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Vanessa Burholt loneliness symposium iph

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Vanessa Burholt loneliness symposium iph

  1. 1. The complexity of loneliness in later life: Addressing the issues Vanessa Burholt, Centre for Innovative Ageing, Swansea University @ProfNessCIA International Loneliness Symposium Clayton Hotel, Belfast 5-7 December 2018
  2. 2. What is loneliness? A model of the multiple pathways to loneliness Examples of pathways to loneliness Addressing the issue with complex interventions
  3. 3. Loneliness is a negative emotional feeling which is the outcome of the discrepancy between desired and achieved levels of social relations  Emotional loneliness: Lack of (desired) close relationship(s) or significant other(s)  Social loneliness: Lack of (desired) social network Loneliness is not synonymous with social isolation
  4. 4. Source: Burholt et al. 2018 (under revision). A critical review and development of a conceptual model of exclusion from social relations for older people. European Journal of Ageing
  5. 5. Loneliness is a negative emotional feeling which is the outcome of the discrepancy between desired and achieved levels of social relations Mismatches may arise due to life events or specific sets of circumstances
  6. 6. Source: Burholt et al. 2018 (under revision). A critical review and development of a conceptual model of exclusion from social relations for older people. European Journal of Ageing
  7. 7. LONELINESS SOCIAL RELATIONS -0.11*** -0.07*** 0.08*** (0.11***) DISABILITY EDUCATION MARITAL STATUS CARE SETTING GENDERAGE 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 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 * p<.05 ** p<.01 ***p<.001
  8. 8. Greater levels of disability can be considered as a precipitating event which leads to a decrease in achieved levels of social relations, ultimately impacting on loneliness Disruptive life events: disability, bereavement, marital breakdown, relocation and the onset of disability  Taken-for-granted assumptions and behaviours It came as such a shock when she [my wife] did leave, that I just had to rethink my whole life and as I say I’m just beginning to get it back together again (Male,78, separated) Source: Morgan, D. J. and Burholt, V. 2018. Biographical disruption as a way of understanding degenerating loneliness Wales (Working paper). Swansea: Centre for Innovative Ageing
  9. 9. Greater levels of disability can be considered as a precipitating event which leads to a decrease in achieved levels of social relations, ultimately impacting on loneliness Disruptive life events: disability, bereavement, marital breakdown, relocation and the onset of disability  Taken-for-granted assumptions and behaviours  Personal expectations and plans I’d always gone to the whist for years on a Wednesday, [my husband] dropped me there, and [my husband] picked me up to bring me home and I went the first time and that was the worst thing, when a friend dropped me at the end of the road and I walked up and the door wasn’t open and my cup of tea wasn’t ready for me (Female, 73, widowed) Source: Morgan, D. J. and Burholt, V. 2018. Biographical disruption as a way of understanding degenerating loneliness Wales (Working paper). Swansea: Centre for Innovative Ageing
  10. 10. Greater levels of disability can be considered as a precipitating event which leads to a decrease in achieved levels of social relations, ultimately impacting on loneliness Disruptive life events: disability, bereavement, marital breakdown, relocation and the onset of disability  Taken-for-granted assumptions and behaviours  Personal expectations and plans  Sense of self I remember thinking about a week later, coming down the stairs I thought, and I took my wedding ring off, and I thought “I’m not married anymore”, I’d been married since I was 16, I’d never known anything else, […] and to be single. And then I was afraid of anybody wanting to be friendly with me, like (Female,68, widowed) Source: Morgan, D. J. and Burholt, V. 2018. Biographical disruption as a way of understanding degenerating loneliness Wales (Working paper). Swansea: Centre for Innovative Ageing
  11. 11. Loneliness is a negative emotional feeling which is the outcome of the discrepancy between desired and achieved levels of social relations Mismatches may arise due to life events or specific sets of circumstances The experience of loneliness can be influenced by psychosocial resources or socio-emotional processes
  12. 12. Source: Burholt et al. 2018 (under revision). A critical review and development of a conceptual model of exclusion from social relations for older people. European Journal of Ageing
  13. 13. Problem focused Emotion focused (distracting/lowering expectations) Meaning focused Using a range of coping strategies contributed to a transition out of loneliness I’ve even got a club together, a lot of us go out for a meal every week, or every fortnight, you know, down to local restaurants or to try a restaurant, you know? They’ve got no husbands a lot of them, it’s all women, yeah. Just one of us, I think has got a husband. I think, we’re all either separated or divorced. (Female, 73, widowed) I always occupy myself you know, I try to direct my attention to something or other to take your mind off sitting doing nothing or thinking about things, you know? I find that helps an awful lot, directing your attention towards something else. (Female, 68, widowed) In the beginning it was for something to do, for the computers, but I got so used to it after then it’s taken on a different meaning to me like, you know. I go for the company now, now we have a talk, it’s good, you know. (Male, 72, divorced) Source: Morgan, D. J. and Burholt, V. 2018 (under revision). Transitions in loneliness in later life: The Role of Social Comparisons and Coping Strategies. Ageing & Society
  14. 14. More likely to hold dysfunctional beliefs and negatively process personal information Less likely to alter their benchmark for ‘desired’ social relations Depressive symptoms
  15. 15. Age Marital Status Gender Education -0.092*** -0.037***0.076*** Social Participation Social Relations Loneliness Depressive Symptoms Social Participation x Depressive Symptoms Social Relations 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<.001 Source: 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.
