Pointers for Policy in an Ageing New Zealand

Judith A. Davey
8/3/19

Recently I was in Wanaka, invited there to give the first of their four sessions entitled “Living in the Third Age: Navigating a changing demographic”, which continue through March. My title was as above – “Pointers for Policy in an Ageing New Zealand”. It was extremely well organised and attended by almost 200 people, in the hall of a modern church not far from the lake. After the size of the audience – well-informed and engaged – I was most impressed with the up-to-date technology which was available, all of which worked without a hitch.

My aim was to set out some of the policy challenges associated with population ageing and to stimulate discussion. There was a very active question and answer question after my talk (and morning tea). Here are some of the issues and questions which I posed – many arising out of my research – and which figured in the subsequent discussion.

I put out four major policy challenges –

1. Ensuring adequate retirement incomes.
This not only centred on the sustainability of NZ Superannuation (important though that is), but also the recognition that this is only one part of the “eco-system” which I outlined in an earlier blog (September 2018). There are other policies which contribute to the adequacy of NZS – Kiwi Saver, free or subsidised health services, the Accommodation Supplement, Super Gold Card, Winter Energy Payment, Total Mobility Scheme and so on.

Then there are ways in which people can contribute to the self-funding of their retirement incomes – through their own savings and earnings and mobilising capital from their housing by downsizing and equity release. I asked whether, in the future as the NZS demand grows, we might be called upon draw on our own resources to a greater extent – “decumulating” assets which we have accumulated/saved through life.

2. Support for Ageing in Place.
I have frequently tried to emphasise that, in the future, we will see very much higher numbers of very old people, the majority of them women, living alone in mainstream housing in the community and in need of supportive services. 85 plus is the fastest-growing age group and over 80% live in the community; 1/3 of the men and 2/3 of the women live alone. The majority require some supportive services, as disability is high in this age group. This support comes from a range of sources, from family, neighbors and friends, from voluntary organisations, commercial firms, local, regional and central government agencies. How can these work together and how will responsibility be shared?

3. The implications of an ageing labour force.
We will soon be in the situation where more people are leaving the workforce than moving into it. Emerging labour and skill shortages bring concerns about productivity and economic growth (see series of blogs in mid 2015). More and more people aged 65 and older remain in paid work, which has benefits for themselves (supplementing other sources of retirement income), but also for government (raising the tax base to pay for costs related to ageing); for employers, and hence for the economy as a whole.

The challenge is to adapt jobs to make them more attractive and more appropriate for older people and, at the same time, to keep up the functional capacity of older workers through (re)training and health promotion. There needs to be adjustment on both sides – jobs and workers.

4. Promoting Positive/Active Ageing.
In 2007, Alan Walker said – “Active ageing should be a comprehensive strategy to maximise participation and well-being as people age. It should operate simultaneously at the individual (lifestyle), organisational (management) and societal (policy) levels and at all stages of the life course.”

This is another challenge – trying to get different policy levels and different sectors (including individual action) to work together for the benefit of all. But what can government do? I concluded with a list –

  • Maximise the potential of older workers
  • Encourage flexible retirement options
  • Redistribute public health resources from cure to prevention across the life course
  • Get on with long-term planning for health service delivery – target chronic conditions
  • Have a stable retirement income system
  • Enhance measures to support ageing in place
  • Challenge and remove ageism/age barriers.
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Ideas on a revision of Positive Ageing Strategy

Judith Davey

22/02/2019

In January the Office for Seniors (OFS) published a summary of the submissions that they had received in the second half of 2018, with the title “Developing a new strategy to prepare for an ageing population”. These were submissions in response to a discussion document of the same name, released in June, which looked at changes since the 2001 Positive Ageing Strategy 2001 was published.

There were 469 submissions in all, of which 367 were from individuals, couples or anonymously; 102 submissions were from organisations, whānau and groups. The latter are listed in the 2019 document, but there is no list of the other group of submitters (as far as I can see on the OFS web site). Ideas and recommendations from the submissions will be considered as the OFS develops the draft strategy for an ageing population. (It is not suggested that “Positive Ageing Strategy II” will be its title).

