Loneliness and Social Isolation

Loneliness and social isolation are conditions related to the quality and quantity of a person’s social relationships. Loneliness is commonly described as an unpleasant experience stemming from a mismatch between a person’s desired and perceived social relationships (Peplau, 1984). In contrast, social isolation is an objective condition, which may be measured by lack of social contact or a reduced social network size (Steptoe et al., 2013).

Social Isolation and loneliness are associated with a wide range of mental and physical ill-health including: an increased risk of cardiovascular disease (Barth et al., 2010); reduced cognitive functioning (Shankar et al., 2013); immune dysregulation (Jaremka et al., 2013); an increased risk of hypertension (Hawkley et al., 2010) and an increased risk of depression (Cacioppo et al., 2006). In addition, there is convincing evidence that loneliness and social isolation are significant risk factors for mortality – comparable to other well established risk factors such as smoking up to 15 cigarettes a day (Holt-Lunstad et al., 2010).

Identified risk factors for loneliness and social isolation include (but are not limited to): marital status; limited education; widowhood; depression; social network size; living alone; anxiety; societal stereotypes and personal expectations (Pikhartova et al., 2015; Victor et al., 2005).

A number of these risk factors are particularly pertinent to older adults. However, loneliness is not a universal aspect of old age - indeed  recent research has suggested that U shape distribution in the prevalence of loneliness may exist – with younger adults as well as older adults more likely to be lonely relative to middle-aged adults (Yang and Victor, 2011).

The local picture

Accurately estimating the size of the population experiencing loneliness and isolation in Calderdale is difficult. Loneliness is a subjective condition and factors that make one person lonely may not make another person lonely - this makes generalising prevalence estimates difficult. In addition, identifying people who are isolated is inherently difficult as the nature of isolation means a person is unlikely to be known to the community or local services. However, nationally representative survey data (ELSA) suggests 25% of people aged over 52 report feeling lonely sometimes and 9% feel lonely often. Calderdale has almost 80,000 people over 52 and (although a crude analysis) applying these national estimates to Calderdale’s 2014 population, we would expect to have:

  • 17,688 older people ‘sometimes’ lonely;
  • 6,367 older people ‘always or often’ lonely.

In addition, we know a number of  factors that increase a persons risk of being lonely or isolated and we can identify wards with higher proportions of people associated with some of these factors – compared to the Calderdale average:

Wards with higher % of pensioners living alone:

  • Town;
  • Ovenden;
  • Park;
  • Calder.

Wards with higher % of people living with a ‘limiting long term illness or disability’:

  • Todmorden;
  • Rastrick;
  • Town;
  • Illingworth and Mixenden;
  • Sowerby Bridge;
  • Park.

Wards with higher % of older people living in deprivation:

  • Park;
  • Ovenden;
  • Illingworth and Mixenden;
  • Town;
  • Todmorden.

Wards with higher % of people over 65 living in them:

  • Northowram;
  • Brighouse;
  • Rastrick;
  • Hipperholme and Lightcliffe;
  • Skircoat;
  • Luddendenfoot;
  • Sowerby Bridge;
  • Elland;
  • Todmorden.

(Public Health England (PHE), 2015)

Further information on the local picture can be gained from the initial findings of an on-going project evaluation in Calderdale. This evaluation suggests that levels of social isolation and loneliness, among service users, vary across the borough. It would seem that older individuals using services in the Park Ward area have the highest levels of loneliness. However, service users in the Elland area have the highest rates of Social Isolation (the charts below show this). It should be noted, however, these are preliminary findings and the final evaluation of the Staying Well project is not due to be published until mid-2016.

Staying Well participant’s levels of loneliness:

Staying Well participants levels of loneliness

Staying Well Participant’s isolated or at high risk of isolation (%)

Staying Well Participants isolated or at high risk of isolation (%)

Current provision

The Neighbourhood scheme

The Neighbourhood Scheme has been established in Calderdale since 2007, with the original aim of supporting and establishing community provision for older people in areas where there were a lack of activities and groups. In recent years, the remit of the scheme has changed and it now receives referrals for older people who are or may become lonely and isolated from a wide range of sources. The service is very much personalised and ‘co-produced’ with individuals consulted about their interests, skills and needs. Individuals are then supported into relevant activities and groups where appropriate. When it is identified that an individual may need other services or support, the worker will signpost or provide further information.

