Older adults are at increased risk of being socially isolated or lonely, over 1 million older people say they are always or often feel lonely (Age UK, 2014). Nearly half (49%) of all people aged 75 and over live alone (Age UK, 2014), mostly because of widowhood. This is predominantly the case for older women who are more likely to be widowed than older men. Older people’s social networks often get smaller and social interactions become fewer, only 46% of over 65s said they spent time together with their family on most or every day, compared to 65-76% for other ages. 12% of over 65s said they never spent time with their family, (Victor, 2017). Research suggests that loneliness can be as harmful to our health as smoking 15 cigarettes a day (Holt-Lunstad, et al 2010) and people with a high degree of loneliness are twice as likely to develop Alzheimer’s as people with a low degree of loneliness (Wilson et al, 2007), this shows the importance of tackling social isolation and loneliness, to help improve the lives of older people.
Significantly, as a world population and specifically in some national health and social care policies and campaigns it is becoming increasingly recognised, how important it is to tackle social isolation and loneliness amongst older people. One key example, in the UK ‘The Campaign to End Loneliness’ was established in 2011 as a network of national, regional and local organisations working together to ensure that loneliness is acted upon as a public health priority at national and local levels (Victor, 2011).
The relationship between social isolation and loneliness is a complex one, involving social contact, health and mood. Loneliness and isolation, or social isolation, are often discussed together and the terms are often used interchangeably in everyday language, however researchers suggest the two concepts are distinct. Social isolation arises in situations where there is a lack of contact with family, friends, community involvement, or access to services (Victor, 2012). Where loneliness can be understood as the subjective perception of insufficient relationships, loneliness is more dependent on the quality than the number of relationships. Despite these variable definitions, evidence suggests significant overlap between social isolation and loneliness (Golden et al. 2009). Victor (2012) found that social isolation is a predictor of loneliness, as is the amount of time spent alone. Most importantly, is that evidence suggests both concepts result in negative self-assessment of health and wellbeing in older people (Golden et al. 2009).
As a practitioner, understanding the changes which take place as we enter old age can help us become attuned to the possible experiences and needs of older people with whom we are working with (Wilson et al, 2008, 118). A key task in social work with older people is to work to reach a balance between independence, self-determination and individual rights against the need to provide protection to vulnerable adults at risk of harm (Russell, D. 1996). Achieving a sense of balance between these challenging demands involves building trust, a holistic assessment approach and support which enables older people to exercise choice and control (Crawford and Walker, 2004). Assessment should consider the impact of ageism on older people’s lives, including low self-esteem, feelings of being a nuisance and so on. On the other hand, care must be taken to ensure that ageist assumptions do not influence our assessment. The importance of anti-ageist practice, and the need to promote the strengths and resilience of older people are strongly emphasised by recent writers (Thompson 2002, Phillipson 2002). According to Trevithick, P (2005) a person-centred approach “encourages the development of an equal, non-authoritarian relationship where both the service user and social worker work together to establish a significant and meaningful relationship” (p.271).
An important outcome goal for effective social work with older people is to bring about positive change, including improved physical functioning, increased confidence, better skills and an enhanced sense of well-being. Intervention research on how to deal with social isolation is limited. A number of systematic reviews of quantitative outcome studies have attempted to evaluate the effectiveness of social isolation and loneliness interventions for older people (Cattan & White 1998, Cattan et al. 2005, Cohen-Mansfield & Perach 2015, Dickens et al. 2011, Findlay 2003, Hagan et al. 2014). However, to date, they have been unable to provide conclusive evidence and findings are often contradictory. In a systematic review in 2005 researchers reported that the most effective interventions were group activities, and the majority of ineffective interventions where one-to-one social support (Cattan et al. 2005). Inconsistently, in their 2015 review, Cohen-Mansfield & Perach (2015) noted that group interventions were less often evaluated as effective compared with one-on-one interventions. Qualitative research suggests that creating opportunities for social interaction, such as attending social programs, even via telephone, may help to reduce social isolation.
Given that social isolation arises from having limited or no social relationships, and loneliness is the individual’s subjective emotional states, research would suggest that loneliness and isolation may require different inputs, (Mima Cattan, 2007). Older people experiencing social isolation may require practical support, or the use of transport, whereas, older people experiencing loneliness may require social support, studies show that older people give great importance, to these practical services of support, which assist them in every aspect of their lives, not just personal care or relationship needs (MacDonald 2004).
A vast array of social day services – such as lunch clubs, day centres, community cafés, and activity classes, among others have an explicit purpose of alleviating loneliness. These day services facilitate group activities, which have been found to be most beneficial in tackling loneliness and social isolation, when they include educational programmes relating to health and physical activities (Cattan et al, 2001). Findlay’s (2003) research has shown that these interventions are most appropriate and successful when they are tailored to meet the individuals need and there is service user involvement in the planning, implementation and evaluation of the programmes. This is supported by the research of Arber and Davidson into the social worlds of older men, which found a strong perception among older men that social organisations specifically for older people do not facilitate for their needs except perhaps as a last resort. Alongside the intervention, being needs led to the individual, the quality of the service being provided has an important impact on its success and the high-quality training of facilitators is essential to its success, (Culture.gov.uk, 2009). Regrettably, there is a lack of research on the benefits or effectiveness of day services, however what evidence does exist has thankfully found that older people attending day services benefited from doing so, as did their carer’s (Social Inclusion Institute, 2008).
Qualitative research carried out by Cattan et al (2001) shows evidence that the telephone befriending schemes covered by the Call in Time programme are similarly effective in tackling social isolation and loneliness. The Good Morning NI Network which operates across Northern Ireland operated the same service. It provides reassurance to older people within the community through daily telephone calls, it connects older people to their community, in a bid to tackle social isolation. Older people value these telephone befriending service as it shows them there is a friend out there who cares, who is not family. They feel that they are not forgotten and that they belong. What older people appreciate most from these services is very simple, they provide ordinary conversation and the service is trustworthy and reliable (Age UK,2014).
In conclusion, common characteristics of effective interventions to tackle loneliness and social isolation include, social activities within a group format, interventions in which older people are active participants and interventions where the older person gets a sense of belonging, all appear to be effective. One theme which is evident in all successful work carried out with older people is that they are involved in the planning, development and delivery of programmes of their care, which is tailored to meet their individual needs. Richards (2000), in his study of assessment of older people’s needs, suggests that when older people’s opinions are not taken into consideration, the risks of unwanted or inappropriate interventions increase. He proposes a service user-centred approach to ensure that information-gathering and service provision are meaningful to the older person and sensitive to their own efforts to manage their situation.
Finally, despite the conclusions of a number of reviews in this area there is still widespread recognition that further investigation is needed into ‘what works with tackling loneliness’ (Victor, 2011).