Dedication
Idedicateittomyparents: Howgreatitistobethesonofgoodparents.Theywillneverbealone.
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Introductionxi
1.Lonelinessinaging:concept,typologyandcharacteristics1
Introduction1
Thecontextofaging,socialchanges4
Demographicchanges4
Familychanges6
Changesinvalues7
Conceptualapproachtothetermloneliness8
Ageism10 Loneliness11
Typesofloneliness13
Characteristicsofloneliness19 Heterogeneity22
2.Explanatorymodelsofthecognitiveapproachtoloneliness25
Introduction25
Paradigmsrelatedtoloneliness27
Existentialparadigm28
Psychodynamicparadigm30
Interactionistparadigm32
Cognitivistparadigm34
Humanistparadigm.Person-centeredmodel39
Finalsynthesis.Paradigmscontributionsfromamultidimensional perspective44
3.Neuroscience:inthedirectionofbuildinginteractive bridgesagainstloneliness47
Introduction.Buildingbridgestoabetterunderstandingregarding loneliness47
Theneuroscienceofloneliness50
Lonelinessisinthebrain53
Proposalstopreventtheimpactoflonelinessonthebrainfroma comprehensiveperspective63
4.Theparadigmofactiveaginginthepreventionofloneliness67
Lonelinessinanincreasinglyagingworld67
Approachesoftheparadigmofactiveaging69
Theneedtobuildasocietyforallages79
Thecontextofactiveagingintheknowledgesociety81
Successfulactiveagingstrategiestocopewithloneliness84
5.Theimpactofsocialrelationsaspreventivemechanismsin lonelinessandqualityoflifeoftheelderly89
Introduction.Socialrelationshipsasavectorofloneliness89
Socialnetworksasahingefortheconstructionofsocialrelationships92
Socialrelationshipsasasourceofresourcesagainstloneliness96
Positiverelationshipsasavectortopreventloneliness102
Socialrelationshipsandqualityoflife108
Socialrelationsintermsofgenderandage114
6.Lonelinessfromapluralpointofview:immigrants,women, dependents,LGTBI119
RainbowlonelinessinLGBTIpeople120
Lonelinesswithinimmigrantpeople128
Pinklonelinessfromagenderperspective135
Lonelinesswithindependentpeople136
7.Designofinterventioninprograms,accompanimentactions, andpreventionoflonelinessintheelderly143
Introduction143
Theneedtopreventloneliness143
Planningstrategiesforthepreventionofloneliness146
Goodpracticestopreventloneliness149
Innovativeprojectsandinitiativestopreventlonelinessindifferent countries151
France.Programmobilizationnationalecontrel’isolementdesâgés
Monalisa156
Experiencesofgoodpracticesinthe fightagainstlonelinessinSpain159
Socialresourcestocombatloneliness163
Noninstitutionalresources165
8.Measurementtoolsandresourcesforlonelinessprevention167
Introduction167
Regardingmeasuringloneliness167
Lonelinessmeasurementscales169
Quantitativescales169
TheJongGierveldscale171
UCLAlonelinessscale175
EastScaleofsocialsolitude,oftheUniversityofGranada (EASTIandEASTII)177
EastlonelinessscaleI177
EastsociallonelinessscaleII178
Qualitativelonelinessmeasurementtools181
Tool1.Semistructuredinterviewtomeasurelonelinessanditsprevention183
Tool2.Caseanalysis188
Phase1.Selectacase190
Phase2.Datacollection190
Phase3.Dataanalysisandcasestudyreport190
Phase4.Showthechallengesthatthestudybringsanditstransfer191
Phase5.Showandpublicizethesolutionsprovided191
Phase6.Conclusions191
References191
References193
Index 199
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Introduction
Thisbookisstructuredineightchaptersthataddressthedifferentdimensionsofaconstructascomplexasloneliness,takingintoaccountthe mostrecentcontributionsfromneuroscience,psychology,medicine,and sociology,fromaninterdisciplinarypointofview,withspecialemphasison theelderlyfromapluralandheterogeneousperspectiveofthissectorofthe population.
