Addressing the Challenges of Loneliness in the Time of COVID-19

The pandemic that’s right next door.

COVID-19 has become the context in which we’re living, the focus of every media outlet, and the worry on everyone’s mind. However, what many don’t realise is that there is another pandemic that has been both ignored and exacerbated by COVID-19 and is likely to last much longer with no hope of a vaccine to prevent it. That pandemic is loneliness, which is a silent enemy[1] and one that leaves those over age 75 especially vulnerable.

Personally, I didn’t know much about the true effect of loneliness until my grandfather was diagnosed with stage III metastatic bladder cancer. Soon afterwards, I began spending my days caring for him while watching news about the second wave of the pandemic and local lockdowns. My grandfather had lived alone since 2012, after both my grandmother and great-grandmother passed away. He was never very sociable and previously relied on my grandmother’s boisterous ability to make friends quickly. Unfortunately, he never recovered socially after her passing and has been unable to forge any new connections in the years since. My sister and I are his only remaining close relatives, and over the years it has become more and more apparent that we are the only people who speak to him on a regular basis. My grandfather is sadly just one example of many in this situation.

Loneliness may seem to be a subjective and immeasurable concept, which could explain the apparent lack of scientific study in this area. However, there is a widely agreed upon definition in the UK. A government-funded report on loneliness defines it as “a subjective, unwelcome feeling of lack or loss of companionship, which happens when we have a mismatch between the quantity and quality of social relationships that we have and those that we want.”[2] In addition, loneliness is known to have serious physical health consequences[3]– including high blood pressure, high cholesterol and increased cortisol – and is associated with increased comorbidity for people with mental health issues.[4]

In England, more than 2 million people over age 75 live alone.[5] While it can be assumed that there has always been a degree of isolation for some members of society, it is believed that loneliness has increased as a result of 21st century social practices and technology. In Noreena Hertz’ recent book, “The Lonely Century: How Isolation Imperils our Future,”[6] she discusses how recent technological advances and changes in society have placed self-interest above interest in others, contributing to a feeling of isolation for those who are less tech savvy. This technological divide leaves senior populations at an increased risk of loneliness especially during COVID-19 lockdowns. Even when restrictions were lifted for others in the UK, seniors were asked to remain home. For those who have a difficult time adapting to technology, it can feel like they’re left on the outskirts of society.

The odds seem doubly stacked against pensioners – many of whom suffer from anxiety, have mobility issues, or have comorbidities that make it unsafe to leave their homes. As we move into the winter season with COVID-19 case numbers in the UK rising again, it’s likely we will see the implementation of more restrictions for pensioners.

Several initiatives have been created to address loneliness in the UK. One initiative from the Campaign to End Loneliness provides patient questionnaires designed to be used in a clinical setting for GPs to refer patients to social prescription workers if necessary.[7] This initiative highlights the need for greater social prescription in primary care and was instrumental in setting a goal of hiring 1,000 new social prescribing link workers by 2020/2021.[8] In the context of COVID-19, the Campaign to End Loneliness has begun researching whether a phone call will help pensioners with lockdown-related isolation.[9] Another initiative is the Silver Service, which also provides this option. Founded by television presenter Esther Rantzen, the Silver Service allows pensioners to call a number and speak to someone about anything, whether it’s about the loneliness they’re experiencing or just the weather.[10]

Other initiatives to combat loneliness also have been trialled elsewhere. In Ireland, the charity Engage with Age has started People Against Loneliness (PAL), a service in which volunteers conduct a half hour call with a senior each week. Unlike current interventions in the UK, the service requires seniors to register in order to be matched with a volunteer, but allows for the same volunteer for each senior.[11] In Canada, a program is in place in which volunteers stop by seniors’ homes and keep them company once a week. To date, this service has received positive feedback from the community.[12] These initiatives are encouraging, but there is no time to wait as we endure another lockdown.

Unfortunately, the challenges with existing interventions regarding loneliness is that they rely on pensioners to take the first step, either by raising the issue with their GP or picking up the phone. For many, denial or pride may stop them from asking for help, or they don’t realise they suffer from loneliness, or that it may impact their health. Additionally, some studies have shown that existing interventions, such as group activities and socialisation, are ineffective in meaningfully treating loneliness.[13]

It’s clear that new, effective interventions need to be created. University College London (UCL) has taken a step in that direction and is currently looking to fund research into initiatives that can make a difference.[14] The Campaign to End Loneliness has reported on an intervention that is being trialled to help those affected by loneliness and depression.[15]

Ultimately, what these examples show is that there is not enough research into loneliness and what can alleviate it, and more proactive steps need to be taken. The studies by UCL are a great start, but they’re only the tip of the iceberg for a problem that is a pandemic of its own.

As we look to end loneliness in seniors, three key issues must be addressed:

  • There must be different ways for people to access interventions, ranging from hospital visits to phone calls to dedicated technology.
  • Interventions must be continually evaluated for their effectiveness, including asking those taking part what has worked best for them and then implementing those changes.
  • All of us must actively reach out to those in the community who may be suffering from loneliness.

Although I know my grandfather is grateful for the connection we’ve maintained over the years, I will always wish I could have done more to make him feel less lonely. Loneliness is an issue that is so common and that we all experience at some point in our lives. Staying silent about it won’t lessen its impact. It’s time for us to be more emotionally aware so that together we can help make the world a healthier place.

Additional information provided by Shanda Kopp.

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[1] https://www.theguardian.com/society/2017/oct/16/tackling-the-silent-epidemic-of-loneliness

[2] https://www.ageuk.org.uk/globalassets/age-uk/documents/reports-and-publications/reports-and-briefings/active-communities/rb_dec17_jocox_commission_finalreport.pdf

[3] https://www.rcn.org.uk/clinical-topics/public-health/inclusion-health-care/loneliness

[4] https://link.springer.com/article/10.1007/s00127-019-01734-6

[5] https://www.nhs.uk/conditions/stress-anxiety-depression/loneliness-in-older-people/

[6] https://www.amazon.com/Lonely-Century-Isolation-Imperils-Future/dp/1529329256

[7] https://www.campaigntoendloneliness.org/frequently-asked-questions/measuring-loneliness/

[8] https://www.england.nhs.uk/personalisedcare/social-prescribing/#:~:text=In%20the%20Long%20Term%20Plan,social%20prescribing%20by%202023%2F24.

[9] https://www.campaigntoendloneliness.org/guest-blog/life-after-lockdown-new-research-to-help-isolated-older-people-post-lockdown/

[10] https://www.thesilverline.org.uk/

[11] http://www.irishnews.com/lifestyle/2020/09/21/news/lynette-fay-covid-exacerbates-loneliness-so-now-might-be-a-good-time-to-reach-out-2070939/

[12] https://ca.news.yahoo.com/student-struck-loneliness-seniors-launches-110000797.html

[13] https://onlinelibrary.wiley.com/doi/pdf/10.1111/hsc.12367

[14] https://www.ucl.ac.uk/psychiatry/research/epidemiology-and-applied-clinical-research-department/loneliness-and-social-isolation-7

[15] https://www.campaigntoendloneliness.org/guest-blog/life-after-lockdown-new-research-to-help-isolated-older-people-post-lockdown/

Elina Berzins
Elina Berzins

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