Author: Fran Abrams, Chief Executive, Education Media Centre

Lessons for policy-makers on social isolation and its links to health have been highlighted at a policy event hosted by the International Longevity Centre UK with the UK-Japan SWAN project.

Among the key messages from the event were:

• Relationships between social isolation and health are complex, and subject to cultural influences.
• More older people are socially isolated in Japan than in the UK, but isolation is more strongly linked to poor health in the UK.
• Older men were more likely to be socially isolated than older women in both Japan and the UK, and were more likely to suffer poor health.
• Most older people have little or no regular engagement with arts activities.
• Those older people who do have sustained engagement with the arts also report better health.

Survey evidence shows us that social connections play a crucial role in maintaining health in later life. Yet such relationships vary across countries and are shaped by cultural contexts. This event aimed to examine those variations and their implications.

Lessons from Japan and the UK

Dr Noriko Cable reported some initial findings from the Social relationships and Wellbeing across Ageing Nations (SWAN) project, which started January 2019 and explores the cultural meanings of social isolation among older people in England and Japan.

The study uses comparable data from longitudinal studies in the two countries – mainly the English Longitudinal Study of Ageing (ELSA), which has involved more than 18,000 over-50s since 2002, and the Japanese Study on Ageing and Retirement (JSTAR), which is a comparable study of over-50s. Both countries have ageing populations and it is hoped lessons for policymakers can be learned in both.

Findings from the project will be published soon, and Dr Cable, who is a member of the research team and is based at the ESRC International Centre for Lifecourse Studies at UCL, described some key themes which have emerged.

The study has found greater levels of social isolation among older people in Japan than in England, and across both countries greater levels of isolation and of poor health among older men than among older women. However, the links between social isolation and poor health were weaker in Japan than in England.

Dr Cable said these findings were particularly important after COVID-19 and could help to highlight complex relationships between social isolation and health outcomes. After the pandemic, the focus on healthy ageing will be sharper, she suggested, as the crisis has led to concerns about increased loneliness and mental ill health among older people.

Researchers on the SWAN project were able to use data from ELSA and JSTAR to gather information on household members among large samples of families, and to examine both their relationships to one another and the frequency of contacts they had with other family members such as non-resident children. The researchers wanted to look at the overlaps and differences between families in the UK and Japan.

They were also able to gather data on social isolation and loneliness from ELSA and from another Japanese cohort study, the Japan Gerontological Evaluation Study (JAGES), which started in 2010 and has gathered data from more than 100,000 over 65s living independently. These two studies also yielded data on physical and mental health conditions, exercise, drinking, smoking and body mass index (BMI), as well as on functional disability and mortality.

Lessons from the arts

Dr Ula Tymoszuk, a member of the SWAN research team, described findings from an arts-focused project which will also have deep relevance for older people after COVID-19.

The HEartS project focuses on the health, economic and social impact of engagement with the arts among older adults. It is led by the Centre for Performance Science, a collaboration between the Royal College of Music and Imperial College London.

This study also uses data from ELSA – in this case about older peoples’ engagement with three types of arts activity: going to concerts, the theatre or opera; visiting museums or galleries; and visiting the cinema.

The findings, drawn from around 2000 older adults, show that a significant majority of older people reported little or no arts engagement – only around half ever went to the theatre, a concert or an opera, while 60% never went to galleries or museums and 56% never went to the cinema.

Only a small proportion reported sustained engagement with the arts over several years: around 22% went often to the theatre, concerts or opera over time; 15% to galleries or museums; and 18% to the cinema.

Yet those who engaged with the arts at least once a month had 50% lower odds of depression than those who never did, and those who engaged every few months had odds 30-40% lower. However, short-term engagement was not linked to any similar effect.

Dr Tymoszuk said the findings could have particular resonance for policymakers at the current time:
“They suggest that policies should be put in place that support people’s access to arts engagement, but also support them in continuous ongoing engagement over time. The benefits that are derived for arts engagement are mainly there for engagement when it’s sustained,” she said.

