On the 17th June 2019 over thirty academics, charities, stakeholders and members of the public came together at the University of Surrey for a British Society for Gerontology and Brunel University London sponsored event to discuss the existing evidence-base around loneliness interventions for older adults and the considerations that we need to have in developing loneliness interventions for the ageing population of tomorrow.
The day commenced with a short introduction from the event co-organiser Dr Kimberley Smith. Dr Smith briefly introduced the overarching goals of the cross-governmental strategy on loneliness, one of which is to build the evidence-base on what works to reduce loneliness. She then gave an overview of some of the types of interventions that people currently use, and asked participants to start considering what loneliness interventions might need to look like in the future.
The keynote presentation titled “How do we solve a problem like loneliness?” was given by Professor Christina Victor from Brunel University London. Her thought-provoking talk critically explored the existing evidence-base for loneliness interventions. Firstly she asked participants to consider issues with defining and measuring loneliness. When intervening in loneliness we need to know what it looks like, and we need to know how to measure it so that we can see how effective interventions are. However, loneliness is a complex multifaceted construct that can be social, emotional or existential and that can differ in intensity and duration. This complexity is not something that is integrated into the most commonly used measure of loneliness (the UCLA loneliness scale), leading to questions about what it is that we are actually measuring. She then went on to explore the consequences of loneliness, which is increasingly being defined as an epidemic and public-health issue. In considering these claims Professor Victor emphasised that the overall proportion of lonely older adults has not changed in 50 years and that much of the evidence-base linking loneliness with poor health is overstated. She concluded her presentation by summarising the results from a she conducted in 2018, which found that there is no concrete evidence that any of the published interventions for loneliness actually work to reduce loneliness.
The second invited presentation was given by Dr Tara Cheetham-Blake, a research fellow at the University of Southampton. Dr Cheetham-Blake gave an overview of the NIHR-funded “Project about loneliness and social isolation (PALS)” intervention being run by the University of Southampton. Dr Cheetham-Blake gave the audience an overview of the recently commenced project which aims to encourage people identified as being at risk for loneliness and social isolation to expand their social networks using a computer-assisted technology called Genie (Generating Engagement in Network Involvement). Genie works by asking people to map their current social networks and consider where there may be opportunities for them to extend their networks. The tool works by suggesting what sorts of activities or services they may be interested in based on their personal preferences, and which people in their existing network could support them in making changes. While only just commenced, there was consensus amongst the audience that they very much looked forward to learning more about the effectiveness of Genie in the future. You can learn more about the PALS intervention by clicking here: http://www.isrctn.com/ISRCTN19193075?q=&filters=&sort=&offset=16&totalResults=17460&page=2&pageSize=10&searchType=basic-search
The third invited presentation was given by Dr Paul Willis, a senior lecturer at the University of Bristol. Dr Willis spoke about his recently completed NIHR-funded study “The older men at the margins project”. As part of this project Dr Willis and his team interviewed 111 single older men aged 65+, focusing on the following groups identified as being at high risk for loneliness and social isolation: Gay men who are single or living alone, men who are single or living alone in rural areas, men who are carers for significant others and men who are living with hearing loss. The project aimed to understand the types of social networks that older men had, experiences of loneliness and strategies to alleviate loneliness within different groups. Dr Willis gave an the audience an overview of the main findings from the interviews including a discussion of how single older men felt discarded by wider society and the types of life events linked with loneliness (such as death of a spouse/partner, relationship changes, living alone, health issues and retirement). Dr Willis also discussed the differences in experiences in loneliness that could be observed between different groups. In terms of the strategies that older single men used to alleviate loneliness, Dr Willis spoke about how older men used distractions (such as watching TV), the sorts of groups they reporting accessing and the difficulties that men had in speaking about their feelings of loneliness and seeking help from others. Dr Willis concluded by discussing the importance of considering intersections of social identities and situations when considering what might work well for loneliness in this group. For more information about the older men at the margins project you can click here: https://www.ageuk.org.uk/our-impact/policy-research/older-men-at-the-margins-how-men-combat-loneliness-in-later-life/
