As I write, the sun is shining and people have emerged from a long, cold winter, exacerbated by rising fuel prices. The pandemic is over and most people are feeling courageous to gather in large groups—inside and out. This brings into sharp relief the plight of our client group— housebound elderly people living alone. It is often cited that social isolation and loneliness have a similar effect on morbidity and mortality as smoking 15 cigarettes a day (Perossinotto et al, 2019).
An article in last month's issue (Ohashi and Kawai, 2023) was about increasing social interaction in older housebound people in Japan, and reducing their isolation and health sequelae. In this month's issue, there is an article about dementia and cognitive decline, which are strongly linked to social isolation, pre- and post-diagnosis (Curelaru et al, 2021). We have an evergrowing population of older, lonely people living with long-term conditions in the UK and need to think creatively about how we can increase their social networks and promote their health.
This leads me to the work of two women who recognise that relationships are crucial to health, and have been able to demonstrate this with considerable success. Donna Hall's ‘Wigan Deal’ was based on the 10-year experiments of Hilary Cottam (described in her excellent book Radical Help). Cottam (2018) developed the concept of ‘Circle’ for healthy ageing—projects that bring people together in creative ways around common interests that lead to a marked reduction in social isolation and improvements in health. As part of the Wigan Deal, these projects included knitting, walking and singing groups, created from the bottom-up by Wigan residents, who knew what was needed and how to make it happen.
Music can be a powerful means of connecting people, as illustrated in Cottam's book (and the musical origins of Circle), but also across the UK, including my home city, where musicians from the Manchester Camerata meet with people living with dementia and their carers, in a beautiful local monastery to make music, sing and socialise. Similarly, in South Wales, another musical enterprise ‘With Music in Mind’ reduces social isolation and loneliness in older people, and improves physical and mental wellbeing through singing, exercising and socialising in the community; illustrative examples of many across the UK.
Our newly formed integrated care systems (ICSs) have considerable promise to improve the lives of older isolated people if we have the courage to think creatively, like Hall and Cottam, and take a step into the unknown. In bringing health, social care and the voluntary sector together, there are unprecedented opportunities to work towards reducing social isolation and improving health. Solutions need not cost more: in Wigan, re-imagining services and bottom-up creative solutions saved money by not an insubstantial amount. ICSs present us with an exciting opportunity to take up the mantle and work together to make a difference to the lives and health of our patients and communities, and by extension, ourselves. Carpe Diem. A journey of a thousand miles begins with a single step.