Loneliness in Older Adults: Effects, Prevention, and Treatment

By Luis Miguel Rondon Garcia

Loneliness in Older Adults: Effects, Prevention, and Treatment analyzes loneliness as a complex phenomenon, taking into account the most recent contributions from neuroscience, psychology, medicine and sociology. This volume describes this phenomenon from an interdisciplinary point of view, with special emphasis on older people from a plural and heterogeneous perspective: older people in general, older immigrants, older women, older LGTBI, etc. Faced with the impact of this emerging issue, this book provides a comprehensive knowledge of loneliness, contributing scientific knowledge to the practice of evidence. Tools are also provided for professionals, providing intervention protocols with debates and proposals, and effective digital resources to combat it. Tables, images, and tools guide students, academics, and professionals step-by-step in solving the cases raised, through an integrated practice.

There is no work that develops this theme from such a plural and pragmatic perspective, covering all the dimensions of loneliness in each of the thematic axes: psychological, neurological, social, and health. Readers are provided feedback for all the knowledge for a comprehensive scientific knowledge based on evidence and given the necessary instrumental skills related to being social and the functioning of our brain. This book is aimed at a very plural audience of researchers, academics and professionals in the social and behavioral sciences including psychologists, sociologists, social workers, anthropologists, and also professionals in the health sciences, among others.

• Delivers a tutorial introduction that addresses real cases
• Applies theory to practice from an interdisciplinary perspective
• Provides tools (chapter introductions, measurement tools, and teaching resources) for a comprehensive approach to individual situations
• Compares intervention protocols to allow users to select the most effective technique

• Language: English
• Publisher: Academic Press
• Release date: Jun 1, 2022
• ISBN: 9780323986144

Luis Miguel Rondon Garcia

With 25 years’ teaching and research experience, in several Spanish universities, Dr. Rondón García is a Professor at the University of Malaga. He was the recipient of the 2018 Scientific Prize in social and behavioral sciences, awarded by the Spanish Society of Geriatrics and Gerontology. He has directed research projects and participated as a researcher nationally in Spain and internationally in Europe, and has directed three doctoral theses on loneliness and quality of life in the elderly. He has directed research contracts on loneliness in the elderly with the Vitalia business group, the Spanish Red Cross, and the Public School of Health in Andalusia. He has national and international publications in SJR and JCR indexed journals and in international publishers such as Elsevier, Springer, Thomson Reuters. He has participated as an advisor in the council of social policies regarding the elderly for the government of Andalusia.

Book preview

Introduction

This book is structured in eight chapters that address the different dimensions of a construct as complex as loneliness, taking into account the most recent contributions from neuroscience, psychology, medicine, and sociology, from an interdisciplinary point of view, with special emphasis on the elderly from a plural and heterogeneous perspective of this sector of the population.

Given the impact of this emerging phenomenon, the book is a great opportunity for a comprehensive understanding of loneliness, applying scientific knowledge to the practice of evidence. Tools are also provided for professionals related to this issue, providing intervention proposals and effective resources to combat it. Beneath, there is a schematic breakdown of the content in the different chapters:

In Chapter 1, as a conceptual approach, the basic concepts of unwanted loneliness in older people are recognized, taking into account their typology and characteristics. Chapter 2 analyzes the main models and approaches when defining, understanding, and addressing loneliness that should be applied to each specific situation in each of the different contexts. Chapter 3 focuses on the complex system of functioning of the brain, taking into account the new advances in neuroscience, in order to find out the behaviors and imbalances that generate difficulties in coping with loneliness. Chapter 4 deals with active aging as a process of optimizing the opportunities that these programs can offer to improve the quality of life of the elderly. Chapter 5 develops the effects of positive social relationships as a determining vector in both desired and unwanted loneliness. In the next Chapter 6, loneliness is explored from a plural point of view, attending to the characteristics and needs of the different specific groups of older people: immigrants, women, dependents, LGTBI. Finally, with a pragmatic intention, answers are provided from a more practical perspective. Thus, in Chapter 7, the main validated tools and assessment scales for the prevention of unwanted loneliness are shown and, finally, in Chapter 8, a mapping of active and community resources is carried out, as well as the main innovative experiences in the international arena that are proving effective for the prevention of loneliness.

Chapter 1: Loneliness in aging

concept, typology and characteristics

Abstract

To begin to approach this subject of study, the notion of aging can be understood as the set of morphological, psychological, and social changes that occur in the human being with the action of the passage of time. In essence, it is a term common to all people regardless of context, gender, culture, or any other differentiation that may be appreciated.

Keywords

Aging; Feminization; Loneliness; Types of loneliness

Introduction

To begin to approach this subject of study, the notion of aging can be understood as the set of morphological, psychological, and social changes that occur in the human being with the action of the passage of time. In essence, it is a term common to all people regardless of context, gender, culture, or any other differentiation that may be appreciated.

