Interventions to address social connectedness and loneliness for older adults: a scoping review

[Determinants for addressing social isolation and loneliness of non-institutionalized older adults from Primary Health Care]

Objetivo

Identificar los principales condicionantes que los profesionales de atención primaria indican a la hora de implementar y desarrollar intervenciones sobre el aislamiento y la soledad.

Diseño

Investigación cualitativa con análisis Sistemático de Teoría Fundamentada y Diseño narrativo de tópicos.

Emplazamiento

Desarrollada en 13 centros de atención primaria del Distrito Sanitario Córdoba y Guadalquivir, abarcando zonas urbanas y rurales.

Participantes

Se identificaron 3 perfiles: medicina de familia/atención comunitaria, enfermería comunitaria y enfermería de gestión de casos. La selección se llevó a cabo entre aquellos que mostraron mayor motivación y compromiso con una intervención sobre aislamiento/soledad.

Método

Muestreo intencional. El trabajo se fundamentó en entrevistas en profundidad individuales, en grupos focales y entrevistas dialógicas.

Resultados

a) Persisten imágenes deformadas sobre la soledad/aislamiento social y el vivir solo que dificultan su identificación; b) Los principales determinantes disruptivos en la estructura y organización del sistema de atención tienen que ver con la ausencia de programas de detección, la hegemonía del modelo biomédico y el déficit de recursos (a la luz de este modelo); c) Los principales facilitadores se vinculan con el rol enfermero, privilegiado para estas intervenciones según los participantes; y, finalmente, d) Es necesario contar con componentes personales, tanto de la persona mayor como de los profesionales.

Conclusiones

La intervención sobre el aislamiento social y la soledad en atención primaria está condicionada por factores, organizacionales y estructurales, profesionales y personales. Contar con ellos es fundamental a la hora de garantizar su factibilidad.

Long-Term Effects on Loneliness of a Computer-Tailored Intervention for Older Adults With Chronic Diseases: A Randomized Controlled Trial

Objectives: This study explores the effects of the Active Plus intervention aiming to decrease loneliness among older adults (>65 years) with chronic diseases. Methods: A randomized controlled trial (RCT) was performed (N = 585; age: M = 74.5 years, SD = 6.4), assessing loneliness at baseline, 6 months and 12 months. Outcome measures in the multilevel linear regression analyses were total, social and emotional loneliness. Results: At 12 months, significant decreases in total (B = -.37, p = .01) and social loneliness (B = -.24, p = .02) were found. Age was a significant moderator for total and social loneliness; however, the intervention was effective only for participants aged 80 years and older. Discussion: The Active Plus intervention showed a significant decrease in total and social loneliness and was especially beneficial for the vulnerable age group of 80 years and older. A more comprehensive tool for measuring social activity and mobility impairments, and using a longer time frame to detect loneliness changes, may form interesting future research.

Feasibility and Enjoyment of Exercise Video Games in Older Adults

Introduction: Several interventions have been developed to enhance social connectedness among older adults. However, little research has demonstrated their performance in a social distancing environment. Exergames are not only beneficial to older adults' physical and cognitive health, but they also allow players to interact with each other at a distance, which can reduce loneliness and increase social connection. The aim of this pilot study was to investigate older adults' perceptions of two commercially available exergames.

Methods: Twenty healthy community-dwelling older adults (M age = 73.30, SD = 5.95, range = 65–84 years, 80% women) were recruited in this pilot study between July 2019 and February 2020. They were asked to play two exergames for 10 min each on the Xbox One with Kinect console: Just Dance and Kinect Sports Rivals. After gameplay, they provided both quantitative and qualitative feedback on these games.

Results: Participants reported an average rating for exergame enjoyment. Greater enjoyment was significantly related with younger age and greater extraversion but not gender. Participants were highly motivated to do well on the games but reported lower scores for likelihood of playing these games in the future. Greater likelihood of future play was associated with younger age but not gender or extraversion. “Not aerobic or strengthen enough; not enough exertion,” and “slower movements, repetition, clear purpose of doing the exercise” were some factors that would influence their decision to buy and play these games.

Discussion: The preliminary results of this pilot study suggest that exergames may help address social isolation and loneliness—particularly during times of social distancing. Before applying exergames as a social isolation or loneliness intervention for older adults, study replication in larger representative studies and future work that examines important design issues related to older adults' experiences with these games is needed.

Prioritizing supports and services to help older adults age in place: A Delphi study comparing the perspectives of family/friend care partners and healthcare stakeholders

Background

Aging in place (AIP) is a policy strategy designed to help older adults remain in their community. While planners internationally have modified aspects of the older adult care continuum (e.g., home care, assisted living, nursing homes) to facilitate AIP, further improvements to community-based supports and services are also required. This study compared and constrasted the community-based factors (e.g., supports, services and personal strategies or characteristics) that family/friend care partners and healthcare stakeholders (i.e., planners/providers) view as most important to help older adults successfully AIP.

Methods

An initial list of factors shown to influence AIP was created from the academic literature. These factors were used to develop a Delphi survey implemented separately on care partners and healthcare stakeholders. Respondents rated the importance of each factor using a 10-point Likert Scale (1 = not important; 10 = absolutely critical). Consensus in each group was defined when at least 80% of participants scored a factor ≥8 (“very important”), with an interquartile range ≤2. Respondents suggested additional factors during Delphi round one.

Results

Care partners (N = 25) and healthcare stakeholders (N = 36) completed two and three Delphi rounds, respectively. These groups independently agreed that the following 3 (out of 27) factors were very important to help older adults age in place: keeping one’s home safe, maintaining strong inter-personal relationships, and coordinating care across formal providers. While healthcare stakeholders did not reach consensus on other factors, care partners agreed that 7 additional factors (e.g., access to affordable housing, having mental health programs) were important for AIP.

Conclusions

Compared to healthcare stakeholders, care partners felt that more and diverse community-based factors are important to support older adults to successfully AIP. Future research should replicate these findings in other jurisdictions, examine the availability and accessibility of the priority factors, and develop sustainable solutions to enhance their effectiveness.

Predictors of Anxiety, Stress, and Concern of COVID-19 Infection in Older Adults During the First and the Second Waves of the COVID-19 Pandemic in Slovakia

OBJECTIVES

This cross-sectional online study examined the role of socio-demographic and psychological characteristics in predicting anxiety, stress, and concern of coronavirus (COVID-19) infection in older adults during the first and second waves of the COVID-19 pandemic in Slovakia.

METHODS

Six hundred and seven older adults (Sample 1) and 156 older adults (Sample 2) participated in the study during the first and second waves of the COVID-19 pandemic, respectively. The older adults completed a battery of validated instruments for anxiety, stress, concern of COVID-19 infection (outcome variables), satisfaction with health, perceived danger of COVID-19, loneliness, intolerance of uncertainty (IU), optimism, powerlessness, and coping self-efficacy (predictor variables). The data were analyzed using multiple linear regression.

RESULTS

The older adults in both samples experienced moderate levels of anxiety, stress, and concern of COVID-19 infection. The greatest amount of variability in anxiety and stress was explained by powerlessness, IU, optimism, and coping self-efficacy. Concern of COVID-19 infection was best predicted by the perceived danger of COVID-19.

CONCLUSION

The findings contribute to the existing knowledge about the mental health of older adults during the COVID-19 pandemic and highlight the role of the psychological predictors of anxiety, stress, and concern of COVID-19 infection during both waves.

Interventions to address loneliness and social isolation in young people: A systematic review of the evidence on acceptability and effectiveness

INTRODUCTION

Loneliness is prevalent and associated with negative health outcomes in young people. Our understanding of how it can be best addressed is limited. This systematic review aims to assess the acceptability and effectiveness of interventions to reduce and prevent loneliness and social isolation in young people.

METHODS

Six bibliographic databases were searched; references of included studies were screened for relevant literature. A pre-defined framework was used for data extraction. Quality appraisal was performed using the Mixed Method Appraisal Tool. Data were synthesised narratively.

RESULTS

9,358 unique references were identified; 28 publications from 16 interventions met the inclusion criteria. The majority of interventions were high intensity, individual or small group interventions, often targeted at specific 'at risk' populations. While 14 interventions were associated with a statistically significant reduction in loneliness or social isolation, the heterogeneous measures of loneliness, small sample sizes, short periods of follow-up and high attrition rates limit evidence on effectiveness. Interventions implemented in more general populations of young people appeared more acceptable than those in specific 'at risk' populations.

CONCLUSION

High intensity interventions are unlikely to be feasible at a population level. Further work is required to develop and evaluate theoretically-informed loneliness interventions for young people that reach wider audiences.