Statistics from Age UK showed 1.2 million people in the UK are chronically lonely and that half a million older people often went at least 6 days a week without seeing or speaking to anyone.

A methodological note

Tarani Chandola, Professor of Medical Sociology at the University of Manchester, offered some cautionary notes on methodological issues which can arise when studying social relationships across cultures.

Cultural norms can mean that people in different countries tend to answer the same questions differently, he suggested. For instance, studies focusing on British, Japanese and Finnish civil servants found Japanese men appeared to report worse health than counterparts in Britain and Finland.

But on closer examination it transpired that in Japanese culture, people were more likely to respond “don’t know” or tend towards the middle of the scale – and this could have been behind the finding.
Similarly life satisfaction studies have found that people in Western Europe tend to report greater satisfaction than those in Sub-Saharan Africa – is this because of real differences in people’s lives, or are cultural differences also at play here?

The questions researchers ask may make cultural assumptions or use language which does not translate clearly, such as: “Did you feel full of pep?” and “Did you feel down in the dumps?”
All these factors need to be taken into account and where possible researchers should ask multiple questions in order to try to eradicate such bias. In addition, biomarkers such as grip strength – a good indicator of physical health – can help to supplement self-reported health information.

Survey evidence has shown that social connections play a crucial role in maintaining health in later life. Yet such relationships vary across countries and are shaped by cultural contexts. Survey instruments, even when harmonised, may miss out on some of this nuance. In addition, the nature of social relationships changes over time, and new measures may be useful or needed.

In recognising this, the SWAN team have explored existing datasets and engaged experts and stakeholders in both the UK and Japan to learn more about what needs to happen next. The work highlights:

• The differences between networks and support, i.e. the structural vs the functional;
• The measures that exist to capture social connections in different ways;
• And how different groups display varying patterns in their social relationships across key characteristics like gender and culture.

At a series of workshops held alongside the event, those engaged in conducting research on these issues from a policy perspective were able to collaborate and to network. Several participants discussed their own circumstances and the importance of staying connected in later life.

“I can relate to the shock of retirement, loneliness and social isolation,” one participant told the group. Despite a busy and successful life he had needed to find ways to stay active and connected, he said. Libraries had provided a vital lifeline, and continued resourcing for these facilities would be an important step.

Another participant, now in her eighties, was the sole carer for a disabled son and also ran a carers’ organisation which had been researching the challenges facing this group, both younger and older.

“Older and younger people do face mutual challenges, but one of the things that came through was a big motivation, given the way COVID-19 is shutting down libraries, sports facilities and social networking, I would use the opportunity now to begin to reinvent some of our town centres, to look at transport, to think of places where people could sit,” she said. “I think it’s a golden opportunity for any organisation interested in and concerned about disabled people to think about the future. Many of us who are older are providing services for the state – I think we can have a better future but we need to begin to plan now.”

A manager in a retirement community talked of a research project there, which was finding significantly better outcomes for its residents than for the general population. The Chair of the event, Dr Brian Beach, Senior Research Fellow at the International Longevity Centre, said this resonated with his own research findings.

“This question of more positive outcomes relates to some of the work I have done over the years looking at retirement communities as an environment that might facilitate positive experiences,” he said.

“Using studies like ELSA and data collected first-hand, there does seem to be lower levels of loneliness. There does seem to be some sort of mechanism and it’s very good that we have empirical evidence behind it to show the reduction in some of these more negative experiences.”

He said the day had shed light on the need for a variety of different approaches to help keep older people connected.

“Policymakers are trying to solve these huge issues that are complex and multifaceted, and making sure things stay on top of their agenda requires diligence. Things can easily get derailed by crises such as COVID-19”, he said.

You can watch a full recording of the ILC policy event hosted by the International Longevity Centre UK with the UK-Japan SWAN project here.