Revisiting Loneliness: Individual and Country-Level Changes

The links between loneliness and overall morbidity and mortality are well known, and this has profound implications for quality of life and health and welfare budgets. Most studies have been cross-sectional allowing for conclusions on correlates of loneliness, but more recently, some longitudinal studies have revealed also micro-level predictors of loneliness. Since the majority of studies focused on one country, conclusions on macro-level drivers of loneliness are scarce. This chapter examines the impact of micro- and macro-level drivers of loneliness and loneliness change in 11 European countries. The chapter draws on longitudinal data from 2013 and 2015 from the Survey of Health, Aging, and Retirement in Europe (SHARE), combined with macro-level data from additional sources. The multivariable analysis revealed the persistence of loneliness over time, which is a challenge for service providers and policy makers. Based on this cross-national and longitudinal study we observed that micro-level drivers known from previous research (such as gender, health and partnership status, frequency of contact with children), and changes therein had more impact on loneliness and change therein than macro-level drivers such as risk of poverty, risk of social deprivation, level of safety in the neighbourhood.

Social Exclusion in Older-Age and the European Pillar of Social Rights

The European Pillar of Social Rights is about delivering new and more effective rights for Europeans. It builds upon 20 key principles, structured around three categories: equal opportunities and access to the labour market; fair working conditions; and social protection and inclusion. Directly relevant to older people, the Pillar has the potential to address the multidimensionality of exclusion in later life from a rights-based perspective – for example, by enhancing the rights to quality and affordable health and long-term care, to adequate pensions to live in dignity, to age-friendly working conditions and an inclusive labour market, or to access goods and services. Despite these valuable elements, there remains significant uncertainly around how the Pillar will achieve this and what kind of implemental actions might emerge across member states. This chapter analyses the potential of the European Pillar to address social exclusion of older people in Europe, the challenges that might impede its efforts, and the measures necessary to overcome such challenges.

Introduction: Framing Economic Exclusion

Economic exclusion is a multidimensional concept that has particular relevance in the context of ageing populations and globalised economies. Sustaining adequate incomes in old age and protecting older citizens from poverty are major challenges for governments and policy makers and they have been amplified in the face of the economic consequences of the COVID-19 pandemic. Over the past few decades most countries have made adjustments to their pension systems and other welfare related policies that concern older citizens, and these reforms have already had and will continue to have a differential impact on economic exclusion. For some, extending the working life and pushing back the legal age of retirement can be a safeguard against inadequate incomes in old age, while for others who are excluded from the labour market, or who are working in low paid jobs, economic exclusion remains a reality. The labour market implications of the pandemic are likely to exacerbate this risk for those whose situation was already fragile before the crisis.

Older People in Long-Term Care Institutions: A Case of Multidimensional Social Exclusion

Living in a long-term care (LTC) institution provides older people experiencing health and social problems with a comprehensive range of support services that address their quality of life. Despite access to such services, challenges arise in relation to their participation in key activities both within and outside the institution. This chapter examines such challenges, reviewing and describing ways to prevent exclusion along various domains, specifically social relationships, civic participation and socio-cultural life. Firstly, we discuss ways in which bio-medical models of care and the quality control systems, which are dominant in LTC services, standardise care, tending to put decisions exclusively in hands of staff, taking away residents’ autonomy, and ultimately curtailing rights and citizenship status. Secondly, we examine how LTC services might prevent such exclusion and promote older people’s participation in at least four respects: (1) prompting and supporting residents’ ability to take decisions on their own care, (2) favouring the maintenance and creation of social relationships, (3) enabling residents’ participation in the activities and management of the institution, and (4) guaranteeing residents’ rights and full access to citizenship. We discuss the impact and limitations of recent initiatives put into practice in these areas of practice.

Exclusion from Social Relations Among Older People in Rural Britain and Belgium: A Cross-National Exploration Taking a Life-Course and Multilevel Perspective

This chapter reports on a cross-national exploration on manifestations and drivers of exclusion from social relations, in rural Britain and Belgium. Each study was composed of a quantitative and qualitative phase. The quantitative phases operationalised exclusion from social relations using existing datasets within each country while both qualitative phases comprised life history interviews with older people. The results demonstrate that although social relations are vital for several reasons (e.g. health and care, practical support in times of poverty, safety), older participants in both countries regularly face exclusion from social relations (e.g. feelings of loneliness, isolation, “bad” social relations). The results show a strong interrelationship between exclusion from social relations and other domains of exclusion (e.g. economic and material exclusion). In terms of drivers of exclusion from social relations, the life stories revealed micro risk factors (e.g. marital status and gender), exo (e.g. being remote and rural living) and macro drivers of exclusion from social relations (e.g. inadequate social security and population change). The conclusion discusses the main limitations of this cross-national exploration and offers some tangible policy and further research recommendations.

