Loneliness of older people aged 70: a comparison of two Finnish cohorts born 20 years apart

The differential effect of emotional loneliness and social loneliness on late-life depression

OBJECTIVES

Loneliness adversely affects the prognosis, treatment, and remission of late-life depression. However, no clear distinction of the cause or definition of loneliness was imposed in existing literatures, resulting in mixed findings of the effect of loneliness to late-life depression (LLD). The aim of this study was to explore the association between different facets of loneliness and risk factors of LLD, specifically, if age of onset in LLD possess a different clinical profile in the clinical group.

METHOD

101 Chinese patients with depression and 81 healthy elderlies aged 60 or above were assessed on loneliness level, depressive symptoms, cognitive symptoms, physical condition, and motivational level. Univariate analyses were applied in exploring group differences in clinical profiles and multivariate regression to determine variables associated with subsets of loneliness.

RESULTS

LLD patients reported more emotional loneliness but not social loneliness than healthy controls (p < 0.001). Emotional loneliness was the only significant predictor of suicidal ideation, particularly on patients with early-onset depression, explaining 26.8% of the effect (p < 0.001). Finally, the effect of medical comorbidity on depression severity was mediated by emotional loneliness(Z = 2.159, p = 0.031).

CONCLUSION

The current research highlights more attention should be placed on the age of onset and medical comorbidity in elderlies with depression. The distinction between emotional loneliness and social loneliness is better understood in the Asian population, reinforcing the importance of taking cultural influence into account when understanding psychological constructs.

COVID-19 restrictions promoted the newly occurring loneliness in older people - a prospective study in a memory clinic population

Introduction

A high burden and many negative outcomes for older people were associated with the COVID-19 pandemic. Social isolation and loneliness are prevalent health problems impacting well-being and quality of life and may have increased due to pandemic-related restrictions. Methods: This study investigate the influence of the COVID-19 pandemic on loneliness in people visiting a mem40ory clinic between March 2020 and September 2022. We conducted a prospective, single-center, questionnaire-based observational follow-up study to assess potential predictors of newly occurring, pandemic-related loneliness. Next to a newly developed COVID-19 questionnaire, a comprehensive neuropsychological test battery, the Neuropsychiatric Inventory and the Geriatric Depression Scale were used.

Results

In total 426 people (mean age: 76.48 years, 12.9% cognitively intact, 33.1% diagnosed with Mild Cognitive Impairment, 49.8% diagnosed with dementia, and 4.2% diagnosed with depression) completed the COVID-19 questionnaire at baseline and 166 at follow-up. Newly occurring loneliness was indicated by 22.3% of baseline participants and by 24.1% of follow-up participants. Results of logistic regression analysis showed that living alone (OR 5.452) and having less contact with friends (OR 2.771) were most predictive of the occurrence of loneliness. The use of digital communication media as an alternative strategy for social interaction was lowest in dementia patients (6-13%).

Discussion

In conclusion, personal contacts and a close friendship network appear to be more decisive to prevent loneliness in older people than does the use of digital communication media. However, promoting an intensified use of digital communication media may be useful to counteract loneliness, especially in dementia patients.

Gender Differences in Loneliness Over Time: A 15-Year Longitudinal Study of Men and Women in the Second Part of Life

Evidence suggests that in old age, women are lonelier than men. Gender differences in loneliness are often explained by gender differences in longevity, social status and loss, health, and mobility-well-established predictors that may influence loneliness differently in "younger" (40-59 years) and "older" (60-80 years) groups of men and women in the second part of life. This study explores loneliness in men and women ages 40 to 80 years at baseline over a 15-year period using panel data from three waves of the Norwegian Life Course, Ageing and Generation Study (N = 2,315). Our analyses show that women were more lonely than men also in adjusted analyses. Logistic regression analyses indicated that loss of a partner and poor mental health are prospectively related to loneliness among men and women, whereas other factors like becoming a partner, stable singlehood, and poor physical health were related to loneliness among women but not men.

Time trends in loneliness from 1984 to 2019 among 27,032 older adults in Norway: A HUNT study

The aging population and increasing evidence of the detrimental health impacts of loneliness emphasize the importance of studying and predicting changes in loneliness prevalence among older adults. To understand and project changes in loneliness over time, we examined 35-year trends in adults aged 70 and older, considering factors such as sex, age, and living situation. Cross-sectional data from 27,032 home-dwelling adults aged 70 years and older who participated in at least one of the four Norwegian HUNT surveys from 1984 to 2019, and Norwegian population data from Statistics Norway were used for the analyses. Loneliness was self-reported, and the prevalence of loneliness was standardized to the Norwegian population at the survey year by age and sex. The results showed that the prevalence of loneliness significantly decreased between each survey. The higher categories of loneliness (a good amount, very much) decreased, from 11.4% (1995-97), 6.7% (2006-08), and 5.8% (2017-19). Across surveys, loneliness was significantly more common among women, the oldest, and those living alone. The prevalence of loneliness among the oldest adults living alone increased from 2006 to 2019. The gradual decline in loneliness observed from 1995 to 2019 coincided with notable societal changes in Norway. We estimated that the number of older adults experiencing loneliness in Norway could rise from 184,000 in 2020 to 286,000 in 2035, and potentially reach 380,000 in 2050.

