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maltatoday | SUNDAY • 3 OCTOBER 2021 14 COMMERCIAL Addressing loneliness and social exclusion in old age October is all about celebrating being an older adult and making the most of this time in your life – which can be as special as you make it. Along with celebrating, October is also a month for generating awareness around specific topics and aff lictions often associated with getting older. Having personally experienced feelings of loneliness and social exclusion felt by older persons throughout the pandemic, ANTHONY CARUANA, assistant manager at Villa Messina, shares a few ref lections, saying it's all about caring with dignity and making the older person feel valued within society. LONELINESS has been associ- ated with higher rates of clin- ically significant depression, anxiety and suicidal ideation, a 59 per cent increased risk of functional decline and a 45 per cent increased risk of death. Social isolation has been as- sociated with an approximate- ly 50 per cent increased risk of developing dementia. It signifi- cantly increases a person's risk of mortality from all causes, a risk that may rival the risks of smoking, obesity and physical activity (The National Acade- mies Press, 2020). Helping people feel valued within a society and raising awareness to eradicate as much as possible any contributing factors leading to social exclu- sion and loneliness, in combi- nation with the various forms of rehabilitation services to help those who unfortunately still end up experiencing such disorders, is crucial to improv- ing the quality of life of older persons. In general, older persons are already more prone to feeling lonely and socially isolated. This is because they are more at risk of facing factors such as living alone, loss of family or friends, a chronic illness and hearing loss (CDC, 2021). Already prior to the COV- ID-19 pandemic, loneliness and social isolation were so dominant across Europe, the US and China (10-40 per cent) that it was described as a "be- havioural epidemic". The situ- ation has only worsened with the restrictions imposed to contain viral spread" (Hwang, Rabheru, Peisah, Reichman & Ikeda, 2020). Also, locally, there were al- ready high concerns pre-pan- demic. In fact, in 2019, Mgr Dr Joe Vella Gauci had also de- scribed loneliness specifically among older persons as a "… worldwide epidemic" (Pace, 2019). Socialisation is crucial for a healthy ageing process, but normal changes in health and lifestyle of older persons might increase risk of loneliness (Bandari, et al, 2019). Loneli- ness is a subjective, unwelcome feeling of lack or loss of com- panionship, which happens where there is a mismatch be- tween the quantity and quality of the social relationships that we have, and those that we want (CEL, 2021). Loneliness leads to various destructive feelings such as fear, anxiety and grief. Older persons who would be expe- riencing a sense of loneliness tend to think negatively and overthink about themselves rather than on positive expec- tations (Aylaz, Akturk, Erci, Ozturk & Aslan, 2012). Unfortunately, loneliness is quite a common factor in later life, and has negative effects on older persons, both physically and psychologically. A commonly used definition of social exclusion which is applicable also to older per- sons (Walsh, Scharf & Keating, 2017) is the one defined by Lev- itas et al. (MacLeod, Ross, Sack- er, Netuveli & Windle, 2017): "Social exclusion is a complex process operating across sev- eral dimensions or domains. It involves both the lack or denial of resources, rights, goods and services, and the inability to participate in the normal rela- tionships and activities, availa- ble to the majority of people in a society, whether in economic, social, cultural or political are- nas. It affects both the quality of life of individuals and the equity and cohesion of society as a whole." Contributing factors to feel- ings of loneliness and social exclusion include having no family support, environmental barriers and ageism. Families need to be more present and involved and environmental barriers, such as the structure of roads and buildings, need to be planned more carefully, tak- ing into consideration people with impaired mobility. Social exclusion and lone- liness experienced by older persons are usually caused by low-quality social relation- ships, or the complete absence of these relationships. How- ever, there can be an exhaus- tive list of factors that could lead older persons to social exclusion and loneliness, such as less social contact, as this tends to decrease with age as one retires; death of family and friends; increased sarcopenia; frailty; ill-health; untreated hearing loss and poor mental health; chronic illnesses; liv- ing alone; limited or no access to finances; reduced access to places and/or services due to environmental barriers; being divorced, separated or wid- owed; inability to remain phys- ically and mentally active; and societal barriers such as ageism and lack of opportunities for older adults to engage and con- tribute (Benesch, 2020). The central goal of rehabilita- tion is to prevent, strengthen, restore or limit the deteriora- tion in physical, mental and social skills in elderly people (Ismail, 2021), thus reducing risks to social isolation and loneliness while encouraging the older person to integrate more within society. All this helps us to under- stand better why we cannot have a "…one-size-fits-all ap- proach to addressing loneliness or social isolation, and hence the need to tailor interventions to suit the needs of individu- als, specific groups or the de- gree of loneliness experienced (Fakoya, McCorry & Donnelly, 2020). Although it is very positive to note that there are many services within the commu- nity, one has to keep in mind that having a service available to those eligible and in need is not enough. We need to make sure that services are available straight away when needed and that the level of service is one that reflects dignity and per- son-centred care. As seen, the outcomes of loneliness and social exclu- sion can be very serious and sometimes even fatal. Taking this into consideration and the fact that "... Malta will be one of the fastest ageing countries in the EU (Formosa, 2019), this highlights the urgent need and importance to use one's social conscience to make every effort in supporting the older person (and other vulnerable individ- uals/cohorts) from the various forms of social exclusion and loneliness. This is to be done in any way and form possible by every in- dividual in order to abolish any contributing factors to these life-threatening syndromes on a national level. Putting to- gether everyone's efforts would prevent, rather than having to rehabilitate, after one falls vic- tim to such societal disorders, thus improving the quality of life of vulnerable cohorts, such as our older persons. CareMalta, which strongly believes in career develop- ment for its staff, offers on- going training opportunities to grow professionally within the organisation. Along with the author of this article, four other employees are currently completing a Higher Diploma in Gerontology and Geriatrics with the University of Mal- ta: Josette Grech, manager at Dar il-Madonna tal-Mell- ieħa, Eleanor Demanuele Farrugia, assistant manager at Casa San Paolo, Marion Abdilla, active ageing facil- itator at Villa Messina, and Sanja Tripkovic, lead carer at Casa San Paolo. To form part of a dynamic team, call 2258 4200 or email your CV to cml. hr@vassallogroupmalta.com.