Life Satisfaction in Individuals With Long-Term Traumatic Spinal Cord Injury: An Investigation of Associated Biopsychosocial Factors

OBJECTIVE

To investigate relationships between self-reported biological, psychological, and social factors and global, vocational, and home life satisfaction in individuals with traumatic spinal cord injury (SCI) an average of more than 30 years postinjury.

DESIGN

Cross-sectional analyses of self-report assessment data.

SETTING

Specialty and university hospitals in the southeastern and midwestern United States.

PARTICIPANTS

Individuals with a history of traumatic SCI (n=546) who responded to the most recent data collection period of the SCI Longitudinal Aging Study (2018-2019) and who were at least 2 years postinjury and at least 18 years or older at initial study enrollment.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Global life satisfaction, home life satisfaction, and vocational life satisfaction as measured by the Life Situation Questionnaire-Revised.

RESULTS

Taken together, the biopsychosocial variables explained 55.1% of the variance in global life satisfaction. Less severe depressive symptoms, greater emotional social support, and greater instrumental social support were significantly associated with greater global life satisfaction. Together, the independent variables explained 50.7% of the variance in home life satisfaction. Being in a relationship, having less severe depressive symptoms, having greater emotional social support, and having greater instrumental social support were significantly associated with home life satisfaction. Together, the independent variables explained 44.8% of the variance in vocational satisfaction. Being White, non-Hispanic, having more years of education, being in a relationship, having less severe depressive symptoms, and having greater emotional social support were significantly associated with greater vocational satisfaction.

CONCLUSION

These results support the need to assess psychological symptoms and available social support as potential modifiable factors related to several domains of life satisfaction in this aging population. Improving psychological symptoms and strengthening available social support may relate to improved life satisfaction.

Faith Community Nursing: Identifying and Combating Social Isolation and Loneliness in Older Adults

ABSTRACT

The number of older adults worldwide is growing; the incidence of social isolation and loneliness among this population is also increasing. Social isolation and loneliness can have significant physical, mental, and spiritual impacts. Faith community nurses are in an optimal position to identify and intervene to help faith communities reduce the social isolation and loneliness among community-dwelling older adults. Risk factors and tools to identify both circumstances are discussed along with interventions and a case study.

The association of social frailty with intrinsic capacity in community-dwelling older adults: a prospective cohort study

Background

Social frailty is associated with poor health outcomes; however, its effects on healthy aging indicators have not been adequately investigated. This study assessed the longitudinal association between social frailty and the intrinsic capacity of community-dwelling older adults.

Methods

A total of 663 participants (56.7% women) aged ≥60 years from in Nagoya, Japan, were included in the study. The first measurement occurred in 2014, and annual follow-ups occurred until 2017. Social frailty was determined based on four items: financial difficulty, household status, social activity, and regular contact with others. A deficit score of 0 represented social robustness, 1 represented social prefrailty, and ≥ 2 represented social frailty. Intrinsic capacity was evaluated by the locomotion, cognition, psychological function, vitality, and sensory function domains. The longitudinal association was analyzed using generalized estimating equations.

Results

The prevalence of social prefrailty and social frailty at baseline was 31.2 and 6.3%, respectively. The social prefrailty group (β = − 0.132, P < 0.001) and social frailty group (β = − 0.258, P < 0.001) were associated with a greater reduction in the composite intrinsic capacity scores than the social robustness group, especially in the cognition, psychological function, and vitality domains. Men with social prefrailty/social frailty demonstrated a greater decrease in the psychological function domain score (− 0.512 vs. − 0.278) than women. Additionally, the cognition domain score only decreased in men in the social prefrailty/social frailty group (β = − 0.122, P = 0.016).

Conclusions

Social frailty was associated with intrinsic capacity and its subdomains longitudinally. Men with social frailty were more vulnerable than women to a decline in their psychological function and cognition domains. Therefore, the advanced management of social frailty is necessary to facilitate healthy aging.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02466-6.

Theories of self-care and self-management of long-term conditions by community-dwelling older adults: A systematic review and meta-ethnography

RATIONALE

The proportion of older adults living with long-term conditions (LTCs) is increasing. Self-care and self-management approaches are seen as valuable in helping older people with LTCs to manage their health and care, yet the theoretical overlaps and divergences are not always clear.

OBJECTIVES

The objectives of this review were to: (1) systematically identify and appraise studies of self-care or self-management of LTCs by community-dwelling older adults (aged ≥60 years) either informed by, applying, creating, or testing theory; (2) explore similarities or points of convergence between the identified theories; and (3) use a meta-ethnographic approach to synthesise the theories and group related concepts into core constructs.

METHODS

We conducted a systematic theory synthesis, searching six electronic databases. Three reviewers independently screened titles and abstracts followed by full texts and two reviewers appraised study quality. Theoretical data were synthesised within and across individual theories using meta-ethnographic line-of-argument synthesis.

RESULTS

A total of 141 articles (138 studies) and 76 theories were included in the review. Seven core constructs were developed: (1) temporal and spatial context; (2) stressors; (3) personal resources; (4) informal social resources; (5) formal social resources; (6) behavioural adaptations; and (7) quality of life outcomes. A line of argument was developed that conceptualised older adults' self-care and self-management as a dynamic process of behavioural adaptation, enabled by personal resources and informal and formal social resources, aimed at alleviating the impacts of stressors and maintaining quality of life.

CONCLUSION

This synthesis provides an overview of theories used in research on older adults' LTC self-care and self-management. Our synthesis describes the complex interplay of intrinsic and extrinsic factors influencing self-care and self-management behaviours and provides considerations for future research, intervention design, and implementation. The utility of the constructs in research and practice requires further attention and empirical validation.

Companionship and Sexual Issues in the Aging Population

Loneliness and social isolation are significant public health crises in older adults. The issues about companionship have many psychosocial and cultural dimensions, which is further compounded by the current COVID-19 pandemic. In modern-day India, there is a significant increase in the number of older adults left to live alone because of sociocultural changes in our society. Companionship in late life is known to promote the quality of life and decrease the mental health morbidity. There is an increasing role of pets as companions to the elderly. Novel technologies such as artificial intelligence in the form of robots are being explored to support the elderly. Sexuality is another complex issue related to older adults that is often ignored. The sexuality and sexual functioning in older adults largely depend on physiological, psychological, and sociocultural factors. The principles of ageism have influenced sexuality in older adults. Sociocultural issues and the aging-related pathophysiological changes can contribute to an increased risk for legal issues related to sexuality in this population. There is a need for more systematic research into the multifaceted concept of companionship and sexuality in the older adult population. This review article addresses these two distinct subjects separately.

Assessing the Impact of A Community-Based Pro-Active Monitoring Program Addressing the need for Care of Community-Dwelling Citizens aged more than 80: Protocol for a Prospective Pragmatic Trial and Results of the Baseline Assessment

The aim of this paper is to describe the protocol of a study assessing the impact of a Community-based pro-Active Monitoring Program, by measuring the effect in counteracting the adverse outcomes related to frailty.

Methods

a prospective pragmatic trial will be carried out to describe the impact of an intervention on people aged>80, adjusted for relevant parameters: demographic variables, comorbidities, disability and bio-psycho-social frailty. They have been assessed with the Functional Geriatric Evaluation questionnaire that is a validated tool. Mortality, Acute Hospital Admission rates, Emergency Room Visit rates and Institutionalization rates are the main outcomes to be evaluated annually, over three years. Two groups of patients, made up by 578 cases (undergoing the intervention under study) and 607 controls have been enrolled and interviewed.

Results

at baseline the two groups are quite similar for age, living arrangement, comorbidity, disability and cognitive status. They differ in education, economic resources and physical status (that are better in the control group) and in social resources (that is better in the case group). The latter was expected since the intervention is focused on increasing social capital at individual and community level and aimed at improving survival among the cases as well as reducing the recourse to hospital and residential Long Term Care.

Conclusion

The proposed study addresses a crucial issue: assessing the impact of a bottom up care service consisting of social and health interventions aimed at reducing social isolation and improving access to health care services.

Technological interventions for loneliness and social isolation among older adults: a scoping review protocol

BACKGROUND

Loneliness and social isolation are prevalent public health concerns among community-dwelling older adults. One approach that is becoming an increasingly popular method of reducing levels of loneliness and social isolation among older adults is through technology-driven solutions. This protocol outlines a research trajectory whereby a scoping review will be initiated in order to illustrate and map the existing technological approaches that have been utilized to diminish levels of loneliness and social isolation among community-dwelling older adults aged 60 years or older. We will address the question: what are the most common and less used technological approaches to reduce loneliness and social isolation among community-dwelling older adults?