Complex association of self-rated health, depression, functional ability with loneliness in rural community-dwelling older people

BACKGROUND

This study aimed to explore whether and how self-rated health, depression and functional ability interactively associated with loneliness using a sample group of older adults residing in China rural communities.

METHODS

Data on socio-demographic information, self-rated health, depressive symptoms, functional ability and loneliness (quantified via a single question) were collected from 1009 participants. Cross-tabulations with chi-square test, bivariate correlations, and Classification and Regression Tree (CART) models were employed for analysis.

RESULTS

We found that 45.1% of the participants were classified as lonely. Our results gain insight into the hierarchical order of predictors for the presence of loneliness, suggesting that there was a significant interaction between functional ability and depressive symptoms while self-rated health was not a significant factor. The probability of loneliness increased with the combination of limited functional ability and depression, and varied with different interaction of functional ability, depressive symptoms, and marital status, respectively. Notably, while there were some differences, similar associations were observed among older male and female respondents.

CONCLUSION

To delay or reduce loneliness, early detection which focuses on older people who report limitations in functional ability, depression, and being female, offers opportunities to start early interventions. Our findings might be helpful not only in designing and implementing loneliness prevention programs but also in improving healthcare for older rural community-dwelling people.

Loneliness across time and space

People feel lonely when their social needs are not met by the quantity and quality of their social relationships. Most research has focused on individual-level predictors of loneliness. However, macro-level factors related to historical time and geographic space might influence loneliness through their effects on individual-level predictors. In this Review, we summarize empirical findings on differences in the prevalence of loneliness across historical time and geographical space and discuss four groups of macro-level factors that might account for these differences: values and norms, family and social lives, technology and digitalization, and living conditions and availability of individual resources. Regarding historical time, media reports convey that loneliness is on the rise, but the empirical evidence is mixed, at least before the COVID-19 pandemic. Regarding geographical space, national differences in loneliness are linked to differences in cultural values (such as individualism) but might also be due to differences in the sociodemographic composition of the population. Research on within-country differences in loneliness is scarce but suggests an influence of neighbourhood characteristics. We conclude that a more nuanced understanding of the effects of macro-level factors on loneliness is necessary because of their relevance for public policy and propose specific directions for future research.

Validation of the De Jong Gierveld Loneliness Scale in Peruvian old adults: a study based on SEM and IRT multidimensional models

Loneliness is a public health problem. Its assessment is important to identify older adults who experience greater loneliness and appropriate interventions can be carried out. The De Jong Gierveld Solitude Scale (DJGLS) is one of the most widely used, at least in the European context, to measure loneliness. Although the Spanish version of the DJGLS has shown reliability and validity in Spanish samples of older adults, there is no evidence of adequacy in the Latin American context. Therefore, this study aims to evaluate the psychometric properties of the DJGLS in Peruvian older adults. Specifically, factorial validity, internal consistency and criterion-related validity were studied, based on a double analytical perspective: Classical Test Theory (SEM models) and Item Response Theory. The participants were 235 Peruvian older adults with ages ranging from 61 to 91 years old (Mean = 72.69, SD = 6.68) that assisted to Centers for the Elderly in the city of Trujillo, Peru. Together with the DJGLS, information from the three-item UCLA loneliness scale, Satisfaction with Life Scale, Brief Resilient Coping Scale and the Patient Health Questionnarie-2 was also gathered. The results support a one-dimensional structure of the DJGLS but with the presence of method effects associated to the negatively worded items. Additionally, the IRT multidimensional model applied also indicated the presence of a second dimension related to these negative items. Finally, other evidences of reliability and validity were adequate. In summary, the DJGLS may be considered a reliable and valid instrument to be used in the Peruvian (older adults) context.

Internet use and cohort change in social connectedness among older adults

Social connections are an integral part of living in society, and trends in social connectedness are thus closely scrutinized. The phenomenon of networked individualism argues that densely knit communities organized around formal social groups such as households and workplaces are becoming less common. Due to advances in technology, individuals are able to develop personalized communities that are more diverse and less geographically-bound. The objective of this study was to determine how both average levels and the variability of social connectedness have changed across cohorts, and how much of this is due to increased internet use. Data from 2006, 2008, 2016, and 2018 waves of the Health and Retirement Study were used to investigate cohort changes in various indicators of social connectedness. The analytical sample consisted of older adults aged 58-69 from the Silent Generation (born 1920-1947) and Baby Boomers (born 1948-1965). Heteroscedastic regression models and decomposition methods were used to investigate the role of increased internet use in driving some of these changes. Findings suggest that increases in internet use was associated with increases in the variance of social participation (i.e., contact with friends and family) in the United States. However, evidence around more subjective measures of social connectedness (i.e., social support, loneliness) was less clear. Future research should seek to understand how cohort change in technological use may affect objective and subjective aspects of social connectedness in different ways.

