Discussion Paper March, 2017 Risk of loneliness among older people in Bournemouth and Poole Research shows that chronic loneliness can result in deterioration of health and well-being and also reduce life expectancy. This paper examines, at neighbourhood and ward levels, the risk that older people in Bournemouth and Poole are often lonely. Unless otherwise stated, “older” means aged 65 or over. We use the term “conurbation” to refer to Bournemouth and Poole together. Note that “risk” is not the same as ”count”. Individual risk reflects the likelihood that an older person will be lonely often. Areas with moderate average risks may have relatively high expected counts if they contain very large numbers of older people. This paper is mainly concerned with risk at Lower Super Output Area (LSOA) level but planners may be interested in expected counts both at this level and Ward level. We therefore also examine modelled expected counts. Key Points: There are eight Lower Super Output Areas (LSOAs) in the conurbation which are in the worst national decile for risk of being lonely often. Five of these are in Bournemouth and three are in Poole. The seven wards (20% of them) in the conurbation with highest risk are: Boscombe West (Bournemouth), Central (Bournemouth), Newtown (Poole), Westbourne & Westcliff (Bournemouth), Town Centre (Poole), Kinson North (Bournemouth) and Alderney (Poole). The seven wards with the highest expected count are Westbourne & Westcliff (Bournemouth), Kinson North (Bournemouth), Newtown (Poole), East Southbourne (Bournemouth), Canford Cliffs (Poole), Town Centre (Poole) and Parkstone (Poole). Thus four wards: Newtown, Westbourne & Westcliff, Town Centre and Kinson North have relatively high risks and counts. 1 1. Why loneliness is a problem Loneliness is hard to define but the Campaign to End Loneliness describes it as: “A negative experience that involves painful feelings of not belonging and disconnectedness from others. It occurs when there is a discrepancy between the quantity and quality of social relationships that we want, and those that we have. Thus, loneliness is a subjective psychological perception.” 1 In recent years there has been a significant increase in the study of loneliness among the older population. Chronic loneliness can have a severe impact on health and well-being. According to a review of evidence by Age UK2: Chronic feelings of loneliness can result in deterioration of health and well- being, and a shorter lifespan. Feeling lonely has been shown to increase blood pressure and risk of cardiovascular diseases. Self-perceived loneliness doubles the risk of developing Alzheimer’s disease. There is evidence that loneliness and social isolation are associated with reduced cognitive function, while socially engaged older people experience less cognitive decline and are less prone to dementia. Lonely adults are more likely to be overweight and smoke, and are less likely to exercise. There is a proven link between loneliness, depression and suicide. It is important not to confuse loneliness with social isolation – the terms are often coupled together as if they were one phenomenon. Social isolation refers to a lack of contact with family or friends, community involvement, or access to services. It is possible to be lonely but not to be socially isolated (research suggests that older people living in large households or care homes are more likely to report loneliness). It is also possible to be socially isolated but not lonely. Some people who live on their own or in remote places may not feel or report loneliness. Before engaging with older people experiencing, or at risk of experiencing loneliness in the conurbation it is useful to have some idea of the location of those neighbourhoods where the risk of being lonely is relatively high. This paper describes a model devised by Age UK and applied by Office for National Statistics (ONS) to census data on individuals. We examine what the model says about the risk of loneliness among the conurbation’s older population. 1 Goodman, A., Adams, A., and Swift, H.J. (2015) Hidden citizens: How can we identify the most lonely older adults? London: The Campaign to End Loneliness. Available at http://www.campaigntoendloneliness.org/hidden-citizens/ 2 Evidence Review: Loneliness in Later Life, Age UK, July 2014. Full references can be found in the Age UK evidence review. 2 2. Assessing risk of loneliness using Census data Loneliness among older people has been analysed in several studies but we restrict ourselves here to a model devised by Age UK which uses data from the English Longitudinal Survey of Ageing (ELSA) and Census 2011 variables. Approximately 5,500 respondents in the ELSA survey are aged 65 or over. For this paper the relevant question in the ELSA about loneliness is: How often do you feel lonely? 