In our report in 2014, Better care for frail older people, we identified, among many other concerns, the issue of chronic loneliness which evidence suggests is as bad for health as smoking 15 cigarettes a day. Indeed, I had previously written a blog in 2013 on Chronic Loneliness - the next Public Health Challenge. I was therefore delighted when one of our new joiners, offered to write this week's blog on tackling loneliness in older people, based on her first-hand experience and I hope that if more of us implement some of the suggestions then we can start to reverse this rising trend.
Throughout my student nurse training, I worked as a care assistant during university holidays. One sunny Sunday I was working on what was then referred to as a Geriatric ward (now rightly referred to as 'Care of the Elderly'). A female patient, who was very frail and slightly confused told me it was her birthday and that her family would be coming to visit. At lunch time I offered her some food but understandably she didn't want any because her family "always bring cake".
2pm visiting time came and went, the usual hustle and bustle of the ward continued but she had no visitors. I assumed she had mistakenly believed that it was her birthday so I checked her date of birth and it was her birthday. I was sure her family would come during evening visiting hours but this came and went and still no one had come. Next of kin details said there was a son who didn't live too far away and a daughter who did. At the end of my shift I went to buy her a card, so someone had at least acknowledged her birthday. It felt like an empty consolation.
I'll never know what was preventing her family from visiting that day. I hope that it wasn't simply that they didn't care, but I remember feeling sadness that this may have been the reason they hadn't come. This, and similar experiences sparked my passion for improving elderly care and dignity for older people. Throughout my nursing career I repeatedly saw this scenario, and realised that despite the hustle and bustle of a hospital ward or a care home, people can still be desperately lonely. However, the understandable necessity for task driven care is no consolation for neglecting personal interaction. Whilst it is the ultimate privilege to 'nurse' someone who is frail and vulnerable, the value of spending time with them, to read to them or simply to talk, is often overlooked. As the statistics below show, this is not a problem that is going to go away, and why finding some solutions is increasingly important.
How does loneliness impact the health system?
Over the next 20 years, the population of older people over 65 years of age is expected to increase by 50 per centi and those over 85 years are expected to grow at the fastest rateii. This latter segment are increasingly frail and have a greater risk of being isolated from the local community as a result. Age UK found that in people aged over 80, self-reported loneliness is 50 per cent.iii Moreover, the 'Campaign To End Loneliness' report that over half of all people over 85 claim their TV is their only company.iv Loneliness in older people can happen suddenly through bereavement, or gradually as a result of our modern day lives and the increase in social mobility that often results in families and children moving away. Busy family and work lives or having a young family later in life are also reasons given for failing to visit elderly relatives.
The adverse health effects of loneliness are well documented as is the obvious emotional toll. Disturbed sleep, high stress and anxiety levels resulting in high blood pressure and poor nutrition all of which represent risks factors for admission into an acute hospital setting, where capacity is low and costs are high.v For example, between 2011 and 2014, there has been an annual increase in emergency admissions to hospital for people aged over 75 of two per cent a yearvi demonstrating how the growing problem of an ageing population is impacting demand on front line NHS services.
How can we tackle loneliness in older people?
Research suggests that the success of interventions designed to combat loneliness vary. Identifying people in need can also be a challenge. One suggestion could be to use Local Authority data for people who have just been bereaved or who request assistance, for example in putting out their rubbish can help paint a picture of who in the local community might be lonely and where resources could be directed.
The telecare and telehealth markets are starting to make an increasing contribution to improving continuous contact with older people. Laing and Buisson report that if deployed properly, telecare and telehealth can create up to £1 billion of savings per year for the NHS and improve people's lives.vii Their use can help stimulate a range of benefits such as a sense of confidence, and a communication lifeline. There are new emerging technologies which allow families to stay in touch even if an older person isn't 'tech savvy'. Companionship technology, which is more popular in the USA, if adopted over here could provide further unquantified cost benefits to the NHS and Adult Social Care budgets but also can add a huge amount of emotional value, which is arguably more precious.viii
There are small things that each of us could do. I am lucky that my parents (who aren't that old) live very close and I hope to always play a part in their care in the future. In the meantime there are multiple volunteer opportunities to help in local communities and support lonely older people. Contact The Elderly has a scheme called 'Spare Chair Sunday' where a family who has a spare chair at their table hosts an older person from their local community who would otherwise be eating alone.ix My family have signed up and look forward to hosting someone soon. Shifting attitudes so that we all do something small to combat loneliness and boost local resources is a good place to start, as is tackling the paucity of formal research into loneliness which could be hugely beneficial for all of us.
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