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I never thought it would be like this – journey into old age
Mima Cattan

Deputy Vice Chancellor, Dean, Colleagues, Friends and Family. A picture can say a thousand  words. Before going on to the words, I want to take you through a musical and pictorial reflection, which will lead us to the theme of this evening’s lecture.

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Some of you may have recognised the piece of music as Valse Triste by the Finnish composer Jean Sibelius. What you may not know is that he composed Valse Triste for a play about the symbolism of death and reflections on life. Sibelius was almost 92 when he died. During the last 30 years of his life he did not compose any major works, but oscillated between severe self-critique and acceptance of what was.

In 1948 he wrote to a friend: 
‘I read in the paper that I cannot accept the invitation to the Edinburgh Music Festival because of my advanced age. This is the first time this has been said of me, and it is certainly more pleasant than saying, for instance, that I am sick, in which case everybody would pity me. I was always the youngest and I got used to being young. Even today, at almost 83 years old, it feels strange to read about "my advanced age".

Sibelius was inspired in much of his music by the vast forests in Finland. Trees have always featured in human history to describe the flow of life. Think of the expressions ‘family tree’ or the ‘tree of life’. The symbol of the tree of life is used in science, folklore, and religion. It has had mythological and sacred properties connecting all forms of creation and heaven and the underworld. Darwin, in his ‘On the Origin of Species’, invoked the idea of ‘tree of life’ to describe the evolutionary relationships between all living beings. 
Trees also epitomise ageing and old age. The oldest known trees in the world, a copse of spruce trees in central Sweden, are 9500 years old. They would have started growing shortly after the last large ice age in Europe.

Our affinity with trees and our life experiences that branch out like trees, takes me to the real theme of this lecture: the experience of growing old as described by older people. Although the lecture may branch out in different directions, it will have a main stem, which focuses on older people’s experiences of social isolation and loneliness, and how these experiences reflect our attitudes to older people and old age. And, through the lecture, I will float some seeds for thought for policy and practice on how well-being in later life can be promoted and sustained.

‘I never thought it would be like this’

This was a quote, by a woman from Tyneside, in a BBC programme about growing old in Britain through the eyes of the old. The film showed pictures of her as a young woman, with friends, smiling, having a good time. In her seventies, when the programme was made, the TV and her cigarettes were her main company. She had some family, but most of her friends had died or moved away and she described an old age of loneliness, with few resources to deal with it.

So, what moulds our expectations and experiences of old age? Undoubtedly, there are several factors, such as societal values, our cultural values and beliefs, our personality and psychological make-up and our own interaction with older people across generations. And as a social scientist, I think it is important to recognise that these factors also influence how we as researchers approach the subject of ageing.

I grew up in southern Finland, and my early year interactions across generations were with a large number of older relatives, including two great grandmothers. Most of the women seemed, in my eyes, fiercely independent, although many had lost out on opportunities as a result of two wars and because men still had the edge in terms of further education. Those women who lived alone either as a result of widowhood or because they had never married all had professional careers of some sort.

In terms of my cultural values and beliefs, my parents were of course a major influence. Both my parents had lived and worked abroad immediately after the 2nd World War, my mother in Stockholm and London and my father in Paris and Gothenburg and this undoubtedly influenced how I viewed the world.
But there were also particular events that I realise in hindsight added to the development of that value base, many of which related to how people were treated. I was, for example, confused by attitudes to indigenous people in Canada where we lived during my primary school years, and upset for my 80-year old Great-Great Aunt when we visited her on a large geriatric ward in Helsinki.

At about the age of 11 I wrote my first observational study at school, describing with great gusto, adults’ social behaviour at a midsummer’s night’s party in the Finnish archipelago. It was a great success; I got top mark and teachers would years later comment to my parents that I had a future in descriptive non-fictional writing.

With regards to societal values, this isn’t the place to discuss the changes Finland underwent economically and politically in the 1960s and 70s but suffice to say that with Sweden leading, all Nordic countries developed some form of social democratic welfare state that was intended to create equal access to resources such as education, health and social security. A three year spell in Sweden in the late 70s gave me a personal insight into the deep-rooted Swedish belief in the paternalistic model of the welfare state.

