Mental health has been defined as the capacity of each of us to feel, think and act in ways that enhance an individual’s ability to enjoy life and deal with life challenges. Mental illnesses, in contrast, are seen as alterations in thinking, mood or behaviour associated with some significant distress and impaired functioning (Standing Committee on Social Affairs, Science and Technology, 2004). The literature also includes cognitive and age-related mental health issues as part of the mental health spectrum. For example, the Mental Health Commission of Canada, as outlined in Guidelines for Comprehensive Mental Health Services for Older Adults in Canada, promotes a holistic approach considering mental illnesses as including Alzheimer’s disease and age-related dementias, serious and persistent mental illnesses complicated by aging issues, and mental illnesses that occur for the first time in old age.
Approximately 20% of seniors living in the community and up to 90% of those living in institutions are estimated to have a mental health problem or illness (Public Health Agency of Canada, 2010). The most common conditions include: depression, dementia, anxiety, delirium, and delusional disorders. Persons diagnosed with mental health issues tend to have fewer social resources, poor social competencies and symptoms that can pose barriers to maintaining connections to family, friends or community (Smith and Hirdes, 2009).
The stigma attached to an individual experiencing a mental illness can be a powerful agent in separating them from social contacts and social support systems (MacCourt et al., 2011; National Seniors Council, 2014a and 2014b). Several studies have shown that there are higher rates of reported loneliness amongst seniors with a mental illness, particularly dementia (e.g., British Columbia Ministry of Health, 2004; Victor et al., 2015). In one recent survey of people with dementia in the UK – the majority of whom were aged 65 and over – nearly two-thirds of those living alone reported feeling lonely, and a third said they had lost friends (Kane and Cook, 2013).
Mental health and mental illness among seniors can be connected to aspects of the aging process as well as situational factors that are associated with end of life experiences. Often, mental illness can be incurred or magnified due to stressors associated with advanced age, such as declines in resilience, physical health, low perceived control over health, death of a partner, moving to a new environment, financial difficulties, social isolation or loneliness (Newall et al., 2013 and 2014; Wister and McPherson, 2014). In this sense, the relationships between social isolation and mental health problems are often related to other aging-related challenges for many individuals.
At the same time, mental health issues of any kind may follow individuals throughout their life in a continual or episodic manner. An earlier onset of mental illness may lead to greater barriers in developing strong social contacts and maintaining social engagement with time, which can be carried forward into old age (Smith and Hirdes, 2009). The association between social isolation and mental health, therefore, needs to be examined from a life-course perspective as well as a dynamic one.
Seniors who become socially isolated, in turn, are at greater risk of mental illness given that social support is a protective factor for mental health problems (Chappell and Funk, 2011). For instance, Iliffe et al. (2007) found that social isolation was a predictor of depressed mood and perceived health among seniors who were not living in institutional settings. Similarly, in a review of the literature on suicide prevention among seniors, Saïas et al. (2013) found that isolation is a major risk factor associated with suicide among seniors. Social contact also attenuates two factors that are closely associated with suicide – depression and sleep disorders (and thus acts as a protective factor). There is also a connection between social isolation and addiction. Graziani (2010), for example, has shown that alcohol abuse among seniors can be a response to solitude, isolation or the loss of social support. The association between social isolation and mental health is therefore complex and bidirectional.
While mental health outcomes appear to be more associated with feelings of loneliness than social isolation per se (Coyle and Dugan, 2012), there is need for more research into the potentially cumulative and reciprocal effects of social isolation and mental health over the later life courses of individuals. Kobayashi et al. (2009) have found, for instance, that socially isolated adults are significantly different from their non-socially isolated counterparts in terms of several factors related to psychological well-being, including having higher levels of distress, lower coping abilities, and more negative feelings.