Emil Girardi moved to San Francisco on New Year's Eve in 1960. He loved everything about the city: the energy, the people and the hills. And, of course, the bars, where Girardi mixed drinks for most of his adult life.
About 10 years ago, the 83-year-old New York native had a stroke and collapsed on the sidewalk near his Nob Hill home. Everything changed.
"I didn't want to go out of the house," Girardi recalled, adding he only felt comfortable "going from the bedroom to the dining room."
He'd started to fear the city's streets — and growing older.
An out-of-state friend worried about his isolation and called a San Francisco-based nonprofit called Little Brothers, Friends of the Elderly. The organization works to relieve isolation and loneliness among the city's seniors by pairing them with volunteers.
Little Brothers matched him with Shipra Narruhn, a computer software trainer who has volunteered with various organizations over the years, and became involved with Little Brothers after her mother's death. The organization started in France after World War II and now operates in several U.S. cities, including Chicago, Philadelphia and San Francisco.
Cathy Michalec, the executive director of the local nonprofit, said older adults often become less mobile as they age. Cities like San Francisco, because of hills, crowded streets or old housing stock, are difficult for many seniors. That can lead to isolation and loneliness, Michalec said.
"Those 50 stairs you used to be able to go up and down all the time, you can't go up and down all the time," she said. "The streets are crowded and sometimes unsafe. ... Sometimes, our elders say, it's easier to stay in the house."
Across the nation, geriatricians and other health and social service providers are growing increasingly worried about loneliness among seniors like Girardi. Their concerns are fueled by studies showing the emotional isolation is linked to serious health problems. Research shows older adults who feel lonely are at greater risk of memory loss, strokes, heart disease and high blood pressure. The health threat is similar to that of smoking 15 cigarettes a day, according to AARP. Researchers say that loneliness and isolation are linked to physical inactivity and poor sleep, as well as high blood pressure and poor immune functioning.
A 2012 study showed that people who felt lonely — whether or not they lived with others or suffered from depression — were at heightened risk of death. It also showed that 43 percent of people over 60 felt lonely.
"If someone reports feeling lonely, they are more likely to lose their independence and they are at greater risk of dying solely from being lonely," said Dr. Carla Perissinotto, a geriatrician and researcher at the University of California, San Francisco who authored the study.
There can be many causes of loneliness, Perissinotto said, including illness, hearing loss or life changes such as retirement or the loss of a spouse. "The usual social connections we have in younger life end up changing as we get older," she said.
Narruhn recalled that she and Girardi would just visit at his apartment, in the beginning. She'd tell him about her travels and her adult daughter. He'd tell her about his adventures in San Francisco. He described what the city was like as a young gay man, and told her about the friends he had lost to AIDS. They talked about music, books and cooking.
"I could tell from talking to him that he had a lot of interests," she said. "At one time, he was very sociable."
Gradually, Narruhn started bringing him music from Italy, India and Mexico. Girardi liked the songs he could snap his fingers to. Finally, Shipra convinced him to go out to lunch — and to visit a hidden, tile-covered staircase in San Francisco with her.
"Shipra came to see me, and came to see me and came to see me," he said. "Finally, she said, 'You have to get out of the house.'"
Soon, they were going to jazz shows, on walks and to the park. Narruhn said she invited Girardi to do eclectic things with her — chakra cleansings, Reiki healing sessions — and he was always game. Over time, his fear subsided. So did his loneliness.
"After she took me out of the house, then I didn't want to stop," Girardi said.
There isn't much research about the effectiveness of programs such as Little Brothers. But Perissinotto said they can help seniors build new social connections. Other efforts to address loneliness include roommate matching services in various states and, in the United Kingdom, a call-in hotline.
"Maintaining connections, that touchy-feely thing, is actually really important," Perissinotto said. "It's hard to measure, it's hard to quantify, but there is something real. Even though we don't have the exact research, we have tons of stories where we know it's [had] an effect in people's lives."
AARP Foundation also recently launched a nationwide online network to raise awareness about social isolation and loneliness among older adults. The network, Connect2Affect, allows people to do a self-assessment test and reach out to others feeling disconnected.
AARP, the Gerontological Society of America and other organizations are hoping to help create more understanding of isolation and loneliness and to help lonely seniors build more social connections.
"Loneliness is a huge issue we don't talk enough about," said Dr. Charlotte Yeh, chief medical officer of AARP Services. "There is a huge stigma."
