Loneliness is a risk factor for overall mortality and conditions such as stroke and heart disease. It is also associated with depression and anxiety. And with the COVID-19 pandemic, there has been great concern about increased isolation and its effect on loneliness and other mental health conditions. For older adults who are more socioeconomically vulnerable, that risk increases. One way to overcome that isolation and loneliness is though empathy-focused telephone calls, says a recent study.

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Published in JAMA Psychiatry, the “Effect of Layperson-Delivered, Empathy-Focused Program of Telephone Calls on Loneliness, Depression, and Anxiety Among Adults During the COVID-19 Pandemic,” uncovers the emotional and psychological impact of the pandemic on older adults. From July 6 to Sept. 24, 2020, there were 240 adults—with the average age of 69—assigned to receive calls. These were Meals on Wheels Central Texas clients who were homebound and expressed a need for food.

Sixteen callers between the ages of 17 and 23 received brief training on empathetic conversational techniques. Each person called six to nine participants over the course of four weeks—daily for the first five days, followed by the option to drop to fewer calls. With layperson delivered, empathy-oriented phone calls, loneliness, depression and anxiety were reduced within four weeks.

“We were actually getting prepared to launch a program and related trial on the impact of medically tailored meals and social connection on an older population,” said Maninder K. Kahlon, PhD, associate professor in population health and vice dean of the Health Ecosystem at Dell Medical School at UT Austin. But when “COVID struck, we couldn’t actually launch the program.”

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“Meanwhile, right in front of us was this huge need where these folks were losing whatever connection they had as Meals on Wheels reoriented to this new reality,” said Kahlon. “We took some of the ideas we’d been developing specifically around empathetic connection and said, ‘Look, now more than ever people need it.’”

In a discussion, Kahlon shared how to approach empathy-focused phone calls works to reduce loneliness, depression and anxiety among older adults.


“Our training was very light, but it was important. Our main piece was the orientation on the purpose of the call,” said Kahlon. “The focus of the calls were for the caller to learn about the other person and to prioritize whatever it was that the person they were calling wanted to prioritize.”

“The bottom line is, you’re listening as much as possible,” she said. “This focus on learning from the other person was a way for us to provide these guidelines to say that if you’re talking too much, then you’re probably not learning about the other person.”

“At the end of this time you should feel like you really learned about the other person—you learned what they like, what they were interested in,” said Kahlon.

Getting the person on the other line to talk and share more about themselves is not easy.

“The challenging part is how do you have a conversation where you get the other person to share?” Kahlon said, adding that coauthor Steven Tomlinson, PhD, “taught us all techniques  on following the clues so that you are really listening to what the person’s saying.”

For example, “if someone mentioned their neighbor, ask them about their neighbor,” she said, adding that “listening to those clues allows you to ask very specific questions—not abstract questions—about the content that they’re already telling you.

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“They’re giving you clues about what they want to talk about—it’s just your job to figure out what they really want to discuss,” Kahlon added.

While there are church and student groups putting together empathy-focused calling programs, it is important to identify some tips and trips.

First, “we gave people the reigns,” Kahlon said. That means letting the person on the receiving end “choose how many times a week they want to be called.”

“Little things like that gives us agency,” she said, adding that these “pieces really helped get us the scale of results that we got.”

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