Key information on loneliness and social isolation

Introduction


The majority of older people are not severely lonely, but current research indicates that about half of older New Zealanders experience some level of loneliness, and 8-9% feel lonely all or most of the time. This is important, not just because loneliness is painful, but because having inadequate social relationships has been shown to be as bad for health as smoking. Loneliness has also been linked to increased likelihood of entering rest home care.

The good news is that there is growing information on effective interventions to reduce loneliness and social isolation, and greater understanding of how people can build resilience to prevent loneliness, or help themselves if they find that their social networks are not meeting their needs. If you are feeling lonely and need some help, please click here. 

If you are feeling lonely


It’s important to do something about it. One simple step is to contact your local Age Concern to find out about social activities and services for older people in your area or volunteer roles within Age Concern.

This article suggests ways to combat loneliness and depression, and discusses how the two experiences are linked.

One of the lead researchers on loneliness and social isolation offers a plan of action for people looking to ease their way out of loneliness (Cacioppo, 2008).

This UK resource also provides suggestions about steps we can take if we are feeling lonely (Joseph Rowntree Foundation, 2013)

 

Getting an overview


In the UK, loneliness has been identified by both NGOs and government as a key issue for older people, and Age UK commissioned a comprehensive overview of knowledge on the subject (Age UK Oxfordshire, 2012)

The report, “Promising approaches to reducing loneliness and isolation” produced jointly by Age UK and The Campaign to End Loneliness was published on the Campaign to End Loneliness in January 2015.

It is described as follows:

Drawing on the expertise and experience of leading figures in the field as well as academic research, the report aims to identify the most promising approaches to tackling the problem. It showcases a range of projects and examples from around the country, demonstrating the many, varied solutions needed for an effective response to a very personal problem.

Crucially, the report argues that commissioners must recognise the complex and individual experience of loneliness and should not seek a ‘one size fits all solution’.  In fact, it should be the ambition of every local authority to ensure access to a full menu of interventions that help those who are lonely and to recognise the role many different types of services can play in responding to the issue.


Another review article provides an Australian perspective (Grenade & Boldy, 2008). Available here: http://www.publish.csiro.au/?act=view_file&file_id=AH080468.pdf

Prevalence of loneliness


The NZ social report 2016 shows that young people experience the highest rates of loneliness. Younger old people (65-75) have lower rates than any other age group, but the prevalence of loneliness rises again in the 75+ age group. Other factors associated with loneliness in this report are: being female, having a low income, being a migrant, identifying as Asian or Maori, not living in a family nucleus, and being a sole parent. See below:
http://socialreport.msd.govt.nz/social-connectedness/loneliness.html

These findings align with those of this 2014 UK study:
http://centreforum.org/publications/ageing-alone-loneliness-and-the-oldest-old/ which reports high rates of loneliness in the oldest old (85+). Findings from this study are that bereavement, living alone, limitations in mobility, being a woman, and difficulty in performing everyday tasks are factors associated with loneliness within the older old age group.

A  New Zealand study surveyed 332 community-dwelling older people using the De Jong Gierveld 11-point loneliness scale. 8% of the sample was severely lonely, and 44% moderately lonely. Both lonely groups scored lower on self-reported health measures than the not lonely group (La Grow & Neville, 2012). Abstract available here: http://www.ncbi.nlm.nih.gov/pubmed/22676172

Auckland Council commissioned a study which found that 9% of Auckland residents aged over 50 were severely lonely, and 44.5% moderately lonely. This study also used the De Jong Giervald 11-point loneliness scale, which includes items relating to both emotional (lack of a close confidant), and social (limited social network) loneliness (Auckland Council, 2012). Available here: http://www.aucklandcouncil.govt.nz/EN/planspoliciesprojects/reports/technicalpublications/Documents/aucklanders50andoverfullreport.pdf

The above findings are similar to those from studies conducted in Western Australia, Northern Europe, the US, and the Middle East (Grenade & Boldy, 2008). They also equate to UK findings that around 10% of people over 65 are lonely all or most of the time (Age UK Oxfordshire, 2012).

The New Zealand General social survey found that loneliness decreases with age (Statistics New Zealand, 2010), but the survey report  groups people over 65 into one age bracket, so does not demonstrate whether or not loneliness increases sharply after age 80, as has been shown  in research overseas (Age UK Oxfordshire, 2012).

