Predictors of loneliness and different types of social isolation of rural-living older adults in the United Kingdom

Can Social Policy Alleviate Loneliness Among Older Adults? A Comparative Analysis of OECD Countries

Loneliness in old age is a multifaceted issue influenced by personal, social, and environmental factors, necessitating a holistic approach. However, most research has predominantly focused on individual-level risk factors, with limited attention given to institutional factors such as social policy. This study investigated how social policies impact loneliness among older adults. Multi-level analysis was conducted using data from the 2017 wave of International Social Survey Programme, involving 6,337 older adults from 23 OECD countries. The analysis revealed that higher public spending on welfare and old-age pensions significantly reduces the likelihood of loneliness among older adults. These findings confirm the protective role of generous social policies in addressing old-age loneliness. They underscore the need for long-term changes in welfare systems to enhance the public response to the significant social risk posed by old-age loneliness.

Creating arts and crafting positively predicts subjective wellbeing

Introduction

This study explored whether engagement with Creating Arts and Crafting (CAC) predicted subjective wellbeing and loneliness, above and beyond known sociodemographic predictors.

Methods

Secondary data from 7,182 adults living in England from the Taking Part Survey (a 2019-2020 UK household survey of culture and sport participation) were analyzed. Hierarchical Linear regressions were used to explore the predictive effect of engagement with CAC on aspects of subjective wellbeing (anxiety, happiness, life satisfaction and a sense that life is worthwhile) and loneliness. Covariates included gender, Index of Multiple Deprivation (IMD), age group, health and employment status.

Results

Engaging in CAC significantly predicted increased life satisfaction, a sense that life is worthwhile and happiness, above and beyond known sociodemographic predictors.

Conclusion

Our study provides support for the wellbeing benefits of engagement with creating arts and crafting, and we suggest that this will be a useful tool at a public health level, noting that relative accessibility and affordability creating arts and crafting.

The silent epidemic of loneliness: identifying the antecedents of loneliness using a lagged exposure-wide approach

BACKGROUND

A large and accumulating body of evidence shows that loneliness is detrimental for various health and well-being outcomes. However, less is known about potentially modifiable factors that lead to decreased loneliness.

METHODS

We used data from the Health and Retirement Study to prospectively evaluate a wide array of candidate predictors of subsequent loneliness. Importantly, we examined if changes in 69 physical-, behavioral-, and psychosocial-health factors (from t0;2006/2008 to t1;2010/2012) were associated with subsequent loneliness 4 years later (t2;2014/2016).

RESULTS

Adjusting for a large range of covariates, changes in certain health behaviors (e.g. increased physical activity), physical health factors (e.g. fewer functioning limitations), psychological factors (e.g. increased purpose in life, decreased depression), and social factors (e.g. greater number of close friends) were associated with less subsequent loneliness.

CONCLUSIONS

Our findings suggest that subjective ratings of physical and psychological health and perceived social environment (e.g. chronic pain, self-rated health, purpose in life, anxiety, neighborhood cohesion) are more strongly associated with subsequent loneliness. Yet, objective ratings (e.g. specific chronic health conditions, living status) show less evidence of associations with subsequent loneliness. The current study identified potentially modifiable predictors of subsequent loneliness that may be important targets for interventions aimed at reducing loneliness.

A global perspective on risk factors for social isolation in community-dwelling older adults: A systematic review and meta-analysis

PURPOSE

Older people's physical and mental health are now significantly impacted by social isolation, a major threat to public health. Our goal was to identify the connections between risk factors and social isolation among this population across various geographic areas.

METHODS

Seven databases were thoroughly searched, from their inception until April 2023. Inclusion and exclusion criteria were used to choose the studies. For the included cross-sectional studies, we used the Agency for Healthcare Research and Quality (AHRQ) to assess the probability of bias, and the Newcastle-Ottawa scale for the cohort studies. The statistical analysis was performed using STATA 15 to calculate pooled odds ratios (OR) and 95% CI.

