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Related to: Ageing Population, Rural Areas, Mental Health and Illness, Dementia, Wellbeing, Internet Access, Transport Infrastructure

Key Facts

  • 10% of those over 65 in the UK experience chronic loneliness
  • 23% of people aged 75+ who live alone do not see or speak with someone every day.
  • Three quarters of family doctors in the UK report that between one and five patients a day attend their surgery primarily because they are lonely.
  • In the UK in urban areas 95% of people live within 13 minutes of a regular (hourly) bus, but in rural areas this falls to 61%.
  • The proportion of younger people (18 – 64) that answered that they did not have enough social contact, or they felt isolated was higher (25%) than the proportion of the older age group (65+)(19%) in the B&NES 2014 Adult Social Care Survey.
  • Over a third of older people (37% or about over 4 million) consider the television as their main form of company.
  • 15% of respondents to the Bath and North East Somerset Resident Survey felt they had no-one they could depend on in their local area (not including members of their families). The age group with the highest proportion that felt this was 18-34 year olds, with 22%. 
  • 49% of respondents to the B&NES Resident Survey outlined they had not taken part in any meetings of clubs, religious or other groups in the past week, the proportion was highest among 18-34 year olds, with 56%. 
  • 16% of respondents to the B&NES Resident Survey stated that they hardly ever talk about their deepest problems with family and friends, the proportion was highest among 65 + year olds, with 20%. 
  • In the B&NES Resident Survey a much higher proportion of 85+ year olds (15%) stated that they hardly ever feel useful to their family and friends than the those in the younger age groups (all with 7% or less). 
  • lower proportion of 35-64 year olds (54%) than 65+ year olds (65%) and 18-35 year olds (65%) stated that they were very satisfied with the kinds of relationships they have with family and friends in the B&NES Resident Survey. 

 

Definitions

Loneliness is a subjective experience, a negative emotion with a perceived gap between the quality and quantity of relationships that we have and those we want.1 Loneliness is a state of mind. Loneliness causes people to feel empty, alone and unwanted. People who are lonely often crave human contact, but their state of mind makes it more difficult to form connections with other people. Loneliness is not necessarily about being alone. Instead, it is the perception of being alone and isolated that matters most. 2

This differs from …

Social isolation, which is an objective state that can be defined in terms of the quantity of social relationships and contacts.3

Information on groups and activities in Bath and North East Somerset open to adults who are socially isolated, affected by mental health issues, substance misuse or homelessness can be found in the Hope Guide

What does the data say?

UK 4

As part of developing their guide, Promising approaches to reducing loneliness and isolation in later life, Age UK carried out a study on loneliness and Isolation in the UK.  Age UK carried out this study with the help of an expert panel including older people, academics, leaders of service delivery organisations, policy thinkers, funders, commissioners and government experts.

According to the Age UK study:

Prevalence - 10% of those over 65 in the UK experience chronic loneliness. These levels have remained relatively consistent over recent decades, however as the population of older people has grown, the absolute number of individuals experiencing loneliness has increased.

23% of people aged 75+ who live alone do not see or speak with someone every day.

13% of people aged 55+ only speak to someone three or four days a week.

Three quarters of family doctors (76%) report that between one and five patients a day attend their surgery primarily because they are lonely.

In urban areas 95% of people live within 13 minutes of a regular (hourly) bus, but in rural areas this falls to 61%.

Figure 1: Proportion of people aged 55 and over who live alone - LGBT and Heterosexual People.

Loneliness and isolation amongst Lesbian, Gay, Bisexual and Trans older people is particularly problematic because they tend to have greater difficulties accessing mainstream provision, because many providers are unsure how to address their needs. Some older LGBT people would like to have connections to other LGBT people; others would favour mainstream provision that was sensitive to their needs.

Loneliness and isolation is a particular issue for black and ethnic minority communities because of language difficulties, especially if they are suffering from dementia because dementia often causes the loss of the second language.

Impact of loneliness – The impact loneliness can have on our mental and physical health should not be underestimated.