The Staying Well project

The Staying Well project is a 12 month pilot aimed at reducing loneliness and social isolation in Calderdale, improving collaborative working, creating more connected communities, networks and opportunities. Four community ‘hubs’ have been commissioned across the borough and allocated funds for a ‘micro commissioning’ exercise aimed at improving partnership working with the voluntary and community sectors and increasing local capacity and provision. This model and method of commissioning is new, innovative and very much ensures that local provision is informed and managed by local people - meeting the diverse need across Calderdale. The pilot has recently been extended to the end of March 2016 and will be externally evaluated by the University of Lincoln.

User views

Case studies are collated on a regular basis across both of the above services, which evidence the difference each intervention has and continues to make to individuals. Examples of quotes from users include:

  • “Despite living in this village all my life, I had lost contact with a lot of people. Attending two local lunch clubs is now the highlight of my week, the food is great and I look forward to meeting up with my old school friends of 40 years ago”;
  • “We meet up with friends, we are not just from the village but some of us are from the hilltops and we are all made very welcome”;
  • “The important part is having someone to talk to”;
  • “We have met more new people and we are all good friends now and we have a really good laugh and it really does you good”;
  • “ I have a great afternoon, met people I haven’t met before, making new friends, it’s a nice atmosphere, what could be better”;
  • “You can’t do enough to look after yourself these days and this is part of my therapy every week, it’s wonderful”.

Letter received from a ‘service user’ supported by a team worker:

  • “It was very nice to see someone face to face, someone who listened, someone who understood and is comfortable to be with.  She made several suggestions for both me and my husband/carer and understands the pressures on relationships when one is a carer. In the past she has arranged for me to get a wheelchair which has changed my life.  People like her are very important to people like me.  What is a little thing to some is the whole world to me.  I have received wonderful support from everybody at Calderdale.”

Letter received from a Staying Well project reference group member:

  • “Thank you for inviting me to the consultation event on co-production today which I found most enjoyable and informative. It was wonderful to see so many there and such friendly helpful staff. I do hope that the ideas discussed and suggestions made will prove useful in progressing the success of what you are all trying to do. I enjoyed the group sessions and amount of ideas which came out of the discussions. Please accept my thanks to all the staff who were there on the day

Unmet needs

  • Early findings from the evaluation of the Staying Well project indicate that preventative services aimed at reducing isolation and loneliness are hampered by inadequate links to mental health services. “From the initial analysis, it would seem that depression and anxiety has a disproportionate impact on the ability of participants to engage with interventions or activities. Further work may wish to be carried out to ensure that such undiagnosed need amongst participants is appropriately recognised and a pathway developed” (Windle., et al 2015).
  • In October 2015, a consultation with staff employed in the Neighbourhood Scheme identified a number of perceived barriers and unmet need in relation to service provision – including:
    • Personal Assistance, transport and befriending are regularly raised as obstacles by service users;
    • Men’s needs are little understood and provision is insufficient across Calderdale”;
    • The need for more gardening and outdoor activities is often cited as a preference among service users;
    • There is a need to better identify activities for those in the 25 – 55 age group;
    • There is a need for the development and maintenance of a comprehensive borough wide directory and calendar of activities;
    • The lack of accessible, reasonably priced venues is an obstacle in many localities;
    • Transport can be improved and should be facilitated through co-production”.

Other gaps identified through the Staying Well Project include:

  • There is a need to identify how to reach those who are typically ‘hard to reach’. We have yet to develop a collaborative and robust approach to identifying lonely and isolated people in our communities.
  • There is a need to establish ‘points of reference’ for older people to easily access current, up to date information about services, community activities and groups, both electronically and in a range of other appropriate formats.
  • There is a need for improved primary care engagement in tackling social isolation and loneliness and the development of an effective social prescribing model.

Projected future need

Current estimates suggest 18% of the population in Calderdale is aged 65 or over. By 2037 the Office for National Statistics (ONS) estimate 25% of Calderdale’s population will be over 65. This will equate to, approximately, 21,000 additional people over 65 (ONS, 2014). Such a large rise, in a little over 20 years, will undoubtedly increase demand on services and the prevalence of conditions pertinent to older adults.

Key considerations linked to the known evidence base (what works?)

The evidence base on what works for alleviating loneliness and isolation is underdeveloped - with some conflicting conclusions emerging from the research. Nonetheless, there have been a number of evidence reviews conducted in recent years and a summary of their findings is presented below. It is, however, important to recognise that loneliness is a subjective condition and different approaches will be needed for different people.