Major themes

Because many submissions covered several areas, the major themes were identified by the number of times the topic was mentioned. I am looking at the (10 ) main themes and, very briefly commenting on what seemed to be the main issues which submitters have raised.

Housing clearly was the dominant theme with 426 mentions. The main concerns were not enough housing options for older people and not enough appropriate housing. There were special mentions of issues for renters – in terms of insecurity and affordability. Declining home ownership rates were seen as a crucial trend. And there were some concerns about retirement villages.

Health came next, in terms of number of mentions – 386. The cost of services, especially those which do not attract subsidies for older people (dental, spectacles) led the list of concerns along with access to services and long waiting times. There were calls for free health checks and more preventive services. There was also concern about the quality of residential care and the availability of carers – what should be the role of family carers?

Third came Financial Security, with 323 mentions. There was a wide variety of mainly familiar concerns, mostly around NZ Superannuation – its adequacy in relation to a rising cost of living (should it be a Living Wage?). Should there be targeted add-on benefits for food etc.? Some submitters considered entitlement to NZS was unfair for people in particular circumstances – again well-rehearsed arguments. A newer point was a call to government to explore the availability of annuities.

Work
– both paid and unpaid – received 240 mentions, noting that this was linked to both financial security and health. There were calls for better valuing of older workers and volunteers. Points about the need to challenge stereotypes and ageing; about the provision of flexible hours and conditions and retraining for older people have frequently been raised (including in this blog). I liked the idea of the IRD providing special help for older people who are likely to have income from several sources.

Social connection and participation came next, with 213 mentions. This centered around loneliness, with calls for more community and intergenerational programmes; to remove barriers to life-long education. Spirituality came under this heading.

Transport came sixth, with 189 mentions. The common themes of affordability and access predominate, with special mention of the impact of losing driving ability. Safety came in here, especially for older people on footpaths. (Safety as a separate theme gained only 62 mentions, mainly regarding elder abuse, scams and crime generally).

Technology in relation to older people has not received a lot of attention, gaining 135 mentions. Technology has both benefits and negatives for older people, who may have limited capability and access in this area. Where agencies offer only on-line access to their services this can lead to deprivation and isolation.

Attitudes (122 mentions) was a feature of the original Positive Ageing Strategy. These include both public attitudes (including media depictions) which may be patronising or offensive and which should rather be steered towards value and respect for older people. But the attitudes of older people themselves may not always be positive. The important point is to recognise diversity, for example to value the role of kaumatua and older people from other cultures.

Ageing and retirement (80 mentions) is surprisingly low (to me) on this list. Submitters saw the concept of retirement as negative and out-of-date, as do I. But the comments mainly centred of planning for later life and the intention not to stop contributing. The emphasis should be on life stages and how they are changing.

I wonder if my readers found anything surprising about these results.


[1] The scope of a new strategy and governance theme was in the top 10 most mentioned themes, with 150 mentions. I have not covered this theme in my blog.

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Longevity – Actions for long life

Judith Davey

8/02/2019

Avoidance of Boredom
– Several studies have found a startling connection between chronic boredom and early death…… perhaps a literal demonstration of being “bored to death.” Following up a 25-year study in Britain, it was found that people who had said that they were bored in the original survey were 40% more likely to have died than those who had found their lives interesting. This could be a demonstration of the powerful connection between mind and body and what may happen if you believe that you have an optimistic outlook.

But, on the other hand, living longer of itself could lead to boredom.

Social Contacts – Keeping up our social contacts is very important as we age as it has been found that loneliness can be as much a health threat as smoking. This may be hard as friends and partners die and families become separated. However, there are organisations, including Age Concerns, which are working to reduce loneliness and promote social connectedness among older people.