Older-Age Exclusion and the 2030 Agenda for Sustainable Development

This chapter explores how far the potential of the 2030 Agenda, a global framework for the Sustainable Development Goals (SDGs), is being utilised to address multidimensional older age exclusion. The available evidence shows that, without a major shift in the coming decade, the pledge that the 2030 Agenda should be met for “all nations, peoples … and segments of society” will not be achieved in the case of older people, and the risks of failure are highest for older people in low- and middle-income countries. Across dimensions of framing, implementation, monitoring and reporting, recognition of ageing and older people is limited in the SDGs. Where recognition is explicit, it relates to the framing of older people as a vulnerable group rather than as rights holders on an equal footing with people of other ages. The major shift required in this context is the recognition of older people as rights holders, of States as duty bearers and the extension of a rights-based approach to policy design and implementation to counteract multidimensional social exclusion. Failure is not inevitable. Political commitment from key stakeholders, coupled with support from bilateral and multilateral donors, could result in better outcomes from Agenda 2030 on older-age exclusion.

Introduction: Framing Exclusion from Social Relations

In this part we focus on the domain of exclusion from social relations where social relations can be defined as comprising social resources, social connections and social networks. Other types of social engagement with formal civic, political and voluntary groups and organisations are not included in this part, but instead are incorporated in the domain of civic exclusion [see Part VI]. Theorising on exclusion from social relations is facilitated by the ROSEnet Cost Action, which brought together experts in the field and led to the publication of a critical review and development of a conceptual model of exclusion from social relations for older people (Burholt et al. 2019). The model captured the complexity of exclusion from social relations through a subjective interpretation of the literature and took into account the inter-relationships between systems in the critical human ecology framework (Fig. 6.1). The synthesis of the findings was endorsed by the working group on social relations comprising 45 members from 25 countries. The purpose of this introduction is to outline what exclusion from social relations involves, and to frame the three contributions within this part in the broader research debates and scholarship on this topic.

The Intersection of Ageing and Social Exclusion

This chapter introduces the topic of social exclusion in later life and presents a rationale for this edited volume. It will provide an overview of existing knowledge, focusing specifically on research deficits and the implications of these deficits for scientific study in the area, and for effective and implemental policy development. This chapter will outline the aim and objectives of the book in response to these deficits and will outline the book’s structure and the critical approach that is adopted for the volume, and that is rooted in state-of-the-art conceptual knowledge.

Receiving Care Through Digital Health Technologies: Drivers and Implications of Old-Age Digital Health Exclusion

The transition from traditional to progressively digitised health systems is leading to new forms of care including, for instance, telehealth and mobile health (mHealth) solutions. On the one hand, such solutions hold the potential for allowing easier, quicker and remote access to health care. On the other hand, digital health technologies can set new challenges for older people, especially for those who are not familiar with such technologies, in terms of receiving the care they need through good access and level of use of services. Furthermore, these services do not necessarily reflect everyone’s preferences and needs. This chapter aims to conceptualise and systematically discuss old-age digital health exclusion. First, we highlight key structural, environmental, individual and socio-technical drivers of the non-use and low-use of digital technologies, considering also the aspect of agency and personal preferences. Second, we point out the main individual and societal implications of old-age digital health exclusion. Third, we provide a conceptual framework for old-age digital health exclusion which includes older people, drivers and implications. Finally, we offer some reflections about digital health technologies in health care, highlighting related issues, risks and challenges for ageing societies.

Reconceptualising Exclusion from Civic Engagement in Later Life: Towards a New Research Agenda

Social exclusion in later life remains a major challenge for ageing societies. Despite widespread acceptance of its multidimensional nature, research and policy debates have tended to focus on exclusion from material resources or social relations, overlooking other recognised dimensions of social exclusion. In this context, exclusion from civic engagement has been the least studied dimension. In this chapter, we argue that future research and policy initiatives should pay attention to four key dimensions of older people’s exclusion from civic engagement. First, we need to embrace the multidimensionality of the concept of civic engagement, which includes a range of qualitatively different activities. Second, it is essential to account for the diversity of the older population, since this shapes who is able to engage civically and in which ways. Third, attention should be paid to the dynamics and experiences of engagement across the life course, in order to understand better civic engagement trajectories. Fourth, we need to consider exclusion from civic engagement as a culturally-embedded process that is largely shaped by the particular socio-political context in which engagement occurs. We provide examples of recent research covering these dimensions of exclusion from civic engagement and conclude by proposing areas of further inquiry.