METHODS

A scoping review of Academic Search Premier, AGEline, Global Health, MEDLINE, PsycINFO, and Web of Science databases will take place using our search terms including the following: loneliness, social isolation, older adults, elderly, Aged, Aged 80 and over, program, evaluation, trial, intervention, technology, computer, information and communication technology, internet, and robot. The initial electronic search will be supplemented by reviewing the reference lists and review articles to identify any missing studies. To meet study inclusion criteria, intervention studies had to pertain to community-dwelling adults aged 60 years or older, include technological interventions, include loneliness and/or social isolation as outcome variables, and be written in the English language. Two parallel independent assessments of study eligibility will be conducted for the title, abstract, and full-text screens. Any disagreement will be resolved by consensus and a third reviewer consulted to make a decision if consensus is not achieved initially. Finally, the amalgamation of results will be an iterative process whereby reviewers will refine the plan for presenting results after data extraction is completed so that all of the contents of the extraction may be included in the results.

DISCUSSION

The information gleaned in this scoping review will be essential to understand the degree to which technological interventions influence social isolation and loneliness among older adults and identify gaps for further research.

An Intentionally Designed Walking Program for Seniors Results in Enhanced Community Connection

Social connection is vital for older adults' physical and psychological well-being, yet nearly one third of them report feeling lonely. The purpose of this study was to evaluate the influence of a monthly walking program (walking once a month for 8 months) on older adults' community connection. Older adults (Mage = 78.06 ± 5.98 years) completed a focus group at the completion of the program (n = 15). Qualitative findings indicate that participation in the walking program led to enhanced social connection. Researchers developed six major themes: (1) frequent and engaging walking programs, (2) benefits of group activity, (3) enhanced social connections, (4) connection to the community, (5) knowledge about transit, and (6) personal well-being, and 10 subthemes. Implications from this study highlight the importance of designing a walking program with older adults' needs and desires in mind.

Social Disconnection in Late Life Suicide: An NIMH Workshop on State of the Research in Identifying Mechanisms, Treatment Targets, and Interventions

Both social disconnection and suicide are significant public health concerns among older adults, and social disconnection is associated with greater risk for suicide-related thoughts and behaviors in late life. We present a synthesis of research discussed during a workshop hosted by the National Institute of Mental Health on social disconnection and late-life suicide. Social disconnection is related to suicide risk in late life via a variety of mechanisms, including biological, behavioral, and psychological correlates. Researchers in several scientific fields have begun to establish these connections and identify targets for interventions to reduce risk in late life. While research has demonstrated that social connection is amenable to change, there is little research to date on the most evidence-based interventions to mitigate social disconnection or the related risks. However, there are several promising biological, behavioral, and psychological interventions that may target various mechanisms, as well as social disconnection itself. With a relative paucity of research in this area, these lines of study are ripe for innovative investigation. In order to most effectively advance the field, we must establish more consistent definitions of social connection and disconnection; more accurately measure and assess older adults' social needs; examine the most effective approaches and modalities for assessment and intervention; take into account important contextual factors; and apply a translational, convergent scientific approach.

Increased Social Interactions Reduce the Association Between Constricted Life-Space and Lower Daily Happiness in Older Adults With and Without HIV: A GPS and Ecological Momentary Assessment Study

OBJECTIVE

Older persons with human immunodeficiency virus (HIV) (PWH) are particularly susceptible to life-space restrictions. The aims of this study included: 1) using global positioning system (GPS) derived indicators as an assessment of time spent at home among older adults with and without HIV; 2) using ecological momentary assessment (EMA) to examine real-time relationships between life-space, mood (happiness, sadness, anxious), fatigue, and pain; and 3) determining if number of daily social interactions moderated the effect of life-space on mood.

METHODS

Eighty-eight older adults (PWH n = 54, HIV-negative n = 34) completed smartphone-based EMA surveys assessing mood, fatigue, pain, and social interactions four times per day for two weeks. Participants' smartphones were GPS enabled throughout the study. Mixed-effects regression models analyzed concurrent and lagged associations among life-space and behavioral indicators of health.

RESULTS

PWH spent more of their time at home (79% versus 70%, z = -2.08; p = 0.04) and reported lower mean happiness (3.2 versus 3.7; z = 2.63; p = 0.007) compared to HIV-negative participants. Controlling for covariates, more daily social interactions were associated with higher ratings of real-time happiness (b = 0.12; t = 5.61; df = 1087.9; p< 0.001). Similar findings were seen in lagged analyses: prior day social interactions (b = 0.15; t = 7.3; df = 1024.9; p < 0.0001) and HIV status (b = -0.48; t = -2.56; df = 1026.8; p = 0.01) attenuated the effect of prior day time spent at home on happiness.

CONCLUSION

Accounting for engagement in social interactions reduced the significant effect of time spent at home and lower happiness. Interventions targeting social isolation within the context of constricted life-space may be beneficial for increasing positive mood in older adults, and especially relevant to older PWH.

Development and psychometric evaluation of the Social Connectedness Index in nursing home residents with Alzheimer's disease and dementia using the Minimum Data Set 3.0

OBJECTIVES

To develop a reliable and valid measure of social connectedness among nursing home residents with Alzheimer's disease and related dementias (ADRD) using items available in the Minimum Dataset 3.0 (MDS).

METHODS

We conducted a retrospective scale development study using the 2016 MDS with two populations of nursing home residents with ADRD: (1) new admissions (not post-acute care) (n = 146,694); (2) residents with comprehensive annual assessments (n = 294,704). Twenty-nine items were included for consideration. Psychometric evaluation included content validity, item analysis, internal consistency reliability, criterion-related validity, and exploratory factor analysis. Analyses were stratified by self- or staff-assessed pain.

RESULTS

The resulting five item Social Connectedness Index (SCI) has good content (Fleiss Kappa = 0.67), criterion-related and construct validity and adequate internal consistency reliability (Kuder Richardson-20: 0.63-0.74) in persons with ADRD. As anticipated, younger residents, men, and those with severe cognitive impairment, anxiety, and depression were more likely to be categorized in the low social connectedness group.

CONCLUSION

The SCI is a promising measure for estimating the amount of social connectedness present for nursing home residents with ADRD. Further work needs to be done to evaluate the usefulness of the SCI for evaluating health and well-being among this population over time.

Barriers and Facilitators to Social Participation in Older Adults: A Systematic Literature Review

Objectives: Social participation has been shown to improve health, well-being, and quality of life in older adults. Previous reviews on social participation have been limited to identifying logistical barriers. The current review sought to examine barriers of social participation more broadly, as well as potential facilitators.Methods: We conducted a systematic review to collate identified barriers and facilitators to social participation in older adults. Seventy-six studies were eligible for inclusion.Results: Four main themes of barriers and facilitators to social participation associated with aging emerged: Demographic factors (such as age and socioeconomic status), Individual/Internal factors (such as motivations and health), Environmental/Infrastructure (such as accessibility, transport, and neighborhood cohesion), and Social Networks (particularly preexisting network size).Conclusions: These findings extended previous reviews to show that personal motivations, preexisting social networks, and neighborhood cohesion play vital roles in improving and maintaining quality social participation. The ability to facilitate this can occur at the individual therapeutic level and at the community level.Clinical implications: The findings highlight the need to consider barriers beyond logistical issues. In particular, healthy aging initiatives may benefit from matching social activities with individual motivations, and preventive measures to establish social networks early in the aging process are important.

Feasibility of an Online Patient Community to Support Older Women With Newly Diagnosed Breast Cancer

BACKGROUND

We conducted a feasibility study of integrating a free, online patient health community, PatientsLikeMe (PLM), into the neo/adjuvant care of older patients recently diagnosed with breast cancer. We assessed whether PLM was an appealing social forum to improve women's treatment experience during this stressful and often isolating time.

PATIENTS AND METHODS

We enrolled women ages ≥60 years with recently diagnosed nonmetastatic invasive breast cancer at a single center. Our primary endpoint was feasibility of patient engagement with PLM, with successful engagement defined as using PLM for ≥50% of the total weeks of one's chemotherapy course or 4 months (if receiving hormonal and/or radiation therapy). Participants were surveyed about their health, social support, and experiences.

