Health and Loneliness in Later Life

Vanessa Burholt

Centre for Innovative Ageing, Swansea University @ProfNessCIA

IPH and Bamford Centre for Mental Health & Wellbeing, Ulster

Loneliness & Ageing: A Public Health Issue

Clayton Hotel, BELFAST

6 December 2016

Overview of the biomedical approaches to health and loneliness

Alternative views of the association between health and loneliness:

enviropsychosocial factors

Cognitive impairment

Rural and deprived communities

Depressive symptoms

Limitations of our knowledge: discrimination and culture

Minority ethnic groups

LGBT elders

Implications for future research

Implications for age friendly / dementia supportive communities

Some research focuses on negative health consequences of

loneliness

vascular hypothesis

stress hypothesis

cognitive reserve

Some research focuses on negative health consequences of

loneliness

vascular hypothesis

Some research focuses on negative health consequences of

loneliness

stress hypothesis

Some research focuses on negative health consequences of

loneliness

cognitive reserve

Physical activity

Mental activity

Better equipped

to deal with

neuropathology of

AD

Social activity

33

33

Social isolation and loneliness diminish cognitive reserve

Individual responsibility?

Structural barriers?

Large scale, nationally representative study of older people

in Wales (Gwynedd and Neath Port Talbot)

Predominantly white British sample

Face-to-face interviews with 3593 people age 65+ years

+PREDISPOSING

FACTORS

SOCIO-CULTURAL &

SOCIAL STRUCTURAL CONTEXT +PRECIPITATING

EVENTS

NEEDED OR DESIRED

SOCIAL RELATIONS

ACTUAL SOCIAL

RELATIONS

MISMATCH OF NEEDED

VS. ACTUAL SOCIAL

RELATIONS

COGNITION AND

ATTRIBUTIONS

EXPERIENCE OF

LONELINESS

AgeMarital status

GenderEducation

Area deprivationCommunity

or care setting

Health: Townsend disability

score (mediator)Social resources:

Lubben Social Network Scale

Loneliness: De Jong Gierveld

Short loneliness

Scale

(moderator)MMSE:

Cognitive impairment

LONELINESS

SOCIAL

RESOURCES

-0.11*** -0.07***

0.08*** (0.11***)DISABILITY

EDUCATIONMARITAL

STATUS

CARE

SETTINGGENDERAGE

AREA

DEPRIVATIONN

-0.01*** -0.02 0.02*** -0.27*** 0.10 -0.03

-0.08*** -0.88*** 0.20*** 0.61** -2.32* -0.06

* p<.05 ** p<.01 ***p<.001

Source: Burholt, V., Windle, G., Morgan, D. 2016. A Social Model of Loneliness: The Roles of Disability, Social Resources and Cognitive Impairment. The Gerontologist. Doi:10.1093/geront/gnw125

Co

gn

itive

imp

airm

en

t

Amplifying difficulties

because of additional

social structural and

socio-cultural barriers

MARITAL

STATUS

0.00*

EDUCATION

0.50*

-1.12

0.90***

0.14***

SOCIAL RESOURCES

LONELINESS

DISABILITY

COGNITIVE

IMPAIRMENT

DISABILITY X

COGNITIVE

IMPAIRMENT

-0.10

0.08***

-0.04**

-0.01

0.32***

SOCIAL RESOURCES

X COGNITIVE

IMPARIMENT

AGE

GENDER

AREA

DEPRIVATION

-0.06*** -0.01***

-0.02

0.03***

-0.27***

0.03

CARE

SETTING

-0.02

-0.03

-0.12***

• p<.05 ** p<.01 ***p<.001Source: Burholt, V., Windle, G., Morgan, D. 2016. A Social Model of Loneliness: The Roles of Disability, Social Resources and Cognitive Impairment. The Gerontologist. Doi:10.1093/geront/gnw125