Giventheimpactofthisemergingphenomenon,thebookisagreat opportunityforacomprehensiveunderstandingofloneliness,applying scientificknowledgetothepracticeofevidence.Toolsarealsoprovidedfor professionalsrelatedtothisissue,providinginterventionproposalsand effectiveresourcestocombatit.Beneath,thereisaschematicbreakdownof thecontentinthedifferentchapters:
In Chapter1,asaconceptualapproach,thebasicconceptsofunwanted lonelinessinolderpeoplearerecognized,takingintoaccounttheirtypologyandcharacteristics. Chapter2 analyzesthemainmodelsandapproaches whendefining,understanding,andaddressinglonelinessthatshouldbe appliedtoeachspecificsituationineachofthedifferentcontexts. Chapter3 focusesonthecomplexsystemoffunctioningofthebrain,takinginto accountthenewadvancesinneuroscience,inorderto findoutthe behaviorsandimbalancesthatgeneratedifficultiesincopingwithloneliness. Chapter4 dealswithactiveagingasaprocessofoptimizingthe opportunitiesthattheseprogramscanoffertoimprovethequalityoflifeof theelderly. Chapter5 developstheeffectsofpositivesocialrelationshipsasa determiningvectorinbothdesiredandunwantedloneliness.Inthenext Chapter6,lonelinessisexploredfromapluralpointofview,attendingto thecharacteristicsandneedsofthedifferentspecificgroupsofolderpeople: immigrants,women,dependents,LGTBI.Finally,withapragmatic intention,answersareprovidedfromamorepracticalperspective.Thus,in Chapter7,themainvalidatedtoolsandassessmentscalesfortheprevention ofunwantedlonelinessareshownand, finally,in Chapter8,amappingof activeandcommunityresourcesiscarriedout,aswellasthemain innovativeexperiencesintheinternationalarenathatareprovingeffective forthepreventionofloneliness.
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Lonelinessinaging:concept, typologyandcharacteristics
Introduction
Tobegintoapproachthissubjectofstudy,thenotionofagingcanbe understoodasthesetofmorphological,psychological,andsocialchanges thatoccurinthehumanbeingwiththeactionofthepassageoftime.In essence,itisatermcommontoallpeopleregardlessofcontext,gender, culture,oranyotherdifferentiationthatmaybeappreciated.
Thevastmajorityofdefinitionsrefertooldageasaspaceforthe protectionoftheelderlyintheareasofhealthandcare.Butthisvision limitstheabilitytodeepenthisobjectofstudybecausehealthhasasocial dimensionthatgoesbeyondtheabsenceofdisease,itisanissueinfluenced bymultiplefactors.Consequently,thepsychologicalandsocialdimensions arenotalwaystakenintoaccount,wheninrealitythefactofhavingan optimalqualityoflifehasamultidimensionalcomponent.Itisvitaltomove towardamorehumanizedvision,morefocusedonthepersonthattakes intoaccounttheneedsfromapsychological,social,andhealthpointof viewbeyondthediseasesthatavoidthestigmatizationofthegroup.Infact, someyoungpeoplehavemultiplepathologies,healthproblems,andforthis reason,thehealthsituationisnotassociatedwithloneliness.
Inaway,thisviewcomesfromdifferentstudiesthatpointtothecausal relationshipbetweenlonelinessandpoorhealth.Butitisworthwondering ifitisthelonelinessthatcauseshealthproblemsorviceversa.Poorhealthis whatleadstoisolationandloneliness.Itisabinomialofcomplexinterdependencebetweenhealthandloneliness,whichisfedbackinabidirectionalwaybecausethehealthsituationcanleadtolonelinessand, conversely,chroniclonelinessovertimetoillness.Still,aswesay,we cannotsimplifytherealityofthelonelinessoftheelderlytothedisease,a comprehensiveapproachofallitsdimensionsisrequired,contemplatingall
LonelinessinOlderAdults
ISBN978-0-323-91659-2
https://doi.org/10.1016/B978-0-323-91659-2.00001-6
aspectsofpeoplethroughoutthelifecycle,fromthemomentchanges occurintheirlifethatcausesloneliness.
Anotherfactortotakeintoaccountwhendefininglonelinessisits multiformcharacterbecause,underthesamenoun,verydifferentrealities areusuallyreferredto,dependingontheobjectiveorsubjectivevisionof thepointofanalysis.Thus,wemaybedescribinganobjectiveorobservable situationofinsufficientsocialrelations;refertothetypeofhomeinwhicha personlivesalone;talkaboutpeoplewhospendalotoftimealone,orelse attendtoamoresubjectiveapproachknownasafeelingofloneliness.
Therelationshipbetweenthesefacetsiscomplexsincetheexistenceofa socialfabricdoesnotimplythepresenceofarelationshipoftrustorthe absenceoffeelingsofloneliness,inthesameway,thatlivingalonedoesnot directlyentailthelackofsocialrelationshipsorthatthepersonsitsalone. Eachhumanbeinghasauniquevalue,astorybehinditthatdifferentiates themfromtherest.Withsomefrequency,thesetermsareusedinterchangeably,whichmakesitdifficulttohaveanadequatehomogeneous approachtothedifferentsolitudes.
Tothisrealitymustbeincorporatedtheidiosyncraticcharacteristicsof thedifferentsocietiesandculturesinwhichsuchsituationsoccur,which influencetheculturalmeaningsandinterpretationscarriedoutand, consequently,thesubjectiveperceptionoflonelinessbothintheindividual andthesocialsphere.Insomecultures,lonelinessisvaluedassomething logicalandevenasanachievement.Inothers,onthecontrary,itis interpretedinthediscourseofsocietyassomethingnegative.
