Aging without support is becoming more prevalent for older people in Canada. How can we stem the tide? A look at inclusive aging during Loneliness Awareness Week

“Why was it, she wondered, so difficult to believe that the old had been young, with the strength and the animal beauty of youth, had loved, been loved, laughed and had been full of youth’s unmeditated optimism?” — PD James —

This past winter, my neighbours found one of our older residents wandering around downstairs in the laundry room hallway of our apartment building. She appeared to be lost and confused.

We ended up calling an ambulance once it became clear that she was unwell. She had been living across from me, but I never really knew her. That day, after a brief phone assessment, the dispatcher told us it would be a four-hour wait. Since there wasn’t any food in her fridge, some of us brought snacks and made her a few cups of tea while waiting for the ambulance at her kitchen table. After learning she was 91 and living alone, we asked her about people we might call. But it took a few hours of chatting before she told us that she had no children or siblings. The one exception was a nephew who lived hundreds of kilometers away, who was surprised when we called him, saying they had not spoken in years.

The events that January day were a turning point for her, and for me. She hasn’t been back since being taken to the hospital. I don’t know what ended up happening, and I will never find out because I am not part of her family. Still, later that evening I couldn’t help wondering whether this was what the future might look like for me.

Aging and loss
Aging can bring an accumulation of losses: loved ones, social networks, physical well-being, financial security, purpose, a sense of being part of the wider world, and even a sense of personal identity. These are the kinds of significant losses that “deeply challenge people’s sense of connection to the world around them,” according to Dr. Sam Carr, principal investigator for The Loneliness Project — which qualitatively explored older people’s experiences of loneliness in depth. Many of them spoke to the researchers about how aging presents unique challenges related to loneliness and isolation. The research — now published in Ageing and Society — generated over 130 hours of conversations. One participant’s experience with losing a spouse shows the extent these losses often have: “When he was gone, I didn’t know where I fitted anymore. I didn’t know who I was anymore because I wasn’t [upset]. You just existed. Went shopping, when you needed food. I didn’t want to see people. I didn’t go anywhere.”

In an interview study of older persons’ loss of meaningful connection, researchers at Malmö University in Sweden concluded that profound loneliness in later life can be understood as if the individual “is in a process of letting go of life.” Such an experience also “involves the body, in that the older person is increasingly limited in his/her physical abilities. The older person’s long-term relationships are gradually lost, and finally the process entails the older person’s increasingly withdrawing into him- or herself and turning off the outside world.”

Getting older without kin
In Canada, aging without support is also on the rise. Sometimes called “solo agers,” an increasing number of older adults are kinless, meaning they are without a spouse or living children (or the children live far away). Others who may not be technically kinless may still be isolated. Even though most of them want to age in place, kinlessness can lead older people into long-term care. As a country that already has one of the highest kinless rates in the world, how will Canada support and care for the increasing number of people in this group?

In the U.K., the issue is connected to a larger theme: loneliness as a growing health threat. In 2018, Prime Minister Theresa May called it “one of the greatest public health challenges of our time” when she established “the world’s first ministerial lead” to tackle loneliness. Japan’s Prime Minister Yoshihide Suga followed suit in early 2021, adding a new minister of loneliness to his cabinet. Its initial appointee, Tetsushi Sakamoto, was tasked with preventing and reducing widespread loneliness, social isolation, and the increased suicide rates accelerated by COVID-19 restrictions.

Such measures are grounded in evidence about the health and mental health risks of loneliness. Research has consistently shown that low social support or increased social isolation is one of the major risk factors for depression at all ages,” according to Dr. Keith Dobson, a professor of clinical psychology at the University of Calgary. The U.S. National Institute on Aging ties loneliness and isolation with “poor aging outcomes,” including higher rates of mortality, depression and cognitive decline.

Loneliness in significant numbers also comes with an economic impact. In the U.S., a decades-long increase in loneliness has reached the point where “more than two out of three working adults consider themselves lonely” — something that costs employers about $154 billion each year due to related health problems, productivity losses, and staff turnover. In England, 45 per cent of adults experience some degree of loneliness, which, according to a 2017 New Economics Foundation report, costs U.K. employers £2.5 billion (C$4.2 billion) each year. The data paints a dire picture, especially when you consider that much of it stems from pre-pandemic research.

It’s not the same for everyone
As we might expect, the effects of loneliness and isolation don’t impact everyone equally. Charitable organizations that support older persons witness first-hand how some people bear the brunt of overlapping life challenges. According to Gregor Sneddon, executive director of Ottawa-based HelpAge Canada, we know that “as people age and experience physical and cognitive impairments, their exposure to the world shrinks, as does their exposure to other people and they ‘bear the fruit of isolation.’ Add in a global pandemic that locks people in their homes, takes away their means of participating in the community and belonging, and disconnects them from family and friends, and the result is critical health effects.” But it is definitely “worse for those with little money. . . . Those who don’t have options are the most susceptible to loneliness, which we know, can be fatal.”

Does Canada need a minister of loneliness?
CARP interim chief policy officer Bill VanGorder understands that “loneliness and isolation doesn’t only affect people who may be considered a senior.” But he’s all for having a minister of loneliness in Canada “if that’s what it takes to address the impact of isolation and loneliness on Canadians. A minister would make sure that programs are in place to ease these issues, other parts of the government would be accountable to them, and maybe, finally, we could change the way we care for older Canadians.” In societies like ours that favour independence and individualism, we tend to let people sort out and manage their own challenges. But if you are unwell, isolated, and lacking support, that’s much harder to do.

The U.K. government is taking an integrated approach to this issue, recognizing that more needs to be done and everyone must play a role. Building an effective network of connection and supports requires government involvement as well as that of friends, family, employers, voluntary and community sectors, local authorities, and public health bodies. But that’s just the start. Its loneliness strategy is guided by a framework to improve and connect social services, reimagine community spaces, transportation, housing, and technology, holistic health approaches, and public health campaigns to raise awareness and reduce stigma around loneliness. One example is the government’s 2019 Let’s Talk Loneliness campaign, which challenges this stigma by emphasizing the importance of talking about it.

The program even uses social prescribing, where community connectors, health and well-being advisers, and community navigators support non-clinical needs (including those of people who feel lonely) by connecting people to community groups and services for practical and emotional support.

While the success of the U.K.’s integrated approach is still to be evaluated, regardless of future results, its common-sense principles seem more robust than the current fragmented and disconnected supports available in Canada. While some resources and programs exist, they can be difficult to find, especially if someone is isolated and has no internet access. And yet, the premise could not be simpler: communities benefit when we support the well-being of older people and their families. The same could be said for people who live with chronic illness or disability. A truly inclusive society benefits everyone.

What does the future of inclusive and healthy aging in our country look like? Is it a society that recognizes the value of older people, and the worth and dignity of all, putting aside ableism and prejudice? I hold out hope for a new vision of supportive and inclusive aging where we “create living environments in which these mechanisms of support are embedded and integrated into [our] communities.”

Resources for people in Canada:

• HelpAge Canada
• Government of Canada Programs and Services for Seniors
• Transforming health-care, social care and community landscapes to optimize the mental health of older adults in Canada 
• Better Supporting the Mental Health of Older Adults in Canada
• Summary: Guidelines for Comprehensive Mental Health Services for Older Adults in Canada 
• Compendium of Good Practices for Improving Seniors Mental Health Care in Canada 
• Supporting Older Adults: Using Principles and Values to Promote Best Practices 
• Applying the Guidelines for Comprehensive Mental Health Services for Older Adults in Canada during COVID-19