The effect of loneliness and isolation on mortality exceeds the impact of well-known risk factors such as obesity, and has a similar effect as smoking 15 cigarettes a day.

Lonely individuals are at higher risk of the onset of disability and are at greater risk of cognitive decline, and one study concluded that lonely people have a 64% increased chance of developing clinical dementia.

The key three challenges –

1.    Reaching lonely individuals

2.    Understanding and responding to the specific circumstances of an individual’s loneliness

3.    Supporting lonely individuals to access appropriate services

 

What does the community say? 

Bath and North East Somerset

2014 Voicebox Resident Survey  5

The large scale Voicebox Resident Survey aims to provide an insight into Bath and North East Somerset and its local communities and to capture resident’s views and experiences of their local area and council services. The questionnaires are posted to 3,150 addresses selected randomly in the local authority area. Selected respondents also have the opportunity to complete the survey online. In 2014 a total of 975 residents completed the questionnaire, a response rate of 31%. 

The Voicebox Survey carried out in 2014 asked a series of questions designed to get a better idea of the extent to which the residents of Bath and North East Somerset might be experiencing loneliness and isolation. 

The questions asked about the following components of resident’s lives:

  • People residents can depend on in the local area
  • Participation in social activities
  • Roles and nature of relationships with family and friends
  • Satisfaction with relationships with family and friends

People residents can depend on in the local area – When respondents were asked - Other than members of your family how many people in your local area do you feel you can depend on or feel very close to? -

Responses by gender - When asked about how many people in their local area they felt they could depend on (not including members of their families), there was little difference between the responses of male (426) and female (470) respondents:

  • 54% of male respondents and 52% of female respondents felt they could depend on more than 2 people
  • 30% of male respondents and 33% of female respondents felt they could depend on 1-2 people
  • 16% of male respondents and 15% of female respondents felt they had no-one they could depend on. 

Responses by age - The age group with the greatest proportion of respondents that said they felt they had no one they could depend on was 18-34 year olds, with 22% (14% of 35-64 year olds, and 10% of 65 + year olds). 

Participation in social activities - When respondents were asked - How many times in the past week have you spent time doing the following activities:

  • Spent time with someone who does not live with you
  • Talked to friends, relatives or others
  • Meetings of clubs, religious or other groups

18% outlined they spent time with someone who does not live with them seven or more times in the last week and 61% outlined two to six occasions in the past week. Of the remainder 12% outlined once and 10% outlined none.

38% outlined they had talked to friends, relatives or others seven or more times in the past week. Only 4% outlined they spoke to friends, relatives or others once and only 2% outlined none.

Nearly half (49%) outlined they had not taken part in any meetings of clubs, religious or other groups in the past week. Just over a third 36% outlined they took part once or twice and the remaining 15% outlined three or more times.

Figure 2: The frequency respondents to the 2014 Voicebox Resident Survey did various social activities in the past week  6

 

Responses by gender:

  • A greater proportion of men (12%) than women (6%) stated that they had not spent any time with someone who does not live with them in the past week.
  • Very similar proportions of men (2%) and women (1%) stated that they had not spent any time talking to friends, relatives or others in the past week.
  • Very similar proportions of men (49%) and women (50%) stated that they had not spent any time in meetings of clubs, religious or other groups in the past week.

Responses by age:

  • A slightly greater proportion of 65+ year olds (13%) than 35-64 year olds (10%) and 18-35 year olds (8%) stated that they had not spent any time with someone who does not live with them in the past week.
  • Very similar proportions of 65+ year olds (1%), 35-64 year olds (3%) and 18-35 year olds (1%) stated that they had not spent any time talking to friends, relatives or others in the past week.
  • A greater proportion of 18-35 year olds (56%) than 35-64 year olds (48%) and 65+ year olds (44%) stated that they had not spent any time in meetings of clubs, religious or other groups in the past week.


Roles and nature of relationships with family and friends - When respondents were asked –

 Do you feel that….?

