Loneliness in old Age - Term Paper Example

? Loneliness in Old Age of the of the Loneliness in Old Age Introduction Loneliness has been deemed to be a universal experience that possesses a multidimensional nature. The notions of living alone, being alone and feeling lonely are related and constitute different dimensions of loneliness. When a person feels lonely, it is usually understood as a subjective feeling of being segregated from others or of being alone. The latter means having to spend time alone, and living alone indicates a household with just one person (Graneheim & Lundman, 2010, p. 433). It is important to recognize that an individual who experiences loneliness may live alone or with others. Loneliness among the old and its relationship to factors, like live events, and health and sociodemographic variables has been researched extensively. With regard to health variables, it was observed that poor health could make an elderly person feel lonely. In addition, loneliness could be developed on account of chronic disease, defective or sub – standard hearing, depression and inability to carry out daily activities independently. The variables of sociodemography that pertain to loneliness among the elderly include inadequate education, low status from the socioeconomic perspective, and dissatisfaction with life, social and family relationships (Graneheim & Lundman, 2010, p. 433). In the older people, loneliness, indisputably decreases the quality of life and is closely related to inadequate medical results. Loneliness and symptoms of depression are closely intertwined. Moreover, the lonely older adult is prone to make increased use of health services. Furthermore, cognitive decline has been seen to result from loneliness among the older people (Chalise, Kai, & Saito, 2010, p. 116). A major disquieting feature noticed with respect to loneliness is that it enhances the danger of mortality. Conceptual framework Loneliness is believed to defy any attempt at universal definition. In general, it is believed to be a subjective feeling that is the personal counterpart of the objective metric of social isolation. However, loneliness can be described as the perception that one has been deprived of social contact, and the absence of individuals to share emotional and social experiences. It can also be described as a state, in which the elderly person, despite having the capacity to interact with others refrains from doing so (Paul , Ayis, & Ebrahim , 2006, p. 223).. Emotional loneliness is the outcome of there being no association of close relationship, whereas social loneliness is caused by the dearth of social interaction. Emotional and not social loneliness was seen to result from the death of a partner. Some researchers have reported that depressive symptomatology was promoted by loneliness, chronic disease, inadequate health as per one’s own assessment, poor functional capacity and vision (Paul , Ayis, & Ebrahim , 2006, p. 223). Merely improving the quality of one type of relationship cannot in general, improve the situation regarding the other type of loneliness. In addition, there is a direct relationship between age and loneliness. A mammoth effort was made by Perlmans, who reviewed the data from 6 surveys, involving some 18,000 respondents in North America. Perlmans found that loneliness was more common among adolescents and the youth, in comparison to individuals of middle age. It was also determined by Perlmans that after the age of 40 years, loneliness had to be examined in the context of divorce, poor health or the death of a spouse (Reevy, Ozer, & Ito, 2010, p. 356). When there is unhappiness regarding one’s relationships, one tends to be dissatisfied. This in turn leads to loneliness, which is an unpleasant emotional state. Those who are lonely could experience emptiness, sadness, emotional pain and a sense of being distanced from and not being properly understood by others. In technical terms, loneliness can be described as a divergence between the actual and desired level of social contract of an individual (Reevy, Ozer, & Ito, 2010, p. 355). In accordance with the classification provided by Weiss, there are two types of loneliness. First, emotional loneliness, which is the result of failure by an individual to establish a close relationship or to have a confident, like a very close friend or a romantic partner. Second, social loneliness, which is the outcome of absence of association with a social group, such as a social organization or group of friends. It is possible for any person to be a victim of any one of these forms of loneliness (Reevy, Ozer, & Ito, 2010, p. 355). The deficit in the amount of desired companionship or emotional support and that provided by a person’s environment that leads to a disagreeable mental state has been described as loneliness. In addition, loneliness has been increasingly held responsible for being a predictive risk factor that could result in physical and psychological illness and deterioration (Molloy, McGee, O'Neill, & Conroy, 2010, p. 1538). Research work in the fields of anthropology, sociology and psychology has provided greater understanding about the development and persistence of loneliness. In addition to age, gender and health, which constitute the background variables; factors such as social network of relationships, personality traits and relationship norms have been taken into consideration. However, deprivation occasioned by economic and social