Loneliness and elderly isolation – a discussion paper- by Andy Orrmiston
She lives in a bubble, watching the world go by, but no one sees her because of the refraction of her bubble.
Loneliness and elderly isolation – a discussion paperShe lives in a bubble, watching the world go by, but no one sees her because of the refraction of her bubble.
Elderly isolation – The paragraphs in italics are from a report on Loneliness of the British Red Cross. 1
Feeling lonely isn't in itself a mental health problem, but the two are strongly linked. Having a mental health problem increases your chance of feeling lonely, and feeling lonely can have a negative impact on your mental health. Nicholson suggests that social isolation is “a state in which the individual lacks a sense of belonging socially, lacks engagement with others, has a minimal number of social contacts and they are deficient in fulfilling and quality relationships” Another important dimension of isolation or loneliness is that it can be positive as well as negative. For example, solitude may be an important part of self-growth, allowing time for reflection and meditation. The British Red Cross distinguishes between three types of loneliness.
> Transient/everyday loneliness includes brief and occasional lonely moods. These experiences have not been of much concern to researchers or clinicians. > Situational/transitional loneliness involves people who had satisfying relationships until some specific change occurred, such as divorce, bereavement or moving to a new town. > Chronic loneliness occurs when a person has lacked satisfactory social relations for a period of two or more years. Although we talk of the Costa Blanca, in reality we are focusing on the Vega Baja area and its 27 municipalities or just the Department of Health 22. See Appendix. Mid-life is an important transition and often a stressful time, burdened with simultaneous demands from work, childcare and aging parents, but also a time where people re-evaluate and recalibrate their life, and might be more likely to suffer from mental health issues. Divorce, breaking of relationships are all too common and each instance causes hurt. The research showed that divorce (or the end of a cohabiting relationship) is the main reason for middle-aged men and women to live alone. Again we do have counseling groups on the Costa Blanca, but unless they can reach out to those individuals they will continue to live in a sort of limbo sometimes. Adults living alone in mid-life tend to have lower incomes than those living with a partner. There are men living alone who do not have (or never had) a partner or children, and older mothers who had broken up with their partner. Elderly isolation is a vast problem on The Costa Blanca. The Spanish regional health authorities are partially to blame by encouraging elderly Spanish patients to move to a better climate It is further exacerbated by the thousands of foreigners who chose to retire here or buy a second residence. 2
The result is that area is top heavy with the elderly. A solution is to take those over a certain age and give them a lethal injection. If that was the case the local economy would collapse because it is the same elderly who are the consumers and, therefore, bringing wealth to the area. One has to look at the quality of life of each individual as everyone has his or her own talents and purpose in life. One also has to respect his or her independence and a right not to be involved with anyone else. Some factors apply to living in Spain. We have a complete change of life, lack the language, but think if we shout hard enough the Spaniard will understand. Relationships can lead to a break or divorce and we have groups such as the Samaratins who can provide support. Bereavement is a further issue and we have bereavement groups and counsellors who can help, but people need to know that they are here. Chronic illness is unfortunately very common and fortunately we have a good network of associations that help people with cancer, Alzheimer’s, strokes, diabetes etc. Support groups and discussion sessions also appear to be beneficial for specific populations, for example people who are bereaved or have a chronic condition. Crucial elements in this are bar/restaurants that are in reality social centres that offer things like darts, snooker or board games. They 3
usually also have live music and dancing which makes the individual more likely to mix with the opposite sex should they wish. More importantly, they find themselves in an environment that enhances quality of life owing to increased social involvement, with the potential of reducing social isolation at the same time. Many associations, particularly lunch clubs, make use of these facilities, while others offer Spanish classes, computer familiarity which is particularly interesting as it offers individuals to connect visibly with family. Loneliness has been associated with personality disorders and psychoses, suicide, impaired cognitive performance and cognitive decline over time (Shankar et al. 2013), increased risk of dementia (Holwerda et al. 2014), and increases in depressive symptoms (Hawkley and Cacioppo 2010: 219). In fact, Holwerda and colleagues (2014) found that people experiencing a high degree of loneliness were potentially twice as likely to develop Alzheimer’s as those experiencing a lower degree of loneliness.
