07 Nov Loneliness can be a killer
No one is immune to that hollow ache of loneliness. Regardless of age, gender, ethnicity or marital status, it is a hurdle we all, at some stage in our lives, have to recognise and surmount. But recent research at Brigham Young University in Utah suggests that a pervasive perception of loneliness – as opposed to actual isolation – does affect physical health.
Based on 70 studies undertaken between 1980 and 2014, the researchers found that the effects on health of loneliness and social isolation are as great or greater than those of obesity and should be regarded as a serious threat.
Loneliness or living alone seem to be particularly bad for adults under the age of 65, presumably because, research suggests, solitary middle-aged adults are more likely to engage in risky behaviours and are less likely to seek medical treatment. According to study authors Julianne Holt-Lunstad and Tim Smith, affluent nations have the highest rates of individuals living alone, and as this number increases, social isolation will reach epidemic proportions in the next two decades.
Previous research by Holt-Lunstad and Smith put the heightened risk of mortality from loneliness at the same level as smoking 15 cigarettes a day and being an alcoholic. This more recent study suggests that not only is the risk of mortality in the same category as these well-known risk factors, but it also surpasses health risks associated with obesity.loneliness if they are over 80, live alone, belong to an ethnic minority, are gay, lesbian, bisexual or transgender, or have poorer health than expected and/or a disability.
Men report higher rates of loneliness than women – as Scott says, women tend to have wider social networks than men – and Pacific and Asian people tend to be lonelier than other ethnic groups. Income also makes a difference. “People in severest hardship or even people who are relatively comfortably off report being more lonely than people who are well off,” says Massey University psychology professor Fiona Alpass. “If you are poor, you have fewer resources to get out or have a computer to contact your family.” For many, loneliness is triggered by key events: the death of a spouse, the loss of a driver’s licence, a neighbourhood scare, even a fall.
“There are all the [physical] implications to do with that fall,” says Age Concern Canterbury chief executive Simon Templeton. “But then there is often a loss of confidence, which means not going out so much. That can be a slippery slope.” There is also the sudden change of location. In Christchurch, many people had to change suburbs following the earthquake. “So people were having to move away from their social connections, their church, the dairy down the road where they bought bread and milk every day.” Three years ago, in the wake of the Christchurch earthquake of 2011, the South Shore Residents Association surveyed 500 local households to gauge their needs. More important than water and insurance advice, says chairman Bill Simpson, was the loss of “bumping into” places.
“Almost all were feeling isolated. We used to have a neighbourhood pub, the fish and chip shop, a cafe – they’ve gone. There’s no school, no church. [Local residents] are not on Facebook or Twitter.” The association established a drop-in facility for coffee, a chat, a weekly game of mah-jong. On a Wednesday morning, there are volunteers from Red Cross; a depression support worker offers confidential advice. For the three women relaxing over a cup of tea, it’s about strengthening roots, feeling safe, re-establishing a sense of community. For others, the response to old age or simply retirement is to leave altogether – to a new life by the sea, a new city close to children, a new home in a new subdivision. A move, says Alpass, that some later regret. “You finally get somewhere and there is not the support as you age and people are quite mobile with their work. You might go there at 65, but when you are 75, who will be looking after you?”
For older migrants this sense of alienation is even more acute. “Often children think it is the best thing to do,” says Templeton. “Dad has died, let’s bring Mum over so she won’t be sad and lonely. So they move her over here. They’re busy at work, she’s in a country where she doesn’t speak the language, has no friends.” In his work with older Chinese migrants, Auckland psychiatrist Dr Sai Wong describes a debilitating combination of loss of friends, loss of language and loss of culture. “People are proud of their culture in their home of origin. They come here and find it is not the same; they have nothing to hang on
to. But they are ashamed to say they are lonely; they are worried people will blame their children.”
AS DAMAGING TO HEALTH AS SMOKING
Investing in social opportunities for older people cannot be dismissed as a “nice to have”, says Alpass. “What we see from health outcomes [is that] services to ameliorate issues around loneliness are critical to keep people out of hospitals and GP surgeries – the more expensive end of dealing with older people.” According to Age UK, loneliness in old age is as damaging to health as smoking 15 cigarettes a day and twice as damaging as obesity. High blood pressure, cardiovascular disease, cognitive decline and anxiety all become more prevalent when social connections fall away.
The lonely are more at risk of drinking too much, smoking, overeating, gambling (older women in particular are gambling in increasing numbers) and being depressed. Ministry of Health figures show an extraordinary 15-20% of people over 65 are affected by depression.