The vast majority of definitions refer to old age as a space for the protection of the elderly in the areas of health and care. But this vision limits the ability to deepen this object of study because health has a social dimension that goes beyond the absence of disease, it is an issue influenced by multiple factors. Consequently, the psychological and social dimensions are not always taken into account, when in reality the fact of having an optimal quality of life has a multidimensional component. It is vital to move toward a more humanized vision, more focused on the person that takes into account the needs from a psychological, social, and health point of view beyond the diseases that avoid the stigmatization of the group. In fact, some young people have multiple pathologies, health problems, and for this reason, the health situation is not associated with loneliness.

In a way, this view comes from different studies that point to the causal relationship between loneliness and poor health. But it is worth wondering if it is the loneliness that causes health problems or vice versa. Poor health is what leads to isolation and loneliness. It is a binomial of complex interdependence between health and loneliness, which is fed back in a bidirectional way because the health situation can lead to loneliness and, conversely, chronic loneliness over time to illness. Still, as we say, we cannot simplify the reality of the loneliness of the elderly to the disease, a comprehensive approach of all its dimensions is required, contemplating all aspects of people throughout the life cycle, from the moment changes occur in their life that causes loneliness.

Another factor to take into account when defining loneliness is its multiform character because, under the same noun, very different realities are usually referred to, depending on the objective or subjective vision of the point of analysis. Thus, we may be describing an objective or observable situation of insufficient social relations; refer to the type of home in which a person lives alone; talk about people who spend a lot of time alone, or else attend to a more subjective approach known as a feeling of loneliness.

The relationship between these facets is complex since the existence of a social fabric does not imply the presence of a relationship of trust or the absence of feelings of loneliness, in the same way, that living alone does not directly entail the lack of social relationships or that the person sits alone. Each human being has a unique value, a story behind it that differentiates them from the rest. With some frequency, these terms are used interchangeably, which makes it difficult to have an adequate homogeneous approach to the different solitudes.

To this reality must be incorporated the idiosyncratic characteristics of the different societies and cultures in which such situations occur, which influence the cultural meanings and interpretations carried out and, consequently, the subjective perception of loneliness both in the individual and the social sphere. In some cultures, loneliness is valued as something logical and even as an achievement. In others, on the contrary, it is interpreted in the discourse of society as something negative.

This chapter seeks to reflect on the concept of loneliness in old age, from a comprehensive perspective, taking into account its different thoughts as a category of cultural, psychological, and social classification, and the implications it may have on coping strategies.

For all these reasons, it is important to deepen these arguments, dismantling the stigmas around loneliness in the elderly. Through a deep discourse on it and trying to avoid perpetuating the cultural burden of the meaning of loneliness, with the search for individual and community actions that support people in a more adequate management of this phenomenon, which is closer to the current reality which is plural and diverse, after decades of research in this line.

The condition of elderly persons opens the space for consideration regarding the way in which the structures that serve as space for their care and maintenance in their own and community spaces should be adapted, in a way that is as similar as possible to live at home. The objective is clear: to cushion the impact or 180-degree turn in their lives that occurs in the elderly by a number, by the mere fact of reaching an age, that takes into account the empowerment of this age group.

Old age, as an inescapable cycle of the human condition, is permeated by multiple changes that make it difficult to understand and make it necessary for all areas of knowledge to contribute their knowledge to deepen this field. When we refer to aging, we usually do so with stereotypes about its limitations, as nonproductive people who should be treated as an object of attention without more. The bias of this qualification is given by the postindustrial society, which does not take into account nonproductive people or we simply stop being interested when we are recipients of services or need the help of others. Consequently, the problems related to the care of the elderly are related to this context of wide significance.

As we have described, it is a difficult concept to evaluate since all kinds of factors are present in the interventions, the professionals and even the elderly themselves, who assume these stigmas as schemes and labels influence. However, these changes are not linear or uniform, and their relationship with a person's age in years is rather relative. In some people, they manifest themselves more than in others and not all of them become fragile, overcoming adversity with their own personal, social, and mental capacities. But aging is also associated with other life transitions, such as the impact of becoming emeritus, having to change location in case of entering a residence, leaving one's home, and gradually losing their ways of life by disconnecting from close people. For this reason, it is important to reinforce recovery, adaptation, and psychosocial growth in the face of the changes that are taking place and the dizzying rate of increase in lonely people.

Concerning the subject of the study, the following chapters are presented according to the description indicated in the first chapter, the determination of the problematic situation, approached from the perspective of its understanding and analysis process. To do this, we will first address the state of the art, a conceptual approach to the term older person as well as its main characteristics. The concept of ageism and the stereotypes associated with old age will also be studied, with the aim of contributing to the understanding of the different dimensions of the problem that in turn serve as a hinge to the study of later chapters. But first, we contextualize aging in the current scenario.

The context of aging, social changes

The longevity revolution is a novel and global phenomenon that has come to stay as one of the unprecedented social changes in the Western social structure. More and more people are growing up, they are longer-lived and they do so with a higher quality of life than in the past. This social phenomenon has been possible, thanks to the scientific and social advances of the last century. Going toward a society of the elderly, of care, seems an inexorable fact for the present century. And in this situation, loneliness in aging is a social challenge that needs special attention, as it is one of the most prominent epidemics of the 21st century. These milestones are explained by a series of social, family, and value changes explained hereafter.

