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One of the grave concerns and issues that the COVID-19 pandemic had spotlighted on are the dangers of prolonged social isolation. Although social distancing was needed at that time to curb the spread of the COVID-19 infection, the effects of isolation has led to some health concerns now. SPD senior social worker, Angela Chung tells us why social isolation is now considered a silent epidemic that we can no longer ignore.
Social Isolation and Loneliness as a Public Health Issue
In recent years, many healthcare providers worldwide are beginning to realise that social isolation and loneliness are no longer a minor health concern. United States Surgeon General Dr Vivek H. Murthy said that the dangers are akin to smoking.
In an advisory, Dr Vivek said: “It (loneliness) is associated with a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety, and premature death. The mortality impact of being socially disconnected is similar to that caused by smoking up to 15 cigarettes a day, and even greater than that associated with obesity and physical inactivity.”
Indeed, social isolation and loneliness can be unbearable as in the case of a 51-year-old unemployed Japanese woman who was investigated by the Police after she allegedly made repeated emergency calls to dispatch ambulances to her home. Media reported that the suspect later divulged that she was driven to make those calls as she was lonely and wanted someone to talk to. This sobering disclosure appears to be the tip of the iceberg indicating that pockets of population who are living in the silent epidemic of social isolation and loneliness are crying for help.
Differentiation Between Social Isolation and Loneliness
There are some subtle differences between social isolation and loneliness but both are inter-related. Social isolation is defined by an objective lack or low number of social relationships that the person could relate to. Whereas loneliness describes the subjective experience that arises between one’s desire for social connection and the actual experience of it.
Loneliness also depicts how a person feels emotionally about their social situation. For example, people who live alone and are socially isolated, either by choice or by circumstances, may not feel lonely if they enjoy their solitude.
On the contrary, a person who is surrounded by family and friends including living in a multi-generational household, may experience profound loneliness. Therefore, the age-old adage of “one can feel lonely in a crowd” rings true. This loneliness could arise from out of a lack of true social connection and intimacy experienced between lonely individuals and their loved ones. Hence therein lies the real irony.
WHOQOL as a quality of life assessment tool that measures social relationships
The WHOQOL is a quality-of-life assessment tool developed by the World Health Organisation that could be applied cross-culturally across different population groups. One of the six domains focuses on social relationships. It seeks to measure the strength and quality of social relationships in a person’s eco-system. This signifies a need for practitioners to pay attention to the respondent’s social relationships as an important determinant and measure of their quality of life.
Role of social worker in supporting socially isolated persons with disabilities in the community
In my work as an SPD social worker supporting persons with physical disabilities in the community, I have often encountered socially isolated individuals living alone in a single-person household. Most are single (could be divorced, widowed or never married) and have acquired their permanent disabilities later in life. Journeying with these individuals have made me realise that they are living with a heightened risk of being unable to support themselves independently in their activities of daily living (ADL) as they age in the community.
Occasional accidents like falls in their homes are expected, resulting in frequent hospital stays. During their hospitalisation, healthcare professionals would have taken the opportunity to explore institutional care as an option for their future care plans. Anecdotally, it appears that these socially isolated individuals with disabilities remained adamant on living alone in the community despite knowing the risks involved. Their resistance towards institutional care could stem from their fear of stigmatism associated with being such a care arrangement.
As a social worker, we acknowledge that these clients, who have no cognitive deficits, still reserve the choice and right to make their own decisions regarding their living arrangements and future care plans as they are cognizant of the inherent risks of living alone with prolonged loneliness and social isolation.
Befriending as a community solutioning to allow facilitated conversations and meaningful connection
As a community social worker, one of my roles is to partner my clients to expand their community touch points. To this end, I adopt the community befriending approach.
This involves the social workers tapping on volunteer management support to match suitable befrienders to socially isolated clients for regular befriending sessions at their homes. These regular sessions form an essential lifeline that is instrumental in relieving the clients’ sense of social isolation whilst also ensuring that they remain under the radar of community helplines.
I remember one of our elderly clients Mdm Tan (not her real name) who is a widow living alone in a 1-room HDB rental flat in an area with a sizable senior population. There is even a Senior Activity Centre (SAC) at her void deck. As social workers, we will normally use the P-I-E (Person-in-Environment) principle in our casework assessment of our clients’ functioning in their respective environments. Hence, I was curious to find out how Mdm Tan relate to other seniors at her SAC. On one occasion, we dropped by the SAC together and made some interesting observations.
