Sometimes, the feeling comes to him as frustration, like the problems in his life are piling up. Other times, it feels like anxiety or dread. Like all he wants is to stay in bed.<\/p>\n
Mondays are when 73-year-old Michael Holtom feels it the most. These aren\u2019t the regular Monday blues \u2013 the dread that many of us get at the end of the weekend, at the idea of diving back into a regular schedule. <\/p>\n
Instead, it\u2019s the opposite. It\u2019s the nothingness he feels. Waking up and staring at the ceiling as he faces down another day, another week, hours and hours ahead with nobody but himself. Wondering, what am I going to do today? and coming up blank.<\/p>\n
\u201cI can\u2019t,\u201d he\u2019ll think to himself in these moments. \u201cI just can\u2019t seem to put it together.\u201d <\/p>\n
It\u2019s taken decades for Mr. Holtom to be able to identify the feeling. It\u2019s loneliness.<\/p>\n
Open this photo in gallery:<\/a><\/p>\n Mr. Holtom lives alone in Toronto. He\u2019s lived his whole life alone. Never married, never had kids. The friends he used to work with down at the marine yard have dropped off. The guys he used to play music with \u2013 the bandmates he played in jazz bands, blues bands with \u2013 are all gone, too. His drummer died last year, a guy he played with for more than 40 years. It felt like losing his right arm. <\/p>\n So he spends almost all of his time alone. He fills his apartment with books and art and knick-knacks from the road. Old Life magazines and Elvis albums. A picture of Spock from Star Trek, under the words \u201cCHEER UP!\u201d on the refrigerator. And in the background, there\u2019s music \u2013 the wailing chords of Jimi Hendrix, the screeching bends of Albert King\u2019s guitar.<\/p>\n Open this photo in gallery:<\/a><\/p>\n But there\u2019s always loneliness. It\u2019s only recently that Mr. Holtom has begun taking measure. Noticing his loneliness and trying to do something about it. <\/p>\n He\u2019s not the only one. Around the world, he\u2019s part of a shift among policy-makers, medical professionals and everyday people beginning to understand loneliness not only as a health hazard but one they need to do something about.<\/p>\n The World Health Organization in 2023 declared loneliness a threat to global health, one that\u2019s linked with nearly 100 deaths around the world every hour. It\u2019s tied with not only mental-health concerns such as depression and anxiety but also increases the risk of conditions including diabetes, stroke and heart disease. And it hits two groups the hardest: the very young (those between the ages of 15 and 24), and the very old \u2013 those 75 years and up. Among the latter group, loneliness is strongly linked with a long list of health challenges, including dementia, cognitive decline and premature death. <\/p>\n Although both men and women experience loneliness, men are much less likely to admit to it. And they\u2019re also much less likely to ask for help. <\/p>\n No wonder. When Mr. Holtom does bring up his feelings of loneliness with his peers, the response is often dismissive or judgmental.<\/p>\n \u201cThey\u2019ll hear me and say, \u2018Get over it,\u2019\u201d he said. \u201cThey\u2019ll say, \u2018You\u2019re bigger than that,\u2019 or \u2018This isn\u2019t you, Michael.\u2019\u201d<\/p>\n And how is he supposed to explain that it is him, that loneliness is a part of him? Especially when, depending on his mood, depending on the day, it can feel different, can look different on him, too \u2013 especially when, depending on the person, depending on their experience, loneliness can have so many different faces. <\/p>\n Loneliness isn\u2019t a cold, or an infection, or a rash. It doesn\u2019t present, in health care settings, with obvious symptoms. <\/p>\n Instead, diagnosing it generally takes some digging, said Gary Bloch, a family doctor with St. Michael\u2019s Hospital in Toronto. <\/p>\n \u201cIt\u2019s really about encouraging front-line clinicians to spend time listening to people, and trying to understand what their social story is in a really deep way.\u201d<\/p>\n And that, he said, \u201cis not something that\u2019s traditionally been taught in medical school.\u201d <\/p>\n Open this photo in gallery:<\/a><\/p>\n Even as the chair of the social determinants of health committee at St. Michael\u2019s Hospital family health team, even working in a part of downtown Toronto that serves some of the city\u2019s most vulnerable patients, Dr. Bloch admits that it took him until the past couple of years to fully understand the health impacts of loneliness.