Fasting – You may have heard of studies showing that dietary restriction, including intermittent fasting, may extend healthy lifespan and delay age-related diseases in species from yeast to mice to monkeys. But drastic changes in diet should not be undertaking without advice from health professionals.

Certainly, intermittent fasting – which does not mean starvation – slows bodily processes, clears the system of toxins and waste products, rests the vital organs and decreases the load on metabolic processes. Alternate-day (500 calories every other day) fasting interventions lasting six to eight weeks in human trials have been associated with lowered cholesterol and triglyceride levels in adults.

However, it is very difficult to study cell biomarkers in humans, especially because most people can’t or won’t participate in long-term intervention studies, especially related to fasting. Compared with most other creatures, humans live for a very long time. This makes it very difficult to run studies that measure the effect of anything on longevity. Scientists would have to wait 90 years to complete a study.

Vegetarianism – Combining data from several studies shows that a diet low in meat can be associated with greater longevity and that the longer a person sticks to a meat-free diet, the greater the benefit. But not all studies agree. Some show very little or even no difference in longevity between meat eaters and non-meat eaters.

There is some evidence that meat-free diets can reduce the risk of developing health problems such as diabetes, high blood pressure and even cancer. And vegan diets possibly offer added protection

Finding a link between two things – such as eating meat and an early death – doesn’t necessarily mean one thing caused the other. Vegetarianism and longevity maybe related but a different variable may explain the link. It could be that vegetarians tend to be the “health-conscious” people who exercise more, watch their weight, smoke less and drink less alcohol than their meat-eating counterparts. Overall healthier lifestyle patterns may be the crucial factor.

Taoism – is perhaps the world’s most established philosophy on longevity. Ancient Taoist masters devised techniques to attain immortality. The philosophy is based on achieving harmony with nature and the universe; detachment from ordinary reality; relaxing body and mind to allow vital forces of nature to take over. Thus our own “chi” – vital breath – can be combined with that of the universe. In more practical terms this involves breathing exercises, along with the use of herbs, and there are links with Tai Chi and Kung Fu. This will help the circulation and bodily functions.

While actual length of life relies on factors beyond one’s control, Tao suggests actions aimed at yang sheng, i.e. nurturing of life, allowing your body and mind to function at their best. Moderation is the key, which brings peace of mind and the state of balance – essential to a healthy and long life.

Laughter – is the best medicine, they say and there is some scientific evident behind this. In one study cancer patients were many times more likely to survive if they managed to maintain their sense of humour. Hearty laughter can be a form of physical exercise – “a form of internal jogging”. It exercises the vital organs, clears the respiratory system, decreases arterial stiffness, increase pain tolerance, reduces depression, relaxes the body and reduces stress.

We hear about humour therapy and laughter workshops, combined with exercises, such as yoga. It has long been accepted that low mood and depression can have a negative effect on physical health. How laughter and humour can have a positive effect on longevity is not clear, but they help to lower levels of the stress hormone cortisol and promote the release of endorphins, that help control pain. And there are physical effects of laughter, including increased breathing, more oxygen use, and higher heart rates.

Other studies have shown reduced risk of death among people with high “humour scores”, especially for women. The gender differences could be due to a slight decline in humour scores as men age. Do women keep their sense of humour longer?

Overall, it is no wonder we feel better with a good laugh.

Sleep – in sleep the body disposes of waste products, generate antibodies and hormones and reduces pressure on the heart. Animals which hibernate live longer than those with a similar genetic make-up. Using up energy reduces the lifespan. But this correlation is not a simple one.

It has been found that mortality is higher among those who sleep very long hours, or very short hours. A large-scale research project found that people sleeping for longer than eight hours a night had a 30% increased risk. People sleeping six or less hours had only a 12% increased risk. What is cause and what effect? The underlying reasons for poor sleep patterns and their possible relation to physiological changes in the body need examination.

People need different amounts of sleep, and this can be influenced by age, lifestyle, diet and environment. So, it may not be sleep which is to blame, but underlying conditions which affect sleep. Professor Horne from the Loughborough Sleep Research Centre: “Sleep is just a litmus paper for physical and mental health.”

