Barriers to Social Participation among Lonely Older Adults: The Influence of Social Fears and Identity

Introduction Loneliness among older adults is a major public health problem that may be associated with processes of social participation and identity. This study therefore sought to examine the relationship between social participation and identity in a sample of lonely older adults living independently in London, England. Method An inductive qualitative approach, based on semi-structured interviews and thematic analysis, was employed. Results Participants commonly spoke of barriers to social participation that have been reported elsewhere, including illness/disability, loss of contact with friends/relatives, lack of a supportive community, and lack of acceptable social opportunities. However, novel findings were also derived. In particular, participants commonly minimised the difficulties they faced alone, and described attempts to avoid social opportunities. These behaviours were linked to fears about engaging in social participation opportunities, including fears of social rejection and/or exploitation, and fears of losing valued aspects of identity. Discussion It is concluded that social participation amongst lonely older people will not improve through the removal of previously reported barriers alone; instead, older peoples’ beliefs, fears and identities must be addressed. Suggestions for implementing these findings within community organisations are provided.

I would like to talk to people who: 1.don't go to groups and activities much and 2. sometimes feel separate from others I would like to find out how older people describe themselves, and how this affects their views of groups and activities.
Taking part involves talking to me about yourself and your views. We can meet in your home or a public place. It would last between 1 and 1 hours.

S2. Participant information sheet (continued)
Who can take part?
• We are looking for people who fit the following description: 1. Aged 65 or older 2. Able to speak English well enough to take part in an interview 3. Tend not to go to groups and services 4. Sometimes feel separate from other people • Unfortunately, if you don't fit all 4 descriptions, you may not be able to take part. • If you are unsure about whether you can take part, please contact the main researcher, Johanna Goll to find out more (her contact details are provided below). She will be very happy to talk to you and answer any questions.
Do I have to take part?
• You do not have to take part.
• It is up to you to decide whether you would like to take part. You may like to spend some time thinking about it first, or you may like to talk it over with someone else. • Choosing not to take part will not disadvantage you in any way. For example, it will not affect the services that you receive. • If you agree to take part, you are free to stop at any time without giving a reason.

Are there any risks involved in taking part?
• It is not expected that taking part will cause you any harm.
• The project involves talking with a researcher (to do an interview), and does not involve any other procedures, or treatments. Some people may find that the interview causes them to think or talk about personal or upsetting topics. However, you do not have to answer all the questions, and you can choose to stop the interview at any point. Additionally, all your information will be kept confidential (for more details about this, see the section below called "What will happen to the information that I give?").
Are there any benefits to taking part?
• If you are suitable for the project, and you take part, you will receive a £10 supermarket voucher to thank you for your time. • Other than this, there are no direct benefits of taking part. However, it is hoped that the project will help to develop services that older people would like. • Some people benefit from the chance to talk to someone else during an interview.

S2. Participant information sheet (continued)
• Additionally, some people enjoy finding out about the results of the project when it is finished, and we will provide this opportunity for anyone who is interested.
What will happen to the information that I give?
• With your permission, your interview will be audio recorded so that it can be transcribed (written down) afterwards. Any information that would allow others to recognise you (e.g. your name) will not be included in the transcription. Once the transcription is complete, the recording will be deleted. • All information (audio recordings, transcriptions, questionnaires) will be treated as confidential, and kept in accordance with the Data Protection Act (1998). This means that the information that you give us will be well protected. For example, your information will be marked with a code rather than your name, so that you cannot be recognised (information will be kept anonymously). Additionally, your information will be stored securely, so that only the researchers working on the project can access it. • However, if we became extremely concerned about your safety or the safety of another person, we would have to break confidentiality. In this type of situation, it is our duty to get in touch with other professionals (like your GP) so that they could protect you (or another person) from harm. We would always try to discuss a situation like this with you before contacting any other professionals.

Will the results be written up and published?
The results of the project will be written up in a report and shared with local organisations including Age UK. Results may also be published in a professional journal. However, reports will include general results only. They will not contain any personal information that would allow you to be recognised. It is hoped that these reports will help organisations to develop the kinds of services that older people would like.

Who is conducting this project?
This project is being conducted by a small team of researchers from University College London (UCL), with the support of Age UK.

If you have answered Yes, please tick the following statements if you agree with them:
• I have read the Information Sheet about the project, OR it has been read to me.
• I understand what is involved in taking part in the project.
• I understand that any information I give will be kept confidential and well protected.
• I understand that I do not have to take part in the project if I do not want to.
• I understand that I may stop taking part in the project at any time without giving a reason.
• I have had the opportunity to ask any questions I wish.
• I have had enough time to think about the project.
• I have the names and contact details of the people running the project. I understand that I can contact them if I have any further questions or concerns.
• I understand that I will receive a £10 supermarket voucher after I have participated, to thank me for my time.

