Loneliness in the elderly: a risk profile

Talking about loneliness is almost as difficult as talking about boredom. Both are phenomena we are both familiar with. We have suffered from them on a daily basis for as long as we have individual and collective memory. We have described them in philosophical treatises and turned them into the common thread of countless literary narratives, seeking to strip them of their absolute character. We explore their pathological roots with suspicion. They affect some of us more than others, depending on the person we are and the context that surrounds us. There are those who consciously pursue them, hoping to find in them the lucidity they lack. Others avoid them at all costs, fearing that they will be consumed by the unfathomable pain they provoke. We want to approach them, however. We want to objectify them and prepare ourselves to taste their bittersweet flavour, but their unique way of manifesting themselves in each of us often defeats the purpose of getting to know them. 

What would we know about these devious companions without the efforts of those who research them relentlessly? Do we have to know anything? Is it not enough to experience them in our own flesh? Not if they pose a danger to the physical and mental well-being of their potential victims. This is not always the case, fortunately. In fact, most of the time it is not. But it cannot be denied that, from time to time, loneliness and boredom become our worst enemies, distressing and suffocating us, robbing life of all meaning. At such times we are grateful for a guide, a beam of light to help us understand what is happening to us, why it is happening to us and, perhaps most importantly, how to stop it happening to us. 

I have just finished reading the report published by the Red Cross of Navarre on the experience of loneliness in the elderly, entitled Loneliness in elderly people living alone (2021), and I recognise in it one of those works that help to clarify the mysteries of these intricate tortures of the spirit in a sector of the population that we often tend to think of as vulnerable, like few others, to loneliness and boredom: that of elderly people living alone. Under the leadership of Juanjo San Martín Baquedano and Esther Jiménez Martín, a multidisciplinary team - supported by institutions such as the La Caixa Foundation, the Observatory of Social Reality of Navarre and the UPNA, among others - took the initiative to make it a little easier for us and analyse the scope of this assumption by focusing on loneliness. What is it?

How does it affect the elderly who live alone? What factors does its appearance depend on? Is it inherent to the condition of living alone? Can loneliness be desired? In its pages we will find answers to all these questions. 

But first, a little background. The Red Cross has been working with older people for more than 20 years, during which time it has seen that the changes in family and care models that have taken place in recent decades are sometimes accompanied by the unwanted loneliness that attacks those living in single-person households. This is not something that happens across the board, but in certain cases that share some common ingredients. In 2019, this observation was put on the table, taking advantage of the celebration of the 9th General Assembly of the Spanish Red Cross in Madrid, to raise the need to study the variables that condition the possible appearance of unwanted loneliness in older people living alone. Where was the key? Age? Sex? Perhaps marital status? Why not the level of studies? Could it be a question of income? Origin? Or perhaps the weight falls on the personal and material support that is available? As an objective for the following years, the priority was set to resolve these unknowns in order to draw a risk profile based on these and other variables and to offer recommendations to address urgent cases and avoid future problematic cases. Loneliness in older people living alone is the result of that statement of intent that materialised only two years later in an open access document. 

During this time, the people from the Red Cross of Navarre have developed a work project that has gone through different phases. First, they have carried out a non-systematic literature review of a wide variety of literature focused on the approach to loneliness in the elderly. When defining what loneliness is, they have opted for the approach of the interactionist and cognitivist models that attribute it to the insufficiency or lack of quality of the relationships that each person requires to satisfy their social needs, distinguishing, in turn, between emotional loneliness, a consequence of the absence of intimate ties, and social loneliness, which results from the lack of friendships and integration into the community. Subsequently, they designed a mixed study consisting of a first approach to a sample through structured interviews and a second one dedicated to in-depth interviews. Finally, they have drawn up a risk profile of elderly people who live alone and who suffer or could suffer from loneliness according to shared characteristics and have shown us how to focus on these characteristics in order to prevent the problem from crystallising during the ageing process.      

Limited to the region of Navarre, the team worked with 400 volunteers over 65 years of age of both sexes living alone in urban and rural environments. They were asked about their marital status, their studies, their income, their origin, whether or not they had family or other types of support, whether they were users of new technologies, how they perceived their state of health, the leisure options available to them and, of course, they were questioned about their feeling of loneliness. Of these, 64% were found to have some degree of loneliness in the tests - although far fewer admitted to feeling lonely in the in-depth interviews (46.3%). What was the profile of those most affected by unwanted loneliness?