Thischapterseekstoreflectontheconceptoflonelinessinoldage, fromacomprehensiveperspective,takingintoaccountitsdifferent thoughtsasacategoryofcultural,psychological,andsocialclassification, andtheimplicationsitmayhaveoncopingstrategies.
Forallthesereasons,itisimportanttodeepenthesearguments, dismantlingthestigmasaroundlonelinessintheelderly.Throughadeep discourseonitandtryingtoavoidperpetuatingtheculturalburdenofthe meaningofloneliness,withthesearchforindividualandcommunityactionsthatsupportpeopleinamoreadequatemanagementofthisphenomenon,whichisclosertothecurrentrealitywhichispluralanddiverse, afterdecadesofresearchinthisline.
Theconditionofelderlypersonsopensthespaceforconsideration regardingthewayinwhichthestructuresthatserveasspacefortheircare andmaintenanceintheirownandcommunityspacesshouldbeadapted,in awaythatisassimilaraspossibletoliveathome.Theobjectiveisclear:to
cushiontheimpactor180-degreeturnintheirlivesthatoccursinthe elderlybyanumber,bythemerefactofreachinganage,thattakesinto accounttheempowermentofthisagegroup.
Oldage,asaninescapablecycleofthehumancondition,ispermeated bymultiplechangesthatmakeitdifficulttounderstandandmakeit necessaryforallareasofknowledgetocontributetheirknowledgeto deepenthis field.Whenwerefertoaging,weusuallydosowithstereotypesaboutitslimitations,asnonproductivepeoplewhoshouldbetreated asanobjectofattentionwithoutmore.Thebiasofthisqualificationis givenbythepostindustrialsociety,whichdoesnottakeintoaccount nonproductivepeopleorwesimplystopbeinginterestedwhenweare recipientsofservicesorneedthehelpofothers.Consequently,theproblemsrelatedtothecareoftheelderlyarerelatedtothiscontextofwide significance.
Aswehavedescribed,itisadifficultconcepttoevaluatesinceallkinds offactorsarepresentintheinterventions,theprofessionalsandeventhe elderlythemselves,whoassumethesestigmasasschemesandlabelsinfluence.However,thesechangesarenotlinearoruniform,andtheirrelationshipwithaperson’sageinyearsisratherrelative.Insomepeople,they manifestthemselvesmorethaninothersandnotallofthembecomefragile, overcomingadversitywiththeirownpersonal,social,andmentalcapacities. Butagingisalsoassociatedwithotherlifetransitions,suchastheimpactof becomingemeritus,havingtochangelocationincaseofenteringaresidence,leavingone’shome,andgraduallylosingtheirwaysoflifebydisconnectingfromclosepeople.Forthisreason,itisimportanttoreinforce recovery,adaptation,andpsychosocialgrowthinthefaceofthechanges thataretakingplaceandthedizzyingrateofincreaseinlonelypeople.
Concerningthesubjectofthestudy,thefollowingchaptersarepresentedaccordingtothedescriptionindicatedinthe firstchapter,the determinationoftheproblematicsituation,approachedfromtheperspectiveofitsunderstandingandanalysisprocess.Todothis,wewill first addressthestateoftheart,aconceptualapproachtothetermolderperson aswellasitsmaincharacteristics.Theconceptofageismandthestereotypes associatedwitholdagewillalsobestudied,withtheaimofcontributingto theunderstandingofthedifferentdimensionsoftheproblemthatinturn serveasahingetothestudyoflaterchapters.But first,wecontextualize aginginthecurrentscenario.
Thecontextofaging,socialchanges
Thelongevityrevolutionisanovelandglobalphenomenonthathascome tostayasoneoftheunprecedentedsocialchangesintheWesternsocial structure.Moreandmorepeoplearegrowingup,theyarelonger-livedand theydosowithahigherqualityoflifethaninthepast.Thissocialphenomenonhasbeenpossible,thankstothescientificandsocialadvancesof thelastcentury.Goingtowardasocietyoftheelderly,ofcare,seemsan inexorablefactforthepresentcentury.Andinthissituation,lonelinessin agingisasocialchallengethatneedsspecialattention,asitisoneofthemost prominentepidemicsofthe21stcentury.Thesemilestonesareexplainedby aseriesofsocial,family,andvaluechangesexplainedhereafter.
Demographicchanges
Populationchangesindicateagrowingincreaseintheworldpopulationin theWesternworld,asopposedtothegradualdeclineinthefertilityrate.As ametaphor,Europecanbetransformedintoaseasideresortorresidence, whileAfricawillremainanursery.Throughoutthe20thcentury,life expectancyhasincreasedexponentiallyandthetrendisthatitwillcontinue todosointhecomingdecades.Thisincreaseinlongevityisareflectionof theprogressofsocietyinthehealth,economic,andsocialconditionsandof allthebasicaspectsofourmodernlifestyle,whichleadtoanevident improvementinsurvivalinoldage.
