Loneliness

Background

Older adults were more likely to be socially isolated during the COVID-19 pandemic, with increased risk of depression and loneliness. The Behavioural Activation in Social Isolation (BASIL+) trial investigated whether a Behavioural Activation (BA) intervention delivered remotely could mitigate depression and loneliness in at-risk older people during the COVID-19 pandemic.

Methods

We undertook a multicentre randomised controlled trial [ISRCTN63034289] of BA to mitigate depression and loneliness among older adults (65+) with multiple long-term health conditions, including low mood or depression. BA was delivered remotely (telephone or video call) with intervention participants (n=218). Control participants received usual care, with existing COVID wellbeing resources (n=217). 

Results

Participants engaged with an average of 5.2 (SD 2.9) of 8 remote BA sessions. Adjusted mean difference (AMD) for depression (Patient Health Questionnaire-9, PHQ-9) at 3 months [primary outcome] was -1.65 (95% CI -2.54 to -0.75, p<0.001). There was an effect for BA on emotional loneliness at 3 months (AMD -0.37, 95% CI -0.68 to -0.06, p=0.02), but not social loneliness (AMD -0.05, 95% CI -0.33 to 0.23, p=0.72). For participants with lower severity depression symptoms (5-9 on the PHQ-9) at baseline, there was an effect AMD PHQ9 1.13 (95% CI –2.26 to 0.01, p=0.051), though this was less pronounced than for those scoring 10 or more at baseline (-2.48, 95% CI -3.81 to 1.16, p=0.0002).

Conclusion

Behavioural activation is an effective and potentially scalable intervention that can reduce symptoms of depression and emotional loneliness in at-risk groups in the short term. The findings of this trial add to the range of strategies to improve the mental health of older adults with multiple long-term conditions. These results can be helpful to policy makers beyond the pandemic in reducing the global burden of depression and addressing the health impacts of loneliness, particularly in at-risk groups.

Background

Loneliness is increasingly impacting older people in the UK and associated with poor health. The “Campaign to end loneliness” estimates that 1.2 million people are lonely. Age UK states that 2 million people will be lonely by 2026. For half of people aged >65, their main source of company is TV or pets.

Our objectives are to identify the prevalence of loneliness in the population presenting to Leighton Frailty Unit, develop a social prescribing tool to reduce this and highlight community services.

Methods

During September 2023- February 2024 we gathered baseline data on loneliness by encouraging staff to provide our questionnaire, based on the UCLA 3-item loneliness scale and Age UK guidance on direct loneliness questioning, to patients in chair spaces at Leighton Frailty Unit. We developed a social prescribing leaflet with activities in the local area using LiveWell Cheshire East. We re-contacted patients from cycle 1, repeated the questionnaire and asked if they had utilised the intervention leaflet.

Results

From Cycle 1, 53% of patients experienced loneliness, with 23% reporting “often” feeling lonely. From Cycle 2 when assessing the impact of the social prescribing leaflet, 37% of patients experienced loneliness, with 19% reporting “often” feeling lonely. Patients did not use the social prescribing leaflet, citing being unable to attend activities as a reason.

Conclusions

We are increasingly identifying and assessing loneliness as part of a CGA and raising awareness of services. Rates of loneliness may have reduced due to simply talking openly about it. However, engagement with the intervention was poor. Loneliness differs from social isolation, it is complex and multi- factorial. Community care connectors are an under used resource and could help support the issue of accessibility. We will ask them to deliver teaching to the Frailty Unit about their services and which patients would be suitable.