  • ... your family and friends (people who are important to you) understand you? - 80% stated ‘most of the time’, 18% outlined ‘some of the time’, and 2% outlined ‘hardly ever’.
  • .. you are useful to your family and friends (people important to you)? - 78% said ‘most of the time’, 20% outlined ‘some of the time’, and 2% outlined ‘hardly ever’.
  • ... you know what is going on with your family and friends? - 76% stated ‘most of the time’, 22% stated ‘some of the time’, and 2% outlined ‘hardly ever’.
  •  ... when you are talking with your family and friends, you are being listened to? - 79% stated ‘most of the time’, 20% said ‘some of the time’, and 1% outlined ‘hardly ever’.
  •  ... you have a definite role (place) in your family and among your friends? - 80% stated ‘most of the time’, 17% outlined ‘some of the time’, and 3% outlined ‘hardly ever’.
  •  ... you talk about your deepest problems with at least some of your family and friends? - 55% said ‘most of the time’, 29% stated ‘some of the time’, and 16% outlined ‘hardly ever’.

Responses by gender – On the whole there was little difference between the genders in terms of responses to the questions about roles and nature of relationships with family and friends. The only real difference was in the proportion of men (19%) and women (12%) that stated that they hardly ever talk about their deepest problems with their family and friends.

Responses by age – For most of the questions about roles and nature of relationships with family and friends there was little difference between the responses of the different age groups.

However –

  • a greater proportion of 65+ year olds (7%) than 35-64 year olds (1%) and 18-35 year olds (1%) stated that they hardly ever feel useful to their family and friends. The proportion was particularly high among 85+ year olds (15%).
  • a greater proportion of 65+ year olds (20%) than 35-64 year olds (16%) and 18-35 year olds (11%) stated that they hardly ever talk about their deepest problems with their family and friends.
 
Satisfaction with relationships with family and friends - When respondents were asked - How satisfied are you with the kinds of relationships you have with family and friends?
 

91% said they were satisfied (very/fairly) with the relationships they have with their family and friends, 4% outlined they were dissatisfied (very/fairly).

Figure 2:  Levels of satisfaction with relationships with family and friends of 2014 Voicebox Resident Survey respondents  7

Responses by gender - A lower proportion of men (57%) than women (62%) stated that they were very satisfied with the kinds of relationships they have with family and friends.

Responses by age – A lower proportion of 35-64 year olds (54%) than 65+ year olds (65%) and 18-35 year olds (65%) stated that they were very satisfied with the kinds of relationships they have with family and friends.

 

What can we realistically change?

Combating loneliness: a guide for local authorities 8

In January 2016 the Local Government Association, Age UK and the Campaign to End Loneliness published Combating loneliness: a guide for local authorities which sets out a range of actions for combating loneliness building on the latest evidence. The guide focuses on older people but it is thought that the recommendations will be beneficial to other age groups as well. 

UK 9

In developing their guide, Age UK investigated the full range of initiatives being undertaken to tackle loneliness which show promise. The guide draws on the expertise and experience of leading figures in the field, as well as on academic and other available evidence.

Figure 2: A new framework for interventions for loneliness and isolation

The approaches in figure 2 are the steps that should be taken as part of the work to reduce an individual’s loneliness:

Foundation services - not specific activities or interventions, but rather services that address one or more of the key challenges

Direct interventions - more commonly recognised interventions, such as lunch clubs, social groups, befriending schemes, psychological approaches

Gateway services - services like transport and technology are playing a critical role in directly enabling or disabling relationships

Structural enablers - approaches that support the development of new structures within communities, and bringing initiatives into being is helping to reduce loneliness in itself

 

Foundation services

1. Reaching lonely individuals - This is a potential area for development in future. Because many lonely individuals are also socially isolated it is difficult for services to reach them. Therefore it is important to ensure that such services are pro-actively offered to those most likely to be affected by loneliness, rather than simply being made universally available.

