Health and Loneliness in Later Life

1. Health and Loneliness in Later Life
Vanessa Burholt
Centre for Innovative Ageing, Swansea University @ProfNessCIA
IPH and Bamford Centre for Mental Health & Wellbeing, Ulster
Loneliness & Ageing: A Public Health Issue
Clayton Hotel, BELFAST
6 December 2016

2. Overview of the biomedical approaches to health and loneliness
Alternative views of the association between health and loneliness:
enviropsychosocial factors
 Cognitive impairment
 Rural and deprived communities
 Depressive symptoms
Limitations of our knowledge: discrimination and culture
 Minority ethnic groups
 LGBT elders
Implications for future research
Implications for age friendly / dementia supportive communities

3. Some research focuses on negative health consequences of
loneliness
vascular hypothesis
stress hypothesis
cognitive reserve

4. Some research focuses on negative health consequences of
loneliness
vascular hypothesis

5. Some research focuses on negative health consequences of
loneliness
stress hypothesis

6. 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
Individual responsibility?
Structural barriers?

7. Large scale, nationally representative study of older people
in Wales (Gwynedd and Neath Port Talbot)
Predominantly white British sample
Face-to-face interviews with 3593 people age 65+ years

8. +
PREDISPOSING
FACTORS
SOCIO-CULTURAL &
SOCIAL STRUCTURAL CONTEXT +
PRECIPITATING
EVENTS
NEEDED OR DESIRED
SOCIAL RELATIONS
ACTUAL SOCIAL
RELATIONS
MISMATCH OF NEEDED
VS. ACTUAL SOCIAL
RELATIONS
COGNITION AND
ATTRIBUTIONS
EXPERIENCE OF
LONELINESS
Age
Marital
status
Gender
Education
Area
deprivation
Community
or care
setting
Health:
Townsend
disability
score (mediator)
Social resources:
Lubben Social Network Scale
Loneliness:
De Jong
Gierveld
Short
loneliness
Scale
(moderator)
MMSE:
Cognitive impairment

10. LONELINESS
SOCIAL
RESOURCES
-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
* p<.05 ** p<.01 ***p<.001
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

11. Cognitive
impairment
Amplifying difficulties
because of additional
social structural and
socio-cultural barriers

13. 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***
• p<.05 ** p<.01 ***p<.001
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

14. Cognitive
impairment
2. Anosognosia:
unrealistic positive
expectation of
social contact
1. Internalize negative
stereotypes in
social comparison

15. 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***
• p<.05 ** p<.01 ***p<.001
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

17. +
PREDISPOSING
FACTORS
ENVIRONMENTAL
CONTEXT +
PRECIPITATING
EVENTS
NEEDED OR DESIRED
SOCIAL RELATIONS
ACTUAL SOCIAL
RELATIONS
MISMATCH OF NEEDED
VS. ACTUAL SOCIAL
RELATIONS
COGNITION AND
ATTRIBUTIONS
EXPERIENCE OF
LONELINESS
Age
Marital
status
Gender
Education
Area
deprivation
Community
or care
setting
Health:
Townsend
disability
score (mediators)
Social resources:
Lubben Social Network Scale
Social participation: breadth of
participation in group activities
Loneliness:
De Jong
Gierveld
Short
loneliness
Scale

19. LONELINESS
SOCIAL
PARTICIPATION
-0.11*** -0.06***
0.11***DISABILITY
EDUCATION
MARITAL
STATUS
CARE
SETTING
GENDERAGE

20. Environment
Or

21. Environment
Or

22. MARITAL
STATUS
-0.17*
EDUCATION
0.60**
-2.31*
-0.87***
0.19***
SOCIAL RESOURCES
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
Social resources mediating the relationship between
disability and loneliness, and environmental factors
(deprivation and rural/urban status) moderating a
and c paths
AGE
GENDER
CARE
SETTING
-0.09*** -0.01***
-0.02
0.02**
-0.27***
0.10

24. -0.16
EDUCATION
-0.04
-0.30
-0.28***
0.05***
SOCIAL
PARTICIPATION
LONELINESS
0.08*
DISABILITY
DEPRIVED
ENVIRONMENT
DISABILITY X
DEPRIVED
ENVIRONMENT
-0.07*
0.05
0.00
0.00
-0.00
0.00*
RURAL/URBAN
ENVIRONMENT
DISABILITY X
RURAL/URBAN
ENVIRONMENT
-0.07
0.00 Social participation mediating the relationship
between disability and loneliness, and
environmental factors (deprivation and rural/urban
status) moderating a and c paths
AGE
GENDER
CARE
SETTING
0.00 -0.01
0.02
0.01
-0.31***
0.24
MARITAL
STATUS

