Loneliness is a silent and effective killer. Everyone experiences it at some point, but few New Zealanders would ever consider loneliness to be a serious health problem.
In an era where high-profile diseases like cancer and Alzheimer’s stalk older New Zealanders, loneliness is often trivialised as just part of life. But it is a strange quirk of twenty-first-century life that in an increasingly connected world, some older Kiwis are feeling more disconnected and isolated than ever before. Worse still, the physical and mental toll of this isolation and loneliness on our older people is largely going unnoticed—and it is devastating.
What makes loneliness a particularly difficult challenge to tackle is that it is a largely unseen “epidemic”, to use the provocative term of former US Surgeon General Dr Vivek Murthy. Outside of academic circles, few people are talking about loneliness in the same terms as they are about obesity or addiction
But we should. Here in Aotearoa New Zealand, approximately 10% of people over the age of 65 are lonely all or most of the time, and this rises to 50% amongst those over 80. In the most serious cases, one in five frail adults is ‘chronically lonely’. And this loneliness is hazardous: almost a quarter of those people who are lonely may be at risk of premature death. Previous research has equated the reduction in life span as a result of severe loneliness to smoking 15 cigarettes a day.
On the international stage, there has been a growing focus on loneliness as a serious health issue. In 2016, for instance, the UK created the world’s first Minister for Loneliness. But in New Zealand, the matter has been relatively overlooked, particularly in regard to Māori and minority groups.
This oversight inspired Ageing Well Principal Investigator Professor Merryn Gott to take action. Professor Gott, of the University of Auckland, sought to rectify this gap in our understanding with a two-pronged project: first, her research team conducted interviews with different ethnic groups (especially Asian, Māori and Pacific peoples) to gauge how they experienced and understood loneliness; and second, they evaluated Age Concern’s Accredited Visiting Service (AVS), which seeks to provide companionship and reduce loneliness amongst socially isolated older people.
In collaboration with Age Concern, Professor Gott’s team analysed this information to assess the effectiveness of the programme and suggested areas where they might adapt their service so that it can better meet the needs of New Zealand’s multicultural population.
Loneliness is hazardous: almost a quarter of those people who are lonely may be at risk of premature death. Previous research has equated the reduction in life span as a result of severe loneliness to smoking 15 cigarettes a day.
Forty-four older people were interviewed, and a further 32 attended focus group sessions. What they shared was always poignant and “often upsetting”, related Professor Gott. Loneliness and social isolation were a “significant concern” for older people. Their accounts resonated with a previous study the team conducted which found many older people are choosing not to hold funerals as they did not believe anyone would attend.
Embarrassment about being lonely, and a desire not to be a burden on family members, were two of the biggest psychological barriers to social engagement, the study found. Professor Gott noted there is a real stigma about identifying as being lonely or socially isolated, and this prevented people from coming forward to seek companionship or help.
Many older people feel their isolation and loneliness is their “own fault” or a reflection of their family or whānau’s “unwillingness or inability” to care enough for them, she said. Most study participants lived alone or with only a spouse, providing fertile ground for isolation. And in a sad irony, Asian migrants often sought to preserve family relationships by avoiding being a burden—thus perpetuating the loneliness experienced.
Though older people are incredibly resilient in their attempts to lessen their loneliness, the study found, physical barriers like mobility issues, loss of a driver’s license, and an inability to leave the house contributed to isolation and loneliness.
These physical impediments can have a significant psychological impact: a home or rental accommodation can often feel like a prison cell. Many vulnerable older people spent days by themselves, which could result in depression. One participant compared loneliness to being “in the dark place”. In stark contrast, getting out of the house was associated with “feelings of belonging”.
Many issues contributed to older adults’ social isolation and loneliness, Professor Gott discovered, and different cultural groups experienced isolation and loneliness for a variety of reasons. So any solutions to these problems will need to be as multifaceted as New Zealand is multicultural.
Embarrassment about being lonely, and a desire not to be a burden on family members, were two of the biggest psychological barriers to social engagement, Professor Gott's study found.
And that’s where the second part of Professor Gott’s project is crucial. In collaboration with Age Concern, an NGO dedicated to supporting people over 65, the research team investigated the effectiveness of the AVS. The study found the AVS was particularly successful when relationships between the volunteer and the isolated individual were based on mutual respect and shared cultural knowledge. Older adults wanted to be valued for their contribution to a relationship, and preferred friendships to be genuine rather than “transactional”.
Participants agreed that the befriending service helped reduce social isolation and loneliness and that supportive services to foster connection are needed. More importantly, the study verified Age Concern’s AVS is making a difference. With the additional learnings gleaned from the study, the AVS will be able to grow purposefully and gain momentum.
The study also has some very important lessons for New Zealand as a whole, and we should be taking notes. Older people are more lonely and more isolated than ever before, but are often too embarrassed or physically unable to do much about it.
This often leads to illnesses such as depression and, in the worst case scenario, even premature death. Investing in ways to promote social connection and reduce loneliness would yield huge cost savings. Given New Zealand’s increasingly constrained health and social care budgets, such information will be critical for policymakers and health economists. This study found that the visiting service is cost effective and “there will be a strong argument for integrating them into DHB and council service provision.” By investing in services such as the AVS that aligns to services, promotes social engagement and values the older person, “the health benefits will be huge, and the cost of stemming the tide of loneliness will be repaid many times over”, Professor Gott concludes.
What Professor Gott and her team have discovered is worthy of a public health campaign that helps to destigmatise loneliness.“It is important to get people talking about loneliness and normalising it,” she says.
For now, as part of her project, her team collaborated with filmmaking colleagues from the Faculty of Arts to create an animation short film, Elder Birdsong. This film powerfully draws upon study participants’ own words to convey the effects and feelings of social isolation and loneliness. The film was shortlisted in the World Health Organisation’s Inaugural Health for All Film festival in 2019.
Professor Merryn Gott and her team are undertaking an extension of this study in Phase 2, entitled ‘Promoting social connection through challenging public attitudes’. This will continue the intergenerational collaboration and produce a second film that furthers the conversation about social isolation and loneliness in older people.
This ground-breaking project has shone a spotlight on loneliness as a serious health problem experienced differently between diverse ethnic groups. Positively, it also showed that programmes like Age Concern’s AVS, when conducted in a culturally appropriate manner based on mutual respect and understanding between the volunteer and individual, can begin to help us to tackle the silent and deadly epidemic of loneliness in New Zealand.