  16. 16. Loneliness is a negative emotional feeling which is the outcome of the discrepancy between desired and achieved levels of social relations Mismatches may arise due to life events or specific sets of circumstances The experience of loneliness can be influenced by psychological resources or attributions Loneliness is dynamic and there are feedback loops
  17. 17. Source: Burholt et al. 2018 (under revision). A critical review and development of a conceptual model of exclusion from social relations for older people. European Journal of Ageing
  18. 18. Some research focuses on negative health consequences of loneliness vascular hypothesis stress hypothesis cognitive reserve
  19. 19. Some research focuses on negative health consequences of loneliness vascular hypothesis
  20. 20. Some research focuses on negative health consequences of loneliness stress hypothesis
  21. 21. 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 3 3 3 3 Social isolation and loneliness diminish cognitive reserve
  22. 22. Biomedical research focuses on loneliness as a risk for dementia Unidirectional causal pathway masks feedback loops (the influence of dementia on loneliness) (for exceptions see Ellwardt et al. 2015; Bosma et al. 2002; Hutsch et al. 1999) Potential for spiral of decline Individual responsibility Does not take into account structural barriers
  23. 23. Loneliness is a negative emotional feeling which is the outcome of the discrepancy between desired and achieved levels of social relations Mismatches may arise due to life events or specific sets of circumstances The experience of loneliness can be influenced by psychological resources or attributions Loneliness is dynamic and there are feedback loops Loneliness is influenced by values and norms (e.g. discrimination), policy and the environment
  24. 24. Source: Burholt et al. 2018 (under revision). A critical review and development of a conceptual model of exclusion from social relations for older people. European Journal of Ageing
  25. 25. Cognitive impairment Amplifying difficulties because of additional social structural and socio-cultural barriers
  26. 26. MARITAL STATUS 0.00* EDUCATION 0.50* -1.12 0.90*** 0.14*** SOCIAL RELATIONS 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*** 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 p<.05 ** p<.01 ***p<.001
  27. 27. Cognitive impairment Anosognosia: unrealistic positive expectation of social contact Internalize negative stereotypes in social comparison
  28. 28. 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*** 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 p<.05 ** p<.01 ***p<.001
  29. 29. 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. 2017. Social Support Networks of Older Migrants in England and Wales: The Role of Collectivist Culture. Ageing & Society. DOI: 10.1017/S0144686X17000034
  30. 30. Source: Burholt et al. 2018 (under revision). A critical review and development of a conceptual model of exclusion from social relations for older people. European Journal of Ageing
  31. 31. Source: Burholt, V., Sardani, A. V. 2017. The impact of residential immobility and population turnover on the support networks of older people living in rural areas: Evidence from CFAS Wales. Population, Space and Place (Special Edition – Putting Rural Stayers in the Spotlight). DOI: 10.1002/psp.2132 Desirable rural areas  high population turnover; gentrification (high property prices); outmigration of younger local people = ageing places Less desirable, deprived rural areas  low population turnover; unable to afford to move away = ageing in place Those ‘ageing in place’ may be more socially engaged in locally integrated support networks, or more marginalized in family dependent networks (Pre-)retirement migrants in ‘ageing places’ characterised by socially engaged wider community focused network (no proximal family), or private restricted networks
  32. 32. Source: Burholt et al. 2018 (under revision). A critical review and development of a conceptual model of exclusion from social relations for older people. European Journal of Ageing
  33. 33. Environment Or