<\/p>\n Until recently, he focused on what he considered \u201cthe sort of \u2018tangible\u2019 pieces, like poverty and access to housing \u2013 the more traditionally recognized social risk factors for health.\u201d<\/p>\n But in the past few years \u2013 and especially after the experience of the COVID-19 pandemic, where we all witnessed the effects that extreme isolation had on many groups \u2013 he\u2019s turned his attention to loneliness, too. And, he said, \u201cI stand corrected.\u201d <\/p>\n The evidence that supports isolation as a risk in itself, he said, is overwhelming. Even at the molecular level, stress hormones can have a detrimental effect on so many of our body\u2019s functions, from our immune system to our cardiovascular health.<\/p>\n \u201cYou\u2019re looking at everything from heart disease, to stroke, to immune responses to ward off infection, to levels of mortality, depression, anxiety.\u201d <\/p>\n In the United States, loneliness costs the health care system more than $9-billion each year; in Australia, the cost is around $2.5-billion. There\u2019s not yet a similar estimate for Canada, though this much is clear: Lonely people get sick more often, visit their doctors more often and turn up at the emergency room more often. <\/p>\n Another challenge is recognizing the difference between loneliness and isolation. Many people enjoy solitude \u2013 spending much of their time alone. <\/p>\n Open this photo in gallery:<\/a><\/p>\n An older photo of (left to right) Michael, his brother and father sits on the mantle in his home.<\/p>\n For many years of Mr. Holtom\u2019s life, for example, solitude was a choice. As the middle child of parents who were divorced, as a quiet, sensitive kid, he often felt lost in the shuffle. It felt easier to go off and spend time on his own.<\/p>\n And as an adult working at the Royal Canadian Yacht Club as a marine yard worker, he lived alone on a houseboat for years. He had girlfriends but nothing serious. He even lived with a woman for a few years, but that ended poorly. Maybe it was better to be alone, he\u2019d think. Maybe he was just a loner.<\/p>\n \u201cSome people are extroverted. I\u2019m introverted,\u201d he said. \u201cThe world scares me. It\u2019s a little overwhelming at times, so I try not to take too many chances.\u201d<\/p>\n Loneliness, on the other hand, is not a choice, said Ami Rokach, a psychology professor at York University and author of The Psychological Journey To and From Loneliness. <\/p>\n \u201cNo one chooses to be lonely.\u201d<\/p>\n Instead, he said, loneliness is the result when a person\u2019s desire for social connection goes unmet. It\u2019s what results when there\u2019s a gap in expectation between what a person has and what a person wants. <\/p>\n Open this photo in gallery:<\/a><\/p>\n Recently, Mr. Holtom has been feeling that gap more and more \u2013 like his solitude is less and less of a choice. After retiring from the yacht club three years ago, he said, he\u2019s had fewer opportunities to connect with people. Fewer excuses to go out. <\/p>\n \u201cIt got more secluded. Solitary. Reclusive,\u201d he said. \u201cIt really started to bug me.\u201d<\/p>\n These days, the 73-year-old lives in a large downtown apartment building. He still looks every part the jazz musician \u2013 tall and scruffy, his long face perpetually hidden behind a pair of Ray-Bans. There are always people around \u2013 in the halls, in the park outside or at the coffee shop across the street. But that doesn\u2019t make him feel any less alone.<\/p>\n Exacerbating the experience, said Prof. Rokach, is the stigma and the fact that loneliness is still so misunderstood. The fact that, to many \u2013 especially older men raised on traditional beliefs around masculinity \u2013 loneliness is still often viewed as a weakness.<\/p>\n To many, he said, \u201cloneliness is seen as a personal failure.\u201d<\/p>\n How loneliness eventually unfolds, said Prof. Rokach, is in stages. It starts with disappointment or anger at the people around them \u2013 lashing out at family or friends for not visiting or staying in touch. The next stage, often, is that the person experiencing loneliness becomes demanding.<\/p>\n \u201cThat looks like them bringing loneliness into every social encounter,\u201d he said. \u201cDemanding of family to be more in touch, blaming people for not wanting to be with them.