The Influence of Disease Status on Loneliness of the Elderly: Evidence from Rural China

At present, the dual pressure of rural labor outflow and population aging in China makes the problems of the rural elderly population increasingly prominent, and its health problem is particularly prominent. Based on the 2014 China elderly population health survey data (CLHLS), this paper finds that the physical health status of the rural elderly has a significant positive impact on their loneliness; that is, the rural elderly with poor health status are more likely to feel lonely. At the same time, the age of the elderly has a significant positive impact on their loneliness. On the contrary, gender, personality, family income and intergenerational support of the elderly have a negative impact on their loneliness. Chronic diseases such as hypertension and diabetes have no significant effect on the loneliness of the elderly in rural areas, but there is a “severe disease effect”; that is, when chronic diseases develop into serious diseases or acute serious diseases, it can negatively impact the elderly psychologically and produce or deepen their sense of loneliness. Based on the above conclusions, this paper further puts forward relevant policy suggestions from three aspects: constructing a disease prevention and control system for the rural elderly, improving the care and service system for the rural elderly, reshaping rural filial piety culture, and creating a good atmosphere of “respecting, loving and respecting parents” in rural areas.

Risk factors for loneliness among older people in a Nordic regional context – a longitudinal study

The aim of this study was to examine the prevalence of loneliness among older people and to identify risk factors for loneliness in a Nordic regional context over a six-year period. Longitudinal data from the Gerontological Regional Database (GERDA) study of 4,269 older adults living in northern Sweden and western Finland, aged 65, 70, 75 and 80 at baseline in 2010, were analysed. Logistic regressions were used to analyse socio-demographic, social and health-related risk factors at baseline and changes in these for experiences of loneliness at follow-up. The results showed that most older adults (85%) did not experience loneliness at baseline or at follow-up in our study region. However, 3 per cent of the sample reported loneliness in both study years, indicating enduring and chronic loneliness. Analyses revealed that being widowed and becoming a widow/er as well as poor self-rated health at baseline and the onset of depression were risk factors for loneliness. Finally, the risk of loneliness was higher in older people living in Sweden. Further work is needed to explore changes and stability in loneliness as well as to increase our understanding of between-country differences in loneliness.

The effects of loneliness and social isolation on all-cause, injury, cancer, and CVD mortality in a cohort of middle-aged Finnish men. A prospective study

OBJECTIVES

Loneliness and social isolation both increase mortality and are likely to affect health via several pathways. However, information on the potential pathways remains scarce. We investigated the associations between loneliness, social isolation, and mortality, and possible mechanisms underlying these connections.

METHODS

The analyzed data comprised a prospective population-based cohort of Finnish men (42-61 years at baseline, n = 2588) who were followed up for an average of 23.2 years. Mortality data were obtained from the national population register in 2012. Cox proportional hazards analysis with adjustments for possible confounding factors was used to examine the associations between loneliness and social isolation at baseline and all-cause, injury, cancer, and cardiovascular disease (CVD) mortality. Mediation analysis was conducted to investigate the mechanisms underlying the associations of loneliness and social isolation with mortality.

RESULTS

Loneliness predicted all-cause mortality, even after adjustments for all covariates. Loneliness predicted cancer mortality, except after adjustments for lifestyle variables or Human Population Laboratory (HPL) depression scores, and also predicted CVD mortality, except after adjustments for HPL depression scores. Social isolation predicted all-cause mortality and injury mortality. The effect of social isolation on all-cause mortality was mediated by loneliness and HPL depression scores.

CONCLUSIONS

Our findings suggest that both loneliness and social isolation increase the risk of all-cause mortality, while they have differing effects on different causes of death. Loneliness and depressive symptoms may mediate the effect of social isolation on increased mortality.

Loneliness in Old Age, the Related Factors, and Its Association with Demographics and Districts of Residence

Loneliness among older people has now become a serious public health issue. There have been few previous studies conducted among Chinese populations on the correlations between loneliness, self-rated health, and instrumental activities of daily living (IADL), and their association with demographic characteristics. In this study, data were collected using quota sampling through survey interviews. Older people living in representative districts were recruited. Of the participants, 60.1% rated their health as average and 58.1% showed a high level of loneliness. IADL and self-rated health (SRH) were found to be moderately positively correlated, with r = 0.357, p < 0.001. A low negative correlation was found between the level of loneliness and IADL, with r = −0.276; and SRH, with r = −0.288, p < 0.05. Ordinal Regression results showed that subjects with higher IADL scores (OR: 0.64, 95% CI: 0.39–1.05) were less lonely, while those with a less desirable economic status (OR: 3.34, 95% CI: 1.40–7.96) and living in the central business district were more likely to have a higher loneliness score (OR: 21.33, 95% CI: 4.81–95.41). It is essential to screen for loneliness, and interventions should be focused on improving social connections and support for older people to overcome their feelings of loneliness.

