The Rt Hon Jeremy Hunt MP in a speech in 2013 referred to loneliness in the UK as ‘our national shame’ highlighting the millions of people who are part of the ‘boarder problem of loneliness that in our busy lives we have utterly failed to confront’ (DOH/Hunt 2013). Loneliness is not just something we feel when we don’t have anyone to talk to, but a state of isolation, depression or abandonment, MIND (2014) call the feeling of loneliness ‘not feeling part of the world’.
Loneliness is not a constant state and recent research suggests that while there is an increase in loneliness with age, older people move in and out of frequent loneliness over time (Dahlberg et al. 2014). Loneliness can affect older men and women differently as for each group there are different predictors and outcomes for loneliness. It may also be difficult to both recognize and admit to feelings of loneliness by the older person who is affected.
Older people are particularly vulnerable to loneliness through a mixture of circumstances including loss of family and friends, lack of mobility, no access to private transport, living alone, increasing disabilities and low levels of income and geographical location for example see Moorley & Corcoran 2014 editorial on older people living in inner cities. Loneliness and social isolation has a negative impact on health and well-being and numerous studies have examined the link between health and loneliness. This includes early admission to residential or nursing care, poorer function in daily activities (DOH/Hunt 2013) and specific poor mental health outcomes such as depression, low life satisfaction and low resilience (Zebhauser et al. 2014).
As with most public health interventions to tackle complex health problems there needs to be a focus at micro and macro levels and thus both individual and community responses to loneliness need consideration. A multi-sectorial response is also important that includes not just health professions but organizations, groups or charities that operate within the community.
A systematic review in 2011 noted that interventions to address loneliness that offer social activity and/or support within a group format, along with interventions in which older people are active participants were found to be the most effective in reducing loneliness (Dickens et al. 2011). Strategies to reduce loneliness may also have an impact on other health domains such as mental health or physical health. For example, programs that use social support to reduce loneliness can reduce rates of depression (Liu et al. 2014).
Other interventions that have shown promise in reducing loneliness include mentoring and befriending schemes (Dury 2014) and social network maintenance and enhancement (Cohen-Mansfield & Perach 2014). The SCIE has produced guidance on reducing isolation and loneliness and they note community befriending schemes and community navigator schemes* are successful (Windle et al.2011). One campaign group that aims to reduce loneliness is ‘the campaign to end loneliness’ which supports organizations who want to tackle loneliness. They also have a comprehensive tool kit and a ‘loneliness harms health’ kit you can download for free (see references).
Environmental barriers can increase loneliness. Rantakokko et al (2014) note that barriers that increase loneliness including weather, hills, distances to services, and difficulties in walking more than 2km. Wider environmental modifications can reduce loneliness so although we cannot change the weather or move hills, we can situate services within local communities and provide groups and club activities or informal meeting spaces in easily accessible venues.
One area that has received attention is the use of the internet and social media, although there are no systematic reviews that examine this area. Generally research is mixed suggesting technology can both reduce and increase loneliness and isolation depending on how it is used. For example Sum et al (2008) found that if the internet was used as a communication tool then there were lower levels of social loneliness, but use of the internet to find new people was associated with higher levels of emotional loneliness.
In summary, older people are at risk of increased loneliness, and with budget cuts in both health and community services the risks around loneliness and isolation may increase. Join the evidence based nursing debate on Wednesday 1st Oct 2014 at 8.00 to consider what health professionals can do to address the challenge of reducing loneliness in older people.
Participating in the EBN Twitter Journal Chat
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*Sometimes called Wayfinder initiatives they use community workers in the local community (i.e. a library or pharmacy) who signpost people to local services i.e. clubs and groups.
References
Campaign to End Loneliness available at http://www.campaigntoendloneliness.org/ the tool kit is available at http://campaigntoendloneliness.org/toolkit/
Dahlberg L, Andersson L, McKee KJ & Lennartsson C (2014) Predictors of loneliness among older women and men in Sweden: A national longitudinal study Aging and Mental Health Aug 15 1-9 [pub]
Dickens AP, Richards SH, Greaves CJ, Campbell JL (2011) Interventions targeting social isolation in older people: A systematic review BMC Public Health 11: 647
DOH/Hunt (2013) the forgotten million available at https://www.gov.uk/government/speeches/the-forgotten-million
Dury R (2014) Social Isolation and loneliness in the elderly: An exploration of some of the issues British Journal of Community Nursing 19 (3) 125-8
Liu L, Gou Z, Zuo J (2014) Social support mediates loneliness and depression in elderly people Journal of Health Psychology Jun 11 [E pub ahead of print]
MIND (2014) Loneliness available at http://www.mind.org.uk/
Moorley, C. R. and Corcoran, N. T. (2014), Editorial: Defining, profiling and locating older people: an inner city Afro-Caribbean experience. Journal of Clinical Nursing, 23: 2083–2085. doi: 10.1111/jocn.12487 Avaiable at http://onlinelibrary.wiley.com/doi/10.1111/jocn.12487/full
Rantakokko M, Iwarsson S, Vahaluoto S, Portegijs E, Vilianen A, & Rantanen (2014) Perceived Environmental barriers to outdoor mobility and feelings of loneliness among community-dwelling older people J Gerontology A Bio Sci Med Sci 26 [epub ahead of print]
Windle et al (2011) SCIE Research briefing 39: Preventing loneliness and social isolation: interventions and outcomes available at http://www.scie.org.uk/publications/briefings/briefing39/index.asp
Zebauser A, Hofmann XL, Baumert J, Hafner S, Lacruz ME et al (2014) How much does it hurt to be lonely? Mental health and physical differences between older men and women in the KORA-Age study. International Journal of Geriatric psychiatry 29 (3) 245-52