It’s a challenge on all fronts. Older people may find it difficult to talk about emotions, particularly if they have grown up with the social stigma attached to mental illness or are worried how such a diagnosis may affect their independence. And family members, even GPs, may assume that downheartedness or general crankiness is an inevitable part of ageing. “Older people do seek help,” says University of Auckland psychiatry lecturer Gary Cheung. “They go to their GP, but they don’t necessarily talk about their feelings.” In analysing 200 suicide cases among those over-65, he found 70% had seen a GP within a month of their death. Provisional suicide figures for the year to June 2014 from the Chief Coroner’s office show that 29 people aged 80 or over took their lives. Of these, 24 were men, the highest rate per 100,000 population of any other age group in New Zealand.
In his study, Cheung found three main predictors: depression, self-reported health problems and perceived loneliness. Personality plays a factor, as does community and family support, but he says there is a clear need for a specific strategy for older people, including stronger screening and treatment of depression in primary care. Any strategy to reduce social isolation will also have a cost benefit. Those struggling with loneliness clock up more doctor visits and more days in hospital. In the UK, at least one in 10 visits by older people to their GP appears to be motivated by social isolation. Emergency services report that elderly people may call just to have someone to talk to.
Lonely older people are also more vulnerable to scams, losing anything up to a reported $850,000 to callers offering prizes, money and friendship by phone, mail, computer or door-to-door encounters. “Scammers are cold-calling, ringing up, becoming friends, making all sorts of promises,” says BNZ security and fraud coordinator Bronwyn Groot. The problem is not naivety but loneliness, she says. Older victims are vulnerable because they are isolated. “And scammers know that. They abuse them, scare them or groom them. Dating romance scams offering online friendship are a real shocker.”
Groot takes her Scam-Savvy presentation to community groups across the country. “I say it’s okay to hang up the phone, delete emails, say no to someone at the door. People have to be suspicious. I recommend people stop and wait, ring someone before they go ahead with it.” And if they have been sucked in, speak up. “Often they’re ashamed. They’re scared of what their family might think or that their kids might take their chequebook or force power of attorney. And that is very worrying.”
REST HOMES NO PANACEA
Last year Peggy Garnett went to see a two-room apartment in a retirement village. “I was a wee bit down and lonely and thought it would be lovely but I don’t think I want to leave my home. I love my home. I have all my bits and pieces that I’ve had all my life. It’s nice to stay with your memories.” Her curiosity is not unusual. Loneliness has been found to almost double the likelihood of an older person entering residential care.
But rest homes are not a panacea for loneliness. Although there is more opportunity for social contact, says Alpass, if you lack mobility or resources, “it’s going to be harder for you to make social contacts”. The Mental Health Foundation in the UK claims that depression affects one in five older people living in the community and two in five living in care homes. “People have this idea they will go into residential care and they’ll be with all of these people and not be lonely,” says Templeton. “But they go there and suddenly they’re sharing lounges, they’re having meals when they are told to have meals – they lose so much of their autonomy.”
It is much worse if the move is not the older person’s choice, he says. “Cognitive impairment aside – and there is a process for that – if you are making decisions for them, that is elder abuse.” Templeton talks of “dignity of risk … Older people have the right to make poor choices. We get families saying Mum has to go into care because she might fall at home and if she does she will lie on the floor for three days – that is about their concern. We talk to [the mother], we say there is a risk of falling and we can get you a walking frame, but she might say, ‘I know that but I want to stay at home.’ Yes, there is a risk she could fall over and die – I could go home tonight and drink four bottles of whisky and die. It is the choice we make.” As with other OECD countries, New Zealand is committed to ageing in place, supporting older people to remain in their own homes or in supported accommodation of some type in the community, rather than moving into residential care.
But in doing that, says Templeton, we need to be thinking about ways we connect with older people, “so they can thrive in a community”.
THE SOCIAL NETWORKS
Around the country, Age Concern runs weekly van outings for over-65s to go to a venue or event or simply meet at one of their houses for morning tea. It also runs a one-on-one weekly visiting service to older housebound people that is staffed by volunteers, half of them over 65. “Some older people have days, weeks, not talking to anybody. Often that [Age Concern] visitor is the only person not paid to come and see them.” In 2002 Age Concern Otago in conjunction with the University of Otago pioneered Steady As You Go (Saygo). Designed as a peer-led falls-prevention exercise class, it was found to provide not only important physical benefits but also vital social connections.
Such has been the success of the programme that Saygo courses are now rolling out across the country. Church groups, Neighbourhood Support groups and residents’ associations are all working, usually on a shoestring budget, to re-establish meaningful social networks for the elderly in their communities. For the past six years, in the last weekend in March, communities around the country have celebrated Neighbours Day, established in 2001 by Neighbours Day Aotearoa to encourage people to get together for a barbecue, a street makeover, a beer or a cup of tea as a catalyst for connecting or re-connecting neighbours with neighbours.
