Loneliness in later life: a longitudinal analysis using the English Longitudinal Study of Ageing

Lead Research Organisation: Brunel University
Department Name: Clinical Sciences

Abstract

Research has consistently demonstrated that social relationships are key to a good quality of life in old age (Bowling 2005). Loneliness is one measure of compromised social relationships and is a significant problem for older people with approximately 42% of those aged 65+ in England reporting loneliness (10% reporting severe loneliness and 32% reporting moderate loneliness). This equates to 3.2 million individuals in England. Loneliness has important negative consequences for both older adults and society being linked with a range of negative health, social and service use outcomes. Death rates for older people who are lonely are 50% higher; emergency hospital admission rates are a third (30%) higher and GP consultation rates 3 times higher (the lonely consult 10 times year) compared with those who are not lonely.

We know the percentage of older people who are lonely and the groups most likely to experience loneliness in later life including those who are widowed, those with fewer material resources and those with poor health. However our understanding of loneliness is based upon studies which measure loneliness at a single point in time. We do not have good evidence examining how loneliness may change as people grow older and we do not understand the pathways into and out of loneliness in later life nor the factors which might help people recover from loneliness (or contribute to the onset of loneliness). Also much of the evidence describing the poor health outcomes for lonely older people are based upon research undertaken in America and we cannot be certain that these findings apply to our population.

Because of the importance of loneliness as a problem for older people a range of services to combat loneliness have been developed but few have shown that they actually achieve this aim. We suggest that part of the failure of current services is because we do not understand the pathways into and out of loneliness; the characteristics of those groups who move/into and out of loneliness; the factors that are linked with changes in loneliness and how social and health factors are linked to loneliness pathways. The availability of this information may help us to design services that are more timely and tailored to the needs of individual older people and so help to promote quality of life in old age.

In our project we will explore changes in loneliness over time for people aged 50 and over using a large existing data set (the English Longitudinal Study of Ageing) which has followed people up from 2002 to 2010 longitudinally. For 6,600 people we will describe how loneliness has changed over the 8 years they have been in the study and identify the factors that are linked with both the onset or worsening of loneliness and those linked with improvements in loneliness. We will also examine the link between loneliness at the start of the study and health status 8 years later. In particular we will be able to examine the link between loneliness and health status. Research in America has reported a link between loneliness and dementia but this has not been studied in Britain. We will also be able to test out the oft quoted statement that the health effects of loneliness are equivalent in magnitude to those attributed to smoking. We will also be able to compare two different methods of measuring loneliness and determine which is the best to measure loneliness and which is the best way to look at changes in loneliness.

Our project aims to contribute to this important academic, policy and practice agenda by developing our understanding of the pathways into and out of loneliness in later life and establishing the health status and service use consequences of loneliness in later life.

Planned Impact

The ultimate aim of this project is to explore the dynamics of loneliness longitudinally in a large national sample focusing upon describing and understanding changes in loneliness longitudinally and identifying the factors predictive of changes in loneliness as a basis for developing more sophisticated and personalised interventions to remediate loneliness. There are 3.2 million individuals aged 65+ in England who experience loneliness. Death rates are 50% higher and emergency hospital admission rates are a third (30%) higher for those who are lonely compared with those who are not. Those who are lonely consult their GP, on average, 10 times a year compared with 3 times for those who are not lonely. Reducing loneliness and its consequences is a long term goal, and it is expected that it will have, in the long term, social impact resultant from our study contributing towards: evidence based policy-making; shaping and enhancing the effectiveness of public services; helping to transform evidenced based policy into practice and influencing professionals and practitioners working in related fields.

In the shorter term, there will be a range of opportunities for the research team to contribute to current debates, policy and practice via our partnership with The Campaign to End Loneliness. Building strong research relationships with potential users, fellow researchers and other relevant parties in the early stages of the project will provide the foundation for creating significant impact in the longer term. Indeed, an important short to medium term impact will arise from the creation of strong working relationships with the range of stakeholders involved in order to facilitate collaboration in developing new projects, the co-production of new research, conference presentations and other activities aimed at raising the profile of this important topic.

Who will benefit and how?

a) Policy makers and practitioners

New knowledge will be generated upon which to develop appropriate policies, practices and understanding about how to identify people vulnerable to the onset/worsening of loneliness in later life and how to support and identify those recovering from loneliness;

b) Third sector and voluntary organisations

Increasingly, the social and physical environment for older people has become central in promoting well-being in later life. This project will recognise the specific needs of older people who experience loneliness and help the Campaign to End Loneliness and other organisations (eg Contact the Elderly) to better understand this populations' needs;

c) Older people

The voices of older people remain muted within much research and this is especially so for those who experience loneliness. Our project will give a voice to this important group of older people and ensure that their concerns and issues are made visible to the research, policy and practice communities;

d) Early career researcher (ECR)

The employment of an ECR will enhance their substantive and methodological skills but they will benefit from a range of career development activities including advice on publishing, mentoring and the opportunity to broaden their networks amongst a range of relevant communities (academic, policy, practice & older people).The ECR will be managed according to the Researcher Development Framework and will have the opportunity to develop a learning needs plan to ensure that all elements of the framework are addressed on completion of the project. A key feature of this plan will be in enabling the ECR to attend national and international conferences to benefit from engaging with the networks of the applicants;

e) Research capacity

Inclusion within the project of a Brunel University sponsored study day focused upon using secondary data within gerontological research will be of particular benefit to ECR/PhD students who will be able to attend free of charge.

