IntroductionThe context for the review of loneliness and social isolation in later life is that of ‘successful aging’ and ‘quality of life’. The term ‘quality of life‘ includes a broad range of areas of life and there is little agreement about the definition of the term. Models of quality of life range from identification of ‘life satisfaction’ or ‘social wellbeing’ to models based upon concepts of independence, control, and social and cognitive competence. However, regardless of how the concept of quality of life is defined, research has consistently demonstrated the importance of social and family relationships in the definition of a ‘good quality of life’.

This study examines the prevalence of loneliness amongst older people in Great Britain, and makes comparisons with the findings of studies undertaken during the last five decades. In addition, the risk factors for loneliness are examined using a conceptual model of vulnerability and protective factors derived from a model of depression. Loneliness was measured using a self-rating scale, and measures of socio-demographic status and health/social resources were included. Interviews were undertaken with 999 people aged 65 or more years living in their own homes, and the sample was broadly representative of the population in 2001. Among them the prevalence of 'severe loneliness ' was seven per cent, indicating little change over five decades. Six independent vulnerability factors for loneliness were identified : marital status, increases in loneliness over the previous decade, increases in time alone over the previous decade ; elevated mental morbidity ; poor current health ; and poorer health in old age than expected. Advanced age and possession of post-basic education were independently protective of loneliness. From this evidence we propose that there are three loneliness pathways in later life : continuation of a long-established attribute, late-onset loneliness, and decreasing loneliness. Confirmation of the different trajectories suggests that policies and interventions should reflect the variability of loneliness in later life, for undifferentiated responses may be neither appropriate nor effective.

Loneliness has been consistently identified as one of the specific ‘social problems’ which accompanies old age and growing older: 90 per cent of the general population of Britain feel that loneliness is a problem associated with old age. There is a widespread presumption that loneliness and isolation have become more prevalent in Britain in the period since the Second World War as a result of the decline in multi-generation households and changes in family structure. This paper examines the accuracy of this stereotype and considers if current cohorts of older people are more likely to report experiencing loneliness than previous generations of elders, through a comparative analysis of historical and contemporary data. Historical data are provided by three ‘classic’ social surveys undertaken in England between 1945 and 1960. Contemporary data are from a postal survey of 245 people aged 65–74 living in South London in 1999. The questions used in all four surveys were comparable, in that respondents self-rated their degree of loneliness on scales ranging from never to always. The overall prevalence of reports of loneliness ranged from five to nine per cent and showed no increase. Loneliness rates for specific age or gender sub-groups were also stable. Reported loneliness amongst those living alone decreased from 32 per cent in 1945 to 14 per cent in 1999, while the percentages decreased for both those reporting that they were never lonely and that they were ‘sometimes’ lonely.

BackgroundOlder people are increasingly retaining their natural teeth but at higher risk of oral disease with resultant impact on their quality of life. Socially deprived people are more at risk of oral disease and yet less likely to take up care. Health organisations in England and Wales are exploring new ways to commission and provide dental care services in general and for vulnerable groups in particular. This study was undertaken to investigate barriers to dental care perceived by older people in socially deprived inner city area where uptake of care was low and identify methods for minimising barriers in older people in support of oral health.MethodsA qualitative dual-methodological approach, utilising both focus groups and individual interviews, was used in this research. Participants, older people and carers of older people, were recruited using purposive sampling through day centres and community groups in the inner city boroughs of Lambeth, Southwark and Lewisham in South London. A topic guide was utilised to guide qualitative data collection. Informants' views were recorded on tape and in field notes. The data were transcribed and analysed using Framework Methodology.ResultsThirty-nine older people and/or their carers participated in focus groups. Active barriers to dental care in older people fell into five main categories: cost, fear, availability, accessibility and characteristics of the dentist. Lack of perception of a need for dental care was a common 'passive barrier' amongst denture wearers in particular. The cost of dental treatment, fear of care and perceived availability of dental services emerged to influence significantly dental attendance. Minimising barriers involves three levels of action to be taken: individual actions (such as persistence in finding available care following identification of need), system changes (including reducing costs, improving information, ensuring appropriate timing and location of care, and good patient management) and societal issues (such as reducing isolation and loneliness). Older people appeared to place greater significance on system and societal change than personal action.ConclusionOlder people living within the community in an inner city area where NHS dental care is available face barriers to dental care. Improving access to care involves actions at individual, societal and system level. The latter includes appropriate management of older people by clinicians, policy change to address NHS charges; consideration of when, where and how dental care is provided; and clear information for older people and their carers on available local dental services, dental charges and care pathways.

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Dental public health (DPH) researchers have traditionally relied on quantitative methods for scientific enquiry. This paper argues that qualitative methodology can make a significant contribution to DPH knowledge and practice because it allows researchers to answer important questions of relevance to procedure and policy that are difficult to answer satisfactorily using quantitative methods alone. Qualitative research can also challenge the norms and assumptions of DPH practice. There are tensions in the relationship between qualitative research and the prevailing paradigm of evidence-based practice (EBP) which potentially influence the utility of DPH-related qualitative research. However, the relevance of qualitative research is increasing as the scope of EBP enquiry extends beyond questions of effectiveness, and methods are developed for incorporating qualitative research into systematic reviews.

The extent and nature of loneliness in later life does not show a consistent relationship with gender. Our study investigates whether there are differences in the nature and extent of loneliness amongst older men and women in contemporary Britain.Loneliness was measured using a self-report four-point scale in a nationally representative survey of people aged 65+ living in the community.Survey response rate was 77 per cent and the sample of 999 approximates to that of the general population. Approximately half of our sample 53 per cent were women. Compared with males in the sample women were significantly more likely to be widowed, live alone and have direct contact with friends and relatives. Preliminary analysis identified statistically significant differences between men and women in and self-reported loneliness (and changes over the previous decade). Ordered logistic regression, indicated that gender was no longer independently associated with loneliness once the confounding influences of marital status, age and living arrangement were excluded.The overall self-reported prevalence of severe loneliness shows little difference between men and women, challenging the stereotype that loneliness is a specifically female experience.

The oral health life-course of older people is an important influence on their perceptions of oral health and dental attendance. They consider oral health of importance and place great emphasis on their citizenship and rights of access to state funded oral health care. This raises important issues for the funding and delivery of NHS oral health care for older people.