Following a year as a biology student in the US and two years at Helsinki University I met a Scot…and so Scotland became my home and fourth country of residence, where my interests in issues around inequality and disadvantage continued to develop. For a while, I worked as a volunteer delivering library books to the housebound, including older people. My visits were welcome, because I was one of the few ordinary outside people they had any contact with. The service wasn’t adequate, but for them it was a choice between that or nothing.

A colleague from Greece would say years later when we discussed this and other similar experiences: ‘Society should be judged by how the weakest individuals in that society are treated’.

It was about this time I came to realise that I would probably not spend the rest of my life crawling through insect infested mires observing the impact of goose migration on the life cycle of trees, or anything similar and that my interests and concerns in human welfare were taking over. This coincided with a move to Newcastle in the late 80s and I am grateful for the opportunities the Council for Voluntary Service and the Health Promotion Department in North Tyneside and Newcastle gave me.

These years working across organisations with an increasing focus on the promotion of health among older people, and mental health promotion were rewarding, rich and a steep learning curve.

I think it’s useful to put this time in a public health policy context. In the UK, Thatcher was in power, with everybody expected to ‘help themselves’, and take responsibility for their own well-being. For health promotion, much of the stimulus was coming from outside the UK, with the World Health Organisation publishing the Ottawa Charter in 1986, which outlined the fundamental conditions and resources for health as peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice, and equity. And, in 1987 the Healthy Cities Network, based on the WHO ‘Health for All 2000’ principles of equity, community participation and intersectoral collaboration was established, with Newcastle joining a couple of years later.

In 1989, the somewhat controversial White Paper on Community Care was published. Shortly after Thatcher was forced out in 1990, Sir Roy Griffiths, the author of the report that preceded the act, while visiting Newcastle was anxious to distance himself from some of the extreme Thatcherite views by emphasising that the important issue was not about how wealth was created, but how that wealth was used to the benefit of the less advantaged.

With John Mayor and Tony Blair came a flurry of public health related policies. Increasingly, older people were mentioned, not just as irritants taking up hospital beds, but as human beings with needs and rights, who could even contribute to society. Newcastle became a hotbed for programmes and activities for older people, many of which are still around today, all be it in slightly different guises. Those of you who were involved will probably remember the excitement and the sense that something was finally happening.

Here, I want to mention a local incident, which many people may have forgotten about or never heard of, but which, in addition to national policy, in my view had a subtle but profound impact on health promotion in North Tyneside and to some extent in Newcastle. In September 1991, the Meadow Well estate in North Tyneside and parts of the West End in Newcastle experienced several days of violent riots. In addition to an intensive regeneration programme, a review of what the ‘real’ health issues were for residents followed. Not surprisingly, instead of lifestyle problems, such as smoking, diet, lack of exercise, which had been the thrust of health promotion, residents flagged up mental health problems, long-term use of anti-depressants and tranquilisers, and older people on the estates becoming increasingly isolated because they were afraid to leave their homes.

Health promotion continued to promote healthy lifestyles, but there was also a recognition that people’s well-being was determined by additional factors, such as money, crime, where they lived, social networks and the external environment. This, combined with national policy and local opportunities for older people gave the impetus for research to get involved, and the start of my academic career.

This would not have been possible without the support of four people: Wendy Patton, Head of Health Promotion, and Martin White, John Bond and Jim Edwardson at Newcastle University. The initial aim of the study was to investigate the effectiveness of health promotion interventions among older people, which would have taken the rest of my life. Instead, I talked with a lot of older people, with those who worked with older people, and with a few academic researchers, about what really mattered. The health issue that stood out was loneliness.

PhDs are a bit like trees; you start off with one small stem and a couple of tiny leaves and before you know it, it’s grown and branched out, and even produced seeds, which establish more trees. My PhD did just that and one day I found myself upping sticks from Newcastle and joining the Health Promotion Team at Leeds Metropolitan University, where previously I had completed my Master’s degree. I should say that shortly before I left Newcastle a colleague whose experience I respected greatly advised me that I was too old to take up an academic career. However, Pablo Picasso once said ‘It takes a long time to grow old,’ so I ignored the advice, with no regrets.