RESULTS

All 3043 papers were carefully examined, and 42 satisfied the criteria for inclusion. The results indicated that multi-domain risk factors and social isolation among older persons worldwide are significantly correlated. These multi-domain risk factors included biological factors, socioeconomic factors, and psychological and behavioral factors. It is also important to note that these factors may vary from region to region.

CONCLUSION

Many domain factors were linked to social isolation in older individuals living in communities throughout the world. To develop effective strategies for controlling social isolation, it is crucial to conduct assessments of social isolation risk factors in local communities.

Explaining how and why social support groups in hospice day services benefit palliative care patients, for whom, and in what circumstances

Background

Palliative care aims to provide holistic support for people with life-limiting illness, responding to psychological, social and spiritual needs, as well as to clinical and physical. In the United Kingdom, hospice day services (including day care, group interventions, group activities, and social events for palliative care outpatients) aim to provide opportunities for patients to gain social support, which is thought to improve their quality of life.

Objectives

This research explored social support within hospice day services, to explain in detail how and why social support obtained within a hospice day service could be beneficial to palliative care patients.

Design

Qualitative research using observations of hospice day services and interviews with service providers.

Methods

Data collection involved nineteen interviews with hospice service providers (n = 19) and researcher observations of hospice day services. The findings detail how patient and hospice context interact to produce mechanisms that lead to outcomes beyond the hospice day service.

Results

Practical, clinical and social aspects of the hospice day service are important for patients feeling welcome and safe in the setting. The opportunity to connect with other people and work towards personal goals can boost self-confidence for patients who have lost access to meaningful activity. New friendships between patients encourages reciprocal support and feelings of belonging. It is beneficial to have permission to speak freely about topics deemed inappropriate elsewhere, because honest communication is helpful in accepting and adapting to their circumstances.

Conclusion

Hospice day services facilitate group settings for reciprocal social support. This research proposes an initial programme theory that can be further developed and tested. It explains how and why, in some contexts, social support increases personal and practical resources to cope with illness and death, leading to changes outside of the hospice (to mood, interpersonal interactions and behaviour) that could improve quality of life.

Social-ecological factors influencing loneliness and social isolation in older people: a scoping review

There are growing calls from researchers and policy makers to redefine loneliness and social isolation (SI) as public health issues, and to move towards a transdisciplinary, systems-based approach, due to their association with significant health risks, particularly in older people. Research about loneliness and SI in older people has typically adopted a narrow focus, evaluating effects of individual and inter-personal factors on these experiences. Less is known about the community and societal influences that may be used to inform public health interventions. We conducted a scoping review applying Joanna Briggs Institute methodology and the social-ecological model framework in order to: i) identify the available evidence for the influence of the community and societal factors on loneliness and SI as experienced by older people; ii) examine how quantitative research about community- and societal-level factors of loneliness and SI in the older population is conducted; and iii) identify current knowledge gaps in relation to the use of the social-ecological model in this area. A total of 52 articles from 30 countries met the inclusion criteria, including 33 observational studies, primarily cross-sectional (88%), and 19 interventions, mostly (89%) pre-post evaluations. The majority of included articles measured loneliness only (n = 34, 65%), while 11 measured both loneliness and SI (21%). To measure these outcomes validated scales were frequently used. Eighteen community/societal factors were investigated in relation to loneliness and/or SI, most commonly neighbourhood safety, access to public third-places and cultural practices. Three societal-level interventions were found: two campaigns to reduce ageism and one which explored the impact of free public transport. Community-based interventions were either educational or enlisted volunteers to foster connections. There is a need for longitudinal studies to better understand the mechanisms through which community- and societal- level factors affect loneliness and SI, which in turn will guide interventions that utilise the social-ecological framework for these issues.

Global rural health disparities in Alzheimer's disease and related dementias: State of the science

INTRODUCTION

Individuals living in rural communities are at heightened risk for Alzheimer's disease and related dementias (ADRD), which parallels other persistent place-based health disparities. Identifying multiple potentially modifiable risk factors specific to rural areas that contribute to ADRD is an essential first step in understanding the complex interplay between various barriers and facilitators.