Publications

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Pikhartova J (2014) Does owning a pet protect older people against loneliness? in BMC geriatrics

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Pikhartova J (2016) Is loneliness in later life a self-fulfilling prophecy? in Aging & mental health

 
Description Our project, using secondary analysis of the English Longitudinal Study of Ageing (ELSA) has identified the following key findings:-

a) over a 10 year follow up period the majority of older people (aged 50+) are not lonely (approximately 65%);

b) that there are five key loneliness pathways-the never lonely; the always lonely; those for whom loneliness increases or decreases and those with a fluctuating pattern

c) that established loneliness risk factors such as widowhood do not operate homogeneously. Some widow(ers) experience loneliness and others do not reflecting their access to other supportive factors;

d) that pets are not protective against loneliness-they are both a protection to loneliness and a response to it but only for women

e) that expectations of loneliness are strongly associated with loneliness outcomes
Exploitation Route Our findings have informed the development of the evaluation of the Ageing Better loneliness interventions, contributed towards shaped the activity of the Campaign to End loneliness
Sectors Healthcare,Other

URL https://youtu.be/hmjMMkPQaDM
 
Description Our findings emphasised that (a) loneliness is experienced by only a minority of older people; (b) that there were a range of trajectories of loneliness in later life-those who had experienced loneliness across the life course and those for whom loneliness increased/decreased across later life; (c) that loneliness across these groups compromised quality of life and showed associations with poor health outcomes. Working with our partner-the Campaign to End Loneliness the information from this project (combined with other data from the United States) informed a range of publications including Promising approaches to reducing loneliness and isolation (Campaign to End Loneliness), Measuring you impact on loneliness in later life (Campaign to End Loneliness) and Combating Loneliness (Local Government Association).Working with the Campaign we have worked with Public Health England to raise loneliness as a public health issue. Our work contributed to the NICE guidelines of promoting independence and mental wellbeing for older people. Prof Victor was a member of the committee that drew up these guidelines. During the period 2017 work from this study has informed the work of the Jo Cox commission and other activities to prevent loneliness undertaken by the Co-Op/British Red Cross The outcomes from the project have been very actively promoted at international conferences (Australia, Sweden and USA) and-very importantly -to the general population and third sector organisations such public lectures at the University and presentations to a wide range of Age UK organisations (Hillingdon, Norfolk, Oxford).
First Year Of Impact 2017
Sector Healthcare,Other
Impact Types Cultural,Societal,Policy & public services

 
Description Member NICE Public Health Committee on Older people: promoting independence and mental wellbeing
Geographic Reach National 
Policy Influence Type Membership of a guideline committee
 
Description Dunhill Medical Trust
Amount £89,000 (GBP)
Organisation The Dunhill Medical Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 05/2016 
End 12/2018
 
Description Evaluation of the Ageing Better programme
Amount £100,000 (GBP)
Organisation Big Lottery Fund 
Sector Charity/Non Profit
Country United Kingdom
Start 01/2014 
End 12/2018
 
Description The Anatomy of Loneliness
Amount £30,000 (GBP)
Organisation Wellcome Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 12/2017 
End 09/2018
 
Description Co chair of the Campaign to End Loneliness Research Hub 
Organisation Campaign to End Loneliness
Country United Kingdom 
Sector Public 
PI Contribution We have contributed to the development of a research hub focusing upon loneliness and isolation in later life. this is a virtual research network of British and European researchers (including PhD students) focusing upon understanding loneliness and isolation in later life including the development and evaluation of interventions. The PI (Prof Victor) co-chairs this network and works with the Campaign to organise events, webinars and meetings to bring researchers together
Collaborator Contribution The campaign support the effective dissemination of research to policy makers, practitioners and third sector organisations and older people.
Impact Promising approaches to reducing loneliness and isolation in later life (http://www.campaigntoendloneliness.org/wp-content/uploads/Promising-approaches-to-reducing-loneliness-and-isolation-in-later-life.pdf) Measuring your impact on loneliness and isolation (http://www.campaigntoendloneliness.org/wp-content/uploads/Loneliness-Measurement-Guidance1.pdf)
Start Year 2013
 
Description International association of Gerontology Dublin April 2015 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Presented posterdisplaying findings of loneliness trajectories. generated increased awareness of the dynamic nature of loneliness
Year(s) Of Engagement Activity 2015
URL http://www.iaggdublin2015.org/downloads/programme.pdf
 
Description Presentation at Campaign to end Loneliness conference 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Presentation at the launch of the campaign to End Lonelinesslearningnetwork
Year(s) Of Engagement Activity 2012
URL https://www.youtube.com/watch?v=hmjMMkPQaDM