In Cheshire data matching (Springboard) is used to identify individual households to target home visits to older people. In Essex and Gloucestershire data has been used to identify neighbourhoods in which high numbers of older people, who match risk criteria, live, so that these can be prioritised.

Some initiatives work by recruiting and training individuals and professionals within a community, with whom older people may make contact. The training gives them the skills to recognise the signs of loneliness and to enable them to make appropriate referrals and offer support.

Another approach is linking up loneliness interventions to the health service. It utilises the knowledge and connections of health professionals to identify potentially lonely individuals and connect them with services (e.g Community Wellbeing Practices – Halton).

2. Talking and understanding - The second key issue is the importance of a personalised response to loneliness. An in-depth conversation is vital in ensuring that the full range of an individual’s needs can be recognised and responded to – including requirements for specialist support to overcome barriers to accessibility caused by mobility issues, sensory loss, or cognitive impairment, etc.

Some examples of foundation services, which focus on talking and understanding are:

Living Well – Cornwall – provides practical support, navigation and coordination to those most at risk of increased dependency and hospitalisation – www.livingwellcornwall.org/knowledgebucket

Village and Community Agents – Gloucestershire – trusted members of the community visit people at home and find out about the issues affecting them an identify solutions – www.villageagents.org.uk

3. Supported access - The final approach in the Foundation Services is the provision of services to support older people through the process of reconnecting with wider provision in their communities.

These services link lonely individuals with a trusted ‘buddy’ or ‘mentor’, who offers practical and emotional support to the individual and may get involved in going along to activities, enabling access to direct interventions.

An example of foundation services that support access:

Time for Life – Devon - supports people aged 65 and over by using coaching techniques and by accompanying them to any activity they wish to attend - www.timeforlife.org.uk

 

Direct interventions

Direct interventions are services and support to which people can be referred to once they have been reached, understood and supported. Direct interventions aim to help people develop meaningful relationships.

There are three main categories of direct loneliness intervention:

  • Supporting individuals to reconnect with and/or maintain existing relationships
  • Fostering and enabling new connections
  • Helping people to change their thinking about their social connections

Group-based approaches

Group-based approaches show promise in supporting new relationships; a shared learning experience can give meaning to social interaction.

Some examples of group-based approaches:

Fit for the future – Age UK – Activities range from dance, cycling and swimming to lessons in cooking, gardening and eating healthily – www.ageuk.org.uk/health-wellbeing/fit-as-a-fiddle/fit-for-the-future

Men’s Sheds /Tools Company – Age UK Exeter - offer a facility for men aged over 50 to meet for a few hours a week in the familiar environment of a shed or workshop – www.ageuk.org.uk/exeter/our-services/men-in-sheds/

One-to-one approaches

The most common form of this is the traditional ‘befriending’ service, where an older person is matched with a worker or volunteer who visits or telephones them on a regular basis.

Particularly for those for whom practical barriers such as disability make getting out and about difficult, and in a context in which social care provision was simply insufficient to overcome these barriers, one-to-one befriending services can play an extremely positive role. Others would benefit from becoming involved as befrienders themselves.

Some examples of one-to-one approaches:

Dementia Friendship Scheme – Age UK Coventry - is for older people with early stage dementia, which aims to support people who live alone to maintain a hobby, or activity within their local community - www.ageukcoventry.org.uk

The Silver Line Helpline - the only 24-hours-a-day free and confidential helpline which offers information, friendship and advice to older people. It also offers telephone and letter based befriending by volunteers - www.thesilverline.org.uk/

Psychological approaches

The third category of direct interventions is focused on supporting people to change their thinking about their relationships. Services of this nature are in their infancy in the UK. Mindfulness and Cognitive Behavioural Therapy (CBT) are currently recommended for use among individuals suffering from depression, and there is good evidence of their efficacy in addressing loneliness, however few organisations offer psychological services as a loneliness intervention at present.

