Hidden Social Isolation Natalie Cotterell and Kingsley Purdam The - PowerPoint PPT Presentation

Best Friends Forever? Friendships in Older Age and Hidden Social Isolation Natalie Cotterell and Kingsley Purdam The University of Manchester 16 th May 2018

Overview • Introductions • Definitions • The importance of friendship • Social isolation and measurement • How can we help someone who is socially isolated? We hope to draw on your views and experiences of friendship

What do you think of when you hear the word ‘friendship’?

What is a friend? • Friends are people we like and with whom we enjoy spending time with (Stevens, 2001). • Friendship is a personal, voluntary and reciprocal relationship. • Research has shown that the main function of a friend is to be a companion and to take part in enjoyable activities - “someone to do things with” ( Jerrome, 2008). • Number of friends decreases with age (Ajrouch et al., 2005); but older adults may have higher-quality relationships within smaller social networks and be more involved in their community.

Hidden Loneliness and Social Isolation? • More than 2 million people in England over the age of 75 live alone, and more than a million older people say they go for over a month without speaking to a friend, neighbour, or family member (Age UK, 2014). • Nearly half of older people in the UK say that television or pets are their main form of company (Age UK, 2014). • In 2014-2015 the English Longitudinal Study of Ageing [ELSA] found that 7% of men, aged over 50, reported having no friends compared to 4% of women.

• The number of people reporting that they had no friends increased after the age of 75. • One-in-twenty older people are detached from social networks. The prevalence for men (7%) is double that for women (3%). • Single, separated, divorced and widowed older people as well as those who are married can suffer from loneliness. Yes married people report being lonely as well! • Older people on lower incomes, those with health problems and those with limited access to transport are more likely to report social detachment.

• Not just older people …. www.bbc.co.uk/news/uk-england-london-43090849

Why Are Friendships Important? • Research suggests friendship may have a protective effect on health. • Individuals with both friends and family have been found to have lower levels of depression, anxiety than those with more restricted networks (Jerrome, 2008). • Having friends is a more important factor in warding off loneliness than frequent contact with these friends (Age UK, 2014). • Research has shown that friendship network size was longitudinally related to psychological health, even after previous psychological health was taken into account (Cable et al., 2013) • People with adequate social relationships have a 50% lower mortality risk compared with those who report poor social relationships (Holt-Lunstad et al., 2010).

• Social relationships provide a platform for the exchange of support and opportunities for social interaction, and research demonstrates their independent influence on mortality, heart attack survival, cognitive decline, depression and anxiety (Umberson & Montez, 2010). • Impact of lack of social connectedness on health has been compared to smoking (Holt-Lunstad et al. 2010). • Individuals who have a limited quantity of social interactions can be described as being socially isolated .

Social Isolation – Objective Measure? • Social isolation is a ‘ measure reflecting an individuals lack of social contacts .’ (Portacolone et al., 2018) • It is distinct from the related concept of loneliness which can be described as a negative subjective feeling about the quality of one’s social interactions. • Social isolation is associated with adverse health, economic, and social impacts. • Yet social isolation often remains undetected as it is not assessed in routine health and social care practice despite over three-quarters of GPs reporting that they see between one and five patients a day who have come in mainly because they are lonely (Campaign to End Loneliness, 2013).

Measures of Social Isolation Three main quantitative scales are used to measure social isolation: • Lubben Social Network Scale (Lubben, 1988; 2006) - 6 items - the size, closeness, and frequency of contact between the respondent and their friends and family. • Duke Social Support Index (Landerman & George, 1989) - 10 items - social interaction and social satisfaction • The Social Disconnectedness Scale (Cornwell & Waite, 2009) - 17 items - perceived isolation and social disconnectedness

Example: Lubben Social Network Scale-6 (Lubben, 2006) FAMILY : Considering the people to whom you are related by birth, marriage, adoption, etc . 1. How many relatives do you see or hear from at least once a month? 2. How many relatives do you feel at ease with that you can talk about private matters? 3. How many relatives do you feel close to such that you could call on them for help? FRIENDSHIPS : Considering all of your friends including those who live in your neighbourhood 4. How many of your friends do you see or hear from at least once a month? 5. How many friends do you feel at ease with that you can talk about private matters? 6. How many friends do you feel close to such that you could call on them for help? Response scale : 0 = none, 1 = one, 2 = two, 3 = three or four, 4 = five to eight, 5 = nine or more.

ELSA Measure of Social Detachment ELSA – Someone is detached from their social networks: “ if they do not have any friends, children or other immediate family or if they have friends, children or other immediate family but have contact with all of them (meeting, phoning or writing) less than once a week .” Composite measure of social detachment linking: civic participation, leisure activities, cultural engagement and social networks

Limitations of Measures • Quantitative measures may not capture a person’s perceptions of their social situation – someone may have few social interactions but may be happy with this and vice versa . • Quantitative measures can also neglect certain issues e.g. men are less likely to report being isolated due to the stigma attached to feeling lonely (Dykstra, 2009). • Some of the measures may not be suitable for use within health/social care or community settings. • This suggests that a mixed methods approach may be useful – particularly for a sensitive and poorly conceptualised issue such as social isolation or friendship.

Example Interventions Interventions can be categorised into the following groups: • One-to-one interventions e.g. befriending services (Age UK, 2018) ; counselling (Campaign to End Loneliness, 2018) . • Group-based interventions e.g. social, educational, or physical activity sessions, group discussions, or group therapies (Miyawaki, 2015). • Service provision interventions e.g. Fit for the Future programme (Wigfield et al., 2015) ; Pennine Care NHS Foundation Trust (2015). …BUT not all friendships are positive and not everybody wants to take part in ‘social facilitation’ programmes.

Interventions • Technology-based interventions e.g. internet, social media, Skype, virtual assistants (Czaja, 2017), robots. • Neighbourhood interventions e.g. Age-Friendly Cities and Communities Initiative (World Health Organisation, 2006; Buffel et al., 2018). • Structural interventions e.g. government-level policies aimed at promoting equality and tackling discrimination to promote attitudinal and behavioural change (Campaign to End Loneliness, 2018; Lianne, 2001) .

Your Help 1. How do you think friendship, loneliness and social isolation could be measured? What type of data would be best? 2. How could we help people to make and maintain new friendships in later life? Group Task - 10 minutes

Feedback from groups

A message to a friend… Please take a postcard from your table and write a message to a friend – new or old.

Conclusions • Friendships can have a protective effect on health. • Friends and family become even more important in later life – a time when an individual’s social network usually shrinks. • If an individual has a restricted social network and is not content with this then they may be socially isolated, increasing their risk of loneliness. • Social isolation is a growing public health concern; more interventions must be developed to tackle and prevent it. • It can be difficult to create and maintain friendships.

Resources Campaign to End Loneliness www.campaigntoendloneliness.org Silver Line www.thesilverline.org.uk Age UK https://www.ageuk.org.uk/information-advice/health-wellbeing/loneliness/ Mind www.mind.org.uk/information-support/tips-for-everyday-living/loneliness/

Let‘s make a new friend today. Before you leave say hello and introduce yourself to someone you don‘t know (yet!).

Questions and Comments Natalie Cotterell Email : natalie.cotterell@postgrad.manchester.ac.uk Kingsley Purdam Email: kingsley.purdam@manchester.ac.uk