8 JCN

With Christmas approaching, we are inundated by charity

appeals from all sorts of good causes such as Age Concern, The Salvation Army, Shelter, etc. While donation of funds are essential to these charitable organisations to continue their valuable work, it makes you think about just how communities are being supported by charitable organisations across the UK.

The population of the UK are living longer; with developments in public health and medical advances, the proportion of people living to 90 years and beyond is increasing (referred to as the ‘very old’ by the Office for National Statistics [ONS], 2016). While many remain independent, 82% aged 85 or more have more than one long-term health condition (UCL Partners et al, 2014), and, as a result, are high users of health services.

Community health services are often frontline when it comes to identifying people who are vulnerable and lonely, those who are bereaved and those with disabilities or living in poverty. It can be argued that they are best placed to identify and work with those who suffer loneliness and social isolation (Landeiro, 2016). It is estimated that among those aged over 65, between 5% and 16% report loneliness and 12% feel isolated (Social care institute for excellence [SCIE], 2012). Thus, it is important that community nurses ensure that they have an updated working knowledge of what interventions are available in

The impact of cold weather and loneliness on our elderly

Community matters

their local area to enable holistic interventions for their clients (Drury, 2014).

The media has reported that NHS trusts continue to have ‘serious operational pressures’, meaning that they are at risk of being unable to provide comprehensive care. Bed occupancy has been as high as 95.3%, resulting in some closures of accident and emergency departments (Campbell, 2017). This leads to a discussion of delayed discharges. One group of people in society is often ‘blamed’ for this — ‘the elderly’. This increases the pressure on community and emergency services to ensure that elderly patients are cared for at home for as long as possible.

The press reported that, ‘Over the second quarter of the year there were around 168,000 delayed

discharges, accounting for 5% of NHS beds’. A lack of social care, i.e. support to help patients return home or move to a care home or other setting, was a key reason for the target being missed (Campbell, 2017).

Interestingly, the risk of mortality from loneliness can be greater than the mortality rate of obesity, and equal to mortality rates seen from smoking fifteen cigarettes per day (Holt-Lunstad et al, 2010). Older individuals who have been identified as being lonely or isolated are associated with cognitive decline and mental health conditions, such as depression, dementia and Alzheimer’s disease (Alzheimer’s Society, 2015; Burton-Shepherd, 2015; Landeiro et al, 2017; Scammel 2017). Loneliness is linked with deficits in self-care and motivation, and shortfalls in nutrition, exercise and personal

Annette BadesDistrict nursing specialist practitioner, Lancashire Care NHS Foundation Trust

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Older people value today what they valued yesterday, that is: independence; life roles; connections with family, friends and communities; fun; challenges … What needs to be recognised is not the ‘oldness’ of a person, but their individuality.

TYPES OF SUPPORT AVAILABLE

GROUP SERVICES

The experience of loneliness has profound implications for health and well-being: ‘Loneliness disrupts the clarity and structure of the self, which, in turn, disrupts people’s mental health’ (Richman et al, 2016: 546). It is also a factor which research suggests increases vulnerability to scam involvement (see in this issue),

impacting on the financial well-being of individuals and wider society. Social isolation and loneliness is a global issue, resulting in a lack of social engagement and belonging (Chen et al, 2014). Research indicates that 200,000 older people (65+) have not had a conversation with friends or family for a month, and 1.2 million older people (65+) are persistently/chronically lonely (Age UK, 2016)

There are many creative community-led approaches to tackling loneliness to be found around the UK (see Campaign to End Loneliness and Age UK websites, for examples), and locally, in Bournemouth, we recently organised a day which brought together local and UK-wide organisations and members of the public to exchange knowledge and information. A highlight was when we were joined by the Caring Canines (and their humans), which demonstrated the value of companionship from all sources. A ‘show and tell’ session where attendees shared details of their projects and experience was both moving and informative (see www.ncpqsw.com for photos and details of the various projects).

Events like these are invaluable for not only highlighting the issue of loneliness, but also communicating creative solutions.

Sally Lee

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Community matters

warm and well this winter. Cold temperatures can be dangerous to older people’s health, as they increase the likelihood and severity of flu, chest infections and other respiratory problems. Although, contrary to public belief, about half (41%) of all excess winter deaths are due to heart attack and strokes (Age UK, 2013; Claeys, 2013; Grey et al, 2017).