\u201d<\/p>\n And the final step, he said, is hopelessness \u2013 when they stop believing that their situation can change.<\/p>\n \u201cLoneliness is always very painful,\u201d he said. \u201cAlmost torturous.\u201d<\/p>\n Open this photo in gallery:<\/a><\/p>\n Berrisford Joseph’s situation illustrates that isolation doesn\u2019t affect everyone equally.<\/p>\n Berrisford Joseph once considered himself a very social person. <\/p>\n \u201cI used to have lots of friends I used to visit,\u201d says the 78-year-old. \u201cI used to have a lot of friends who would visit me.\u201d<\/p>\n That\u2019s changed in the past few years. <\/p>\n \u201cI don\u2019t know what happened,\u201d he said. \u201cThey just dropped out of sight. Now I don\u2019t hear them. I don\u2019t see them at all.\u201d <\/p>\n Mr. Joseph, who was born in St. Vincent and came to Canada in his 20s, used to work as a security guard and as a maintenance worker. But since retirement a few years ago, he\u2019s had fewer excuses to go out. Outside of medical appointments or running errands, he spends almost all of his time in his apartment, watching TV, reading his Bible or sleeping.<\/p>\n He had a bad fall recently, which has made it hard to get out and move around. His TV broke recently \u2013 the picture stopped working. So he\u2019s been sleeping even more. <\/p>\n He was referred recently by doctors to a program for socially isolated seniors. <\/p>\n Open this photo in gallery:<\/a><\/p>\n He doesn\u2019t like the word lonely. He says he\u2019s content by himself. He\u2019s content with his TV and his Bible. \u201cI\u2019m not lonely.\u201d He is okay, however, with the word \u201cisolated.\u201d <\/p>\n What Mr. Joseph\u2019s situation illustrates is that isolation doesn\u2019t affect everyone equally.<\/p>\n This was on full display during the COVID-19 pandemic, when older adults were most likely to experience extreme isolation, either living alone or in group settings with little contact with the outside world. <\/p>\n Many older people are still struggling to move on from the pandemic, said Lisa Rae, the director of volunteer programs at Circle of Care at Sinai Health in Toronto. The program offers friendly visits to seniors who have been identified as socially isolated. But in the past few years, it has experienced a drop in volunteers and clients. <\/p>\n \u201cWe still have clients who are afraid to go out, who don\u2019t want to come to groups any more,\u201d she said. There\u2019s also the opposite problem \u2013 seniors who, because of the pandemic, are afraid to allow visitors into their homes.<\/p>\n And within the demographic of older adults, it\u2019s marginalized groups who are especially vulnerable to isolation.<\/p>\n Those who belong to immigrant, racialized, Indigenous or LGBTQ+ communities \u2013 those who are more likely to face discrimination \u2013 are especially likely to experience loneliness. Even newcomers with specific ethnocultural communities to rely on for social supports face other obstacles to integration, such as language barriers and employment challenges. <\/p>\n Open this photo in gallery:<\/a><\/p>\n Also vulnerable are those living on lower income or with disabilities. A 2019 Angus Reid survey found that older adults with incomes below $50,000 were twice as likely to describe themselves as \u201cvery lonely\u201d or \u201cvery isolated.\u201d <\/p>\n Which brings us back to Mr. Joseph. When he stopped working, his world got smaller. This is true for many older people. <\/p>\n Open this photo in gallery:<\/a><\/p>\n But he\u2019s also Black and speaks openly about the racism he\u2019s faced. He\u2019s an immigrant who came to Canada as an adult without existing social networks. <\/p>\n He also faces strict income challenges. He has a monthly income of about $1,500. Two-thirds of that he spends on rent (a cost that\u2019s about to go up to $1,200), which leaves just a few hundred dollars each month for all his other expenses. He uses the food bank to get by.<\/p>\n This means that many of the opportunities that others have for social connection \u2013 a walk to the local coffee shop, a fitness class at the community centre \u2013 become inaccessible. Even the cost of visiting a friend becomes prohibitive when you consider the cost of bus fare or a taxi.<\/p>\n \u201cI try to leave [my apartment], but there\u2019s nothing suitable,\u201d he said. \u201cIt\u2019s too expensive.\u201d<\/p>\n Recently, he\u2019s avoided even going for walks. He\u2019s lived in Regent Park for decades, but the area around his building has begun feeling, to him, more and more dangerous.