METHODS

An interdisciplinary, international group of ADRD researchers convened to address the overarching question of: "What can be done to begin minimizing the rural health disparities that contribute uniquely to ADRD?" In this state of the science appraisal, we explore what is known about the biological, behavioral, sociocultural, and environmental influences on ADRD disparities in rural settings.

RESULTS

A range of individual, interpersonal, and community factors were identified, including strengths of rural residents in facilitating healthy aging lifestyle interventions.

DISCUSSION

A location dynamics model and ADRD-focused future directions are offered for guiding rural practitioners, researchers, and policymakers in mitigating rural disparities.

HIGHLIGHTS

Rural residents face heightened Alzheimer's disease and related dementia (ADRD) risks and burdens due to health disparities. Defining the unique rural barriers and facilitators to cognitive health yields insight. The strengths and resilience of rural residents can mitigate ADRD-related challenges. A novel "location dynamics" model guides assessment of rural-specific ADRD issues.

Social isolation, loneliness, and their correlates in older Japanese adults

BACKGROUND

Loneliness and social isolation are elevated in older adults and associated with a range of detrimental outcomes. Despite this, there has been little research on these phenomena or on similarities and differences in their occurrence or combination in older Japanese adults. The current study aims to (i) determine what factors are associated with social isolation and loneliness among older adults in Japan; and (ii) describe the characteristics of individuals who are socially isolated but not lonely, as well as those who feel lonely but are not socially isolated.

METHODS

Data were analysed from 13 766 adults aged ≥65 years who participated in the 2019 wave of the Japan Gerontological Evaluation Study. Poisson regression analysis was used to examine associations.

RESULTS

Among older Japanese adults, the attributes of higher age, male gender, lower socioeconomic status, being a welfare recipient, and having depressive symptoms were associated with social isolation, while lower socioeconomic status, unemployment, welfare receipt, and poor physical and mental health were associated with loneliness. In addition, better educated, and mentally and physically healthy people were less likely to feel lonely even when socially isolated, while people who were not working and who had mental or physical health problems were more likely to feel lonely even if they were not socially isolated.

DISCUSSION

Our results indicate that in order to reduce unwanted social isolation and loneliness among older Japanese adults, in the first instance the focus should be on those individuals who are socioeconomically disadvantaged and unhealthy.

A matter of participation? A critical incident study of municipal care personnel in situations involving care-dependent older persons and emergency medical services

Purpose

This study aimed at describing municipal care personnel’s experiences of and actions in situations when older persons need emergency medical services (EMS) at home.

Methods

An inductive descriptive design adhering to critical incident technique (CIT) was used. Data were collected through interviews and free text written questionnaires, analysed in accordance with CIT procedure.

Results

Experiences related to the main areas of Lifesaving competence and Collaborative care. Lifesaving competence involved having sufficient knowledge to guide older persons in emergencies without organizational support. The lack of care alternatives carries dependence on inter-organizational collaboration, as well as having to accept the collaborative conditions provided by the EMS. Actions meant Adjusting to situational needs and EMS authority, which involved safeguarding the person while being directed by the EMS.

Conclusions

Lack of organizational support, care alternatives, and structured collaboration jeopardize care-dependent older persons’ health, and ability to influence care when emergency situations occur at home. Municipal care personnel’s actions as the older person’s representative support human agency, allowing older persons to become active participants in care despite acute suffering. This study underlines the importance of further developing welfare policies that facilitate and regulate inter-organizational responsibilities of health and social care to favour older people.

How can Quality of Life be Achieved in a Sustainable Way? Perceptions of Swiss Rural Inhabitants

Rural regions in Europe are often structurally weaker than urban areas and are subject to strong socio-economic development. At the same time, they offer opportunities for a high quality of life and sustainability. The key question of this article is how quality of life in high-income countries can be achieved more sustainably. Little is known about the perception of the rural population itself on the reconciling of high quality of life with sustainability. Thus, based on a concept of sustainable quality of life, qualitative interviews with 90 rural residents were conducted to ask them which factors benefit sustainable quality of life. In the perception of the interview participants, a change in attitudes and values would be a starting point for shaping many other areas to enhance sustainable quality of life; social and legal norms should provide reference points for individuals and economic actors; infrastructure should support individuals in their ecological behaviour; and the economy should serve the common good. We derive four strands of recommendations for decision-makers from these results: the enhancement of education on applicable environmental behaviours, equal access to renewable energies and local productions and services.

