UK: Chronic Loneliness - The Next Public Health Challenge

Last Updated: 11 November 2013
Article by Karen Taylor

Most Read Contributor in UK, August 2017

Last week the Secretary of State for Health, Jeremy Hunt, called for a shift in attitudes towards the elderly in the UK, to avoid them becoming the forgotten generation.  Numerous reports over the last couple of years have identified that many of our most vulnerable members of society, be they the frail elderly or people with physical and mental health conditions, live alone or find themselves spending their last years of life in a care home with few if any visitors, leading to chronic loneliness. 

A BBC survey this month shone a spotlight on the issue of loneliness in old age and the debilitation caused by isolation. Indeed, loneliness is a challenge that has become increasingly difficult to tackle as people live longer but with life limiting conditions; suffering pain and discomfort from physical illnesses; and loss of independence, social isolation and loneliness as a result of a diminishing circle of family and friends.  Mr Hunt's call for a reinvigoration of the social contract between generations, while admirable, is unlikely to be enough, as many elderly and vulnerable people do not have family or friends nearby, or may not have any family at all.  These particular individuals are likely missing both social contact and the benefits of advocacy that families and friends can provide.

Loneliness is not simply a social problem but is considered increasingly to be a public health issue. While chronic loneliness can affect people of all ages it poses a particular threat to the very old, quickening the rate at which their faculties decline and cutting their lives shorter. Research studies have shown that chronic loneliness is associated with significantly greater risk of cardiovascular disease and stroke; it contributes to a more rapid progression of Alzheimer's disease and suppresses the functioning of the immune system. Loneliness also reduces life-span, with researchers finding that chronic loneliness poses as large a risk factor for long term health as smoking as well as increasing likelihood of early admission to residential or nursing care.

There are many reasons for loneliness, but people who live alone suffer from loneliness more frequently than people who share their homes with others. Currently, over two million people over the age of 75 live alone.  Childless widows, those who have infrequent contact with their children, and those without adequate transportation are among the loneliest of elderly people. There is also a relationship between loneliness and physical incapacity, poor health, and sensory deficits with loneliness linked to patterns of depression and increased suicide rates among the elderly. The sicker that lonely people get the more care they need but ironically the less they are likely to get given their lack of access to informal carers.   Last week's exposure of the short (15 minute) and infrequent visits provided by social care staff to frail elderly people, many of whom live alone; whilst distressing in itself, also illustrated that for many people this 15 minute visit is often the only visit that many of these elderly people receive.   

This month's survey by public sector union Unison found 73 per cent of local authorities commission visits lasting just a quarter of an hour, leaving elderly people 'suffering' in their own homes. This scandal has arisen because many councils now buy in care from outside firms in blocks of 15 minutes. Those in the greatest need are supposed to get longer, 30 or 45 minutes, but in reality, more and more are getting the absolute minimum for cost reasons. About 640,000 carers visit people in their homes across the UK on a daily basis, helping them with basic tasks such as helping with medication; getting them up out of or into bed; dressing, washing, and heating up meals. But charities say that buying time in 15 minutes slots means the carer has no time to carry them all out. Home helps themselves report that they often have to leave lonely and vulnerable people before all their work has been done. They say they have to rush off to other jobs even when their client urgently needed their help.  Those with dementia find the rush of such a short visit particularly distressing. The rushed visit can also makes the risk of mistakes with medication higher.

So what's to be done about it?  

Predictably the government has announced a review of the system that bases visits on time as opposed to need. And while that might help, there are still many other elderly people who don't qualify for even a 15 minute home visit. So more does need to be done and everyone has a role to play. Including better use of technology not only for monitoring changes in the physical and mental health but also in improving communication, for example older people find tablets particularly intuitive to use, using applications to "face time" their relatives, keep in touch with grandchildren and play games with each other etc.

As we get older, we are more likely to suffer illness and disability which will reduce our mobility and our social networks can and will often shrink due to life-changing events such as retirement and bereavement which can increase the risk of loneliness. But it doesn't have to be like this.  We can all do something about it. Whether its ensuring we maintain more regular contact with family and friends, volunteer to help local support groups, join a befriending service, offer to become a buddy at a local hospice or care home or simply talk to people we think may be missing that social contact. In Japan, where they have had to face up to this and many other issues linked to aging much earlier than other countries, one initiative finding a great deal of support is the concept of "play it forward", in which volunteers "Bank" hours of care that they provide to others and when they need access to care themselves or for their family can draw down from this time bank. 

As many societies face up to the magnitude of the long term elderly care crisis new innovative approaches for tackling the challenge are being developed.  But loneliness is arguably something that doesn't need innovative solutions it just needs us all to stop and think and do something, no matter how small, to help alleviate the chronic loneliness and support needs of the frail elderly and other vulnerable members of our society, including those in our own families.  

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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