Research suggests older adults are the most likely demographic to experience feelings of loneliness and social isolation.

By numbers, one in four Australian adults experience feelings of loneliness (APS & Swinburne University 2018).

Data from 2018 suggests that at least 13% of older adults over 65 experience loneliness, with those over 75 more likely to be lonely than any other age group. Furthermore, at least 8% of older adults over 65 are socially isolated (AIHW 2019).

Other research has found that living in a residential aged care facility can potentially contribute to these feelings of loneliness and social isolation (Neves, Sanders & Kokanović 2019).

Loneliness and social isolation are associated with poor physical and mental health, with research even suggesting that they increase the risk of premature death, even to the same extent as obesity, smoking and physical inactivity (CDC 2020).

Ensuring that your clients feel adequately supported and connected is therefore essential to optimising their health, wellbeing and overall quality of life.

Loneliness v Social Isolation

• Social isolation is the objective state of being in minimal contact with other people.
• Loneliness is the subjective feeling that you have less companionship, social contact or quality relationships with other people than you would like.

(AIHW 2019; Beyond Blue 2018)

Loneliness and social isolation might co-exist, but this is not always the case and the two terms are distinct. It is possible for a socially isolated person to feel content, or a socially connected person to feel lonely (AIHW 2019).

While loneliness may arise as an emotional response to being socially isolated, the quality of relationships seems to be more important overall than the number of social connections a person has (ACSA 2015).

It is important to note that loneliness varies in severity and is not always a significant issue. In some cases, the feelings may pass on their own. However, if an individual is experiencing constant loneliness that is causing self-reinforcing negative thoughts, this might be a serious problem (ACSA 2015).

The Five Dimensions of Loneliness in Older Adults

1. The individual’s private and personal feelings
2. The quality of the individual’s relationships
3. The individual’s sense of connection with their community
4. Time (of day, of the year, of the individual’s life)
5. Adjusting to loss, declining health and other changes.

(ACSA 2015)

What can Cause Loneliness and Social Isolation in Older Adults?

There are a variety of factors that may contribute to loneliness and social isolation in older adults, including:

(Seasons 2019; Beyond Blue 2018; CDC 2020; AIHW 2017; ASCA 2015)

How Does Aged Care Contribute to Loneliness and Social Isolation?

Living in a residential aged care facility can present unique challenges that may contribute to loneliness and social isolation. These include:

• Feeling the need to conform to rules or expectations related to age
• Feeling self-conscious about displaying certain emotions in fear of a negative reaction
• Staff, family and other residents dismissing feelings and experiences of loneliness, leading to embarrassment and stigmatisation
• Negative emotions being dismissed or redirected to positive topics by staff and family
• Difficulty maintaining identity and sense of self while simultaneously trying to avoid stigmatisation or being viewed as a burden
• Feeling pressure to be a ‘good citizen’, participate in activities and follow the social expectations of the facility
• Lack of autonomy due to institutionalisation
• Lack of regular contact with family and friends
• Dependency
• Daily life being routinised
• Alienation from other residents.

(Neves, Sanders & Kokanović 2019)

The Impacts of Loneliness and Social Isolation

Loneliness and social isolation may have a variety of adverse effects, including:

• An increased risk of:
  • Premature mortality
  • Dementia
  • Heart disease
  • Stroke
  • Depression, anxiety or suicide
  • Hospitalisation
  • Presentation to the emergency department
  • Chronic pain
  • Physical frailty
  • Terminal illness
• A doubled risk of obesity
• Higher blood pressure
• Poor social relationships
• Increased care needs
• Reduced independence
• Reduced social participation
• Social exclusion
• Low social engagement
• Breakdown in relationships
• Decreased feeling of wellbeing
• Negative feelings such as anger, sadness, depression, worthlessness, resentment, emptiness, vulnerability and pessimism
• Poor mood
• Psychological distress
• Feelings of discomfort in social situations
• Overall poorer quality of life.

(CDC 2020; Beyond Blue 2018; Neves, Sanders & Kokanović 2019; COTA VIC 2019; ACSA 2015)

Overcoming Loneliness in Aged Care

As previously mentioned, the quality of a person’s relationships is more important than the number of social connections they have. Therefore, helping clients develop meaningful relationships with others may be more effective in overcoming loneliness than simply facilitating interactions with many people (ACSA 2015).

