CHY 8259
RCN 20020057

Relationships, Social Connection and Community

Loneliness and Social Connection:

Loneliness is a significant issue which affects older people and many other cohorts across Ireland. In
2024, loneliness was the second highest reported concern among older people referred to ALONE4.
At a national level, TILDA research has found that one-third of all adults aged 50+ report feeling
lonely at least some of the time5. People who experience prolonged loneliness and social isolation
are significantly more likely to present with additional physical health issues. For example, loneliness
has been linked to an increased risk of early death, with some studies highlighting that older people
experiencing high levels of loneliness are twice as likely to die within six years compared to those
who are not lonely.6 Further studies have linked loneliness and social isolation to higher risks of
physical and mental difficulties, including heart disease, anxiety, depression, and Alzheimer’s
disease7.

The COVID-19 pandemic exacerbated the numbers of people over 65 who felt lonely, due to the
unprecedented social distancing and ‘cocooning’ policies that were put in place to limit the spread of
the virus8.
.Although cocooning measures were initially put in place with the intention of
safeguarding the health and wellbeing of older people, the long-term effects of loneliness and social
isolation may not have been sufficiently recognised and addressed. In 2020, ALONE and TILDA
published a report which considered the impacts of loneliness and public health measures on people
over 709 and highlighted that public policies should be developed to address these. ALONE also
released a press release warning of the physical and mental health impacts of cocooning10
,encouraging Government to consider the possible long-term ramifications of the policy on health
and wellbeing.

Like many other services, ALONE had to adapt its in-person Support and Befriending services
(whereby volunteers provide regular visits to an older person, providing friendship, practical support
and links to local activities and initiatives) during the pandemic, so that the increasing number of
older people experiencing loneliness could still receive support, while also ensuring our services
were compliant with COVID-19 measures. Prior to the pandemic, ALONE volunteers were able to
visit older people in their homes. During the pandemic, ALONE adapted to making telephone calls
and providing practical supports where we could, including making onward referrals to other
services for older people who called in about their mental or physical health needs. Thanks to the
increased levels of staffing, volunteers, and financial support from the community who came
together to support the rapid increase in calls from older people, we were able to successfully
deliver 136,966 Support and Befriending phone calls throughout 2020, an increase of 40% on the
previous year with 2,426 unique older people receiving a call each week.


Once cocooning measures were relaxed, ALONE welcomed the ‘Hello Again World’ campaign run by
the Department of Health and Healthy Ireland in 202311 to encourage older people to return to their
lives after the primary threat of COVID-19 had passed. The campaign encouraged older people to
reconnect with their communities to avoid loneliness and isolation. At the time, however, many day
care centres, rural transport and social activities had not resumed normal operations, even though
COVID-19 restrictions had been lifted 12(see Relationships and Community for more information on
the closure of community services). ALONE advocated at Government level for the return of these
services, urging Government to consider a re-emergence plan for older people.13

Unfortunately, although levels of loneliness have decreased in the years following the pandemic,
rates have not returned to pre-2020 levels across all age groups in Ireland14
. Ireland has never implemented a dedicated policy or national plan specifically addressing
loneliness; however, the issue has been acknowledged in government policies and documents,
including the Programme for Government, the Healthy Ireland Strategic Plan, and the Roadmap
for Social Inclusion. ALONE believes that a dedicated national strategy to tackle loneliness would
represent an important step toward addressing the issue among older people in Ireland. Such an
action plan would have been especially valuable in the immediate aftermath of the COVID-19
restrictions, providing targeted support to older people and other groups most affected by the
isolation and loneliness brought about by the pandemic.

The negative impacts of loneliness can be mitigated with community level supports. Between
September 2018 and June 2021, ALONE and the Health Research Board (HRB) developed an
evaluation of our Support and Befriending Service in the Befriending, Loneliness and Health Report.
This research demonstrated that engaging in the intervention was associated with less decline
in health-related quality of life, indicating the service can have a therapeutic effect on health.15
Additionally, ALONE’s recent Impact Evaluation Transforming Ageing at Home found reduced
loneliness, improved quality of life, decreased reliance on emergency departments and community
healthcare services, and increased personal capability and older people supported by our services.

