An Australian Study of Loneliness in Older People: Implications of Stigma Taiwan, June 2008

1. An Australian Study of Loneliness in Older People: Implications of StigmaTaiwan, June 2008 Professor Wendy Moyle Deputy Director, Research Centre for Clinical and Community Practice Innovation

2. Background • Older people are at higher risk of loneliness due to: • death of spouses & close friends • onset of disability and illness preventing social activities • living alone increases risk of loneliness • Relationships between: • loneliness and chronic conditions • anxiety & depression • increased utilisation of health care services, & • increased risk of nursing home admission Research Centre for Clinical and Community Practice Innovation, and Griffith Institute of Health

3. Loneliness not Understood • Loneliness as a concept is not clearly defined or consistently used in the research literature • Loneliness used interchangeably with social isolation • Not all people who live alone or have limited social contacts are lonely • Conversely, those with many social contacts and/or not living alone may still experience loneliness • Need to consult older people about loneliness Research Centre for Clinical and Community Practice Innovation, and Griffith Institute of Health

4. How does literature define loneliness? • Loneliness is depicted as the perceived subjective condition that may or may not co-occur with being alone (Parsons 1997). • Without companions; lone. • Characterized by aloneness; solitary. • Unfrequented by people; desolate: a lonely crossroads. • Dejected by the awareness of being alone. • The American Heritage Dictionary of the English Language, 4th edition, published by Houghton Mifflin Company Research Centre for Clinical and Community Practice Innovation, and Griffith Institute of Health

5. Loneliness Research Interests • Qualitative Studies • Alone in a Crowd: Supporting Older Australians Managing Loneliness – Cheek, Moyle, Ballantyne, Stanley, Corlis & Oxlade (2007-2010) • An International Comparison of Loneliness in Older Peoplein Australia, Norway, UK, Japan, South Africa– Cheek, Moyle, Ballantyne, Meyer et al.(2007-2009) • Mixed Methods • Loneliness in People with Dementia and their Carers – Moyle, Cheek, Kellett & Ballantyne (2007 -2009) Research Centre for Clinical and Community Practice Innovation, and Griffith Institute of Health

6. Alone in a Crowd: Supporting Older Australians Managing Loneliness • Aim: Provide a comprehensive & in-depth understanding of loneliness to inform practice • Three stage 3 Year project – conducted in South Australia / QLD • Stage 1 Interviews (60 older people) and focus groups x 8 with support & service providers (2007) • Stage 2 Workshops with support & service providers to identify solutions (early 2008) • Stage 3 Development of recommendations, implementation and evaluation of solutions (2008 – 2009) Research Centre for Clinical and Community Practice Innovation, and Griffith Institute of Health

7. Methods and Sampling • Maximum variation purposeful sampling • Individual in-depth interviews with older people – • over 65 years, of varying ages, living in varying types of accommodation, receiving various levels of service, having family or not • Focus groups with people providing services to older people including - • nurses and personal care assistants, other health professionals, managers of those providing direct car, individuals with responsibility for allocation of resources, family members/significant others of older people receiving support/services; and representatives of consumer groups. Research Centre for Clinical and Community Practice Innovation, and Griffith Institute of Health

8. Interview and focus group questions • semi-structured and initial probes were developed around six areas: • What participants perceive and understand loneliness to be • Important factors contributing to loneliness • How older people manage loneliness • The effect of loneliness on the health and well-being of the older person • What assists or could assist older people to manage loneliness • Perceived barriers to managing loneliness. Research Centre for Clinical and Community Practice Innovation, and Griffith Institute of Health

9. Data analysis • Two members independently reviewed and thematically analysed each interview & focus group transcript • Reviews exchanged, discussed and resolved by consensus • Themes & issues across interviews and focus groups were generated according to the perceptions and understandings of loneliness and its management • Major categories of themes used to produce discussion paper to inform Stage Two workshops Research Centre for Clinical and Community Practice Innovation, and Griffith Institute of Health

10. Stage 2 workshops • Participants - older people participating in Stage One, family members of older people, those providing supports and services for older people and relevant consumer groups • Aimed to: • Identify the implications of the findings from Stage One of the study • Design and initiate changes or enhancements to existing supports, services and programs and/or develop new ones to address gaps or weaknesses identified and/or enhance identified strengths; • Produce examples of supports, services and programs that provide solutions for, and better understandings of, assisting older people to manage loneliness. Research Centre for Clinical and Community Practice Innovation, and Griffith Institute of Health

11. Five Ways of Understanding Loneliness • 1. Loneliness as Relational • 2. Loneliness as Connectedness • 3. Loneliness as Temporal • 4. Loneliness as Enabling Adjustment • 5. Loneliness as Private Research Centre for Clinical and Community Practice Innovation, and Griffith Institute of Health

12. Loneliness as Relational • Loneliness is influenced by the relationships with others, and whether these are missing, are felt to be needed and or maintained Research Centre for Clinical and Community Practice Innovation, and Griffith Institute of Health

13. Loneliness as Connectedness • Loneliness is influenced by whether people feel like they are connected to the community at large Research Centre for Clinical and Community Practice Innovation, and Griffith Institute of Health

14. Loneliness as Temporal • Loneliness has something to do with time, as expressed by older people (time of day or more broadly time of life) Research Centre for Clinical and Community Practice Innovation, and Griffith Institute of Health

15. Loneliness as Private • Loneliness is private, personal & emotional • It is stigmatized and often kept secret • Associated with shame, defeat, weakness & failure • Can be awkward to talk about Research Centre for Clinical and Community Practice Innovation, and Griffith Institute of Health

16. Loneliness as a Failure • “Society sees it as a nasty problem that they don’t want to know about and people who are lonely being able to express this without feeling they are a failure of some kind [is difficult]” Research Centre for Clinical and Community Practice Innovation, and Griffith Institute of Health

17. Personal, Subjective & Individual • Individual meanings of loneliness. • “You know you could be in a room full of nice people and beautiful dresses [the people] are all polite to you and you can be as lonely …” Research Centre for Clinical and Community Practice Innovation, and Griffith Institute of Health

18. Different Explanations Why People are Lonely • Loneliness is related to an individual’s persona • Loneliness is influenced by specific experiences • At times being lonely can be beyond individual control • At other times individuals need to want to help themselves in order not to be lonely Research Centre for Clinical and Community Practice Innovation, and Griffith Institute of Health

19. Service Providers Explanation • “ Lots of them went through a war and depression. They came out of that really made to grin and bear everything. So they don’t reach out, they think what they are experiencing is how it is… and you grin and bear it. They don’t jump up and down and say someone help me. They kind of wear it” Research Centre for Clinical and Community Practice Innovation, and Griffith Institute of Health

20. Workshops • Potential solutions and strategies • Importance of transportation • Grief counselling • Family therapy • Raise awareness of potential for loneliness • Assist people early in life to overcome loneliness Research Centre for Clinical and Community Practice Innovation, and Griffith Institute of Health

21. Conclusion • Importance of relationships • Frequency of relationships shapes loneliness • Relationship strategies as a preventative strategy Research Centre for Clinical and Community Practice Innovation, and Griffith Institute of Health