The following are some strategies that may help clients overcome loneliness:

• Involving clients in the planning, delivery and evaluation of activities
• Facilitating meaningful interaction with familiar people (e.g. family)
• Facilitating programs that allow clients to strengthen their existing relationships and interests
• Allowing clients to choose what activities they participate in and when
• Allowing clients to express their opinions and choices
• Facilitating activities that allow clients to take an active role in society
• Facilitating activities that encourage a healthy lifestyle
• Facilitating programs that help improve function and mobility
• Facilitating interactions with people of different ages and backgrounds, and pets
• Facilitating meaningful activities that help others (e.g. volunteering)
• Managing physical and mental chronic health conditions
• Providing the means for clients to connect with others through social media, letters, email and phone calls
• Ensuring the service environment is age-friendly (e.g. rest areas, accessibility, green areas, safe design)
• Individualising these strategies for each client.

(ACSA 2015)

Conclusion

Loneliness and social isolation have the potential to cause significant adverse effects on a person’s physical and mental health. In order to ensure your clients feel well-connected, it is important to understand why loneliness may arise and know how to help them overcome these feelings.

Keep in mind that interventions should be tailored to suit each client, as loneliness is a subjective and individual experience that can not be addressed using a one-size-fits-all approach (Fakoya, McCorry & Donnelly 2020).

Additional Resources

• ACSA, Social Isolation and Loneliness Among Older Australians
• Beyond Blue, Connections Matter: Helping Older People Stay Socially Active

References

• Aged and Community Services Australia 2015, Social Isolation and Loneliness Among Older Australians, ACSA, viewed 30 September 2020, https://www.acsa.asn.au/getattachment/Publications-Submissions/Social-Isolation-and-Loneliness/1015-Social-Isolation-and-Loneliness-Paper.pdf.aspx?lang=en-AU
• Australian Institute of Health and Welfare 2017, Australia’s Welfare 2017: 5.1 Ageing and Aged Care, AIHW, viewed 30 September 2020, https://www.aihw.gov.au/getmedia/d18a1d2b-692c-42bf-81e2-47cd54c51e8d/aihw-australias-welfare-2017-chapter5-1.pdf.aspx
• Australian Institute of Health and Welfare 2019, Social Isolation and Loneliness, AIHW, viewed 30 September 2020, https://www.aihw.gov.au/reports/australias-welfare/social-isolation-and-loneliness
• Australian Psychological Society & Swinburne University 2018, Australian Loneliness Report, APS & Swinburne University, viewed 30 September 2020, https://psychweek.org.au/wp/wp-content/uploads/2018/11/Psychology-Week-2018-Australian-Loneliness-Report.pdf
• Beyond Blue 2018, Connections Matter: Helping Older People Stay Socially Active, Beyond Blue, viewed 30 September 2020, https://resources.beyondblue.org.au/prism/file?token=BL/1366
• Centers for Disease Control and Prevention 2020, Loneliness and Social Isolation Linked to Serious Health Conditions, CDC, viewed 30 September 2020, https://www.cdc.gov/aging/publications/features/lonely-older-adults.html#:~:text=Older%20adults%20are%20at%20increased,chronic%20illness%2C%20and%20hearing%20loss.
• COTA Victoria 2019, Social Isolation, COTA VIC, viewed 30 September 2020, https://www.cotavic.org.au/policy/social-isolation/
• Fakoya, McCorry & Donnelly 2020, ‘Loneliness and Social Isolation Interventions for Older Adults: A Scoping Review of Reviews’, BMC Public Health, vol. 20 no. 129, viewed 1 October 2020, https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-8251-6
• Neves, B B, Sanders, A & Kokanović, R 2019, ‘ “It's the Worst Bloody Feeling in the World”: Experiences of Loneliness and Social Isolation Among Older People Living in Care Homes’, Journal of Aging Studies, vol. 49, viewed 30 September 2020, https://bbneves.com/wp-content/uploads/2019/06/its-the-worst-bloody-feeling-in-the-world.pdf
• Seasons 2019, Could the Effect of Loneliness in Old Age be Worse Than Obesity?, Seasons, viewed 30 September 2020, https://seasonsagedcare.com.au/blog/what-is-the-health-impact-of-loneliness-in-old-age/