A social exclusion perspective on loneliness in older adults in the Nordic countries

Several factors associated with loneliness are also considered indicators of social exclusion. While loneliness has been proposed as an outcome of social exclusion, there is limited empirical evidence of a link. This study examines the associations between social exclusion indicators and loneliness in older adults (60+ years) in four Nordic countries. Data from four waves of the European Social Survey were pooled, providing a total of 7755 respondents (Denmark n = 1647; Finland n = 2501, Norway n = 1540; Sweden n = 2067). Measures of loneliness, demographic characteristics, health, and eight indicators of social exclusion were selected from the survey for analysis. Country-specific and total sample hierarchical logistic regression models of loneliness were developed. Significant model improvement occurred for all models after social exclusion indicators were added to models containing only demographic and health variables. Country models explained between 15.1 (Finland) and 21.5% (Sweden) of the variance in loneliness. Lower frequency of social contacts and living alone compared to in a two-person household was associated with a higher probability of loneliness in all countries, while other indicators were associated with loneliness in specific countries: lower neighbourhood safety (Sweden and Denmark); income concern (Sweden and Finland); and no emotional support (Denmark, Finland, and Sweden). A robust relationship was apparent between indicators of social exclusion and loneliness with the direction of associations being highly consistent across countries, even if their strength and statistical significance varied. Social exclusion has considerable potential for understanding and addressing risk factors for loneliness.

Managing Perceived Loneliness and Social-Isolation Levels for Older Adults: A Survey with Focus on Wearables-Based Solutions

As an inevitable process, the number of older adults is increasing in many countries worldwide. Two of the main problems that society is being confronted with more and more, in this respect, are the inter-related aspects of feelings of loneliness and social isolation among older adults. In particular, the ongoing COVID-19 crisis and its associated restrictions have exacerbated the loneliness and social-isolation problems. This paper is first and foremost a comprehensive survey of loneliness monitoring and management solutions, from the multidisciplinary perspective of technology, gerontology, socio-psychology, and urban built environment. In addition, our paper also investigates machine learning-based technological solutions with wearable-sensor data, suitable to measure, monitor, manage, and/or diminish the levels of loneliness and social isolation, when one also considers the constraints and characteristics coming from social science, gerontology, and architecture/urban built environments points of view. Compared to the existing state of the art, our work is unique from the cross-disciplinary point of view, because our authors' team combines the expertise from four distinct domains, i.e., gerontology, social psychology, architecture, and wireless technology in addressing the two inter-related problems of loneliness and social isolation in older adults. This work combines a cross-disciplinary survey of the literature in the four aforementioned domains with a proposed wearable-based technological solution, introduced first as a generic framework and, then, exemplified through a simple proof of concept with dummy data. As the main findings, we provide a comprehensive view on challenges and solutions in utilizing various technologies, particularly those carried by users, also known as wearables, to measure, manage, and/or diminish the social isolation and the perceived loneliness among older adults. In addition, we also summarize the identified solutions which can be used for measuring and monitoring various loneliness- and social isolation-related metrics, and we present and validate, through a simple proof-of-concept mechanism, an approach based on machine learning for predicting and estimating loneliness levels. Open research issues in this field are also discussed.