Butthesetransformationsworrythegovernmentsbecauseoftheincreasetheyrepresentinspendingonhealth,socialservices,andthedecrease inpublicincomefromworkincome.Althoughinsocialtermsthey representasocialsuccessthatthepopulationlastsformoreyearsandevery timeitdoessowithabetterqualityoflife,althoughfromsomevoicesit pointstoaneconomicproblem.Butregardlessofthepoliticalperspective, insocialthought,itisinterpretedasavalueorconquestofsocietythatit recognizesasitsownvalue.Olderpeoplearemorethananumber,andthey aresocialbeingswithsocialrightsincitizenship,whichtheyhave conqueredthroughouthistorythroughthesocialactionofgroups, movements,andlegislativeadvances.
AccordingtothelatestreportfromtheWorldHealthOrganization (2021a,b),peoplearelivinglongerallovertheworld.Currently,forthe firsttimeinhistory,themajorityofthepopulationhasalifeexpectancy equaltoorgreaterthan60years.By2050,theworldpopulationinthisage groupisexpectedtoreach2billion,anincreaseof900millionfrom2015.
Today,thereare125millionpeopleaged80andover.By2050,there willbeanalmostequalnumberofpeopleinthisagegroup(120million)in Chinaalone,and434millionpeopleworldwide(OMS,2021).Tothese generalpopulationindicators,wesyntheticallyaddglobalsocialtrends:
- Itisaglobalphenomenoninalmosttheentireworldwithdifferences betweenthenorthandthesouthoftheplanetbecausethelatterstill hasagapintermsoflifeexpectancy.
- ThegrowthrateismostrapidinEastandSoutheastAsia,LatinAmerica, andtheCaribbean.By2050,theproportionofolderpeopleisexpected todoubleinthesefourregions.
- Newmeasuresofpopulationagingbasedontheprospectiveageoryears ofliferemaining,progressivelyincreaseaslifeexpectancyincreases, pointingtoasloweragingprocessofthepopulationthanthatpredicted byconventionalindicators.Inotherwords,thedemandforhealthand socialservicesincreasesatarapidratethanageornumberofyears.
- Theindicatorssuggestthatthelevelofagingofthepopulationdepends onthepatternsofproductionandconsumptionbyageranges.Thisrate showsthatpopulationaginghasthegreatestimpactincountriesorregionswithhighproportionsofolderpeopleandhighlevelsofresources allocatedtothisgroup,suchasinareasofEurope,NorthAmerica, Australia,andNewZealand.
- Theagingofthepopulationdoesnotleadtomacroeconomicdeclineas mostalarmistreportsindicate.Moreefficientpoliciescanmaximizethe benefitsandmanagetherisksassociatedwithanagingpopulation.Some expertshaveclaimedinscientificforumssuchasthereductionofpsychoactivedrugs,sugar,andsaltinfood,togetherwithbettermanagementoftheenvironment,reducespendingandimprovetheliving conditionsofthepopulation.Tothis,weaddtheneedformore advancedpoliciesintermsofreconcilingwork,personal,andfamily life.However,thesearesocialrightsthatmustbeenjoyedastheyare recognizedintheWelfareStateand,therefore,arealwaysenforceable. Inlightofthesesocialtrends,weneedtoabandontheoutdated conceptionthatlifeisdividedintothreestages,wherethelasttwoor3 decadesareidentifiedwithdecline.Adifferentperspectiveofthepopulationcanopenenormouspossibilitiestobuildmoreequitableandinclusive societiesforallgenerations,wherelongevityisasuccess,notaburden,and intergenerationalactionbecomesthenorm,notanexception.
Theextensionoflifeexpectancyoffersopportunitiesnotonlyforthe elderlyandtheirfamiliesbutalsoforallcitizens.Thesavingsthat
governmentshaveinmanycountrieswiththesupportoftheelderlyin caringforgrandchildrenandotherfamilymembersarenotquantified.
Alongtheselines,allisnotlost,uponreachingacertainageitcanbe redefinedorreinventedasastageoffulfillment.Inthoseadditionalyearsof life,newactivitiescanbeundertaken,suchascontinuingstudies,startinga newprofession,orreturningtooldhobbies.Inaddition,olderpeople contributeinmanywaystotheirfamiliesandcommunitiesasproducersof well-being.Withadequateresources,olderpeoplecanlivethoseadditional yearsoflife,inanenvironmentconsistentwiththenaturalenvironment,in theirownhome,providedthataccessible,inclusivecitiesaredesignedwith adequatesocialsupportnetworks,health,andcommunity.