Demographic changes

Population changes indicate a growing increase in the world population in the Western world, as opposed to the gradual decline in the fertility rate. As a metaphor, Europe can be transformed into a seaside resort or residence, while Africa will remain a nursery. Throughout the 20th century, life expectancy has increased exponentially and the trend is that it will continue to do so in the coming decades. This increase in longevity is a reflection of the progress of society in the health, economic, and social conditions and of all the basic aspects of our modern lifestyle, which lead to an evident improvement in survival in old age.

But these transformations worry the governments because of the increase they represent in spending on health, social services, and the decrease in public income from work income. Although in social terms they represent a social success that the population lasts for more years and every time it does so with a better quality of life, although from some voices it points to an economic problem. But regardless of the political perspective, in social thought, it is interpreted as a value or conquest of society that it recognizes as its own value. Older people are more than a number, and they are social beings with social rights in citizenship, which they have conquered throughout history through the social action of groups, movements, and legislative advances.

According to the latest report from the World Health Organization (2021a,b), people are living longer all over the world. Currently, for the first time in history, the majority of the population has a life expectancy equal to or greater than 60 years. By 2050, the world population in this age group is expected to reach 2 billion, an increase of 900 million from 2015.

Today, there are 125 million people aged 80 and over. By 2050, there will be an almost equal number of people in this age group (120 million) in China alone, and 434 million people worldwide (OMS, 2021). To these general population indicators, we synthetically add global social trends:

- It is a global phenomenon in almost the entire world with differences between the north and the south of the planet because the latter still has a gap in terms of life expectancy.

- The growth rate is most rapid in East and Southeast Asia, Latin America, and the Caribbean. By 2050, the proportion of older people is expected to double in these four regions.

- New measures of population aging based on the prospective age or years of life remaining, progressively increase as life expectancy increases, pointing to a slower aging process of the population than that predicted by conventional indicators. In other words, the demand for health and social services increases at a rapid rate than age or number of years.

- The indicators suggest that the level of aging of the population depends on the patterns of production and consumption by age ranges. This rate shows that population aging has the greatest impact in countries or regions with high proportions of older people and high levels of resources allocated to this group, such as in areas of Europe, North America, Australia, and New Zealand.

- The aging of the population does not lead to macroeconomic decline as most alarmist reports indicate. More efficient policies can maximize the benefits and manage the risks associated with an aging population. Some experts have claimed in scientific forums such as the reduction of psychoactive drugs, sugar, and salt in food, together with better management of the environment, reduce spending and improve the living conditions of the population. To this, we add the need for more advanced policies in terms of reconciling work, personal, and family life. However, these are social rights that must be enjoyed as they are recognized in the Welfare State and, therefore, are always enforceable.

In light of these social trends, we need to abandon the outdated conception that life is divided into three stages, where the last two or 3 decades are identified with decline. A different perspective of the population can open enormous possibilities to build more equitable and inclusive societies for all generations, where longevity is a success, not a burden, and intergenerational action becomes the norm, not an exception.

The extension of life expectancy offers opportunities not only for the elderly and their families but also for all citizens. The savings that governments have in many countries with the support of the elderly in caring for grandchildren and other family members are not quantified.

Along these lines, all is not lost, upon reaching a certain age it can be redefined or reinvented as a stage of fulfillment. In those additional years of life, new activities can be undertaken, such as continuing studies, starting a new profession, or returning to old hobbies. In addition, older people contribute in many ways to their families and communities as producers of well-being. With adequate resources, older people can live those additional years of life, in an environment consistent with the natural environment, in their own home, provided that accessible, inclusive cities are designed with adequate social support networks, health, and community.

Ultimately, the longevity revolution is an inexorable social fact in current time and space. Changes are taking place in the size, composition, and distribution of the world's population that have implications for the achievement of the Sustainable Development Goals, agreed at the global level to ensure that all the world's people have dignified and prosperous lives. To do this, we must overcome both the stereotypes associated with older people, as well as the traditional systems of demographic analysis, to study the aging of the population from other more realistic perspectives, which are aimed at taking advantage of the opportunities that this phenomenon offers, instead of focus on the downsides. It is a paradigm shift to be seen as an opportunity for growth and prosperity. The starting point is very clear: adding life to the years and years to life within an inclusive society for all ages.

Family changes

The changes that have occurred in the postmodern family have been crucial in the dynamics that the elderly person occupies in this system, as well as in the attention to their needs. At first, the transition from the nuclear family to the extended family led to a reduction in the number of members and a growing separation with the ascendants, which caused fragility and ruptures with the family bond that united the entire network. Over time, family deinstitutionalization has given rise to various plural and diverse family models, the family diversifying, but focusing on the core person/couple and progeny, regardless of the gender or ethnic group of the couple. This has reduced family functions with the elderly, focusing support and affectivity in the reference nucleus. They have also lost authority when making decisions in the family, breaking with the myth of the grandfather as the wise consultant who was turned to as a mediator in the face of a family difficulty or conflict. This loss of the social place previously occupied by the elderly can lead to isolation and, therefore, to an unfavorable state of mind. In addition to this, the hectic and liquid moment that we live, where there is little time and space for family communication, to attend to