Loneliness Across the life-span

1. Thursday 10th of July 2014 LonelinessAcross the life-span Jolanthe de Koning PhD student at the University of Bath PhD focus: Social well-being and active lifestyles of older adults in rural Britain Overview of academic literature

2. Contents • Definitions: What is loneliness? What is social isolation? • Prevalence (in the UK) • Health consequences • Evidence on link with alcohol use/abuse • What increases the risk of loneliness? • Life-course approach: • Childhood influences • Gender differences • Life-time events & personality • What protects against loneliness? • Which interventions work? • Discussion points

3. Definitions • Social isolation = the lack of/infrequent contact with family, friends or neighbours (<weekly, or <monthly) (Victor, 2009) • Loneliness = the feeling of a mismatch between social contact that you desire and social contact that you have. (Victor, 2009) • Practitioners often see this distinction • Social network type = the pool of social resources an individual routinely draws from (e.g. family, friends, diverse, congregant and restricted) (Litwin & Siovitz-Ezra, 2010) • Social network position = the place within a social network; i.e. in the centre, or at the periphery. (Locke et al., 2010) • It is important to treat SI and Loneliness as different phenomena.

4. Prevalence Social isolation: 310 Dutch adolescents, followed from age 11-14 (Witvliet et al., 2010) • Isolated from cliques: 19%, 15%, 16% age 11, 12, 13, respectively An American poll in 2011: • 22% of teenagers log onto a social media site 10/day or more English older adults, 52+yrs, 2010-11 (ELSA: Jivraj et al., 2012) • 5% overall socially isolated (< weekly contact) • 7% for men, 3% for women (ns. different)

5. Prevalence Loneliness: 2,091 American adolescents, 16-17 yrs (Woodhouse et al., 2011) • 17% felt lonely 2,393 British children and adults, 15-97yrs, 2006 data (Victor & Yang, 2012) • Highest in under 25s (9%) and over 55s (9%), lowest for 25-55s (5%)

6. Health consequences Social isolation 4,432 English adults, 50+ yrs (ELSA, 2-waves, Kamiyaet al., 2010) • Social ties not linked to CVD risk factors (blood tests) 4004 Dutch adults, 65+ yrs (10-yr study, Holwerdaet al., 2012) • No link with mortality – except if also lonely • Solitude can be chosen and valued (Qualitative, Wenger & Burholt, 2004) Studies including ‘participation’ (e.g. ELSA, Shankar et al., 2012) • Social isolation linked with earlier mortality

7. Health consequences Loneliness In younger years… 310 Dutch adolescents, followed from age 11-14 (Witvliet et al., 2010) • Clique isolation led to depression, only if also feeling lonely 10,576 American adolescents (3-waves, Goosby et al., 2013) • Depression (strongest association) • Poorer self-rated health & incr. risk factors for CVD (weaker associations) In later life… • Depression, one-way (229 Americans, 50+, 5yrs; Cacioppo et al., 2010) • Poorer cognitive function (6,034 English, 65+, 4yrs; Shankar et al., 2012) • Doubled risk of Alzheimer’s (823 Americans, 65+, 6yrs; Wilson et al., 2007) • CVD risk factors (229 Americans, 50+,5-yrs; Hawkley et al., 2010) • All-cause mortality for men (4004 Dutch, 65+, 10yrs; Holwerda et al., 2012) • Out-patient service use (153 frail Swedish, 65+; Taube et al., 2014)

8. Alcohol use/abuse? No strong evidence of a link with isolation or loneliness Social isolation 1,563 American 10th grade students (Huang et al., 2014) • Frequency of social network site use & no. of close online friends not related • Instead, influence via pictures of drinking behaviours 791 American adults, followed from 55-65 to 75-85 yrs(Moos et al., 2010) • More friends who are / approve of heavy drinking – more risk of risk-drinking Social network type 3005 American adults aged 58-85 (Shiovitz-Ezra & Litwin, 2012) • Less resourceful network more linked to risk Loneliness No link in older age (Dutch, v.d.Berget al., 2013; US, Shiovitz-Ezra & Litwin, 2012)

9. What increases the riskof loneliness? In younger years… 832 American children, at age 9, 11 and 15 (Schinka et al., 2013) • Higher family income – more chance of low, stable loneliness, less chance of both high-increasing and decreasing loneliness. • Better age 7 social skills – greater chance of low, stable loneliness • Higher age 7 depression – more risk of high increasing and persistent loneliness • Higher age 7 aggression – more risk of high increasing loneliness 20 American adolescents (Locke et al., 2010) • With autism more lonely vs. peers

