“All the lonely people
Where do they all come from?
All the lonely people
Where do they all belong?”[1]
Paul McCartney said of this song and its lyrics (from Observer Music Monthly November 2008): “When I was a kid I was very lucky to have a real cool dad, a working-class gent, who always encouraged us to give up our seat on the bus for old people. This led me into going round to pensioners’ houses. It sounds a bit goody-goody, so I don’t normally tell too many people. There were a couple of old ladies and I used to go round and say, ‘Do you need any shopping done?’ These lonely old ladies were something I knew about growing up, and that was what ‘Eleanor Rigby’ was about – the fact that she died and nobody really noticed. I knew this went on.”
Recently a friend’s frail elderly aunt has been experiencing declining physical and mental health and more so since her long standing partner passed away last year. Discussion turned to how loneliness was playing a part in her decline. The conversation revealed that there was a lack of clarity about what we mean by loneliness and how this was impacting negatively on her health and well being.
Definitions of loneliness all include the idea of social isolation; lack of friends and companions and are not age specific. It is further complicated because you can be surrounded by people yet still feel lonely. Additionally feelings of loneliness maybe transient and context specific (lonely at a weekend) or more chronic because the feelings are persistent.
It turns out that the association between loneliness and risk for mortality among young populations is actually greater than among older populations. So what is going on and what does it all mean given that so much of the emphasis is on older adults?
Research on health related harms and loneliness find that if you already have a diagnosis of ill health your prognosis is better if you have strong social relationships and networks; and if you become unwell your prognosis is better if you have strong social relationships and networks.
To draw a parallel, years ago high mortality rates were observed among infants in orphanages, even when controlling for pre-existing health conditions and medical treatment. Lack of human contact predicted mortality. Infants died without social interaction. This single finding was responsible for changes in policy that markedly decreased mortality rates in infants in orphanages. We need new approaches that recognise that social relationships influence the health outcomes of adults.
What do we know and what should we do?
Human beings are social animals. We like to live in communities with an ordered social structure and hierarchy. Industrialisation and mobility have changed part of the old social structure where we lived in extended families and communities. We have new and different communities including on line communities. These changes of course have impacted on loneliness for good and ill.
The evidence shows that having care and support staff coming into your home is not the answer to the problems of loneliness and isolation. Important as they are they are not a substitute for the kind of relationships that protect against loneliness and isolation.
We need to do much more to help us understand what factors make some individuals much more resilient than others. When we understand this in greater depth we can help the development of resilience in those who would benefit.
The challenge for us is how we can recreate the ethos that builds a new sense of community that encouraged the kind of behaviour that led to Paul McCartney popping around to pensioners houses. We need to:
– Encourage inter generational integration through housing policies;
– Review the tax system to better reflect intergenerational differences that currently only favour the elderly;
And of course all of us need to take personal responsibility and recognise that in every street of every community there will be people who fit the demographic of being at risk of being lonely and isolated. It takes little time and effort to find our humanity and pop around to see if we can do anything with and for the person.
[1] Songwriters: John Lennon / Paul McCartney