Prevalence of loneliness amongst older people in high-income countries: A systematic review and meta-analysis

Background and objective

Loneliness is associated with increased rates of morbidity and mortality, and is a growing public health concern in later life. This study aimed to produce an evidence-based estimate of the prevalence of loneliness amongst older people (aged 60 years and above).

Study design and setting

Systematic review and random-effects meta-analysis of observational studies from high income countries 2008 to 2020, identified from searches of five electronic databases (Medline, EMBASE, PsychINFO, CINAHL, Proquest Social Sciences Premium Collection). Studies were included if they measured loneliness in an unselected population.

Results

Thirty-nine studies reported data on 120,000 older people from 29 countries. Thirty-one studies were suitable for meta-analysis. The pooled prevalence estimate of loneliness was 28.5% (95%CI: 23.9% - 33.2%). In twenty-nine studies reporting loneliness severity, the pooled prevalence was 25.9% (95%CI: 21.6% - 30.3%) for moderate loneliness and 7.9% (95%CI: 4.8% - 11.6%) for severe loneliness (z = -6.1, p < 0.001). Similar pooled prevalence estimates were observed for people aged 65–75 years (27.6%, 95%CI: 22.6% - 33.0%) and over 75 years (31.3%, 95%CI: 21.0% - 42.7%, z = 0.64, p = 0.52). Lower levels of loneliness were reported in studies from Northern Europe compared to South and Eastern Europe.

Conclusions

Loneliness is common amongst older adults affecting approximately one in four in high income countries. There is no evidence of an increase in the prevalence of loneliness with age in the older population. The burden of loneliness is an important public health and social problem, despite severe loneliness being uncommon.

PROSPERO registration

CRD42017060472.

Effects of transient and chronic loneliness on major depression in older adults: A longitudinal study

OBJECTIVES

The number of older adults is rapidly rising globally. Loneliness is a common problem that can deteriorate health. The aims of this work were to identify different types of loneliness (transient and chronic) and to assess their association with depression over time.

METHODS

A nationally representative sample from the Spanish population comprising 1190 individuals aged 50+ years was interviewed on three evaluations over a 7-year period. The UCLA Loneliness Scale was used to measure loneliness. While chronic loneliness was defined as the presence of loneliness across all three waves, transient loneliness expressed the presence of loneliness in one wave only. A 12-month major depressive episode was assessed at each interview. After confirming the cross-sectional relationship, a multilevel mixed-effects model was used to examine the association between loneliness and depression.

RESULTS

Almost a quarter of individuals felt lonely and one out of 10 presented depression at baseline. Of the sample, 22.78% showed transient loneliness, while 6.72% presented the chronic type. People experiencing chronic loneliness were at a higher risk of presenting major depression (OR = 6.11; 95% CI = 2.62, 14.22) than those presenting transient loneliness (OR = 2.22; 95% CI = 1.19, 4.14). This association varied over time and was stronger at the first follow-up than at the second one.

CONCLUSIONS

Focusing on loneliness prevention could reduce the risk of depression. Chronic loneliness is a public health problem that should be addressed through the full participation of the political, social, and medical sectors.

Adapting the UCLA 3-item loneliness scale for community-based depressive symptoms screening interview among older Chinese: a cross-sectional study

OBJECTIVE

Loneliness is a significant and independent risk factor for depression in later life. Particularly in Asian culture, older people may find it less stigmatising to express loneliness than depression. This study aimed to adapt a simple loneliness screen for use in older Chinese, and to ascertain its relevance in detecting depressive symptoms as a community screening tool.

DESIGN, SETTING AND PARTICIPANTS

This cross-sectional study was conducted among 1653 older adults aged 60 years or above living in the community in Hong Kong. This was a convenient sample recruited from four local non-governmental organisations providing community eldercare or mental healthcare services. All data was collected by trained social workers through face-to-face interviews.

MEASURES

Loneliness was measured using an adapted Chinese version of UCLA 3-item Loneliness Scale, depression symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), and social support with emotional and instrumental support proxies (number of people who can offer help). Basic demographics including age, gender, education and living arrangement were also recorded.

