Thomas Scharf Irish Centre for Social Gerontology, NUI Galway Project Lifecourse Seminar Series, 28 May 2014, NUI Gal

1. New Perspectives on Loneliness and the Lifecourse Thomas Scharf Irish Centre for Social Gerontology, NUI Galway Project Lifecourse Seminar Series, 28 May 2014, NUI Galway

2. Outline • Rethinking loneliness: • As a public health issue • As a lifecourse issue • Loneliness: • Definitions and characteristics • Links to other forms of disadvantage • Prevalence • Cross-national and within-nation variation • Interventions to address loneliness • Considerations for policy, practice and research

3. Impacts of loneliness In research, loneliness has been associated with: • Reduced quality of life • Premature mortality • Broad range of physical and mental health conditions (e.g. sleep disorders, risk of cardiovascular disease, low self-esteem, dementia, depression) • Increased use of medications • Increased alcohol consumption

4. Loneliness as a public health issue “Individuals with adequate social relationships have a 50% greater likelihood of survival compared to those with poor or insufficient social relationships. The magnitude of this effect is comparable with quitting smoking and it exceeds many well-known risk factors for mortality (e.g., obesity, physical inactivity).” Holt-Lunstad J, Smith TB, Layton JB (2010) Social Relationships and Mortality Risk: A Meta-analytic Review. PLoS Med 7(7): e1000316. doi:10.1371/journal.pmed.1000316 http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000316

5. Comparison of odds of decreased mortality across conditions associated with mortality

6. Social and economic impacts of loneliness Loneliness has broader social impacts that reach beyond the individual: • Impacts on families, friends and neighbours (loneliness as ‘contagious’) • Impacts on communities (e.g. community-based interventions to tackle loneliness) • Impacts on broader society (e.g. increased use of health/social care services; GP consultations; emergency admissions to hospital; re-admission to hospital; entry into institutional care)

7. Loneliness: as a lifecourse issue Loneliness to be considered in terms of a lifecourse approach: • Individuals’ experiences of loneliness likely to fluctuate across life, reflecting changing personal circumstances • Loneliness may be more characteristic of certain life stages (e.g. ‘empty-nest’ stage; retirement for some people) • Some life transitions may be more closely associated with loneliness than others (e.g. leaving home, relationship breakdown, migration, bereavement, onset of chronic ill health) • Loneliness as a cohort issue (e.g. impact of AIDS/HIV)

8. Loneliness: definitions • Loneliness is a subjective and negative experience: “[T]he unpleasant experience that occurs when a person’s network of social relations is deficient in some important way, either quantitatively or qualitatively” (Perlman and Peplau, 1981, p.31) • Social isolation is an objective measure reflecting an individual’s lack of contacts or ties with others

9. Loneliness: forms Weiss (1973) distinguishes between emotional and social forms of loneliness: • Emotional loneliness reflects a person’s perceived lack of an intimate attachment – perhaps a spouse/partner, a best friend, or someone else whom one can confide in • Social loneliness refers to a person’s sense that they are not part of an engaging social network of family, friends and others (Dykstra, 2009) Individuals may be experience emotional and social forms of loneliness at the same time

10. Loneliness: forms • Emotional loneliness: “I wouldn’t say friends. We laugh and talk and you know … I don’t really go to them with my problems … We talk about the weather and talk about our arthritis and so on.” • Social loneliness: “My neighbour’s pretty ill and when her son goes out … I go and sit with her … to keep her company … I do that every day. As I say, it’s a bit of company for me because I don’t see anybody and we have a cup of tea and a chat.”

11. Loneliness: duration • ‘Transient’ loneliness: may occur from time to time, but passes over the course of a day • ‘Situational’ loneliness: may arise after a specific change in an individual’s circumstances, but passes with time • ‘Chronic’ loneliness: refers to persistent feelings of loneliness that may endure over a considerable period of time (Young, 1982) • ‘Seasonal’ loneliness: typically associated with winter months and/or with particular seasonal events (e.g. Christmas and New Year period)

12. Loneliness: duration • ‘Chronic’ loneliness: “But, my husband died in, well he’s dead now 13 years, and since he died I feel very lonely and eh…it can be very lonely, really… As I said I can’t…change the fact that it is very lonely when you’re a widow and living alone.” • ‘Seasonal’ loneliness: “The clocks alter, you draw the curtains at four o’clockish and you don’t see anybody again. And I’m off the main road, so I can’t even see people going past.”

13. Loneliness and social exclusion • Helpful to recognise loneliness within the context of other aspects of an individual’s life • Loneliness may be related to other forms of disadvantage (experienced by older people): • Poverty • Lack of civic engagement • Limited use of or access to services • Negative perceptions about the local community

14. Prevalence of loneliness in later life • Surveys conducted in the UK since the 1940s consistently suggest that 7-10% of people aged over 60/65 identify themselves as being often or always lonely (Victor et al., 2005) • Intense loneliness affects only a minority of the older population. But demographic change means that more people are affected by feelings of loneliness • Assuming a loneliness rate of 7-10%: • In Ireland, between 37,500 and 53,600 of 536,000 people aged 65+ likely to be often/always lonely

15. Prevalence of loneliness in later life Loneliness tends to be higher amongst: • People aged 75 and over (especially aged 85 and over) • People who live alone • People who are widowed, divorced or separated, or never married • People in poor physical and/or mental health • People living on limited material resources • People belonging to some black and minority ethnic groups • People who spend a lot of time alone

