Fighting Loneliness and Social Isolation in Old Age: A Policy Perspective

Fighting Loneliness and Social Isolation in Old Age: A Policy Perspective

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By: Riddhita De

The most terrible poverty is loneliness, and the feeling of being unloved.
-Mother Teresa

Did you know that loneliness and social isolation during old age are serious problems in Canada?1 According to the most recent Canadian Census, one quarter of the population aged 65 and over live alone.2 Moreover, being over 80 years of age is considered a risk factor for chronic social isolation, as reported by the National Seniors Council of Canada.3 Many older seniors find themselves withdrawing from society based on diverse risk factors ranging from being childless, living away from family,4 divorce or the passing of a spouse, or having a disability.5 This in turn causes elderly individuals to lose important social connections.4-6 Additionally, people in minority groups, such as older immigrants, indigenous people, and LGBTQ individuals, may be more vulnerable to social isolation and loneliness.6 Seniors residing in rural areas may also face challenges accessing resources when compared to individuals residing in urban areas.6

While loneliness and social isolation are used interchangeably, they are in fact different yet interrelated concepts.7 Social isolation pertains to an individual having a lack of close contacts or relationships, whereas loneliness usually focuses on the negative feelings associated with social isolation.7 In a study conducted by University of Toronto researchers studying mouse models of chronic isolation, it was discovered that serotonin-producing neuronal excitability was considerably decreased in socially-isolated mice.8 Loneliness and social isolation together has been termed an epidemic by many experts, who say the problem leads to major mental health and chronic physical health issues.9 Long term illnesses can include depression, arthritis, lung disease, stroke, and depression amongst numerous others, which undoubtedly increase the risk of mortality in the population. In addition, with the large number of baby boomers aging in Canada, there is an increasing demand for health and nursing care.1 Thus, there are significant reasons for the government to take action to prevent the already escalating healthcare costs associated with social isolation and loneliness.10

Call for Action

The Canadian Medical Association (CMA) states that Canada’s universal healthcare system was not built to sustain and care for the aging population, especially in terms of handling chronic diseases. The CMA has identified Canada to be struggling to best serve our aging population, particularly with addressing the affiliated chronic disease burden.10 Up until now, no policy level changes have occurred to address isolation and loneliness amongst seniors. There are essentially non-existent resource allocations by our government to address the issue, with the problem being mostly unknown amongst the general public.3 As a consequence of this, there are minimal public awareness campaigns, leaving the issue almost buried.

This might prompt us to ask about how other countries are approaching the topic of isolation and loneliness. In fact, at the beginning of last year, the UK appointed their very first Minister of Loneliness. The minister’s duties include addressing health as well as social challenges brought on by isolation. Nine million Britons are affected by social isolation, and although the Minister’s responsibilities do not specifically focus on older adults, this is a commendable initiative brought forth by Theresa May’s government.11

For Canadians, despite there not being any single policy approach to solving the issue, beginning with small-scale regional approaches could prove to be beneficial. Senior-focused, customized services dictated by a National Senior Care strategy could be funded and implemented by the government.

First and foremost, seniors could be kept engaged through social support in the community. Social networking circles often put individuals of a similar age in touch with each other. Alternatively, another approach focuses on programs that match a senior with a local volunteer, through home or telephone visits.12 By engaging with community members, meeting other seniors, and having an individual who serves as a friend to the elderly, studies have indicated positive impacts on seniors’ quality of life.13 Through the introduction of a social network, levels of physical activity amongst older individuals could be increased, thus improving their mental health.14 Furthermore, involving children into the daily activities of seniors has been shown to improve mood in this population.12 It has also been noted that due to disabilities which seniors may face or for those unable to drive, transportation services could be useful.12 Such assistance programs would encourage dialogue between individuals, as the service could act as a medium for volunteer or employee drivers to connect with seniors in the community.

Besides social engagement through various initiatives, involving family physicians, geriatricians, psychiatrists, and social workers into the circle of evidence-based care, is integral. Many seniors who experience loneliness and social isolation, have poor diets and sedentary lifestyles. Since the older cohort frequently make visits to their family physicians,12 any suspicions of loneliness and therefore respective interventions, could be initiated by the practitioner. It is also essential that family members and friends, who may be involved in the care of seniors are educated and trained to identify signs indicative of loneliness and isolation.

By applying a holistic and inclusive lens of care in the community comprised of the general public, government workers and healthcare workers, the fight against loneliness can be won.  Even though national level policy changes can be both time and resource-intensive, the consequences may be far larger if the problems are not addressed starting now.

References

  1. Alpert PT. Self-perception of Social Isolation and Loneliness in Older Adults. Home Health Care Management & Practice. 2017 Nov;29(4):249-52.
  2. Statistics Canada. Living arrangements of seniors. Statistics Canada. 2011.  Available from: http://www12.statcan.gc.ca/census-recensement/2011/as-sa/98-312-x/98-312-x2011003_4-eng.cfm
  3. The National Seniors Council. Report on the Social Isolation of Seniors. Government of Canada. 2014.   Available from: https://www.canada.ca/content/dam/nsc-cna/documents/pdf/policy-and-program-development/publications-reports/2014/Report_on_the_Social_Isolation_of_Seniors.pdf
  4. Milne V, Tepper J, Nolan M. From Alzheimer’s to heart attacks, loneliness in seniors has serious health effects. Healthy Debate. 2016.  Available from: http://healthydebate.ca/2016/10/topic/isolation-and-seniors
  5. Menec V. Loneliness and social isolation are important health risks in the elderly. McMaster Optimal Aging Portal. 2016.  Available from: https://www.mcmasteroptimalaging.org/blog/detail/professionals-blog/2016/04/08/loneliness-and-social-isolation-are-important-health-risks-in-the-elderly
  6. The National Seniors Council. Report on the social isolation of seniors- Consultation Highlights. Government of Canada. 2014. Available from: https://www.canada.ca/en/national-seniors-council/programs/publications-reports/2014/social-isolation-seniors/page05.html
  7. Alspach JG. Loneliness and social isolation: Risk factors long overdue for surveillance.2013; 33(6):8-13
  8. Sargin D, Oliver DK, Lambe EK. Chronic social isolation reduces 5-HT neuronal activity via upregulated SK3 calcium-activated potassium channels. elife. 2016;5.
  9. Steptoe A, Shankar A, Demakakos P, Wardle J. Social isolation, loneliness, and all-cause mortality in older men and women. Proceedings of the National Academy of Sciences. 2013 Apr 9;110(15):5797-801.
  10. Canadian Medical Association. The State of Seniors Health Care in Canada. Canadian Medical Association. 2016. Available from: https://www.cma.ca/En/Lists/Medias/the-state-of-seniors-health-care-in-canada-september-2016.pdf
  11. Dakers S. The minister for loneliness will need all the friends she can get. The Guardian . 2016 . Available from: https://www.theguardian.com/society/2018/jan/23/tracey-crouch-minister-loneliness-friends-powerful-vested-interests
  12. Gouveia OM, Matos AD, Schouten MJ. Social networks and quality of life of elderly persons: a review and critical analysis of literature. Revista Brasileira de Geriatria e Gerontologia. 2016 Dec;19(6):1030-40.
  13. Salman S. The battle against loneliness among older people. The Guardian. 2016. Available from: https://www.theguardian.com/healthcare-network/2017/may/10/loneliness-older-people
  14. Pels F, Kleinert J. Loneliness and physical activity: A systematic review. International Review of Sport and Exercise Psychology. 2016 Jan 1;9(1):231-60.