Two weeks after slipping on a rug and breaking her leg in December, Terry Doyle insisted the physical pain from her injury did not compare with the mental anguish of spending another holiday alone.

"On a scale of one to 10, the pain of being alone is a 10," said Doyle, 69, teary-eyed, from her bed in the Good Samaritan Society nursing home in Robbinsdale.

Years of solitude have taken their toll on Doyle — and on many of the estimated 226,000 older Minnesotans who live alone.

The dangers of prolonged isolation are getting an unprecedented amount of attention this year. Social service agencies throughout the Upper Midwest are hosting parties, delivering home-cooked meals, and visiting senior centers in an effort to combat loneliness and isolation. As part of the public campaign, more than 620 agencies nationwide will be helping seniors assess their risk of isolation and connect them with services.

But loneliness is an inherently challenging problem to confront.

For one, the experience of being lonely is a subjective emotional state, which makes it difficult to quantify and treat, researchers say. Some older people actually prefer to be alone, while others with many social contacts crave more meaningful relationships, studies have found. There is also the unspoken stigma of loneliness, which makes it difficult for seniors to admit their own feelings of abandonment.

Loneliness is subtly evident in the range of calls made to Minnesota's Senior LinkAge Line for services. Often, older people call the line asking for the name of a person they spoke with the day before — and it's evident they really crave a conversation with a real person, said Dawn Simonson, executive director of the Metropolitan Area Agency on Aging, which operates the senior linkage line for the seven-county metro area.

"Sometimes, they just want to talk," she said.

Even broaching the issue of loneliness can be difficult. Sandy O'Donnell, an elder advocacy director for Little Brothers — Friends of the Elderly, a Minneapolis nonprofit focused on relieving isolation, has seen older people break down in tears over simple questions such as, "How lonely have you felt over the past few days?" O'Donnell said that, in recent years, she has been to area funerals where not a single family member is present, and the only other people at the grave site are a county social worker and a minister.

"Our entire American culture revolves around this idea of privacy and respect for one's individual space," said Tetyana Shippee, a sociologist at the University of Minnesota who studies aging and social isolation. "People don't want to impose, and it's difficult to get beyond that."

Path toward isolation

Doyle attributes much of her current isolation to her upbringing. Her father was a heavy equipment operator, and the family would move every time he landed a new job. Doyle recalls attending 20 schools in 12 years as a child. Because of her family's itinerant lifestyle, Doyle became wary of forming deep relationships that would later be torn apart, she said.

Decades later, when her children were teenagers, Doyle was diagnosed with bipolar disorder, a mental illness marked by severe mood swings. Often unable to control her emotions, Doyle would occasionally lash out at her children, and behave in ways that embarrassed them in public, she said. Her youngest son and daughter stopped calling her — even on holidays.

"They have cellphones and very, very busy lives," Doyle said of her children, her voice quavering with emotion. "And to them, my mental illness is a source of major shame. They just slither around it, like it's poison ivy."

The holidays have always been a tough time for Doyle. Because of dissension among her children, the family no longer gets together for a holiday meal. Each Christmas brings back memories of her years as a young parent in southwest Michigan, when she would take her children to their grandparents' for a turkey dinner with mincemeat pies. "Grandma always had the best pie crust in the county," she said. "But those are the good things that don't exist in my life anymore."

Her only real connection to the community is through the nonprofit Little Brothers — Friends of the Elderly. Eight years ago, she spotted the agency's phone number on a passing van and scribbled it down while traveling on Metro Mobility. Through the agency, she has since built a "phone tree" of about 18 other senior citizens who can reach out and call each other at times of loneliness. "Sometimes, it's just nice to hear another voice when you feel like you're the only person in the world who is lonely," she said.

This holiday season, Doyle hatched another plan for dealing with her loneliness. Late in the morning on Christmas Day, she planned to pull on her bright-blue reindeer slippers and maneuver her wheelchair through the wide corridors of the nursing home while shouting, in her husky voice, "Merry Christmas and Happy New Year!" to every person she saw.

"No one will be spared," she vowed earlier, laughing. "Because everyone needs to know that someone cares."

Twitter: @chrisserres