Ultimately,thelongevityrevolutionisaninexorablesocialfactin currenttimeandspace.Changesaretakingplaceinthesize,composition, anddistributionoftheworld’spopulationthathaveimplicationsforthe achievementoftheSustainableDevelopmentGoals,agreedattheglobal leveltoensurethatalltheworld’speoplehavedignifiedandprosperous lives.Todothis,wemustovercomeboththestereotypesassociatedwith olderpeople,aswellasthetraditionalsystemsofdemographicanalysis,to studytheagingofthepopulationfromothermorerealisticperspectives, whichareaimedattakingadvantageoftheopportunitiesthatthisphenomenonoffers,insteadoffocusonthedownsides.Itisaparadigmshiftto beseenasanopportunityforgrowthandprosperity.Thestartingpointis veryclear:addinglifetotheyearsandyearstolifewithinaninclusive societyforallages.
Familychanges
Thechangesthathaveoccurredinthepostmodernfamilyhavebeen crucialinthedynamicsthattheelderlypersonoccupiesinthissystem,as wellasintheattentiontotheirneeds.At first,thetransitionfromthe nuclearfamilytotheextendedfamilyledtoareductioninthenumberof membersandagrowingseparationwiththeascendants,whichcaused fragilityandruptureswiththefamilybondthatunitedtheentirenetwork. Overtime,familydeinstitutionalizationhasgivenrisetovariouspluraland diversefamilymodels,thefamilydiversifying,butfocusingonthecore person/coupleandprogeny,regardlessofthegenderorethnicgroupofthe couple.Thishasreducedfamilyfunctionswiththeelderly,focusingsupport andaffectivityinthereferencenucleus.Theyhavealsolostauthoritywhen makingdecisionsinthefamily,breakingwiththemythofthegrandfather
asthewiseconsultantwhowasturnedtoasamediatorinthefaceofa familydifficultyorconflict.Thislossofthesocialplacepreviouslyoccupied bytheelderlycanleadtoisolationand,therefore,toanunfavorablestateof mind.Inadditiontothis,thehecticandliquidmomentthatwelive,where thereislittletimeandspaceforfamilycommunication,toattendtoothers.
Allthese fluctuationshavehadanimpactonthesocialpositionofthe elderly,whoseehowtheygointothebackgroundanditisshockingfor thembecausetheyhavesocializedtheirchildrentoalsoobtainsupportand careinthefutureastheydidwiththeirchildren.Thenewdilemmamakes theolderadultgothroughthecycleoftheemptynest,experiencingin manycasesthedepartureoftheirchildrenandthelossoftheirpartner,who begintodevelopaseriesofaffection,communication,androledeficiencies thathaverepercussionsontheloneliness.
Ontheotherhand,socialchangesintermsofgender,togetherwiththe newworksociety,havebeenreducingtheroleofwomenascaregivers, whowerethosewhotraditionallytookcareoftheelderly.Inolderwomen, thishasanadditionalemotionalimpact,becausetheyarenotpreparedto takeontheirnewlifealonewithoutthissupport.
Therepercussionsofthechangesthathaveoccurredaredirect,asthe socialandemotionalsupportthatthefamilyimpliesintheelderlyis graduallylost,whoperformsthesefunctionslikenootherinstitutionand notonlybecauseofemotionalandcaringissues.Alsointheaspectof motivation,feelingthatsomeonecaresaboutyou,sharingyourproblemsis ofvitalimportanceinlifeforeveryone.Inthesameway,basiclifemanagement,decision-making,orhavingsomeonewithwhomtoshareyour experiencesarekeyelementsforpersonalwell-being.
Changesinvalues
Socialvalueshavealsochanged.Withrespectfortheelder,thesocialstatus grantedbyageinsocialpositionarevaluesthathavegraduallydissipated towardvaluesbasedonthedevelopmentofthepersonalityofeachmember ofthefamilyandautonomy.
Atthesociallevel,inthecurrentcontext,thereisaclashbetween modernityandtraditionthatisintroducingnewhabitsandcustomsthat movetraditiontothebackgroundandleadtheelderlytochooseadifferent world,seekingtoanchorthemselvesintheirhistory,theirethics,andtheir space.Thisconceptofwithdrawalisrelatedtothetheoryofdisengagement, whichstatesthatolderadultchoosestoisolatethemselvesandreducetheir relationshipsasawayofdetachingthemselvesfromtheirterritory.
Ontheotherhand,theprotectionoftheelderlyisnotavaluewidely sharedbysociety.Wehaveverifiedinthecovid-19pandemichowthe grouphasbeenmostaffectedbythishealthcrisis,withalargenumberof deaths,withoutanappropriateresponsefromthehealthandsocialservices systems.Millionsofdeathsthatiftheywerefromanothersocialsector wouldhavehadagreatersocialimpact.Moreover,itwasexpectedthatthis dramaticsituationwouldleadtomoreactivepoliciesfocusedonthe elderly,butaswesay,asitisnotanessentialvalueatthemoment,thishas notoccurred.Olddebatesarestillpending,oldsocialrights,which,since theyarenotrecognizedbysocietyastheirown,arenotontheagendaof topics,noronthenewsinthesocialmedia.Inaddition,whentalkingabout theelderly,itisalwaysdonewithnegativenews.