To listen to the presentations from Professor Victor, Dr Cheetham-Blake and Dr Willis you can click on this link: https://surrey.cloud.panopto.eu/Panopto/Pages/Viewer.aspx?id=bec395ad-5c3f-41b9-bc56-aa6f00946ba0
The afternoon sessions commenced with a panel titled “Loneliness for the ageing population of tomorrow”. We invited experts to discuss loneliness and loneliness interventions in Black and minority ethnic (BAME) populations and LGBTQ+ communities. The panel comprised representatives from the Campaign to End Loneliness (Dr Kalpa Kharicha), the Centre for Ageing Better (Catherine Foot), experts on ageing in BAME communities (Professor Christina Victor and Dr Emily Williams) and experts on ageing in LGBTQ+ communities (Professor Andy King and Professor Julie Fish). The panel discussed specific issues faced by these populations which could lead to issues with loneliness: specifically discrimination and stigma. Issues around communication and language were also discussed as being potentially problematic for BAME communities. However, for both groups the main issue that was identified was the lack of research examining these populations and the fact that labelling someone as being from a particular population does not take the heterogeneity of these populations into account. While the panel acknowledged that an awareness of culturally appropriate interventions could be important, that it was more important to tackle the societal and structural issues associated with loneliness rather than developing population-led initiatives. Alongside stigma and discrimination the panel spoke about major life events, life transitions, ageing families, the proximity of family and transportation as all being things that need to be considered for developing loneliness interventions for the ageing population of tomorrow.
Following the panel there were three breakout sessions that explored different considerations for developing loneliness interventions for the ageing population of tomorrow.
The first session, facilitated by Professor David Frohlich from the University of Surrey, explored the possible role of technologies in developing loneliness interventions. The group discussed the different types of social media that they consistently used, and how they could be used to develop social networks. The group discussed the issues that older adults could face when using technologies, and issues with accessibility for older adults.
The second session, facilitated by Professor Holly Nelson-Becker and Dr Mike Thomas from Brunel University London explored how to commence the loneliness conversation with older adults. Discussants talked about how difficult it can be to have a direct conversation about loneliness, and the need to talk about loneliness gently using abstract terms of speaking about other people’s experiences. The group discussed issues around stigma, and the narrow view of loneliness as a deficit in social networks rather than people considering emotional and existential loneliness. The group also discussed possible strategies for loneliness, and the issues that arise when a person finds it difficult to admit to feelings of loneliness. Instead to group suggested that a more positive framing of loneliness interventions (e.g., making connections, empowering people to feel as though they have something to contribute to rather than being a passive recipient) could be important for developing interventions.
The final session, facilitated by Dr Alison Armstrong from the Whiteley Foundation for Ageing Better, examined the role of the structural environment in developing loneliness interventions. Dr Armstrong spoke about her own experiences working at Whiteley Village, where many of the environmental features that people point to as being needed to help older adults be less lonely are met (e.g., transportation, community groups, green space, disability access etc). However, Dr Armstrong described they still see a high proportion of loneliness within their community. The group discussed the fact that it was interpersonal rather than structural issues that might be contributing to loneliness, and the need to develop interventions that might help develop interpersonal relationships. The group then discussed how it may be important to develop an intervention that focused around people being kinder to one another rather than focusing only on lonely older adults.
The event finished by asking participants to fill in a postcard titled “What works well for loneliness?” The responses from participants indicated the need for us to conduct more research in underserved populations to know how we can intervene, the need to better understand what loneliness is in order to intervene, that to intervene in loneliness that we might need to consider alternatives (such as developing kinder communities), the need to reduce the stigma of loneliness and that no one-size fits all intervention will help us reduce an issue as complex and individual as loneliness.
At the end of the event we were able to identify four special interest groups where we are interested in developing critical mass. These include loneliness in BAME communities, loneliness in LGBTQ+ communities, the role of technology in loneliness and developing kindness interventions. To join the interest groups that evolved from this event please contact the event organiser who will be able to link you up with other people interested in developing research in these areas: Kimberley.firstname.lastname@example.org