RESULTS

The average loneliness score was 3.9±3.0, and it had a moderate correlation with depressive symptoms (r=0.41, p<0.01). A loneliness score of 3 can distinguish those without depression from those with mild or more significant depressive symptoms, defined as a PHQ-9 score of ≥5 (sensitivity 76%, specificity 62%, area under the curve=0.73±0.01). Loneliness explained 18% unique variance of depressive symptoms, adding to age, living arrangement and emotional support as significant predictors.

CONCLUSION

A 3-item loneliness scale can reasonably identify older Chinese who are experiencing depressive symptoms as a quick community screening tool. Its wider use may facilitate early detection of depression, especially in cultures with strong mental health stigma.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov NCT03593889.

Digitalization and the Social Lives of Older Adults: Protocol for a Microlongitudinal Study

BACKGROUND

Digital technologies are increasingly pervading our daily lives. Although older adults started using digital technologies later than other age groups, they are increasingly adopting these technologies, especially with the goal of communicating with others. However, less is known about how online social activities are embedded in older adults' daily lives, how they complement other (offline) social activities, and how they contribute to social connectedness and well-being.

OBJECTIVE

Data generated by this project will allow us to understand how older adults use digital communication in their daily lives to communicate with others, how this relates to well-being and social connectedness, and how communication using digital technologies differs from other types of communication depending on situational and individual characteristics.

METHODS

Microlongitudinal data were collected from 120 older adults from German-speaking regions of Switzerland to examine these questions. Data collection took place from April 2019 to October 2019. Data collection took place over different time scales, including event-based (reporting all social interactions for 21 days), daily (well-being, loneliness, and technology use every evening for 21 days), hourly (cortisol assessments 6 times per day for 3 days), and baseline (relevant interindividual characteristics, including sociodemographics, health, technology use, personality, and cognitive performance) assessments.

RESULTS

Data collection for this study was completed in November 2019. Participants reported an average of 96.35 interactions across the 21 days. Among the total 11,453 interactions, 5494 (47.97%) were face-to-face, and around 16% each were interactions by phone (1858, 16.16%), email (1858, 16.22%), and text message (1853, 16.18%). Otherwise, 246 (2.15%) of the interactions took place on social media, 96 (0.84)% were letters, and 54 (0.47%) of the interactions took place on videochat.

CONCLUSIONS

Participants used a variety of modalities in their daily communication, including digital means such as text messages, email, and video calls. Further analysis will provide more detail as to the role that communication via digital media plays in older adults' daily lives.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/20306.

Trends in the Mortality Risk of Living Alone during Old Age in Sweden, 1992-2011

Objectives: This study investigates the association between living alone and mortality over a recent 19-year period (1992-2011). Method: Data from a repeated cross-sectional, nationally representative (Sweden) study of adults ages 77 and older are analyzed in relation to 3-year mortality. Results: Findings suggest that the mortality risk associated with living alone during old age increased between 1992 and 2011 (p = .076). A small increase in the mean age of those living alone is partly responsible for the strengthening over time of this association. Throughout this time period, older adults living alone consistently reported poorer mobility and psychological health, less financial security, fewer social contacts, and more loneliness than older adults living with others. Discussion: Older adults living alone are more vulnerable than those living with others, and their mortality risk has increased. They may have unique service needs that should be considered in policies aiming to support aging in place.

Changes in prevalence of loneliness over time in institutional settings, and associated factors

OBJECTIVES

The aim of this study was to examine changes in the prevalence of loneliness over time from 2011 to 2017 in long-term care facilities; and its related factors.

MATERIAL AND METHODS

Repeated cross-sectional studies exploring loneliness and its associated factors among residents in long-term care facilities were conducted in Helsinki, Finland in 2011 (N = 4966) and 2017 (N = 3767). Residents in temporary respite care or with severe cognitive impairment, and those unable or refusing to respond to the loneliness item were excluded. The total number of participants in this analysis was 1563 in 2011, and 1367 in 2017. In both samples, we used the same loneliness measurement by asking "Do you suffer from loneliness?" (never/sometimes/often or always). When comparing the samples in order to reduce the effect of confounding between them, we used propensity score matching. A multivariable logistic regression model explored the relationship between various characteristics and loneliness.

RESULTS

Loneliness showed no change in prevalence over time: propensity score-adjusted loneliness was 36 % in 2011 and 2017. In the multivariate logistic regression model, feeling depressed was the only independent characteristic associated with loneliness. Of the respondents who did not feel depressed, 24 % suffered from loneliness at least sometimes. Among the respondents who felt depressed, the respective figure was 55 %.

CONCLUSION

Loneliness is common in institutional settings. It remained stable, and not decreased over time. Because loneliness impairs the well-being, quality of life and health of residents, it needs to be addressed. Screening loneliness and developing interventions to alleviate it, is essential.

The association between smoking and loneliness among Chinese university freshmen

Background

In Chinese culture, smoking can promote social connectedness and integration. We therefore hypothesized that smoking would be negatively associated with loneliness in China. Given that loneliness is common and associated with adverse academic and health outcomes in university freshmen, examining correlates of loneliness in this population may deepen our understanding on the etiology of loneliness. This study investigated the association between smoking and loneliness in Chinese university fresh students.