Health effects of loneliness and social isolation


A meta-analytic study found that people with adequate social relationships have a 50% greater likelihood of survival when compared to people with poor or insufficient relationships. This effect is comparable to stopping smoking, and greater than the effect of risk factors such as obesity or inactivity (Holt-Lunstad, Smith, & Layton, 2010). Available here: http://www.plosmedicine.org/article/fetchObject.action?uri=info%3Adoi%2F10.1371%2Fjournal.pmed.1000316&representation=PDF

A US review article on the health effects of loneliness collates evidence showing that loneliness is a risk factor for a range of physical, mental, and emotional health issues including raised blood pressure, cardiovascular disease, depression, cognitive decline, and Alzheimer’s disease. The authors state, “Overall, it appears that something about our sense of connectedness with others penetrates the physical organism and compromises the integrity of physical and mental health and well-being.” This article also discusses the mechanisms by which loneliness affects health (Hawkley & Cacioppo, 2010). Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874845/pdf/nihms538929.pdf

The cost of loneliness

This UK discussion paper provides an analysis of the impact of loneliness on public sector resources, and reports on a social investment model used to design and deliver services to alleviate loneliness amongst older people in Hereford and Worcester, UK: http://www.socialfinance.org.uk/wp-content/uploads/2015/06/Investing_to_Tackle_Loneliness.pdf

The ASPIRE trial, which assessed services promoting independence and recovery in elders showed that loneliness almost doubles the likelihood that an older person will enter residential care (University of Auckland, 2006). Available here: 
https://www.health.govt.nz/system/files/documents/pages/aspire-research-report.pdf

The results of a UK survey indicate that at least 1 in 10 visits by older people to their GP appear to be motivated mainly by loneliness (Campaign to end loneliness, 2013). Available here: http://www.campaigntoendloneliness.org/blog/lonely-visits-to-the-gp/

Community action


The Joseph Rowntree foundation in the UK has published an online resource pack to help individuals, groups, neighbourhoods, and communities to understand and reduce loneliness. The information is based on a 3-year action research programme, and includes an evaluation report (Joseph Rowntree Foundation, 2013). Available here: http://www.jrf.org.uk/publications/loneliness-resource-pack

Evaluation of interventions to reduce loneliness


In 2015, Age UK and the UK “Campaign to End Loneliness” jointly published the following guide, which offers a framework for understanding approaches to reducing loneliness that show promise of effectiveness, and provides examples of the different types of intervention: http://www.openage.org.uk/sites/default/files//Promising-approaches-to-reducing-loneliness-and-isolation-in-later-life.pdf .

This was followed by a further report in 2016 describing how the framework has been applied in practice to develop and test ways of offering more targeted approaches to improve quality of life for older people at risk of loneliness:
http://www.ageuk.org.uk/documents/en-gb/services/loneliness/testing_promising_approaches_to_reducing_loneliness_report_2016.pdf?dtrk=true

A 2011 review cited evidence that: 

- Social group interventions increase survival
- Community navigation interventions are effective at identifying those who are lonely and at reducing loneliness
- Befriending interventions make people feel less lonely and isolated
- Community navigation and befriending schemes can be cost-effective

(Social Care Institute for Excellence, 2011). Available here: http://www.scie.org.uk/publications/briefings/briefing39/

The Ministry of Health conducted a review of befriending services in New Zealand in 2004. Conclusions from this study were that befriending services offer an invaluable means to improve social connectedness and decrease loneliness, and that these services should continue. The report recommends that befriending services should demonstrate the following: Reliability, Compatibility, Reciprocity, Intimacy, and Support. Available here: http://www.health.govt.nz/system/files/documents/pages/an-evaluation-of-befriending-services.pdf  

 

Who is lonely?

The following have been identified as risk factors for loneliness amongst older people (Age UK Oxfordshire, 2012):

  • Low income
  • Living alone
  • Being of an ethnic minority
  • Being gay or lesbian
  • Being over 80
  • Poor health and disability
  • Reduced mobility
  • Cognitive and sensory impairment
  • Living in deprived urban, or isolated rural area

    In the New Zealand General Social Survey, loneliness amongst older people has been strongly linked to low income (Statistics New Zealand, 2010).