Why Calling Mom or Dad Is Not the Same As Visiting

A study found people receiving in-person visits were less likely to become depressed

Phoning or emailing an older relative is a good way to stay in touch but it doesn’t have the same positive impact as stopping by for a cup of tea or an intimate chat.

So finds a recent study in the Journal of the American Geriatrics Society that examined how older adults respond to different types of contact. Specifically, the study looked at depression, analyzing over 11,000 adults in their 50s, 60s, 70s and above.

Were older adults who received regular visits from family and friends less likely to be depressed years later than those who received regular phone calls and emails? Yes, and higher amounts of face-to-face contact were associated with lower levels of depression, researchers discovered.

“It’s a remarkably intuitive finding,” said Dr. Alan Teo, the report’s lead author and an assistant professor at Oregon Health & Science University in Portland. “Most of us feel that the time we spend together, in person, with family and friends seems more fulfilling.”

Study Findings

Here’s the data: About 11 percent of older adults who saw family and friends every few months or less were at risk of developing symptoms of depression two years later. By contrast, those who got visits once or twice a week had a roughly 7 percent chance of becoming depressed. For those with in-person encounters three times a week or more, the risk of depression dropped to about 6 percent.

The frequency of telephone contact didn’t have the same impact: when friends and family called more often, older adults weren’t any more or less likely to feel depressed. Nor did the amount of email contact appear to make a discernable difference.

Although this study didn’t examine Skype, the bottom-line conclusion is almost surely the same: Nothing substitutes for in-person contact with older adults, Teo said.

Altogether, face-to-face contact carries more information that allows someone to make a better assessment of the person they’re with.

— John Cacioppo, University of Chicago

Does it matter who is visiting? Yes, researchers found.

“For those in their 50s and 60s, social contact with friends may be particularly important in preventing future depressive symptoms,” they wrote. “In contrast, results in those aged 70 and older suggest that frequent contact with children or other family members is protective against depression.” The exception: When children visit, an acrimonious relationship can heighten the risk of depression, the authors said.

Wired for In-Person Contact

John Cacioppo, one of the world’s leading experts on loneliness and director of the Center for Cognitive and Social Neuroscience at the University of Chicago, offered an explanation: “Through evolutionary history, human brains have been designed for actual face-to-face contact. We’re a social species.”

We read other peoples’ expressions better when we’re in their presence and are better able to evaluate their emotions and intent, Cacioppo elaborated. We pick up clues about peoples’ mental state from their posture — where they’re leaning in or out, relaxed or tense.

Someone’s tone of voice — does she sound warm or distant? — is easier to appreciate when we’re with her, Cacioppo added. And people are better able to synchronize physical responses, for instance when they go on a walk and move together at the same pace, which has a calming effect.

“Altogether, face-to-face contact carries more information that allows someone to make a better assessment of the person they’re with,” Cacioppo said. “Is this person being authentic? Are they telling me the truth? Are they likely to help me? Do they value me?”

Hormones Activated

Susan Pinker, author of The Village Effect: How Face-To-Face Contact Can Make Us Healthier, Happier, and Smarter, summarized a large body of evidence linking face-to-face contact with improved health and longer life spans in that book.

When we’re with someone and contacts are pleasurable or comforting, neurotransmitters and hormones such as oxytocin are released, lifting mood, reducing stress and giving a boost to our immune systems, she said.

Those effects are often enhanced by the tendency to give a hug, pat someone on the arm, or put a hand on a shoulder when we’re with them — an impulse to touch shared by many primate species.

“Face-to-face contact has a huge impact on health — it’s even more important than getting a flu shot or eating a healthy diet — and it’s free,” Pinker said.

‘A Hug Is More Than a Kiss’

“There’s a tendency for us to lump all forms of contact together, but they they’re not really created equal,” she continued. What people really want and need is a sense of intimacy, and in-person contact is more likely to foster this than contact over a distance, made possible by technology.

Irene Roberts, an 87-year-old widow who lives in Manhattan agrees wholeheartedly with that assessment. She put it this way: “There’s an emotion that you feel when you’re with another person. There’s a warmth that you don’t feel on the phone.”

More than anything else, Roberts enjoys a chance to hug her two daughters, who live in Queens and North Carolina, when they visit. “To me, a hug is more than a kiss. A kiss, you can keep your bodies apart. A hug, you’re so close — and that’s wonderful.”

Emails are faster than arranging get-togethers and phone calls are easier, but Skype is second best to in-person because it allows you to see someone, said Roberts, who tries to make sure she sees a friend or a close acquaintance six days a week.

Seeing Is Believing

Sometimes you learn things from an in-person visit that you wouldn’t learn any other way. This really hit home for Jane Wolf Waterman, a social worker, coach and founder of Parenting Our Parents, an online community for caregivers, on a trip to visit her then 85-year-old parents eight years ago.

Her mother and father had both sounded fine when she talked to them over the phone earlier in the week. But when she met them for dinner, her mother was disheveled and could barely put whole sentences together, while her father seemed drained and exhausted. Ultimately, it turned out both of Waterman’s parents had pneumonia but hadn’t wanted their daughter to worry.

“The capacity of people to camouflage over the phone is extraordinary,” Waterman said. “And older people often don’t want their children to know what’s really going on because they’re concerned about having their lives taken over.”

Every Little Bit Counts

But what if a son or daughter lives 3,000 miles away, as Waterman did, or even 100 miles? What if work schedules don’t permit frequent visits by plane or train? What then?

Teo has confronted the issue with his 79-year-old father, who lives in Indiana, more than 2,000 miles away. “If my two brothers and I each see him a few times a year and then he visits regularly with other people, that’s enough to make a difference,” he said. “The takeaway from our study is that every step I take to have more face-to-face contact makes a difference. And this is something that everyone who’s caring for an older person should build into their routines, whenever possible.”


Judith Graham
By Judith Graham
Judith Graham is a contributing writer to Kaiser Health News and Next Avenue.

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