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OBJECTIVES To comprehensively assess the effect of a living will on end-of-life care. Included studies were conducted in adults with and without living wills.

Cody Delistraty.


He writes on literature, psychology and interesting humans. Brought to you by Curio , an Aeon partner. Edited by Marina Benjamin. On a humid July evening, a young woman in a red dress made her way along the banks of the Seine, walked beneath the Pont Neuf and, tucking auburn tresses behind her ears, sat down next to me. She introduced herself in a hybrid English accent typical of international boarding-school students who think of home not as a singular place but as something seasonal — London in the autumn, the Austrian Alps in winter. Then she introduced her pup.

She admitted this one evening, as the summer came to a close. Then she stopped showing up. She stopped phoning, too. Still, loneliness remains a slippery concept. Indeed, there are many serious drawbacks to longterm loneliness, from severe depression to irreparable cognitive damage.

In a study on the subject, Holt-Lunstad aggregated data from a range of independent studies within which participants were followed for an average of seven years. Henry David Thoreau rhapsodised his alone time. How romantic to be alone! And yet, Walden Pond sat within a large park that was often swarmed with picnickers and swimmers, skaters and ice fishers.

Loneliness can be a miserable state and people, accordingly, work hard to avoid it.

Over the past three decades, Americans have reported decreasing levels of loneliness, and one can assume that this holds true for other first-world countries, where a stream of invention works both directly and indirectly to prevent it: social media, artificial intelligence, virtual reality. The promise is that one can always be connected, or more accurately, constantly engaged in the simulacrum of companionship as mediated by iPhones, the internet or, sometime soon, an artificial being.

But, as Olivia Laing shows in The Lonely City , the very technologies that promise to connect us to others serve to sever us, even quarantine us, from opportunities to make genuine connections. Y et there is a central paradox around loneliness. While it can lead towards very undesirable places isolation, depression, suicide , it can also make us better observers of the social world. We can become more perceptive, more in charge of our own reality, as loneliness makes life compelling. Vitally, loneliness assures us that our life is our own.


Historically — and mythically — it has been the singular and narrow path towards virtue, morality and self-understanding. In The Epic of Gilgamesh, written circa BCE, it is only once the gods kill Enkidu that his friend and fellow traveller Gilgamesh can complete the journey to find the source of eternal life. And only when Christ spent 40 days and 40 nights alone in the desert, confronting the devil — without aid of God or angels — was he able to prove that he could resist all temptation.

Unable to escape the throngs of people querying him for advice and prayers, the 5th-century sage Saint Simeon Stylites, spent 37 years sitting atop a pillar on a one-square-metre platform outside Telanissus modern-day Taladah, Syria.

Chronic Loneliness: Causes, Symptoms, Treatments, and More

He believed that if he could not escape the busyness of the world on the ground, perhaps he could be alone — and truly in control of his world and his thoughts — if he were closer to the sky. In fact, Dr. Carla Perissinotto and colleagues at the University of California at San Francisco reported in that most lonely individuals are married, live with others and are not clinically depressed. We have to consider the quality of relationships, not simply their existence or quantity.

As Dr.

Nancy J. It may be simplistic to suggest to people who are lonely that they should try to interact more with others. Perhaps equally surprising is the finding that older adults are not necessarily the loneliest among us. Although most studies of the effects of loneliness have looked only at older people, Dr.

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Holt-Lunstad, who with colleagues has analyzed 70 studies encompassing 3. Holt-Lunstad said. We need to address this for all ages. And the majority of those living alone have learned to optimize the social resources they have left. Nonetheless the absolute number of persons living alone means an increase in the number of those vulnerable to loneliness, social isolation and their undesired effect on health. As a result, loneliness, social isolation and living alone are a greater threat to health and well-being than the other way around. Loosening the Grip of Loneliness: Engagement vs.

Isolation If this is true—and the evidence is compelling—what should older adults, their family members and their communities do to combat loneliness? For the individual, feelings of loneliness can serve as motivation to get connected or reconnected and to find an environment that offers opportunities for contact, for stimulation, for belonging. One cannot maximize the network but it can be optimized. The computer can be a means of maintaining contact through Skype, email and video conferencing with friends and family. However, the blessing and curse of computer socialization is that it is sedentary and largely home-bound.

Enlisting friends and older neighbors in a walking group can provide both social contact and safe exercise. For younger persons living in apartments or neighborhoods, reaching out to an older adult around holidays or if the person has not been seen for a while takes little time but can be quite rewarding for both parties.

For the older person living alone, an independent-living or assisted-living apartment also provides opportunities for new relationships, for shared meals, for group activities. The key element is to take action, which is better than an antidepressant to lessen the stress of loneliness. But for persons who have grown hopeless, pessimistic and negativistic, their lack of ability to act may be the result of a depressive illness that would benefit from counseling, psychotherapy and perhaps medication. Family Members: Look for the Early Signs For families it is also important to recognize the warning signs and act when a member is at risk of isolation.

Here are three things a family member can do:. Any person living alone could be at risk for loneliness—but those who are in their 80s or older are especially vulnerable. Religious institutions may be the most widespread source of social support for older adults and should continue to treat older members as congregants even when they can no longer attend services.

This is especially the case following bereavement. Transportation and home-care health programs are critical to reducing isolation and promoting social contact.