RESULTS

During February 8, 2016 to June 25, 2018, 47 women enrolled; 14.9% were ages 71 to 75 years and 8.5% were ages ≥76 years; 63.8% received chemotherapy. Two women withdrew after consent; 45 were included in analyses. Overall, 1 (2.2%) patient met the feasibility endpoint, although 8 (17.8%) met engagement criteria for ≥25% of weeks on study. Over time, women submitted a total of >1200 posts to the "InstantMe" feature (rates how they feel) and >130 "MyFeed" stories. Evaluation of satisfaction with PLM was limited by the small number of end-of-study surveys.

CONCLUSION

Although our online social support intervention did not meet the prespecified criteria for feasibility (required sustained PLM utilization), many engaged with PLM. Future interventions should explore ways we can optimally support older patients, who have an increasing access to technology while facing threats of social isolation.

Social Connection is Essential in Long-Term Care Homes: Considerations During COVID-19 and Beyond

COVID-19 has had a profound impact on long-term care (LTC) homes in Canada. But the measures put in place to control infection within LTC homes have also had devastating impacts on the health and well-being of residents through the effects on social connection. Here, we offer guiding principles to enable social connection and promote health and quality of life for LTC residents during COVID-19 and beyond. These principles were generated by a working group of the COVID-19 and Dementia Task Force, convened by the Alzheimer Society of Canada to identify the urgent and emerging issues raised by COVID-19 for Canadians with dementia.

Older Chinese migrants in coronavirus pandemic: exploring risk and protective factors to increased loneliness

Older migrants may be one of the most vulnerable populations during the coronavirus pandemic, yet the degree of impact remains largely unknown. This study explores (1) the consequences of the coronavirus pandemic for older Chinese migrants in Belgium and the Netherlands in terms of increased loneliness and its risk factors (reduced in-person contact, decreased social participation, feelings of existential threat) and protective factors (increased non-in-person contact, more individual activities), and (2) which risk and protective factors have contributed to the incidence and prevention of higher loneliness levels. Using quantitative data of a survey among 98 Chinese migrants aged 50 years and older in Belgium (n = 84) and the Netherlands (n = 14), the findings first indicate that the coronavirus pandemic has a significant impact on older Chinese migrants' lives. One in five experienced more loneliness. Second, reduced social participation (measured as less frequent participation in outdoor group activities) and financial insecurity (measured as experiencing financial difficulties) lead to higher than pre-pandemic loneliness levels. Problem-focused coping strategies (measured as increased non-in-person contact, via telephone or social media) and emotion-focused coping (measured as finding distraction through increased participation in individual activities) were not found to protect against increased loneliness in the pandemic. Two practical implications for loneliness interventions for older Chinese migrants are put forward. Organizing COVID-19-safe social participation activities and paying more attention to older Chinese migrants' financial situation can be beneficial when addressing higher levels of loneliness due to the coronavirus pandemic.

Music Connects Us: Development of a Music-Based Group Activity Intervention to Engage People Living with Dementia and Address Loneliness

There is a need for intervention research to understand how music-based group activities foster engagement in social interactions and relationship-building among care home residents living with moderate to severe dementia. The purpose of this conceptual paper is to describe the design of ‘Music Connects Us’, a music-based group activity intervention. Music Connects Us primarily aims to promote social connectedness and quality of life among care home residents living with moderate to severe dementia through engagement in music-making, supporting positive social interactions to develop intimate connections with others. To develop Music Connects Us, we adapted the ‘Music for Life’ program offered by Wigmore Hall in the United Kingdom, applying an intervention mapping framework and principles of engaged scholarship. This paper describes in detail the Music Connects Us program, our adaptation approach, and key adaptations made, which included: framing the project to focus on the engagement of the person living with dementia to ameliorate loneliness; inclusion of student and other community-based musicians; reduced requirements for care staff participation; and the development of a detailed musician training approach to prepare musicians to deliver the program in Canada. Description of the development, features, and rationale for Music Connects Us will support its replication in future research aimed to tests its effects and its use in clinical practice.

How is the COVID-19 lockdown impacting the mental health of parents of school-age children in the UK? A cross-sectional online survey

OBJECTIVE

Investigate the impact of the COVID-19 lockdown on feelings of loneliness and social isolation in parents of school-age children.

DESIGN

Cross-sectional online survey of parents of primary and secondary school-age children.

SETTING

Community setting.

PARTICIPANTS

1214 parents of school-age children in the UK.

METHODS

An online survey explored the impact of lockdown on the mental health of parents with school-age children, and in particular about feelings of social isolation and loneliness. Associations between the UCLA Three-Item Loneliness Scale (UCLATILS), the Direct Measure of Loneliness (DMOL) and the characteristics of the study participants were assessed using ordinal logistic regression models.

MAIN OUTCOME MEASURES

Self-reported measures of social isolation and loneliness using UCLATILS and DMOL.

RESULTS

Half of respondents felt they lacked companionship, 45% had feelings of being left out, 58% felt isolated and 46% felt lonely during the first 100 days of lockdown. The factors that were associated with higher levels of loneliness on UCLATILS were female gender, parenting a child with special needs, lack of a dedicated space for distance learning, disruption of sleep patterns and low levels of physical activity during the lockdown. Factors associated with a higher DMOL were female gender, single parenting, parenting a child with special needs, unemployment, low physical activity, lack of a dedicated study space and disruption of sleep patterns during the lockdown.

CONCLUSIONS

The COVID-19 lockdown has increased feelings of social isolation and loneliness among parents of school-age children. The sustained adoption of two modifiable health-seeking lifestyle behaviours (increased levels of physical activity and the maintenance of good sleep hygiene practices) wmay help reduce feelings of social isolation and loneliness during lockdown.

Factors Related to Self-Confidence to Live Alone in Community-Dwelling Older Adults: A Cross-Sectional Study

BACKGROUND

Many older adults prefer to live alone in their own homes, with age-related issues in physical movement, regardless of their cultural background. Importantly, however, to identify the features of successfully ageing in place (AIP), and foster independent living among these individuals, this study explored their level of self-confidence to live alone and its related factors.

METHODS

We conducted a cross-sectional study using secondary data from an earlier study with older adults living alone in South Korea recruited by convenience sampling methods (N = 936, mean age = 77.1 years, 76.1% female). Data regarding the general, health-related, and social characteristics as well as self-confidence to live alone were collected via face-to-face interviews in 2019. Self-confidence to live alone was measured with a numeric rating scale of 0 to 10.

RESULTS

The average self-confidence score to live alone was 6.59. A regression analysis showed that mould exposure at home, depression, emergency department visits, and loneliness hinder self-confidence to live alone. Meanwhile, such self-confidence was facilitated by independency in instrumental activities of daily living (IADL), interactions with family members, social service utilisation, and social support.

CONCLUSIONS

This study suggests that healthcare providers need to consider the importance of self-confidence to live alone and influencing functional, mental, social, and environmental factors to promote quality of life as well as successful AIP for older adults living alone. Further, self-confidence to live alone could be a new practical index in the field of health and ageing to screen the successful AIP of older adults living alone.

[Loneliness in nursing homes-Experience and measures for amelioration : A literature review]

BACKGROUND

Public health and health economics consider loneliness to be an important determinant of health and quality of life for all people. For older people, loneliness can be considered as possibly the most important health determinant.

OBJECTIVE

The purpose of this paper is to describe the experience of loneliness from the perspective of residents in residential long-term care and to identify interventions to reduce loneliness by caregivers.

MATERIAL AND METHODS

Systematic literature search and study evaluation.

RESULTS

Talking about their loneliness is not easy for many residents. The manifestations of loneliness vary from being alone, to boredom and to not feeling at home. Interventions range from the use of laughter yoga and animal-assisted therapy to technological measures and the use of volunteers.

CONCLUSION

Measures that focus on the spiritual level of relationship building and trust have proven to be most effective.