Despite having a great public health system, where nurses in particular work long shifts, there is too much strain on the resources to deal with so many elderly. This can be seen in the hospital observation unit by the
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number of patients being of an advanced age and many being there because of a fall or other injury that the older person is liable to have. But others are there because they have a serious medical condition and are moved on into the main hospital to be treated by specialists. A large section of these patients are British. Some of them die there. This raises anther problem for some elderly. Many live on a very small income with little or no savings. Many leave their body to “science�, but the protocol for this has changed as the hospitals realize they have too many bodies, some of which are of little use. Now there is a charge of 1,000 euros, which some people cannot afford. A burial in a niche or by cremation is much the same and a minimum cost will be around 2,500 euros but more likely to rise to 5,000. Just taking the body out of the hospital will have a price. Apart from costs, as said elsewhere many elderly die alone, and that can mean there is no one, absolutely no one to grieve for them or attend their funeral. So another possibility is that of the Gospel and Middle Ages, namely a group of persons who will undertake to attend someone’s funeral and give them a dignified send-off. HELP, SAMARITANS or church organization interested?
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Predisposing factors can include characteristics of the person (e.g. low selfesteem, shyness, lack of assertiveness), characteristics of the situation (e.g. lack of resources, competitive environments), and general cultural values (e.g. individualism). Precipitating events are factors such as the breakup of a relationship or moving to a new community, which change a person’s social life in some significant way. Situations that cut us off from the mainstream of society, such as unemployment, poverty, mental illness or old age, also put us at a heightened risk of feeling lonely, as do those in which people need an unusual level of support: disability, drug or alcohol addiction, caring for a relative or being a lone parent. The majority of the elderly have some form of support, whether it be family, friends or some sporting or social club. The Spanish tend to use Pensioners clubs, paid for by local council or government. Torrevieja has five such clubs that offer companionship, games, dancing, libraries and outings, sporting events and other activities. Then there are regional clubs centred on the culture of Andalucía, Galicia, Madrid etc. This enhances the overall culture of the area as well as forming a foundation for a richer cultural offer to tourists. AFA, AFECANCER, ALPE, APANEE, ADIEM, AMFA, AEEC are only some of the Spanish based associations. MABS has done well in aftercare of cancer and has recently opened a respite house in Torrevieja.
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But there is a wide swathe of younger British now living the dream and they do not realize how an illness can suddenly appear and leave them incapable of communicating with others. Many of these have their own businesses and may or may not have decided to live on the Costa Blanca, raise children and take roots. Others only want to stay several years as an experience and hanker back after UK. There are people whose impairment or long-term condition has made them more at risk of experiencing isolation or loneliness, including older people who are more likely to become disabled. Long-term health conditions and impairments can have a negative impact on various aspects of individual well-being. Impairments involve a reduction or loss of function and difficulty in performing activities of normal daily living, such as walking or reading. Because disabling health problems are often associated with the loss of independence and autonomy, they affect not only the lives of the disabled but also the lives of those who are close to them. This is where Age Concern, Help at Home, HELP, CARE and organisations that specialise in specific disease related disabilities come in.
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To consider both partners’ health is especially relevant for older adults. Older couples are particularly at risk of disability of both partners for two reasons. First, both partners of the older couple have an increased risk of disabling health p r o b l e m s because of the i n c re a s e d longevity for both men and women. Second, caring for a disabled spouse is a risk factor for one’s own health as mentioned above. If a non-disabled partner assumes more care responsibilities, he or she is particularly at risk of developing health problems. Again we have a large slice of the elderly who live their own lives in isolation, keeping to themselves and proud of their independence, especially true of Spanish, who because of the language have the ability to get help. But this same independence makes them vulnerable in a health emergency, when they can’t reach the phone or call a neighbour, partly because so many surrounding houses are empty as they are second homes. Someone may notice their absence but not think about it or call police on suspicion that something may be wrong. Often police are called out and enter the premises and able to call SAMU or ambulance. But all too often they find mummified remains as dehydration has a big effect in this warm climate. Bearing this in mind elderly people need to be encouraged and reminded to drink their 8
daily one and a half litres of water as normally they don't feel thirsty. Also they should be aware o f Teleassistance and other aids. The response to reach out to those living in isolation has to be a grass root one, involving neighbours, and dedicated associations like Age Concern, Alzheimers etc. It also requires a greater political and economic commitment. Churches tend to reach out to their members and can be a great support if visiting these people a couple of times a week. It should be noted that here we are not just talking of individuals living alone, but often married couples who no longer have much to say to each other as with the arrival of retirement they no longer have much in common. The Catholic church has well defined parishes and most of them a branch of the Caritas organization who have a programme connecting to immigrants, and like the Cruz Roja, helping with documentation, food for the poor, literacy classes for immigrants, etc. It would be nice if they could be persuaded to reach out to the elderly if they do not already do as part of their apostolate.Similarly another organization is of young people, las Hijas de la Inmaculada whose members might also be able to visit the elderly in the parish, but I’ve still to talk to the parish priest about this. . Ameliorating feelings of loneliness is more complex, but by reducing social isolation through the provision of social connections, there is a greater possibility to develop emotionally satisfying relationships and thereby reduce feelings of loneliness. Nowadays town councils have a social services department, but their resources go nowhere to reach the demand, as there is a tendency to assist younger people suffering a wide range of social problems - single mothers, drug dependents, broken families etc. If support is offered to the elderly it is likely to be someone popping in for a brief clean for which the person has to 9
