Mind the Care Gap: Friendship and a greater connection with others is the key to tackling isolation and loneliness in later life

This week saw the launch of Mind the Care Gap, a campaign looking at the current state of adult social care provision, during which we will share the views of health and care professionals and aim to amplify the experiences of older people, whether they are providing or in receipt of care themselves.

Our modern society is more fast paced and better connected than ever before, but we sometimes forget that people can get left behind. Loneliness is an issue for young and old, but we are particularly concerned about the impact in later life. We need to do more to ensure everyone in our society feels a sense of belonging and community around them.

The growing Incidence of loneliness

Loneliness is a human tragedy irrespective of age but particularly for those people in later life who do not have any contact with friends, family or loved ones. Surely, we can and must do more to forge connections with vulnerable people in our local communities?

With the rise in life expectancy over recent decades and a steady increase in the overall population, our high standard of living nonetheless presents us with new social challenges.

People in later life who live alone are at risk of becoming isolated from the communities around them. The Office for National Statistics estimates that by 2025, there will be 19% more people aged 65 years+ and 40% more people aged 85 years+.[1] In fact, people now live an average one-third of their lives after the age of retirement.[2] An estimated 1.2 million people live with “chronic” loneliness[3] – in excess of 1 million older people state that they are always lonely or often feel lonely, 12% feel trapped in their own home, and almost half say that television or pets are their main form of company.[4]

Taken together, these make for depressing statistics but people aren’t mere ‘statistics’ and, unsurprisingly, health and care professionals are eager to reverse the current trend. The debate about appropriate societal responses and what more can be done in local communities to promote a greater sense of connectedness is also gathering momentum.[5]

Public policy challenge

Being lonely or isolated are deeply personal – the causes and consequences are impossible to determine without reference to the individual and their own values, needs, wishes and feelings.[6] They are not an inevitable consequence of ageing. Both can affect anybody at any stage in their life, but it can be a particularly acute experience for those in later life. It is also important to note that ‘it is possible for individuals to be lonely, but not isolated, or isolated, but not lonely.’[7]

The response to this nexus of challenges cannot be divorced from physical and mental health needs, so central and local government will need to work together to ensure that older generations are not forgotten, that communities are hard-wired for ‘connectivity’ in the broadest possible sense of the term. We need a fundamental culture change to tackle loneliness and isolation in older people.

Potential risk factors

Some of the potential risk factors to becoming lonely or socially isolated include:

• Aged 80 years or over;
• a loss of friends;
• not having access to a car or not using public transport;
• living on a low income or on benefits as a main income;
• not having access to a telephone; and
• the loss of your hearing and sight.

Pensioner poverty is also a contributing factor that cannot be ignored. The Joseph Rowntree Foundation suggests that 1.9 million pensioners are now living in poverty.[8] Low income in retirement is often linked to low earnings during their working years or time out of employment, which can be as a result of caring responsibilities, a long-term condition or disability, missing out on entitlements or unemployment at some stage.[9]As we have advocated in our report, Securing the Future, there needs to be a concerted effort to plan ahead for individual’s health and care needs so that provision is better designed for age.[10]

Real tangible health implications

Living alone can have a significant impact on a person’s wellbeing and quality of life, it can increase the risk of premature death by 30% and be as harmful as smoking 15 cigarettes a day.[11] Loneliness can also lead to poor lifestyle behaviours, including excessive alcohol consumption, smoking, drug abuse, bulimia or a poor diet.[12] A growing problem amongst older people living alone is a lack of regular meals because they are too frail to get out and buy food or prepare something to eat for themselves. Increases in the cost of living are also a factor.

The health risks associated with loneliness have proven links to a range of physical and mental health conditions, including depression, low self-esteem, increased blood pressure, elevated cortisol and a risk of stroke and cardiovascular diseases.[13] People who experience a higher degree of loneliness are twice as likely to develop Alzheimer’s disease as those people who do not.[14]

Use of health and social care services

In the course of preparing our campaign, we spoke to health and care professionals as well as services users about their experiences.

Jane Steer, an individual with several disabilities who lives alone, talked to us about the importance of a tackling loneliness in local communities and ways to help people:

“What we should have is what we might call a befriending scheme. Not just for those that have severe disabilities, but also for those that are just elderly. Do you need to go out? Would you like to be walked to the bus stop? Do you want me to pick you up and collect you when you come back once you’ve gone out and had a bit of a social life? That would help independence become true independence because they have the choice then of going out by themselves just for a little bit and then being taken safely home.”

The loneliest in our society are more likely to:

• Visit their GP;
• have a higher use of medication;
• have a higher incidence of falls and increased risk factors for long term care;
• have an earlier entry into residential or nursing care; and
• use accident and emergency services independent of chronic illness.[15]

According to Professor Keith Willett, Director of Acute Care with NHS England, the practical consequences of older people living alone, without support, places a huge burden on the NHS, which becomes “the endpoint of a pathway where unsupported patients end up”. He also stated that it is a much wider societal problem, which individuals, local authorities and the NHS have a joint responsibility to tackle.[16]

Dr Joshi, a General Practitioner in Leicestershire, talked to us about the link between mental health and loneliness as part of our Mind the Care Gap campaign, and said:

“Often as GPs when we go into people’s homes, the medical issue tends not to be the primary problem because they are not functioning, they cannot function, there is a breakdown because they cannot manage their daily activities and what you really need then is an integrated care approach to support that patients care. A lot of the time, poor mental health and loneliness plays a big part in how a patient deals with their medical issues.”

The voluntary sector delivers a significant amount of support in local communities, but cannot cope in isolation and is stronger in some places than others. Private and public-sector health and social care providers need to work more closely with it to help identify isolated older people and tackle the problem head-on. This would help to improve older people’s quality of life and reduce their reliance on costlier services.[17] It would also make good financial sense. The London School of Economics has said that for every £1 spent in preventing loneliness via better signsposting and navigation services, a very conservative estimate of £3 can be saved in terms of health costs to the public purse and pressure on local services. For a decade of an older person’s life, the extra economic cost of loneliness is calculated as £6,000.[18]

Conclusion

The consequences of not addressing the growing incidence of loneliness in later life are clear. Service users and care professionals have told us that an integrated care approach is the best way to help support people in later life. In our recently published report – Securing the Future – we recommend the Government introduce measures and invest to create the environment for local government and civil society to tackle loneliness and social isolation. Often small acts of kindness and friendship can make all the difference. By reaching out to others and developing a greater sense of connectedness in our local communities we can help make a real impact.