<\/p>\n He\u2019s taught himself that it\u2019s better, safer, to be alone. Outside, he said, \u201ctoo many things happen.\u201d<\/p>\n Open this photo in gallery:<\/a><\/p>\n Arkady Balanovsky, 70, treats loneliness like any other potential health risk.<\/p>\n Around the world, countries have ramped up efforts to combat loneliness. In 2018, Britain appointed its first-ever \u201cminister of loneliness.\u201d There, people suffering from loneliness cost the National Health Service each year, on average, \u00a3850 (about $1,500) more than those who are not. Japan, Germany and Denmark also have national strategies aimed against social isolation. <\/p>\n But Canada has lagged. In a 2021 Commonwealth Fund study of older adults, Canada ranked as the loneliest of all the 11 countries surveyed. <\/p>\n Still, there are reasons for hope. Many communities \u2013 especially urban ones, like the ones where Mr. Holtom and Mr. Joseph both live \u2013 have seniors groups and seniors socials. And health care providers such as Dr. Bloch and his team at St. Mike\u2019s have begun experimenting with \u201csocial prescribing,\u201d where older patients suffering from loneliness are paired with staff members – non-health care professionals – who pay them weekly visits.<\/p>\n Programs such as these, which operate in a similar manner to Mount Sinai\u2019s Circle of Care, are already seeing positive results. <\/p>\n Take Arkady Balanovsky. He\u2019s a part of the Circle of Care program. It\u2019s easy to see why Mr. Balanovsky was identified as a candidate.<\/p>\n The 70-year-old lives alone, in a one-bedroom Thornhill apartment. His wife and son both died more than a decade ago. He was born in Tiraspol, Moldova, and came to Canada in 2015, so his English is limited. And he\u2019s completely blind. His service dog, his most constant companion over the past decade, died last year.<\/p>\n Open this photo in gallery:<\/a><\/p>\n Mr. Balanovsky meets with Circle of Care volunteer Brahm Goldhamer at his home once a week.<\/p>\n Mr. Balanovsky is isolated in so many ways. But, he said, \u201cit\u2019s not lonely, no.\u201d<\/p>\n He\u2019s taken matters into his own hands, treating loneliness like any other potential health risk. As such, he approaches social connection like a part of a healthy routine. <\/p>\n He\u2019s arranged his schedule such that he has a rotation of regular visitors: Circle of Care volunteer Brahm Goldhamer comes to see him every week; and also his girlfriend, who visits regularly. And he\u2019s an avid musician \u2013 he plays the accordion \u2013 and meets often to play with other musicians. Mr. Goldhamer, too, is a retired vocal coach and fellow musician. So they\u2019ll play music together as well.<\/p>\n And on days when his friends aren\u2019t available, Mr. Balanovsky pays a personal support worker to visit him \u2013 not to help with bathing or cleaning, but just to take him on a walk. To him, this is an act of self-care \u2013 not dissimilar to taking a vitamin or getting regular exercise.<\/p>\n \u201cI feel that around me,\u201d he said, \u201cI have a lot of friends.\u201d<\/p>\n Open this photo in gallery:<\/a><\/p>\n And instead of thinking of loneliness as something to eliminate entirely, Prof. Rokach added, it\u2019s helpful to think of loneliness as a necessary warning sign, like hunger or pain. <\/p>\n \u201cIt\u2019s a natural reaction that protects us,\u201d he said. \u201cHunger doesn\u2019t feel good, but it\u2019s an alarm system to go and eat something. The experience of loneliness, similarly, tells you that you need to do something.\u201d<\/p>\n It\u2019s through Dr. Bloch\u2019s program at St. Michael\u2019s that Mr. Holtom was connected with Murshida Samsun Mueen. For the past six months, she\u2019s been visiting with him regularly. They go for walks and talk about what\u2019s going on in his life. She\u2019s introduced him to new community programs and seniors\u2019 groups.<\/p>\n Standing in his St. James Town apartment one recent afternoon, with an Albert King album playing in the background, Mr. Holtom showed Ms. Mueen around his place for the first time. He was proud to show off the guitars and the tapestries he\u2019s hung on the walls. The bachelor apartments in this building are choice, he said \u2013 they have the biggest balconies, for parties.<\/p>\n He described a visit he paid to the emergency room recently. He was having trouble breathing and was made to wait for 15 hours. On that day, Ms. Mueen was a lifeline.<\/p>\n