Health & Wellness 2024/25

2024/25 Methow Valley

HEALTH

& Wellness

Coordinating care for healthy aging Facts vs. Fear The importance of FREE

social connection

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2024/25 Methow Valley

HEALTH

Staying healthy as a community

& Wellness D

HEALTH & WELLNESS

Don Nelson : publisher/editor Tera Evans: advertising MyKenzie Bennett: design

CONTRIBUTORS

Sandra Strieby Steve Mitchell

A publication of the Methow Valley News P.O. Box 97, 502 S. Glover St. Twisp, WA 98856 methowvalleynews.com

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COORDINATING CARE FOR HEALTHY AGING A primer on growing older in the Methow Valley

FACTS VS. FEAR

What to know about Alzheimer's disease

THE IMPORTANCE OF SOCIAL CONNECTION

How loneliness and islation can undermine our health - and what we can do about it

espite its relative isolation, the Methow Valley has access to a wide variety of health care professionals who can provide both primary care and referrals for additional treatments.

We’re fortunate that so many providers have chosen this community as the place they want to live and practice. Together, they form a cohesive network with an impressive range of treatment options, all devoted to the valley’s well-being.

That availability is especially important to the valley’s over-65 population, whose demographic is larger than in most parts of the country.

People like to live, work and play here into their senior years. Learn the basics of healthy aging in the story that begins on page 4. You don’t

have to reach out very far for support.

Dementia and Alzheimer’s disease are scary to contemplate for those who may suffer from those conditions, and those who care for them.

But fundamental facts about mental decline are not always readily understood. The story beginning on page 7 will help remedy that.

Loneliness, or the lack of social interfaces, is not just a challenge for seniors. Depending on their health and living conditions, people of all ages can suffer from the effects of isolation. The story beginning on page 13 outlines how to recognize and counter the pitfalls of loneliness.

Please take note of our advertisers, whose support is essential to our work. They offer an array of essential services that are locally available, all related to some aspect of health care. The directory on page 15 is a valuable yearround resource that we hope you will take advantage of.

ON THE COVER Photo by Steve Mitchell Staying active in all seasons is a key component of aging in place.

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Coordinating care for healthy aging A primer on growing older in the Methow Valley

BY S A N D R A S T R I EBY

G

rowing older in the Methow Valley presents a conundrum: how can seniors get their health care needs met in this remote rural community?

The active lifestyle that prevails here gives us an advantage; nonetheless, health-care requirements

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often become increasingly complex as we age. Here’s an inside look at how to coordinate care to support healthy aging — and how to decide when it may be time to move to a place that offers more comprehensive care.

HOW NEEDS CHANGE With growth comes change — welcome in youth, potentially debilitating as we age. “Function, cognition, and metabolism are three important areas to consider,” said Nick Belanger, ARNP, and Kyra Carpenter, DO, members of Confluence

Health’s geriatric team, in an email.

“Decreased flexibility and problems with balance lead to injuries and falls. Cognitive impairment can be from dementia, delirium, depression, or side effects of medications, amongst other things. Multiple changes associated with aging can affect metabolism which can lead to adverse effects of medications. Drug-drug interactions from prescriptions and even prescription-supplement interactions can lead to bad outcomes,” they said.

In addition, hearing and visual impairments become more

common, said Betsy Weiss, a retired physician and a volunteer with Methow At Home’s Lookout Coalition. Those impairments can lead to social isolation and difficulty navigating the world. “As we age, our world gets smaller,” she said; the interpersonal connections that people count on can falter, and that undermines wellness.

WHAT WE HAVE — AND WHAT WE DON’T With two health clinics — each part of a larger system — the Methow Valley is well positioned

to meet seniors’ most basic needs.

Nevertheless, a remote location and long, icy winters hamper access to specialty care, hospitals, and longterm care.

That can make arranging for and navigating care challenging. When the complex needs that often come with aging are factored in, coordinating care can begin to seem like anything from a full-time job to a futile endeavor.

Kelly Lazelle, CMA, a Clinical Supervisor at the Family Health Centers clinic in Twisp, acknowledges that “there is a major disconnect” between primary-care providers and specialists such as cardiologists, pulmonologists, and dermatologists. That disconnect is in part a function of the structure of the modern health care system; it’s exacerbated by the Methow Valley’s remoteness and its isolation from hospitals and the specialists’ offices.

