Loneliness and social isolation

Accurately estimating the size of the population experiencing loneliness and isolation in Calderdale is difficult. Loneliness is a subjective condition and factors that make one person lonely may not make another person lonely - this makes generalising prevalence estimates difficult. In addition, identifying people who are isolated is inherently difficult as the nature of isolation means a person is unlikely to be known to the community or local services. However, nationally representative survey data (ELSA) suggests 25% of people aged over 52 report feeling lonely sometimes and 9% feel lonely often. Calderdale has just over 70,000 people over 52 and (although a crude analysis) applying these national estimates to Calderdale’s 2016 population, we would expect to have:

• 17,540 older people ‘sometimes’ lonely;
• 6,314 older people ‘always or often’ lonely.

In addition, we know a number of factors that increase a person’s risk of being lonely or isolated and we can identify wards with higher proportions of people associated with some of these factors – compared to the Calderdale average:

Wards with higher % of pensioners living alone:

• Town;
• Ovenden;
• Park;
• Calder.

Wards with higher % of people living with a ‘limiting long term illness or disability’:

• Todmorden;
• Rastrick;
• Town;
• Illingworth and Mixenden;
• Sowerby Bridge;
• Park.

Wards with higher % of older people living in deprivation:

• Park;
• Ovenden;;
• Town;
• Todmorden;
• Illingworth and Mixenden.

Wards with higher % of people over 65 living in them:

• Rastrick;
• Brighouse;
• Northowram and Shelf;
• Hipperholme and Lightcliffe;
• Luddendenfoot;
• Skircoat;
• Sowerby Bridge

(Public Health England (PHE), 2017)

Further information on the local picture can be gained from the participants from the Staying Well project in Calderdale.

Staying Well participant’s levels of loneliness:

Loneliness and social isolation is an issue of inequality. A study was carried out (Niedzwiedz CL et al 2016) looking at the relationship of loneliness among older people and wealth. The study found that those with the least wealth suffered a greater level of loneliness compared to those with the most. It is important to assess the barriers that older people face to increase social participation, and ensure that those from disadvantaged groups have as much if not more opportunity to participate than those who are less deprived. 

The Neighbourhood scheme

A Neighbourhood Scheme is a group of people aged 50+ in your area who participate in healthy activities. Volunteers help to organise these activities as part of a steering group or committee, with support from a dedicated team at Calderdale Council. The aim of the scheme is to make residents feel more connected in their community.

There are Neighbourhood Schemes running in Todmorden, Halifax, Pellon, Sowerby Bridge, Illingworth and Southowram, as well as an Asian women’s group currently based in the Queens Road area of Halifax. These groups run a wide variety of activities in different venues, including Tai Chi and exercise classes, art and craft groups, computing, singing and much more. These groups run independently, with committees organising their own local activities.

For a wide variety of classes and activities aimed at people over 50, visit: Neighbourhood Schemes.

The Staying Well project

The Staying Well project was established as a 12 month pilot in 2014, aimed at reducing loneliness and social isolation in Calderdale, improving collaborative working, creating more connected communities, networks and opportunities. After the pilot concluded, Staying Well has continued and been expanded to include all ages and areas within Calderdale.

Examples of the range of activities include:

Elland and District

• Chit Chat activity group.
• Jigsaw group in Hipperholme Library.
• YODA (Young Onset Dementia Alzheimer’s group).

North Halifax

• Phoenix Men’s Shed.
• Dementia café at Illingworth Moor.
• Dementia Friendly Illingworth project has included training to community members.
• Head, Shoulders, Knees & Toes events.

There are numerous case studies about how the Staying Well programme has benefited both individuals and communities. For more about this, see: Calderdale's 'Staying Well' programme (YouTube video).

As one example, a local GP in a disadvantaged part of Halifax recently wrote:

I had a patient who came in to see me and unrelated to his current problem I talked to him about his smoking. He said he smoked about 10rollups a day because he was bored. He is a very fit 81 year old so I referred him to staying well and discussed with him what he might be able to do in terms of volunteering himself and joining in activities. He rang the surgery back a few weeks later to say how thrilled he was with what he had been offered at staying well and that he had nearly completely stopped smoking and promised to do so completely soon.

