Loneliness and Dementia

In the recently-published Bulletin from Affinity’s Social Issues Team, this article by Roger Hitchings focuses on the often-misunderstood link between loneliness and dementia.

Loneliness is a major issue in our society and something that affects people of all ages and situations. It is generally well recognised that social isolation and loneliness can adversely affect people’s general health and sense of well-being, and so needs to be addressed. The Alzheimer’s Society website, under the heading of loneliness, suggests that the lack of social connections can damage a person’s health as much as smoking fifteen cigarettes a day. They also claim that loneliness increases the risk of dying by 29%. Conversely, it is also known that strong social networks and support can enhance recovery rates from serious illness. Older people are one of the most affected groups in society as far as loneliness is concerned.

The Royal Voluntary Service, previously known as the WRVS, published an analysis in October 2018 on the impact and value of Lunch Clubs. One of their observations was that of the ten million people over 65 in the UK, four million live alone and one million say that they are lonely. Part of the reason for this loneliness is that they are no longer able to drive and they have difficulty going out, especially for shopping, and specifically that they eat alone. They also point out that by 2023 the number of people over 65 will rise to thirteen million which will bring increased demand for community-based support services. The Alzheimer’s Society report that half a million older people claim that they do not speak to anyone for periods exceeding six days a week. It should be noted that being alone is not the same as being lonely. Loneliness is about a person’s expectations, the perceived absence of social attachments, so that someone can feel lonely when among a crowd.

The NHS website ‘Moodzone’ has a page on ‘Loneliness in Older People’ which is dated 30 November 2015 (it is due to be updated on 30 November 2018). In this article they state that ‘according to Age UK, more than two million people in England over the age of 75 live alone, and more than a million older people say they go for over a month without speaking to a friend, neighbour or family member.’ A number of reasons are given for this social isolation including ‘getting older or weaker, no longer being the hub of their family, leaving the workplace, the deaths of spouses and friends, or through disability or illness.’ One of the outcomes for many older people is the development of ‘depression and a serious decline in health and wellbeing’. It should be noted here with sadness that family support networks are often very fragile and limited.

These kind of statistics are becoming more commonly known as public perception of the reality of social isolation and loneliness is better informed. But what are the effects of loneliness? And how does loneliness relate to dementia.

A review of 19 studies on loneliness undertaken in July 2015 and reported on by Science Direct (volume 22, pp39-57) found that ‘low participation, less frequent social contact, and increased loneliness are significant in the incidence of dementia’. The Alzheimer’s Society claim that there is a 64% increase in the likelihood of dementia when people experience persistent loneliness. This figure is based on a study undertaken in Holland in 2012. Details of this research are published at www.alzinfo.org/articles/feeling-lonely-increases-risk. I quote:

The researchers followed 2,173 older people, ranging in age from 65 to 86. None had dementia at the start of the study, which lasted three years. About half lived alone, and one in five reported feeling lonely. The study participants also were given memory and thinking tests to look for signs of serious memory loss and incipient Alzheimer’s disease. After taking account of socioeconomic status and concurrent medical problems, the researchers found that those who felt lonely were more likely to develop dementia. Those who were socially isolated but didn’t feel lonely, on the other hand, were not at an increased risk of developing dementia.

A number of explanations can be given for this impact of loneliness. Alzheimer’s disease is a complex condition that probably has a number of different causes. Among those are contributory factors which, while not causing the disease directly, influence and strengthen its progress. These factors include stress and anxiety, exercise and diet, social and intellectual engagement, as well as advancing age and genetic factors. Loneliness creates considerable stress and anxiety and may also have an effect on the nervous system, but this latter suggestion has yet to be established.

The Alzheimer’s Society undertook a survey in 2013 of over 500 adults with dementia. This showed a number of causes of loneliness:

• Loss of confidence after diagnosis (speaking from 45 years personal experience of working with people with dementia this is often exacerbated by a failure by medical services to give adequate and accurate information about the condition and how to respond to it).
• Fears of becoming confused and getting lost – people living alone have no-one to go out with and so stay in the safety of their own home.
• Mobility difficulties and other physical impairments.
• Half the people surveyed said they had lost friends once they had been diagnosed.
• Forgetting that people have visited and so feeling loneliness (perception is critical to the feeling of loneliness).

