The intergenerational fix for the loneliness epidemic | with Assoc. Prof. Clare Littleton

Loneliness is increasingly described as a modern epidemic - one that affects people of all ages and impacts both physical and mental health. In this episode of Let’s Talk Health, host Natalie Cook speaks with Associate Professor Clare Littleton, a public health researcher and Director of the Centre for Healthy Sustainable Development, to explore how where and how we live shapes our wellbeing.

In this episode, we cover:

• What loneliness really means and why it’s considered a modern epidemic
• How social isolation affects physical, mental and cognitive health across the lifespan
• Why where you live and who you see each day shapes your sense of belonging
• What intergenerational housing looks like in practice (and why it works)
• How the built environment can encourage connection, community and healthier ageing
• Cultural differences in ageing, caregiving and multigenerational living
• How incidental interactions between older adults and children build empathy and resilience
• Why public health researchers see intergenerational design as a key preventative strategy
• The role of policy, community planning and aged care providers in reducing loneliness
• What Australia is learning from global models of intergenerational living

Curious about public health, ageing, or how research is reshaping the way we live? Learn more about Clare and her team's research at the Centre for Healthy Sustainable Development. Interested in public health? Learn more about our programs at https://www.torrens.edu.au/courses/health/master-of-public-health .

Connect with us and follow our news and stories:
→ Blog and Newsroom: https://www.torrens.edu.au/stories
→ TikTok: https://www.tiktok.com/@torrensuni
→ LinkedIn: https://www.linkedin.com/school/torrens-university-australia/
→ Facebook: https://www.facebook.com/TorrensUni/
→ Instagram: https://www.instagram.com/torrensuni

Transcript

Natalie Cook: 0:15

Welcome to Let's Talk Health. I'm your host, Natalie Cook, Director of Innovation, Industry and Employability in Health and Education at Torrens University Australia. On this podcast, you'll hear from experts who will share their knowledge to help you make more informed choices about your health. This week we're talking about something that affects people of all ages, but often in silence. Loneliness. It's been described as a modern epidemic impacting our physical and mental health in ways we're only beginning to understand. But what if one of the most effective ways to combat loneliness wasn't a medical intervention at all, but a change in the way we live? Could bringing generations together under one roof would be the key. Today I'm joined by Associate Professor Claire Littleton, who is a public health researcher and the director of the Centre for Healthy Sustainable Development at Torrens University Australia. Thanks for joining me, Claire. My pleasure, Nat. Good to be here. First off the bat, loneliness is a modern epidemic. We spend a lot of time alone, but what what is loneliness and how does it impact us as humans? And does that differ by generation?

Clare Littleton: 1:20

Look, I think loneliness is an interesting concept, and it's something that has really come to the fore in the last sort of ten years. World Health Organization talks about loneliness and social isolation as being something that we really need to deal with in terms of affecting our physical and our mental health. So it is important. It's probably something we've named, and we we talk much more about mental health these days, and loneliness is part of that. There's some statistics in Australia and across the globe, but I'll mention some statistics in Australia. We're going to have, I think by 2066, 20% of the population is going to be 65 and over. And by that same time, we'll have four times the amount of 80-year-olds. So we're living longer, and that means that our circumstances are changing. So there's different configurations in that time where we live with people, we live on our own, we live in different circumstances. So there's going to be different aspects to loneliness. When we talk about people being lonely, there was a um a recent study done by COTA, which is the Council of Aging, really, in New South Wales. And up to 45% of people in the community who are over 50 say that they're lonely. And then, you know, there's another percentage, a smaller percentage of people who are extremely lonely. So then we look at youth and younger people, and they're also saying they're lonely. So they're saying it's and especially if you look at post-COVID, COVID brought out a lot of these things. Uh, if if you look at post-COVID, there's some stats around saying that 60% of people between 18 and 25 are lonely. And that can get quite extreme to up to 60%. So, you know, we we need to deal with this epidemic. It's an epidemic because there's lots of people experiencing it. Um, and there's lots of ways to deal with that. And obviously, loneliness is complex, and there's lots of things that mean that this happens. So it's a bit like if you look at a heart condition, there's probably five things that could lead to a heart condition, and same with loneliness. So it's complex, and in public health we like to unpack complex things. And as you mentioned, one of the ways we're doing that is looking at the built environment and housing and how that interacts with loneliness. If someone's lonely and they're feeling lonely, there's usually a reason for it. And there's a complexity of reasons what that could be. I think that it's really important to set up environments where people have the ability to have social connection, and this is one way of doing it.