Early findings from the evaluation of the Staying Well project indicate that preventative services aimed at reducing isolation and loneliness are hampered by inadequate links to mental health services. “From the initial analysis, it would seem that depression and anxiety has a disproportionate impact on the ability of participants to engage with interventions or activities. Further work may wish to be carried out to ensure that such undiagnosed need amongst participants is appropriately recognised and a pathway developed” (Windle., et al 2015).

In October 2015, a consultation with staff employed in the Neighbourhood Scheme identified a number of perceived barriers.Also unmet need in relation to service provision, which included:

• Personal Assistance, transport and befriending are regularly raised as obstacles by service users;
• “Men’s needs are little understood and provision is insufficient across Calderdale”;
• The need for more gardening and outdoor activities is often cited as a preference among service users;
• There is a need to better identify activities for those in the 25 – 55 age group;
• There is a need for the development and maintenance of a comprehensive borough wide directory and calendar of activities;
• The lack of accessible, reasonably priced venues is an obstacle in many localities;
• Transport can be improved and should be facilitated through co-production”.

Other gaps identified through the Staying Well Project include:

There is a need to identify how to reach those who are typically ‘hard to reach’. We have yet to develop a collaborative and robust approach to identifying lonely and isolated people in our communities. The West Yorkshire fire and rescue service are expanding their fire safety visits to include a safe and well check. The safe and well visits will be targeted to the over 65 population in particular those who live alone. Fire officers will be trained to identify issues and refer people onto services, this will include social isolation.

There is a need to establish 'points of reference' for older people to easily access current, up to date information about services, community activities and groups, both electronically and in a range of other appropriate formats.

There is a need for improved primary care engagement in tackling social isolation and loneliness and the development of an effective social prescribing model.

Current estimates suggest 18% of the population in Calderdale is aged 65 or over. By 2037 the Office for National Statistics (ONS) estimate 25% of Calderdale’s population will be over 65. This will equate to, approximately, 21,000 additional people over 65 (ONS, 2014). Such a large rise, in a little over 20 years, will undoubtedly increase demand on services and the prevalence of conditions pertinent to older adults.

The evidence base on what works for alleviating loneliness and isolation is underdeveloped - with some conflicting conclusions emerging from the research. Nonetheless, there have been a number of evidence reviews conducted in recent years and a summary of their findings is presented below. It is, however, important to recognise that loneliness is a subjective condition and different approaches will be needed for different people.

What seems to work:

• Group interventions lasting over 12 weeks (Cattan et al., 2005; Hagan et al., 2014).
• Interventions targeting specific cohorts (eg. women, carers, the widowed, the physically inactive, people with mental health conditions) (Cattan et al., 2005).
• Services that enable some level of participant control or consult with the intended target group before the intervention (Cattan et al., 2005).
• Services developed and conducted within an existing service (Cattan et al., 2005).
• Services where participants are identified from agency lists (GPs, social services, service waiting lists) (Cattan et al., 2005).
• The use of new technologies and Internet usage that encourage interactive dialogue (Findlay., 2003; Hagan et al., 2014).
• High quality approaches to the selection, training and support of the facilitators or co-ordinators of the interventions (Findlay., 2003).
• Move it or lose it resistance based exercise sessions not only have clear benefits for an individual’s physical health but also their overall wellbeing. The pilot study found that half of the participants reported feeling less lonely at the end of the programme.

Where the evidence is unclear:

• One-to-one interventions: particularly conducted in people’s own homes (Cattan et al., 2005).
• Befriending: There is mixed evidence on befriending for reducing loneliness (Windle., 2011). Although, there is relatively robust evidence of its effectiveness in reducing mild depression (Mead et al., 2010). This is a condition strongly associated with loneliness. In addition, as befriending involves an increase in a persons’ social network size it has the potential to reduce social isolation, if not loneliness.
• Mentoring services (Windle et al., 2011).

Implicit in the vagueness of the recommendations of what works is the importance of evaluating any services or interventions implemented locally in order to add to the current evidence base.

References

• Barth, J. et al. 2010. Lack of social support in the etiology and the prognosis of coronary heart disease: a systematic review and meta-analysis. Psychosomatic Medicine. 72(3), pp.229-38.
• Cattan. et al. 2005. Preventing social isolation and loneliness among older people: a systematic review of health promotion interventions. Ageing & Society. Pp.41–67.
• Cacioppo, J.T. et al. 2006. Loneliness as a specific risk factor for depressive symptoms: cross-sectional and longitudinal analyses. Psychology & Aging. 21(1), pp.140-51.
• Dr A. Smith and J. Robinson. Exercise can aid independence. The Medical Journal, May 2017.
• Findlay, R. 2003. Interventions to reduce social isolation amongst older people: where is the evidence?. Ageing and Society. 24(5), pp.647-658.
• Hawkley, L.C. et al. 2010. Loneliness predicts increased blood pressure: 5-year cross-lagged analyses in middle-aged and older adults. Psychology & Aging. 25(1), pp.132-41.
• Hagan, R. et al. 2014. Reducing loneliness amongst older people: a systematic search and narrative review. Aging & Mental Health. 18(6), pp.683-693.
• Holt-Lunstad, J. et al. 2010. Social relationships and mortality risk: a meta-analytic review. PLoS Medicine / Public Library of Science. 7(7), pe1000316.
• Jaremka, L.M. et al. 2013. Loneliness predicts pain, depression, and fatigue: understanding the role of immune dysregulation. Psychoneuroendocrinology. 38(8), pp.1310-7.
• Lund R, Nilsson CJ, Avlund K. 2010. Can the higher risk of disability onset among older people who live alone be alleviated by strong social relations? A longitudinal study of non-disabled men and women. Age and Ageing 39 (3) pp. 319-26 http://www.ncbi.nlm.nih.gov/pubmed/20208073.
• Mead, N. et al. 2010. Effects of befriending on depressive symptoms and distress: systematic review and meta-analysis. British Journal of Psychiatry. 196(2), pp.96-101.
• Niedzwiedz CL, Richardson EA, Tunstall H, Shortt NK, Mitchell RJ, and Pearce JR (2016) The relationship between wealth and loneliness among older people across Europe: Is social participation protective? Preventive Medicine doi: 10.1016/j.ypmed.2016.07.016
• ONS. 2014. Available from: Sub-national Population Projections.
• Peplau, A., L. 1984. Loneliness Research: A Survey of Empirical Findings. In: Goldston, S. ed. Preventing the Harmful Consequences of Severe and Persistent Loneliness. Indiana: US Government Printing Office, pp.13-46.
• Pikhartova, J. et al. 2015. Is loneliness in later life a self-fulfilling prophecy? Aging and Mental Health doi: 10.1080/13607863.2015.1023767.
• Shankar, A. et al. 2013. Social isolation and loneliness: relationships with cognitive function during 4 years of follow-up in the English Longitudinal Study of Ageing. Psychosomatic Medicine. 75(2), pp.161-70.
• Steptoe, A. et al. 2013. Social isolation, loneliness, and all-cause mortality in older men and women. Proceedings of the National Academy of Sciences of the United States of America. 110(15), pp.5797-801.
• Victor, C. et al 2005. The prevalence of, and risk factors for, loneliness in later life: a survey of older people in Great Britain. Ageing and Society, 25, pp 357-375 doi: 10.1017/S0144686X04003332.
• Windle, K. et al. 2011. Preventing loneliness and social isolation: interventions and outcomes. London: Social Care Institute for Excellence.
• Yang, K. and Victor, C. 2011. Age and loneliness in 25 European nations. Ageing & Society. 31(08), pp.1368-1388.

Further Information

For more on older people, please see: Further resources.

For a more comprehensive list of risk factors for loneliness and isolation see either Victor et al., 2005 or the Campaign to end loneliness: risk factors.