Co

gn

itive

imp

airm

en

t

2. Anosognosia:

unrealistic positive

expectation of

social contact

1. Internalize negative

stereotypes in

social comparison

MARITAL

STATUS

0.00*

EDUCATION

0.50*

-1.12

0.90***

0.14***

SOCIAL RESOURCES

LONELINESS

DISABILITY

COGNITIVE

IMPAIRMENT

DISABILITY X

COGNITIVE

IMPAIRMENT

-0.10

0.08***

-0.04**

-0.01

0.32***

SOCIAL RESOURCES

X COGNITIVE

IMPARIMENT

AGE

GENDER

AREA

DEPRIVATION

-0.06*** -0.01***

-0.02

0.03***

-0.27***

0.03

CARE

SETTING

-0.02

-0.03

-0.12***

• p<.05 ** p<.01 ***p<.001Source: Burholt, V., Windle, G., Morgan, D. 2016. A Social Model of Loneliness: The Roles of Disability, Social Resources and Cognitive Impairment. The Gerontologist. Doi:10.1093/geront/gnw125

+PREDISPOSING

FACTORS

ENVIRONMENTAL

CONTEXT +PRECIPITATING

EVENTS

NEEDED OR DESIRED

SOCIAL RELATIONS

ACTUAL SOCIAL

RELATIONS

MISMATCH OF NEEDED

VS. ACTUAL SOCIAL

RELATIONS

COGNITION AND

ATTRIBUTIONS

EXPERIENCE OF

LONELINESS

AgeMarital status

GenderEducation

Area deprivationCommunity

or care setting

Health: Townsend disability

score (mediators)Social resources:

Lubben Social Network ScaleSocial participation: breadth of participation in group activities

Loneliness: De Jong Gierveld

Short loneliness

Scale

LONELINESS

SOCIAL PARTICIPATION

-0.11*** -0.06***

0.11***DISABILITY

EDUCATIONMARITALSTATUS

CARE SETTING

GENDERAGE

En

viro

nm

en

t

Or

En

viro

nm

en

t

Or

MARITAL STATUS

-0.17*

EDUCATION

0.60**

-2.31*

-0.87***

0.19***

SOCIAL RESOURCES

LONELINESS

0.07*

DISABILITY

DEPRIVED ENVIRONMENT

DISABILITY X DEPRIVED

ENVIRONMENT

-0.38*

0.03

0.00

0.00-0.00

0.00

RURAL/URBAN ENVIRONMENT

DISABILITY X RURAL/URBAN ENVIRONMENT

-0.16

-0.08Social resources mediating the relationship between disability and loneliness, and environmental factors (deprivation and rural/urban status) moderating a and c paths

AGE

GENDER

CARE SETTING

-0.09*** -0.01***

-0.02

0.02**

-0.27***

0.10

-0.16

EDUCATION

-0.04

-0.30

-0.28***

0.05***

SOCIAL PARTICIPATION

LONELINESS

0.08*

DISABILITY

DEPRIVED ENVIRONMENT

DISABILITY X DEPRIVED

ENVIRONMENT

-0.07*

0.05

0.00

0.00-0.00

0.00*

RURAL/URBAN ENVIRONMENT

DISABILITY X RURAL/URBAN ENVIRONMENT

-0.07

0.00 Social participation mediating the relationship between disability and loneliness, and environmental factors (deprivation and rural/urban status) moderating a and c paths

AGE

GENDER

CARE SETTING

0.00 -0.01

0.02

0.01

-0.31***

0.24

MARITAL STATUS

Large scale, nationally representative study of people

aged 50 and over in Ireland

Predominantly white Irish sample

Face-to-face interviews with 8178 people age 50+ years

(and 329 with participants <50 years)

7191 self-completion questionnaires returned

Presentation uses data for N=6613 with no missing data

+PREDISPOSING

FACTORS

ENVIRONMENTAL

CONTEXT +PRECIPITATING

EVENTS

NEEDED OR DESIRED

SOCIAL RELATIONS

ACTUAL SOCIAL

RELATIONS

MISMATCH OF NEEDED

VS. ACTUAL SOCIAL

RELATIONS

COGNITION AND

ATTRIBUTIONS

EXPERIENCE OF

LONELINESS

AgeMarital status

GenderEducation

Health: # chronic

condition

(mediators)Social resources:

Berkman-Syme Social Network Index

Social participation: breadth of participation in group activities

Loneliness: UCLA 3-item Loneliness

Scale

(moderator)CES-D:

Depressive symptoms

More likely to hold

dysfunctional beliefs

and negatively process

personal information

Less likely to alter their

benchmark for ‘desired’

social relations

De

pre

ssiv

e

sym

pto

ms

More likely to hold

dysfunctional beliefs

and negatively process

personal information

Less likely to alter their

benchmark for ‘desired’

social relations

De

pre

ssiv

e

sym

pto

ms

Age

Marital Status

Gender

Education

-0.092*** -0.037***0.076***

Social Participation

Social Resources

Loneliness

Depressive Symptoms

Social Participation x Depressive Symptoms

Social Resources x Depressive Symptoms

Health x Depressive Symptoms

0.089***

0.002

-0.006*

0.004*

Health

Environment

Health x Environment

-0.08***

-0.015

-0.015

0.007

0.068**

-0.25***

-0.01-0.033*

0.149***

-0.032-0.072***

-0.301***

0,048

0.087*

0.089

-0.113***

-0.642***1.09***

-0.068***

-0.092***

• p<.05 ** p<.01 ***p<.001Source: Burholt, V., Scharf, T., 2014. Poor Health and Loneliness in Later Life: The Role of Depressive Symptoms, Social Resources, and Rural Environments. Journal of Gerontology Series B: Psychological Sciences and Social Sciences, 69,2), 311 – 324. Doi: 10.1093/geronb/gbt121

Migration is particularly important to the study of loneliness

Increased geographical distance between kin and non-kin

Language barriers may hamper the development of

satisfying social relationships

Studies have accounted for length of residence, language

and ethnic background - they have not addressed the role

that cultural values and norms play in the judgements

concerning the adequacy of social relationships and the

experience of loneliness.

Minority ethnic populations of older people may differ from

the majority population in terms of normative beliefs

Loneliness

Good Health -

Network type

Multigenerational Households: Older Integrated +

Middle Aged Friends +

Restricted Non-Kin +

Multigenerational Household: Younger Family -

Source: Burholt, V., Dobbs, C., Victor, C. 2016. Social Support Networks of Older Migrants in England and Wales: The Role of Collectivist Culture. Ageing & Society (in press)

Sub-populations of older people may differ from the

majority population in terms of discrimination/prejudice that

has hampered social relations

For many older people, being gay was illegal earlier in their

lives and may have hindered social opportunities with

family and friends

Institutionalized racism and heteronormativity in care

settings (e.g. ‘white’ British and heterosexualised spaces)

in which ethnic and LGB identities are neglected in

comparison to the needs and preferences of other

patients/residents/older people

Cognitive impairment has an impact on social

resources and impacts on older people regardless

of the level of disability

Cognitive impairment amplifies the influence of

social resources on loneliness, because of

internalization of negative portrayal of people with

dementia and cognitive impairment or

anasognosia.

Greater levels of disability (in CFAS) or number of chronic conditions

(TILDA) can be considered as a precipitating event which leads to a

decrease in achieved levels of social interaction and social participation,

ultimately impacting on loneliness

Environmental deprivation has an impact on

social participation, but this impacts on all older

people regardless of the level of disability

Rural/urban areas impact on loneliness: urban

areas amplify the effect of disability at appreciable

and severe levels of incapacity, but not by

influencing levels of social resources or social

participation.

Expectations concerning contact with family and

friends, and social participation (based on life time

experiences) may be greater in urban areas than

in rural areas

Depression is a ‘cognitive process’ that moderates

how intensely people react to their personal levels

of social contact and support, and their functional

ability to participate fully in society.

Adjusting one’s expectations regarding quantity

and quality of social contact - desired social

relations - in light of one’s physical ability to

maintain social ties is more difficult to achieve for

those with depression.

Increasing social contact is often considered the ‘cure’ for loneliness.

Provision of more opportunities for older people with cognitive

impairment to maintain or develop social relationships

Positivity toward people with cognitive impairment in attitudes, beliefs,

communication and behaviors.

Provision of more opportunities for older people to participate in social

groups in deprived areas

Older people with depressive symptoms may need to make

psychological adjustments concerning desired level of social relations

by changing patterns of thinking as well as patterns of behavior.

DIVERSE PATHWAYS INTO LONELINESS REQUIRE FLEXIBLE

PERSONALISED INTERVENTION RESPONSES: COMPLEX

INTERVENTIONS