features, at the state or community level, have to be studied at much greater depth (Gierveld, Tilburg, & Dykstra, 2006, p. 495). The states of their moods and the extent of their social activity have a major bearing on the health and well – being of the elderly. Several research scholars have provided data that demonstrate a negative effect of loneliness on the health of the older adults. These individuals develop depression, when their loneliness joins forces with physical and mental problems (Singh & Misra, 2009, p. 55). In the context of gender differences and health problems among the elderly, it has been observed that there are substantial differences. This is with regard to loneliness and depression. In other words, loneliness and depression are experienced to the same degree by the elderly, regardless of their gender. However, from the perspective of sociability, the elderly men were found to be more gregarious, in comparison the elderly women (Singh & Misra, 2009, p. 55). Although, it is generally believed that loneliness is a common feature of old age, a few research scholars of social science have contended that loneliness and other emotional responses reduce in later life. One study examined the life cycle fluctuations in loneliness, by surveying some 25, 000 respondents. This study disclosed that young adults experienced the highest level of loneliness. During middle age, loneliness was seen to reduce and thereafter in old age, it depicted a modest increase (Perlman, 1990). A few scholars have contended that the elderly are vulnerable to loneliness, due to the reduction in their social relationships. Literature Review As disclosed in a report of the President’s Council on Bioethics, the average life expectancy in the US increased from 47 years in 1900 to 77 years in 2000. Moreover, this life expectancy is on the increase and as per the reports of the US Census Bureau, those aged 85 years or more constitute the fastest growing group among the elderly. By the year 2050, this group is expected to constitute 5% of the population. At present, it is 2% of the population (Moses , 2007, p. 336). It is very important to realize that the population of the US has become older. In other words, the proportion of young individuals has decreased with time. In the year 1900, the number of people 65 years or older constituted just 4% of the total population. By the year 2000, this changed to 13% and according to estimates those aged 65 years and above would constitute 20% of the population or seventy million (Moses , 2007, p. 336). The increase in the proportion of the older people has several outcomes. For instance, major changes are effected to the economic and social life of the nation. An example of such change is the effect of this development on the need for distinct housing, products and services that will address the requirements of the elderly (Moses , 2007, p. 337). Suicidal tendency is one of the dangers encountered by the older people. In this regard, Duberstein and Heisel provide some invaluable insights into suicide among the older adults. It had been noticed that the suicide rate among males increased with age in the US. On the other hand, the suicide rate among females was seen to reach a maximum in middle age and thereafter remain steady or even undergo a slight reduction. A substantial difference in the rate of suicide among the older people was noticed between the residents of the mountain states and those living in mid – Atlantic states, with the former having a much larger rate of suicide. This variation was attributed to several factors, such as the availability of mental health services, differences in religious practice, ethnicity and the availability of firearms (Duberstein & Heisel, 2006, p. 46). Suicide rates were seen to be higher among the single, widowed or divorced individuals. It can be stated en passant that the risk of suicide among the young and widowed is higher than that in their older counterparts. This has been attributed to the fact that death of a spouse in young couples is in general an unexpected occurrence. In view of these important aspects, it has been suggested that a clinical assessment of marital status should incorporate investigations regarding the present marital status, relationship satisfaction, presence of conflict and marital history (Duberstein & Heisel, 2006, p. 46). In accordance with this study, the older adults with lower income and less education could be at greater risk of committing suicide. These drawbacks tend to reduce access to quality and affordable health care. In addition, the service providers could subject such individuals to subtle bias; there could be lower levels of mental health literacy, chronic strains and a higher level of stigmatized attitude with regard to being provided with mental health care (Duberstein & Heisel, 2006, p. 46). In addition, the older individuals face many challenges, due to aging. These issues have been discussed by Nolan. The sense of belonging assumes considerable significance in this context. As such, it assumes a complex state, because the aging process is in itself, subject to several factors. Some of these are economic, attitudinal features, psychological, sociological and biological. The effect of these aspects is made worse by biases, negative myths, discrimination and negative attitudes regarding the older people (Nolan, 2011, p. 317). It is intuitively obvious that individuals, irrespective of their