pay. But social services often can offer financial support for buying aids such as hospital style beds, stairlifts. Spain is not a welfare state. Spanish law puts the onus on family to care for their elderly members. This can be a problem for British as they are used to the idea that the old dear can be put in a residence or similar. In Spain residences will ensure that there are resources to pay for a placement such as a house that can be sold.
In lieu of this many elderly opt to pay a person they think they can trust to come in. One old English lady pays to have her house cleared once a week, but the cleaner (of her own conscience) pops in each morning to give her a cup of coffee and ensure she is all right and twice recently has had to call an ambulance as the patient has fallen and bruised her face. What is clear is that GPs, social workers, housing associations, and other frontline services are well placed to identify people who are at risk of isolation or loneliness. Other elderly, especially Spanish women, can afford to hire a companion, mostly South American, who help them through the day with cleaning, shopping and cooking, as well as pushing them in a wheelchair along the promenade for a short time to get fresh air. This entails having confidence in the honesty and integrity of the companion and is open to abuse. As the companion is being technically employed she should have a contract and 10
National Insurance paid; however some are autonomous and pay their own social security. APANEE help in many of these instances. Keeping fit is also an important feature as many individuals can just sit in their armchair all day and watch the world go by. Most beaches and some parks have fixed exercise equipment that could be used if one is not inclined to go to the gym. In these situations it may be possible to strike up a new relationship. Of course the best exercise is to get out of that chair and walk a few kilometers if possible. Then we have residential care. The social worker in any residence has a prime position and needs to be a determined person with projects for patients to socialise. Keeping patients animated is most important as all too often patients are stuck in a nappy and stuck in front of the television, even if they don't understand Spanish. Some hospital doctors are inclined to think that residential patients are dumped in Urgencias to die, Â but I have witnessed a social worker force doctors to admit an English patient to the main hospital because she considered his condition had deteriorated from the day before.
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Age notwithstanding, people receiving care in residential or communitybased settings are both at risk of experiencing social isolation or loneliness. Activities can include bringing cats or dogs to visit patients, fish tanks , possibility of gardening with waist high area to permit wheelchair users to plant their flowers. A UK report found that with regards to older adults who reported owning a pet are 36% less likely to report loneliness than older adults not reporting pet ownership. Caring for a pet also requires behavioral activation, such as walking or going to the veterinary office, which may bring about interactions with other people and, by virtue of increased mobility. Often dog owners can be seen exchanging information about their pets. Congratulations on the initiative of CasaVerde in organising courses for school children in preparation to mix with elderly in that residence. Perhaps this could be used as a foundation for similar initiatives. Children can also become lonely and these are vulnerable to bullying, which today is a huge social problem that many Spanish schools are tackling. Because the schools are very much of an international nature with so many nationalities, there can be a tendency that some particular child can be picked on just because he is different. But by involving children at an early age to regard elderly people as persons of value then they can be guided towards being valuable 12
volunteers or professionals of the future. This is part of education for life. In some ways the British are better off because of support offered by a variety of associations. Other nationalities tend to have social clubs rather than support associations, apart from Russian/Ukrainian have 5 Continentes association that offers free food to a variety of people from a shop and centre in calle Fragata. Their presence has been augmented recently by an Orthodox church. Previously they shared the los Locos church. Some countries do offer some support to their Nationals. The Swedes have two apartments in Quesada for the use of disabled to holiday and these are fully equipped with gadgets to facilitate the life of the patients. Where necessary two carers will accompany the patient. The Norwegians have their own church and facilities at La Siesta, but other club houses. The Lutheran Finnish tend to use the la Inmaculada for their larger services. Then there is the social club Los Amigos with a variety of activities. Normally Carers tend to be family members and also at risk of loneliness. These “informal carers� are also at risk of becoming isolated or lonely in their roles as carers. It is important to remember that this role is a form of unpaid work. Many informal carers have care duties that take 20 or more hours per week. In effect it can become a full time job. Carers need to have a fruitful social life and, therefore, some ability to have respite. Many times I have seen a woman becoming a widow, but feels the need for companionship and takes into her house another man, who later can become a burden she ill expected, after the experience of looking after her sick husband. For many the feeling of loneliness comes when the doors are locked and you face an empty bed.