Based on our learnings, ALONE and the Loneliness Taskforce, which works to increase awareness of
the problem and to produce a set of recommendations for Government, state agencies and all policy
makers, 16 have urged the Government to adopt the following policy recommendations, drawn
specifically from the experiences and lessons of the pandemic.

Recommendations:

• Develop a comprehensive cross-sectoral strategy to address loneliness and support social
  connection, and appoint a Minister to lead on the implementation.
  
• Develop a public awareness and education campaign on loneliness at a national level to
  improve loneliness health literacy.
• Establish a community-focused grant funding scheme to enable social connection and
  combat loneliness at a local level (estimated cost: €4m)17
  .
  Relationships and Community:
  The report by the Age Alliance, Telling It Like It Is: What Older People Told Us About their Experience
  of Covid-19, and What Ireland Should Do About It 18 , outlines the impact of cocooning on the lives
  of older people: on their experiences in their communities, their physical and mental health, and their
  social lives. The report found that older people‘s social contacts were heavily affected by the closure
  of social spaces such as clubs, cafes and other activities. Social engagement and connection are key
  to positive ageing, and this was heavily fractured during the lockdowns, particularly for the “older
  old” and those who do not use the internet or social media.
  
  A clear example of this impact was seen in the closure of day care centres. Older people, especially
  those who are widowed, disabled, or living alone, rely on these centres not only for care and support
  but also for a sense of community. As of August 2023, there were 323 HSE funded day care centres
  in operation in Ireland.19 Evaluations indicate that 75% of attendees are over the age of 75,
  representing 5.4% of Ireland’s population in that age group.
  
  Day care centres were heavily affected during and after the COVID-19 restrictions, with many
  remaining closed for extended periods even after restrictions were lifted20. In some cases, staff had
  been redeployed to other roles, such as COVID-19 testing centres, and replacing them took
  considerable time21. As of 2025, closures continue due to insufficient funding to meet new health
  and safety standards, reflecting long-standing structural underfunding22
  . Some attempts have been made by Government to address this, including an additional
  €10 million allocated to day care centres in Budget 2024. (23) Despite these efforts, day care
  centres remain largely unregulated, and the adequacy of funding has yet to be properly assessed.
  These centres continue to be an invaluable resource, helping older people maintain connections with their communities.
  
  In addition, during periods when restrictions eased, the lack of COVID-19 compliant public transport
  for older people exacerbated difficulties being experienced by older people as they began to reengage.
  For many, this resulted in missed medical appointments or required the use of expensive
  taxi services.24 This resulted in older people not only missing out on community social experiences
  such as in restaurants or cafes, but unable to access basic services such as grocery shopping or
  pharmacies.
  
  The critical role of the community
  
  As well as the challenges experienced throughout this time, we believe it is important to recognise
  the exceptional mobilisation of our communities who volunteered to support older people during
  the pandemic restrictions. ALONE volunteers mobilised to distribute food, medication and solid fuel
  to older people, resulting in 14,000 practical supports successfully delivered by volunteers and
  ALONE Support Coordinators in the month of April 2020 alone. As restrictions eased later in 2020,
  volunteers also participated in outdoor visits and walks with older people, though many older
  people struggled with the lack of accessible, walkable green spaces.
  
  ALONE received an overwhelming response from the public looking to volunteer. Building on the
  learnings from the rapid increase in volunteer interest, ALONE streamlined its recruitment and
  training processes, introducing faster and more efficient online self-learning modules during 2020.
  By the end of the year, all ALONE telephone services were operating at full capacity with volunteer
  support.
  
  The uptick in community participation proved to be a vital resource for many older people, many of
  whom reached out to ALONE as they did not have family members locally to support them. Without
  this significant level of community support, the impacts of cocooning may have been even more
  severe on older people. The role of the community and voluntary sector in providing necessary
  support such as grocery and medication deliveries, as well as social supports, brought the critical
  role of organisations and volunteers in providing essential services into sharp relief.
  