One afternoon in November, Narruhn came by to take Girardi out to one of their favorite restaurants on Polk Street. The waiter greeted them by name. Over Italian food, they planned several more visits together.
Girardi said he doesn't fear growing older anymore. He's surrounded by his new family. And by good music, he said, and "snapping fingers."
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. You can follow Anna Gorman on Twitter: @annagorman.
LOURDES GARCIA-NAVARRO, HOST:
Being lonely is difficult for people of any age, but it can be especially harmful for seniors. Isolation for them is linked to shorter life spans and illness. Anna Gorman of Kaiser Health News reports from San Francisco on one effort to help them feel more connected.
ANNA GORMAN, BYLINE: Eighty-three-year-old Emil Girardi lives in Nob Hill just off the cable car line.
(SOUNDBITE OF CABLE CAR BELL)
GORMAN: His friend Shipra Narruhn is here to visit him. She hops on an antique elevator to the sixth floor. They have plans to eat lunch at their favorite Italian restaurant.
SHIPRA NARRUHN: Hi, Emil. How are you doing?
EMIL GIRARDI: Hi, Shipra.
NARRUHN: (Laughter) Good to see you. Big hug.
GORMAN: Shipra and Emil became friends about six years ago. They were paired by a group called Little Brothers - Friends of the Elderly. It's designed to reduce loneliness by matching seniors with volunteers. Before meeting Shipra, who's 67, Emil spent years feeling trapped in his apartment.
GIRARDI: I didn't want to go out of the house. I was very comfortable going from my bedroom to the dining room. That was my day.
GORMAN: Researchers say that puts seniors at greater risk of memory loss, strokes and high blood pressure. It can be as bad for their health as smoking 15 cigarettes a day. Carla Perissinotto is a geriatrician at UC San Francisco.
CARLA PERISSINOTTO: What we know about loneliness is that if someone reports feeling lonely, they are more likely to lose their independence and they are at greater risk of dying.
GORMAN: Loneliness is often caused by life changes common in older adults - retirement, the loss of a spouse, children moving away.
PERISSINOTTO: The usual social connections we have in younger life end up changing as we get older.
GORMAN: There isn't much research on how to solve the problem, but Perissinotto says groups like Little Brothers can help seniors build new social connections. It's now in seven U.S. cities. San Francisco director Cathy Michalec says the home visits are key, especially for seniors who can't get around so well anymore.
CATHY MICHALEC: As you age, your mobility isn't the same. So those 50 stairs that you used to be able to go up and down all the time you can't go up and down all the time.
GORMAN: And that can lead to loneliness.
MICHALEC: Our elders just say, well, it's easier to stay in the house.
GORMAN: Emil spent most of his adult life mixing drinks at San Francisco's bars. His nickname was Tony Lasagna.
GIRARDI: Of the 32 years that I was a bartender, every one of those days was spent in a bar whether I was working or not.
GORMAN: He loved the city - everything about it.
GIRARDI: The atmosphere, the energy. And it's nonstop, 24 hours. I've done it.
GORMAN: But that changed after he had a stroke and collapsed on the sidewalk. The city's streets started to scare him. At first, Shipra said they would just visit at his apartment.
NARRUHN: I can tell from talking to him that he had a lot of interests.
GORMAN: She started bringing him music. He likes the ones he can snap his fingers to.
(SOUNDBITE OF MUSIC, SNAPPING)
GORMAN: Finally, Shipra convinced him to go out to lunch.
NARRUHN: After that, it was kind of fun for me to think of things to do with him. And I have very eclectic tastes. Anything I suggested, he was open for it.
GORMAN: Over time, his fear subsided, and so did his loneliness.
GIRARDI: After she took me out of the house, then I didn't want to stop.
GORMAN: This afternoon at the Italian restaurant, the waiters greet them by name.
NARRUHN: Do you see something on the specials that you're interested in?
GORMAN: Emil says he's not afraid of getting older anymore.
GIRARDI: I'm surrounded with love. I'm surrounded with snapping fingers (laughter).
GORMAN: And for Shipra, She says Emil is part of her family.
I'm Anna Gorman in San Francisco.
(SOUNDBITE OF SONG, "LA MER")
CHANTAL CHAMBERLAND: (Singing in French). Transcript provided by NPR, Copyright NPR.