New musical interfaces for older adults in residential care: assessing a user-centred design approach

Purpose:For older adults in aged-care, group music-making can bring numerous physical and psychological benefits, ultimately improving their quality of life. However, personalising music-making to optimise these benefits is often difficult given their diverse ages, experiences, abilities, cognitive and motor skills, and their experience with music technology.Materialsandmethods:In this study, we conducted a 10-week group music-making intervention with twenty participants in an aged-care home, using a prototype digital musical instrument that we iteratively refined by following a user-centred design approach from direct resident feedback. The prototype instrument adopted a novel method for errorless learning in music-making settings, which we also refined, by increasing the difficulty level of the instrument's operation. We also assessed the residents' engagement with the sessions by obtaining feedback from caregivers and facilitators.Results:Results show that residents' enjoyment decreased as the complexity (difficulty) of our errorless learning implementation increased. We also found that resident engagement increased when changes to the prototype digital musical instrument were provided, but not when residents were giving feedback. Results also found that participation over the course of the intervention, and the number of songs played during each session also enhanced engagement.Conclusions: Overall, our results show the intervention was beneficial to residents, although we note some areas of enhancement for further interventions in designing prototype musical instruments for group music-making in aged-care settings. IMPLICATIONS FOR REHABILITATIONOlder adults positively engage with novel music technology, and do so increasingly over subsequent sessions. Repeated sessions may have the potential to enhance longer-term adoption of technologies as well as any rehabilitative effects of the group music-making activity.There is significant potential for residents with different abilities to all make music together, although to maximise the sustainability of the devices, the sessions, and the subsequent rehabilitative benefits, residents must be given the right adaptation for individual interfaces that balances ambition and ability.Rapid DMI prototyping positively enhances engagement among older adults, suggesting that in the case of a custom DMI, an upgrade schedule should be aligned with key rehabilitative milestones. Similarly, in the case of pre-developed digital music systems, resident exposure to new features or functionality should be strategically introduced, so as to maximise engagement for key phases of resident rehabilitation.

Impact of terrorist attacks on social relationships

BACKGROUND

People that experience a trauma might also experience problems in their social relationships. However, how witnessing a terrorist attack influences social relationships is still understudied. This is important, as currently, there is more focus on the individual's mental health and not on how this mental health can impact the individual's social relations. In this study, the impact of the experience of a terrorist attack on social relationships was studied.

METHODS

In-depth interviews were conducted, with 31 directly exposed people during the 22 March 2016 attacks in Belgium. Data were analysed using reflexive thematic analysis.

RESULTS

Three factors related to the impact on social relationships were found. First, participants felt that they had changed. This includes feeling more aggressive, guilty, distrusting or psychosomatic factors, such as migraine attacks, which can hamper social visits. Second, the reactions of others on the participant's expressing their feelings and behaviour also caused participants to not feel understood by their social relationships. Third, due the first two factors, participants coped in different ways (e.g. remaining silent and avoiding certain triggers), which in turn caused their social relationships to change.

CONCLUSIONS

The social relationships of witnesses of terrorist attacks can be hampered due to both themselves as well as the reaction of others. More awareness seems to be needed on the possible mental health consequences of terrorist attacks for witnesses.

Social Relationships and Risk of Type 2 Diabetes Among Postmenopausal Women

OBJECTIVES

We examined whether social relationship variables (social support, social strain, social network size, and stressful life events) were associated with risk of developing type 2 diabetes among postmenopausal women.

METHOD

139,924 postmenopausal women aged 50-79 years without prevalent diabetes at baseline were followed for a mean of 14 years. 19,240 women developed diabetes. Multivariable Cox proportional hazard models tested associations between social relationship variables and diabetes incidence after consideration of demographics, depressive symptoms, and lifestyle behaviors. We also examined moderating effects of obesity and race/ethnicity, and we tested whether social variable associations were mediated by lifestyle or depressive symptoms.

RESULTS

Compared with the lowest quartile, women in the highest social support quartile had lower risk of diabetes after adjusting for demographic factors, health behaviors, and depressive symptoms (hazard ratio [HR] = 0.93, 95% confidence interval [CI] = 0.89-0.97). Social strain (HR = 1.09, 95% CI = 1.04-1.13) and stressful life events (HR = 1.10, 95% CI = 1.05-1.15) were associated with higher diabetes risks. The association between diabetes and social strain was stronger among African American women. Social relationship variables had direct relationships to diabetes, as well as indirect effects partially mediated by lifestyle and depressive symptoms.

DISCUSSION

Social support, social strain, and stressful life events were associated with diabetes risk among postmenopausal women independently of demographic factors and health behaviors. In addition to healthy behaviors such as diet and physical activity, healthy social relationships among older women may be important in the prevention of diabetes.

Evaluation of an Intergenerational and Technological Intervention for Loneliness: Protocol for a Feasibility Randomized Controlled Trial

BACKGROUND

Social integration and mental health are vital aspects of healthy aging. However, close to half of Canadians older than 80 years report feeling socially isolated. Research has shown that social isolation leads to increased mortality and morbidity, and various interventions have been studied to alleviate loneliness among older adults. This proposal presents an evaluation of an intervention that provides one-on-one coaching, is intergenerational, provides both educational and socialization experiences, and increases technology literacy of older adults to overcome loneliness.

OBJECTIVE

This paper describes the protocol of a randomized, mixed-methods study that will take place in Ontario, Canada. The purpose of this study is to evaluate if an intergenerational technology literacy program can reduce social isolation and depression in older adults via quantitative and qualitative outcome measures.

METHODS

This study is a randomized, mixed-methods, feasibility trial with 2 conditions. Older adults in the intervention condition will receive 1 hour of weekly technological assistance to send an email to a family member, for 8 weeks, with the assistance of a volunteer. Participants in the control condition will not receive any intervention. The primary outcomes are loneliness, measured using the University of California, Los Angeles Loneliness Scale, and depression, measured using the Center for Epidemiologic Studies Depression scale, both of which are measured weekly. Secondary outcomes are quality of life, as assessed using the Older People's Quality of Life-Brief version, and technological literacy, evaluated using the Computer Proficiency Questionnaire-12, both of which will be administered before and after the intervention. Semistructured interviews will be completed before and after the intervention to assess participants' social connectedness, familiarity with technology, and their experience with the intervention. The study will be completed in a long-term care facility in Southwestern Ontario, Canada. Significance was set at P<.05.

RESULTS

This study was funded in April 2019 and ethical approval was obtained in August 2019. Recruitment for the study started in November 2019. The intervention began in February 2020 but was halted due to the COVID-19 pandemic. The trial will be restarted when safe. As of March 2020, 8 participants were recruited.

CONCLUSIONS

Information and communication technology interventions have shown varying results in reducing loneliness and improving mental health among older adults. Few studies have examined the role of one-on-one coaching for older adults in addition to technology education in such interventions. Data from this study may have the potential to provide evidence for other groups to disseminate similar interventions in their respective communities.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/23767.

Cognitive health risks posed by social isolation and loneliness in older Korean Americans

BACKGROUND

This study examines associations among social isolation, loneliness, and cognitive health risks in older Korean Americans, focusing on the mediating role of loneliness in the relationship between social isolation and objective and subjective measures of cognitive impairment.

METHODS

Data are from 2061 participants in the Study of Older Korean Americans, a multi-state survey of Korean immigrants age 60 and older (Mage = 73.2, SD = 7.93). Social isolation was indexed with the Lubben Social Network Scale- 6; loneliness, with the short-form UCLA Loneliness Scale. Objective and subjective measures of cognitive impairment included the Mini-Mental State Examination and a single-item self-rating of cognitive health.

RESULTS

In the logistic regression model for objective cognitive impairment, social isolation was significantly associated, but loneliness was not. In the model for subjective cognitive impairment, both social isolation and loneliness were significant factors. However, the effect of social isolation became non-significant when loneliness was considered, suggesting a potential mediating role of loneliness. The subsequent mediation analysis confirmed that the indirect effect of social isolation on subjective cognitive impairment through loneliness was significant (B = .20, SE = .03, 95% CI = .12, .28).

CONCLUSION

Our analyses provide evidence for the proposed mediating effect of loneliness in the relationship between social isolation and subjective cognitive impairment. Intervention efforts should focus on reducing feelings of loneliness experienced by older immigrants, possibly by engaging them in socially meaningful and cognitively stimulating activities.

The Impact of a Digital Intervention (Happify) on Loneliness During COVID-19: Qualitative Focus Group

BACKGROUND

Loneliness is a growing area of concern, attracting attention as a public health concern due to its association with a variety of psychological and physical health problems. However, interventions targeting loneliness are less common than interventions for other mental health problems, such as depression and anxiety, and existing interventions focus primarily on building social skills and increasing opportunities for social interaction despite research suggesting these techniques are not the most effective. Furthermore, although there is an increasing need for scalable and convenient interventions, digital interventions for loneliness are even less common.

OBJECTIVE

Using a qualitative approach, we explore how adults (18-64 years of age) who express wanting to be more connected to others experience loneliness and react to a digital mental health intervention targeting loneliness.

METHODS

A total of 11 participants were recruited from a pilot randomized controlled trial exploring the impact of a digital mental health intervention, Happify Health, on loneliness among adults aged 18-64 years who indicated wanting to feel more connected to others when signing up for the platform. Participants were invited to participate in a 3-day asynchronous focus group about their experiences with loneliness, with Happify Health, and with social distancing during the COVID-19 pandemic. All 11 participants completed the focus group in May 2020.