I know there were rumours that I ended up staying as long as I did in Leeds because I was trying to learn the rules of cricket. These rumours are completely unfounded. A game where some men run around aimlessly after a wooden ball that could kill them if it hit them in the wrong place and where when the players get bored they stop for tea is surely a game that only people from Yorkshire or thereabouts can understand.

The research I’ve conducted over the years has ranged from small scale consultancy investigations to complex national studies. Most of the studies concerning older people have not been about loneliness specifically, and yet loneliness seems to crop up as an issue in the majority of them. This research would not have been possible without my colleagues in Leeds. I can’t mention everyone, but I know many of you are here tonight, and I would like to express my gratitude to those of you who are here as well as to the rest of the team.

‘I never thought it would be like this’ – older people and loneliness
The first thing to understand about loneliness is that it is not a static experience. You don’t become lonely one day and that’s it. Nor do we necessarily stop being lonely forever. People can oscillate between feeling lonely and not lonely, or between different types of loneliness, depending on a range of factors from personality and genes to relationships, experiences of loss and perceptions of the surrounding environments. I’m sure most of us have at some point experienced a moment of loneliness, standing in a crowd where we don’t know anyone, moving to a new area or losing someone or something we treasure.

The second point about loneliness is the issue of stigma, which understandably has bearing on loneliness research. Most of us are social beings. Research suggests that we feel failures by admitting to being lonely. Particularly in focus group interviews older people are reluctant to talk about their own loneliness but refer to others, neighbours, friends, even people in the groups they attend. In one to one interviews admitting to loneliness relies heavily on the trust developed between the researcher and the older person, which might not happen in a single interview. In some cases the older person opens up to the researcher in a way that, in their words, they have never done with anyone else, whilst in other cases the expression loneliness is never used even though the experiences they describe reflect factors and feelings associated with loneliness. Thus, the stigma of admitting to the feeling of loneliness can be so strong that people will do everything to avoid even mentioning the word, especially in relation to themselves.

And finally, there is the question of numbers. Loneliness is not simply a disease of old age. Recent data from the UK show that the proportion of people who are never or rarely lonely is lowest amongst those aged 25 years and under and those aged 75 and over. In addition, research by Victor, Bond and Bowling has demonstrated that the proportion of older people who are lonely most or all of the time has remained fairly static over the past fifty years. This does, however, mean that there is an absolute increase in the numbers of older people experiencing loneliness, because of the increasing numbers overall of older people.

Socially active lonely older people
I will start by considering two broad categories of experiences of loneliness. The first category is the group of socially active lonely older people, an expression first used by Jenny Gierveld and colleagues in the Netherlands. Many older people in this category have experienced acute, sudden loneliness through for example bereavement or moving house, although for some it has been a gradual almost invisible chipping away of the things they value most.

They deal with it by trying to do something that will change the negative feelings to more positive. They do this through their social networks and other available resources. They join groups and become volunteers, they travel, visit friends and family and so on. Sometimes they can describe, almost like a reformed smoker, the time and day when they took a decision to ‘do something about it’, how they regained control after a major life event and dealt with their loneliness.

In a group of older volunteers, one of the women gave her reason for becoming a volunteer:

I became extremely lonely and depressed after having to give up work. I didn’t know what to do with all the time I had. That’s what made me turn to volunteering. Loneliness is a killer.

In another study, two recently widowed women described their response to loneliness after the loss of their partners:

I’ve been known to come back with a loaf of bread when I’ve spent a day in the shops in Newcastle, and my daughter has asked me: what’ve you been doing all day. And I says shopping, and she says ee and all you’ve got is a loaf of bread, you could have got that in Wallsend. But, you know, it’s not the bread that’s important.

And the other one said:

…I’d do anything just to see some people, even cutting the grass. At least people nod and say hello

The conversation with these two women took place after the main interview was finished after an exercise class they had recently joined. The intensity of their feelings was obvious. At one point one of the women was clutching my hand, visibly emotional. Although both still described very strong feelings of loneliness, they also expressed a desire to take control of their lives and find solutions that would alleviate it.

Ester who lived on her own acknowledged that she was lonely, although she didn’t say this directly:

It’s more pleasurable when you have company, even though you don’t talk all the time. It’s just nice to have a companion. I live on my own and I’m alone all the time. I’m not frightened of being on my own in my own house, but when I’m out I like company. We have a good laugh. You end up talking to everyone.

