Cora Sledge soberly recalled all the useless prayers she had offered up throughout her 80 years of hardscrabble living. Without a hint of self-pity, she recounted: "I used to pray to keep my ma and daddy safe, but that was no use. I prayed for gifts at Christmas and to win the school prize. I prayed to be slim, so no one would make fun of me. That didn't happen, either. I asked Jesus to protect my kids. Look what happened."
Yet somehow, despite all the tragedy that had seeped into her long life through small holes in her big prayers, Cora remained hopeful about her uncertain future. But her hopes now focused more internally, and her prayers reshaped around her longing to escape the assisted-living facility in which her children had abandoned her. She asked for her heart to be healed, all the while it stayed open and "ready to love." She explained, "I pray now like I did when I was a little girl -- not needing to understand. I ask for simple things. Let me not hurt. Let me not be hungry, or cold. Please keep my loneliness at bay."
I finished reading about Cora Sledge in Berkeley novelist Leslie Larson's moving (and comical) novel "Breaking Out of Bedlam" the same day that UC San Francisco researchers reported finding statistical associations between loneliness and an increased risk of dying among elderly people.
Published June 18 in the Archives of Internal Medicine, the study showed that about 23 percent of elders who claimed to
After reading the new study and with "Breaking Out of Bedlam" fresh in my mind, I couldn't help but wonder what Cora would have to say about the researchers' findings. Like many of the elderly patients I used to see in my geriatrics clinic, Cora longed for meaningful connections to people, pets, community and home that kept her alive. She reminded me that making "life support" decisions in old age often had little to do with medicine and technology, yet much to do with keeping "loneliness at bay."
But because Cora was a fictional character, I had to ask her real-life creator for commentary. After reading the study and noting that fully 43 percent of the 1,600 surveyed elders had been categorized as "lonely," Larson commented: "It's interesting how often we hear about people 'finding' themselves alone at the end of their lives -- as if this state comes as a surprise, or as if it matters more when one is facing death than it does at any other time of life. That's when it becomes downright dangerous."
Larson suggested that "we have to cultivate connections throughout life, and be responsible for building connections that carry us through in old age. Maybe it becomes clearer, as our physical robustness subsides, how dependent we are on others -- not just for emotional well-being, but for survival, for health and the desire to thrive."
Larson added that it was "no coincidence that the severest form of punishment, one that can break even the most hardened criminals, is being put in solitary confinement -- something that happens to many older people in their own homes."
Despite consistent reports attesting to a high prevalence of "loneliness" among people facing old age or life-threatening illnesses, we understand very little about what it means to be lonely -- conceptually, medically and experientially.
A central problem is that "loneliness" is defined in various and ambiguous ways by the health care researchers who have provided us with what scant information we have.
In the current UCSF study, researchers attributed "loneliness" to anyone who indicated that they had "often" or "some of the time" felt either "left out," isolated, or lacking in companionship. But it's patently unclear whether study participants would have self-identified as "lonely" or agreed with the researchers' interpretations. And because the survey was administered only once, at the beginning of the six-year study, it's uncertain whether participants' answers would have remained stable over time. That's important because a lot of relationship-shifting and life-changing experiences can occur over six years, throwing into question whether feelings of loneliness at a single point in time can be correlated with any long-term outcome.
Still, the study throws new clinical light on the complex phenomenon of loneliness. And by pointing out that the majority of elderly categorized as lonely actually lived with someone, the study reminds us to remain open and curious about each other's experiences of being in the world, rejecting false inferences based on surface appearances.
Through Cora, Larson says something to the same effect: "A lot of people think that old people are just a bunch of dried up zombies with no feelings left. Well, I am here to tell you that the hunger for love doesn't go away. Not ever. If anything, it gets stronger. We've seen a lot and have been through a lot and we're pretty much stripped down to the basics. Eating, sleeping, and loving .... We just want someone to look at us and know who we are."
Kate Scannell is a Bay Area physician and the author of "Flood Stage."