S4. Interview schedule a) Introduction
• Thanks for agreeing to take part.
• Interview focus recap. I will ask you about (1) how you describe yourself, and (2) your views and experiences of local groups and services.
• Timing recap. The interview will last 1 -1 V* hours. Please feel free to ask for breaks and/or multiple shorter interviews if required.
• Confidentiality recap. Your information will be unrecognisable, well-protected, and anonymous.
• Recording recap. I will use audio recording to enable transcribing. All recognisable info will be removed. After transcription, your recording will be deleted.

b) Identity
Aim: to gain a sense of participant 7 s valued social identities, and associated personal meanings.
Main Question 1: How would you describe yourself? Sub-questions (use flexibly to help fulfil the stated aim of main question) • What kind of person are you?
• How would you describe yourself to a person who didn't know you?
• How would other people describe you?
• What groups have you belonged to?
• What roles have you played in life?
• What are your most important characteristics?
• • What would you think? What would go through your mind?
• Why would you do (or not do) that?
• What gets in the way of you going to a group/accepting a service?
• What do you think it would be like if you went to a group/accepted a service?
• What's the worst thing that might happen if you went to a group/accepted a service?
• What would it say about you as person if you went to a group/accepted a service? •

f) Quantitative Measures
Measures (see below) are administered with support from the interviewer as required.

g) Debriefing
• How did you find the interview?
• Do you have any questions about any of the things we talked about?
• Was there anything we said that has left you feeling concerned or unsettled in any way?
Would you like more information about anything that we talked about?
• Do you have any questions about the research project or what will happen to your information? p Well they were, hard to say, it's hard to say that, they were handicapped unfortunately, but they didn't sort of mix or talk the way you used to do it, therefore, to me, there was no point in going I Ah, how did they mix and talk? P Pardon I What did you see happen there? What was it like when you saw it?

S5. An excerpt from a coded transcript
Well they just sat there and just looked at one another and er I wanted to be more jolly than that, P there was no er no enjoyment in going to that at all, make you as miserable as sin, I know I'm old myself, but I can still mix with people, even now

S6. Themes and constituent codes Cluster 1. Overt barriers
Worrying about ability to manage mobility/health issues when out Feeling that health/mobility issues make it difficult to go out Feeling that health/mobility issues make it impossible to go out

Illness and disability
Feeling that going out is too much effort Feeling unable to go out due to caregiving role Being so preoccupied with health/mobility problems that I can't think about social interactions Difficulty managing transport

Having less interaction with family than desired
Losing interaction with a deceased spouse Losing interaction opportunities because friends/neighbours have died, become ill/disabled or moved away Having less support from others than desired Losing spouse as a "bridge" to social interaction

Loss of friends and family
Wanting to mix with people I already know Perceiving that there's no-one to contact/help

Perceived lack of social opportunities
Predicting that I won't like/be able to do offered activities Predicting that I won't like/be able to eat offered food

S6. Themes and constituent codes (continued) Cluster 2. Responses to barriers
Minimising/hiding my lack of interaction

Minimising the difficulties of loneliness
Preferring own company/not wanting to interact Accepting current situation Accepting inadequate social interaction without asking for any more

Not seeking social interaction
Not asking for support

Not seeking social interaction
Feeling hopeless/defeated with regards to socialising Perceiving going out/socialising as impossible

Refusing social invitations very quickly
Deciding not to interact based on negative predictions

Relying on the telephone
Interacting by means other than face-to-face

Cluster 3. Social fears
Fearing being let down Fearing that others at the group might gossip/talk about me

Fear of rejection
Withdrawing from social situations due to social fears

Fear of rejection
Fearing social "failure"/being shamed/humiliated

Fearing exclusion/rejection
Fearing having to talk about personal matters

Fear of exploitation
Fearing that interaction will harm rather than help me

S6. Themes and constituent codes (continued) Cluster 4. Fear of losing preferred identities
Feeling undeserving of support Not wanting to be a burden

Fear of losing "independent" identity "
Wanting to remain self-sufficient Wanting to support others Feeling that I am "too old" Avoiding identification with old/sick/disabled people Predicting that people at groups will be "lifeless"

Fear of losing "youthful" identity ncuiuiMBmm^Kaisiuupwinuc
Avoiding being around "old" people because it will make me "old" Seeking proximity to "young" people because it will make me "young" Fear/experience of discrimination/stigmatisation/rejection on basis of age/disability/illness

Barriers to social participation among lonely older adults
Loneliness is common among older people, and is widely recognised as a major public health problem because it leads to poorer health and earlier deaths. Lonely older people tend to show lower levels of participation in social and community events outside the home than expected, and this may contribute to their loneliness. Therefore, this research sought to investigate why lonely older people do not often engage with available interaction opportunities.

Key findings
• The barriers that prevent lonely older people from accessing social opportunities are not only practical, but also psychological.
• Lonely older people report that they avoid social opportunities, and do not attempt to increase their interaction levels. Additionally, some admit to giving up on socialising altogether.
• Lonely older people avoid social opportunities in part because they fear social rejection, humiliation and exploitation by their peers.
• Lonely older people also avoid social opportunities because they fear losing the selfconceptualisations or identities that they value. In particular, they fear losing their "independent" and "youthful" identities, as well as the identities that they have developed in occupational or social arenas throughout their lives (e.g. "educated person", "sports fan", "bloke", "caregiver").
• In this report, suggestions are provided for strategies that community organisations might employ to tackle these issues and increase social participation among lonely older people.

Background
Loneliness describes the distress experienced when an individual has fewer (or poorer quality) social interactions than desired. Loneliness is common among older people, and is widely recognised as a major public health problem because it leads to poorer health and earlier deaths. Lonely older people tend to show lower levels of participation in social and community events outside the home than expected, and this may contribute to their loneliness. Therefore, this research sought to investigate the barriers that prevent lonely older people from attending social and community opportunities. It particularly aimed to explore lonely older people's beliefs, motivations, and preferred ways of describing themselves (preferred identities), in order to understand their responses to interaction opportunities.
Findings are based on in-depth interviews that were conducted with 15 lonely older people living independently in inner London during 2013/14. Interviewees came from a wide range of social, cultural and economic backgrounds. Qualitative data analysis techniques (Thematic Analysis) were used to interpret findings.