age, have to be the members of a group. Thus, it is indispensable for people to be socially interdependent. This has been affirmed by the gerontological, social and psychological sciences. In fact, the third most important need of individuals is to possess such a sense of belonging. Such sense of belonging can be understood as the necessity for an older individual to have a relationship with others and to be accepted. Such acceptance should ensure that person’s perception that he belongs to a specific group (Nolan, 2011, p. 319). It can be derived from oneself, one’s family or society in general. Social identity is chiefly dependent on possessing a sense of belonging. Consequently, it is essential to be connected with the community, friends and members of one’s family. Despite the deterioration of multigenerational household living, family relationships are significant for the wellbeing of the older people. There is an undeniable strengthening of the perception of belonging, when there is such family interdependence. There are a few ethic groups, in which the cultural traditions promote multigenerational households. In some other instances, multigenerational households result from the financial dependence of the older person on the younger generation or vice versa (Nolan, 2011, p. 320). In fact, when grandchildren and grandparents live together, the latter provide childcare, emotional support and a certain degree of financial support. Furthermore, there are several instances, wherein grandparents have assumed the role of full time care providers. Likewise, many adult children have emerged as full time caregivers with regard to their aged parents (Nolan, 2011, p. 320). However, there are several instances where the older people have been considered a burden, on account of their social, economic or other requirements. In addition, the older people are on occasion, provided with care by their families merely because the latter feel that it is their duty to do so. Under these circumstances, the older people are treated as outsiders, and they tend to feel lonely, even though they live amidst their family. Research workers in the field of mental health have established a correlation between a sense of belonging and depression (Nolan, 2011, p. 321). As a result, they have predicted that people who do not have a sense of belonging tend to be depressed. With the recognition of the intimate relationship between a sense of belonging and depression, mental health professionals have acquired the ability to diagnose and treat depression successfully. This is also corroborated by the intuitive perception that depression is more intimately related to a sense of belonging than to social support. The capacity to age gracefully is severely impaired by depression (Nolan, 2011, p. 322). The latter has detrimental effect on emotional, motivational, behavioral, cognitive and physical features of a person’s life. For instance, the older people would benefit to a great extent by actively participating in the activities of their church, temple or other religious association. The perception of the ageing process as one that persists throughout life in conjunction with remaining involved with life enables an older person to age well. Such involvement eliminates monotony, generates creativity, and provides an inducement to live (Nolan, 2011, p. 323). However, loneliness is not caused by aging alone. There are other factors involved, such as increasing disability and emasculation of the social integration of the aging individual. In general, a person who is isolated develops loneliness, and keeping pets has been seen to decrease such isolation. This constitutes the use of animal assisted therapy, with regard to the older people. Such therapy is of great importance to the homebound, and it has demonstrated its significance in assisted living facilities and nursing (Nolan, 2011, p. 325). In his study, Moses states that there is almost universal recognition of the fact that aging and the elderly is a significant feature of contemporary life. Population demographics and human longevity have changed tremendously in the 20th century and this has exposed society to novel cultural and economic challenges. The problem of the aging is no longer an issue related to filial duty and has assumed the dimensions of a major social problem (Moses , 2007, p. 335). During the Second World Assembly on Ageing in the year 2002, one of the officials of the United Nations pointed out that the theme for the 21st century was the elderly. This indicates the change in perspective from education and employment of the young to the problems associated with the ageing. Longevity has increased in an extraordinary manner (Moses , 2007, p. 336). It is very important to study the variables associated with loneliness, due to the fact that psychological distress is influenced to a major extent by loneliness. In some research studies it had been shown that loneliness was prevalent to a greater extent among those living by themselves (Paul , Ayis, & Ebrahim , 2006, p. 224). In addition, it was seen that people devoid of supportive neighbors or people who did not maintain contact with friends were more prone to feeling lonely. Furthermore, loneliness was seen to be present to a much greater extent among the elderly who were having difficulties in their relationship with a child. This study did not find any definite connection between loneliness and absence of children or