1 Hardly ever or never 2 Some of the time 3 Often We can examine how the response “often” is related to responses to other questions. This gives us our model. The Office for National Statistics has data on all individuals who answered Census questions, so were able to apply the model to a much wider population and determine each individual’s risk of being lonely. (Unlike the ELSA the Census did not ask about loneliness). The risk score for an individual is the natural logarithm of the odds of being lonely ”often” as determined by a standard logistic regression. See the Appendix for further details. Risk scores for geographical areas are the means of the scores of older persons living in households in those areas. We focus here on the 203 Lower Super Output Areas and 34 wards in the conurbation. 3. Predictors of loneliness The AGE UK model identifies six predictors (for or against) of being lonely often for those aged 65 or over. The five self-reported health classifications in the census were “very bad”, ”bad”, “fair”, “good” and “very good”. Note that “fair” health is worse than “good” or “very good”. The model uses three categories for health: “bad or very bad”, “good or very good” and “fair”. Six predictors remain in the model. Those that increase the risk of being lonely often are, in order: Being in “bad” or “very bad” health Being in “fair” health Being widowed or being a surviving partner from a civil partnership Marital status is divorced, dissolved civil partnership or separated. Key predictors that reduce the likelihood of being lonely are, in order: Being aged 75- 79 3 Not living alone It is interesting that being aged 75-79 appears to reduce the risk of loneliness, holding other variables constant. 4. Mapping the risk of loneliness Interactive heat maps of the risk scores at lower level super output area (LSOA) can be viewed at an Age UK website3. These maps represent the data at local quintile level, i.e. the worst 20% of LSOAs within the authority, followed by the next 20% and so on. These are labelled from “very high” risk to “very low” risk. This may be misleading if, in fact, local values are “benign” within the distribution of national scores. We have therefore chosen to map the same data at national quintile level but have divided the worst national quintile into two deciles. There are 32,844 LSOAs in England, 110 of which are in Bournemouth and 93 in Poole. Five of the LSOAs in Bournemouth and three in Poole are in the worst national decile. The worst area, which is nearly in the worst 1% nationally, is Bournemouth 23B (also known informally as “Poole Road” ) which is in the Westbourne & Westcliff ward.4 3 Age UK’s map for Poole can be viewed at http://data.ageuk.org.uk/loneliness-maps/england-2016/poole/ 4 We are somewhat surprised that this area has such a high risk given other statistics such as percentage of elderly who are in poor health. But these statistics are based on proportions rather than how individuals answered a set of questions. 4 Map 1. Risk of loneliness, aged 65+, Bournemouth (LSOAs) Five (4.5%) of Bournemouth’s LSOAs are in the worst national decile and thirteen (11.8%) are in the worst national quintile 5 Map 2. Risk of loneliness, aged 65+ Poole (LSOAs) Poole has three LSOAs in the worst decile. There is one in Newtown and two (contiguous) LSOAs in the Town Centre Three (3.2%) of Poole’s LSOAs are in the worst national decile and six (6.5%) are in the worst national quintile concerning risk of loneliness. 6 5. Risk of loneliness by Ward We have also calculated the risks at (2011) Ward level across the conurbation. Table 1 shows the rank of risk for wards in Bournemouth, Table 2 for wards in Poole and Table 3 shows ranks across the conurbation. Rank 1 is worst. Table 1: Rank of risk in Bournemouth Table 2: Rank of risk in Poole Risk Risk Ward Rank Ward rank Boscombe West 1 Newtown 1 Central 2 Town Centre 2 Westbourne & Westcliff 3 Alderney 3 Kinson North 4 Hamworthy East 4 Strouden Park 5 Branksome West 5 Queen's Park 6 Oakdale 6 Winton East 7 Creekmoor 7 East Cliff & Springbourne 8 Branksome East 8 Boscombe East 9 Parkstone 9 Kinson South 10 Hamworthy West 10 Wallisdown & Winton West 11 Canford Heath West 11 West Southbourne 12 Canford Heath East 12 Moordown 13 Penn Hill 13 Throop and Muscliffe 14 Canford Cliffs 14 Redhill & Northbourne 15 Broadstone 15 East Southbourne and Tuckton 16 Merley & Bearwood 16 Littledown & Iford 17 Talbot & Branksome Woods 18 7 Table 3: Rank of risk, conurbation Ward Rank Authority Boscombe West 1 Bournemouth Central 2 Bournemouth Newtown 3 Poole Westbourne & Westcliff 4 Bournemouth Town Centre 5 Poole Kinson North 6 Bournemouth Alderney 7 Poole Strouden Park