Methods

In this cross-sectional study, by using a two-stage cluster sampling approach, we recruited a total of 1,452 fresh students from a comprehensive university in Wuhan, China. These students completed a self-administered questionnaire containing the Chinese six-item De Jong Gierveld Loneliness Scale (DJGLS) and standardized questions on socio-demographics, internet use, and substance use, including smoking and use of alcohol and illicit drugs. Multiple linear regression was used to test the independent association of loneliness with smoking.

Results

In Chinese university freshmen, current smokers had significantly higher DJGLS scores than non-smokers (11.9±4.60 vs. 8.53±3.72, t=7.351, P<0.001). After controlling for socio-demographic variables, current drinking, lifetime illicit drug use, and daily hours of internet use, the positive association between current smoking and DJGLS score remained statistically significant (unstandardized coefficient: 3.053, P<0.001).

Conclusions

Smoking is independently and positively associated with loneliness in Chinese university freshmen. Smoking cessation might be helpful for preventing and reducing loneliness among Chinese university fresh students.

The Stability and Change of Loneliness Across the Life Span: A Meta-Analysis of Longitudinal Studies

Individuals experience loneliness when they perceive a deficiency in the quality or quantity of their social relationships. In the present meta-analysis, we compiled data from 75 longitudinal studies conducted in Asia, Australia, Europe, and North America (N = 83, 679) to examine the rank-order and mean-level development of loneliness across the life span. Data were analyzed using two- and three-level meta-analyses and generalized additive mixed models. The results indicate that the rank order of loneliness is as stable as the rank order of personality traits and follows an inverted U-shaped trajectory across the life span. Regarding mean-level development, loneliness was found to decrease throughout childhood and to remain essentially stable from adolescence to oldest old age. Thus, in contrast to other personality characteristics, changes in loneliness are not generally related to age. Implications for theory are discussed.

Effects of a smartphone-based videoconferencing program for older nursing home residents on depression, loneliness, and quality of life: a quasi-experimental study

Background

Smartphones can optimize the opportunities for interactions between nursing home residents and their families. However, the effectiveness of smartphone-based videoconferencing programs in enhancing emotional status and quality of life has not been explored. The purpose of this study was to evaluate of the effect of a smartphone-based videoconferencing program on nursing home residents’ feelings of loneliness, depressive symptoms and quality of life.

Methods

This study used a quasi-experimental research design. Older residents from seven nursing homes in Taiwan participated in this study. Nursing homes (NH) were randomly selected as sites for either the intervention group (5 NH) or the control group (2 NH); NH residents who met the inclusion criteria were invited to participate. The intervention group was comprised of 32 participants; the control group was comprised of 30 participants. The intervention group interacted with their family members once a week for 6 months using a smartphone and a “LINE” application (app). Data were collected with self-report instruments: subjective feelings of loneliness, using the University of California Los Angeles Loneliness Scale; depressive symptoms, using the Geriatric Depression Scale; and quality of life using the SF-36. Data were collected at four time points (baseline, and at 1-month, 3-months and 6-months from baseline). Data were analysed using the generalized estimating equation approach.

Results

After the intervention, as compared to those in the control group, participants in interventional group had significant decreases in baseline loneliness scores at 1 months (β = − 3.41, p < 0.001), 3 months (β = − 5.96, p < 0.001), and 6 months (β = − 7.50, p < 0.001), and improvements in physical role (β = 36.49, p = 0.01), vitality (β = 13.11, p < 0.001) and pain scores (β = 16.71, p = 0.01) at 6 months. However, changes in mean depression scores did not significantly differ between groups.

Conclusions

Smartphone-based videoconferencing effectively improved residents’ feelings of loneliness, and physiological health, vitality and pain, but not depressive symptoms. Future investigations might evaluate the effectiveness of other media-based technologies in nursing homes as well as their effectiveness within and between different age cohorts.

Efficacy of path-oriented psychological self-help interventions to improve mental health of empty-nest older adults in the Community of China

BACKGROUND

China has the world's largest aging population and the number of empty-nest older adults is on the rise. In comparison to the aging population in general, empty-nest older adults have a lower level of subjective well-being and poorer mental health status due to a lack of emotional support from their children. The aim of this study is to conduct an empirical study to evaluate the efficacy of the 'Path-oriented Psychological Self-help Intervention' (P-oPSI) led by nurses on the mental health of empty-nest older adults in the community, to provide a scientific foundation for improving their quality of life.