RESULTS

Participants' responses were coded using thematic analysis, which led to identifying five themes, each with separate subthemes, that could be applied across the 3-day focus group: loneliness, relationships, social distancing, skill acquisition, and coping. Overall, we observed variability across participants in terms of the source of their loneliness, their perceptions of their social connections, and their motivation to reduce feelings of loneliness; however, participants commonly referred to negative self-perceptions as a cause or consequence of loneliness. Participants also varied in the extent to which they felt social distancing increased or decreased feelings of loneliness. In regard to the intervention, participants showed evidence of adopting skills they used to address their loneliness, particularly mindfulness and gratitude, and then using these skills to shift toward more active coping strategies following the intervention, including during the COVID-19 pandemic.

CONCLUSIONS

The heterogeneity in participants' experiences with loneliness described during this focus group emphasizes the subjective and complex nature of loneliness. This highlights the importance of developing loneliness interventions that use a variety of strategies, including both direct and indirect strategies for reducing loneliness. However, based on our data, a key component to loneliness interventions is incorporating strategies for addressing underlying negative self-perceptions that stem from, but also contribute to, loneliness. This data also provides preliminary evidence that digital platforms may be an effective tool for disseminating loneliness interventions while providing the added benefit of offering a productive distraction when feeling lonely.

"It makes me feel not so alone": features of the Choose to Move physical activity intervention that reduce loneliness in older adults

BACKGROUND

Despite the well-known health benefits of physical activity (PA), older adults are the least active citizens. Older adults are also at risk for loneliness. Given that lonely individuals are at risk for accelerated loss of physical functioning and health with age, PA interventions that aim to enhance social connectedness may decrease loneliness and increase long-term PA participation. The objectives of this mixed-method study are to: (1) evaluate whether an evidence-based PA intervention (Choose to Move; CTM) influenced PA and loneliness differently among self-identified 'lonely' versus 'not lonely' older adults and (2) to describe factors within CTM components most likely to promote social connectedness/reduce loneliness.

METHODS

CTM is a flexible, scalable, community-based health promoting physical activity intervention for older adults. Two community delivery partner organizations delivered 56 CTM programs in 26 urban locations across British Columbia. We collected survey data from participants (n = 458 at baseline) at 0 (baseline), 3 (mid-intervention) and 6 (post-intervention) months. We conducted in depth interviews with a subset of older adults to understand how CTM facilitated or impeded their PA and social connectedness.

RESULTS

PA increased significantly from baseline to 3 months in lonely and not lonely participants. PA decreased significantly from 3 to 6 months in lonely participants; however, PA at 6 months remained significantly above baseline levels in both groups. Loneliness decreased significantly from baseline to 3 and 6 months in participants identifying as lonely at baseline. Factors within CTM components that promote social connectedness/reduce loneliness include: Activity coach characteristics/personality traits and approaches; opportunity to share information and experiences and learn from others; engagement with others who share similar/familiar experiences; increased opportunity for meaningful interaction; and accountability.

CONCLUSION

Health promoting interventions that focus on PA and social connectedness through group-based activities can effectively reduce social isolation and loneliness of older adults. Given the 'epidemic of loneliness' that plagues many countries currently, these kinds of interventions are timely and important. Research that further delineates mechanisms (e.g., sharing experiences vs. lectures), that modify the effect of an intervention on social connectedness outcomes for older adults engaged in community-based PA programs would be a welcome addition to the literature.

Beneficial effects of choir singing on cognition and well-being of older adults: Evidence from a cross-sectional study

Background and objectives

Choir singing has been associated with better mood and quality of life (QOL) in healthy older adults, but little is known about its potential cognitive benefits in aging. In this study, our aim was to compare the subjective (self-reported) and objective (test-based) cognitive functioning of senior choir singers and matched control subjects, coupled with assessment of mood, QOL, and social functioning.

Research design and methods

We performed a cross-sectional questionnaire study in 162 healthy older (age ≥ 60 years) adults (106 choir singers, 56 controls), including measures of cognition, mood, social engagement, QOL, and role of music in daily life. The choir singers were divided to low (1–10 years, N = 58) and high (>10 years, N = 48) activity groups based on years of choir singing experience throughout their life span. A subcohort of 74 participants (39 choir singers, 35 controls) were assessed also with a neuropsychological testing battery.

Results

In the neuropsychological testing, choir singers performed better than controls on the verbal flexibility domain of executive function, but not on other cognitive domains. In questionnaires, high activity choir singers showed better social integration than controls and low activity choir singers. In contrast, low activity choir singers had better general health than controls and high activity choir singers.

Discussion and implications

In healthy older adults, regular choir singing is associated with better verbal flexibility. Long-standing choir activity is linked to better social engagement and more recently commenced choir activity to better general health.

Social isolation enhances cued-reinstatement of sucrose and nicotine seeking, but this is reversed by a return to social housing

Physical or perceived (i.e. loneliness) social isolation is increasing in Western cultures. Unfortunately, social isolation is associated with a range of negative physical and mental health outcomes, including increased incidence of obesity and smoking. Here we monitored the impact of social isolation on a range of physical measures, and then tested whether social isolation in adult rats changes how reward-related stimuli motivate sucrose- or nicotine-seeking. Socially isolated rats showed elevated baseline CORT, gained significantly less weight across the study, were more active in response to a novel or familiar environment. Isolated rats also acquired nose-poking for a food pellet more rapidly, and showed increased susceptibility to cue-, but not reward-induced reinstatement. Notably, these effects are partially mitigated by a return to group housing, suggesting that they are not necessarily permanent, and that a return to a social setting can quickly reverse any deficits or changes associated with social isolation. This study advances our understanding of altered reward-processing in socially isolated individuals and reiterates the importance of socialisation in the treatment of disorders such as overeating and addiction.

Social support and health among older adults – the Singapore Chinese Health Study

While having social support can contribute to better health, those in poor health may be limited in their capacity to receive social support. We studied the health factors associated with social support among community-dwelling older adults in Singapore. We used data from the third follow-up interviews (2014–2016) of 16,943 participants of the Singapore Chinese Health Study, a population-based cohort of older Singapore Chinese. Participants were interviewed at a mean age of 73 years (range 61–96 years) using the Duke Social Support Scale (DUSOCS). We first applied ordinary least squares regression to DUSOCS scores and found that those with instrumental limitations, poor self-rated health, cognitive impairment and depression had lower social support scores. We then applied latent class analysis to DUSOCS answer patterns and revealed four groups of older adults based on the source and amount of social support. Among them, compared to the ‘overall supported’ group (17%) with the highest social support scores and broad support from family members and non-family individuals, the ‘family restricted’ (50%) group had the lowest social support scores and only received support from children. Health factors associated with being ‘family restricted’ were instrumental limitations (odds ratio (OR) = 1.33, 95% confidence interval (CI) = 1.19–1.49), poor self-rated health (OR = 1.40, 95% CI = 1.28–1.53), cognitive impairment (OR = 1.19, 95% CI = 1.04–1.37) and depression (OR = 2.50, 95% CI = 2.22–2.82). We found that while older adults in poor health have lower social support scores, they were more likely to receive a lot of support from children. Our results showed that lower social support scores among Singaporean older adults in poor health may not indicate lack of social support, but rather that social support is restricted in scope and intensified around children. These results may apply to other Asian societies where family plays a central role in elder-care.

How Does Participation in Formal Education or Learning for Older People Affect Wellbeing and Cognition? A Systematic Literature Review and Meta-Analysis

Objective: To determine the effect of later-life formal education or learning on quality of life (QOL), wellbeing, mood, and cognition. Methods: A systematic literature review of interventional clinical trials and observational studies was conducted for adults aged ≥55 years who had undertaken formal education or learning programs. Outcome measures included physical activity, happiness, affective and behavioral symptoms, cognitive function, and QOL. Bias was assessed using funnel plots, Egger’s test, and leave1out analysis. Results: From 32 studies identified, we showed qualitative increases in cognitive function, life satisfaction, and self-confidence associated with learning. A meta-analysis revealed a significant pooled mean difference in MMSE scores (0.40, 95% confidence intervals = [0.12, 0.67]). Although there was a low risk of publication bias there was a high risk of sampling bias. Conclusion: Participation in formal education or learning contributed to increased wellbeing, QOL, healthy cognitive function, self-dependency, and a sense of belonging in older adults.

How Elderly Residents in Nursing Homes Handle Loneliness-From the Nurses' Perspective

Introduction

Elderly people who leave their home environment and move to a nursing home enter a phase in life with diminishing contact with family and friends. This situation often results in a feeling of loneliness with a concomitant deterioration in physical and mental health. By exploring the topic through the lens of the nurses, this study takes a novel approach to address an under-researched area in the nursing field.