An example of a psychological approach:

Psychological Support Services – Age UK Warwickshire - A counselling service available to clients  aged over 55, or who are caring for someone aged over 55. - www.ageuk.org.uk/warwickshire/our-services/psychological-support-service/

 

Gateway Services

Technology - There is dispute about the impact of technology on loneliness among older people. Some experts say the increasing use of technology exacerbates the exclusion of older people; other say technology makes social connection possible for older people.

Some examples of technology gateway services are:

Call in time – Age UK - staff volunteer to befriend an older person -
www.ageuk.org.uk/health-wellbeing/relationships-and-family/telephone-befriending/

Active Online – Viridian Housing - free internet training scheme for residents aged 50 and over - www.viridianhousing.org.uk/residentsandcommunities/activeonline

Transport - is important to keep up connections with existing family and friends and to reduce social isolation. Some initiatives provide transport to their activities as part of their service.

Some examples of transport gateway services are:

Elderly Tea Parties - for people aged 75 and over, who live alone and have limited support from family and friends, are organized. - www.contact-the-elderly.org.uk/

Shopping Service – Age UK Kensington and Chelsea - This initiative enables older people who are unable to use public transport, to do their shopping, have a meal and socialise. - www.aukc.org.uk

 

Structural enablers

Neighbourhood approaches

Neighbourhood approaches are very important to tackle loneliness because old people often spend their time in their immediate neighbourhood.

An example of neighbourhood structural enabler services is:

Leeds Neighbourhood Networks - Health related activities, digital inclusion, social groups, outings and trips, information and advice and practical support - www.leeds.gov.uk/betterlives

Asset based community development (ABCD) - delivers a range of service for older people that meet the three key criteria:

  • being what local older people want
  • involving older people
  • being sustainable

Volunteering

Volunteering has some positive impacts on the wellbeing and social connection of the volunteers themselves. Thus it can be a good remedy against loneliness.

An example of volunteer structural enabler services is:

LinkAge Bristol – Involve, Inspire, Enjoy - This local charity works with people aged 55 and over and local communities on social activities to reduce isolation and loneliness. There is a broad range of activities such as archery, choirs, cooking and IT offered by the hubs - www.LinkAgeBristol.org.uk

Age positive approaches

A positive attitude to ageing helps the initiatives to find creative solutions on how to enable older people to remain socially connected.

An example of age positive structural enabler approaches is:

Culture Champions – Age Friendly Manchester - It is focused on encouraging arts engagement among older people.
http://www.manchesterculturalpartnership.org/wp-content/files_mf/vopculturechampionsevaluation.pdf

Loneliness within care settings

Social interaction among older people living in care settings can be limited due to physical disability and cognitive impairment. However, a research in extra care housing has shown that the most important relationships of the residents were those they already had before they entered the schemes.

Some examples of structural enabler approaches within a care setting are

My Home Life – Community Visitors - The volunteers visit the homes once a week for some hours to spend some time with the residents. - www.mhlec.org/about/community-visitors

Hen Power - Older people living in care settings, artists and hen-keeping are put together to tackle loneliness and depression and enhance wellbeing - www.equalarts.org.uk

An example of a structural enabler approach for Black and Minority Ethnic groups is:

New Beginnings – Migrant and Refugee Communities Forum - This project supports isolated refugees, migrants and asylum seekers accessing services and developing new skills. - http://migrantforum.org.uk/

 An example of a structural enabler approach for Lesbian, Gay, Bisexual and Trans older people is:

Opening Doors London (ODL) - Age UK Camden runs this programme which supports almost 1000 Lesbian, Gay, Bisexual and Trans Londoners. The programme provides social activities, one-to-one befriending, information and advice and active campaigns work. - http://openingdoorslondon.org.uk/

 

What does the community say?

B&NES

2014 Adult Social Care Survey 10

In the 2014 Adult Social Care Survey carried out in B&NES 478 clients were asked whether they had as much social contact as they wanted. The precise question read…

"Thinking about how much contact you've had with people you like, which of the following statements describes your social situation?”.

Owing to the fact that just a small number of people answered the survey, the result may not representative. However, 21% (101 people) answered that they did not have enough social contact, or they felt isolated.