The more extroverted seniors were hogging the karaoke system and very happily, belting out songs after songs. On the other hand, the more introverted seniors like Mdm Tan were seen sitting alone amongst other seniors. No one came over to say hello nor interacted with her. In the end, we went back to her flat for a chat. That SAC visit was a lightbulb moment for me: I realised that we could still feel lonely in a crowd due to a lack of meaningful conversations and connections.
However, there are still many health benefits to participating in group activities such as joining the Active Ageing Centres (AACs) which the Ministry of Health is rolling out in the next few years. This national initiative encourages seniors to be more active and socially engaged so that they could age in place gracefully. Even Prime Minister Lee Hsien Loong in his 2023’s National Day Rally speech spoke about the need to expand the network of these AACs in our rapidly ageing population. The good news is that services offered at these AACs will also be enhanced to keep an expanding and diverse pool of older people engaged, active and healthy in the community.
Another senior who I remember quite vividly is an octogenarian named Mdm Lim (not her real name) who was separated from her family and relatives during the second world war. Hence, she has no next of kin. During my home visits, I would encourage her to attend the activities at the SAC at her void deck whenever she could. As I was curious about her social functioning, I asked to accompany her to the SAC. While she was there, I observed that she was teased by other seniors for her faith, and she appeared uncomfortable. We made our way back to her home soon after. Reflecting on what had happened, it appeared to me that being in large group is not always the only solution for some seniors, especially those with introverted personalities.
After giving some thoughts, I decided to introduce Mdm Lim to one of our volunteers, Ms Josephine Lee, who befriended and journeyed with Mdm Lim for over a decade until her demise.
While Mdm Lim had the option to attend the SAC whenever possible, Mdm Lim needed facilitated conversations with a dedicated befriender whom she could have meaningful conversations and form deep social connection with.
When Mdm Lim was diagnosed with dementia and had to be admitted into a nursing home as she could no longer care for herself, Josephine, our committed volunteer remained by her side and continued to visit her regularly at the nursing home till she passed on. Josephine had remarked that even though Mdm Lim or Ah Por’s (affectionally termed by us, meaning grandmother in Cantonese) dementia had robbed her of her precious memories, Ah Por still remembered Josephine and called her “my goddaughter”.
Josephine’s befriending stints were spurred by her late mother’s loneliness when she became immobile and stayed home due to various health ailments. With a sincere heart and desire to bring smiles to our beneficiaries, Josephine went on to befriend at least three of our SPD beneficiaries at their own homes.
“Smiles from my befriending clients were very rewarding. It is a return I received that no dollars and cents can substitute. Working with beneficiaries changes my perspectives on life. Befriending makes me become thankful for what I already have as well as I have become calmer and more appreciative of life,” said the long-time SPD volunteer.
SPD befrienders provide such a valuable partnership in our case management work that it is our earnest expectation that many of our socially isolated and lonely clients with disabilities in the community could experience the benefits and joy that befriending bring.
Conclusion
There is a growing body of evidence that suggests social isolation is a powerful indicator of health and mortality. We can no longer ignore the profound adverse effects of prolonged social isolation and loneliness potentially faced by persons with disabilities living alone in the community or even within households. Their physical limitations coupled with their lack of IT connectivity predispose them to the heightened risk of being socially and digitally excluded from mainstream society.
Indeed, social isolation remains an underappreciated determinant of physical health. As the population is greying rapidly, it is our earnest expectation that the healthcare system starts to view social isolation and loneliness as a public health issue with the same urgency as combating chronic diseases such as diabetes, high blood pressure and cholesterol.
In the same vein, combating social disconnect is not just a social service agency’s role, but the larger community who could step up to volunteer, reach out and befriend these socially isolated and lonely individuals hidden behind closed doors. May there be more conversations on battling social isolation and loneliness to remove the stigmatism that comes with the admission of one’s loneliness. The pandemic has taught us a painful lesson of the prevalence and perils of social isolation and loneliness in our communities, may we all learn from this episode and start connecting.
References
https://www.sciencedirect.com/science/article/abs/pii/S2352250X21001111
https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf
