Tackling Loneliness in Older Adults and Planning Ahead for Caregiving

A Conversation with Julie Norstrand, PhD, MSW, MSc

 INTRODUCTION

Back in January--in what seems like years before the pandemic invaded our lives--Julie Norstrand, an executive board member at the Newton Council on Aging, invited me to join a panel to discuss social isolation among older adults. Already, loneliness and isolation had been declared an epidemic according to AARP (Connect2Affect studies). Most Americans were beginning to be aware of the isolating forces in the lives of many seniors, especially those who lived alone (one in three people over age 65 live alone according to the US Census Bureau). This panel was to provide a public forum for the citizens of Newton to tackle loneliness and brainstorm on ways to increase the quality of the social lives of older adults.

I was keen to join Julie’s mission and sit on the panel at the Newton Free Library, scheduled for June 8th.  It was heartening to get to know her as we discussed our talking points --but suddenly, in the middle of March, the lockdown began, and all of our planning froze. We decided to pause for a few weeks. But Julie persisted in staying in touch to pull together the other panelists and organizers. We all marveled at the irony of our predicament: Now we ourselves are isolated and painfully aware of how our older loved ones were even more isolated. What could we do to break through the isolating forces of the pandemic, particularly in Newton? Julie’s determination led us through our planning and goalsetting, and her passion for the project was inspirational.

The panel was held on June 8th, and over sixty citizens of all ages attended.

As an eldercare consultant and a gerontology scholar, Julie has been aware for decades that older adults as they age “become increasingly invisible and isolated.” With the advent of the pandemic, she felt a call to action to organize a response in the Newton community. Indeed, before the panel at the library, Julie had been spearheading a group of Newton Council on Aging members to raise awareness of social isolation among older adults in the general community. Before the pandemic hit, Julie and her team had been standing at the library with brochures and ready to answer questions about this important topic. Unfortunately, due to the pandemic, this community activism had to stop. In an ongoing effort to tackle loneliness, along with her colleagues at Regis College, Julie recently started to develop a survey of older adults in Newton to assess how well organizations and individuals were reaching out to those most isolated.

She also runs her own consultancy, Help My Aging Parents, LLC, guiding her clients in how to juggle the havoc of the pandemic with all the other tasks of caregiving. Ultimately, the goal is to help families plan ahead for caregiving! Finally, Julie is also an adjunct professor in the social work program at Regis college where she teaches social work as well as gerontology courses. Teaching gerontology speaks to another of Julie’s missions which is to help students realize the enormous value that the aging population brings to our society; ultimately, to have more students enter the gerontological workforce.

I was shocked that Julie had the time to do an interview with me for HSC. I was eager to know what she thought about the effects of COVID-19 on the lives of older adults six months since the start of the pandemic (as of August 2020). Most of all, what could she tell us about how communities could take action in meeting the dire needs of seniors moving forward?

My Conversation with Julie

Val: What alarmed you about COVID and how it was affecting older adults?

Julie: It was quite apparent that there was tremendous anxiety and need for social contact among seniors. When the Newton Senior Center offered phone contact to them, we heard, “Yes please, I want a call back!” They were hungry for human contact. The need for contact becomes more poignant as you become older and more vulnerable.

I was also hearing from my clients, typically in their fifties or sixties, who had aging parents. I run a support group for adult caregivers through Zoom and was listening to their stories of how COVID had touched their lives. It was so painful for them because they felt so powerless about their parents. One daughter was so worried about her mother in an assisted living community because she could not see her in person (due to COVID visitor restrictions). She said her mother told her, “I don’t see the point of living.”

Some of my clients were in a terrible bind. For example, one daughter wanted to bring her mother home to live with her, but her husband was a physician—there was too much risk of her mother being exposed to COVID. This is the reality of so many families who want their parents to be home with them but worry about their safety.

I wondered what more could be done to promote quality of life during COVID at nursing homes and assisted living communities. There needs to be more interventions to create remote groups for social media and online communication. But this would entail more training and access to technical skills for older adults.

Val: Having worked recently in activities programs with seniors at assisted living communities, I know that during COVID there has frequently been a shortage of staff and unfortunately not enough time to teach seniors how to use social media or Zoom. So very tragic for those who are left out of the technical solutions.

Julie: One thing is certain as we move forward since the pandemic: Older adults will need better access to social media—particularly those who live in assisted living communities and nursing homes. There needs to be more effort put into training them for online communication. It should be easier to get access by creating remote groups. Our Aging in Place models are now looking at different social engagement interventions for a post COVID world.

On the bright side, baby boomers (adults in their sixties and seventies) tend to be more savvy about using social media and online social networks. Let’s hope that in the next few years, as boomers move into these communities, they will be more comfortable and resilient in building community online. But still, for people now in their eighties and nineties, this technical transition has been terribly difficult for them without the support they have needed during COVID.

Val: Even as a boomer myself, I don’t take to Zooming too well. I get fed up and exhausted with it. I am starving for more “warm fuzzies” from in-person human connection. I can only imagine how it feels to be eighty-five and hungry for human touch. 

Julie: But as I see it, sadly, this pandemic will last a long time, and there are likely to be more pandemics in the future. This pandemic has forced us to change the way we view social engagement—and older adults who live in nursing homes or assisted living communities will need a much better range of social activities online balanced alongside their in-person activities offline—in short, a good balance.

Val: Long before COVID, you were doing research on the benefits of social support for older adults. For over a decade, you have studied how important it is to prevent loneliness and isolation as we age. For example, socially isolated adults are more likely to develop Alzheimer’s, as well as develop heart disease. What got you started in this research?

Julie: About twenty years ago, I was a research assistant with the Philadelphia Corporation for Aging. Back in the early 2000s, we were involved with a team from New York City working on disaster preparedness planning. We knew of the dire consequences of heatwaves, such as in Chicago and Paris, where older adults were the most vulnerable. Specifically, single or widowed white men were more likely to die of heat exhaustion. Quite frankly, they did not know how to ask for help and get support—and it seemed to them that asking for help was a sign of weakness (but okay for their wives to ask for help.) They had previously relied on their wives or sisters to do all the reaching out as they had the social skills for this task. The men perished trying to tough it out all alone, trying to fend for themselves against the heatwave.

So, it all came down to this, as I saw it: Our rugged individualism and social stigma about asking for help was not a healthy approach to aging because we become more vulnerable as we age. We need to learn how to tap our communities, ask for help, talk openly about our needs, build social networks. This was my realization that building social capital was essential as we aged, and our communities could play a greater role in this (especially at removing the stigma against asking for help).

Val: You are now working on a survey for older adults coping with COVID-19 and aim to use the survey results to initiate a community response. Based on what you learned from the study during the Chicago heatwave—that some seniors are reluctant to reach out for help, or don’t know how—then, how are you planning to offer support in the midst of this pandemic?   

Julie: I am now in talks with my colleagues at Regis College in developing a survey for older adults in Newton. We will be mailing out surveys to adults aged 75 and older in October.  Our surveys will entail 20 to 30 questions. We will be asking how they are coping during COVID-19. It is a nuanced assessment that looks at: how adults are coping, the services and outreach that they have been receiving, the extent to which needs are met, and who they have been reaching out to receive and provide help, and how they are spending their time on a daily basis. Furthermore, a subset of these respondents will also receive friendly phone calls from a Regis college student over a four to five month period. It is hoped these friendly calls will provide some emotional support and friendship during these difficult months ahead.

Val: That sounds really helpful. It makes so much sense that you are giving seniors a chance to spell out exactly who is helping them and how they are helping. Specifics are vital here. And even the reluctant folks (proud, “rugged individualists”) have the opportunity to identify what they need without coming off as too “needy.” I also love the idea of the Regis students, mostly young Gen Zs, chatting with the eighty-year-olds.

Julie: Yes, and some of those students are feeling scared, left out, and lonely themselves. The older adults can share their life’s experiences to comfort and encourage the students—and that makes them feel relevant.

Val: Right, feeling relevant. Researchers studying loneliness have often reported on the importance of having meaningful conversations to alleviate loneliness. But--now that you say the word “relevant”--I can see how older adults yearn to be relevant to others, and this is what gives them meaning.

Julie:  Yes, that’s right. The most resilient older adults I studied were the ones who still felt relevant to others. Not only do older adults want to be needed, they want to feel relevant to others.

When studying social capital with older adults as part of my dissertation, what mattered was the quality of the relationships they had, not just the number of contacts. The key to their emotional and physical health was the quality of their connections. So, in considering how to increase social engagement for older adults, we need to ask the question: How can we help to make them feel more relevant?

