John Bond Professor of Social Gerontology and Health Services Research - Well being and older people: Reflections on the experience of social ...
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Well being and older people: Reflections on
the experience of social relations and
engagement in later life
John Bond
Professor of Social Gerontology
and Health Services ResearchAcknowledgements
• Ann Bowling, University College London
• Lynne Corner, Newcastle University
• Christina Victor, Reading University
• Many anonymous participants of our
research studiesAn alternative title?
Wellbeing and older people:
loneliness and social
isolation in later lifeStructure of talk • Well being and quality of life • Older peoples’ experiences • Loneliness and social isolation • Factors associated with loneliness and social isolation • Changing family and social relations • Policy response
Well being concepts • Psychological or personal well being • Life satisfaction • Quality of life
Historical context • Negative discourse – Personal decline – Social problem • Atheoretical empiricist tradition • Positivism to • Critical gerontology – Feminism – Political economy – Social constructionism
Quality of life “On the whole, social scientists have failed to provide consistent and concise definitions of quality of life. The task is indeed problematic, for definitions of quality of life are largely a matter of personal or group preferences, different people value different things” Source: George, L. K. and Bearon, L. B. (1980) Quality of life in older persons. Meaning and measurement. New York: Human Sciences Pre.
Quality of life domains
Health
status
characteristics Clinical
Cultural
characteristics
factors
Subjective
well-being QOL Physical
environment
Personal Social
autonomy environment
factors
Socio-
Personality economic
factors factors
Source: Hughes, B. (1990) 'Quality of life', in Peace, S. M.(ed),
Researching Social Gerontology. London: Sage, pp. 46-58.Important areas of
life for older people
Area of life Most important1 Proportion identifying any of top2
%* %+
Own health 40 63
Family relationships 24 47
Health of close person 16 30
Standard of living 9 43
Social activities 2 21
Spiritual or religious 2 6
Other relationships 2 13
Environment 1 8
Other 4 -
Total 100 410
Number of respondents 409
Notes: * Subject to rounding error. + Percentages add to more than 100% as this question was multicoded.
Sources: Bowling (1995b: Table 1; 1995c: Table 2)Things that give
quality to the lives of
older people
Sample 1 Sample 2 Sample 3
(85+ in 1987) (65-84 in (65-89 in
1989) 1989)
Nothing 12% 3% 0%
Family 34% 40% 49%
Social activities 29% 23% 49%
Other social contacts 25% 23% 21%
Health 10% 35% 24%
Material circumstances 10% 23% 21%
Number 68 66 70
*Respondents gave more than one answer.
Source: Farquhar (1995: Table 4)Loneliness and
social isolation
• Loneliness
– deficit between actual and desired level of
social engagement
• Being alone – time spent alone
• Living alone – a living arrangement
• Social isolation
– level of integration into the wider social
environment‘Measuring’
loneliness
• Self-rated loneliness
Do you always feel lonely, often feel lonely,
sometimes feel lonely or never feel lonely
• Social isolation
– Social contact score – total number last week
– Face-to-face contacts
– Other methods of contact e.g. telephone, E-
mail.ESRC Growing older
project
• ONS Omnibus surveys 2000-1
– April, September, November 2000 and
January 2001
– Optimise sample size
– Control for seasonal effects
• 999 people aged 65 or over participated
– 63% of older people participating in index
wavesNon-response bias in
surveys of older people
• Excludes 5% of older people resident in
long-term care
• ONS omnibus response rate ≈ 60%
• Factors associated with non-response
– Very old age
– Cognitive and physical impairment
– EthnicityPrevalence of loneliness
Always/ Some- Never
often times
Age 65-74 6% 38% 55%
Groups: 75-84 13% 38% 49%
85+ 18% 24% 58%
Source: Victor, C. R., Scambler, S. J., Bowling, A. and Bond, J. (2005) 'The