‘That is a place where I would want to go’: investigating digital nature to enhance social wellbeing among older adults

Feelings of disconnectedness and social isolation among older adults are increasingly recognised as important challenges of our times. Interestingly, nature interaction can stimulate social connectedness and enhance perceived social support, indicating that nature can contribute to social wellbeing. However, nature may not always be around or accessible for older adults. In such cases, digital nature could provide an alternative means for enjoying nature's benefits. To identify limitations and restrictions that older adults experience with respect to nature interaction, and to explore preferences with respect to digital nature and their potential for influencing social wellbeing, two studies are reported: a qualitative study comprising focus groups with Dutch care centre residents (N = 26) and a subsequent quantitative study (N = 200) testing effects of digital landscapes on social wellbeing measures. Findings from the focus groups indicate that opportunities for nature interaction and preferences for digital nature vary with mobility restrictions, whereas findings from the quantitative study testify to the potential of digital nature for enhancing social wellbeing and related emotions. These findings extend research on how (digital) nature interventions can contribute to the social wellbeing of older adults and pinpoint essential nature characteristics important for doing so.

Experiences of social frailty among rural community-dwelling and assisted-living older adults: a qualitative study

Although social frailty has been described from a theoretical perspective, the lived experiences of older adults regarding social frailty are yet unknown. In this paper, we aim to (a) gain more in-depth insights into community-dwelling and assisted-living older adults’ experiences of social frailty and (b) explore the differences in these experiences between these two groups. We conduct a thematic analysis of 38 interviews with community-dwelling and assisted-living older adults in rural villages the Netherlands. We structure our findings along three overarching themes which highlight different aspects of the social frailty experiences of our participants: (a) present resources and activities to fulfil social needs, (b) resources and activities that have been lost, and (c) how they manage and adapt to changes in resources and activities over time. Loneliness is only reported among the community-dwelling participants, while the loss of mobility and participation in (social) activities is experienced most strongly by the assisted-living participants. These findings challenge the widespread policies and practices of ageing in place. We conclude that for some older adults, living in assisted arrangements is preferred over ageing in place, as doing so can prevent social frailty. The key reason for this is that life in assisted living is likely to bring about new social resources and activities, which may serve to fulfil the social needs of older adults.

Financial Strain and Loneliness among Young Adults during the COVID-19 Pandemic: The Role of Psychosocial Resources

The COVID-19 (2019 novel coronavirus) pandemic, which has been accompanied by an economic crisis and multiple restrictions on our lives, has sparked renewed interest in the topic of loneliness as well as its determinants. We examined (1) the association between financial strain, occurring upon the outbreak of the virus, and loneliness among Israeli young people (aged 20–35); (2) the associations between cognitive social capital, psychological resources, and loneliness; and (3) whether these social and psychological resources were moderators in the financial strain–loneliness link. A real-time survey based on snowball sampling was conducted during April 2020 (N = 426). Hierarchical linear models were employed to explore associations between financial strain, cognitive social capital, psychological resources, and loneliness. Financial strain emerging during the pandemic was associated with greater loneliness. Cognitive social capital and optimism decreased loneliness. Sense of mastery moderated the financial strain–loneliness link. Policymakers must develop and extend mental health initiatives aimed at alleviating the psychological consequences of the pandemic and must also combat financial strain via unemployment compensation and social assistance programs. In line with the United Nations sustainable development goals, these tasks should be viewed as an integral part of promoting public health.

Profiles of Loneliness and Social Isolation in Physically Active and Inactive Older Adults in Rural England

Objective: Loneliness and social isolation are associated with higher risk of morbidity and mortality and physical inactivity in older age. This study explored the socioecological context in which both physically active and inactive older adults experience loneliness and/or social isolation in a UK rural setting. Design: A mixed-methods design employed semi structured interviews and accelerometer-measured moderate-to-vigorous physical activity (MVPA). Interviews explored the personal, social and environmental factors influencing engagement with physical activities, guided by an adapted-socioecological model of physical activity behaviour. Findings: Twenty-four older adults (Mean Age = 73 (5.8 SD); 12 women) were interviewed. Transcripts were thematically analysed and seven profiles of physical activity, social isolation and loneliness were identified. The high-MVPA group had established PA habits, reported several sources of social contact and evaluated their physical environment as activity friendly. The low MVPA group had diverse experiences of past engagement in social activities. Similar to the high MVPA, they reported a range of sources of social contact but they did not perceive the physical environment as activity friendly. Conclusions: Loneliness and/or social isolation was reported by both physically active and inactive older adults. There is wide diversity and complexity in types and intensity of PA, loneliness and social isolation profiles and personal, social and environmental contexts.