the frequency of interaction with relatives (Paul , Ayis, & Ebrahim , 2006, p. 224). It was also noticed by Carstensen and his fellow researchers that the older people preferred to develop relationships that were important from their point of view and which provided them with emotional satisfaction. The elderly were seen to ignore relationships that they considered to be inconsequential (Harper, 2008). However, there is significant amount of research, which indicates that the number of close relationships in social networks, do not change. With increasing age, individuals develop closer ties that remain stable until the onset of a very old age. The decrease in the social networks, according to these researchers, is due to the selection of relationships made by the elderly, as they grow older (Harper, 2008). Scogin has highlighted in his article Depression and Suicide in Older Adults that suicide and depression constitute major public health issues for this section of society. Although, depression is quite frequent among the aged, it lends itself to cure. In the contemporary US society, the cohorts of older adults depict a lower rate of major depression, in comparison to younger cohorts. However, the older adults were seen to experience a greater degree of minor depression, in comparison to the younger groups (Scogin, 2009). Members of the group of adults, who are on the verge of entering later adulthood, have been seen to display symptoms of depressive disorders to a much greater extent than the other groups. This is a poorly understood phenomenon, and requires much more research. Depression can be effectively controlled, by means of psychotherapy and pharmacotherapy. It is interesting to note that the elderly invariably indicate a preference for psychological interventions, rather than medication (Scogin, 2009). Pavey, Douglas and Hodges disclosed in a report that isolation was consequent to difficulty in communication, grieving for deceased relatives and friends, and adapting to changes in life. Older people have been known to lose sensory perceptions. Measures have been adopted to provide specialist equipment and facilities, such as specialist housing for those afflicted with impaired hearing and vision (Pavey, Douglas, & Hodges, 2008, p. 17). Increasing longevity and loneliness in old age have posed a serious challenge for practitioners and researchers in gerontology. In fact a fourth of the people regularly experience spells of loneliness. However, among the elderly, the proportion of those affected by loneliness varies between 7% to 49%. With regard to individuals in the US over 70 years of age, this proportion reaches 60% (Chalise, Kai, & Saito, 2010, p. 116). The various life events that have been seen to promote loneliness among the older adults are loss of a spouse and friends. In quite a few research studies it was noticed that loneliness was prevalent to a lesser extent, when the older adult had a spouse, better health, support of the family, perceived affection from children and had a strong faith in God (Graneheim & Lundman, 2010, p. 433). There is substantial evidence to establish that higher levels of loneliness result in some explicit stress related processes of a pathophysiological nature, which in turn promote cardiovascular, immunological and neuroendocrine responses. Therefore, there is every justification for associating loneliness and health in a biological manner (Molloy, McGee, O'Neill, & Conroy, 2010, p. 1538). The specific importance of loneliness arises due to its effect on the self – management of health by an elderly person. It has been contended that when an older adult feels lonely most of the time, this results in cognitive, emotional and behavioral disturbances. Health care use by the elderly provides important information regarding loneliness and its effect on the elderly (Molloy, McGee, O'Neill, & Conroy, 2010, p. 1538). In one study in this area, it was observed that among 232 frequent users of the emergency department, such continued use of emergency healthcare services was related to a greater perception of loneliness. In another study conducted with elderly females, it was discovered that the frequency of visits to the physician was related to loneliness. This association was seen to be unrelated to health status and sociodemographic features (Molloy, McGee, O'Neill, & Conroy, 2010, p. 1538). Conclusions Loneliness affects a wide range of people and has social, psychological and physical ramifications.The elderly are in general, viewed as group of people who are lonely and isolated. It is also believed that the elderly are in need of strengthening their relationships with family members and friends. This has been the long established view about older people. With the onset of age, people lose social contacts and some of the reasons for this reduction in contacts can be attributed to frailty, health problems, reduced opportunity to meet new people and restriction in socializing with existing contacts. Research studies indicate that increasing age diminishes social networks. Since loneliness is a subjective experience, it is possible for an individual to be alone but not lonely. An important aspect of this phenomenon is that a person may have several friends and social contracts, but experience loneliness. Depression has emerged as a persistent and pervasive problem. The older people with depression tend to utilize health services with great frequency. This behavior is