industry & reform
“ We must rethink our understanding of the causes and impacts of isolation and loneliness .
Isolating the problem
Pandemic solution threatens to become an endemic problem for aged care .
By Michael Fine
Social isolation and physical distancing have never looked as good as they have over the past year-and-a-half , proving to be essential tools in limiting the impact of the COVID-19 virus .
More recently , much of NSW , Victoria and even occasionally south-east Queensland , South Australia and Western Australia have once again been returned to lockdown conditions . Perhaps that ’ s not so surprising given the disappointments and limitations of the vaccination program in Australia to date .
We ’ re not the ‘ envy of the world ’ anymore . Neither are we unique . Similar responses have once again been reintroduced in many other countries , as the limits of even the best run and resourced vaccination policies to date have become increasingly evident through a significant increase in active COVID cases .
Despite its benevolent use as a life saving measure in the pandemic , the idea of social isolation still holds significant fears for most people . For those older people who need care , the situation should be seen as even more alarming . We now have strong evidence that prolonged isolation for such people is nothing less than life threatening . Isolation clearly remains a major social problem and threat to mental health for all age groups . Medical research has now also shown it to be one of the leading causes of illness , morbidity and dependency among older people . It is also a leading cause of admissions to aged care services , including residential care .
As we emerge from the pandemic , however slowly and uncertainly , it is time , once again , to pay attention to the problems of social isolation and loneliness amongst older people . We must rethink our understanding of the causes and impacts of isolation and loneliness , and work to improve our responses to best counter its ill effects .
An important new report , released by the WHO in May , documents how social isolation and loneliness among older people are growing public health and policy concerns internationally .
According to research cited by the WHO report , increasing numbers of older people live alone or in isolation , while as many as 20 to 34 per cent of older people in China , Europe , Latin America , and the US report that they are lonely . According to a study cited by the AIHW , in Australia in 2018 approximately 8 per cent of those aged 75 and above are socially isolated , and almost 20 per cent experience loneliness . These figures are probably higher today .
Loneliness and social isolation are not the same and should not be confused . Loneliness is an unpleasant subjective emotional response to lack of good companionship . Social isolation , in contrast , is an objective state , an observable absence of regular contact with people who know and care about you . It may be caused by poverty , social exclusion or housing problems , or come about as a result of bereavement , physical or mental health problems . Both women and men are commonly affected . In the worst cases , it results in a lonely death , a product of a life lived in isolation for years .
The WHO report and a significant body of medical research also shows how both social isolation and loneliness are harmful . In addition to reducing quality of life , they can shorten older people ’ s lives as well as damage their mental and physical health .
There is no vaccine available to treat the underlying conditions . It is , however , clear that social isolation is a social condition that requires social responses . That ’ s where aged care comes in .
Left alone when in need of care , what emerges is a form of neglect for which the only readily available response is expensive forms of aged care . But we can do so much better .
Rather than promoting social contact , Australian aged care services in recent years , especially those delivered to people at home , have increasingly been reshaped to focus on the complex needs of individuals . Those who are isolated and who don ’ t seek out help or social connections often miss out . Day care and social activity programs , long associated with the community sector , often struggle for funding . In the Home Care Packages , access to social activity programs is often accorded low priority and is in danger of becoming increasingly rare .
In the wake of both the Royal Commission and the COVID-19 pandemic , social isolation ceases to be a solution . It becomes an endemic and increasing problem , a challenge that needs to be faced as Australia reforms its aged care system for the future . ■
Michael Fine is honorary professor in the School of Social Sciences at Macquarie University .
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