Names – A statistical relationship has been reported between names and life expectancy. Research in the UK and USA showed that people whose last names began S to Z died 12 years earlier than the national average. Could they be victims of “alphabet neurosis” caused being at end of every alphabetical line?

Several studies have also reported that people with uncommon first names are perceived to be less intelligent, attractive, and likable than are people with more popular names. This leads to the possibility that social stigmatisation may affect life expectancy. If names are associated with low self-esteem, names may also be associated with conditions that can affect life expectancy.

Another study reported that life expectancy was related to a person’s 3-letter initials. Specifically, people with positive initials (such as ACE or WIN) lived much longer than do people with negative initials (such as PIG or DIE).

Can we believe this? Could it be that any effects of names on longevity are related to ethnic, religious, cultural, and socioeconomic factors that are correlated to name choices?

It is hard to pinpoint actions which definitely prolong life, they include some which are clearly out of “left field” like this last one (1) .

 


(1) My selection of items for this series of blogs came from a book I picked up at a sale a few years ago – “The Complete Book of Longevity” by Rita Aero. Perigee Publishers, New York, 1980.

 

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What food items are linked to longevity?

Judith Davey

25/01/2019

Healthy eating is clearly an important consideration as we age, bearing in mind changes in nutritional requirements.

Garlic – is one of the most common cooking ingredients around the world. Many dishes in Europe, Africa, Asia and the Americas use this strong-flavoured vegetable, which is similar to other bulb-shaped plants, including onions, chives and leeks and scallions. Garlic in ancient India was known in Sanskrit as a heal-all and “slayer of monsters”. In Europe it was considered to be proof against the plague.

Its only side-effect is its characteristic odour which permeates the whole body and can last for days. Garlic creates a gas called hydrogen sulphide, which is toxic and flammable. and smells like rotten eggs. But it does an important job in our bodies. relaxing blood vessels and allowing more oxygen to travel to the body’s organs. It lowers high blood pressure and protects the body against cardiovascular disease. Garlic is also considered effective for boosting the immune system, reducing inflammation and infections and even repelling mosquitos. German health authorities have approved garlic as a defence against atherosclerosis and high cholesterol levels. Some researchers in China have gone so far as to call hydrogen sulphide the key to a longer life.

However, it is suggested that you may have to eat a lot of raw garlic to experience its benefits, as much as 10 cloves a day—a prospect that may drive your friends away.

Ginseng – is the oldest traditional longevity tonic, with a history going back 4,000 years. The shape of the root, reminiscent of human form, is taken as a sign from the gods that it is a tonic and rejuvenator. There have been studies that asked whether ginseng might increase life span in mice, and these were negative. (The internet commentator wryly suggested that if the gods had intended ginseng for mice, the root would be shaped like a mouse!)

Ginseng is seen as a builder of “chi” (vital energy) in the human body. Hundreds of studies show that ginseng is great for the heart, regulates cholesterol and blood sugar levels and lowers blood pressure. It also can increase energy levels and enhance the immune system. Ginseng also increases blood flow to the brain, which can lead to an improvement in cognitive function. There is also good support for cancer prevention. These attributes will help alleviate the maladies of old age and could therefore increase longevity.

Honey – honey harvesting is depicted in Stone Age rock art pictures. It was used by athletes in ancient Greece and by ancient Britons in their mead. The Israelites were promised a land flowing with milk and honey.

Honey has long been considered a superfood, used to treat many maladies and to boost overall health. It has incredible antibacterial, antifungal, antiseptic, anti-oxidant and anti-bacterial qualities which help to improve digestion and ward off common diseases. Honey eliminates free radicals in the body and has been shown to support new tissue growth. It even protects and rejuvenates the skin – a good point for the ageing. Honey is a potential cancer therapeutic agent to complement other treatments. The anti-bacterial action of our own Manuka honey has been used to assist healing after surgery.