Worry about debt is related to social loneliness in older adults in the Netherlands

The amount of financial debt held by older adults has grown substantially over the past two decades in Europe. This study examines the association of objective and subjective debt burden with social and emotional loneliness among 1,606 older adults in the Netherlands. Objective debt burden is based on financial terms, such as debt-to-income ratio; whereas subjective debt burden measures the psychological distress caused by financial debt. Data are from the 2015/2016 wave of the Longitudinal Aging Study Amsterdam. First, we use means-comparison tests to examine whether older adults who experience social and emotional loneliness differ from older adults who do not experience loneliness regarding their subjective and objective debt burdens. Subsequently, using linear regression models we address two questions: whether social loneliness and emotional loneliness are associated with objective and subjective debt burden; and whether social participation, social network size, anxiety and depression mediate these relationships. We find that subjective debt burden (i.e. the worry related to debt) is a significant predictor of social loneliness, above and beyond the role of social and psychological measures. Objective debt burden, in contrast, is unrelated to social and emotional loneliness. Social participation, social network size, anxiety and depression do not mediate the debt-burden-to-loneliness relationships. The results point to the importance of subjective debt burden in understanding social loneliness and designing interventions.

Virtual Reality Representations of Nature to Improve Well-Being amongst Older Adults: a Rapid Review

Poor well-being amongst older adults poses a serious health concern. Simultaneously, research shows that contact with nature can improve various facets of well-being, including physical, social, and mental well-being. However, nature is not always accessible for older adults due to mobility restrictions and related care needs that come with age. A promising strategy aims at bringing nature inside through pervasive technologies. However, so far, there is little academic understanding of essential nature characteristics, psychological processes involved, and means for implementation in practice. The current study used a three-folded rapid review to assess current understanding and strategies used for improving well-being for older adults through virtual reality representations of nature. Searches were performed across three databases, followed-up by content-based evaluation of abstracts. In total, a set of 25 relevant articles was identified. Only three studies specifically focus on digital nature as an intervention strategy for improving well-being amongst older adults. Although these studies provide useful starting points for the design and (technological) development of such environments, they do not generate understanding of how specific characteristics of virtual nature representations impact social well-being measures in particular, and of the underlying psychological processes involved. We conclude that follow-up research is warranted to close the gap between insights and findings from nature research, gerontology, health research, and human-technology interaction.

Predictors of older adults' objectively measured social isolation: A systematic review of observational studies

BACKGROUND

Preventing social isolation is essential for promoting healthy aging. This study aims to 1) systematically review and synthesize the predictors of objectively measured social isolation from observational studies that have treated isolation as an outcome in community-dwelling older adults, and 2) overview previous studies in this area and reveal an agenda to develop future research.

METHODS

Peer-reviewed primary studies published in English or Japanese were identified from PubMed, ScienceDirect, PsycINFO, Igaku-Chuo-Zasshi, and CiNii. We followed the PRISMA statement. Risk of bias of included studies was assessed using the Newcastle-Ottawa Scale.

RESULTS

Of the 1,161 studies identified, 10 were included in the review. Most studies were cross-sectional and published in the past 20 years. The risk of bias score ranged from 3 to 6 for the individual studies, indicating a moderate to high risk. The assessment measures for social isolation and proportion of isolated subjects varied greatly across studies. Findings on the predictors of social isolation from each study were clustered into four categories: socio-demographic factors, physical health factors, psychological and cognitive factors, and social and cultural factors.

CONCLUSIONS

It was difficult to confirm these predictors conclusively because of the cross-sectional study design and a huge variety of assessment tools for social isolation. This result suggests the need to build consensus on the appropriate scales and standard cut-off points for assessing social isolation. Furthermore, longitudinal studies are urgently required. When considering predictors of social isolation, it is also essential to consider the regional and ethnic background of the samples studied.

