Loneliness

In just a few decades loneliness has escalated from a personal misfortune into a social epidemic.

Loneliness can affect anyone, at any age, in any circumstances.

It is damaging to both our physical and mental health.

It is crucial that all nurses, in every setting, recognise loneliness and have easy to access resources to offer the best advice.

Key insights around loneliness

• Loneliness is a subjective experience. It is not an issue that can be judged against objective measures, and there is no ‘one size fits all’ approach that will prevent everyone from feeling lonely.
• Because loneliness is stigmatised, people are often reluctant to admit to feeling lonely. Therefore tick-box approaches to referrals, in which people are simply asked whether or not they are lonely, are unlikely to be effective in identifying those most in need.
• Loneliness affects mental and physical health. The effect of loneliness and isolation can be as harmful to health as obesity or smoking 15 cigarettes a day lonely individuals are at higher risk of the onset of disability loneliness puts individuals at greater risk of cognitive decline.
• Long-term loneliness can damage our ability to relate to one another. People often need support to build their confidence and skills to engage with new activities, and may need someone to come along with them to groups and activities.
• The most lonely individuals may need significant one-to-one support before they are able to connect with wider groups and activities in the community.
• Some of the most lonely people are completely isolated from other people and services. People from particularly marginalised communities can be at significant risk of loneliness and may not be in contact with health services – so outreach will be needed.
• Tackling loneliness is therefore an important way of improving people’s overall health and wellbeing.
• Loneliness can be tackled in a range of ways. This includes supporting people to improve the quality of their existing relationships, working on their attitudes, expectations and skills around relationships, as well as providing new opportunities for social connection.

What are the effects of loneliness

• loneliness can have serious physical Implications including  
• high blood pressure
• high cholesterol
• obesity / poor nutrition
• vasoconstriction
• increased cortisol
• increased interluken
• increased inflammatory response
• prolonged, high cortisol levels can cause anxiety, depression, digestive problems, heart disease, sleep problems, and weight gain
• deficits in self-care and motivation, and shortfalls in nutrition, exercise and personal hygiene
• other groups of older people more at risk are those with chronic illnesses that undermine their energy and morale
• maintaining medication regimens, looking after hygiene, dealing with wounds, stomas and prosthetics may be much more difficult when patients ask, ‘Why am I bothering?’ or ‘Who is this all for?’ 

The hidden wound - how to identify loneliness

Nursing staff have unique opportunities for identifying loneliness. 

Assessing if someone is lonely is an essential part of a nursing assessment, social connectedness has positive health implications and it is important we promote it. There are a wide range of assessment tools to help you identify loneliness but as a start one direct question should be asked:

How often do you feel lonely?

• often or always
• some of the time
• occasionally
• hardly ever
• never.

What helps people to over come loneliness

The evidence is not one solution that suits everyone. Interventions need to be individual and people often need help accessing opportunities.

Activities to consider include:

• helping people understand that initiating and maintaining social connectedness are important to health
• ensuring people have transport
• ensuring people have money
• helping them access Social Media and new technologies
• have friends and links with people all ages
• encourage people to be engaged and accommodating
• ensure vision and hearing are assessed regularly
• help people acknowledge the changes that are occurring in their lives
• consider pets and virtual companions
• help individuals volunteer and share their talents and skills.