prevalence of, and risk factors for, loneliness in later life: a survey of older
people in Great Britain', Ageing and Society, 25, (3), pp. 357-376. Table 2.Variables significantly
associated with self-
rated loneliness
Age, sex, marital status, household status, tenure,
car ownership, education, social class, problems
with sight or hearing, chronic illness, self-rated
health, disability, fall in last year, expected
health, GHQ score, time alone, increased time
alone in last decade, increase in loneliness in
last decade, voted in last election, confident and
activities in previous week
Note: Statistical significance identified as pVariables not
significantly associated
with self-rated
loneliness
Proximity of children, proximity of other
relatives, contact with neighbours, direct
and by phone contact with family, direct
and by phone contact with friends, and
environmental factors
Note: Statistical significance identified as pVulnerability factors
independently associated
with loneliness
Vulnerability factor Adjusted odds ratio (95%CI)
Widowed 3.3 (2.1-5.0)
Time spent alone 3.2 (1.7-6.2)
Increased loneliness 3.8 (2.2-6.5)
High GHQ-12 scores 3.3 (2.1-5.0)
Worse expected health 1.2 (0.8-1.7)
Poor self-rated health 1.1 (0.8-1.7)
Note: Statistical significance identified as pProtective factors
independently associated
with loneliness
Vulnerability factor Adjusted odds ratio
(95%CI)
Advanced age 0.4 (0.6-1.1)
Post-basic educational 0.7 (0.5-1.0)
qualifications
Note: Statistical significance identified as pSocial relationships
“We have not entitled this chapter ‘the family’ and older
people. Even if people’s family or personal lives have
always involved a complex range of relationships and
behaviours, until recently they have been studied
within a fairly rigid set of assumptions about kinship
behaviour and the ‘institution of the family’. Recent
theorising suggests that we no longer inhabit an
institution of the family, but construct it as we
experience the changing influences and
manifestations of personal relationships.”
Askham, J., Ferring, D. and Lamura, G. (2007) 'Personal relationships in later
life', in Bond, J., Peace, S., Dittmann-Kohli, F. and Westerhof, G.(eds) Ageing
in Society: European Perspectives on Gerontology. London: Sage, pp. 186-
208.Marital status Marriage and widowhood – 61% married – 27% widowed
“Almost 56 years. Just two months short. We were married on 27th December 1944 and my husband died on 30th October last year. So Christmas we would have been married for 56 years. He was everything you could ever want in a husband. That’s why I miss him so much you see. But still, you can’t have it for ever.” [301: 1: 33]
Children 86% had living children Proximity of closest child – 33% lived within one mile – 61% lived within 5 miles
“Not very often, they’ve got their own families. I mean I’ve got a daughter who lives within 10 minutes … I sometimes see her when she takes her daughter to school, that’s about the only time I do see her, when she goes by taking the young uns to school. I never see my son.” [702:6: 20-24]
Siblings 70% had living siblings Proximity of closest sibling – 14% lived within one mile – 36% lived within 5 miles
Contacts
Every day At least weekly
Phone relatives 22% 78%
See relatives 13% 62%
Phone friends 11% 64%
See friends 15% 71%
Speak neighbours 36% 69%
Receive/send letter 1% 8%
Source: Victor, C., Scambler, S. and Bond, J. (2009) The social world of
older people: understanding loneliness and social isolation in later life.
Cambridge: Open University Press. Table 3.2“They bought me this mobile so they could check on me, I was walking the dog on Monday morning and … click, click, click. I thought what the Dickens is that? And then I realised it were that thing going off. Somebody on the line says ‘Good morning grand dad’ … ‘I expect your walking in the woods’ … ‘Now don’t walk too far. Just be careful what your doing’ … And he’s 13! So they think a bit of their granddad. … I don’t know how some people cope; you keep reading about them in the paper, you know, they haven’t got anybody. [402: 6: 30].”