Coordinating care between the Twisp clinic, specialists, and supporters such as the Lookout Coalition, Okanogan Palliative Care, and Room One is “a team effort,” said Lazelle. There are “a lot of different roles within FHC to help patients get the help they need,” she said.

Patients can talk with her or ask any provider in the clinic for help initiating care coordination.

At Confluence Health’s Methow Valley Clinic, Linda Stanforth plays a similar role in her position as Referral Coordinator. She can help patients identify and work through any barriers to coordinating care, said Weiss. In addition, Confluence Health’s geriatrics team can help individuals develop an overview of their current needs and plan for the future, say Belanger and Carpenter.

“Geriatricians are skilled at geriatric assessments (fall risk, cognitive assessment, medication reviews), palliative care, goals of care conversations, subacute, and home-based care,” they said.

THE PATIENT’S ROLE Ultimately, said Lazelle, patients need to “rely on advocating for themselves.” Talking with your primary care provider can be a good place to start.

Belanger and Carpenter say that “one primary provider should be able to coordinate most [of a] patient’s needs. Ask for medication

reviews to minimize polypharmacy and drug-drug interactions, stay up to date on immunizations, and talk about what screening tests (mammograms, colonoscopies, etc.) might or might not be beneficial.”

In addition, say Belanger and Carpenter, “Ensure the primary provider is aware of the visits to the specialist so they can stay up to date on what is happening. Ask the specialist to fax their note to your primary provider.”

Finally, they say, there are steps anyone can take to improve health and reduce overall health risks: “Move it or lose it. Stay active

— walk for cardiovascular and mental health. Tai chi is great for balance, osteoarthritis pain, flexibility, and function. The Mediterranean diet is great for healthy weight, diabetes control, and reducing your risk of stroke and heart attack. By decreasing these comorbidities, you may also reduce your risk of dementia.”

WHO ELSE CAN HELP? Methow At Home (MAH) is a virtual village that supports local residents through the transitions inherent in aging. MAH coordinates a cadre of volunteers to provide a

suite of support services, including rides to health care appointments, support for people living with dementia and their caregivers, and the Guardian Angel program, which matches seniors with volunteers who provide companionship and assistance so the individual senior’s specific needs are met. All of those options can ease the challenge of navigating complex care.

MAH can also help residents stay active and eat well with senior exercise classes and free health education programs, and can help seniors find walking buddies.

The Lookout Coalition is another

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MAH program, “providing free medical and social service support to those who are facing difficult health challenges, connecting community members with the resources they need,” says MAH’s web site. The site goes on to explain: “Volunteer expertise includes medicine, social work, mental health, occupational therapy, mindfulness, spiritual support, nursing, and trauma therapy.

Many of the volunteers are hospice trained and all live in the Methow community.”

Okanogan Palliative Care is another valuable resource. “Palliative care is specialized care that helps relieve the stress and symptoms of serious illness to improve the quality of life. We work alongside your other doctors to provide an extra layer of support for you and your family,” according to the organization’s website.

Room One can help residents navigate their health insurance coverage, connect people with Medicare advisers, and assist with care coordination, said client advocate Stephanie Foster. Room One is also a member of the Methow Valley Community-Based Long-Term Care

Network, a group of local organizations that have been working together since 2022 to create a comprehensive support system.

That resource is still in the works, said Foster. In the meantime, Room One and others will help callers find the right organization to meet their needs — there is “not a wrong door” to step through as you start working on care coordination, she said.

Altius Physical Therapy and Winthrop Physical Therapy offer physical therapy, and Winthrop has recently added occupational therapy services. Both modalities can improve strength and balance and support mobility and home safety.

MAKING DECISIONS Many seniors are able to remain in the Methow Valley for their entire lives. Others find they need to move away in order to meet their health care needs. The decision depends on individual needs and resources — factors that are “very individualized,” said Belanger and Carpenter.

Some to consider include: • Ability and willingness to travel for care. Travel to Omak,

local Resources

• Lookout Coalition: https://www.methowathome.org/ programs • Methow At Home: https://www.methowathome.org/ • Okanogan Palliative Care: https://www.okanoganpalliativecare.com/ • Room One: https://roomone.org/ Wenatchee, or beyond is time-consuming and can become expensive, especially when recurring trips are required. Winter driving adds an element of risk. It’s important to evaluate your capacity to seek and continue care that may require travel, including whether you’ll be able to drive yourself or will need to enlist help.