10. What increases the riskof loneliness? In later years… Older age… not by itself. Often assumed, but not always so. 999 British adults, 65+yrs (Victor, 2005) • Pathway 1: continued long-established (68%) • Pathway 2: late-onset (23%) • Pathway 3: decreasing (10%) Female gender... Or are they more likely to admit? • Women more likely to report (2,393 British, 15-97yrs, Victor & Yang, 2012) • Higher loneliness for women (8,688 English, 50+, Shankar et al., 2011) Widowhood… one of the strongest predictors. • Strongest predictor (2,295 Dutch, 65+yrs, 7-yr study, Dykstra et al., 2005) • Pervasive sense of loneliness (39 bereavement studies, Neaf et al., 2012)

11. What increases the riskof loneliness? Health & Physical function… a two-way relationship. 2101 American adults, 50+yrs, 6-year study (Luo et al., 2012) • Loneliness both affected and was affected by functional limitations Cognition and psychological factors • ‘Cognitive discrepancy theory’ (Cacioppo et al., 2010) • Tendency not to ask for help (30 adults, 75+yrs, Wenger & Burholt, 2004) • Low optimism, 10-year study (416 men, 70+yrs, Ruis-Ottenheim, 2012) Low income 7,780 English adults, 50+yrs (ELSA: Demakakos et al., 2006) • A major correlate of loneliness

12. Life-course approach: Childhood influences Loneliness in adulthood affected by… 3,980 Dutch adults aged 21-85 (2-waves, Mers and Jak, 2013). • Both parents’ reliability, closeness and supportiveness • Conflicts and violence with father (not mother) 7,446 American adults aged 50-102 (retrospective survey, Palgi et al., 2012). • Traumatic events (affecting self* and others) that happen up until adulthood (e.g. being abused by others, or a significant other’s death, substance abuse) • Not related to loneliness if happened after age 18. 10,576 American adolescents (3-waves; Goosby et al., 2013) • Loneliness in childhood increases risk of adult depression and poor self-rated health (and thus loneliness in adulthood).

13. Life-course approach: Gender differences Childhood influences: 3,750 Norwegian adults, 40-80yrs (Nicolaisen & Thoresen, 2014) • Bullied in childhood & Conflicts between parents (men) • Economic problems in childhood family (women) 2,645 Irish adults, 65+yrs (Kamiya et al., 2013) • Poor childhood SES (men and women) • Parental substance abuse (men) Later life influences: 3,750 Norwegian adults aged 40-80yrs (Nicolaisen & Thoresen, 2014) • Partners death in later years (men more than women) • Divorce in later years (women)

14. Life-course approach: Life-time events & personality 137 Centenarians in the US (Hensley et al., 2012) • +/- ve events had an indirect effect on loneliness through neuroticism. • -ve events only predicted loneliness if competence was also low. 699 Norwegian adults 67-79yrs (5 year follow-up, Nicolaisen & Thoresen, 2012) • Mastery(influencing one’s own life situation) protective against loneliness, for those with and without physical limitations. • Having a partner strongly protective, only if without physical limitations. • Age, gender, self-rated health not predictive of loneliness.

15. What protects against loneliness? Parenting • Reliability, closeness, supportiveness (3,980 Dutch, 21-85yrs, Mers & Jak, 2013) • Better age 7 social skills (832 Americans, 9, 11, 15yrs, Schinkaet al., 2013) Social engagement 2,393 British children and adults, 15-97yrs (Victor & Yang, 2012) • In younger years, quantityof social engagement is protective • In mid- and later- life, qualityof social engagement is protective Health & Confidence • Health improvements decreased loneliness over time (999 British, 65+, Victor & Bowling, 2012) • Confidence to overcome life’s difficulties protected against loneliness, despite physical limitations. (699 Norwegian, 67-79yrs, Nicolaisen& Thoresen, 2012)

16. Which interventions work? Reviewers’ conclusions: • One-to-one, informal referrals to other services (Findley, 2003) • Groups with education or support element/ not one-to-one (Cattan et al., 2005) • Interventions addressing maladaptive social cognition (Masi et al., 2011) Recent review of 17 studies (Hagan et al., 2014) • A community-based Mindfulness Based Stress Reduction (MBSR) programme • None of the 3 one-to-one interventions showed long term effectiveness • Effective new technology interventions: • Web-based communication (e.g. Skype) in care-home setting • Games console with a partner (e.g. the Wii) in private home setting • Contact with a living or robotic dog

17. Discussion points A. Should policy, health professionals, local practitioners etc… B. How could they…. (for different age groups) • Help with avoiding/overcoming negative life-time events? • Help with increasing people’s positive life-time events? • Help increase peoples’ confidence in their ability to deal with life’s challenges? • Provide accessible counselling to reduce negative personality traits? • Help stimulate a nurturing and supportive home / school environments? • Help increase social engagement in older age? • Help overcome & deal with bereavement?