Last year entrepreneurs Casey Eden and Shane Bradley launched the Neighbourly website and app, an online bush telegraph aimed at fostering a community feeling for neighbourhoods through a local and secure listing service for events and activities, be it a garage sale or community sausage sizzle. Today it has more than 60,000 members in 1400 suburbs. Around the country some 17,000 retirees are enrolled in SeniorNet programmes, negotiating new computer technologies to master online banking, research family history or keep in contact with family and friends via Skype or email. As executive officer Grant Sidaway says, “We’re the largest technical school in the country.” Technology is not the answer, says Templeton, but it is an answer to an increasing problem. “As the population of that age doubles, we will struggle to double our service, so we need to come up with other ways.
Some people will need face to face [contact]. For others Skype is perfect.” He describes a programme launched by Age UK, whereby older British citizens link up with overseas students studying English via Skype. “The older person gets to talk to these young 20-year-old students and they get to practise their English. It’s a great mix of ages. I’d love to see that here.”
We are an ageing population. By the late 2030s, close to a quarter of us will be flashing our SuperGold Cards. The number of single-person households is increasing generally but most dramatically in the over-65 age group. According to Alpass, we will be living longer in, say, widowhood “and many of us will not have family support around us …
The most at risk of loneliness are over 80 and we are going to have a lot more people living well past 80 in the future. We need to be thinking about this now.” Many – currently nearly a quarter of over-65s – will continue in paid employment. “A farm labourer might not want to be still working at 70,” says Templeton, “but as the population ages and the workforce decreases, there won’t be enough nurses, taxi drivers or burger flippers. There just won’t be enough people to man the pumps. There’s two ways around that – immigration and people working longer.”
Which may mean less demanding work and more flexible hours. “It is about workplaces valuing [older people’s] input.” More flexible forms of housing are also in demand. Across the world new models are being established to cater to the growing number of single or widowed elderly people wanting to live independently but not alone. The Golden Girls Network in the US runs a database for members seeking compatible housemates. In the Netherlands, the Humanitas Apartments for Life challenges the inevitability of nursing homes with age-friendly housing developments that include restaurants, shops and other services so older residents can live as they choose in a social and supported environment. In New Zealand, the Bays Community Housing Trust in Auckland runs two five-bedroom houses for women over 65 with limited assets.
Around the country, the Abbeyfield model provides homes staffed by a cook-housekeeper that have a communal lounge, dining room and kitchen. Basically, flatting for ageing baby boomers. Massey’s Neville talks about age-friendly communities and more integrated neigh- bourhoods that enable older people to engage with others through well-designed housing, public transport, places to meet, footpaths designed so people can safely walk – or use a scooter – to meet friends. “Communities must be designed so older people can easily, safely, confidently move around.”
He cites the World Health Organization’s Global Age-Friendly Cities Project, by which cities are encouraged to boost the participation, health and independence of olderpeople. “It’s about fostering a sense of community within communities, so people feel they belong, and there are activities that bring people together.” To better meet the needs of this growing sector of our population, Templeton is calling for more involvement of older people in planning decisions. “There is a requirement for every government body or organisation to have a statement relating to the Treaty of Waitangi, and that’s important, but I’d like the same thing to be mandated for old people.
For every change, every decision, every plan, there has to be a statement about how is this going to effect older people? What have we done to consult with them?” It is a whole of society challenge, he says, and a whole of society responsibility. “Our children don’t stay in the same city; family members live all over the world. So when older people require some support, families aren’t in a position to do that. And you often hear, ‘My son lives in [the same city] but he is so busy with his own life.’ As a society we need to take a look at that. This is not just about old people. It’s about the whole continuum of us looking after and supporting each other. It is a two-way street, and the benefits to society are huge.”
NEW LEASE OF LIFE
Every Wednesday up to 40 mainly older local residents arrive at the hall at St Faith’s Anglican church in Christchurch’s New Brighton for a bite of lunch and a sip of companionship. Ben Jensen has been alone for 15 years. His wife died in 2000; he has no family in New Zealand. In summer he plays bowls once or twice a week, and he enjoys outings organised by the local church. “But days can be long. There are quite a few days when I don’t talk to anyone. If you are a person who is chatty, you get on well, but if you are lonely and don’t talk much, it’s a lot harder.” In the kitchen Grace Dunstan, 83, is helping prepare lunch. After her partner of 34 years died, she says, she “felt a bit lost”.
She tried volunteering at the local library but they wanted someone with computer skills. “I’m not that kind of person.” Now on Tuesdays she helps prepare vegetable boxes and on Wednesdays she’s on lunch duty. “I knew I had to do something with my life. I’ve got friends in a similar position, but they just can’t make the effort. Here I’m meeting different people and I go home feeling good about myself. There’s no point in looking at four walls all day, and you can’t keep going out because that costs money. But this has given me a new lease of life.”