• Caregiving needs. Caregivers are in short supply in the valley. There is no skilled nursing facility. Jamie’s Place is the only long-term care facility, and is not able to meet current or projected demand (although expansion plans are in the works).

• Your support network. Health care providers, support teams like Okanogan Palliative Care and the Lookout Coalition, friends, family,

and MAH volunteers and programs can all make staying in the valley feasible, but they may not be able to meet all of your needs for the rest of your life.

• Your long-term goals. Your personal priorities are perhaps the most important consideration, and may prove most elusive, with unknowable future changes a part of the equation. Advance planning can provide a structure for deciding what’s important to you. Both Okanogan Palliative Care and the Lookout Coalition are “used to having those discussions” and can help seniors articulate their goals and make plans and decisions, said Weiss. Conversations with family and close friends are another way to facilitate that planning.

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FACTS VS. FEAR What to know about Alzheimer's disease ARTICLES AND P H OTO G R A P H Y BY G R EEN S H O OT M ED I A

ALZHEIMER’S OR DEMENTIA? Think of dementia as an umbrella term. It’s defined as a decline in mental ability severe enough to interfere with daily life, the Alzheimer’s Association says, while Alzheimer’s is a specific disease and the most common cause of dementia.

WHAT IS DEMENTIA? Dementia is a term that

describes a group of symptoms associated with a decline in memory or other thinking skills. There’s more than one cause of dementia, and patients may have more than one dementia-causing disease at a time.

A common misconception is that dementia is a normal part of aging.

It’s not; it’s caused by damage to brain cells that affects their ability to communicate. While Alzheimer’s accounts for 60-80% of dementia cases, there are other causes, such as Creutzfeldt-Jakob disease, Huntington’s disease, Lewy body dementia, Parkinson’s disease and more.

No matter the root cause, research has shown that maintaining a healthy lifestyle, such as eating properly, not smoking, exercising regularly and getting routine cognitive stimulation can decrease the risk of dementia.

WHAT IS ALZHEIMER’S? Alzheimer’s disease is a degenerative brain disease caused by complex brain damage. The symptoms worsen gradually over time and most commonly affect the part of the brain associated with learning first. This is why, many times, the first symptom of Alzheimer’s is an inability to remember new

information.

As the disease progresses, symptoms get more severe. They can, in time, include confusion, behavior changes and difficulty speaking, swallowing and walking. Other early signs and symptoms to watch for include difficulty planning or solving problems, challenges with completing familiar tasks, confusing times and places, difficulty understanding spatial relationships, losing the ability to retrace steps, poor judgment and withdrawal from activities.

EARLY-ONSET ALZHEIMER’S While most patients affected by

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Symptoms of earlyonset Alzheimer’s

Symptoms of early-onset Alzheimer’s disease are similar to the common form of the disease. They include: • Forgetting things, particularly newly learned information or important dates.

• Asking for the same information over and over.

• Trouble solving basic problems, such as keeping track of expenses or following a recipe.

• Losing track of the date or time.

• Losing track of where you are and how you got there.

• Trouble with depth perception.

• Trouble finding the right word for something.

• Increasingly poor judgment.

• Withdrawal from work and social situations.

Later symptoms of the disease include: • Severe mood swings and behavior changes.

• Confusion about time, place and life events.

• Being suspicious of friends, family or caregivers.

• Trouble speaking, swallowing or walking.

• Severe memory loss.

There are two forms of this more-rare occurrence of Alzheimer’s disease. Most patients who have early-onset Alzheimer’s disease have the common form of the disease. It progresses in about

DIAGNOSIS Diagnosing Alzheimer’s disease can be a difficult and trying journey. Because there’s no one cause for Alzheimer’s at any age, it can be more difficult to diagnose.

Doctors simply don’t always look for Alzheimer’s as the cause of memory problems at younger ages, and may attribute symptoms to stress or other diagnoses.

Early-onset Alzheimer’s is diagnosed by cataloging symptoms and running a few tests. Once a person or friends and family notice early symptoms of the disease, health care professionals may do cognitive tests along with neuropsychological tests, blood tests, urine tests and spinal fluid tests. There may also be CT and MRI tests to see how much damage has been done to the brain.