Objective

The objective of the study was to identify, based on the nurses’ experience, how elderly residents handle loneliness in the nursing home.

Methods

This study used a qualitative explorative approach with data collected through two focus group interviews with nine nurses at two elderly care facilities in Norway. The resulting transcripts were examined using an approach based on inductive content analysis.

Results

Three main categories emerged as crucial to help lonely nursing home residents cope with day-to-day life: (i) maintaining ties to one’s earlier life; (ii) engaging in recreational pursuits; and (iii) building new networks.

Conclusion

Analysing the findings based on sense of coherence (SOC) and person-centred care (PCC) theories illustrates the importance of maintaining a connection with both family and friends. To that point, having access to familiar objects from their earlier life seemingly provides meaning to the residents by bridging the past and the present. Recreational activities, ideally adapted to each person’s needs and ability, have a positive impact by providing structure and meaning that help overtake feelings of loneliness. Building a new network with fellow residents and staff imparts a sense of meaningful community belonging and projects both dignity and self-worth.

Characteristics of Socially Isolated Residents in Long-Term Care: A Retrospective Cohort Study

Objectives: To identify socially isolated long-term care residents and to compare their demographic characteristics, functional status, and health conditions to residents who are not isolated. Methods: We conducted a retrospective cohort study using the Resident Assessment Instrument, Minimum Data Set, 2.0 (RAI-MDS) data, from residents in 34 long-term care homes in Alberta, Canada (2008–2018). Using logistic regression, we compared the characteristics, conditions, and functional status of residents who were socially isolated (no contact with family/friends) and non-socially isolated residents. Results: Socially isolated residents were male, younger, and had a longer length of stay in the home, than non-socially isolated residents. Socially isolated residents lacked social engagement and exhibited signs of depression. Discussion: Socially isolated residents had unique care concerns, including psychiatric disorders, and co-morbid conditions. Our approach, using a single item in an existing data source, has the potential to assist clinicians in screening for socially isolated long-term care residents.

A systematic review of interventions for loneliness among older adults living in long-term care facilities

OBJECTIVES

This study aimed to review loneliness interventions for older adults living in long-term care (LTC) facilities over the past 10 years, to categorize interventions by type, and to compare effectiveness of loneliness interventions in these settings.

METHODS

Systematic review followed PRISMA guidelines. Articles matching search criteria were collected from PubMed, PsycINFO, and Web of Science from 2009 to 2019. The inclusion criteria were as follows: 1) English language, 2) intervention studies with a quantitative measure that compares pre-trial to post-trial changes, 3) loneliness as a primary or secondary outcome 4) subjects age >65, and 5) subjects living in a LTC facility, such as a nursing home, assisted-living, or hospice.

RESULTS

A total of 15 intervention studies qualified for systematic review. Most of these interventions were psychological therapies and leisure/skill development interventions. Approximately, 87% of studies reported significant decreases in loneliness following intervention. Laughter therapy, horticultural therapy, and reminiscence therapy were associated with the greatest decreases in loneliness.

DISCUSSION

Results suggest that, although less common than interventions in the community, there are several effective interventions to reduce loneliness among older adults living in LTC facilities. Lack of standardized measures and high-quality studies limits comparisons between intervention types and generalizability to different populations.

Social Connection in Long-Term Care Homes: A Scoping Review of Published Research on the Mental Health Impacts and Potential Strategies During COVID-19

Objectives

Good social connection is associated with better health and wellbeing. However, social connection has distinct considerations for people living in long-term care (LTC) homes. The objective of this scoping review was to summarize research literature linking social connection to mental health outcomes, specifically among LTC residents, as well as research to identify strategies to help build and maintain social connection in this population during COVID-19.

Design

Scoping review.

Settings and Participants

Residents of LTC homes, care homes, and nursing homes.

Methods

We searched MEDLINE(R) ALL (Ovid), CINAHL (EBSCO), PsycINFO (Ovid), Scopus, Sociological Abstracts (ProQuest), Embase and Embase Classic (Ovid), Emcare Nursing (Ovid), and AgeLine (EBSCO) for research that quantified an aspect of social connection among LTC residents; we limited searches to English-language articles published from database inception to search date (July 2019). For the current analysis, we included studies that reported (1) the association between social connection and a mental health outcome, (2) the association between a modifiable risk factor and social connection, or (3) intervention studies with social connection as an outcome. From studies in (2) and (3), we identified strategies that could be implemented and adapted by LTC residents, families and staff during COVID-19 and included the articles that informed these strategies.

Results

We included 133 studies in our review. We found 61 studies that tested the association between social connection and a mental health outcome. We highlighted 12 strategies, informed by 72 observational and intervention studies, that might help LTC residents, families, and staff build and maintain social connection for LTC residents.

Conclusions and Implications

Published research conducted among LTC residents has linked good social connection to better mental health outcomes. Observational and intervention studies provide some evidence on approaches to address social connection in this population. Although further research is needed, it does not obviate the need to act given the sudden and severe impact of COVID-19 on social connection in LTC residents.

Influences on participation in a programme addressing loneliness among people with depression and anxiety: findings from the Community Navigator Study

BACKGROUND

Loneliness is associated with negative outcomes, including increased mortality and is common among people with mental health problems. This qualitative study, which was carried out as part of a feasibility trial, aimed to understand what enables and hinders people with severe depression and/or anxiety under the care of secondary mental health services in the United Kingdom to participate in the Community Navigator programme, and make progress with feelings of depression, anxiety and loneliness. The programme consisted of up to ten meetings with a Community Navigator and three optional group sessions.

METHODS

Semi-structured interviews were carried out with participants (n = 19) shortly after programme completion. A co-produced two-stage qualitative approach, involving narrative and reflexive thematic analysis, was undertaken by members of the study's working group, which included experts by experience, clinicians and researchers.

RESULTS

The narrative analysis showed that individuals have varied goals, hold mixed feelings about meeting other people and define progress differently. From the thematic analysis, six themes were identified that explained facilitators and challenges to participating in the programme: desire to connect with others; individual social confidence; finding something meaningful to do; the accessibility of resources locally; the timing of the programme; and the participant's relationship with the Community Navigator.

CONCLUSIONS

We found that people with severe depression and/or anxiety supported by secondary mental health services may want to address feelings of loneliness but find it emotionally effortful to do so and a major personal challenge. This emotional effort, which manifests in individuals differently, can make it hard for participants to engage with a loneliness programme, though it was through facing personal challenges that a significant sense of achievement was felt. Factors at the individual, interpersonal and structural level, that enable or hinder an individual's participation should be identified early, so that people are able to make the best use out of the Community Navigator or other similar programmes.

Acceptability of personal contact interventions to address loneliness for people with dementia: An exploratory mixed methods study

Background

Personal contact interventions involve routine visits with a person or animal to address loneliness. Research supports the promise of these interventions to address loneliness among cognitively intact older adults, but little is known about their use with people with dementia.

Objective

To assess the acceptability of personal contact interventions for use to address loneliness with older people with dementia, according to formal and informal care providers.

Design

Cross-sectional, mixed methods complementarity design.

Setting

Ontario, Canada.

Participants

A purposive sample of 25 family members, friends, and health care providers of people with dementia.

Methods

Participants attended a face-to-face interview to discuss the acceptability of personal contact interventions. Participants completed questionnaires to rate acceptability (adapted Treatment Perception and Preference measure). A semi-structured interview followed to discuss the ratings and features of personal contact (with another person or animal) in more detail. The analysis involved descriptive statistics (quantitative data) and conventional content analysis (qualitative data). During the interpretation of the results, the qualitative findings were compared to the quantitative results to provide context and understand participants' perceptions of intervention acceptability in more depth; these are presented together in the results to demonstrate their distinct and complementary contributions to the findings.

Results

Personal contact with a person or animal was rated as effective, logical, suitable, and low risk to address loneliness by over 80% of participants. Participants' willingness to engage in this type of contact, for example as a visitor or as a facilitator of animal contact, was 72%. Participants emphasized the benefits of personal contact. The findings highlight that individualized, flexible interventions that include appropriate facilitation are needed.