Natalie Cook: 3:37

So, this notion of, and you can correct me on anything about your research, I'm really interested in it though, is that it's around intergenerational housing. What does that actually look like? What do you mean by intergenerational housing?

Speaker 1: 3:49

So, if you look across the globe, there's a whole lot of different definitions. Um, some people talk about multi-generational housing, which we all know, and in different cultures, we live in multi-generations. So that's not really what we're talking about here. We're talking about a fairly Western concept of saying we want to bring generations together in a living environment, and at the moment in Australia, that means an aged care provider wanting to bring in younger people to an environment so that older people and younger people can interact on a daily basis. And we're doing some case studies around this at the moment, and it's a really interesting development. It's quite new and emerging across the world, really, in terms of doing this in a purpose-built way. So not just doing it in a community or a neighbourhood that it's kind of already happening. In Europe, there's certainly some examples of where they really look at the way that apartment blocks are built, and they'll have older people living in the bottom, and then they'll have youth living in the top, and they get very cheap rent to make sure they drop in on their neighbours every day. And then they'll have the families and professionals living in the middle, and they don't really have to take so much responsibility. But it works really well. They also got some examples where they actually give free rent for young, very young people, youth to live in aged care homes so that they can be quite good friends with older people, and that works really well. How it's sort of coming out in Australia is aged care providers are saying, you know, wouldn't it be interesting to have a childcare centre or an early learning centre on the same site so that we can build like a village or a community. And that can take some time. But what um this case study that we're looking at, and we've just had a paper published on actually, has an early learning centre and 77 semi-retired living apartments, and the children and the older adults can interact in a very program-directed way. So they might do art classes or cooking classes together, or the older adults might come and help do reading with the children, or that can be more organic, I suppose. So they have an incredible community garden, and often the children and the adults are working along there side by side. And then I'll go into the research a bit later, but there's some other interactions which we found really interesting, which are more incidental and also very, very important to a community like that, and to reducing loneliness.

Natalie Cook: 6:02

Claire, some research suggests that living alone is one of the biggest predictors of loneliness. Is that true? From a public health perspective, what does the built environment, what role does that play in reducing that isolation?

Speaker 1: 6:17

Look, I think loneliness and living alone is an issue. We know that more people live alone now, but that doesn't just make you lonely. No, someone who lives alone. Lots of people live alone and and are quite happy, but they're very connected to their community often. Um different people need different levels of interaction. Yeah. Do you know what I mean? Yeah. Um, but when we're talking about an older person who's who sort of isn't going to work, isn't necessarily interacting with people on a daily basis, and perhaps their community isn't as active as it could be. Yeah. And alongside that their mobility is reduced, the co-located age care centre with younger children who are also spending a lot of time doing things that older adults might do anyway. You know, if you think about doing some cooking, doing some craft, um, wanting to read books and that sort of thing, it makes sense to bring them together to reduce that sense of loneliness.

Natalie Cook: 7:20

Are there from what you've said, I I'm anticipating there might be cultural differences. So in some parts of the world it's really normal that you've of course the grandparents live with the the family and or you've there's an oblig obligation, I don't like to use that word particularly, but that of course you that's what's expected. You look after and so you do have just naturally these intergenerational, multi-generational sort of households. Whereas I think we speak probably a whole lot less of that here in Australia. Is that is that a fair observation that there might be cultural differences?

