- The Washington Times - Sunday, December 2, 2001

Our major problems are usually pretty obvious. In fact, we couldn't miss the war in Afghanistan and the terrorism here at home if we tried. As a society, we're also concerned about conflict in the Middle East, the economic recession, energy shortages, and the implications of cloning and stem cell research. Individually, we worry about our health, our personal finances, our safety and our love lives. Newspapers address these issues almost daily.

There is another problem of overriding significance that is much more subtle and insidious, yet rarely mentioned in the press: the increasing isolation of our elderly citizens. This phenomenon has tremendous consequences on the quality of their lives as well as upon our public policy and coffers. It's becoming more and more common for seniors to be living away from family, friends and their longtime religious and social organizations. Many of them struggle on alone, with only limited resources or support.

All-to-often the result is an increasingly significant unhappiness (if not outright depression) as well as a decreasing ability to access needed assistance in such areas as medical care, home maintenance, financial management, security and even simply getting to the store for food. I routinely see some of the results of this isolation in my psychiatric practice as I watch the elderly struggle to just get to the office for appointments, articulate their needs and carry out treatment recommendations. I shudder as many of them leave to go to a precarious existence. Even those who are financially secure are not spared their own day-to-day battles to survive.

The problem is that the older people get, the more likely they are to become separated from the psychological and practical supports they need to shore themselves up.

This creeping "disconnectedness" of American senior citizens has impact not only on them directly, but also involves such hot-button political issues as Medicare, taxes, Social Security, abuse in nursing homes, street crime, faith-based initiatives and many more. The greater the disconnect, the greater the consequences, and the more expensive the programs needed for correction. As a simple example, people lacking assistance for accessing health care services get sicker and sicker. They not only feel worse, but wind up requiring more costly treatment.

Although isolation of the elderly is nothing new, it now has modern contributors: an affluent, more mobile, and "me first" society. Yet, this isolation and its devastating consequences have escaped the notoriety it deserves.

Not long ago, in two separate incidences in Chicago, elderly gentlemen were found long dead in their homes, having not been missed enough by anyone to discover their demise. They represent the extreme end of the spectrum of isolation. But to some extent, almost all older people are at risk to a greater or lesser degree.

Isolation so characterizes this rapidly expanding problem that it's time to take note and try to more fully understand it. It's so pervasive and serious that it deserves it's own designation. I suggest "eppies" (with a nod to my daughter for her input)Elderly PeoPle Increasingly Estranged from Support. Perhaps this acronym will help keep it in our consciousness, the way "yuppies" reminded us of the goals and strivings of yet another large population group.

There's no single reason this happens to our elderly. Explanations range from the personal (including psychiatric) to the societal (including pathological).

On an individual level, isolation can even be secondary to personal choice as some older people with the money and strength decide to move to the South or West, or even out of the country. Or the children may move away from the parents. An early retirement age removes the often significant support given by the work environment. Obviously, divorce, separation and death take an accumulating toll. Aging and illness can lead to declining ability to interact because of pain or loss of stamina, decreased hearing or vision, declining mental capacity or emotional difficulties including depression. For some, there is a descent into poverty making staying connected more monetarily difficult.

As a society, we add to the estrangement. Collectively we more readily accept separation of families by many mechanisms as a fact of modern life. This can be coupled with the pervasive "me first" attitude and attachment to material goods, rather than valuing family and other personal relationships. Also, our streets are not as safe as would make many elderly feel comfortable on them. And there's been an increasing reliance on secondary care givers such as nursing homes. Even some of our churches have become more glitzy and feel-goody rather than providing close sustaining communities.

All this is compounded by new barriers posed by our gated communities, cul-de-sacs, hermetically sealed residences, drive-throughs and the virtual elimination of the practice of sitting out on our front porch or stoop we've moved out of the flow, onto the patio.

For some, there's a core moral point to be made here: Don't miss the real purposes in our lives almost exclusively involving our satisfying attachments to others. Miss that and be prepared to pay the price in old age. For all of us, there is the message that estrangement of the elderly has broad implications on public policy and finance.

Some estrangement will occur no matter what we do. But as we develop a patchwork of laws, policy and institutions directed to the elderly, let's remember the isolation at the root of so much we strive to correct. Perhaps it's time we addressed the underlying cause. The emotions of September 11 may provide the impetus we need.

Tom Minogue is a board-certified psychiatrist in private practice and on the medical faculty of the University of Illinois at Urbana-Champaign. He is also author of two books on health care delivery.

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