No one can doubt that there is an epidemic of loneliness among older people in the UK. The most senior acute care doctor in England, Professor Keith Willett, recently warned that the issue needs to be addressed urgently. Professor Willett told a reporter from the Guardian newspaper that doing nothing would result in hospitals being transformed into ‘dormitories for older people’ with no support structure at home.
There are many different reasons why loneliness is on the rise. The UK population is ageing, with a larger proportion of over 65s and over 85s than ever before. Close-knit communities with extended families are in decline. More than half of people over the age of 75 in the UK live on their own, (although of course, not everyone who lives alone is lonely). A poll carried out by AgeUK found that a million people over 65 admitted they feel lonely always or often. More than half the callers to our helpline, The Silver Line, tell us there is absolutely nobody else they can have a conversation with. And we know that quite often, that is the real reason they visit their local surgery.
Loneliness is not trivial; it is a serious health problem. The Department of Health has assessed it to be as damaging as smoking 15 cigarettes a day, more dangerous than obesity. It can lead to such a serious loss of self-esteem that older people lose the confidence even to step outside their own front door. They may start to lose the ability to speak fluently, because they are so out of practice. Anxiety, depression, despair can all have their root in loneliness. This can lead to costly drug treatments such as antidepressants which may have been unnecessary if the issue of loneliness had been tackled from the outset. Drugs like benzodiazapines, can be addictive and should not be taken for longer than 2-4 weeks. The biggest users of benzos are the elderly. SSRIs, like Prozac, can be taken for the long term but can also have side effects and may not be tackling the root of the problem. Social isolation is strongly correlated to poor health outcomes.
The good news is that doctors and health workers have one new weapon in their armoury – Silver Line, the free, confidential helpline open 24/7, offering information, friendship and advice to older people, which we launched in November 2013. We have an army of Silver Line Friends, volunteers who regularly ring Silver Line callers once a week, they facilitate Silver Circles, which are regular conference calls, and write Silver Letters for people who prefer Pen Pals or are hard of hearing. Unfortunately, too often, GPs, hospital nurses and community practitioners aren’t even aware that The Silver Line exists. In the first two years more than 700,000 people called our helpline, but only a small proportion were referred by medical staff. We hope that every surgery will display our leaflets, and act as our champion. Because we have discovered that pride, and the strong desire not to appear “needy” means that many of your older patients will need encouragement from you to make that first call.
For there is a stigma attached to admitting to loneliness. People who were used to being relied upon as they brought up their own families, or holding down responsible jobs, as they grow older are often so reluctant to be a “burden” that they don’t even admit to their families that they are lonely. I myself know a little about this. When my husband died, our children moved out, and I downsized from our family home, I found myself very lonely – I believe loss is one of the major causes of loneliness. I wrote about it and a very good friend responded with surprise. ‘How could you write about something like that? Haven’t you got too much pride?’ I wasn’t too proud to admit that I suddenly felt isolated, but many elderly people are.
We ask a simple question when we suspect that a caller is isolated and lonely: ‘When is the last time you had fun?’ You might find that someone who seems to brush off problems in life, but is back in the surgery every fortnight for a knee ailment, might admit that they haven’t had fun for a very long time, or tell you that “fun is just for young people.” At The Silver Line we think everyone has the right to have fun, so if you visit our helpline, the sound you will hear is laughter, as we share jokes, and memories. And the outcomes? As one caller told our independent evaluator, “When I get off the phone I feel like I’ve joined the human race”, and another told us “It’s not just a phone line, it’s a life line. You know somebody cares about you.” And we do.
We have found an unpatronizing way to encourage proud, independent older people to contact The Silver Line. Why not ask your patients if they are prepared to do some mystery shopping for me, make that first, free, confidential phone call at any time, maybe in the insomniac hours of three in the morning, and see if they like what they hear. Tell them I have suggested it because we need our service to be the best it can be. And then you will feed back to us if we are getting things wrong, or right. Or turn it round. We need volunteers to become Silver Line friends – many of whom are also older, I spoke to a brilliant Silver Line Friend who is 91, befriending a caller of 86. So suggest they think about coming a Silver Line friend and reach out to other people who need conversation, a bit of fun in their lives.
And please, do put up Silver Line posters in your surgeries or clinics – somewhere patients can easily see them. If Silver Line is going to fulfil its potential, doctors and nurses, social workers and community health workers must be our champions. Overcoming loneliness is a challenge for all of us. We can only meet that challenge by working together.
The Silver Line Helpline number is free, confidential, open every day and night of the year, 0800 4 70 80 90. You can get more information from our website.