There are a number of reasons for cold-related illnesses and mortality from poorly insulated homes to sustained low indoor temperatures (Grey et al, 2017). Living room temperatures should ideally be kept at 70°F (21°C) and above, whereas bedroom temperatures should be kept at a minimum of 64°F (18°C) (World Health Organization [WHO], 2003). However, Age UK’s (2013) research shows that over 80% of older people didn’t know the ideal living room and bedroom temperatures.

During the ‘Spread the Warmth’ campaign, Age UK and its local and national partners are working hard to help older people keep warm and well throughout the winter in a number of ways, including winter benefit checks and handyperson services. They are providing hot nutritious meals at local lunch clubs, as well as home visits and friendly telephone calls through befriending services for those who may feel isolated.

Contact the Elderly is an example of a social group scheme. This national charity organises free monthly Sunday afternoon tea parties for small groups of older people aged 75 and above, who live alone without nearby family and friends, in local communities across England, Scotland and Wales. The network of friendship groups continues to grow through increasing volunteer numbers and partnerships with statutory and other voluntary organisations.

Case study of using social group services When Pauline’s husband died, she fell into a downward spiral of depression. They had been married JCN

for 46 years and went everywhere together. With no other friends or family to spend time with, Pauline was left with an empty void she could not fill. She remained isolated in her home for two years; ‘After Geoff died I felt that I didn’t want to live anymore and fell into a rut, not wanting to go out’. Pauline spotted an advert for Contact the Elderly in her local paper and decided to apply to become a guest. She spoke to a staff member who explained how the group worked and he arranged for a volunteer to pick her up for her first tea party a couple of weeks later. When the Sunday afternoon arrived, however, Pauline was nervous and unsure about leaving her home. She found the courage to go and ‘has never looked back’ since. The group setting has enabled her to widen her social circle and form new friendships. Pauline said, ‘Contact the Elderly has changed my life. I feel like I have a whole new set of friends to talk to. It’s wonderful.’

OTHER LOCAL SUPPORT

This winter, some local trusts, supported by Age UK, are providing free winter warm packs for older people that contain fleecy blankets, thermal socks, thermal cups, a hot water bottle, room thermometer and soup packets.

Loneliness and social isolation are highly complex personal issues. To this end, to promote excellence in patient care, it is important that nurses and healthcare professionals tailor any interventions to suit individual circumstances.

The impact of loneliness and social isolation on an individual’s health and wellbeing has cost implications for health and social care services. Awareness of what local voluntary organisations have to offer can help alleviate loneliness and improve the quality of life of older people, reducing dependence on more costly services. It is important that nurses and healthcare professionals work together with local support groups in getting the right help to those most in need.

REFERENCES AND FURTHER READING

Age UK (2011) Safeguarding the Convoy. A Call for action from the Campaign to End Loneliness. Available online: http://bit.ly/1jQsc6o (accessed 21 November, 2017)

Age UK (2013) Available online: www.ageuk.org.uk/latest-press/archive/over-3-million-older-people-are-concerned-

Community nurses are in a unique position to identify clients and patients at risk of loneliness, and to work in partnership with other organisations to influence the development and delivery of services that help to address loneliness in their local communities, and beyond. In Scotland, the Reshaping Care for Older People programme has a range of initiatives to identify the best way to support older people and their carers. Age Scotland has also recognised the social isolation of older people, particularly at Christmas, and is campaigning for a coordinated approach across organisations that work with older people.

Anne WilliamsLecturer in nursing/lymphoedema consultant nurse, Queen Margaret University, Edinburgh

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about-staying-warm-in-their-own-home-this-winter/

Age UK (2016) Later Life in the United Kingdom: October 2016. Age UK, London. Available online: www.ageuk.org.uk/Documents/EN-GB/Factsheets/Later_Life_UK_factsheet.pdf?dtrk=true

Alzheimer’s Society (2015) Facts on dementia. Available online: http://bit.ly/1o2Pced (accessed 21 November, 2017)

BBC News (2015) Flu and freezing weather may be driving up winter death rates. Available online: www.nhs.uk/news/medical-practice/flu-and-freezing-weather-may-be-driving-up-winter-death-rates/#what-were-the-figures (Accessed 21 November 2017)

Burton-Shepherd A (2015) Face in the crowd: loneliness and isolation in older people. Nurs Residential Care 17(12): 698–701