Duringthisperiod,thelonelinessoftheelderlyhasrevealedtheir fragilityinthefaceofadversecircumstances,leavingmanyelderlypeople withoutacareintheirhomesandhaveevendiedalone.Somevoices suggestsavingsingovernmentspendingbyreducingthissectorofthe population.Societyfocusesitsattentiononyouthandtheirneeds,without takingintoaccountthatolderpeoplearefullcitizens.Inshort,theelderly increasebutthisnumberdoesnotmakethemmorevisibletosociety,rather anytragedyisnormalizedwhenconsideringthatitissomethingtypicalof theage.
Ontheotherhand,theindividualvaluesoftheelderlyalsobeginto change,whichincreasinglydemandselfrealizationandthefactofmaking decisionsforthemselvesautonomously,withanopenattitudetochange, facedwiththedifficultdilemmaofreconcilingvaluesofyesteryearwith newonesfrom1daytothenext.
Afteranalyzingsocialchanges,weapproachthefundamentalconcepts aroundagingtoendwiththedefinitionsandcharacteristicsofloneliness, whicharethereferencepointsforthistopic.
Conceptualapproachtothetermloneliness
AsthefamousAdolfoBécquersaid,lonelinessisverybeautifulwhenyou havesomeonetotellyou.Itiscomplextoconceptuallyapproachagingand lonelinessduetothedifferentconceptionsandmeaningsthatexistanddue tothepolysemicnatureofbothterms.However,we firstdescribethemost importantgeneralconceptsrelatedtothesubjectandlaterdefineloneliness inaspecificway.
Westartwiththeconceptofseniorcitizens.Itreferstoaperiodinthe lifeofthehumanbeinginwhichtheabilitiesandcapacitiesforthe developmentoftraditionalproductiveactionsdiminishforpeoplewhoare inadifferentiatedstratumoftheproductiveadult.Thereisacertainsocial consensusinclassifyingoldageasbeingover65yearsofageandspeakingof beingolderfromtheprismofbiologicalage,whichdoesnottakesocialage intoaccount.Ontheotherhand,thefourthagewouldbefromtheageof 75.Yet,itwillalsodependonhowthepersonisintheirhealthsituation, howtheyfeel,whatsocialresponsibilitytheyhave,andespeciallyhowlong theyhavebeeninaperiodofinactivity.So,evenifthereisanaverage number,itwillactuallydependonthepsychosocialandhealthsituationof eachone.Thesamepersoncangofromthirdtofourthageinafewyears duetohersituation,whileanotherforworkorhealthreasonscanarrive later.Forthisreason,itisimportanttoavoidthepossiblebiasesderived fromageismandtoconsiderthesecircumstancestodeterminethefourthagestatusinqualitativeratherthanquantitativeterms.
Aspointsout,civilizationmultipliesandaggravateslifeproblems becauseitgivesrisetoadisagreementbetweenthelengtheningoflife achievedbymedicineandthepossibilitiesofasocietyinneedofyouthto achieveadequateperformance.Thisconsiderationdevelopsoneofthemost commonthemesaroundtheconsiderationoftheelderly,asatopicofa social,medical,andeveneconomicnature.Andfromananthropological pointofviewinsomeculturessuchastheJapanese,thefactofbecoming greatergrantsstatus,withwhich,thenumericalactiondoesnothavethe samemeaning.InAsianculture,oldage,determinedbyexperience,is consideredanaddedvalueasanirreplaceableelementfortheeffective developmentofagroup.Inothersocieties,oldageisseenasaperiodof maximumwisdomandrealappreciationofmaterialthings.Inthisregard, saidassessmentestablishesanothermarkerfortheelderly,assusceptibleto collaboratinginareasdeterminedbytheknowledgethatthesepeople handleinrelationtoparticulareventsandsituations.Ontheotherhand,in Westernsocieties,itistheoppositeandthenumberisthepanaceathat explainseverything.
Inthisway,itisunderstoodthattheconceptassociatedwiththeelderly isnoteasytoestablishinanyoftheareasofhumanactivity,whichisfrom, thebiologicalperspectivepeopleageatdifferentrates,whicharenotalways similar.Incultures,itisnotauniversalconcept.Likewise,inthesocial aspect,eachgroupestablishessociallyestablishedcriteriaorrulesthatold ageendsupbeingaconceptrelativizedbyrealityandbythecharacterizationofeachgroup.
Ageism
Ageismissomethingthathasbeenhappeningfordecadeswiththelossof powerandprominenceofolderpeopleinsociety.Butinrecentyears,ithas comeintothefocusofattentionofthinkersandscientists,especiallydueto theconnotationsofgenderthatitimplies,aswomenaretheoneswho sufferthemost.The firstauthortonamethisconceptwasButler(1969) whenhedefinedageismasaprocessofsystematicstereotypesand discriminationagainstpeopleforthemerefactofbecomingolder. Therefore,itisconsideredaspartofthesocialsystemandisrelatedtoit everytimethatthemembersofsaidsocietygenerateanegativeconcept aboutaging,evenfromchildhood.