In the interview, she identified the factors that contributed to her loneliness, i.e. the lack of a companion and not feeling safe going out on her own and also a solution by joining a walking group. Enjoyment is frequently given as a reason for joining social activities, although people may also be looking for social support and a confidant.   

The point here is that these older people have the resources, both personal and external, such as availability of acceptable services and activities, supportive, active social networks, their physical health and sufficient money to be able to take positive action. And, with regards to their internal, personal resources, active lonely older people are likely to have high levels of perceived self-efficacy, meaning that they believe they can reduce or eliminate their negative experience of loneliness. They also have the capability to access the support and services they require to do so.

Older people living with their loneliness
The second group I want to consider are those ‘living with their loneliness’. The majority of older people in this category have been lonely for a long time, they are chronically lonely. In fact, some have probably been lonely most of their lives. In our interviews, their loneliness has been associated with lack of companionship or social support, lack of or perceived lack of services, physical and mental health problems, and low self-confidence. The way they cope with their loneliness rarely eliminates it, and in some cases actually accentuates and intensifies it. Compared with the active lonely older people their self-efficacy levels are likely to be low and they are less likely to have the personal resources to access services and support, as illustrated here:

I have nobody, no family, no friends. During the day I keep filling my hot water bottle, it gives me something to do. About two years I was invited to go on a trip with a group. After looking forward to it for ages, it was cancelled at the last minute and I felt very let down. I haven’t been asked to go anywhere since.

Nora was 89 years old, housebound with very little contact with the outside world. We can question why the organisers of the outing never came back to her, but it is also clear that she did not have the confidence to contact them. What she really wanted were some organised activities that would enable her to have social contact with other people.

I try not to get lonely but I do. I go out to try to stop being lonely. I sit and talk to people in the park. I get lonely a lot. That’s why I go out a lot.

When I feel lonely I go out to make myself feel better. I go in the car and sit in the supermarket car park where there are lots of people about and lots of traffic and that helps.

John and Elsie who were mobile coped with their loneliness by mingling with strangers, thereby convincing themselves that they had a social world.

So what do these stories tell us? The first thing to note is that solutions are very much left to older people to find, which means that those who are articulate, with supportive families, active social networks are more likely to identify and access the help and support they desire to alleviate their loneliness, if of course it’s available. Indeed, word of mouth is the most common way of finding out about activities and services. In some cases information about activities is given to individuals perceived to be at risk of loneliness, but there is rarely any follow-up. This also means that those with few contacts and personal resources are likely to lose out, to be ignored and forgotten about.

But this is a very broad brush stroke. Older people aren’t all the same or have identical needs. Let me illustrate this with a few further examples.

First, older people who have difficulties getting out and about
One of the themes that has come through most of my research, is the fear of being completely reliant on others for going about your daily life. For older people, being housebound through health problems and therefore dependent on others to get out of the house can become a vicious spiral of loss of sense of control, loss of confidence and self-esteem, isolation and loneliness.

I will sit here and sometimes I don’t know what I do… if it wasn’t for people ringing in the mornings I’d go in there and just lie on the bed.

There are times when I long for the phone to ring. I’ve sat two days this week and I’ve had no-one…I sit there and I cry my eyes out.

Susan and Margaret were in receipt of a telephone befriending service, which apart from the occasional visit by a health professional, was their only contact with the outside world.

Both women spent long periods alone without seeing or speaking to anyone. They were dependent on outside help to have contact with others and to get out and about and they did not have the resources to take control over the support they desired.  Research has shown that having some say over the way services are provided improves older people’s mental well-being. And yet, the most common model of service provision for older people is still one of maintaining control and reinforcing dependency. Why, for example, are there hardly any activities for isolated older people over the weekend, when weekends are perceived as particularly difficult to get through?

For some housebound older people maintaining an active mind is a way of coping with loneliness as described by Fred who was visually impaired:

When you’re alone for 20 hours per day you start talking to yourself and you don’t always get the answers you want. When I feel lonely I give myself mathematical tasks to keep my mind occupied

It’s a bit like numbing the pain, it doesn’t go away but at least you’re not thinking about it.