Help availability
Emergency Ill in bed Daily chores
lift
Available 91% 96% 91%
Provided by:
Spouse 33% 52% 39%
Relative 58% 62% 55%
Friend 45% 29% 33%
Neighbour 48% 32% 38%
Source: Victor, C., Scambler, S. and Bond, J. (2009) The social world of older
people: understanding loneliness and social isolation in later life. Cambridge:
Open University Press. Table 3.3“Yeah, well next door, I can ring them, or the other side. Well I always see the other side, she gets my tea from Sainsbury every week, I’ve only got to ring. And if they (family) can’t get me on the phone they ring next door and they come round and see what’s happened.” [105: 5: 1-5]
Civic and cultural
participation
Voted in last election 81%
Undertaken voluntary work 16%
Used library 40%
Attended religious organisation 29%
Attended local organisation 42%
Gone to theatre or cinema 29%
Source: Victor, C., Scambler, S. and Bond, J. (2009) The social world of
older people: understanding loneliness and social isolation in later life.
Cambridge: Open University Press. Table 3.4‘Social’ activities Gone for a walk 68% Sporting activity 20% Gardening 59% Childcare 24% Caring for someone who is ill or frail 17% Source: Victor, C., Scambler, S. and Bond, J. (2009) The social world of older people: understanding loneliness and social isolation in later life. Cambridge: Open University Press. Table 3.4
“I spend a lot of time … my granddaughter, she lives about 300 yards away and she’s on her own with two children and she’s had a rough time. … so I spend a load of me time , she’s got a house and things and I help out on occasion with clothes for the children and things because she’s on next to nothing being a single parent.” [406: 2: 4]
Social isolation • Has no relatives or sees relatives less than weekly • Has no friends or chats with friends less than weekly • Has no neighbours or sees neighbours less than weekly Scoring: None (score 0) to High (score 3)
Levels of social
isolation
None (0) 19
Low (1) 45
Medium (2) 31
High (3) 5
Victor, C. R. and Scharf, T. (2005) 'Social isolation and loneliness', in Walker,
A.(ed), Understanding quality of life in old age. Maidenhead: Open University
Press, pp. 100-116.Table 7.3Social isolation-
multivariate analysis
• Years of widowhood
• Contacts with family, friends and
neighbours
• Proximity of family and friends
• Availability of help in time of emergency
• Availability of a confidant
• Knows neighbours
• Access to car“Yes see I’ve got next door, the lady over the road, number 50 down the road, they’ve all got keys so that if I wanted assistance I could sound the alarm and ask them to come and hel me, you know” [204:4:43].
Loneliness and
isolation
Allocation decision Allocation decision
(sometimes = no) (sometimes = yes)
(%) (%)
Lonely but not 3 35
isolated
Isolated but not 6 12
lonely
Lonely and 22 42
isolated
Neither lonely or 69 11
isolatedDistinct social
entities
22% Isolated and lonely
Loneliness Isolated
36% Medium or high
5% often or always • availability of :
– social network
• time alone – help and presence of a
confidante
• perceptions of health
• social embeddedness
and old age
– knowing and trusting
neighboursSource: Bond, J. and Corner, L. (2004) Quality of life and older people. Buckingham: Open University Press.
Tackling loneliness
and isolation
• Reduce poverty and inequality
• Improve the physical environment – age friendly
environments
– Public toilets, seats and benches
– Pedestrian friendly
– New housing built for all age groups
– Public transport
• Social environment
– Attitudes to ageing
– Community participation and development‘Health promotion’
interventions
• Group interventions
– Educational and social support
• Involve older people
– planning, development and delivering
activities
• Creative and innovative thinking with older
peopleKey messages • Pathologisation of loneliness and isolation • Life course experience – individual and structural influences • Tackle poverty, social exclusion and improve physical and social environment for all • INVOLVE older people in planning, development and delivery of interventions
Contact details • Tel: (+44) 191 222 6777 (Direct Line) • Fax: (+44) 191 222 6043 • E-Mail: john.bond@ncl.ac.uk • Web Page: http://www.ncl.ac.uk/ihs
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