1. Campaign to End Loneliness Seminar December 2013 Loneliness in later life: analysis of the English Longitudinal Study of Ageing Christina Victor, Brunel University christina.victor@brunel.ac.uk

2. Overview of presentation Project introduction Definitions & data Expectations of loneliness Prevalence of loneliness Who is vulnerable to loneliness? Loneliness: a fluid concept? Campaign to End Loneliness Seminar December 2013

3. Project details Project title:Loneliness in later life: a longitudinal analysis using the English Longitudinal Study of Ageing Funder: Economic and Social Research Council –grant reference: ES/K004077/1 Co-Investigator:Prof Ann Bowling Research fellow: Dr Jitka Pitkahova Partner: Campaign to End Loneliness Duration: April 2013 –October 2014 Campaign to End Loneliness Seminar December 2013

4. Project research questions To understand longitudinal changes in loneliness for those aged 50+ by addressing 3 substantive research questions:  How does loneliness status change over a 10 year period?  What factors are associated with changes to feelings of loneliness over this time?  Does loneliness predict health outcomes over a 10 year period? Campaign to End Loneliness Seminar December 2013

5. What is loneliness? Loneliness: the difference between desired and actual social relations (Perlman & Pelau, 1981)- either in quantity or quality of relationships (or both)-perhaps also the mode of relationships Living alone Being alone IsolationSolitude Loneliness-emotional, social, existential Language... has created the word "loneliness" to express the pain of being alone. And it has created the word "solitude" to express the glory of being alone.” - Paul Tillich Campaign to End Loneliness Seminar December 2013

6. Data Secondary analysis – English Longitudinal Study of Ageing (ELSA) ELSA started in 2002 and is a longitudinal study of people aged 50+ The study is repeated every 2 years (waves 1 to 5 available) Modelled on Health & Retirement survey in the USA Includes bio-medical, health, psychological and social questions about ageing and later life Campaign to End Loneliness Seminar December 2013

7. Measuring loneliness? Can we measure loneliness? I think it’s a very difficult thing to quantify, ….And I think perhaps it is something which you can’t quantify because it is something which is within oneself perhaps, one’s outlook on life. (F aged 67 married) Can we measure it if we can’t talk about it? Some argue that language can never convey all that is intended, by words such as loneliness “even if the other manages to visit for a moment, he can never stay” (Mijuskovic, 2012, p67). Campaign to End Loneliness Seminar December 2013

8. Measuring loneliness MEASURES OF LONELINESSw1w2w3w4w5 Have you felt lonely much of the time during past week? (Y/N) +++++ I often feel lonely living in this area (7-point Likert scale) ++ UCLA loneliness scale (3-item form ) (3-point Likert scale) ++++ How often do you feel lonely? (3-point Likert scale) +++ I expect to grow lonelier as get older (5 point Likert scale) + Old age is a time of loneliness(5 point Likert scale) + Campaign to End Loneliness Seminar December 2013

9. Characterising loneliness Loneliness an opportunity for personal growth Loneliness as pathological – Associated with high levels of stigma, stereotyping & ‘othering’ of older people as excluded from society – Seen as being a key problem of ‘old age’ Campaign to End Loneliness Seminar December 2013

10. This is not new... ‘’A distressing feature of old age is loneliness. All who have done welfare work among the old have found it the most common, if at the same time the most imponderable, of the ills from which the aged suffer, and its frequency was amply confirmed by our study’’ (Rowntree, 1947,52) Campaign to End Loneliness Seminar December 2013

11. Why are we interested in loneliness? “Social relationships, or the relative lack thereof, constitute a major risk factor for health— rivaling the effect of well established health risk factors such as cigarette smoking, blood pressure, blood lipids, obesity and physical activity” House, Landis, & Umberson; Science 1988 “Being isolated shortens life and increases disability. It is equivalent to 15 cigarettes a day.” Duncan Selbie, Chief Executive of Public Health England Campaign to End Loneliness Seminar December 2013

12. Beliefs & expectations % agreeing old age is a time of loneliness % expecting to get more lonely with age Source: ELSA Wave 2 analysis Campaign to End Loneliness Seminar December 2013

13. Loneliness: a self fulfilling prophesy? & % of those who are lonely by expectation of loneliness in old age % lonely by expectation of loneliness Campaign to End Loneliness Seminar December 2013

14. Prevalence of loneliness Campaign to End Loneliness Seminar December 2013 Source: Victor & Yang, 2012

15. Prevalence of loneliness Campaign to End Loneliness Seminar December 2013 LONELINESS Males <65 years Females < 65 years Males > 85 years Females > 85 years Low score (3/4) 74%68%57%48% Medium score (5/6/7) 24%28%37%42% High score (8/9) 3 %4%5 %10%

16. ‘Risk factors’ for loneliness Large number of risk factors for loneliness – focus on vulnerability, NOT protective factors Vulnerability = widowhood, time alone, expectations of health in old age, psychological ill health, perceived health, perceived increase in loneliness Protective = increased age, education Note: the presence of a risk factor does not guarantee loneliness, for example 40% of those widowed in ELSA become lonely but 60% do not Pets not the answer! Campaign to End Loneliness Seminar December 2013 Interpersonal Engagement Life Stage Events Wider Social Structures Social Environment Intrapersonal Factors

17. Loneliness across Europe Campaign to End Loneliness Seminar December 2013 2004 2011

18. Campaign to End Loneliness Seminar December 2013 Loneliness and ethnicity % lonely

19. Longitudinal changes in loneliness? Campaign to End Loneliness Seminar December 2013 Loneliness pathway UCLA scale- waves 2 to wave 5 Self rating scale- wave 1 to wave 5 Never lonely66.2%71.3% Always lonely6.7%2.0% Out of loneliness9.8%6.8% Into loneliness8.7%4.6% Fluctuation*8.7%15.4% * 8 pathways for UCLA scale and 22 for self rating

20. Longitudinal changes in loneliness? Campaign to End Loneliness Seminar December 2013 Fluctuating pattern of loneliness 0=not lonely 1=lonely

21. Variations in loneliness? Loneliness described as both temporal & spatially experienced. ’I'm lonely of a night. ‘’(Man 16) ‘’Such a lonely life … Saturdays and Sundays are a bit dead for me…’’ (Woman 21) ‘’So long [Sunday] and so lonely.’’ ‘’I never sat on my own as my husband was always there’’ (Woman 9) ’’I was always sat in that chair there and whenever I looked up from here she was there. But when she'd gone she was not ‘’ (Man 8). Campaign to End Loneliness Seminar December 2013

22. Loneliness is not at a given time. It comes and it goes.” (73 yr old widow) Source Sullivan and Victor 2013 0 – Never 1 – Rarely 2 - Sometimes 3 – Often 4 – Most of the time

23. It comes and it goes... Campaign to End Loneliness Seminar December 2013 0 – Never 1 – Rarely 2 - Sometimes 3 – Often 4 – Most of the time Source Sullivan and Victor 2013

24. Back by popular request! christina.victor@brunel.ac.uk Campaign to End Loneliness Seminar December 2013