The people here have contact with a few outside agencies, and therefore receive some support. But, what about those who are not in contact with any services? The chances are we simply treat them as out of sight out of mind. It is tempting to suggest that what we see here is a direct consequence of so called modern society, with people leading busy lives, adult children not living near their ageing parents and so on. But, are we deluding ourselves through rose coloured spectacles by claiming that in the past, people always looked out for one another? I’m sure it happened in some cases, but I wonder if in the past some of the housebound older people we’ve interviewed would actually have ended up in the dreaded work house or on a long-stay hospital ward because of lack of resources.

That is not to say that the conditions for housebound, isolated and lonely older people today are ideal. There is often a misguided belief among service providers that older people will vote with their feet and not use a service if it is unsuitable. But for many older people, if it is a choice between a poor service or nothing they will choose to receive the service even if it is inadequate.

The second group I will consider are older people living in sheltered housing or care homes

An older volunteer who visited people living in sheltered accommodation pointed out that trees aren’t good conversationalists:

Isolation…even in sheltered accommodation there’s so much isolation. It’s like prison. They’ve got the facilities, which are very good, they’ve got nice gardens and it’s a nice place, but you can’t talk to trees. Well you can talk to them, but they don’t answer back. There’s so much isolation..  

In an interview with care home residents:

I would have liked somewhere more central, but would have had to wait a long time. In the other house everyone knew where I lived. It’s very out of town here and my friends are old themselves so they can’t visit me and I can’t visit them. There’s nothing exciting about my life. I would like to go out more, have someone to take me out.

Dorothy, who was visually impaired and in her mid-80s, had moved from her home where she had lived for 58 years, into accommodation that was more suited to her mobility needs but at some distance from her friends and relatives. She commented on the good facilities and the lovely green surroundings, but described herself as being isolated and quite lonely in her new home.

Although sheltered accommodation and care homes can provide a positive and safe social environment for residents, for some the geographical location leads to loss of familiarity with the external environment and isolation from their friends. Many of our studies have demonstrated that whilst we are quick to identify instrumental help and support, such as here with housing that is better suited for the older person’s mobility, older people’s emotional needs are rarely recognised. It is as if we’re saying that older people should be grateful for what they get, such as a warm and safe home and stop making a fuss about not seeing their friends. After all, there are other oldies in the same block; surely they can make new friends!

Social isolation can also occur in care homes as a result of personal choice. Some residents choose to avoid socialising with other residents because of hearing or sight loss.

Jean a 97 year old woman with sight and hearing loss described how she isolates herself from other residents in the care home where she lives, to avoid embarrassment:

I don’t mix here as probably I should do, because I can’t join in. I feel stupid you know. I think I’m alright one to one. Two, I can manage but if it gets more and they’re all talking and then they turn to me. I haven’t got a clue what they’re saying….I’d rather be on my own in a way, but I’m not grumbling. No disrespect to them, I can understand it, but I feel unwanted.

Jean says she doesn’t grumble, but then goes on to say that she feels unwanted, thereby indirectly indicating that she is lonely. Staff and residents are rarely aware of the specific experiences and needs of those residents with sight or hearing loss, and as our interviews have shown many staff do not even see it as their job to find out. Without going into the politics of care homes, many institutions continue to allow a culture of ageism to flourish, without acknowledgement of residents’ own experiences and specific needs.

Voluntary isolation happens in other situations as well. In a study on older people’s experiences of transport which I conducted in collaboration with colleagues at Leeds University, we found that older people frequently stopped using public transport because of a fall on a bus.  Without access to other forms of transport such decisions increase the risks of social isolation, depression and loneliness. And transport services rarely acknowledge or respond to this – another area where old age is ignored.

So, what can we conclude from these narratives?

For a start, in the 21st century after fifty years of research on loneliness and many political niceties we shouldn’t be hearing descriptions such as the examples I have just given. But perhaps it isn’t so surprising. In today’s youth obsessed society old age is portrayed as something undesirable, something to be avoided at all cost, and therefore we do not want to be reminded of what old age is like for some and perhaps may be for ourselves in years to come. The easy option is to ignore the so called problems of old age or better still, make older people the problem and let them find the solutions! Such perceptions are reinforced on a daily basis. A recent Lancet article titled: ‘How would you spend £1 million to tackle ageing?’ exemplifies society’s view of old age by using expressions such as ‘The world population is ageing at an alarming rate.’ ‘The number of people aged 65 and over…threatens to overtake the number of children younger than 5 years.’ ‘looming health costs’ and the country being ill prepared to deal with this ‘burden’.