16. Prevalence of loneliness across age-groups • European Social Survey data for Britain show two age-related peaks in the prevalence of loneliness: late adolescence/early adulthood (ages 16-24) and later life (age 65+) at 9% and 11% respectively (Victor & Yang, 2012) • In the UK, Griffin (2010) reports an inverse relationship between age and loneliness (highest rates in those aged 18-34 as compared with 35-54 and 55+) • In Australia, Lauder et al. (2006) report the highest mean loneliness for people aged 40-49 years as compared with those aged 18-19 and 60 and over

17. Loneliness in context • Loneliness and ageing do not necessarily go hand in hand – otherwise the prevalence of loneliness in later life would be the same everywhere • Cross-national and within-nation variation in loneliness rates suggests that context matters: • National contexts (culture, socio-economic level, welfare state etc.) • Local contexts (urban/rural environments etc.)

18. Loneliness in context: national variation • Walker and Maltby (1997) reported that the prevalence of loneliness amongst older people in Europe ranges from: • under 5% in Denmark • around 5% to 9% in Britain, the Netherlands and Germany • to over 20% in Portugal and 35% in Greece • More recent work points to similar cross-national variation (e.g. Fokkemaet al., 2012), with especially high rates of loneliness amongst older people in former Soviet bloc nations (Yang & Victor, 2011)

19. Loneliness in context: urban/rural The (limited) research evidence relating to specific types of environment suggests that the prevalence of loneliness is: • Lower in rural than urban communities in some European nations, including Austria, Sweden, and the UK, but not in others such as the Netherlands, Luxembourg or Italy (Burholt et al., 2007) • Higher in socially deprived urban communities, although variations exist across such communities (Scharf & De Jong Gierveld, 2008)

20. Socio-spatial features of loneliness Increased risk of loneliness potentially influenced by: • Design/planning, which may limit older people’s capacity to form/maintain meaningful social relationships (e.g. poor transport; lack of seating; inaccessible buildings; poor pavements; topography; age-segregated living etc.) • Population change, which disrupts older people’s social relationships (e.g. migration patterns; commuting habits; ‘zones of transition’) • Social problems (e.g. crime; absence or loss of services; poor housing etc.)

21. Loneliness in the city • “We’ve lost all our neighbours. Well they were more than neighbours. They were friends and even our relatives. They had their children when I had my children…Now there’s nobody. If I really needed anybody there isn’t anybody around that I think that I could go to”. • “You don’t see anybody because you don’t go anywhere. There’s nowhere to go. I used to meet people at the Post Office…but you don’t see them now. The chemist is the only place you’re likely to see anybody you might know. It’s...rather a sort of lonely estate…it’s like being in the middle of a cemetery…”

22. Loneliness in rural communities • “It’s a lonely experience in a small village.” • “Now last weekend I didn’t see one soul from when I came home from town on Friday until Monday morning…nobody… It’s a long weekend. I usually go to my daughter every Sunday, but she was working.” • “It’s okay when you’re younger, you know, but when you get old it’s not… [It gets] very lonely…because…the neighbours are nearly all working…and you wouldn’t see them… I’m on my own a lot.”

23. Preventing loneliness • “There isn’t time [to be lonely]. Because, if I got lonely I’d put one thing aside and I’d get something else, and there wouldn’t be any lonely… It’s good to be busy. It keeps your mind occupied and keeps you from worrying… It’s like people going to the hospital and you’re saying “Oh, they had to spend the night on a trolley.” I spent the night on a trolley; I thought it was the best of craic!” • “[The] home help comes Sunday and Tuesday…and maybe she’ll come on Friday…but that means there’s always someone here… I don’t…ever feel lonely.”

24. Features of successful interventions • Group interventions with focused educational input or provision of targeted support activities • Interventions addressing loneliness amongst specific groups of older people (e.g. women, informal carers, widow/ers, people with mental health conditions) • Interventions broadly representative of group targeted • Interventions had degree of participant and/or facilitator control, involved consultation ahead of implementation • Interventions originated and conducted within existing service (Cattan et al., 2005; Cattan, 2010).

25. Drivers of loneliness in later life • Structural drivers: changing norms and behaviours around social relationships; social and economic policies; global trends (migration patterns, individualisation) etc. • Environmental drivers: changing (urban/rural) communities; planning policies; age-segregated living etc. • Individual drivers: disrupted social (support) networks; transitions/life events; ill health and disability; loss of mobility; personal and family migration patterns; psychological factors etc.

26. Potential responses to loneliness • Structural: addressing societal values/behaviours (towards ageing adults); guaranteeing access to sufficient resources/supports at all life stages; anti-poverty measures; supports for transnational families etc. • Environmental: creating and maintaining sociable environments; community development; counteracting trends towards age-segregated living • Individual: preventative strategies at all stages of the life course; co-ordinated services/supports to help individuals at times of need; forms of befriending; digital literacy schemes, ICTs, telecare etc.

27. Considerations for policy, practice and research • Loneliness a major challenge for public policy and professional practice (e.g. public health; social policy; community development; urban and rural planning) • Loneliness shaped by life-course factors, necessitating interventions across the entire lifecourse • Loneliness associated with other forms of disadvantage • Variation in loneliness rates across communities points to possibility for interventions to reduce loneliness • Loneliness interventions require careful consideration and should be subject to formal evaluation

28. Contact thomas.scharf@nuigalway.ie