Getting a correct diagnosis as early as possible can gain patients valuable time to continue to live a full, productive life. You should see your health care professional as soon as you notice symptoms of Alzheimer’s disease. You may start seeing your general practitioner, but then move on to a neurologist or a gerontologist, a doctor who specializes in treating seniors.

While there are no definitive tests for Alzheimer’s before symptoms start, researchers are working to change that. Tests are under development that would measure amyloid, or tau, in a patient’s blood, the Mayo Clinic says.

These tests may be used to pinpoint who is at risk for Alzheimer’s disease and whether Alzheimer’s is the cause of a patient’s dementia. Research is being done, Johns Hopkins says, on biomarkers that will allow experts to diagnose the disease more quickly.

Getting an early diagnosis of Alzheimer’s disease means treatments can start earlier to slow the decline in the patient’s condition. Patients may also be able to participate in clinical trials to treat the disease,

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Alzheimer’s disease are more than 65 years old, the disease can strike people as young as their 30s, 40s and 50s, Johns Hopkins says. This is known as early-onset or younger-onset Alzheimer’s disease.

the same way as it does in older patients.

Genetic, or familial, Alzheimer’s disease is very rare. Patients have genes that contribute directly to Alzheimer’s disease. People with this form of the disease start showing symptoms of the disease in their 30s, 40s and 50s.

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and conversations about future treatments and the patient’s wishes can happen earlier.

Working as a team, caregivers and health care professionals can work with the patient to answer questions and make a plan to maintain their independence, health and safety.

TREATMENTS AND RESEARCH Early-onset Alzheimer’s, like the more common form of the disease, has no cure. But there are some treatments that can help patients maintain mental function and slow the progress of the disease. These include Donepezil, Rivastigmine, Galantamine, Memantine and Lecanemab-irmb.

Physical activity, antioxidants and cognitive training may also slow the progress of the disease, Johns Hopkins says.

The U.S. Food and Drug Administration approved three new drugs in recent months to treat Alzheimer’s disease: • Kisunla (Donanemab): Manufactured by Eli Lily, Kisnula was approved in July for people with early symptomatic Alzheimer’s disease, including mild cognitive impairment and the mild dementia stage of Alzheimer’s disease with confirmed amyloid plaques.

“This is real progress,” says Joanne Pike, Alzheimer’s Association president and CEO. “Having multiple treatment options is the kind of advancement we’ve all been waiting for.”

• Rexulti (Brexpiprazole): Approved last year, Rexulti treats agitation associated with Alzheimer’s disease. The Alzheimer’s Association says around 45% of people living with Alzheimer’s experience symptoms of agitation, including

pacing, gesturing, profanity, shouting, shoving and even hitting.

“People living with moderate and severe Alzheimer’s and other dementia need and deserve treatment that improves the quality of their life, including effective treatments for behavioral and psychiatric symptoms associated with dementia,” says Nicole Purcell, the Association’s senior director of clinical practice.

• Leqembi (Lecanemab): The FDA approved Leqembi in 2023 for the treatment of early Alzheimer’s.

It was the first treatment granted traditional FDA approval that changes the underlying course of

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“This treatment, while not a cure, can give people in the early stages of Alzheimer’s more time to maintain their independence and do the things they love,” Pike says.

“This gives people more months of recognizing their spouse, children and grandchildren.

This also means more time for a person to drive safely, accurately and promptly take care of family finances, and participate fully in hobbies and interests.”

In January, drugmaker Biogen discontinued the drug Aduhelm (aducanumab), which was approved by the FDA via an

accelerated approval process in 2021. It was the first FDA-approved treatment to address an underlying cause of the disease, not just the symptoms, the Alzheimer’s Association says.

Medicare coverage was denied for Aduhelm unless the patient was in a clinical trial, a move the Association says restricted access to the treatment and confused both patients and doctors.

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care. Damage to the brain during this stage of the disease can make it difficult to express thoughts and perform routine tasks. Patients may have trouble getting dressed, jumble their words, and get frustrated or angry. Be patient and try to be flexible and adapt daily routines as needed.

The Association says structure is important during this stage, and workshops and other support can be beneficial for both the caregiver and the patient.

