Dr Michael Fine and Dr Bob Davidson discuss the prevalence of loneliness amongst older people and investigate possible interventions and local responses.
Loneliness isn’t new, but services have been sounding the alarm about the toll that it is taking on older adults in our LGA. At ISV, we’ve noticed a steady increase in requests to support socially isolated older people, as did community service leaders at JNC, ESC, NNC, and 4Cs. Determined to understand why, we commissioned Dr. Michael Fine and Dr. Bob Davidson to investigate the driving factors behind this trend and pinpoint effective local responses.
Ahead of the publication of Older and Connected, we spoke with one of the authors: Dr Michael Fine (Hon Professor, Macquarie University), whose nearly five decades of research on ageing and care give him a unique lens on this growing problem. He points to a confluence of social, demographic, political, economic, and technological changes that have fragmented our communities and intensified individualism, alongside shifts in community development and aged care that have cut people off from the social connections they desperately need. Yet amidst this sobering reality, Fine offers hope, suggesting that revitalised local services could help combat this escalating crisis.
Early Recognition of Loneliness as a Social Issue
The first meaningful studies on loneliness coincided with research into the growth of the welfare state in Britain after WWII. Following the destruction of inner-city places in London and other cities during the Blitz, many older people were moved to new housing estates. When investigating the effectiveness of this social experiment, medical doctors and social policy researchers found that, cut off from their families and communities, these older people were identified as ‘socially isolated’.
“They didn’t have the means of visiting their family. Often, they were left alone after their son had died in the war and their daughter-in-law had married someone else and moved away,” explains Dr Fine. “Now, they were facing these diseases and conditions that no one knew what to do with.”
Being socially isolated, the English researcher Peter Townsend reported, was a major cause of loneliness. This, he warned, often led to a decline in the older person’s general health. But isolation was not the same as loneliness. Indeed, it was possible to identify loneliness among older people who were surrounded by many others, such as in the old Workhouses that after the war were often still used as residential care homes for the aged.
The Decline of Social Capital
“Fast forward up through the 1990s and 2000s and we begin to document the loss of social capital that’s starting to occur in late capitalism.” Robert Putnam’s research on Civic Traditions in Modern Italy, for example, found that where patterns of civic engagement were weaker, regional governments tended to be more corrupt and inefficient. “There were little employment opportunities apart from farming, so if you couldn’t work, then you were very lonely.”
A decade later, in Bowling Alone, Putnam looked at how social capital was falling apart in the US. “All the things that people were doing together were falling apart; people weren’t going to church or joining sports clubs. They were scared of walking around in a lot of neighbourhoods. And we were starting to find this in Australia and Sydney.” “As a result,” he says, “we started to pay attention to this issue of social isolation, particularly around older people.”
Evolution of Community Care in Sydney
Dr Fine has researched and studied ageing and care for over forty years. Having completed postgraduate research in the Netherlands, widely considered to have one of the best aged care systems in the world, Fine returned to Sydney.
He explains that nursing services had existed in Sydney since the 19th century, but it wasn’t until the 1950s that home nursing services were introduced as a specialist aged care service and in the 1960s, Meals on Wheels was developed to bring meals to isolated older people. However, there wasn’t a systematic program to help older people live independently in their communities.
“We had hundreds of nursing homes but no community care. From the 70s, we started to say, ‘hey, we want something like what they have in Britain, Canada, and New Zealand.’” In 1985, the Home and Community Care (HACC) Program was introduced under the Labor government, based on the community development model. Fine visited service providers to research possible improvements to the program and was surprised by how positively they were received by users.
“These little services really started to grow; they were full of enthusiasm, and it was really interesting to see how much attention was being paid to building social support.” By 2012, however, there was a move towards marketisation, and in 2015, the Commonwealth Home Support Programme prioritised individualised funding that targeted high-needs patients. “That’s where all the expansion of services has gone in the last 20 years,” says Fine.
The Erosion of Local Activity Centres
Michael Fine argues that the increased social isolation of older people is at least in part due to the individualisation and marketisation of care, and to the decay of social capital. He suggests that when older and frail people are discharged from hospital, “we need a system where they are referred to a community centre, ideally with a nurse. It’s important to get in early, so they have support around them. ‘It might be shopping, but they also need friends, they need connections. They need someone to ring up and say ‘I’ve got a dreadful headache and I don’t know what to do.’”
Affordable Interventions and Early Support
“We need to target our services for older people but they don’t need the most expensive forms of therapy.” They need imaginative but fairly cheap forms of intervention. “The research that we’ve been looking at around the world shows that they really need early intervention to try to help maintain what physical help they’ve got left. You need to stay active, you need to meet up with other people and you need to form friendships.”
So what can be done? Greater investment in local activity centres seems like an effective—and cost-effective—solution. The report recommends extending the CHSP program beyond the existing high-risk recipients of aged care, to engage people before they become too withdrawn.
While loneliness is a serious issue across most age groups, for older people, the causes and solutions are distinct. “We need a system where, when an older, or frail person falls into the medical sphere, they are referred to an activity centre which also has a nurse, or to other services, social clubs and so on. The main thing for social isolation is getting in early.”
Ultimately, tackling isolation and loneliness among older adults will require a renewed focus on community-oriented programs, early referral systems, and low-cost but creative interventions. By rebuilding social connections and strengthening local activity centres, communities can offer older people the chance to maintain their independence, health, and most importantly, their sense of belonging.
Dr Michael Fine is an Honorary Professor in the School of Social Sciences at Macquarie University.
Dr Bob Davidson is an Honorary Research Fellow in the Department of Sociology at Macquarie University and a Director of Danett Associates.