian seniors] have."

Often, Gock said, the stigma of mental illness in Asian communities has delayed elders or family members from seeking help. He continued, "They might have symptoms of psychosis--hearing voices, talking to the wall and sometimes acting uncontrollably. However, the family has been taking care of them for 20 years without medication."

Ghosts in the Living Room

Anne Wong, who directs the center's OASIS program, recalled a "very special client," a Chinese woman living alone in senior housing, who was referred to the program by the local adult protective services.

The woman was frightened of ghosts she believed were in her living room, so she barricaded herself in her bedroom with a small refrigerator and microwave and used a bucket to urinate.

When Wong and her staff could not coax the woman out of her room, they called a Christian couple the woman had listed as her emergency contact with the housing manager. The couple, who had been bringing the woman food every week or so, finally persuaded the woman to open the door. On finding the woman in filth, they got her to a medical facility where she died soon thereafter.

"It was very sad and exhausting for our staff," said Wong, "but they felt honored to help someone at the end stage of her life."

Wong stressed that community education about treatable mental health conditions is central to the center's work. She has participated in Asian-community radio and other media interviews aimed at destigmatizing mental illness.

This article was written as part of the California Endowment Health Journalism Fellowships, a program of the University of Southern California's Annenberg School for Communication and Journalism.