  
  Based on these learnings, ALONE has the following policy recommendations:

1. Improve Day Care provision. In line with the 2025 Programme for Government commitment
   to enhance our network of day centres, Government should develop and implement a
   sustainable model for day care services for older adults in Ireland. This model should ensure
   access to high-quality care, meaningful social engagement, and support with daily living
   activities, and should include development of a system of regulation, and a review of capital
   infrastructure needs.
2. Provide integrated funding for transportation as an element of the day care service and
   provide a clear funding mechanism for this. ALONE’s 2026 Pre-Budget Submission25 calls for
   €20m in transport funding to day care centres from the Department of Health.
3. Increase funding and support for community and voluntary sector organisations by €60m,
   as recommended by ALONE and Social Justice Ireland26
   
   
   Mental Health and Wellbeing
   Older people’s mental health is an increasingly important issue that does not get the attention it
   deserves. The levels of unmet mental health needs amongst older people are extremely high and
   improving current services is critical. Indeed, TILDA has found that 78% of older adults who have
   evidence of depression, and 85% who have evidence of anxiety do not have a doctor’s diagnosis27
   Older people often experience mental health difficulties due to major life changes such as being
   widowed, the onset of physical illness, disability and bereavement28
   .
   COVID-19 worsened mental health and wellbeing among older adults, particularly because most
   deaths occurred within their age group. Many faced deepened depression as they dealt with the
   sudden loss of spouses or family members, leaving them newly widowed and grieving.
   29 ALONE observed a rise in calls to our National Support and Referral Line (NSRL) from older people
   who were living alone and those experiencing suicidal ideation during the pandemic30
   . Similarly, the HSE found that hospital-presenting suicide-related ideation increased in older people by
   27% in the first two years of the pandemic.31
   
   Despite the clear need, mental health services for older people are inadequate. Many mental health
   professionals receive little training in older age issues and feel unprepared to address them. A
   literature review found that ageism contributes to low interest in older person’s services for
   graduating psychologists32 leading to fewer specialists and more unmet needs. The Mental Health
   Commission’s 2020 report underscored these service gaps33, noting that no region met the
   recommended number of dedicated acute mental health beds for older people, and provision was
   only 50% of that recommended by A Vision for Change. The HSE’s Model of Care for Specialist
   Mental Health Services for Older People (MHSOP), launched in 2019, outlined care pathways,
   training standards, and governance structures, but its implementation has stalled due to severe
   staffing shortages. 34
   
   These shortages have persisted – and in some cases worsened – since the pandemic. According to
   HSE data published by Sinn Fein, 21,132 people were waiting on primary care psychology services as
   of February 2024, a 102% increase from 2020.35 Of this number, 2,564 were adults, although it is
   unclear how many are over the age of 65.
   
   ALONE services have played an important role in protecting older people’s mental health. As noted
   in earlier sections, ALONE’s recent impact evaluation36 confirmed that our supports reduced
   loneliness, improved quality of life and strengthened personal capability.
   
   Older people’s mental health remains critically underserved, even as demand rises. Community
   based supports such as ALONE’s programmes clearly improve wellbeing, but they are not a
   substitute for properly staffed specialist mental health services.
   Therefore, ALONE has the following recommendations to improve
   mental health services for older people:
   
   1: Fully Implement the Model of Care for Older People to ensure comprehensive,
   evidence-based services are available nationwide.
   
   2: Expand mental health supports tailored to older adults, ensuring services are
   accessible, age-appropriate, and responsive to their unique needs.
   
   3: Expand acute mental healthcare capacity for older adults, considering the significant
   shortages. In our Pre-Budget Submission 2026, ALONE called for €25.6m to support
   mental health beds and staffing issues37
   .
   
