Jeremy Kyle is the new best friend of many… Is this an issue we should be interested in?
Dr Lauren Wentworth is a Consultant Geriatrician at Manchester Foundation Trust. She has a specialist interest in frailty, front door acute Geriatric services and Community Geriatrics.
Over the past year there has been increasing press focus on loneliness in the older population and its negative impacts on health. Suddenly it’s the new kid on the block and we should all be thinking about it.
Jeremy Hunt highlighted the plight in 2013 stating...
"Some five million people say television is their main form of company, and that as a society means we have completely failed to confront the problem of loneliness."
But what actually are its impacts, and should we as Specialists in Geriatric Care and the BGS be taking an interest?
As a Geriatrician whose interests lie with the acute front door and community I have become increasing aware of the number of patients living alone whose often only contacts on a weekly basis are with people that provide formal care. When asked they often express a sadness at not seeing or speaking to people more regularly. However when I suggest social activities these are rarely taken up as ‘I don’t like to meet new people’ or ‘I’m not a sociable person’.
At the front door there are increasing numbers of ED attendances which when actually explored can be explained by people seeking more regular contact. But does isolation make you more vulnerable and when did loneliness, a social problem, become a health problem?
In June the BGS ran its first conference on Loneliness. This was a great day where I learnt from speakers from all areas of expertise including epidemiology, cell pathology and technology and together with the workshops this really sparked my interest. I came away inspired and fully on board with why people become lonely and how this has negative impacts on health; health being a state of complete physical, mental and social wellbeing. However the next week I attended a key note by an expert in health ageing who made me question what I had heard, especially the research into its negative health impacts and whether its risk factors are actually modifiable.
Levels of loneliness follow a ‘U shape’ curve with the highest incidence being in those less than 25 and over 65, with an exponential increase in those over 85. Reported incidence is supposedly increasing with the ageing population and subsequent low levels of physical activity due to long term conditions. As a result people become housebound and reliant on professionals for activities of daily living. Gone are the times where they would meet up with friends and family. Also, this population has increasing numbers of unmarried and widowed people meaning they don’t have a household companion; nowadays this is usually Homes Under the Hammer or Jeremy Kyle.
With austerity the ability and opportunity to access social activities, both with transport and participation costs, are limited. Those who are fulltime carers for their spouses are also at risk, often stopping all of their hobbies and past times to care for their loved ones and no longer leaving their home for fear of what may happen whilst they’re out.
Actually though, 70% of those over 65 aren’t lonely and more people now are recorded as never being lonely. Also, loneliness and isolation aren’t the same thing and data is often skewed by reviewing the number of people living alone.
Levels of loneliness can be described as either a quantitative or qualitative deficit and is a personal viewpoint on how many interactions they perceive they should have. It is not a static experience and goes in waves. It is very subjective and is associated with negative feelings; ‘no meaning to my life’, ‘a lost sense of purpose’. As technology becomes ever more integrated in our lives the rise and importance of social media is central to modern lifestyles. This has influenced and increased expectations of what our life should be like and causes us to reflect on how ours is less than perfect.
Even living in a communal setting can be an issue. Reported levels in Nursing Homes are high perhaps associated with the high levels of dementia. On personal experience visiting sheltered accommodation and newer assisted living flats advertised as being sociable and friendly, often have an eerily empty feel with communal lounges being unoccupied and no promoted group activities. Meaningful connections and relationships rely on others and with families and friends living further away and having increasing working responsibilities, the once close family network structure has also gone. 60 years ago families lived in close proximity and also were much more like to live together with children taking on caring roles of older parents.
It is reported that loneliness is associated with an increased risk of mortality of 26% (OR 1.26). This may be explained by the fact that psychological stress can be linked to premature cell ageing through increase levels of CRP, cortisol and blood pressure (stress response). Some studies claim being lonely is worse than smoking, but are those lonely smokers? It has been said to be associated with an increased risk of developing dementia but this was a very limited study with a half a word difference in recall used to ‘prove’ this link. What can be said confidently though is that loneliness compromises wellbeing and therefore we should take this seriously.
So should the BGS take a more integral role in loneliness and its impacts? I would argue yes and for the establishment of a Specialist Interest Group. We are at risk of ‘pilotitis’ with people taking an interest in this area due to its increased publicity. There needs to be a more robust health view on its actual impact and if and how it can be addressed, so that future service development can be advised.