Speaker 1: 7:50

Absolutely, and I'm certainly not a specialist in that, but definitely um, you know, in Australia we live in a very individualized way versus a a sort of collective way. So some cultures definitely would really embrace all of the members of the family on a daily basis, and you know, ol older adults would be part of the care system within that family, and at different times in their life would have different roles, and that's the expectation. Whereas that's not actually what happens in the majority in Australia. Often it is that the grandparents don't live in the same state, the same country, and vice versa. Children, you know, we're very mobile, which is there's many great things about having this sort of globalisation and that sort of thing, but what it does sometimes mean is that children don't have older or elders in their in their life. So bringing together these intergenerational focus points, I suppose, and making them sustainable in a in a daily interaction is really, really good for people's health.

Natalie Cook: 8:46

So you're saying that the bonds that are formed by having these connections are important?

Speaker 1: 8:52

Really important. And I think that's what's come out in our study. So we looked at a particular case study in South Australia. You know, some would say it's a bit of an experiment, there's an aged care environment, which we all know we put in Australia, we traditionally we put older people sort of on their own into a community. They live together. Quite isolated. We also do that with children, you know, we expect them to spend eight days in a a place where it's just zero to five year olds, which is fine, but you know, there's a lot more to society than that. So this is really starting to look at we're aging in place, and we want to age in place in a community. And it's almost like a neighborhood. It's being created rather than happening organically, but eventually it will continue to be organic and people will come and go, but they do most people stay around for you know, um, once they go into an aged care home, they could stay for quite a long time. The children, if they're in an early learning centre, will be there for five years. And so what we're starting to see is the way that this environment is built is built by design to facilitate these interactions. So, for example, the childcare centre has an intergenerational room attached to it, which means there's a space, a safe space for older adults to come in and spend time with the teachers and children, but not in the busy classroom necessarily. Also, the other thing is that some of these um cases, and we're doing another case study in Mornington Peninsula, they actually have some glass and some visualization of the classroom so the older adults, if they don't really want to interact at that level of being in with the children all the time, they can just come and observe what's going on, and then perhaps that would mean that they would then want to get involved. And so, what we're finding is these spaces are being designed to facilitate those relationships. I'll tell a little story because it's always good to have a little story. So imagine my mother was getting a bit older and I wanted her to go into a nursing home because I lived interstate and I was a bit worried about her falling. And so perhaps she would go and live in this retirement village. And when she got there, she's probably a bit lonely because she lives in a neighbourhood where she has got friends, and if she can't get out, they can come and come and see her. And often neighbours did drop in where she was living, and she might hear some children singing, and so she might just get out on her balcony and have a bit of a listen and think, Well, that's nice. I might go downstairs and I can sort of see where that's happening. Someone's in a little nook of this building, and there's a piano playing, and a few children have gathered and they're singing, and so my mother goes and she loves singing, so she goes and joins in singing and realizes, oh, this is great, I I can have a bit of a community here and has a bit of a chat to the children, and then you know, by one of the carers is invited to perhaps attend a cooking class and does that too because she also loves cooking and slowly gets integrated into that community, and then at the same time, you know, on the weekend or the end of the week when the children are leaving that early learning centre, some of the kids say hi. And in this particular community, the children actually call the older adults their grand friends. Grandfriends, yeah, which is just beautiful, and and what happens is then older adults start to share and to teach on a more daily basis, and the children really, really respect the older adults and them being part of their lives. And one lovely example of that is um they have a community garden and there's quite a lot of handles and things put into the garden, and they've got some smaller beds and some higher beds, so if anyone needs to be out of, there's something for the children, and there's something for an older adult who can't sit down. And the children in the study, um, when we talked to them, when we asked them to take photos of where they spent time with their grandfriends, really talked about some of these mobility aids. And they said, Oh, well, that's there because our grandfriends need to be safe, and we want them to be safe. So this is starting to learn about having real empathy. And we talk about ageism and ageing from both perspectives, but certainly it's good for us to spend time with older adults so that we understand what it's like to get old and that we can empathize and we can support, and vice versa. You know, if you don't spend any time with a younger child, you know, you might be impatient with that child. You know, a lot of people talk about how youth are, you know, to risky behaviour and these sorts of things. Another example of these ages coming together, this is not actually related to this case, but quite a while ago, I was involved in an intergenerational program where they had high school children and they just happened to be an aged care environment right on the border. So we brought in year 10s and people who had quite high-level dementia. And they did a set of photos that they took of their own daily activities, and then they brought them in together and talked about them, and that was the thing. And we had a local artist who actually turned those photos into a mural. So that then the activity to do together on that weekly visit was to paint that mural. And in the first week, no one talked. So we had morning tea, and mostly the older adults who had some cognitive decline but were quite capable of talking, and the children they just sort of all ate and did a bit of painting. By the second week, one of the older adults started to sort of opening up and saying, you know, when I was young, I sort of I ran out my window and I just ran down the street and met a friend and you know, we went to the local bar or whatever it was, and we came back. And that just opened up the floodgates. So it was an eight-week program of visiting by what week six. We're like, okay, we've got to paint this mural. You know, because there's so much talking. As soon as they got in, there was no eating or doing an art, it was all talking, and it was that was what was so impactful about it.