They were men, especially over 85, living in urban areas. Older men who did not receive the desired attention from their relatives, but who also did not want to claim it for fear of becoming a burden. Isolated, resigned subjects, who hardly engaged in leisure activities or socialising with others, and who had not discovered the virtues of technology to do so. The situation was worse for those who were not natives of Navarre, and even more worrying for foreigners. Moreover, those who were defeatist about ageing and perceived their health as poor had every chance of falling prey to loneliness. On the other hand, women under 80, living in rural areas, unconcerned about their relatives, committed to social participation and passionate about leisure, with a good perception of their health and life, and with friendly relationships, were the most protected against unwanted loneliness. They even valued loneliness as a space for intimacy and reunion with themselves at the end of life.  

The analysis in Loneliness among older people living alone shows that the negative experience of loneliness in this population group depends mainly on gender, age, place of residence and, especially, on the availability of family support and access to leisure. In the in-depth interviews, participants emphasised the obsolescence of the traditional care model in which they had been brought up. While wishing to be cared for by family, they preferred to make up for this lack through friends, volunteers and peer carers. However, they were aware that social networks would become increasingly narrower due to age and associated ill health, as if they were aware that there is no fate to embrace other than that of self-imposed isolation. 

In terms of leisure, they complained about the scarcity of resources in rural and peripheral areas, the limited variety of activities on offer, and the lack of personalisation of activities, lamenting the fact that no one had asked their opinion when designing entertainment proposals! This sounds familiar, doesn't it? To combat boredom in company - for that is the crux of the matter, if we want to tackle two problems that feed on each other - there are group walks in nature, visits to bars and cafés, IMSERSO trips and a reduced, outdated and homogeneous range of activities that include visits to the senior citizens' club or the pensioners' home, among which bingo and dominoes stand out, far removed from the desirable objective of intergenerationality. 

The conclusion of this illustrative work could be summarised in the following sentence that diagnoses and resolves the conflict: "The older person needs to feel loved and important to someone. To feel listened to" (p. 153). Not only the older person, but everyone needs to love and be loved, to listen and be listened to! We need to be taken into account and to be taken into account by those around us. We need to rely on others and others need to rely on us. The fact that we feel listened to makes us feel important, valued, necessary, useful, if you like. The remedy for unwanted loneliness lies in having the opportunity to continue to grow as people alongside others who really mean something in our project and to whom we mean something at the same time. 

Once again, a report of these characteristics closes with a call for attention to the institutions, responsible for managing this risk and building bridges so that the elderly are supported and integrated into society, respected as masters of their own lives. With the best of intentions, the Red Cross Navarra group shares with anyone interested a set of recommendations ranging from group interventions that allow the verbalisation of the preferences and concerns of the elderly, their specificities and demands, to gatherings and debates mediated by technology or preventive plans for the transition to retirement. The challenge of detecting who is at risk of suffering from unwanted loneliness has already been overcome, but who will take up the baton of developing sustainable projects to prevent it?

There are many fronts from which awareness of the impact of unwanted loneliness on the well-being of older people is beginning to emerge, and from which formulas are already being proposed to put an end to the ordeal of those who live with it, especially since the pandemic began. National strategies do not yet include specific measures to alleviate it, but at least we can all observe, for some time now, that the issue of unwanted loneliness is gradually gaining prominence on political agendas and in the media. I wish it were the same for boredom! Does it make any sense to address the problem of unwanted loneliness without simultaneously paying attention to boredom? The answer is no, as the authors of Loneliness in Older People Living Alone demonstrate. 

I must admit that Juanjo and Esther's group has pleasantly surprised me, giving the issue of boredom the space it deserves to fulfil its objectives. If I have to be honest, when I came across this title on the internet, the first thing I thought was that, as in so many others, the inseparable relationship that is naturally established between the two states would be ignored. But fortunately I was wrong. In its pages it is made clear that boredom and loneliness are two sides of the same coin and that they affect us in a very similar way: both states depend on oneself and one's environment; on socio-demographic variables such as age, sex, income, level of studies, place of residence, etc. They are caused by a mismatch between expectations/needs and reality; they affect physical and mental health... The parallels are endless, but the most striking, in my opinion, is that both loneliness and boredom are parts of our lives that we are ashamed of because they make us feel like failures. 

To focus on one, ignoring the other, is to remain halfway there. The Red Cross of Navarre have gone the whole way, with the appropriate depth required by their own goals. However, if there is one thing I have to reproach them for, it is that the link between loneliness and boredom has not been established even more explicitly, and that the good number of bibliographical sources that deal with the two phenomena together is absent. This is understandable, because the concern with boredom is only just beginning to make itself felt. If we really want to take a definitive step forward to eradicate unwanted loneliness, studies and recommendations can no longer exclude boredom from the equation. 

As many readers of this blog know, I am studying boredom in the context of older people living in institutions in the Community of Madrid. I am convinced that future Red Cross projects on loneliness and my own projects focusing on boredom can mutually benefit from working together to rise to the occasion. From here I throw the ball.