Alexander Chancellor in a biting commentary in the Guardian on the fashionability of celebrating old age states that ‘now is a grim time to be getting old’, pointing out that poverty, ill health and problems with pensions may get in the way of enjoying and celebrating old age as propounded by Dame Joan Bakewell, the government appointed champion of older people. The notion of celebrating old age could, according to Chancellor, be an insidious way of covering up our guilt for not responding to older people’s actual needs.

I would argue that this fixation on the financial cost of old age, which incidentally completely seems to ignore the contributions older people make to society, immobilises us like rabbits in headlights and we lose sight of all the other facets of ageing.

One of the frustrations older people often express is being treated as one homogenous group with services provided as if one size fits all.

In my studies, not only have older people made a clear distinction between the experience of loneliness and social isolation, but they have also made a distinction between the types of activities that are appropriate depending on whether someone is socially isolated or lonely. This, however, is rarely taken into account, with organisations indiscriminately continuing to provide groups for socially isolated and lonely older people, befriending services for those who can’t get out of the house, and volunteering for those who insist on doing something meaningful.

I’m not saying that these services and activities don’t have a place, but if it was that simple, loneliness in later life would have been relegated to our public health history books a long time ago.

There are some sparkles of light at national and international policy level, however, with for example the Department of Health’s recent New Horizon guidance document on mental health and well-being including the prevention of social isolation and loneliness among older people as top level evidence for developing sustainable connected communities, and AgeUK identifying the reduction of loneliness as one of its key campaigning areas. Globally older people are also coming to the forefront through, for example, the United Nations proposal for a UN Convention on the Rights of Older Persons. And next week the Spanish Presidency of the Council of the European Union hosts a conference in Madrid on Mental Health and Well-being in Older People, which will mark an important milestone in the way older people’s well-being is prioritised in the EU.

It is important that this high level activity takes place, because without it priorities with regards to older people would not change. However, as action programmes and research have demonstrated, without older people’s direct involvement in shaping these policies, the impact of these changes may be short-lived.

One thing we shouldn’t forget is that the transition into old age doesn’t have to be filled with dread. A few weeks ago, a good friend asked me if my presentation would have any positive messages to give in addition to some of the more sombre accounts of older people’s lives. And, there are of course plenty of examples of older people with solutions rather than problems. Some years ago, my father, an architect, visited a leisure centre he had designed for a Finnish pharmaceutical company. Among those he talked to were five older men who met every week to play cards. These men had all led active, fulfilling lives [two of them were well-known professors] and had come together for the company and for something to do. I suspect that loneliness had not been a major issue for any of them, but they also had the resources available to them to prevent becoming lonely in the first place. The slightly unusual thing about this group was their age; four were between 100 and 104 and the youngest was a mere 97. Shortly after, my father heard that the youngest member of the group had died, and that his son had replaced him in the card group. Apparently, the four older men were not happy, not because he couldn’t play cards, but because… it brought their average age to below 100.

Could these 5 men have foreseen what their journey into old age would be like? I started this presentation by asking what shapes our expectations of old age.

There have been enormous changes in the way we view old age and our expectations of old age, from the time my Great Grandmother was born in 1872, through to my father, now in his 80s, who expects to be able to work and lead an active life. So, what about the future? What are our expectations of our journey into old age? Technology is often flagged up as the panacea to preventing older people from becoming socially isolated and lonely, but I suspect that we will continue to have the same needs for human contact and interaction as previous generations. Technology will provide some tools but not the complete solutions. With family structures becoming increasingly more complex our interactions with family and friends will change, and I think we will see more imaginative ideas for co-habitation and the support we require.

As for me, what expectations do I have for my journey into old age? Based on years of research and best scientific evidence I want to mention the most important on my well-being list [and some of them are here tonight]: my partner and companion, and my children and step children and little Erin and of course my many friends.

Thank you

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