Posted on Oct 15, 2020 in Editorial.
With the world facing many more difficult months in its battle with Covid-19, the population of elderly people who live both inside and outside care homes will continue to be seriously affected by one of the most mentally debilitating scourges of modern life – loneliness.
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Humans are social animals and while the need for interaction with other humans might diminish with age, it never completely disappears. According to the charity Age UK, around 1.4 million older people in England alone suffer from chronic loneliness and, of course, there are many more who feel lonely either intermittently or to a lesser extent. As people live longer, it is predicted that this figure will increase to two million within the next five years. Furthermore, research by the charity has suggested that as many as 49% of over 65s consider their television and/or pets to be their main form of company, while people reporting a high degree of loneliness are twice as likely to develop Alzheimer’s as those with only a low degree. Loneliness can also lead to depression, anxiety and other negative emotions, as well as a shortened life expectancy.
Loneliness and social isolation are two separate conditions but are linked. While the former involves the lack of interaction with others, especially on a personal level, the latter is related to a more general loss of social contact combined with feelings of non-involvement and disengagement at both community and society level. Health issues, such as hearing and sight loss, can increase the sense of isolation as communication becomes more difficult. Similarly, reduction in mobility can make it challenging for an older person to leave the home to take part in community activities or even to do something as simple as going shopping, something that for many represents a lifeline with the outside world. It is hardly surprising then that low mood and depression are common in older adults who are no longer able to take pleasure in pastimes that had previously boosted their sense of wellbeing.
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As might be expected, those who live alone suffer the most from loneliness but there are many other factors that come into play, such as ethnicity, state of health, residential status and age. Gender also is significant. While both sexes report loneliness, men especially can find it hard to cope alone, especially after the loss of a spouse or partner. Research carried out by Dr Paul Willis of Bristol University showed that men have a particularly strong perception of having been socially discarded and left without a purpose in life. It suggested too that men are less likely to seek support for their loneliness, as to do so might be considered a sign of weakness and an inability to cope with life. Older men also tend to want to spend time with other men like themselves rather than in mixed groups and, in fact, this has led to the growth of a very successful programme called Men in Sheds that has been established internationally and aims to bring older men together at a local level to socialise and, through activities, learn and share skills and knowledge.
In contrast to men, women usually show a preference for contact with individuals over taking part in group situations and are more willing to admit to feeling lonely. However, men are more likely than women to confess to having feelings of social isolation, possibly because this, in their eyes, carries less stigma. The results of the research suggest that older men prefer to take part in activities with a social element, while women tend to look for personal interaction over activity.
Of course, there is no ‘one size fits all’ solution to loneliness in older people, as each individual has his or her specific needs and it would also be unwise to stereotype according to age, gender or any other characteristic. However, older men have been shown to enjoy taking part in projects that engage the mind and have a definite goal that ultimately leads to a sense of achievement. Women, on the other hand, seem to benefit most from opportunities that allow for discussion of feelings, experiences and personal relationships.
Finding a solution to loneliness in older people is never going to be easy but there are plenty of ways to provide help. Befriending schemes in particular have been shown to be very effective at boosting the self-esteem of lonely older adults, not simply by providing the chance to talk but also because the participants can become listeners too, perhaps offering useful advice or opinions. After all, conversation is a two-way street.
In the fast-moving modern world, with its many horror stories, older people can often find it difficult to know whom to trust so that being able to talk openly in a relaxed manner to someone who has come to them through a trustworthy and reliable source can be extremely important. For the very elderly who have limited community engagement, a visit by an individual who is not a family member is especially valuable, as the relationship is completely independent. In fact, older people who have used a befriending service have reported an improved sense of wellbeing and quality of life, as well as a greater peace of mind, as they know there is another human being who is interested in them as a person and is looking out for them. In addition, as a further benefit, a befriender who sees the older adult on a regular basis is likely to pick up on any potential problems or issues that might require professional assistance from medical or other specialist services.
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Interestingly, research has shown that the quality of social interaction is more important to the individual than its frequency and this is the strength of befriending. Emotional support is paramount so that a weekly visit that involves plenty of chatting is more rewarding to the individual than, for example, daily ones for routine tasks such as meal preparation, cleaning or personal care. Thus, the older adult who has a regular carer to perform various duties but has no one to talk to on an informal one-to-one level can still suffer from high levels of loneliness, as can the resident of a care home.
The full extent of the effects of the Covid-19 isolation are yet to be seen in the older population but there is no reason to think that they will be any less profound than those experienced by younger people. Although the younger generation might struggle to accept a reduction in their freedom to go wherever they want, to do whatever they want, with whomever they want, the self-shielding and very restrictive measures recommended to older people, who might already be suffering from early or established states of loneliness and depression, must inevitably lead to feelings of isolation.
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A number of loneliness interventions are being developed based on research that hopes to identify those approaches that are likely to be the most effective, although strong evidence to support these programmes is still patchy. However, two things are clear – first, that loneliness in older adults is a major problem in society today and, second, that the best intervention of all is, without doubt, contact with another human being.
Maintaining contact with people living alone, even if it can only be via video or phone, should be something we all do on regular basis. Something as simple as a few words of kindness or a box of chocolates can make all the difference to the recipient. These small, but greatly appreciated, gestures show that we care.
Enabling or assisting an elderly relative to undertake a project that is both fun and engaging can also boost the mental wellbeing of that person and this is where a LifeBook project can prove so valuable. Feedback from our past and current authors, particularly in the current challenging times, confirms the sense of purpose and the joy of remembering times past achieved through working on such a project. Importantly, the associated interaction with family members and the LifeBook team is reported as being especially beneficial to our authors.
With the dark days of winter approaching and the possibility on the horizon of further Covid-related restrictions on meeting with others, there can surely be no better time for you or your loved one to start a LifeBook?
By Halima Crabtree
Based on research carried out on behalf of Age UK, the Campaign to End Loneliness and Independent Age.
(Main photo by Sasha Freemind on Unsplash)