Thisculturalperceptiontendstodespisetheadultwhenheages,asitis associatedwithastageofdecrepitudeandfragility.Inthecaseofwomen, thereisanaddedplusofageism,especiallyincertainprofessionsandsocial roles,consideringthattheyarealreadyoldevenaftermiddleage.Wecan observeitintheentertainmentworld singers,actresses butalsoin certainprofessions.Itissomethingthatisparadoxical,becausesocietyrenouncesthewisdomandcapitalinvestedinthesepeoplewhentheyare mostprepared,duetothefactthattheyreachacertainage.Take,for example,theUniversityandmanyqualifiedprofessions.Ateacherwhohas beenpracticingfor40years,youhavemoreknowledge,experience,and wisdom.Theinstitutionhasalsoinvestedforyearsintheirtrainingand learning.Isitworthlessthansomeonewhohasjuststarted?Thetruthis thatintheworksociety,aftertheageof45,theydonothavejobopportunities.Butalsointhecollectiveunconscious,itisthoughtthathehas lesscapacitytoexerciseroles,toenjoyhislifeandsexualitytothefull.Itis, inshort,asocialbarrierthatpreventstheelderlyfromleadinganormalized lifeconcerningothers,evenbeforereachingretirement.
Agingandoldagehavebeenassignedaninherentlynegativeconnotation,whichmustnecessarilybeeliminatedtoavoidsocialsegregationand discriminationinthisagegroup.Bothmenandwomenbecomepartofa passivecitizenshipeverytimetheyretireandceasetobeproductiveto becomeadirectburdenontheStatecoffers,notonlyduetounproductivity butalsoduetothearrivalofdiseasesandcomorbiditiescharacteristicofthe degenerativeprocessthatbeginsattheendoflife.
Afterdescribingsomeconceptsthathelpustoplacetheroleofthe elderlyinsocietyinageneralway,weanalyzeinparticulartheterm loneliness,withitsdifferentmeaningsandtypologies.
Lonelinessinaging:concept,typologyandcharacteristics 11
Loneliness
Beforerespondingtotheconcept,weaskourselvesthefollowingquestion: Lonelinessorloneliness?Thesolitudesalreadyoriginatedfromits compositionagreatdebateduetotheextremesofdifficultyofitsdecorationandtheaccumulationofcomplexallusionsinitsdiscourse.As Benedettisaidinhispoemsafterjoycomeslonelinessafterfullnesscomes lonelinessafterlovecomesloneliness.
Itistruethatlonelinessinthepluralissomethingthatextendstoallages andgenderswithoutdistinction,butthereisacertainconsensuswhenit statesthatisolationincreaseswithage.Livingaloneisafrequentand growingphenomenon,allthemoresotheolderthepersonis.Butitisnot alwaysaproblem.Itwillbenecessarytodifferentiateitfromtheemotional lonelinessandsocialisolationthatarethetruesocialandhealthproblems.In Fig.1.1,theprocessisdescribeduntilreachingloneliness:
Ifwefocusontheterminthesingular,themostcommondefinitionof lonelinessisthecircumstanceofbeingaloneorwithoutcompany.ItsetymologycomesfromtheLatinsolĭtas,solitatis.Thislackcanbevoluntary whenthepersondecidestobealoneorinvoluntarywhenthesubjectis aloneduetodifferentcircumstancesoflife.Itistruethatwedonotalways choosewithabsolutefreedom,sometimestheconditionsmakeuschoose nottobeaburdenforothers,orbecauseoftheinabilitytofaceit.
Lonelinessisrelatedtotheabilityofpeopletoexpresstheirfeelingsand opinions.Itmeansconfinementorlackofcontactwithotherpeople.The
Residential loneliness. Living alone
Emotional loneliness. Feeling alone.
Negative perception and few social relationships
Social isolation. Lack of social media
New geriatric syndrome.
Profiles at risk
Frailty and dependency
Comprehensive geriatric assessment
Multidimensionality
Interdisciplinarity
Figure1.1 Lonelinessintheelderly. (OwnelaborationbasedonFreedman,A.,&Nicolle, J.(2020).Socialisolationandloneliness:Thenewgeriatricgiants:Approachforprimary care. CanadianFamilyPhysicianMedecindeFamilleCanadien, 66(3),176 182.PMID: 32165464;PMCID:PMC8302356.)
philosophicalorientationunderstandsitasaninherentconditionofhuman existence,rootedintheprimaryrealityoftheindividual,immanent,and subjective.Therefore,somethinkersconceiveitasapositivestate,whichis notlinkedtopainandwhichthepersonactivelyseeksbecauseitallows self-realization.