Val: I imagine you ask your clients that very same question:  How can they make their parents feel more relevant? Can you tell me more about your consultancy, Help My Aging Parents?

Julie: Yes, I do ask that question a lot. But, more fundamentally, I help my clients plan ahead and think out loud. To have serious conversations about the future of their loved one.

I provide eldercare consultation to individuals and families who are increasingly concerned about the well-being of an aging relative, but do not know how to “step in.” After a thorough consultation, an effective action plan is developed, tailored to the aging relative’s needs and wishes.

It all comes down to thinking ahead. Being proactive, not reactive.

It’s better to plan ahead and consider options when you are not in the middle of a medical crisis. There is no reason to be caught with financial hurt and emotional hurt in a messy situation that could have been avoided with good planning. Ultimately, you know your parent will need assistance at some point, and the whole experience is just so much more positive if you are ready.

And best of all, sometimes, having an honest conversation about caregiving can actually bring the parent emotionally closer with their adult children. I encourage my clients to speak from their hearts about what is on their minds.

Val: Hopefully, that honesty can open doors—if it’s expressed with genuine love. It’s really sad that in our society we tend to put off having those deeper heart-to-hearts, especially about what we need and desire as we become more vulnerable in our aging process. Julie, the work you do is so vital. You empower family members to “go there” to the hard topics and scenarios that we often dread talking about. And your research and insights are valuable. I am so pleased we could talk today. Thank you very much.

And, oh yes, please keep me posted on how the survey is going.

Julie: I certainly will. This was a lovely chat, and I appreciate your time. Thank you.

MORE ABOUT JULIE NORSTRAND

Julie’s Consultancy, Help My Aging Parents: www.helpmyagingparents.net

Julie has worked in the field of aging for the last fifteen years by serving in the clinical, academic, and research domains of gerontology. Her academic qualifications include a PhD in Social Work, Master’s in Social Work, and a Master’s in Clinical Psychology. She is extensively experienced in assessing individual older adults and the environments in which they live, having worked in hospital and community settings as well as serving on various boards focused on aging-related issues. Her research has specialized in examining the role of community life of older adults and age-friendly communities.

Julie is a native of Denmark, and lives in Newton with her husband and son. She currently serves as an adjunct faculty member at Regis College and runs her consultancy, Help My Aging Parents, LLC, providing guidance to families about their caregiving needs for their aging relatives.

Julie’s philosophy: “Since coming to America in 1995 I have gained the appreciation of the value of older adults in our communities. Sadly, too often older adults, as they age, become increasingly invisible and isolated. This is tragic. We as children of our aging parents have a moral responsibility to ensure that we maximize the quality of their lives by giving them a meaningful and safe environment to grow old in.”

Peer-Reviewed Publications

·      Ring, L., Glicksman, A., Kleban, M. & Norstrand, J. (2017) The future of age friendly: Building a more inclusive model using principles of ecology and social capital. J of Housing for the Elderly, 31(2), 117-129

·      Xu, Q., Norstrand, J.A. & Du, Y. (2016). Effects of living alone on social capital and health among older adults in China. Int J Aging Hum Dev. Advance online publication. doi: 10.1177/0091415015624419.

·      Norstrand, J.A. & Glicksman, A. (2015). Influence of living arrangements of community dwelling older adults on the association between social capital and health. In F. Nyqvist & A.K. Forsman (Eds.) Social capital and health among older people: the meaning of community and context (pp. 89-109) NY: Springer.

·      Norstrand, J.A. & Chan, K. (2014). The relationship between health and community across aging cohorts. J Aging Research, Article ID 626097, 10 pages.

·      Norstrand, J.A., Glickman, A., Lubben, J., Kleban, M. (2012). The role of the social environment on physical and mental health of older adults. J Housing for Elderly, 26(1-3), 290-307.

Val Walker, MS, is a contributing blogger for Psychology Today and the author of The Art of Comforting (Penguin/Random House, 2010) which won the Nautilus Book Award. Formerly a rehabilitation counselor for 20 years, she speaks, teaches, and writes on how to offer comfort in times of loss, illness, and major life transitions. Her new book, 400 Friends and No One to Call: Breaking Through Isolation and Building Community, was released in March, 2020, with Central Recovery Press. Learn more at www.valwalkerauthor.com