Association says caregivers can expect as the disease progresses.

Early-stage care partnership Early in the disease, many Alzheimer’s patients still function independently. They may still drive, go to social activities and even work.

As a care partner, a term the Association says may be more palatable than caregiver in this stage, be supportive and help the patient make decisions about the future, such as legal, financial and long-term care planning.

Care partners can also coordinate

treatment and participation in clinical trials.

Middle-stage caregiving The middle stages of Alzheimer’s can last for many years, the Association says, and are marked by a progressively greater level of

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Late-stage caregiving This stage, the final one, can last weeks or years. It typically requires intensive, around-theclock care. The patient may have difficulty eating and swallowing and may need assistance and eventually be unable to walk.

Late-stage Alzheimer’s patients are vulnerable to infections, especially pneumonia.

Caregivers should focus on preserving quality of life and dignity for the patient. While the patient may be severely diminished, research shows some core of the self remains. Show care through touch, sound, sight, taste and

smell. Play favorite music and read parts of meaningful books. Look at old photos together or prepare a favorite food.

This stage of caregiving may mean leaving the home and moving into a facility to get the care they need. Families making such a stressful decision may benefit from support from local resources and groups as they navigate this challenging time.

The Alzheimer’s Association stresses that discussions about end-of-life care should take place while the patient still has the capacity to make decisions and share wishes about life-sustaining treatments.

least once. Many states have enacted unique public messages, often called Silver Alerts, to help locate missing seniors. Thirty-seven

SILVER ALERTS In 2006, 68-year-old Mattie Moore, an Alzheimer’s disease patient from Atlanta, disappeared from her home.

Eight months later, her body was found 500 yards from her home. In response, Atlanta created20 Mattie’s nd operated for over years. call, an effort to support city law e andenforcement, L&I Accepted. emergency management and broadcasters to issue an urgent bulletin in the case of a y-Thursday 8 a.m. to 4 p.m. missing senior citizen.

The Alzheimer’s Association says roughly 60% of people living with dementia will wander off at

states (including Washington) and the District of Columbia now have Silver Alert or similar programs in place. A federal program hasn’t yet

been implemented, but there have been efforts in Congress to make it nationwide.

Because the programs vary from state to state, there are different activation criteria depending on where you are. Some states limit Silver Alerts to people over 65 who have been diagnosed with Alzheimer’s disease, dementia or a mental disability. Other states include other adults with mental or developmental disabilities. Across state lines, however, Silver Alerts usually consist of a name and description of the missing person and a description of any vehicle that may be involved.

The Alzheimer’s Association says these are some signs a dementia patient may be at risk of wandering: • Returning from a regular walk or drive later than usual.

• Forgetting how to get to familiar places.

• Talking about fulfilling former obligations, such as going to a regular appointment that they no longer attend or going to work.

• Trying or asking to go home, even when they are at home.

• Becoming restless, pacing or

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making repetitive movements.

• Having difficulty locating familiar places.

• Asking the whereabouts of past friends and family.

• Acting as if doing a hobby or chore, but nothing gets done.

• Appearing lost in a new or changed environment.

• Becoming nervous or anxious in crowded areas.

The Association says caregivers can reduce the risk of wandering by: • Providing opportunities for the patient to be engaged in structured, meaningful activities during the day.

• Identify the time of day the patient is most likely to wander. Some patients experience sundowning, a worsening of symptoms in the early evening. Caregivers can plan to do activities that may help reduce the patient’s agitation.

• Ensure basic needs are met, including toileting, food and hydration.

• Involve the patient in daily activities such as household chores.

• Reassure the patient if they feel lost or abandoned.

• Avoid busy places that can cause disorientation.

• Observe the patient’s response to new surroundings. Do not leave the patient unsupervised if new surroundings may cause confusion or agitation.

ORGANIZATIONS TO SUPPORT Nonprofit organizations help support Alzheimer’s disease patients and their families in myriad ways, including funding research into new treatments, providing funding to keep patients at home, supporting caregivers and more.

Here are some Alzheimer’s organizations to consider supporting from Charity Navigator, a group that evaluates charities.

• Alzheimer’s Drug Discovery Foundation. The Foundation, headquartered in New York, seeks to accelerate the discovery of drugs to prevent and treat Alzheimer’s disease and related dementias.