  34. 34. MARITAL STATUS -0.17* EDUCATION 0.60** -2.31* -0.87*** 0.19*** SOCIAL RELATIONS 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 -0.08 AGE GENDER CARE SETTING -0.09*** -0.01*** -0.02 0.02** -0.27*** 0.10 Source: Burholt, V., Morgan, D. J. 2018. Bio-socio-ecological influences on loneliness in later life: Evidence from CFAS Wales (Working paper). Swansea: Centre for Innovative Ageing
  35. 35. Source: Burholt, V., Morgan, D. J. Bio-socio-ecological influences on loneliness in later life: Evidence from CFAS Wales (Working paper). Swansea: Centre for Innovative Ageing
  36. 36. Many pathways in the model have yet to be explored Risks: neurological risks, such as cognitive psychology and/or psychophysics decoding facial emotions; mutual eye contact; joint social attention Moderating or mediating effect of psychological processes (e.g. resilience) Socio-cultural, social structural and environmental factors (e.g. the role of discrimination, neighbourhood safety and cultural effects on exclusion from social relations) Dynamic interrelations between the phenomena within the human ecological framework need sophisticated modelling techniques (e.g. complex system dynamic modelling – agent based models)
  37. 37. Group interventions  Education/training  Discussion  Social activation  Self-help/support  Caregiver support  Bereavement support  Telephone conversation  Group therapy  Physical activity One-to-one interventions  Individual therapy  Home visiting  Telephone/technology communication  Information/advice Services  Transport  Recreation  Medical (hearing aid)  Co-ordination of services (Community Connectors) Community Development  Social activities Source: Cattan, M. et al. 2005. Preventing social isolation and loneliness among older people: a systematic review of health promotion interventions. Ageing & Society, 25(1), 41-67.
  38. 38. Increasing social contact or social support (e.g. befriending, community groups) Increasing opportunities for social interaction (e.g. social recreation) Improve or develop social skills (e.g. speaking on phones, giving receiving compliments) Corrects maladaptive social cognition (e.g. CBT) Masi, C. et al. 2011. A Meta-Analysis of Interventions to Reduce Loneliness. Personality and social psychology review, 15(3), doi:10.1177/1088868310377394.
  39. 39. There are many alternative routes to loneliness Increasing social contact is often considered the ‘cure’ for loneliness Socio-cultural, socio-structural and environmental barriers to social participation, social engagement need different types of macro- intervention
  40. 40. UK Denmark Canada - Social isolation of seniors USA: Oprah Winfrey et al.; AARP Foundation; Women’s Fund Current purpose: raising awareness, sharing good practice, delivering individual interventions (and intentions – pledges) Future purpose: challenging stereotypes, cultural exclusion, environmental issues?
  41. 41. There are many alternative routes to loneliness Increasing social contact is often considered the ‘cure’ for loneliness Socio-cultural, socio-structural and environmental barriers to social participation, social engagement need different types of macro- intervention Personal interventions need to take into account the pathway into loneliness . DIVERSE PATHWAYS INTO LONELINESS REQUIRE FLEXIBLE PERSONALISED INTERVENTION RESPONSES: COMPLEX INTERVENTIONS
  42. 42. Takes place in a naturalistic setting Several…  Components  Behaviours  Pathways to outcome Heterogenous population Almost always needs tailoring
  43. 43. 1 • Problem definition and goal determination 2 • Identification and hierarchy structure of criteria 3 • Cacluating relative weights 4 • Preference order of options / alternative comparisons
  44. 44. Alleviate Loneliness Risks Psychological processes Environmental barriers And so on… Group intervention x, y, z … One-to-one intervention x, y, z… Services x, y, z… And so on… Goal Criteria Options
  45. 45. Vanessa Burholt, Centre for Innovative Ageing, Swansea University Wales, UK Email: v.burholt@swansea.ac.uk Twitter: @ProfNessCIA

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