Loneliness is both a state and a feeling

Written by Rachell Wass for the hello leaders Summer-Autumn Print Publication.

Mental health is at the top of everyone’s care strategies post the COVID-19 pandemic and has shown us how crucial it is to have well-trained and educated staff, especially when it comes to dealing with the intangible aspects of a resident’s life.

Recently I was presenting at a loneliness event when an audience member posed a question that I believe resonates with many providers and caregivers in aged care: despite efforts to engage in social activities, why do interactions often remain superficial, confined to pleasantries, and fail to foster deeper connections? This question reflects a pervasive experience of feeling alone even amid a crowd for a growing number of older Australians.

The reluctance to unveil one’s true self in social settings can be attributed to many factors, especially for those in the minority regarding identity, culture, belief, ability, or lifestyle. We live in an era marked by polarisation. People are often reluctant to reveal perceived vulnerability. Research has shown that over 80% of Australians prefer to disclose a mental illness rather than admit to loneliness.

For diverse older Australians, these challenges are compounded by intersectionality, communication barriers, cognitive decline, homelessness, isolation, and neurodivergent experiences. Loneliness exists in different forms, from situational to existential. Despite the notion that we experience increased happiness after the age of 70, ageing demands of us to navigate many transitions, losses, and separations, testing one’s mortality, financial stability, and emotional resilience.

Acknowledging the diversity among older people is crucial to offer true support. Diversity is recognised in the draft revised Aged Care Quality Standards, defining diversity as: ‘encompassing various needs, characteristics, and life experiences, including social, cultural, linguistic, religious, spiritual, psychological, medical, or care needs, as well as diverse gender and sexuality identities. (DOH, Revised Aged Care Quality Standards 2023).

With the heightened awareness of identity and belonging, emotional well-being emerges as a cornerstone for aged care transformation in Australia. Creating environments where our older Australians can feel genuinely at ease and at home is imperative, and loneliness poses a significant risk to achieving this goal.

Loneliness, both as a state and a feeling, can be intensified by external factors and exacerbated by mental health issues, past trauma or even the built environment. Many older people as recipients of aged care have a stoic attitude to hardship, coupled with feelings of shame and embarrassment, that in turn contribute to the hidden nature of loneliness. For those living at home, according to the Australian Bureau of Statistics Australians over 65 are increasingly likely to live alone, living alone is one of the common causes of social isolation.

And loneliness is painful. ‘It entails immense emotional suffering. However, some people think we are talking about solitude. Solitude is often a chosen circumstance and one that we associate with a pleasant time for oneself. Yet, loneliness is not positive ‘me-time’ or ‘self-care’’ (Neves, B, 2022).

But recognising that not all loneliness is alike is also important. Different types and reasons exist, necessitating an understanding of contemplative aloneness across faiths and cultures, changes in mobility or sensory abilities, and the ability to identify and differentiate social, emotional, and existential loneliness.

Aged care staff can help by identifying what is important and fulfilling for everyone through conversation, relationship-building, and a willingness to listen and learn. This awareness becomes even more profound when staff reflect on their own sources of fulfilment and connection. To truly respect the diversity within the sector, efforts must encompass both older individuals and the staff caring for them.

For those who work in aged care, it is important to know how to have conversations about the circumstances and situations that might lead to loneliness for every individual in their care.

As our colleague, Jacquie Molloy points out: It can be difficult for people to honestly answer the direct questions of ‘How are you feeling?’ and ‘Are you lonely?’ especially absent of a trusted relationship. (This applies both to staff as well as the older people they care for.)

It is even more difficult, without support and preparation, to know how to recognise and respond appropriately – and without patronising someone, especially if that person is not someone who is used to yielding or who does not even understand that the discomfort or distress they are feeling is a type of loneliness.

For example, emotional loneliness can be experienced as a lack of connectedness to what is most important (which might not even be about being with other people) whereas existential loneliness is not so much about a lack of connectedness but rather being in a state of separateness from others and the world, including the natural world and a sense of creativity and wonder.

It is only social loneliness that is about a lack of human-to-human connections. But if social loneliness is due to the lack of a particular type of person, then no amount of social interaction would satisfy that which is not there. An example of this might be for a Buddhist who has a strong personal faith and practice but who no longer belongs to a sangha and feels this lack of connection. Unless you know and perceive this you would not easily recognise it.

It is important therefore for staff to be able to identify what is most important and fulfilling to someone. One of the important ways to do this is through conversation and relationship and a willingness to listen & learn.

Even better if staff can reflect on what is important for them and their own fulfilment and connection. (If we are to truly respect our diverse sector and be wholly inclusive then we must include in our efforts both older people and the staff who care for them.)

In the words of Rev John Swinton, a research consultant with Meaningful Ageing Australia and Chair in Divinity and Religious Studies, University of Aberdeen, ‘In order to feel that we belong, people need to affirm us, to notice us and to offer the gifts of time and friendship’.

As a timely coincidence, this week, the World Health Organisation (WHO) took a significant step by launching a commission aimed at fostering social connections, further underscoring the global importance of addressing loneliness.

Rachael Wass has a solid foundation in Health Sales Account Management spanning over 25 years. She is a carer and spiritual practitioner and her passions include learning about indigenous culture, meditation and philosophy, pilgrimages and the power of song.