26. Large scale, nationally representative study of people
aged 50 and over in Ireland
Predominantly white Irish sample
Face-to-face interviews with 8178 people age 50+ years
(and 329 with participants <50 years)
7191 self-completion questionnaires returned
Presentation uses data for N=6613 with no missing data

27. +
PREDISPOSING
FACTORS
ENVIRONMENTAL
CONTEXT +
PRECIPITATING
EVENTS
NEEDED OR DESIRED
SOCIAL RELATIONS
ACTUAL SOCIAL
RELATIONS
MISMATCH OF NEEDED
VS. ACTUAL SOCIAL
RELATIONS
COGNITION AND
ATTRIBUTIONS
EXPERIENCE OF
LONELINESS
Age
Marital
status
Gender
Education
Health: #
chronic
condition
(mediators)
Social resources:
Berkman-Syme Social Network
Index
Social participation: breadth of
participation in group activities
Loneliness:
UCLA 3-item
Loneliness
Scale
(moderator)
CES-D:
Depressive symptoms

28. More likely to hold
dysfunctional beliefs
and negatively process
personal information
Less likely to alter their
benchmark for ‘desired’
social relations
Depressive
symptoms

29. More likely to hold
dysfunctional beliefs
and negatively process
personal information
Less likely to alter their
benchmark for ‘desired’
social relations
Depressive
symptoms

30. Age
Marital Status
Gender
Education
-0.092*** -0.037***0.076***
Social Participation
Social Resources
Loneliness
Depressive Symptoms
Social Participation x
Depressive Symptoms
Social Resources 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. Doi: 10.1093/geronb/gbt121

31. Migration is particularly important to the study of loneliness
Increased geographical distance between kin and non-kin
Language barriers may hamper the development of
satisfying social relationships
Studies have accounted for length of residence, language
and ethnic background - they have not addressed the role
that cultural values and norms play in the judgements
concerning the adequacy of social relationships and the
experience of loneliness.

32. 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. 2016. Social Support Networks of Older Migrants in England and Wales: The Role of Collectivist Culture.
Ageing & Society (in press)

33. Sub-populations of older people may differ from the
majority population in terms of discrimination/prejudice that
has hampered social relations
For many older people, being gay was illegal earlier in their
lives and may have hindered social opportunities with
family and friends
Institutionalized racism and heteronormativity in care
settings (e.g. ‘white’ British and heterosexualised spaces)
in which ethnic and LGB identities are neglected in
comparison to the needs and preferences of other
patients/residents/older people

34. Cognitive impairment has an impact on social
resources and impacts on older people regardless
of the level of disability
Cognitive impairment amplifies the influence of
social resources on loneliness, because of
internalization of negative portrayal of people with
dementia and cognitive impairment or
anasognosia.
Greater levels of disability (in CFAS) or number of chronic conditions
(TILDA) can be considered as a precipitating event which leads to a
decrease in achieved levels of social interaction and social participation,
ultimately impacting on loneliness

35. Environmental deprivation has an impact on
social participation, but this impacts on all older
people regardless of the level of disability
Rural/urban areas impact on loneliness: urban
areas amplify the effect of disability at appreciable
and severe levels of incapacity, but not by
influencing levels of social resources or social
participation.
Expectations concerning contact with family and
friends, and social participation (based on life time
experiences) may be greater in urban areas than
in rural areas

36. Depression is a ‘cognitive process’ that moderates
how intensely people react to their personal levels
of social contact and support, and their functional
ability to participate fully in society.
Adjusting one’s expectations regarding quantity
and quality of social contact - desired social
relations - in light of one’s physical ability to
maintain social ties is more difficult to achieve for
those with depression.

37. Increasing social contact is often considered the ‘cure’ for loneliness.
Provision of more opportunities for older people with cognitive
impairment to maintain or develop social relationships
Positivity toward people with cognitive impairment in attitudes, beliefs,
communication and behaviors.
Provision of more opportunities for older people to participate in social
groups in deprived areas
Older people with depressive symptoms may need to make
psychological adjustments concerning desired level of social relations
by changing patterns of thinking as well as patterns of behavior.
DIVERSE PATHWAYS INTO LONELINESS REQUIRE FLEXIBLE
PERSONALISED INTERVENTION RESPONSES: COMPLEX
INTERVENTIONS