similar to that exhibited by the depressed youngsters. Although several treatments are available for depression among the elderly, their use has not been to the extent required. Depression is a disorder that repeats itself, and this indicates that a significant number of the older adults would have experienced it on many occasions. The increase in the tendency among the older people to commit suicide was attributed by a research study to isolation resulting from retirement, widowhood, poor health, and the loss of friends and close relatives. Loneliness is the exact opposite of belonging and results in depression. Although, an older individual may be residing with his family, he could feel unwanted and isolated. Consequently, it is essential to maintain relations with friends and to take part in community activities. As per the research, it was revealed that the problem of loneliness is lesser in cases where the old person had a spouse, good health, support from the family, love and affection from children, and strong faith in the almighty. The above discussion suggests that even though there are many people around a person, he may feel loneliness. This is for the reason that he was not being emotionally supported by the people who surrounded him. Ageing is not the only reason for loneliness and there are other factors, such as diminished social interaction, absence of a spouse or close relation in old age, enhance the emotional dependence in older adults. In addition, age related problems, such as communication failures, and stress oriented ailments were observed in people living alone. In some cases suicidal tendency was also observed in the older people who were living alone and managing their own affairs. Thus, it can be surmised that ageing and loneliness are related to each other in one way or the other. Further research is needed to assess all the issues underlying the topic from a much wider perspective. Implications of this study The findings from the above discussion revealed that old age and loneliness are related to each other, via many factors. Consideration of loneliness as a totally subjective issue relating to personal experiences may hinder the furtherance of any active research in this area. This may result in further aggravation of the problem to those suffering from old age loneliness. Hence, research should be conducted for eliminating loneliness in the older adults, from a much broader perspective. As per the review of research studies, ageing is not the only reason behind loneliness. Factors, such as loss of a spouse, absence of education, reduced social interaction, and low economic viability are some of the factors that have been identified as causing loneliness in old age. However, much more research is required in this area, in order to suggest appropriate measures for dealing with the problem of loneliness in old age. List of References Chalise, H. N., Kai, I., & Saito, T. (2010). Social support and its correlation with loneliness: a cross-cultural study of Nepalese older adults. International Journal of Aging and Human Development , 71(2), 115 – 138. Duberstein, P., & Heisel, M. J. (2006). Suicide in Older Adults: How Do We Detect Risk and What Can We Do About It? Psychiatric Times , 23(13), 46. Gierveld, J. d., Tilburg, T. v., & Dykstra, P. A. (2006). Chapter 26. Loneliness and Social Islolation. In A. Vangelisti, & D. Perlman, Cambridge handbook of personal relationships (pp. 485 – 500). Cambridge University Press. Graneheim , H. U., & Lundman, B. (2010). Experiences of loneliness among the very old: The Umea 85+ project. Aging & Mental Health , 14(4), 433 – 438. Harper, R. (2008). Designing for Elders: Exploring the Complexity of Relationships in Later Life. Retrieved November 19, 2011, from http://research.microsoft.com/en-us/um/people/r.harper/papers/designing%20for%20elders.pdf Molloy, G. J., McGee, H. M., O'Neill, D., & Conroy, R. M. (2010). Loneliness and Emergency and Planned Hospitalizations in a Community Sample of Older Adults. Journal of the American Geriatrics Society , 58(8), 1538 – 1541. Moses , S. (2007). A Just Society for the Elderly: The Importance of Justice as Participation. Notre Dame Journal of Law, Ethics & Public Policy , 21, 335 – 362. Nolan, L. C. (2011). Dimensions of Aging and Belonging for the Older Person and the Effects of Ageism . Brigham Young University Journal of Public Law , 25(2), 317 – 338 . Paul , C., Ayis, S., & Ebrahim , S. (2006). Psychological distress, loneliness and disability in old age. Psychology, Health & Medicine , 11(2), 221 – 232. Pavey, S., Douglas, G., & Hodges, L. (2008). The needs of older people with acquired hearing and sight loss. Birmingham: Visual Impairment Centre for Teaching and Research (VICTAR), University of Birmingham . Perlman, D. (1990). Age Differences in Loneliness: A Meta-Analysis. Retrieved November 21, 2011, from Education Resources Information Center: http://www.eric.ed.gov/ERICWebPortal/search/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=ED326767&ERICExtSearch_SearchType_0=no&accno=ED326767 Reevy, G., Ozer, Y. M., & Ito, Y. (2010). Encyclopedia of Emotion, Volume 1. ABC – CLIO. Scogin, F. (2009, September). Depression and Suicide in Older Adults Resource Guide. Retrieved November 19, 2011, from http://www.apa.org/pi/aging/resources/guides/depression.aspx Singh, A., & Misra, N. (2009). Loneliness, depression and sociability in old age. Industrial Psychiatry Journal , 18(1), 51 – 55. Read More