As another Christmas approaches and the Third Sector gears up their efforts to ensure that those facing isolation and loneliness are supported at such an important time, a worrying trend appears to be emerging.
Faced with the fact that, as our new research has found, some 2.5 million people over 65 wouldn’t know where to go to get support for loneliness – it seems that our A&E and GP services are being increasingly visited by lonely individuals. Indeed a new report by the Scottish Parliament released just last week generated headlines that loneliness is prompting older people to visit their GPs and A&E.
Perhaps rather than falling back on easy stereotypes about ‘bed blocking’ and indulging in lazy ageism, we should make a real effort to understand the factors which are leading to so many older people finding their way to A&E. We need to think about how they can be better supported before arriving at the hospital doors, and once they leave, how we can reduce the shockingly high number of readmissions amongst older people.
There are of course countless reasons that lead to older people ending up in this situation. But here, we want to emphasise the role that loneliness and social isolation can play. Loneliness and isolation must be taken into consideration; firstly when examining underlying causes of why people end up at A&E, and secondly, when trying to identify solutions. These solutions should be focused on preventing the escalation of care need and avoidable hospital admissions and readmissions.
A study from the South West Academic Health Science Network showed a clear link between social isolation and care needs in people over 75 admitted to A&E. There are many reasons why this is this likely to be the case, such as:
- Loneliness increases the risk of hypertension and associated conditions such as stroke or heart attack
- Loneliness is also known to put individuals at great risk of cognitive decline and the onset of physical disability
Lonely adults are more likely to be smokers, and loneliness is a maintaining factor in alcohol abuse and in attempts to give up alcohol. There is also some evidence that older people who are lonely are more likely to be readmitted to hospital. Older people can be especially vulnerable and frail following a stint in hospital, and often require careful management of their health conditions. Currently, 13 per cent of over-75s are readmitted within three months of discharge, and whilst most are relieved to return home once discharged, some older people feel anxious at the prospect, particularly those living alone.
There are some fairly simple steps, which have proven to be highly successful in reducing admission and readmission to hospital, working specifically with lonely and isolated people. A good example of one of these interventions is the Dorset Befriending Service. The service was originally designed to increase self-confidence of patients who were identified as needing emotional support, and who were making numerous visits to their GP surgery, sometimes with unexplained symptoms and were also seeking admission to hospital at night. It was considered that the main causes were loneliness, panic and an inability to cope with life. The costs to the NHS were huge.
Generally, befrienders, either on the phone or in person, offer support and reassurance. They also encourage the older people they work with to engage in social activities. GPs at the surgery reported fewer appointments for the older people involved and an assessment of the GP and unscheduled hospital visits of six of the participants prior to and post their participation in the scheme indicates significant cost savings for the NHS (£80,000 for these six alone).
To understand why support services such as this are successful, we need to get to the bottom of why people are returning time and time again to their GP and to A+E. Local authorities place heavy emphasis on the primary prevention of poor health – such as smoking cessation, housing, and ‘winter preparedness’ to reduce excess winter deaths. We strongly advocate that services to prevent or alleviate loneliness and isolation should be invested in as part of a primary prevention programme to maintain independence in older age for longer and ensure everyone has the connections they need in later life.