Mary was in no mood to leave the consultation room. The allocated 15 minutes for the appointment had long passed and I could hear patients waiting outside becoming restless as clinic was running late. This was not entirely Mary’s fault. It was a pleasure to talk to her; an intelligent, engaging and friendly nonagenarian, she entertained me with anecdotes of her time working at Bletchley Park during the Second World War.
Her GP referred her to me as she was experiencing palpitations and I was pleased to inform her that these were due to benign extra heart beats (ectopics) and that her investigations were otherwise normal. She was not reassured by this news and was very concerned that something sinister was being missed.
Since her husband of 62 years had died the previous summer, she felt that her health was declining and was convinced that her palpitations were the cause. It was at night that she felt particularly anxious, the ectopics felt stronger and she couldn’t sleep. It dawned on me that while she does not have a major cardiac problem, like so many of my elderly patients, she has a condition that is widespread in the UK but is seldom talked about: Mary is lonely.
The UK has an ageing population. There are almost 12 million older people (aged 65 and over) and, depressingly, nearly half of them consider the television their main form of company. Around 3.5 million live alone, and nearly 70 per cent are women. By 2040, one in four people will be in this age group, while the number of 85-year-olds is set to double over the next 23 years to 3.2 million. Loneliness is going to increase on a huge scale.
It is not always easy to detect but loneliness can manifest itself in subtle ways, such as patients being reluctant to be discharged from hospital back to their homes. Some ask to be placed in residential care homes even if they do not meet the criteria. Others present with self-neglect or substance misuse, especially with alcohol.
It can have other serious physical consequences and is said to be as harmful as smoking 15 cigarettes per day, with a 26 per cent increased risk of premature death. Social isolation and a lack of social interaction increases the risk of strokes and heart attacks, and doubles the risk of getting Alzheimer’s and dementia.
Loneliness can occur at any time in life. In the elderly, it is associated with bereavement, poor health, increasing age and living alone. Demographic changes have increased the number of socially isolated elderly people. Due to changes in employment patterns, it is less common for people to care for elderly relatives, and we do not always know or check on our neighbours: society is becoming increasingly atomised and so are the elderly.
Loneliness is still a taboo subject. To help combat this, the government has appointed a “minister for loneliness”, Tracey Crouch, and the Health Secretary Matt Hancock recently advocated “social prescribing”, whereby qualified practitioners help older people to engage with social activities.
Yet is it right to see loneliness through the prism of medicine? Should it be viewed as an illness that, like a disease, needs to be eradicated, or could it be viewed as an aspect of life that can occur for anyone, for a variety of reasons, at any point in their lives, thus reducing the stigma attached to it?
There is, of course, no single “cure” for loneliness. As a doctor, it is easy for me to prescribe an antidepressant or a visit to a day centre if someone is depressed through social isolation but this does not address the cause. As a society we need to ask ourselves what we can do in order to ensure older people live better, more dignified lives. How can they have better access to social activities, exercise, health care and, more importantly, meaningful relationships?
As Mary left the room apologetically, she tearfully turned round and thanked me saying, “This was the best day out I’ve had in months and the first proper conversation I’ve had in weeks.”
Nishat Siddiqi is a cardiologist based in south Wales
This article appears in the 21 Nov 2018 issue of the New Statesman, The real Brexit crisis