Natalie Cook: 14:15

I'm interested with social animals. We've got social media. Does that bring people together, or is it is it's part of the the problem that we're not actually engaging with people in reality?

Speaker 1: 14:24

Yeah, well, certainly there's a lot of research to say that people are more lonely with social media around. Not to say, and I don't like to say that it's totally that way because some people find their social connections on social media, but I think we need both. But yeah, definitely since COVID and since socialization from that, but also social media really brings this gratification very quickly, and you don't have to do so much to get that, but you're not getting that real social connection. And in public health research, we know that we have a sort of saying called social connectedness is really important, even around social capital. You think about the amount of people you see in a week. As we get older, that diminishes. And if you think about the if you have someone who has a disability, for example, and you compare that to someone who's 35 and doesn't have that a disability, the amount of people that someone sees in a week compared to someone with a disability is really small. So, you know, there's lots of things to think about when we think about how many people we should interact with with, and people have different versions of that, but when we're finding the statistics, say loneliness is a problem, and that's coming from the World Health Organization, who have released a massive campaign on ageism, and one of the things or the strategies, and they've got a side kind of report on, is to look at intergenerational engagement as a preventative factor for that.

Natalie Cook: 15:43

That's fascinating. I remember one when I was studying one of my lectures speaking about new mothers and loneliness in new mothers because often you're at home isolated. Isolated, yeah. And then she said, you know, she would tell people literally go outside when the post comes and say hi to the post person because you need to interact with some people every day, ideally.

Speaker 1: 16:02

Yeah, and if you think about again some technology, we don't go to the bank anymore. You can get everything delivered, and especially if your mobility is going down, that's happening more and more. So I mean, I remember when I first had to spend some time. I'm from a family of six, I'm a twin. So I've never spent time on my own. I remember in Sydney, my flatmates all went back to Adelaide when I was doing an undergrad there, and I thought, what am I gonna do? So what did I do? I went down to the deli, had a chat, chatted the guys here, or I went to the bank, you know. So that was my way of sort of still socializing. But we're losing some of those things and doing everything on an app and not having these is is you know progress, but we need to work out ways to replace that. And certainly, I, from what I've seen and what we've researched, these ideas of doing this in a fairly purposeful way and building these environments that facilitate that is one way of moving forward in a housing model. Not only do we need to house older people because the housing environment for older people is changing. People now who are in their 80s are expecting to live in the four-bedroom family home and they will do that as long as they can. They will then probably go into an aged care home or facility if they can afford it, but that's not till quite later on. And certainly governments don't want people going into aged care facilities because it costs them a lot more money. And also, we know from findings and commissions around aged care that the results aren't that great once you're into an aged care home. So certainly Australia is fairly far ahead on this. There's some really visionary aged care providers and early learning centres who are so keen to be involved in this space. And there's, you know, they're coming about four or five more of these sorts of centres that will be available for people to look at and to maybe think about having their age parents go into. And there's also waiting lists for the early learning centres where these centres are operating because people are keen for this intergenerational engagement. I think that the investment is worth it, and that that is being proven. We're going to need the private sector, we're going to need the NGO sector, and we're going to need um universities, everyone to work together on this. So yeah, it's exciting. Once you've got a model that shows it can work, then that's that's the way it grows. That's right, yeah. We presented the research as a whole of what's happening in Australia at a conference um on international practice in the US, and they were like, wow, Australia's really far ahead. You know, if you can get that evidence base, if you can start to develop that, it's going to be really powerful in what you do.