Conclusions

Future studies to develop and test personal contact interventions should involve flexible delivery, assess the feasibility and acceptability of these interventions (as in a Phase 2 trial of a complex intervention), and focus on the experiences of people with dementia.Tweetable Abstract: Tailored, routine, and facilitated contact with a person or animal shows promise to address loneliness for people with dementia.What is already known about this topic:• Loneliness is emotionally painful and harms the health and quality of life of those that experience it.• Personal contact interventions refer to routine visits with another person or animal and have been found effective in addressing loneliness among cognitively intact older adults.What this paper adds:• Friends, family members and health care providers of people with dementia view personal contact interventions as logical, suitable and effective to address loneliness of older adults with dementia.• Personal contact interventions are not always easy to implement and do not automatically promote meaningful connection and prevent loneliness for people with dementia.• Strategies to tailor and facilitate personal contact interventions are needed to promote their effectiveness when used with people with dementia.

Healthy ageing in a deprived northern UK city: A co-creation study

With ageing comes an increased risk of poor health and social isolation, particularly in poorer populations. Older people are under-represented in research and as a result interventions may not take account of their context or barriers to participation. In co-creative work, future service users work with professionals on an equal basis to design, develop and produce a service or intervention. Our objectives were to (a) undertake a co-creation study with older people living in a northern city in the United Kingdom, (b) explore maintenance of health and well-being in older age, (c) explore the application of co-creation with an older community population and (d) evaluate the process and inform future work. The study was conducted during 2017 by a project team of 10 lay community dwelling older people and four university researchers. Findings demonstrate that state of mind and of health were key to well-being in older age. Feeling safe, comfortable and pain free were important along with being able to adapt to change, have choice and a sense of personal freedom. Social connectedness was seen as the keystone to support healthy behaviours. Rather than developing new interventions, there was a perceived need to connect people with existing resources and provide a human 'bridge' to address barriers to accessing these. In conclusion, the co-creation process proved productive, even when undertaken on a small scale. The scope of the project needs to be realistic, to use diverse methods of recruitment and skilled facilitators, and to prepare well in terms of accessibility, simple systems and appropriate information provision.

Correlation Between Aspects of Perceived Patient Loneliness and Spinal Cord Stimulation Outcomes

OBJECTIVES

Loneliness as a whole has been characterized as a health-related risk factor and is associated with worse outcomes after cardiac procedures. Evidence suggests that chronic pain patients are particularly vulnerable to feeling lonely. We examined the relationship between different aspects of loneliness and one-year postoperative outcomes after spinal cord stimulation (SCS) for chronic pain.

MATERIALS AND METHODS

We contacted 69 patients with thoracic SCS who had participated in our prospective outcomes database with one-year follow-up to complete the validated, abbreviated UCLA Loneliness Scale (UCLA-3). We examined responses on question 9 of the Oswestry Disability Index (ODI), question 12 of the Beck Depression Inventory (BDI), and UCLA-3 due to their relevance to different aspects of loneliness. We conducted regression analyses to determine the relationship between aspects of loneliness and pain outcomes.

RESULTS

We identified that loss of interest in people, companionship, and feeling excluded were associated with pain outcomes. Loss of interest in people was associated with improvement in pain (NRS worst p = 0.021, r = 0.32, NRS least p = 0.004, r = 0.4; NRS right now p = 0.016, r = 0.33). Companionship and feeling excluded were also associated with pain. We examined the interface between depression and total loneliness and found that while both were related to each other, depression was not associated with pain outcomes.

CONCLUSIONS

This study demonstrates an association between loss of interest in people, companionship, and feeling excluded and worse postoperative pain outcomes after receiving SCS. It identifies aspects of loneliness as important factors to consider when predicting the outcomes of SCS therapy for chronic pain control.

Role of clinical, functional and social factors in the association between multimorbidity and quality of life: Findings from the Survey of Health, Ageing and Retirement in Europe (SHARE)

OBJECTIVE

An increasing number of diseases is linked to deterioration of quality of life (QoL). Part of this association can be explained by socio-economic factors, which are most commonly accounted for. Our aim was to explore the potential contribution of other factors related to clinical burden, social interaction and functioning.

METHODS

A cross-sectional analysis was conducted on wave 6 of the population-based Survey of Health, Ageing and Retirement in Europe (SHARE), among participants aged 50+ (n = 67 179). The Control, Autonomy, Self-Realization and Pleasure (CASP-12v1) questionnaire measured QoL. The association between number of diseases and QoL was tested in a mixed-effects linear regression model. The base model controlled for socio-economic characteristics. Factors of interest (symptoms, polypharmacy, unmet care needs, utilisation of care, social network, personal and financial help, loneliness and activities of daily living (ADL) with instrumental activities (IADL)) were added to the base model one at a time and tested for relevance (i.e. change in the β-coefficient of the number of conditions of 15% or more).

RESULTS

Symptoms, polypharmacy, loneliness and ADL/IADL appeared relevant and were retained in the final model. The association between number of conditions and QoL in the base model was -2.44 [95% CI: -2.72; -2.16], while this association was -0.76 [95%CI: -0.97; -0.54] after all relevant factors were included.

CONCLUSION

Factors beyond the socio-economic circumstances play an important role in explaining the association between number of conditions and QoL. These factors should be considered to better estimate the impact of chronic diseases on QoL, and for improving patient care.

The Leveraging Exercise to Age in Place (LEAP) Study: Engaging Older Adults in Community-Based Exercise Classes to Impact Loneliness and Social Isolation

OBJECTIVE

Social isolation and loneliness are associated with morbidity and mortality in older adults. Limited evidence exists regarding which interventions improve connectedness in this population.

DESIGN/SETTING/PARTICIPANTS

In this pre-post study we assessed community-based group health class participants' (age ≥50) loneliness and social isolation. Participants (n = 382) were referred by a Cedars-Sinai Medical Network (Los Angeles, California) healthcare provider or self-referred from the community (July 2017-March 2020).

INTERVENTION

Participants met with a program coordinator and selected Arthritis Exercise, Tai Chi for Arthritis, EnhanceFitness, or the Healthier Living Workshop.

MEASUREMENTS

We measured social isolation using the Duke Social Support Index (DSSI) and loneliness using the UCLA 3-item Loneliness Scale at baseline, class completion, and 6 months.

RESULTS

Mean age was 76.8 years (standard deviation, SD = 9.1); 315 (83.1%) were female; 173 (45.9%) were Non-Hispanic white; 143 (37.9%) were Non-Hispanic Black; 173 (46.1%) lived alone; mean baseline DSSI score was 26.9 (SD = 4.0) and mean baseline UCLA score was 4.8 (SD = 1.8). On multivariable analysis adjusted for gender, race/ethnicity, income, self-rated health, and household size, DSSI improved by 2.4% at 6-week compared to baseline (estimated ratio, ER: 1.024; 95% confidence interval [CI]: 1.010-1.038; p-value = 0.001), and 3.3% at 6-month (ER: 1.033; 95% CI: 1.016-1.050; p-value <0.001). UCLA score after adjusting for age, gender, race/ethnicity, live alone, number of chronic conditions, income, and self-rated health, did not change at 6-week (ER: 0.994; 95% CI: 0.962-1.027; p-value = 0.713), but decreased by 6.9% at 6-months (ER: 0.931; 95% CI: 0.895-0.968; p-value <0.001).

CONCLUSION

Community-based group health class participants reported decreased loneliness and social isolation at 6-month follow-up.

Improving survivorship care: Perspectives of cancer survivors 75 years and older

PURPOSE

This work describes perspectives of older adult cancer survivors about improvements that should be considered during the early period of survivorship. Findings will be useful in program development of age-appropriate services following completion of cancer treatment for older adults.

METHODS

A national survey was conducted across ten Canadian provinces to understand follow-up experiences of cancer survivors one to three years post-treatment. The survey included open-ended questions enabling respondents to offer insight into their experiences. This publication presents analysis of responses from older adults (75+ years) about suggestions for improving survivorship care.

RESULTS

In total, 3274 older adults (75+ years) responded to the survey and 1424 responded to the question about improvements. Fifty-five percent of the older adults were male, 28% had experienced metastatic disease and 75% reported comorbid conditions. A total of 640 respondents offered 932 suggestions in the areas of service delivery (n = 763, 81.9%), support (n = 108, 11.6%), and practical assistance (n = 61, 6.5%). Improvements in information/communication (n = 291) and follow-up care (n = 180) accounted for the highest number of suggestions regarding service delivery. Thematic analysis revealed three key messages about improvement: 'offer me needed support', 'make access easy for me', and 'show me you care'.

CONCLUSION

Suggestions for improvement in survivorship care by older adults treated for cancer emphasize need for changes in the approaches taken by health care providers in interactions and organization of care delivery. Proactive provision of information, detailed schedules for follow-up care, and ease of access to post-treatment care are needed.