   Physical Health
   As people age, a natural decline in physical health is common. TILDA has identified several key
   health issues facing older adults. These include cardiovascular diseases (e.g., hypertension, stroke),
   non-cardiovascular chronic conditions (e.g., diabetes, sensory impairment) and chronic respiratory
   diseases. In addition, issues such as obesity, polypharmacy (use of multiple medications), cancer and
   falls are significant and growing health concerns.38
   
   The COVID-19 pandemic intensified these risks. Research from ALONE and TILDA found that
   cocooning measures led to an increase in calls to ALONE’s National Support and Referral Line (NSRL)
   from older people experiencing physical pain, chronic obstructive pulmonary disease (COPD), and
   diabetes-related issues39. Further research has shown that cocooning measures meant older peopl
   spent more time indoors, leading to less physical activity, increased screen use, poorer sleep, higher
   stress, more frequent snacking and lower protein intake, increasing the risk of developing these
   diseases40 The lack of sun exposure also resulted in less Vitamin D, further affecting health 41.
   Indeed, according to the CSO, 42% of deaths in Ireland due to COVID were in those aged 85 and
   over, 75% in people aged 75 and over and 91% in people aged 65 and over42
   
   Several reports have since criticised elements of the cocooning measures and associated public
   communication, describing them as unnecessarily broad and potentially ageist43, which treated all
   older people as being the same regardless of the diversity of personal situations, capacities, health
   statuses, and needs that exist among this broad group. Nonetheless, 60% of participants in a TILDA
   study reported that they agreed with government advice regarding cocooning44.
   .
   Many older adults delayed or avoided medical treatment during the pandemic. In the TILDA study
   cited above, almost 1 in 6 of study participants reported that while cocooning they did not seek
   medical attention for an illness, when they otherwise would have done so45
   . ALONE and TILDA research highlighted an increase in callers to ALONE reporting postponed
   check-ups or treatment, even after falls. Half of those who did not seek medical attention said this
   was because they were afraid of catching COVID-19.46 At the same time, limited appointment
   availability meant that even
   those who tried to access care often could not, with insufficient numbers of GPs to meet demand47.
   .
   The HSE’s Enhanced Community Care (ECC) Programme has shown how shifting care to the
   community can ease hospital strain. During the pandemic, ECC services increased patient contacts
   by 31.5% and successfully supported over 7,000 frail adults which prevented unnecessary hospital
   admissions. ALONE believes that ageing well depends on more than medical treatment. Equitable
   access to primary care, integrated community services, and preventative measures to reduce frailty
   and falls are vital to maintaining quality of life and preparing for future public health crises. Drawing
   on the lessons from the pandemic’s impact on older people’s physical health, ALONE proposes the
   following policy recommendations:
   
   1: Invest in Fall Prevention through Community Exercise Programmes: As recommended by
   ALONE and Social Justice Ireland, the roll out of fall prevention programmes can support
   older people to age well at home (estimated 2026 cost: €1.7m)
   48
   .
   2: Invest in Primary Care Services: Increasing the number of GP practice teams across the state
   will strengthen Primary Care services, ensuring timely access to care and reducing overreliance on hospital care services (estimated 2026 cost: €100m)
   49
   .
   
