Giving voice to the silence to improve senior loneliness

We recently published an article on the "quiet crisis" of senior loneliness. It spent some time highlighting the issue and offering context for those of us who only vaguely know it exists.

But for those facing this daily, it takes a closer look to discover how caregivers and loved ones can get to the core of the issue.

MHAI's Morayo Orija spoke with Sharon Dornberg-Lee, LCSW, Clinical Director of Community Services at CJE SeniorLife in Evanston, IL. As an expert in the field, Sharon offered detailed, practical insight into identifying and supporting seniors facing isolation.

If you're facing this with an older relative or loved one, here are the active steps you can take to help improve their situation.

Only fools rush in: Identify the "why" before responding

When someone we love changes, alarm bells start to ring, but before offering solutions, it's important to understand why the change happened.

As Sharon says, "It's not a single or easy answer... when you see a change in behavior of somebody who was formerly very active socially, and then you see a change, that's beginning to look more like withdrawal."

There are two possible causes for behavioral change: physical or emotional. As we age, we become less able to do what we once did, or face more ongoing health issues – a difficult reality to confront. Often, an emotional element comes with it too (or can arise on its own), as the person develops a fear of rejection and struggles to feel authentic with others.

The point is this: when you notice a change, start by simply acknowledging it and asking. Let them tell you what's bothering them. Their answer will guide how you help them going forward.

"Solo agers": a high-risk group for loneliness

While everyone's story is different, certain circumstances put people at greater risk of loneliness.

Sharon points to one particularly at-risk group: the "solo ager." She's careful to note there's no universal definition: the NYC-based nonprofit DOROT defines it broadly as anyone aging alone, while CJE narrows it to those with no involved family as they age, such as estranged children (not simply those living far away).

As Sharon says, "Very often, solo agers are people who never married, never had kids... folks who, through circumstance or choice, find themselves aging alone."

Isolation can work both ways. Often, especially when someone is facing cognitive decline, family and friends begin to distance themselves out of sadness or an inability to face the loved one's decline. It's a complex dynamic, as Sharon notes: "It gets hard and challenging if somebody has a physical disability or a cognitive disability... it makes them think about their own future in aging and that's uncomfortable."

How to actually start the conversation

Once you understand why someone might be withdrawing, the next challenge is talking about it. This is especially difficult across generational or cultural lines where mental health carries real stigma. Sharon's advice is to stay direct without reaching for a diagnosis. 

Instead of asking "Are you depressed?", a question loaded with assumptions many people will simply deny, try something more observational: "I've noticed you seem sad lately," or "You don't seem like yourself since Mom passed." Lead with concern, not a clinical label.

It can also help to normalize the conversation by mentioning others' experiences: "My friend's mom went through something like this, and this helped her."

Try “motivational interviewing”

Sharon also described a technique borrowed from clinical practice called “motivational interviewing”, one any family member can use, not just a therapist. The idea is to roll with what someone tells you instead of correcting it. If a loved one insists, "I'm not sad, I'm just frustrated," don't argue the label. Get curious instead: "Tell me more about that" keeps the door open, while "No, I think you're depressed" tends to close it. 

The second part is listening for what Sharon calls change talk, the small openings where someone mentions, even in passing, a friend who started therapy or a habit they've been meaning to break. Those moments are worth leaning into gently, without pushing.

As Sharon says, "Instead of saying, well, you got to do that too, just kind of leaning in and listening for openings where they may be contemplating change."

 Sharon Dornberg-Lee, LCSW, Clinical Director of Community Services at CJE SeniorLife.

Sometimes honesty is the therapy

Not every case of isolation traces back to depression or grief. Sometimes an older adult has simply lost confidence in their own social instincts. In these cases, the honest conversation that helps most is with the people already in their life. 

Therapy is still a good place to start, but family and friends can offer something just as valuable: honest feedback about how a person comes across. It's a hard thing to ask for, and often just as hard to hear.

Sharon described a moment from one of her own therapy groups. One member finally told another, "I reach out to you, and you never call me back." The second woman had genuinely believed the opposite, that nobody reached out to her at all. That kind of honest, gently delivered feedback is often what shifts a stuck pattern.

"When you start having those honest conversations about what's going on interpersonally, then there's all kinds of room to repair and to fix it."

Building a team, not just a therapist

When a conversation reveals something deeper, it may be time to bring in professional support, and that support can look like more than a single therapist. Sharon's team at CJE draws on evidence-based approaches, including cognitive behavioral therapy and PEARLS, an eight-session program developed at the University of Washington that helps older adults set their own small, concrete goals toward becoming more active. 

Not everyone wants that kind of structure. Sharon stresses that no single method works for every client. That said, a full support team can extend well beyond a therapist and can be genuinely life-changing. 

This can include a psychiatrist or geriatric nurse practitioner for medication needs, and a care manager, who helps with the practical scaffolding of daily life, like safe housing, transportation, and benefits access. "Mental health doesn't exist divorced from those social determinants of health," Sharon said.

Families should also know the limits of what's covered. Medicare has only recently begun paying for limited care management billing codes, typically in partnership with a medical provider, so most comprehensive care management, including CJE's, still relies on other funding. CJE's own counseling and caregiver resources serve Cook and Lake Counties, including Chicago's North Side and North Shore suburbs.

Put your own oxygen mask on first

None of this works if the person doing the reaching out runs themselves into the ground. Remember – your mental health is not separate from theirs. "If you want to be there for the care partner, you've got to take care of your own mental health and physical health," she said, adding that caregivers sometimes die before the person they're caring for, worn down by stress and self-neglect.

She pointed to the federally funded GUIDE Model (Guiding an Improved Dementia Experience) through Medicare, which she said provides roughly $2,600 a year in respite funding for caregivers of someone with a dementia diagnosis, as well as Illinois's Community Care Program for lower income families.

This isn't about sending anyone away, Sharon emphasized. It's about getting extra hands so caregiving is sustainable for the long haul, including for caregivers whose cultural or generational values make asking for help feel like a failure of duty.

"We're not talking about sending anybody away. We're talking about getting another set of helping hands to give you a break... it's part of your duty to take care of yourself... so that you can do this for the long haul."

There's reason to hope

Sharon ended the conversation with something the statistics alone can't capture: real optimism, earned from 28 years of watching people change. "I've seen so often people's potential for change and growth at any age," she said.

She also pointed to a shift in the national conversation. A 2020 National Academies report on the health toll of social isolation in older adults, and the U.S. Surgeon General's 2023 advisory on the epidemic of loneliness, have brought funding, research, and new programs into a space that barely had a name a decade ago.

There's a quieter comfort in that too. Nearly everyone feeling isolated assumes they're the only one. They rarely are.

Have you been affected by anything in this article? Reach out to us at MHAI for more support.