Who's in your life?
In Loneliness John Cacioppo and William Patrick discuss the three dimensions of our identities:
personal
relational
collective
These three dimensions translate to a social self:
close friends
extended family and other close groups
large groups and group identities, like nationality or alumni networks
For so many people in intense or long-term caregiving scenarios, their personal identity is lost to their relational identity. They stop being them and become their tie to someone else. Similarly, close friends step back and are replaced by less close relationships with extended family and care providers.
We each have different social needs, but it's hard to not be lonely when we've lost touch with our core identity and the people who once affirmed it.
PS. Later in the book (chapter 6) they use whether or not someone has been admitted to a nursing home as a stand-in for their health, which I think we all know says less about the patient's health and more about the health of their spouse or children! Or perhaps the health of their insurance coverage and bank account balance. All measures are imperfect measures.