   
   Footnotes
4. 1 https://assets.gov.ie/static/documents/the-community-call-advice-and-contact-information-for-your-county-6c3f0617- bc92-4bde-b.pdf
   2 https://www.gov.ie/ga/roinn-an-taoisigh/preaseisiuinti/covid-19-public-information-booklet-to-be-delivered-to-everyhousehold-nationwide/
   3 Over 27% of Covid-19 deaths were in nursing homes
   4 ALONE-ECC-Report-2024.pdf
   5 https://tilda.tcd.ie/publications/reports/pdf/Report_Loneliness.pdf
   6 Ye Lou, Hawkley LC, Waite LJ et al. Loneliness, health and mortality in old age: A national longitudinal study. Soc Sci Med 2012; 74,pp. 907-914
   7 https://www.nia.nih.gov/news/social-isolation-loneliness-older-people-pose-health-risks
   8 https://tilda.tcd.ie/publications/reports/pdf/Report_Covid19SocialIsolation.pdf
   9 https://tilda.tcd.ie/publications/reports/pdf/Report_Covid19SocialIsolation.pdf
   10 ALONE warns that cocooning will have a long term impact on the physical health and wellbeing of older people – ALONE
   11 https://www.gov.ie/en/department-of-health/press-releases/ministers-and-chief-medical-officer-advise-older-peoplehow-to-reconnect-with-their-communities-as-they-launch-online-resource/
   12 https://alone.ie/alone-calls-for-long-awaited-national-strategy-to-combat-loneliness-in-light-of-hello-again-worldcampaign/
   13 ALONE urges Government to begin their plans towards a re-emergence programme for older and medically vulnerable groups – ALONE
   14 CSO Wellbeing Information Hub
   15 HALO Report
   16 A briefing from the Loneliness Taskforce (2024)
   17 Policy Options to Support Ageing Well at Home: Budget 2026
   18 https://alzheimer.ie/wp-content/uploads/2021/07/Telling-It-Like-It-Is.pdf
   19 https://www.hse.ie/eng/about/personalpq/pq/2023-pq-responses/july%202023/pq-35274-23-richard-bruton.pd
    20 https://www.rte.ie/news/coronavirus/2021/0519/1222604-sage-day-care/
   21 Elderly ‘forgotten’ as care centres closed since 2020 | Southern Star
   22 Dementia sufferers are unable to return to their day care as centres are not yet Covid compliant | Irish Independent
   23 Ministers for Health announce €10 million in additional funding for Day Centres and Meals on Wheels community care services
   24 https://alone.ie/alone-raises-concerns-regarding-access-to-safe-public-transport-for-older-people/
   25 ALONE Pre-Budget 2026 Summary – ALONE
   26 Policies for Ageing Well at Home in Ireland’, ALONE and Social Justice Ireland, 2024
   27 https://tilda.tcd.ie/publications/reports/pdf/w1-key-findings-report/Chapter6.pdf
   28 https://tilda.tcd.ie/publications/reports/pdf/w1-key-findings-report/Chapter6.pdf
   29 Mental Health Issues Associated With COVID-19 Among the Elderly Population: A Narrative Review – PMC
   30 https://tilda.tcd.ie/news-events/2020/2024-covid19-loneliness-over70s/
   31 Patterns of Hospital Presenting Suicide-Related Ideation in Older Adults before and during COVID-19:
   32 https://www.sciencedirect.com/science/article/pii/S1041610224005052#:~:text=’Developmental%20psychol ogy’%20is%20often%20presented,in%20an%20old%20age%20service
   33 https://www.mhcirl.ie/sites/default/files/2021-01/Mental-Health-Services-for-Older-People-Report2020.pdf 34 https://www.hse.ie/eng/about/who/cspd/ncps/older-people/moc/specialist-mental-health-services-forolder-people-model-of-care.pdf
   35 Psychology waiting lists have doubled under this government – Mark Ward TD – Sinn Féin
   36 ALONE-IMPACT-ASSESSMENT-REPORT_FINAL.pdf
   37 ALONE Pre-Budget 2026 Summary – ALONE
   38 2025.06.24-Policies-for-Ageing-Well-at-Home-in-Ireland-Health-and-Wellbeing.pdf
5. 39 Report_Covid19SocialIsolation.pdf
   40 https://pubmed.ncbi.nlm.nih.gov/33001410/
   41 interim-report-on-the-impact-of-cocooning-measures-on-older-people.pdf
   42 Covid-19: Nine out of 10 deaths among over-65s, CSO data finds – The Irish Times
   43 https://alzheimer.ie/wp-content/uploads/2021/07/Telling-It-Like-It-Is.pdf
   44 ‘Physical and Mental Health of Older People while Cocooning during the COVID-19 Pandemic’, https://academic.oup.com/qjmed/advance-article/doi/10.1093/qjmed/hcab015/6104561
   45 Ibid
   46 Findings reveal stark health impacts of ‘cocooning’ for older people – News & Events | Trinity College Dublin 
   47 Chronic shortage of doctors will have devastating implications if not addressed
   48 ’Policy Options to Support Ageing Well at Home: Budget 2026’, ALONE and Social Justice Ireland
   49 ‘Policy Options to Support Ageing Well at Home: Budget 2026’, ALONE and Social Justice Ireland