Donations to this group are tax deductible, and Charity Navigator gives it high marks for culture and community and accountability and finance.

• Alzheimer’s Family Center. This California organization provides

care solutions for patients Monday through Saturday, including therapeutic activities, health and care coordination, counseling, education for families and caregiver support. It is part of the Pickup Family Neurosciences Institute at Hoag, and also offers free memory checkups for the community. Donations are tax deductible and it gets high marks for accountability and finance.

• Alzheimer’s Foundation of America. The foundation provides support, services and education to patients, families and caregivers affected by Alzheimer’s disease and related dementias. While the organization is headquartered in New York City, it serves people across the country. It also funds research to find better treatments and, eventually, a cure. Donations are tax deductible. Charity Navigator ranked it highly in accountability and finance, culture and community, and leadership and adaptability.

• Alzheimer’s Research & Prevention Foundation: Since 1993, this Arizona-based organization has sought to reduce the incidence of Alzheimer’s disease by conducting clinical research and providing educational outreach.

It advances a holistic approach to preventing memory loss and Alzheimer’s. Donations are tax deductible and it gets high marks for accountability and finance and culture and community.

• Alzheimer’s Resource Center: Based in Alabama, this organization seeks to enhance the quality of life, dignity and respect for people with Alzheimer’s disease, their families and caregivers. It conducts educational programs, support groups, advocacy activities and more. Donations are tax deductible. It scored well in accountability and finance.

• Alzheimer’s Disease International: This group aims to build and strengthen Alzheimer’s associations and raise awareness worldwide. It scored well in accountability and finance and donations to this group are tax deductible.

The importance of social connection How loneliness and isolation can undermine our health — and what we can do about it

BY S A N D R A S T R I EBY

The COVID-19 pandemic gave all of us a dose of isolation and the loneliness that can ensue. But for many Americans, loneliness is more than a brief episode — it’s become a way of life.

In 2023, U.S. Surgeon General Vivek Murthy issued an advisory in which he characterized loneliness and isolation as “profound threats to our health and well-being.” They are threats that can affect both physical and mental health —and, fortunately, there are steps we can take to counteract them.

What are loneliness and isolation?

Dr. Ashwin Kotwal, an assistant professor of medicine at the University of California San Francisco, defines loneliness as “the subjective feeling of lacking connection to other people.” Social isolation, by contrast, refers to “having objectively few social relationships.” It’s something that can be measured, while loneliness is an experience that may have little to do with how many relationships a person has.

Although loneliness and isolation are separate phenomena, there can be overlap between them. Not surprisingly, social isolation can lead to loneliness; loneliness can also lead people to isolate themselves.

The flip side of social isolation is social connection, which can also be an antidote for loneliness.

WHY SOCIAL CONNECTION IS IMPORTANT Julianne Holt-Lunstad is a professor of psychology and neuroscience, and director of the Social Connection and Health Lab at Brigham Young University. She was the lead scientific editor of the Surgeon General’s advisory, titled Our Epidemic

of Loneliness and Isolation. “[T]he public perception is that isolation and loneliness are the result of the pandemic,” she said. “And yet, we have evidence of these concerning trends from the American Time Use Survey, that goes back two decades.”

The survey data show that Americans are spending more time alone, and less time with family, friends, and other community members, than we were 20 years ago, said Holt-Lunstad. “[I]t’s not surprising that according to some estimates, roughly one in two American adults report experiencing loneliness,” she said.

According to Holt-Lunstad, social connection is “often seen as nice to have, but not essential.” In fact, she said, it’s critical, because “humans are fundamentally a social species,” and when social needs are not met, biological systems can become dysregulated, impairing normal functions that keep us healthy.

That dysregulation “has been linked to physical health outcomes, including cardiovascular disease, stroke, type two diabetes, mental and behavioral health, including depression and anxiety, suicidality and addiction, as well as cognitive health, including cognitive decline, dementia, and specifically Alzheimer’s disease,” said Holt-Lunstad.

Those risks are serious, says the Surgeon General’s advisory, noting that “The mortality impact of being socially disconnected is similar to that caused by smoking up to 15 cigarettes a day … and even greater than that associated with obesity and physical inactivity” and “Loneliness and social isolation increase the risk for premature death by 26% and 29% respectively.”