What could be better than something which tastes good and may lead to a long life?

Kelp – a seaweed which is one of the most nutrient-dense vegetables on earth. It is a staple in in Japanese and Korean cuisines and the ancient Chinese considered it food for the gods. Kelp is found in near-shore ecosystems throughout the world.

It is a natural source of essential vitamins, minerals, and antioxidants and one of the best natural sources of iodine. Iodine deficiency can play a part in prostate disorders, thyroid conditions (goiter), autoimmune diseases, and diabetes. Research has shown that kelp can have cancer-fighting qualities. can aid people with diabetes and act as a powerful anti-inflammatory agent.

As if this was not enough, kelp also promotes hydration, strengthens the bones, helps to maintain a healthy skin and even protects against radiation poisoning.

There are some warnings about overconsumption of iodine. It may be difficult to get too much iodine in natural kelp – you would have to eat an awful lot of seaweed- but this could be an issue with supplements.

Yoghurt – is basically milk which has been fermented using bacterial cultures. It has been known as a food product for millennia, but it was not until the early 1900s that Ilya Mechnikov, a Russian Nobel Prize winner, linked yoghurt with longevity. After compiling data from 36 countries he found that more people lived to 100 in Bulgaria than any other and attributed this to the traditional food of home-made yoghurt. In central Asian yoghurt was often based on sheep or mares’ milk. Legend says that Genghis Khan fed his armies on the latter.

Later scientific studies proved that the bacteria in yoghurt help to maintain good health by protecting the body from toxins, infections, allergies and some types of cancer. Yogurt has a much higher concentration of protein, vitamins and minerals than milk. This makes it easier for the body to absorb such nutrients as calcium, zinc and magnesium. It is more easily digested by those with lactose intolerance.

Yogurt is a good source of nutrients but whether it has a cause and effect relationship with longevity remains to be substantively proved. Certainly, it can improve bone density which protects against hip fracture. It can be easily eaten by people who have difficulty chewing. Beneficial bacteria inside our digestive tract may help bodily functioning and immune response.

Now yoghurt is found in just about every supermarket around the world and huge claims are made by producers and retailers about its health benefits. Some may even be true.

So, what can we do to live long lives – that comes next.

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Where do people live the longest?

11/01/2019

Judith Davey

This sounds like a simple question and it is easy to find plenty of answers, many of them hard to reconcile with each other. The ranking tables of the countries with the highest life expectancy at birth in 2018 vary depending on when the data was derived and what is considered a “country”. For example, among the top ten in one list are tiny states or areas – Monaco, Singapore, Macau, San Marino, Andorra, Hong Kong and Guernsey. Some figures are adjusted for “healthy life expectancy” which estimates years of life in good health.

Some sources imply that all you have to do to live a long life is to move to one of the top places for life expectancy. A pretty naïve conclusion!

Tops for life expectancy at birth (years) appear to be:

1. Japan – 83.8
2. Italy – 83.5
3. Spain – 83.4
4. Switzerland – 83.2
5. Iceland – 82.9
6. France – 82.7
7. Singapore – 82.6

Australia comes 10 on this list at 82.5 years and New Zealand at 24 with 81.5.

But these are figures for average life expectancy at birth, for the total population. The picture is much more complicated than assuming that the average person in the particular country lives to that particular age. Life expectancy at birth is not based on how old the oldest citizens are but takes into account the number of people who die young. Life expectancy at birth reflects public health factors: water and air quality, traffic safety, hospital capacity, lifestyle factors such as smoking and so on.

Life expectancy can vary over time. It dropped in the Russian federation 1971 to 1994 and then rose again. In the USA it is dropping, due to “premature” deaths from factors such as drug use, suicide and crime.

Looking to the future, it is predicted that life expectancy in some Asian countries will overtake those in so-called “western” countries. Life expectancy at birth in China has overtaken that in the USA, and South Korea is likely to become the first country where life expectancy at birth will exceed 90 years, according to a Lancet study. This is probably down to overall improvements in economic status, health care and child nutrition.

So, what can we say about longevity? In these blogs I propose to get away from comparative statistics and look instead at Places, Foods and Actions which are or have been associated with long life.

Another way of looking at this is pinpointing areas which have large numbers of very old people. Four of these appear regularly in the literature:

Abkhazia – is in the Caucasus Mountains in southern Russia and is “partially” recognised as a state. There are some doubts about claims that people in this area are regularly living well over 100 years, in the absence of formal birth records. But the region certainly has high levels of physical and mental fitness among its older people and this has been known since the time of Ancient Greeks. It is a mountainous region, so the inhabitants regularly move up and down high altitudes in thin air. There is no one secret of longevity, but as well as regular exercise the local diet consists, on average, of less than 2000 calories a day, which is very low by “western” standards. It is composed of fresh raw vegetables, nuts and yoghurt. There is no alcohol or smoking and people never retire from work on the land and with their animals. The local older people appear to enjoy being old. It seems that the high quality of their personal relationships is another factor in their high level of wellbeing.

Hunza – is a remote and isolated valley in Pakistan-ruled Kashmir, at 7000 feet above sea-level. It was not well known by outsiders until the late 19th century although the inhabitants claim descent from lost soldiers of Alexander the Great (?). Its culture is unique, and it has been sometimes suggested to be the mythical Shangri-La. Here also there are reported to be large numbers of centenarians and “super-centenarians” (aged 110 plus). Like the Abkhazians, the people grow their own food, have a diet of raw fruit and vegetables, take regular exercise and enjoy good water and air. There is very little stress in their lives.

Vilcabamba – is an isolated area in the high Andes of southern Ecuador. Situated on the equator, the climate is balanced – mild and pleasant all year. The old people of Vilcabamba are certainly in good health and live long lives. They have a low calorie, low- fat diet, with fresh fruit and vegetables, good water and clean air. They work hard but have little stress and old people are valued and treated with respect.

You are beginning to see similarities between these regions, in environment and lifestyle, not to mention a social environment which is good for older people. Nevertheless, in the absence of scientific data it is difficult to be sure exactly how long people live.

Okinawa – an archipelago 360 miles to the south of Japan is different geographically, but it has the world’s highest prevalence of proven centenarians. Okinawan cuisine consists of green and yellow vegetables, fish, rice (smaller meal portions than in mainland Japan) as well as pork, soy and other legumes. Special local foods include the Satsuma sweet potato, the Okinawan bitter melon and seaweed, all low-calorie and known to be beneficial for health. Turmeric is also common in the Okinawan diet – noted throughout history, especially in South Asia for its health benefits, with antioxidant properties and anti-ageing properties

Next time I will look at some of the food items which may contribute to longevity.

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Loneliness – and the time of year

14/12/2018

Judith Davey

Loneliness and social isolation can threaten the wellbeing of older people. They are particularly vulnerable due to deteriorating physical health, the death of spouses, partners, and friends, being more likely to live alone, and difficulty in getting around. A wide range of health outcomes are associated with loneliness and social isolation including depression, cardiovascular disease, cognitive function and even mortality.

Data on Loneliness

Looking on the bright side – in the New Zealand General Social (GSS) Survey 2016 (the most recent published results) only 15% of people aged 65-74 and 16.5% of those aged 75 or older said that they had felt lonely some, most of all of the time, in previous four weeks. These were lower levels than for people under age 35. Looking at this more positively, 85% did not feel lonely . Perhaps these older people should think of ways to communicate with lonely teenagers this Christmas!

Much of what constitutes “Christmas”, in the popular view, is contact with friends and family. Here again, older people do not do too badly. In the 2016 GSS survey, 70% of people aged 65 plus had face-to-face contact with family and friends at least weekly; and 80% had non-face-to-face contact. This would mean telephone calls, email, video calls and other form of digital communication.

There has been a significant growth in non-face-to-face contact with friends in recent years, for all age groups, probably linked with digital device use. The figures decrease with age – 94% of respondents aged 15-24 said they had non-face-to-face contact with friends in 2016, and over 80% of the 25-44 age groups. The figures for older people were lower, but still significant, 71% for people 65-74 and 66% for those 75 and over.

Do people have enough contact?

People will vary in the amount of contact they need. There are the gregarious and the reclusive. In GSS 2012, 81% of people aged 65-74 said they had enough contact with family and 84% of those 75 plus. In the same survey, 87% of people aged 65-74 said they had enough contact with friends and 86% of those 75 plus. These figures were higher than for any other age group. So it seems that most older people are happy with the amount of contact they have.

Overall Life Satisfaction

Perhaps we can sum up the situation by looking at information on Overall Life Satisfaction. In every GSS survey since 2008 the percentages in the “very satisfied” category have increased for the older age groups and are higher than for younger people. In 2016-17 three out of every four people aged 65 plus indicated 8 or more on a scale there 0 is completely dissatisfied and 10 is completely satisfied.
But although this information suggests that the majority of older people in NZ do not describe themselves as lonely, have regular contact with family and friends and are satisfied with the extent of this contact, we must not forget the minority who suffer from social isolation and loneliness.

What can be done about it?

There are a variety of “interventions” designed to combat loneliness and social isolation among older people .

Social facilitation interventions are designed to promote social interaction on the basis of mutual benefit to participants. Many are group-based activities, such as friendship clubs, shared interest groups, and day care centres.

Psychological therapies may also be group activities facilitate by trained therapists. They involve cognitive and social support interventions – such as humour and reminiscence.

Health and social care provision activities often involve health and social care professionals and may take place either in the community or in residential care. The “Eden alternative” is an example of the latter.

Animal interventions. Pets can provide social support and companionship. Evaluations have shown that both a robotic dog and a living dog could help reduce loneliness, but there was a higher level of attachment to a living animal, as one would expect.

Befriending interventions. Age Concern’s Accredited Visitors scheme is an example, providing one-to-one support for lonely people, by volunteers. Telephone projects can also generate a sense of belonging and ‘knowing there’s a friend out there’

Leisure/skill development interventions. These can include gardening programmes (indoor gardening programmes for rest home residents), computer/internet use, holidays and sports. Productive activities (e.g. reading or engaging in hobbies) have been shown to reduce loneliness, while passive activities (such as watching TV or listening to radio) do not.

What makes interventions successful?

Three common characteristics of effective interventions to combat loneliness are –

• Being adapted to a local context;
• Having service users involved in their design and implementation;
• Involving productive engagement rather than passive activities.

But a key underlying factor will always be the individual’s own social network, which brings us back to the figures which I set out above.

All of this can come to the fore at a time of year when the joys of social interaction are emphasised (probably too much given all the commercial hype about Christmas which is being heaped upon us). As the Minister for Seniors says in her recent newsletter –

If you’re anything like me, you’ll now be looking forward to spending some time with your families, and I hope, having a relaxing Christmas.


[1] This does not mean that loneliness among younger people is of no concern.

[2] This information is not available for the last two GSS surveys.

[3] Clare Gardiner, Gideon Geldenhuys and Merryn Gott (2018) Interventions to reduce social isolation and loneliness among older people: an integrative review. Health and Social Care in the Community, Vol.26, 2, pages 147-157.

 

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What is loneliness and how can it be measured?

Judith Davey

30/11/2018

Loneliness as a social issue has come to the fore recently and much has been made of moves by governments to put it on the policy agenda. Prime Minister Theresa May’s announcement in January this year that a Minister for Loneliness had been appointed in Britain was seen as a significant step forward.

What has not been highlighted is that the said minister – Tracey Crouch – also held ministerial briefs for charities, social enterprise, sport, gambling and lotteries, which cannot have given her much time for her new responsibility. She resigned on November 1st and was replaced by Miriam (Mims) Davies on November 6th. The new minister also has multiple portfolios.