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Consulates will also have some support for their nationalities as in the case of a Dutch national dying in the hospital with no financial means to bury him and the consulate undertook to arrange a burial. He is presently out of hospital and is looked after twice a day by CARE association and paying 15 euros per hour, which seems to be a common amount to pay off this kind of support.
As we know The British consulate is also aware of the huge problem facing British elderly and want to do something. This needs to include financing suitable Projects.  The fact is that many entities I spoke to were well aware of the problem, but consider that they don't know where to start. It’s too big for them. It requires a cohesive plan where every club, every Association, every person work together in cooperation and not on their own - Social workers, police, clergy and hospital chaplains, some politicians, doctors, are all faced with this problem daily and all affirm willingness to cooperate in any solution. So as can be seen there is a network available, but needs to be drawn together in some way. I would suggest that once there is a coherent plan then all the editors of all the different newspapers, radio and TV stations be invited to a dual language presentation by professionals who can talk to this particular audience about how they can participate in putting a plan before their readers. I would suggest that Quiron Hospital might like to sponsor this. Similarly, bring together all the other professional and political groups for a similar workshop.
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OPTIONS Private health care is part of the Spanish landscape, but there seems to be no policies that are programmed for actually growing old and akin illnesses such as Alzheimer's. This idea was floated in UK but it was never successful as it implied people putting up about 100,000 pounds upfront. There are some successful implementations of ideas in UK such as someone shared-lives schemes whereby councils pay individuals to provide care, in their own home. There are about 150 such schemes in the UK, two thirds run by councils, the rest falls on the voluntary sector. A similar idea is someone moving in with an older person who has the space in their house and they can provide basic support, such as shopping, cleaning, but not personal care in return fro free accommodation of for a small rent. Then there are so-called retirement villages, where retired persons buy an apartment on the site, or even part-buy or even rent a property on site. This idea would fit in with our Appendix about the Los Balcones building. Residents bring their own furniture, decorate as they wish, and are free to have friends and family come to stay. Most villages allow pets to come too.They can also pay for care and support services, which are on-site, as and when they need them.The properties have been designed to keep the individual living independently as long as possible and so can be kitted out with alarms, fall sensors and easily accessible showers. Such complexes are popular in Australia, New Zealand and South Africa. There are many different types of sheltered-housing schemes.Some will have a warden, living on or off the premises, and all provide 24-hour emergency help through an alarm system. Rented accommodation is usually self-contained, but there are often communal areas, such as the lounge, laundry room and garden. For those needing more support, extra-care sheltered housing may be available where residents can have personal care and meals provided.