The proportions of males and females that responded that they did not have enough social contact, or they felt isolated, were very similar (23% male, 20% female).

Surprisingly, the proportion of younger people (18 – 64) that answered that they did not have enough social contact, or they felt isolated was higher (25%) than the proportion of the older age group (65+)(19%).

A greater proportion of the respondents living in care-homes and supported living felt they had adequate, or as much social contact as they wanted (86%), than those living independently in the community (75%).

Figure 3: Responses to the 2014 Adult Social Care Survey about social contact – a comparison between respondents in B&NES care-homes and supported living, and those living independently in the community.

Social isolation is often associated with rural communities, however, respondents across rural, urban and suburban areas answered that they did not have enough social contact, or they felt isolated.

Amongst other things the prevalence of social isolation in clients with physical disabilities, mental health problems and learning disabilities were examined. The greatest proportion of respondents that answered that they did not have enough social contact, or they felt isolated were those with mental health conditions (26%) and it is interesting that respondents with learning disabilities seemed to experience the least social isolation (14%).

Figure 4: Responses to the 2014 Adult Social Care Survey about social contact – a comparison between respondents with physical disabilities, mental health conditions and those with learning disabilities.

UK 11

  • 9% of older people feel trapped in their own home. 12
  • Nearly half (49%) of all people aged 75 and over live alone. 13
  • By 2033, 19% of the household population of England is projected to live alone, compared with 14% in 2008. 14
  • Over a third of older people (37% or about over 4 million) consider the television as their main form of company. 15
  • 5% (500,000) people aged 65+ in the UK say they spent Christmas Day 2010 alone. 16
  • Over 65s also spent less time with friends: only 35% spent time with friends most or every day in the last 2 weeks, and 12% never did. 17

In developing their guide, Age UK surveyed users of different approaches to addressing loneliness and isolation.

Foundation Services

Survey responses of service users of Community Wellbeing Practices to address loneliness:

  • 64% of participants improved their subjective wellbeing levels after an intervention;
  • 55% of participants reported a reduction in depression symptoms after an intervention.

Survey responses of service users of technology schemes to address loneliness:

  • 83% of patients experienced positive change in at least one social outcome area.
  • 27% of patients made progress against the family and friends outcomes, with 69% of those with a low score on this measure at baseline making progress.

Technology

Survey responses of service users of technology schemes to address loneliness:

  • 76% found a tablet easy to use
  • 61% felt more in touch with the world around them
  • 80% of the participants found their new skills valuable
  • Many respondents liked playing online games and using skype active.

Transport

Survey responses of service users of the elderly tea parties scheme to address loneliness:

  • 96% of guests say the tea parties give them something to look forward to;
  • Almost 90% have made friends with volunteers;
  • Over 80 % have made friends with other guests;
  • 80 % of guests feel happier as a result of joining a group;
  • Almost 80 % feel less lonely since joining a group.

Structural enabler approaches within a care setting

Survey results of service users of the My Home Life – Community Visitors scheme to address loneliness:

  • Older people were less isolated and had greater opportunities to develop friendships, and have company;
  • Older people had access to, and took part in a greater range of activities;
  • Older people had more opportunities to take part in activities beyond the home;
  • Older people received support and guidance when joining the home.

Survey results of service users of the Hen Power scheme to address loneliness:

  • Significantly improves the health and wellbeing of older people;
  • Significantly reduces depression among older people;
  • Reduces loneliness among older people;
  • Reduces the need for anti-psychotic medication.

Survey results of service users of the ODL programme to address loneliness: 

  • 91% said at ODL they felt they could be themselves without fear of being judged by others;
  • 81% said they felt more connected to the LGBT community because of their involvement with ODL; 
  • 73% said they felt more comfortable attending ODL groups/events than other mainstream services;
  • 71% said that ODL has made them feel less isolated;
  • 55 % felt that ODL has benefitted their mental health;
  • 70 % said ODL has benefitted their social wellbeing.