When 92-year-old Carolyn Bochau gets a visitor at home, she concedes that she turns into a chatterbox.
Because of health problems and old age, the Baltimore resident doesn't go out for much more than doctor appointments, so she gets excited when she has company. Around the holidays she said she wants companionship even more.
"I can't keep quiet when someone is here," she said. "Because I am always cooped up in here, when someone comes I say everything and anything that comes out of my mouth."
As people age, they start to outlive spouses and friends and become more homebound as their bodies slow down. Feelings of loneliness — and the health consequences that come with them — become more common.
About 29 percent of people age 65 or older live alone, according to the Administration on Community Living, an agency established in the U.S. Department of Health and Human Services to encourage housing choice and community support for older Americans and people with disabilities.
Interaction with others is crucial to positive emotional health. Isolation is associated with higher rates of chronic disease, depression, dementia and death, various studies have shown. Prolonged isolation can be as bad for health as smoking 15 cigarettes a day, according research published last year in the journal Perspectives on Psychological Science.
Detrimental feelings associated with isolation can become more pronounced around the holidays, given the emphasis on celebrating with friends and families.
Senior centers around the region pay more attention to loneliness this time of the year. They host extra activities, such as gift exchanges, caroling and holiday parties. Social workers are more mindful about mood changes in their clients.
"This can be the most difficult time for an old person who is alone," said Dallas Jamison, a spokeswoman with the National Association of Area Agencies on Aging. "What is worse than being alone between Thanksgiving and New Year's than not having family and friends to spend that time with? There are a lot of people out there facing this. It is not an uncommon problem."
The association and the AARP Foundation are running a joint campaign, "Home for the Holidays," to raise awareness about loneliness among the elderly during the holiday season.
As part of the campaign, 622 agencies around the country received promotional materials to help spread the word. These agencies work with seniors in their homes and are often the first to see signs of isolation. They also often provide a lifeline to social interaction by connecting people to activities and programs.
The Baltimore County Department of Aging is one of the agencies taking part in the campaign. It offers activities throughout the year but beefs up offerings during the holidays. It also has a program that sends volunteers to visit with homebound seniors on a regular basis and more frequently during the holidays.
"We want them to have that human connection every now and then," said Joanne Williams, director of the Baltimore County Department of Aging. "The lack of social stimulation and human touch really has an impact on how well people take care of themselves."
Seniors can suffer feelings of loneliness and isolation any time of year, said Dr. Joseph J. Gallo, a professor of mental health at the Johns Hopkins University's Bloomberg School of Public Health. Such feelings can be a sign of depression, along with trouble sleeping, loss of appetite and low energy.
Sometimes health problems sap mobility or enthusiasm for interacting with others, leading to mental health problems, he said. Other times, mental health problems inhibit people from properly caring for themselves. It's important for neighbors, caretakers and medical providers to "interrupt the spiral," he said, and get seniors attention, even professional help.
"It's up to other people in someone's circle to be paying attention," Gallo said. "If someone feels bad, they have to figure out what else is going on."
Some of the elderly might not realize they are missing out on companionship.
Odell Johnson, 90, said she's gotten used to being alone. Her husband died nine years ago and she has no children. Holidays without him were tough at first, but she said that feeling waned with time.
Johnson's niece visits occasionally, but she said most of her interaction with people comes when she goes to the doctor. She used to walk to church but said arthritis in her legs made that difficult. Johnson said she passes the time sleeping or watching television.
She also enjoys her visits with a buddy from the Baltimore County Department of Aging's homebound seniors program. Her buddy is in the military, as was Johnson's husband. Johnson shares stories with her about being deployed to Spain and England and seeing the Temptations and other groups perform on Army bases.
"I miss it when she doesn't come," Johnson said. "I call her house sometimes when she doesn't come and then remember she had an appointment or something."
Those who work with seniors at the Keswick Multi-Care Center in Baltimore said those who live in the nonprofit retirement community's buildings have ready access to social activities. Reaching people who live alone in their homes can be more difficult. Lack of transportation can be a major issue for elderly people who are not very mobile.
Through a new division called Keswick Community Health, the nonprofit now does more community outreach. It provides transportation to a senior center on its grounds that offers social activities. Administrators hope that getting homebound seniors involved can foster improvements in their health.
"What we know is people really need to be engaged in their own life before they can begin to try to improve their health," said Aileen Tinney, executive director of Keswick Community Health. "The more they have a sense of purpose and meaning in their own lives, the more likely they are to work to improve their health on their own."
The holidays have always been a hard time for Bochau. When she was younger and working as a waitress, she often missed Christmas dinner with her family because of her job. Around the holidays she starts to regret that.
Bochau, who can't leave her house without assistance, never married, and the man she dated for many years died several years ago. Her nearest relative is a cousin who lives more than 150 miles away. Sometimes she has Christmas dinner with her cousin's family. But mostly she feels alone during the holidays.
An employee at MECU of Baltimore, a local credit union, heard about Bochau's predicament about a decade ago and began bringing her gifts each Christmas. The employee has since retired, but other MECU staff still bring her goodies.
Thelma Matthews, a MECU assistant vice president and co-chair of the community outreach committee, said it makes her feel good to see Bochau's face light up when she gets the gifts.
"She dresses up for us and puts on makeup," she said. "It is a joy for us to see."
This year they gave her perfume, candy and gift cards. Each year she asks for a perfume that her fiance used to give her, but the MECU employees haven't been able to find it.
Still Bochau is grateful for their visits and looks forward to them each year.
"MECU has been my Christmas," Bochau said, "because I don't have much family."