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Many people do not want to leave their home and preserve their independence. Councils can help in providing equipment or people can buy their own to make life easier. One lady in Torrevieja had a steep flight of outside stairs going up to her house and the council put in a stair lift for her. Technology has provided many other aids such as sensors that cause an alarm when the person does not move are found normally. There has been greater use of "telehealth" and "telecare" technology, including devices to remind people to take medication and ways for carers and health staff to remotely monitor things such as blood pressure. The 22 Health Department has a system of patient monitoring for those most at risk whereby the patient has a code that can be put into their computer or smartphone, and connects with their doctor, but requires that the patient daily feed in basic information such as blood pressure, glucose levels etc. depending on their infirmities. SIRI is another option to serve as a robotic companion. IN UK most elderly depend on family, but this is not the case for the majority of elderly in Spain as their families are far away, and in many instances they do not want to bother their family, or their family cannot be bothered with them. But it is of prime importance that families keep in touch with their parents, either by telephone regularly using Skype, FaceTime or other communication system. In UK there is a growing awareness that elderly isolation is a community problem and is being tackled at grass roots. In Frome village the doctor identifies a person with loneliness and asks if he/she would like to consult with an experienced person about this. This assessor then talks over the
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problem and offers suggestions such as a regular visitor, or joining in a group. In this way the assessor may have 20 people which, when multiplied means that there are 10,000 people involved one way or another. (BBC News report)ยบ What the British associations are doing is wonderful, and envied by the Spanish, but as they depend on volunteers are limited in what can be done. The question is how to raise awareness of the isolation problem and attract younger volunteers. But many young people have the same problem of isolation because of their dependency for social media of Internet. Thus they never really get to know others of their age apart from distant contact friends, who may or may not exist. So part of an overall policy is to reach out to the young for support. But also involve all parts of our society in an integral plan. Undoubtedly fund raising for leaflets, training etc. is needed so perhaps a GOFund could be organised. 24 hour tv/radio marathon. One idea would be to bring together all the many professionals of stage singers, musicians, dance groups,theatre groups, bands and orchestra. This would involve almost the whole of the population either as participants or viewers. But hopefully would raise the main funds for an ongoing programme. Undoubtedly we all grow old and kept alive by the modern medicine technologies. The losses associated with becoming old involve not only loss of physical and cognitive capacity and functional ability, but also the loss of friends and family members. Any or all of these losses may contribute to 17
experiences of loneliness among the very old. Yet being old does not mean that a person is useless. So many active and bright over 75’s have knowledge and skills that should be used in society. The U3 movement is a good example of keeping those skills alive, but could be extended further into teaching younger people from older peoples life experiences. Just 1 in 4 people aged 75 and over reported meeting with friends, relatives or work colleagues less than once week in 2012 to 2013. It is known that older people, especially those aged 75 and over, are vulnerable to social isolation which can impact on their physical and mental health. More men than women reported having no close friend across all ages, with the difference between sexes being more marked at older age: around 14% of men aged 75 and over reported having no close friend compared to 9% of women aged 75 and over. For example, volunteer friendly-visiting programs, psychosocial group rehabilitation, or the use of technology for social networking are approaches that could be harnessed to reduce isolation. These types of interventions have been effective in connecting isolated adults to new network members, inducing feelings of “being needed�, and increasing well-being A big obstacle for some to get out of their bubble is lack of transport. Some associations have transport for use of their members. But many people would enjoy someone offering to take them shopping or to have a drink in a seaside bar. Again this requires awaking a social awareness among the general community to think about the old lady next door in her bubble. Torrevieja council has tried to make their bus services suitable for older people and disabled. There are also taxis for disabled wheelchair users. Bus trips may be the core of an organised outing, ranging from regular shared trips to local shopping amenities, to more ambitious projects such as visits to places of interest, or (for one group) educational outings linked to museums, concerts and theatre, lectures or fiestas in other towns. e.g. Fallas in Valencia, Hogueras in Alicante or even the Feria de Mayo in Torrevieja. But mobility is also an issue with nurses working out of the various clinics, as they are expected to visit patients at home for dressing a wound etc. They go on foot, use their own vehicle but do not get any petrol expenses. So they can sometimes be reluctant to visit. 18
While the impact of mobility characteristics on loneliness are often overlooked, the use of different transport modes (bicycle, car and public transport) significantly reduces loneliness and may even explain age-related effects Transportation modes provide access to social relations outside the neighbourhood and may be essential to maintain one’s social network. In addition, public transport provides a space where people are in close proximity and where social interactions can take place. Being able to use the public transport network isn’t just about getting around. It is also about feeling part of the community and having a chance to interact with other people, especially on the bus network. Using a taxi is often the only option some disabled have to get around. In tackling loneliness there is a need for people with social skills. Social skills can take a range of forms, including conversational skills, speaking on the telephone, giving and receiving compliments, handling periods of silence, non-verbal communication methods, and approaches to physical intimacy. We also have some problems with those patients who use electric wheelchairs. In Torrevieja, because of the state of the pavements, cars parking on ramps and other obstacles, these wheelchair users are at risk by having to go on the road. But it is a good option using bicycle lanes.
