Yesterday, in the first of a three-part series about the impact of loneliness on elderly men, Shereen Ali spoke with three elderly men who lived in a retirement home about how they are dealing with ageing and loneliness.
The British charity Independent Age said: "If you allow people to suffer from loneliness, it has the equivalent impact as smoking 15 cigarettes a day and is as big a risk as obesity."
Today's instalment explores issues such as the psychological impact of loneliness, loss of relatives and independence.
What happens if you find yourself all alone in your older years? Is loneliness worse if you're a man? How does too much isolation affect the mind and body?
According to the 2011 population census, there were 54,461 men who were 65 and over. Compared to the 1980 figure of 26,870, numbers of older men have more than doubled in the past 35 years.
For some men, like Carlton, Gregory and Trevor who live at a Diego Martin private residential seniors' home, ageing is not so bad. For these gentlemen, the interest of caring family members combined with adequate funding mean they have a safe, comfortable place in which to live.
They enjoy the companionship of fellow housemates and freedom from housekeeping chores. The seniors' home provides them with decent meals. And attentive staff monitor any health care needs.
For many other lone men, however, it's not so rosy. Apart from the normal challenges of ageing–such as increasing frailty, health issues and loss of independence–there may be economic and family challenges, as well as psychological challenges caused by isolation.
These factors can all make it hard to connect with others and feel a sense of meaning and purpose.
Older people may be left physically alone, virtually abandoned by relatives, or they may be surrounded by people but still feel alone owing to lack of communication and minimal engagement in anything interesting or stimulating that connects them with others, according to Dr Jennifer Rouse, the director of the Division of Ageing (Ministry of the People and Social Development).
"Many old people use television as a substitute for human engagement," she said in an interview with the T&T Guardian.
Too much loneliness is definitely a health risk for older men, believes Leslie Garcia, an occupational therapist specialising in gerontology. She runs Hibiscus Place, a successful day centre for seniors in Diego Martin which offers a range of personalised therapy and structured activities for older folks, including varied outings, gardening, health exercises and creative arts.
Loneliness: A cascading effect
In the UK, a recent study of ageing there found that the number of severely lonely men over 50 was set to rise to one million in the UK in 15 years.
The British charity Independent Age said this mattered because loneliness was a health risk: "If you allow people to suffer from loneliness, it has an impact equivalent to smoking 15 cigarettes a day and is as big a risk as obesity."
We haven't yet done similar studies here in T&T, though we already know that more services for the elderly will be needed.
"Loneliness can cascade to a series of other complications," said Leslie Garcia. "For example, from just the person being alone, they may eat less; this may lead to under-nutrition and weakness, and the next thing you know, the person is not moving enough, he falls and gets a hip fracture."
Psychologist and T&T Guardian columnist Monica Starke says: "Some (older) adults may choose to get out there and start a garden, learn to use a computer, join a chess club, a gym, start a dance class, a reading club or initiate some other kind of activity.
"Unfortunately, many older people just accept and live with the loneliness and the lack of companionship and mental stimulation.
"With deteriorating mental health, very often depression can set in, and with depression comes the physical neglect. An elderly person may not be inclined to visit the doctor, exercise or eat properly and this negligence, though often unintentional, can lead to increased illness and earlier death."
Sioban Costelloe, operations manager at Hibiscus Place, said men's cultural attitudes often play a big factor in their own loneliness: "The Caribbean man has so much pride. He just will not accept the fact that he needs help. He needs systems, people who are caring for him, healthy activities...And yet he just would not pursue that.
"The male generation of our fathers is a group that we find extremely difficult to get to stay in a programme. Many rely a lot on their wives."
New neighbourhoods, no friends
Rouse offered many other reasons for isolation. One, she said, is the trend for some people to move to new neighbourhoods in pursuit of a better material life. In the process they often break valuable community ties with people from towns or villages where they grew up.
Sometimes, though, home relocations aren't voluntary. With the best of intentions, some adult children move ageing parents or grandparents to live with them, or to other homes, in the process unwittingly cutting off the elderly person from his familiar network of neighbours, his corner shop or his church, said Garcia.
"I recommend that people need to age in place, and not be uprooted at 75 from one house to another. The loss of that whole familiar environment can be very isolating and a cause for loneliness," said Garcia, who instead believes each community should have a senior centre offering a range of good activities and advice.
Mobility and transport difficulties can also be very isolating.
"It's not always easy to walk, or drive, or take a taxi" when you're older, said Rouse. "Life becomes more sedentary. And seniors may be reluctant to impose on their adult children to ask for transport here and there."
Crime compounds the transport woes: instead of going out and socialising, many prefer to be back home by 6.30-7 pm, just to be safe, said Rouse.
The structure of households has also changed a lot over time in ways that increase isolation, said Rouse.
"Many homes now are electronically gated and burglarproofed, with guard dogs...But in locking out the bandits, senior citizens have also been locked in. Many never grew up this way, and suffer from this confinement, feeling trapped in their own homes."
The family structure has also changed, said Rouse.
"Women, who were the de-facto caregivers, the bearers of culture and developing social relationships and nurturing, have joined the workforce (especially in the informal market) and are oversubscribed in the universities. In spite of life expectancy being longer for women (average–78 years for men and 81 years for women), women often marry men who are older, while a growing number of women choose to remain unmarried. So that there are many more single elderly women who are widows, divorcees or unmarried. This means many men may not even have mates or female companions when they get older."
Death of a spouse
A big cause of loneliness is the death of a spouse. "And remember, same-sex couples get old too; if one partner dies, they will also suffer pain, loss and isolation," said Rouse.
Garcia recalled the old saying: "Women bend, men break," when she explained that while the death of a spouse deeply affects both men and women, the impact tends to hit men harder.
"Generally, in our 65-and-up population, in a married couple, the husband is older than the wife. He gets to 80 first, then she gets to 80...The women tend to have more coping mechanisms. They're able to deal with the stresses better than men.
"They tend to have a wider social network because of the supports they have had to provide.
"So when you have the husband dying first, the woman has the resources and the social support to take care of herself. She knows how to cook, how to clean, how to get around in the grocery, how to survive, a little bit more than men in that group."
No class is exempt
Loneliness can affect older men of all backgrounds, said Rouse, giving this example:
"We receive a variety of calls at the division's help desk, including some from retired professionals who are lonely after their children migrated and their wives died.
"One retired engineer with a mansion and several cars called us to ask for help in connecting with mentorship programmes, since he felt frustrated and lonely and wanted to engage in meaningful activity."
"And what of our ageing intelligentsia?" asked Rouse. "What happens when they are affected by loneliness, or widowhood, or are no longer able to invest time in meaningful activity?
"These things can help cause early depression or dementia. They may start to ask themselves: After working so hard, what is it all for? The whole 'mid-life' idea has shifted up by 20 years; so the recently retired, in their 60s, may feel they are only now in the prime of their lives, and yet there is no one to share it with.
"Some of them kind of implode. Others may turn to drugs, or risky behaviour, or just get reckless."
An overlooked reason for loneliness in T&T men may simply be that despite several well-meaning drop-in senior centres, there may be a dearth of lively, engaging places specifically designed with older men in mind.
Many men prefer to do activities they find meaningful, practically useful or enjoyable.
Many men will not see the need to join activity groups which they find too boring or irrelevant to their own interests and gender. This is where groups like the Men's Sheds movement–which has grown like wildfire throughout Australia and now has gone global–may provide some relevant, motivating solutions.
NEXT: PART 3–The Men's Sheds movement: Keeping the guys connected