What seems to work:

  • Group interventions lasting over 12 weeks (Cattan et al., 2005; Hagan et al., 2014);
  • Interventions targeting specific cohorts (eg. women, carers, the widowed, the physically inactive, people with mental health conditions) (Cattan et al., 2005);
  • Services that enable some level of participant control or consult with the intended target group before the intervention (Cattan et al., 2005);
  • Services developed and conducted within an existing service (Cattan et al., 2005);
  • Services where participants are identified from agency lists (GPs, social services, service waiting lists) (Cattan et al., 2005);
  • The use of new technologies and internet usage that that encourage interactive dialogue (Findlay., 2003; Hagan et al., 2014);
  • High quality approaches to the selection, training and support of the facilitators or co-ordinators of the interventions (Findlay., 2003).

Where the evidence is unclear:

  • One-to-one interventions: particularly conducted in people’s own homes (Cattan et al., 2005);
  • Befriending: There is mixed evidence on befriending for reducing loneliness (Windle., 2011). Although there is relatively robust evidence of its effectiveness in reducing mild depression (Mead et al., 2010) – a condition strongly associated with loneliness. In addition, as befriending involves an increase in a persons’ social network size it has the potential to reduce social isolation, if not loneliness;
  • Mentoring services (Windle et al., 2011).

Implicit in the vagueness of the recommendations of what works is the importance of evaluating any services or interventions implemented locally in order to add to the current evidence base.

References and further information

References

  • Cattan. et al. 2005. Preventing social isolation and loneliness among older people: a systematic review of health promotion interventions. Ageing & Society. pp.41–67.
  • Barth, J. et al. 2010. Lack of social support in the etiology and the prognosis of coronary heart disease: a systematic review and meta-analysis. Psychosomatic Medicine. 72(3), pp.229-38.
  • Cacioppo, J.T. et al. 2006. Loneliness as a specific risk factor for depressive symptoms: cross-sectional and longitudinal analyses. Psychology & Aging. 21(1), pp.140-51.
  • Findlay, R. 2003. Interventions to reduce social isolation amongst older people: where is the evidence?. Ageing and Society. 24(5), pp.647-658.
  • Hawkley, L.C. et al. 2010. Loneliness predicts increased blood pressure: 5-year cross-lagged analyses in middle-aged and older adults. Psychology & Aging. 25(1), pp.132-41.
  • Hagan, R. et al. 2014. Reducing loneliness amongst older people: a systematic search and narrative review . Aging & Mental Health . 18(6), pp.683-693.
  • Holt-Lunstad, J. et al. 2010. Social relationships and mortality risk: a meta-analytic review. PLoS Medicine / Public Library of Science. 7(7), pe1000316.
  • Jaremka, L.M. et al. 2013. Loneliness predicts pain, depression, and fatigue: understanding the role of immune dysregulation. Psychoneuroendocrinology. 38(8), pp.1310-7.
  • Mead, N. et al. 2010. Effects of befriending on depressive symptoms and distress: systematic review and meta-analysis. British Journal of Psychiatry. 196(2), pp.96-101.
  • ONS. 2014. Available from: Sub-national Population Projections .
  • Peplau, A., L. 1984. Loneliness Research: A Survey of Empirical Findings. In: Goldston, S. ed. Preventing the Harmful Consequences of Severe and Persistent Loneliness.  Indiana: US Government Printing Office, pp.13-46.
  • Pikhartova, J. et al. 2015. Is loneliness in later life a self-fulfilling prophecy?, Aging & Mental Health, DOI: 10.1080/13607863.2015.1023767
  • Shankar, A. et al. 2013. Social isolation and loneliness: relationships with cognitive function during 4 years of follow-up in the English Longitudinal Study of Ageing. Psychosomatic Medicine. 75(2), pp.161-70.
  • Steptoe, A. et al. 2013. Social isolation, loneliness, and all-cause mortality in older men and women. Proceedings of the National Academy of Sciences of the United States of America. 110(15), pp.5797-801.
  • Victor, C. et al 2005. The prevalence of, and risk factors for, loneliness in later life: a survey of older people in Great Britain. Ageing and Society, 25, pp 357-375 doi:10.1017/S0144686X04003332
  • Windle, K. et al. 2011. Preventing loneliness and social isolation: interventions and outcomes. London: Social Care Institute for Excellence.
  • Yang, K. and Victor, C. 2011. Age and loneliness in 25 European nations. Ageing & Society. 31(08), pp.1368-1388.

Further Information

More information on older people can be found in the Further resources .

For a more comprehensive list of risk factors for loneliness and isolation see either Victor et al., 2005 or the Campaign to end loneliness: risk factors .

Authors

John Lomas, Information and Evaluation Officer, Public Health, Calderdale Council;
Julie Hosty, Staying Well Project Manager, Communities, Calderdale Council.

November 2015.