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Personally I still consider that The Cruz Roja has the best qualifications to run any campaign and subsequent project. They have experience, offices in almost every town, can train personnel and volunteers. For this they need to be funded by the general community, businesses and public services. This would require printed material with contact numbers and advice to anyone who feels isolated in some form. These could be distributed via health centers, public and private, pharmacies, health shops.
APPENDIX ONE
If you feel lonely have a look at these tips. They might help you to cope with feelings of loneliness. • Think about what is making you lonely • Make new connections • Join a club • Be a volunteer • Open up • Take it slow • Be careful when comparing yourself to others • Check how you are feeling • Get some help • Read others' stories
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APPENDIX 2
Los Balcones building One of the places visited recently is an almost completed building at Los Balcones that was intended by the constructor to be a residence for elderly. However, the Swedish company interested pulled out and he was faced with bankruptcy and debt, the bank taking over The deeds until the issue can be resolved. It has 250 studios, each almost complete, painted, tv and telephone connections, large bath room suitable for wheelchairs. There is provision for an American kitchen. We were assured that all the furniture and white good's are in storage waiting for a conclusion to the building, that is a buyer. There is a central area with garden and swimming pool adapted for disabled. The whole building has easy access for disabled including two underground garages that we were assured were soundproofed. There are common areas, such as bar/ restaurant, gymnasium and rehabilitation rooms and laundrette room. There is adequate office and administration zone. It is next to a commercial zone with alternative restaurants and bars and within walking distance to two parks. The gate here has a special lock and located here is a large tank for gas that meets current safety regulations. It is only a five minute drive from Torrevieja's hospital. Meant to sell off individual units, this has never been realized what is required is a health group to manage it as it is a large project as it has so much potential. Especially in the context of a “Retirement village” (see above). In looking at the elderly and their social isolation we can see a number of needs. 1). Sheltered housing Project. 2) Carers respite. 3). Hospice facilities. The hospital does have a protocol for those near death. 4). Alzheimers residential facilities. 5) Possibility of disabled youngsters to have their own little nest. 6). Hospital patient aftercare. All too often patients are released from hospital on the assumption that a family member, friend or neighbour will care for their needs. This is not the case as the family might only be a sentimental partner even older than the patient.
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7). The hospital does have a couple of holiday initiatives for patients to come and use The hospital facilities. This is the case of the dialysis department and requires somewhere for patients to live, as well as visiting family. APPENDIX 3 As said previously we are looking at the whole of the Vega Baja, but probably a more realistic area is theHealth Department 22 that reaches from Pilar de la Horadada to Guardamar, inland encompassing Rojales, San Miguel de las Salinas. However here are some statistics for the Vega Baja with each town, its population and area.
Municipal Population Torrevieja 84.213 Orihuela 80.359 Pilar de la Horadada 21.348 Almoradí 20.138 Callosa de Segura 18.497 Rojales 17.622 Guardamar del Segura 15.386 Albatera 11.756 Catral 8.551 Redován 7.765 San Fulgencio 7.384 Dolores 7.264 Cox 7.193 San Miguel de Salinas 6.993 Bigastro 6.724 Benejúzar 5.364 Los Montesinos 4.912 Rafal 4.218 Formentera del Segura 3.995 Algorfa 3.222 Benijófar 3.163 Granja de Rocamora 2.461 Jacarilla Benferri San Isidro Daya Nueva Daya Vieja
1.939 1.920 1.915 1.750 672
Area 71,44 365,44 77,1 42,72 25 27,6 35,58 66,33 20,01 9,45 19,75 18,25 16,6 54,9 4,1 9,33 15,05 1,6 4,3 18,4 4,4 7,2 12,2 12,4 11,69 7,09 2,98
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APPENDIX 4
As the idea is to bring the whole community together, making use of their skills, bringing awareness to the problem. 24 hour marathon. We have a wealth of talent in the Vega Baja area and as we know many professionals make use of their talents to raise funds for charities. One idea would be to bring together all the many professionals of stage singers, musicians, dance groups,theatre groups, bands and orchestra. Not forgetting judo, kung fu or rhythmic gymnasts. Together with chats on loneliness and social isolation a 24 hour marathon could be made making use of television channels and radio with press support. This could also be used to raise funds via a bank transference with the option of announcing a growing total. But this would require a definite cohesive sustainable plan.
HELP PEOPLE BURST THEIR BUBBLE
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