Campbell D (2017) NHS faces even worse winter crisis than last year, watchdog warns. Guardian, 16 November. Available online: www.theguardian.com/society/2017/nov/16/nhs-faces-even-worse-winter-crisis-than-last-year-watchdog-warns (accessed 21 November, 2017)

Centre for Policy on Ageing (2015) Depression and older people. Available online: http:// bit.ly/1M0xKrG (accessed 21 November, 2017)

Chen Y, Hicks A, While AE (2014) Loneliness and social support of older people in China: a systematic literature review. Health Soc Care Community 22(2): 113–23

Claeys P (2013) Cold weather produces more heart attacks. Available online: www.escardio.org/The-ESC/Press-Office/Press-releases/Cold-weather-produces-more-heart-attacks (accessed 22 November, 2017)

Drury R (2014) Social isolation and loneliness in the elderly: An exploration of some of the issues. Br J Community Nurs 19(3): 125–8

Greaves CJ, Farbus L (2006) Effects of creative and social activity on the health and well-being of socially isolated older people: outcomes from a multi-method observational study. J R Soc Promot Health 126(3): 133–42

Grey C, Schmeider-gaite T, Jiang S, et al (2017) Cold homes, fuel poverty

and energy efficiency improvements: A longitudinal focus group approach. Indoor and Built Environment Research. Available online: www.nea.org.uk/wp-content/uploads/2017/05/Cardiff-Uni-study.pdf (accessed 22 November, 2017)

Harrison P (2012) Loneliness increases dementia risk among the elderly. A report from the AMSTEL Study. Available online: http://wb.md/1KjAMzV (accessed 21 November, 2017)

Holt-Lunstad J, Smith T, Layton JB (2010) Social relationships and mortality risks: A meta analytic review: PLOS Med. Available online: http://bit. ly/1yYtZY2 (accessed 21 November, 2017)

Hunt L (2016) Working together. Nurs Older People 28(10): 20

Landeiro F, Barrows P, Musson EN, Gray AM, Leal J (2017) Reducing social isolation and loneliness in older people: a systematic review protocol. BMJ Open. Available online: http://bmjopen.bmj.com/content/7/5/e013778

Landeiro F, Leal J, Gray AM (2016) The impact of social isolation on delayed hospital discharges of older hip fracture patients and associated costs. Osteoporosis Int 27(2): 737–45

Marshall S, Crampton J (2015) Making connections — reducing loneliness and encouraging well-being. Working With Older People 19(4): 182–7

Nicholson NR (2012) A review of social isolation: an important but under assessed condition in older adults. J Prim Prev 33: 137–52

Office for National Statistics (2016) Estimates of the very old (including centenarians), UK: 2002 to 2015. Available online: http:// tinyurl.com/gl3fonh

Pitkala KH, Routasolo P, Kautiainen H, Tilvis RS (2009) Effects of psychosocial group rehabilitation on health, use of health care services, and mortality of older persons suffering from loneliness: a randomised, controlled trial. J Gerontol: Med Sci 64A(7): 792–800

Price B (2015) Approaches to counter loneliness and social isolation. Nurs Older People 27(7): 31–9

Richman SB, Pond Jr, RS, Dewall CN, et al (2016) An unclear self leads to poor mental health: self-concept confusion mediates the association of loneliness with depression. J Soc Clin Psychol 35(7): 525–50

Scammell J (2017) Older people and health care: challenging assumptions. Br J Nurs 26(3): 177

Social Care Institute for Excellence (2012)Available online: www.scie.org.uk/publications/ataglance/ataglance60.asp (accessed 21st November, 2017)

UCL Partners, National Voices, Age UK (2014) I’m Still Me: A Narrative for Coordinated Support for Older People. Available online: http://tinyurl.com/j5tdkr6 (accessed 25 January, 2017)

World Health Organization (2003) Extreme Weather Events: Health Effects and Public Health Measures. Fact Sheet No. EURO/04/03, WHO, Geneva

Find out more...Age UK offers information and advice 365 days a year and older people and their families can call on 0800 169 65 65, where they can also order a free copy of Age UK’s ‘Winter Wrapped Up’ guide with a free thermometer.

Independent Age have a free advice guide called ‘If you’re feeling lonely’, which provides information for older people on topics such as how to recognise why they might feel lonely, how to help themselves and the opportunities to look out for. It’s free to order and download from independentage.org/lonely-guide, or can be ordered by calling 0800 319 6789. Other useful free guides include ‘Dealing with depression’ and ‘Coping with bereavement’, which are also available via the website or helpline.

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