METHODS

A Quasi-Experimental controlled intervention study was conducted from 2015 to 2017. A total of 76 empty-nest older adults from 2 districts were recruited using a convenience sampling and assigned to 2 groups based on their residential communities in the city of Chifeng in the Inner Mongolia Autonomous Region, China. The wait list control group participated in a mental health lecture to gain knowledge and learn techniques of mental health promotion. The intervention group additionally received 1 month of training in a nurse-led 'P-oPSI' for a month. Both groups were followed-up for 3 months. Mental health status, coping styles, and psychological self-help ability of the participating empty nest older adults were assessed at the baseline, 1 month, and 3-months follow up, respectively. Two-way analysis of variance and a simple effect test were used to analyse the differences of the two groups.

RESULTS

The P-oPSI yielded a greater benefit for the mental health status, coping styles, and psychological self-help ability of the participants in the intervention group. Combined with a simple effect test, the scores of the mental health status, positive coping style, and psychological self-help ability of those in the intervention group significantly increased at 1 month after the baseline (F _{mental health status} = 7.59, F _{positive coping style} = 7.24, F _{psychological self-help ability} = 7.07); and the sustainable effect of this program lasted for 3 months after the intervention (F _{mental health status} = 13.24, F _{positive coping style} = 10.42, F _{psychological self-help ability} = 10.45), which reached statistical significance (P < 0.01).

CONCLUSIONS

The P-oPSI program significantly improved the level of mental health of empty-nest older adults in China. This intervention provides a new approach of self-management to improve mental health of older adults in community settings.

TRIAL REGISTRATION

chictr.org.cn: ChiCTR1900025552. Retrospectively registered 1 September 2019.

"You Never Get Used to Loneliness" - Older Adults' Experiences of Loneliness When Applying for Going on a Senior Summer Camp

The aim of the present study was explore why the informants were feeling lonely and considered themselves to be in need of attending a senior summer camp, and how the informants were experiencing loneliness before they went to the senior summer camp. Interviews was made with nineteen older adult people (15 women and 4 men). A phenomenological inspired approach was used for the analysis of the interviews. Eight themes resulted: Hard to make new friends, Other circumstances making it hard to be social, Feel very lonely even if they lead rich social lives, Loss of loved ones, Do not want to do things alone, Friends make a difference, Do not feel lonely but need a change and Loneliness occurs at certain times. Through this analysis, we have gain insights to better understand loneliness as a multifaceted phenomenon that is associated with both personal circumstances and social situations. Many of the informants experienced being very lonely, even if they lead rich social lives. The experience of loneliness was connected to not having anyone they can turn to in confidence or to share experiences with and the need to belong to something or the need of a change in everyday life.

Peer-to-peer support model to improve quality of life among highly vulnerable, low-income older adults in Cape Town, South Africa

Background

Developing countries are experiencing rapid population ageing. Many do not have the resources or formal structures available to support the health and wellbeing of people as they age. In other contexts, the use of peer support programmes have shown favourable outcomes in terms of reducing loneliness, increasing physical activity and managing chronic disease. Such programmes have not been previously developed or tested in African countries. We piloted a peer-to-peer support model among vulnerable community-dwelling adults in a developing country (South Africa) to examine the program’s effect on wellbeing and social engagement.

Methods

A pre-post, pilot design was used to evaluate targeted outcomes, including wellbeing, social support, social interaction, mood, loneliness and physical activity. A total of 212 persons, aged 60+ years and living independently in a low-income area in Cape Town were recruited and screened for eligibility by trained assessors. Participants were assessed using the interRAI CheckUp, WHO-5 Wellbeing index, and the MOS-SS 8 instruments before and after the 5-month intervention, during which they received regular visits and phone calls from trained peer volunteers. During visits volunteers administered a wellness screening, made referrals to health and social services; built friendships with clients; encouraged social engagement; promoted healthy living; and provided emotional and informational support.

Results

Volunteer visits with clients significantly increased levels of self-reported wellbeing by 58%; improved emotional and informational support by 50%; decreased reports of reduced social interaction by 91%; reduced loneliness by 70%; improved mood scores represented as anxiety, depression, lack of interest or pleasure in activities, and withdrawal from activities of interest; and increased levels of physical activity from 49 to 66%.

Discussion

The intervention led to demonstrable improvement in client wellbeing. Policymakers should consider integrating peer-support models into existing health programs to better address the needs of the elderly population and promote healthy ageing in resource-poor community settings. Longer-term and more rigorous studies with a control group are needed to support these findings and to investigate the potential impact of such interventions on health outcomes longitudinally.

