Social Isolation - How to Help Patients be Less Lonely

Although social isolation is most common in the elderly, younger adults (e.g. house-bound and disabled due to multiple sclerosis or a single mother of young children) may also be affected by both social isolation and loneliness. Reduced social contact, being alone, isolation and feelings of loneliness are associated with reduced quality of life.

Loneliness refers to how individuals evaluate their level and quality of social contact. Social isolation can be more accurately measured (e.g. by the number of social contacts the person has). Wellbeing may not be positively correlated with social contact and a great deal depends on the nature of the contacts made. Someone who has brief visits 3 times a day, e.g. a care assistant, is not socially isolated but may be very lonely. But if he or she gets on well with just one of these visitors, this can be enough to relieve loneliness.¹

For some people, solitude is a way of life which temperamentally suits them and they may not feel lonely even if they have no visitors.

General practitioners and community nurses are in a unique position to identify loneliness as they are in contact with the three groups most at risk, i.e. very old people, bereaved people, and people with disabilities.

• The extent of loneliness amongst older people has been stable in the post war period. Only 7% of older people report severe loneliness and there is no evidence to suggest that older people are lonelier now than in the past.²
• About a third of carers report feeling lonely, at least sometimes. Loneliness is more likely to occur in resident carers. Other groups at risk of loneliness include older married women, older people who live with married children, those living in sheltered housing or residential care and older people who emigrated from other countries (especially those who do not speak the language well).
• Loneliness seems to be less prevalent in those rural areas where a sense or community still remains than in more densely populated urban areas.
• Lack of money limits the opportunities for overcoming loneliness: those on lower incomes are more prone to feelings of loneliness than those who are better off.

Consider loneliness in any isolated person, especially the house-bound. Possible signs of loneliness include:

• Verbal outpouring
• Prolonged holding of your hand or arm
• Body language: defeated demeanour, tightly crossed arms and legs
• Drab clothing

Lonely people who are reluctant to go out may be troubled by depression, anxiety, agoraphobia, deafness or urinary incontinence.

A review found that educational and social activity group interventions that target specific groups of people can alleviate social isolation and loneliness among older people. The effectiveness of home visiting and befriending schemes was unclear.³

Wherever possible, lonely people should be offered opportunities to reach out to others so that they retain active involvement in the pattern of their own lives, rather than sitting passively waiting for the doorbell to ring. Lonely people may need encouragement and guidance on how to be creative and how to have a positive approach to meeting others.

• Be nice to people, and take trouble to find out their hopes and fears.
• Local groups, e.g. mother and toddler groups, may provide a social network for isolated mothers.
• What facilities already exist (e.g. local pub, day centre or lunch club)? It does not matter initially whether they get anything out of a social interaction as they may meet someone of like mind, so enabling these artificial crutches to be thrown away.
• As well as receiving visitors and telephone calls and going on outings, lonely old people may be helped by becoming pet owners.
• Alternative therapies, e.g. massage and aromatherapy, can relieve loneliness.
• Befriending schemes can be very helpful to those who are house-bound. They can be contacted through the local Age Concern group,⁴ local churches (in some areas the Methodist church has "live at home" schemes), or community care schemes linked to the area office of the social services department.
• One way that house-bound people can feel useful is through offering telephone support to others who are isolated, such as carers or other older house-bound people. Another useful activity is letter writing, perhaps for a worthy cause (such as Amnesty International) or corresponding with a pen pal.
• Technology forums such as the Internet may provide relief from boredom and loneliness.
• Getting a telephone: not only gives the reassurance of being able to request help in an emergency, but also allows the opportunity to chat to friends and family. Some local authorities offer financial help with installation costs.

Community activities for all ages

Older people do not necessarily want to spend their time exclusively with other older people. There are many activities in which they can join with people of other ages:

• Adult education classes, e.g. painting, creative writing. A good but often expensive way to meet like-minded people. The acquisition of new skills improves confidence and social interaction becomes more pleasurable.
• Join a book club.
• Involvement in community action, e.g. membership of Good Neighbour schemes (which visit housebound people), local history groups, sporting activities, e.g. bowling.
• Membership of local churches.
• Participation in locally organised outings, either to the countryside or to the theatre or cinema.
• Details of local community activities can be obtained from the local Council for Voluntary Service,⁵ from the local library or the social services area office.

Activities with other older people

• The University of the Third Age⁶ offers locally run courses (not necessarily academic). No qualifications are needed, no diplomas are awarded and many of the teachers are retired people.
• Smaller gatherings of three or four people who share an interest (e.g. gardening, sport, Bible study) who are invited into the home of a younger person for coffee or afternoon tea. One national group encouraging schemes whereby people are invited for afternoon tea, etc, is Contact (telephone 0171 240 0630), which will supply names of leaders of local groups.
• Luncheon clubs are run both by voluntary organisations (such as church groups, Age Concern⁴) and by the social services department of local authorities; they offer social activity as well as a hot meal.
• Reminiscence and local history groups can be very stimulating if they are well and sensitively run. The social services area office or Age Concern can usually supply details.
• Holidays for older people are organised by Saga Holidays.⁷

Specialist groups

Certain specialist groups may be of assistance at times of loss, either through bereavement, retirement, or illness:

• Cruse:⁸ offers counselling and support after bereavement. Local groups, established around the country, offer a drop in centre, a telephone advisory line, literature, and individual visits by trained counsellors.
• Support groups for people with a particular illness can be helpful, e.g. the Parkinson's Disease Society, MS Society, Arthritis Care, the Stroke Association and the Alzheimer's Disease Society.

Housing provision and loneliness

• Suitable housing can play a significant part in alleviating loneliness.
• There is a range of provisions which can help: central alarm systems, contact with a warden, well designed resident-friendly buildings, and care and repair schemes.

• Alcoholism and depression may be exacerbated through lack of company.
• Potential suicide risk.
• Lonely and isolated old people are at risk of nutritional problems.