Natalie Cook: 18:37

There seems to be that there's so many different factors that you're looking at, you know, like you said, some about some's about the way things are built, some is about education, some's which to me it sort of sums up why public health is so interesting, because it's about health overtly, that's in the name it says that, but yet it seems that studying public health isn't about understanding about just sickness and disease. Absolutely not. Could you give a bit of a just a 101 on what is public health and why social determinants of health matter?

Speaker 1: 19:08

Absolutely. Look, the social determinants of health are difficult to explain in some circumstances, but when when you think about it, if you look at the Centre for Healthy Sustainable Development, when we wrote that strategic plan, we said, okay, so we we we want to have a public health overview, what's important here. Um, and we looked at health for all, which is a social determinant of health, and I'll answer that question in a minute. We look at education for all, which is education is a determined determinant of health, and we look at housing for all, and housing is a determinant of health. I suppose if you think of a child, what's scaffolded around them? Do you know? So it it to have a child really reach their full potential, you need to make sure that they have an income, and that's coming through their family. Hopefully, they have a house. They are going to get an education, social connectedness is going to be really important.

Natalie Cook: 20:06

And by the sounds of it, also at the other end of the lifespan, having appropriate housing that allows for connectedness, it feels like it's it's a web of interconnected things.

Speaker 1: 20:16

It is web, yeah, absolutely. And it's important to think of how do we solve these complex problems and how do we work with society to do that. So like I said, it it takes government, NGOs, private enterprise, and universities, learning institutions to do that. So in this case, housing policy becomes a health policy in a way. And that's the aim, really, is to get there first and for everyone to have a fair go. Because often what ends up is the most vulnerable populations end up being the ones that are in that crisis care situation more often. And we have a very good health system, but if we could level it up and we could start to think about those social factors, then we wouldn't have things like so much a loneliness epidemic, so many mental health issues, and obviously all those issues are complex, but you know, housing, income, access to good education, and support for families, and to scaffold that around is really, really important.

Natalie Cook: 21:16

Last question of all of the research that's emerging or that you wish might happen, what are you most optimistic about? Where do you see this research might go or what doors might it open for us?

Speaker 1: 21:27

I think that Australia will be leading the way in aged care and bringing in education alongside. So older people and younger people living those parts of their lives in community and feeling supported and also valued and learning from each other. Lifelong learning is another thing that makes people healthy and happy. So I think that is going to be something that's really important, and our research will hopefully stack six to eight to twelve examples of that, that we can then have a best practice model. So when an aged care provider decides that they want to get engaged in that sort of visionary thinking, they don't have to go the whole hog. You know, there might be 10 to 20 things we recommend, they might do 10 of them. I suppose it's important to learn from what's happened before rather than reinvent the wheel every time. And if our research can be part of those sort of fact sheets to help, you know, it's quite a complicated thing to bring together aged care, early childhood, and then government as well. So the research we're doing at the moment, and in particular this case study in Rodbury that we've finished the research on shows that this is best practice collaboration. You know, people are really putting forward what they what is best for the older adults and children before some of the commercial interests. Do you know what I mean? But the benefits are so big. And I think for society and for governments, that's important to remember that if we do invest in visionary community initiatives, that that would be good for all of us.

Natalie Cook: 22:56

Like you said, with a population that's growing and living longer, isolation and loneliness is only going to become more probable if we don't do something about it. So I think your research is fascinating. Thank you.

Speaker 1: 23:07

Thank you for no, thanks for listening, and it's really been great to chat to you about it and get it out into the into the world. Thanks, Claire. Thank you.

Natalie Cook: 23:16

And a disclaimer the information discussed in this podcast is for general information purposes only and is not intended as medical advice. The content should not be relied on as a substitute for professional healthcare. And if you have any concerns about your health, please do consult a qualified healthcare professional.