Likewise,lonelinesscanrefertothefeelingofdiscouragementthatis experiencedduetotheabsenceofsomeoneorsomethingthatwewish werewithus,suchashavingapartner,beingwithourchildren.Itisa subjectivestatesincetherearedifferentdegreesorshadesoflonelinessthat canbeperceivedindifferentwaysdependingontheperson.Manisasocial beingbynature,whoneedsinterpersonalrelationshipswiththeenvironmenttohaveanintegraldevelopmentofthepersonality.Whenthereis loneliness,theintimaterelationshipwiththeotherislost.
Frommanyforumsanddebates,itisconsideredasthepandemicofthis centuryduetoitsincreasebecauseitisaverycommonfeelingevenamong thosewhoareaccompaniedsinceitispossibletofeelaloneeveninthe companyofothers.Itisalsotruethatsinceithasbeenthesubjectofdebate inthemedia,thisinvisiblepandemichasbeennamed,whichwasnotgiven dueimportanceinpreviousstages.
Forthispretext,lonelinessisastatethatallpeoplehaveexperiencedat somepointintheirlife,andinturnoneofthemostdifficultconstructsto define.Firstofall,becausebeingaloneisnotthesameasfeelingalone.The firststatereferstosocialisolation,thelackofsocialnetworks,uprooting, amongothers;butthetruelonelinessisfeelingalonebecauseitisafeeling thatgeneratesnostalgia.Forthisreason,adifferenceismadebetween isolationandloneliness.Thus,whilethe firstconceptreferstoobjectivity, thelackofsocialcontacts,thesecondreferstothesubjectiveexperiencesof thestructureofsocialinteractions.
Facedwiththisdifficultyofconsensusintheterm,eachauthorassertsa definitionthatcanbeasvariedashumannatureitselfbecauselonelinessis notalwayspartofthemomentthatolderadultslive.Itdependsonthe cognitivestateateachmomentonthepartofeach.Forthisreason,quality andsatisfactionwithlifeiscloselyrelatedtoloneliness,whencontemplating theobjectiveconditionsoftheexternalenvironmentandsubjectivewellbeing,whichencompassespersonalandsocialvaluesandexpectations,as wellasconditionsofthemomentlived.Thismakesusevaluatesatisfaction withourlifebasedonpreviousexperiencesandthepossibilitiesoffulfillmentthatwehaveateachstage.Andofcourse,theaffectiveelementisalso decisive,whichreferstothelevelofpleasureexperiencedasfeelings,
emotions,inthedialogicrelationshipsthatwebuildwithpeople.Thisstate makestheindividualevaluatethecurrentstageasagoodoldageorhappy oldage,inaccordancewiththevaluesinforceinagivensociocultural context,accordingtoourcognitiveevaluationsbetweenexistingrelationshipsandpersonalstandards.Thegreaterthedisagreementbetween whatthepersonwantsandwhattheyreallygetfrominterpersonalrelationships,thegreaterthesubjectiveperceptionofloneliness.
Afterthisgeneralapproach,wedescribethemostconsensualtypologies inthemostrecentliterature.
Typesofloneliness
Ifwecontinuetoexploretheconcept,itispossibletodiscerntheobjective lonelinessfromthesubjectiveone.Objectivelonelinessindicatesliving aloneandsubjectivelonelinessimpliesfeelinglonely(Rubio,2004).
Aswesay, objectiveloneliness referstotherealabsenceofaregular socialsupportnetworktoseeeachotherfrequentlyandonwhichyoucan count.Itistruethatthismaybebychoicebecausesomepeopleenjoytheir spaceofisolationandhavelivedlikethisalltheirlives.
Theolderadultgivesoffprimaryemotionsasaresultofthecognitive evaluationswiththereferencegroups,whichcanalsobeaccumulatedover time,dependingonthecognitiveschemesofeachculture.Incultures wheresociabilityisdifferent,communityrelationshipsareeasierforolder people.Inthewesternone,ontheotherhand,theyaremuchmore complex.Itcanalsobetheconsequenceofpastnegativeexperiences,of dissatisfaction.However,wecannotanalyzesocialrelationshipswiththe currentphoto.Thesocialandpersonalhistoryofthepersonhelpsusto knowhowhehasbeenweavingrelationshipsthroughouthislife.Inthis society,itisnoteasytohavesocialgroupsandmaintainthemovertimeand evenmoresowhentheyareintrovertedorhavecomplexpersonalities(Buz &PrietoAdánez,2013).
Regardingsubjectiveloneliness,thereisaconsensusindiscursive practicesconsideringitasanexperiencethatislivedwithdiscomfort, anguish,andtobeavoided.Althoughitdependsonthehistoricaltimeand thepersonalmeaningsthateachonegrantsit(Muchinik&Seidmann, 1998),ttreflectsthefeelingofquantitativedeficiencies:nothavingclose contacts,friends,family;andqualitative:lackofintimacyorcloserelationshipswithothers.