Getting back to the definition of loneliness. As I mentioned in an earlier blog (January 2015), loneliness and social isolation have been as associated by sociologists with living alone, with psychiatric disorder and antisocial behaviour. But this cannot be the whole story. Many people choose to live alone, and this can be a sign of individualism, independence, and/or wealth. It has become a viable lifestyle. Loneliness is something much more complex.

The upsurge of interest in loneliness in the 21st century can be related to social change – as well as growing numbers of people living alone, there is the fragmentation of families, population ageing, high workforce participation by women and the growth of Internet use, at home and at work.

Loneliness is an invisible condition. It cannot be observed or clinically assessed. Every person’s experience of loneliness is unique. People have to perceive themselves as lonely for it to be measured. Often it is not disclosed, because it is stigmatised in many cultures. As well as being difficult to define, it is hard to measure and may be intermittent.

Loneliness comes in many different forms and can arise from a mixture of social, cultural and situational factors. Living in a very competitive society can make under-achievers feel alienated and lonely. It is related to both close personal relationship and also integration into wider society. Both seem to be necessary to protect from loneliness.

There are mixed feelings about the effect that the Internet has on social relationships and hence loneliness. Is it a positive or a negative? It can encourage contacts but takes away face-to-face relationships. Internet links do not end with a handshake, a kiss or a hug.

No wonder being a Minister for Loneliness is a challenging job!

There have been many attempts to measure loneliness. The Campaign to End Loneliness, based in Britain, suggests four loneliness scales which can be used in community-based research, evaluating their strengths and weaknesses.

The UCLA Loneliness Scale
This was developed at the University of California. First published in 1978, it has been revised several times. The scale is widely used in the scientific literature, including New Zealand research (see Horizon Research data in my next blog).

There are 3 questions:

1. How often do you feel that you lack companionship?
2. How often do you feel left out?
3. How often do you feel isolated from others?

The scale generally uses three response categories: hardly ever / some of the time / often. The questions can be difficult to ask older people (I know from personal experience).

The De Jong Gierveld Loneliness Scale
This scale has been widely used in Europe and translated into several languages. It is designed for use with older people. Its six items cover emotional loneliness (missing intimate relationships) and social loneliness (missing a wider social network). The items are:

1. I experience a general sense of emptiness
2. I miss having people around me
3. I often feel rejected
4. There are plenty of people I can rely on when I have problems
5. There are many people I can trust completely
6. There are enough people I feel close to

The scale generally uses three response categories: yes/more or less/no. Or an agree/disagree scale.

Again, it doesn’t mention loneliness, but has tricky, negatively-worded and somewhat ambiguous propositions.

Single-item scales
These ask directly how lonely individuals feel. For example, they may ask:

Are you:
• Very lonely?
• Lonely at times?
• Never lonely?

The New Zealand General Social Survey (GSS) asks, “In the last four weeks, how much of the time have you felt lonely?” (There will be data from this in my next blog) The possible answers – on a show-card – are:

1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time

These scales go directly to the issue of interest and are easy to administer. But they may be too blunt and don’t pick up gradations of loneliness, or its duration.

The Campaign to End Loneliness Measurement Tool
The campaign’s own scale contains 3 statements:

1. I am content with my friendships and relationships
2. I have enough people I feel comfortable asking for help at any time
3. My relationships are as satisfying as I would want them to be.

It asks respondents to answer: strongly disagree/disagree/neutral/agree/strongly agree/don’t know.

This also doesn’t mention loneliness and is framed positively. It is a practical resource for use in face-to-face work with older people.

I welcome comments on these approaches to measuring loneliness.


Morrison, P.S. and Smith, R. (2018) Loneliness: An Overview. In Narratives of Loneliness. Sagan, O. and Miller, E.D. (Eds), Routledge, London and New York.

Posted in Risks-loneliness and social isolation, EAN, discrimination | 2 Comments