Isolation has social costs, as well, increasing spending on health care, reducing productivity, and hampering community well-being and the economy.

Illustration courtesy of Julianne Holt-Lunstad, Brigham Young University.

WHAT WE NEED Being socially connected means more than just having a lot of relationships and spending time with people. Holt-Lunstad stresses the importance of the structure, function, and quality of relationships — what they do for you and how they make you feel as well as how many people you know and how often you see them.

We also need different kinds of relationships, says Karen Fingerman, a professor of human development

and family sciences and director of the Texas Aging and Longevity Center at UT Austin. She describes strong and weak social ties, and says they’re both important.

We tend to focus on strong social ties — those with people who are emotionally meaningful to us, and who support us in our day-to-day lives. But weak ties — with the barista, the librarian, the checker at Hank’s — are important sources of “novelty and stimulation,” said Fingerman, qualities we need “to

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Illustration courtesy of Dr. Ashwin Kotwal, UC San Francisco. keep our brains active.”

Fingerman cited a study that evaluated participants’ close and weak ties over a period of 25 yeas. “[I]t was the weak ties that carried the weight on whether or not you were depressed, whether or not you were lonely over the years,” she said.

She also described her own research, which found a correlation between weak ties and physical activity. “[W]hen [the study participants] were with the weak ties, they were more physically active. … And that makes sense because Americans are incredibly sedentary.

And to be with a weak tie, you at least have to get out of your chair to answer the door. But more often than that, you have to get up and leave your home.”

WHAT WE CAN DO Nurturing both strong and weak ties can make a difference in health, longevity, and quality of life. The Surgeon General’s advisory recommends steps such as minimizing distraction during conversations, seeking help if you’re struggling with loneliness or isolation, and looking for ways to support others and participate in your community.

If people you’re close to seem to be grappling with aloneness, Kotwal suggests starting a conversation with questions like “A lot of people have been feeling lonely recently, is that something you have experienced?” or “Do you need help

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connecting with others?“ Then create space for discussion and offer to brainstorm solutions if that’s something you think the other person will welcome.

Fingerman recommends reinforcing weak ties by letting the people you see from time to time know they matter to you. Her research suggests that “if you do know the guy on the treadmill next to you, wishing them a happy holiday, bringing some cookies to the barista, or the checkout person that you know … may, in fact, make a difference.”

Children and young adults may be particularly vulnerable to loneliness and isolation. The Surgeon General’s advisory reports that, based on research findings, “childhood social isolation is associated with increased cardiovascular risk factors such as obesity, high blood pressure, and blood glucose levels

in adulthood.” Both parents and schools can make a difference for students, according to the advisory.

(See the link below to read specific recommendations.)

The Methow Valley School District (MVSD) does an excellent job of supporting elementary students at school, said Methow Valley Elementary Counselor Keri Moore.

She reports “massive support from [district] leadership” and “an administration that values and sees the positive impact that a well-run school counseling program can have.”

Making sure enrolled students get to school is key, said Moore.

Among students enrolled in MVSD, chronic absenteeism — missing more than 10% of school days in a year — is high, she said. That sets students back both academically and socially.

“Social isolation for elementary students often means not coming to school,” said Moore. Local home-schooling families have a strong network that supports those students, but for children and adolescents enrolled in MVSD “school is where social connection is,” she said. Parents can help by being empathetic but firm about school attendance, and community members may be able to pitch in — if transportation is a challenge, for instance.

At school, Moore and other staff members collaborate to support students in getting their social needs met.

Seniors are another group with special needs related to social connection. Kotwal notes that age exposes people to more risk factors, and some conditions, such as dementia and advanced lung disease, are particularly isolating.

In-person connection is particularly important for seniors, said Fingerman. Phone calls don’t do as much to reduce loneliness among elders. Older adults may use digital technology to enhance close ties, not as a substitute — and they may rely on younger relatives to keep that technology working, she said.

Methow At Home offers seniors a wealth of exercise, community learning, and social support programs — both in-person and online — that can boost connection.

To learn more about how individuals, workplaces, tech companies, the media, governments, and others can support social connection, take a look at the Surgeon General’s advisory, Our Epidemic of Loneliness and Isolation, at https://www.hhs.gov/sites/default/ files/surgeon-general-social-connection-advisory.pdf.

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