An Australian Study of Loneliness in Older People: Implications of Stigma

Taiwan, June 2008

Professor Wendy Moyle Deputy Director, Research Centre for Clinical and Community Practice Innovation

BackgroundOlder people are at higher risk of loneliness due to:

• death of spouses & close friends• onset of disability and illness preventing social activities• living alone increases risk of loneliness

Relationships between:

• loneliness and chronic conditions• anxiety & depression• increased utilisation of health care services, & • increased risk of nursing home admission

Loneliness not Understood• Loneliness as a concept is not clearly defined or consistently

used in the research literature

• Loneliness used interchangeably with social isolation

• Not all people who live alone or have limited social contacts are lonely

• Conversely, those with many social contacts and/or not living alone may still experience loneliness

• Need to consult older people about loneliness

How does literature define loneliness?Loneliness is depicted as the perceived subjective condition that

may or may not co-occur with being alone (Parsons 1997).

Without companions; lone.

Characterized by aloneness; solitary.

Unfrequented by people; desolate: a lonely crossroads.

Dejected by the awareness of being alone.

The American Heritage Dictionary of the English Language, 4th edition, published by Houghton Mifflin Company

Loneliness Research Interests• Qualitative Studies

• Alone in a Crowd: Supporting Older Australians Managing Loneliness – Cheek, Moyle, Ballantyne, Stanley, Corlis & Oxlade (2007-2010)

• An International Comparison of Loneliness in Older People in Australia, Norway, UK, Japan, South Africa– Cheek, Moyle, Ballantyne, Meyer et al.(2007-2009)

• Mixed Methods• Loneliness in People with Dementia and their Carers – Moyle, Cheek,

Kellett & Ballantyne (2007 -2009)

Alone in a Crowd: Supporting Older Australians Managing Loneliness• Aim: Provide a comprehensive & in-depth understanding of

loneliness to inform practice

• Three stage 3 Year project – conducted in South Australia / QLD

• Stage 1 Interviews (60 older people) and focus groups x 8 with support & service providers (2007)

• Stage 2 Workshops with support & service providers to identify solutions (early 2008)

• Stage 3 Development of recommendations, implementation and evaluation of solutions (2008 – 2009)

Methods and Sampling• Maximum variation purposeful sampling• Individual in-depth interviews with older people –

• over 65 years, of varying ages, living in varying types of accommodation, receiving various levels of service, having family or not

• Focus groups with people providing services to older people including -

• nurses and personal care assistants, other health professionals, managers of those providing direct car, individuals with responsibility for allocation of resources, family members/significant others of older people receiving support/services; and representatives of consumer groups.

Interview and focus group questionssemi-structured and initial probes were developed around six

areas:

• What participants perceive and understand loneliness to be• Important factors contributing to loneliness• How older people manage loneliness• The effect of loneliness on the health and well-being of the

older person• What assists or could assist older people to manage

loneliness• Perceived barriers to managing loneliness.

Data analysis• Two members independently reviewed and thematically

analysed each interview & focus group transcript

• Reviews exchanged, discussed and resolved by consensus

• Themes & issues across interviews and focus groups were generated according to the perceptions and understandings of loneliness and its management

• Major categories of themes used to produce discussion paper to inform Stage Two workshops

Stage 2 workshops• Participants - older people participating in Stage One, family members

of older people, those providing supports and services for older people and relevant consumer groups

• Aimed to:

• Identify the implications of the findings from Stage One of the study • Design and initiate changes or enhancements to existing supports,

services and programs and/or develop new ones to address gaps or weaknesses identified and/or enhance identified strengths;

• Produce examples of supports, services and programs that provide solutions for, and better understandings of, assisting older people to manage loneliness.

Five Ways of Understanding Loneliness

1. Loneliness as Relational

2. Loneliness as Connectedness

3. Loneliness as Temporal

4. Loneliness as Enabling Adjustment

5. Loneliness as Private

Loneliness as RelationalLoneliness is influenced by the relationships with

others, and whether these are missing, are felt to be needed and or maintained

Loneliness as ConnectednessLoneliness is influenced by whether people feel like

they are connected to the community at large

Loneliness as TemporalLoneliness has something to do with time, as

expressed by older people (time of day or more broadly time of life)

Loneliness as Private• Loneliness is private, personal & emotional

• It is stigmatized and often kept secret

• Associated with shame, defeat, weakness & failure

• Can be awkward to talk about

Loneliness as a Failure “Society sees it as a nasty problem that they don’t

want to know about and people who are lonely being able to express this without feeling they are a failure of some kind [is difficult]”

Personal, Subjective & IndividualIndividual meanings of loneliness.

“You know you could be in a room full of nice people and beautiful dresses [the people] are all polite to you and you can be as lonely …”

Different Explanations Why People are Lonely• Loneliness is related to an individual’s persona

• Loneliness is influenced by specific experiences

• At times being lonely can be beyond individual control

• At other times individuals need to want to help themselves in order not to be lonely

Service Providers Explanation“ Lots of them went through a war and depression.

They came out of that really made to grin and bear everything. So they don’t reach out, they think what they are experiencing is how it is… and you grin and bear it. They don’t jump up and down and say someone help me. They kind of wear it”

Workshops Potential solutions and strategies

• Importance of transportation

• Grief counselling

• Family therapy

• Raise awareness of potential for loneliness

• Assist people early in life to overcome loneliness

Conclusion• Importance of relationships

• Frequency of relationships shapes loneliness

• Relationship strategies as a preventative strategy