Loneliness: the present and the future

Abstract

Key points

• Loneliness can have a negative impact on the psychological and physical health of an older adult.

• The perception of loneliness can be altered.

• Social and psychological interventions can counter the harms caused by loneliness.

• Identifying loneliness and social isolation should form an integral part of a comprehensive geriatric assessment.

The impact of loneliness on psychological well-being and physical health is recognised and a topic of growing interest. Cultural factors and societal expectations influence both reported rates and patterns of loneliness across the world [1]. However, whilst patterns may differ, the effects are similar in that depression, poor mental health and lower quality of life are reported by those who feel lonely [2]. Both young and old can be lonely. The UK study, The Loneliness Experiment, highlighted the complex nature of loneliness in the adult population. Perhaps unexpectedly, the online survey of over 55,000 adults reported that those aged 16–24 were the most likely to report feeling lonely (40%), compared to 27% of adults aged over 75 [3]. In the UK, the importance of loneliness is being raised by charitable campaigns such as the Campaign to End Loneliness [4]. Additionally, loneliness features within political strategy and has seen the appointment of a Minister for Loneliness.

Loneliness can describe the perception a person has about a lack of closeness, affection and often social contact in their life, giving arise to negative feelings [2]. There remains heterogeneity relating to the definition of loneliness given the multifaceted nature of the descriptor. Social loneliness describes the lack of social integration and its negative impact on ones’ feelings, whilst emotional loneliness refers to the lack of closeness to others that may then contribute to negative mood symptoms. Social isolation describes ones’ lack of social integration. It is important to recognise that a person’s perception of the quality of social interactions can result in loneliness [5]. Differentiating between different types of loneliness can help to explain why an older adult living in residential housing can have the self-reported perception of feeling lonely; even if living with others.

Loneliness affects 6–13% of the older population with the presence of social isolation known to be higher affecting 11–24%; interestingly with little change in incidence over the past few decades [5–7]. The situation throughout the European Union is similar, with social isolation increasing with age [8]. Older adults who report feeling lonely are more likely to develop Alzheimer’s disease and depression and with social isolation there is an association with poorer physical health, reduced cognition, mobility, and increased difficulties with activities of daily living [2, 5]. Within a rural population of adults older than 50, social isolation was independently associated with poorer health status using physical and mental health scores outcomes; even when groups were matched for age, health conditions, type of housing and depression [6].

Crucially, the perception of loneliness can be altered. Providing a comprehensive geriatric assessment promotes support for the health and well-being of the older adult; identifying loneliness can form part of such an assessment [9]. Social interventions have been found to reduce feelings of loneliness and combat the negative sequalae [5]. Successful interventions have aimed to improve access to social opportunities, develop social skills, whilst enhancing social support and counteracting maladaptive social behaviours [10]. A meta-analysis by Dickens et al. [2] showed that group interventions were more likely to reduce loneliness compared to one-on-one interventions [2]. Interventions that included participatory involvement or social engagement were shown to be effective. Psychological therapies targeted at re-aligning maladaptive social cognition through either cognitive behavioural therapy or psychological reframing, were also shown to have a greater reduction in perceived loneliness compared to those targeting social interactions alone [10]. Drawing population-based recommendations is challenging, given the heterogeneity of the various interventions that were shown to make an improvement to loneliness [2]. The variability of the definition used for loneliness also limits the mainstream applicability of any intervention.

Clinicians should strive to be more proactive in combatting loneliness, irrespective of our specialist field of practice. For instance, the NICE guidance for falls prevention cites the need for a social component within exercise programmes, and recognition of lonely adults within such a service may assist overall participant well-being [11]. Social isolation and loneliness in older adults can be improved by encouraging participation in social activity groups [12, 13]. Joint ventures and voluntary sector initiatives such as Connecting Communities (Red Cross /Co-op) highlight efforts to encourage community engagement, with the intention of improving well-being within those communities. Befriending interventions aimed at providing social support, through the development of meaningful relationships, have also been associated with reduced rates of depression compared to usual care [14].

So, what now? Asking about loneliness and social isolation should be an integral part of a comprehensive geriatric assessment [9]. Raising awareness of the impact that loneliness can have on the psychological and physical well-being of older adults is important. Voluntary sector initiatives are offering promising solutions to tackle the issues caused by loneliness. Further studies are required, however, to assess the efficacy of social and psychological interventions to influence existing strategy and policy.

Declaration of Conflicts of Interest: None.

Declarations of Sources of Funding: None.

References