The survey highlighted the importance of family and friends for socialising and being able to leave the house. Anecdotal evidence would strongly support all these factors. Also, dementia often brings with it increasing memory loss, more frequent periods of confusion, loss of skills, changes in personality and depression. All of these can intensify a sense of loneliness. To be diagnosed with dementia is, for many people, like a sentence where the punishment is loneliness. 

The required responses to loneliness will vary according to each individual situation, the personality of the person with dementia and the general health of the person. It is only recently that there has been a growing awareness of the degree and impact of loneliness on older people. Many initiatives have been started by groups working with older people suffering dementia and loneliness. GPs have now been encouraged by Government to prescribe activities for those who are lonely. But the task is a huge one and goes to the heart of the nature of our society.

It is at this point the church should come to the fore. Thankfully some churches have done so with great effect and are to be applauded for their initiatives. Indeed, it has to be said that many of those churches who have done so have found that along with their caring initiatives have come wonderful opportunities for the gospel both with lonely older people and with their families and others in the community. It has been a privilege to go to a number of churches to speak about ageing and associated issues, and especially dementia, and to find excellent work being done for the glory of God. A great promoter of new initiatives is the website of Faith in Later Life (https://faithinlaterlife.org).

But there are more churches doing little or nothing than there are those taking the opportunity to reach out to older people. I started the article with reference to the Royal Voluntary Services comments on Lunch Clubs. For a large number of churches this is the full extent of their work with older people. That should not be minimised but it is not an adequate response to the massive need in our communities, and even in our churches.

Again, speaking out of personal experience, I recently had a conversation with a member of a gospel church that has a large congregation, a very comprehensive range of activities for younger people, young mums and single people, but scarcely anything for older people beyond its Sunday services. Yet it had a significant number of people over 70 attending or associated with the church. The idea that some of those older people could be lonely was a shock and was totally rejected by this person who was an office bearer. But I had been able to hold good conversations with several of the older people in that church, and it was tragically clear that loneliness was a real issue. Indeed, the situation was exacerbated in that the Sunday services tended to be less accessible to older people. As might be expected, several of the older people I spoke with had the beginnings of dementia, but there was no formal support in place for them.

It needs to be remembered that many Christian older people will not raise their own personal feelings of loneliness. This is partly because they will feel it sounds ‘unspiritual’, a comment made to me innumerable times. Or I frequently hear the following sentiment: ‘I should be more content and believe the Lord is with me, even though I don’t feel Him.’ Then again there is the dread of being a burden, even though there is a requirement on all believers to ‘bear one another’s burdens’. And while Galatians 6:2 is speaking about spiritual issues, practical concerns are not excluded, especially since the practical influences the spiritual. We must face the fact that there will be some godly elderly saints who still feel very lonely, even though they may be in church on Sunday morning.

A difficulty for those who would support older people is that conversation with someone with dementia can be difficult. So people may shy away, leaving the older person feeling a degree of rejection, which increases feelings of loneliness. Churches should do much more to equip leaders and members to be able to respond to people with dementia. Pilgrims’ Friend Society do a range of seminars and workshops which would greatly help (https://www.pilgrimsfriend.org.uk).

The New Testament has much to say about mutuality. The whole range of ‘one anothers’ emphasise the responsibility of every believer to minister to and care for each other. There is no age limit placed on this duty. Indeed, in Philemon v9 the Apostle Paul expects his advanced age to be one reason why others should listen to him. Churches need to be much more aware of the situation of their older members and develop responses that will suit their own resources and minister to the plague of loneliness which exists in our own midst. Then, of course, there are the opportunities for reaching out to lonely older people in our community, and through them to many others.

Loneliness can be a contributory factor to the development of dementia. And people with dementia often feel very lonely, which only intensifies their condition. These people are in our churches and on our doorsteps. May God give us wisdom and compassion to respond to a growing need.

Roger Hitchings

Roger Hitchings retired in 2011 from the pastorate of a small church in the East Midlands after 15 years of ministry. Previously he worked for 23 years in the field of social welfare with a particular emphasis on older people, and continues with that area of interest through writing and speaking.

(This article was originally published in the Affinity Social Issues Bulletin for November 2018. The whole edition can be found at www.affinity.org.uk)

The Social Issues Team publishes The Bulletin three times each year, containing information about current issues relevant to churches and Christians.

A PDF of this article is available to download here.

The whole issue of the latest Bulletin may be downloaded here:

The Bulletin – November 2018