Emil Girardi moved to San Francisco on New Year's Eve in 1960. He loved everything about the city: the energy, the people, the hills. And of course, the bars, where he 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 said, adding he only felt comfortable "going from the bedroom to the dining room."
He 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 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 their hills, crowded streets and old housing stock, are difficult for many seniors. That can lead to isolation and loneliness, she 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," said Michalec. "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 it 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.