Improvement of Attention, Executive Functions, and Processing Speed in Elderly Women as a Result of Involvement in the Nordic Walking Training Program and Vitamin D Supplementation

Research indicates that life satisfaction declines with age, and cognitive abilities are gradually reduced—mainly attentional functioning and cognitive processing speed. Therefore, scientists seek to find protective factors and test possible intervention programs; moderately intensive physical activity stands out as particularly promising. In this context, we evaluated the influence of Nordic Walking training supported by vitamin D supplementation (as this nutrient is especially deficient in older people in Poland) on the cognitive and psychological functioning of elderly women. A total of 52 healthy elderly women took part in a Nordic Walking training program complemented by vitamin D supplementation. Cognitive functioning was assessed with the Trail Making Test and the D2 Test of Attention. Quality of life and severity of depressive symptoms were measured with the Short Form Health Survey and the Beck Depression Inventory 2. Significant improvements in all aspects of cognitive functioning was observed (p = 0.01–0.47). The study also showed a decrease in depressive symptoms (p = 0.026). Physical activity and adequate levels of vitamin D can be the key factors in maintaining self-reliance in old age. Involvement in Nordic Walking training, supported by vitamin D supplementation, can strengthen the cognitive functioning of older people—reflected in higher attentional capabilities, better executive functions, and improved cognitive processing speed.

Lonelier than ever? Loneliness of older people over two decades

To live with feelings of loneliness has negative implications for quality of life, health and survival. This study aimed to examine changes in loneliness among older people, both with regard to prevalence rates, and socio-demographic, social and health-related correlates of loneliness. This study had a repeated cross-sectional design and was based on the nationally representative Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD). Analyses of trends in loneliness covered the years 1992, 2002, 2004, 2011 and 2014, and included people aged 77 years or older (n=2 572). Analyses of correlates of loneliness covered 2004 and 2014, and included people aged 70 years or older (n=1 962). Logistic regression analyses were conducted with findings presented as average marginal effects. Contrary to what is often assumed, there has been no increase in loneliness among older people over time (1992-2014). Regression analyses for 2004 and 2014 showed that social and health-related correlates were more strongly associated with loneliness than socio-demographic correlates. Psychological distress was most strongly associated with loneliness, followed by widowhood. Most associations between the correlates and loneliness were stable over time.

Who often feels lonely? A cross-sectional study about loneliness and its related factors among older home-dwelling people

AIM AND OBJECTIVES

To investigate the prevalence of individuals who often feel lonely among a sample of Norwegian older home-dwelling people aged ≥65 years old, as well as to identify any possible factors explaining their loneliness.

BACKGROUND

Loneliness is known to be common among older people. To identify those older adults who are lonely, and to acquire knowledge about the complexity of their loneliness, is important to provide them with adequate help and support.

DESIGN

This study employed a cross-sectional design.

METHOD

A questionnaire was mailed to a randomised sample of 6,033 older home-dwelling persons aged ≥65 years. A total of 2,052 persons returned the questionnaire and were included in the study. The questionnaire consisted of questions asking whether the subjects often felt lonely or not, as well as health-related and background questions and instruments to measure the participants' sense of coherence, mental problems, nutritional screening and self-care ability. The data were analysed using univariate and multivariate statistical methods.

RESULTS

A total of 11.6% of the participants reported often feeling lonely. Six factors emerged to be independently associated with often feeling lonely among the respondents: Living alone, not being satisfied with life, having mental problems, a weak sense of coherence, not having contact with neighbours and being at risk for undernutrition.

CONCLUSIONS

The study shows that often feeling lonely among older home-dwelling persons is a health-related problem that includes social, psychological and physical aspects. Moreover, these persons have limited resources to overcome feelings of loneliness.

IMPLICATIONS FOR PRACTICE

Lasting loneliness among older home-dwelling persons requires an overall, person-centred and time-consuming approach by nurses. Nurses with advanced knowledge on geriatric nursing may be required to offer appropriate care and support. Healthcare leaders and politicians should offer possibilities for adequate assessment, support and help.

Empty-nest-related psychological distress is associated with progression of brain white matter lesions and cognitive impairment in the elderly

This study evaluated the association between empty-nest-related psychological distress and the progression of white matter lesions (WMLs) and cognitive impairment in 219 elderly subjects aged 60 years or over. Psychological distress was assessed using the University of California at Los Angeles Loneliness Scale (UCLA-LS) and Geriatric Depression Scale (GDS) Short-Form. Cognitive function was evaluated using the MMSE and MoCA. White matter hyperintensities (WMH) were assessed using magnetic resonance imaging. After 5.2-year follow-up, the reductions in MMSE and MoCA scores and the increases in periventricular (P)WMH, deep (D)WMH, and total WMH volumes in the empty-nest elderly were greater than those in the non-empty-nest elderly (P < 0.05). The reduced MMSE and MoCA scores and increased volumes of PWMH and total WMH in the empty-nest elderly living alone were greater than those in the empty-nest elderly living with a spouse (P < 0.05). UCLA-LS and GDS scores were significantly and independently associated with reduced MMSE and MoCA scores and the increased volumes of PWMH, DWMH, and total WMH. The results indicate that empty-nest-related psychological distress is associated with progression of WMLs and cognitive impairment in the elderly.