Community-Enhanced Social Prescribing: Integrating Community in Policy and Practice

The NHS Plan is introducing social prescribing link workers into GP surgeries in England. The link workers connect people to non-health resources in the community and voluntary sector, with the aim of meeting individual needs beyond the capacity of the NHS. Social prescribing models focus on enhancing individual wellbeing, guided by the policy of universal personalised care. However, they largely neglect the capacity of communities to meet individual need, particularly in the wake of a decade of austerity. We propose a model of community enhanced social prescribing (CESP) which has the potential to improve both individual and community wellbeing. CESP combines two evidence-informed models - Connected Communities and Connecting People - to address both community capacity and individual need. CESP requires a literacy of community which recognises the importance of communities to individuals and the importance of engaging with, and investing in, communities. When fully implemented the theory of change for CESP is hypothesised to improve both individual and community wellbeing.

Age-friendly care for older adults within rural Australian health systems: An integrative review

OBJECTIVES

To identify the core elements of interventions and models that facilitate age-friendly care for older adults within rural Australian health systems, and assess the extent to which these align with core elements of the Institute for Health Improvement's (IHI) Age-Friendly Health Systems 4Ms Model.

METHODS

Peer-reviewed journal articles examining core elements of Australian rural geriatric care models were collected and analysed using an integrative review methodology.

RESULTS

Identified models and interventions addressed all four core elements of the IHI model-what matters, medications, mobility and mentation. There was more evidence relating to mobility and mentation, with lesser evidence relating to medications and what matters. A series of core elements not aligned with the model were also identified.

CONCLUSION

The IHI 4Ms Model appears to be applicable in the rural Australian context. More high-quality, systematic evidence is needed to investigate the core elements of age-friendly care across diverse rural contexts.

Stigma, isolation, and depression among older adults living with HIV in rural areas

There is a growing population of ageing individuals living with acquired immunodeficiency syndrome (HIV). Older adults living with HIV often contend with intersecting stigmas including HIV stigma, ageism, and for some, homonegativity and/or racism. Although the HIV stigma literature is quite robust, research on the relationship between HIV stigma, social support, and mental well-being among older adults living with HIV is limited. This study begins to address this gap by examining how intersectional stigma affects social support and mental wellbeing among rural-dwelling older adults living with HIV. Qualitative interviews were conducted by phone with 29 older adults living with HIV, over the age of 50, living in rural areas of the United States. Interviews were transcribed verbatim and analyzed using thematic content analysis in MAXQDA qualitative analysis software. Analysis revealed three primary themes. The first had to do with gossip and non-disclosure of HIV status, which intersected with ageism and homonegativity to exacerbate experiences that fell within the remaining themes of experiences of physical and psychological isolation and loneliness, and shame and silence surrounding depression. The prevalence of social isolation and the effects of limited social support among older adults living with HIV are prominent and indicate a need for tailored interventions within the HIV care continuum for older adults living with HIV.

Loneliness, Social Isolation, and Objectively Measured Physical Activity in Rural-Living Older Adults

This cross-sectional, observational study examined whether objectively measured physical activity (PA) and specific activities are associated with loneliness and social isolation (SI) in rural-living older adults. A total of 112 participants (Mage = 72.8 [SD = 6.6], 51.8% female) from 23 villages in Wiltshire, United Kingdom, completed questionnaires, 7-day accelerometry, and activity diaries. Regression analysis was used to test associations between objectively measured light PA, moderate to vigorous PA, and total PA; loneliness; and SI from family, neighbors, or friends and to explore these associations using specific activities. Daily mean light, moderate to vigorous, and total PA were not associated with loneliness or SI. Volunteering, accompanying others, and sports/exercise were associated with lower SI from neighbors (odds ratio = 0.23, 95% CI [0.06, 0.91]), family (odds ratio = 0.39, 95% CI [0.22, 0.68]), and friends (odds ratio = 0.56, 95% CI [0.33, 0.97]), respectively. There were no associations between loneliness, SI, and objectively measured PA. The contribution of PA to loneliness and SI needs to be further investigated with larger and diverse samples of rural-living older adults.

Soledad en personas mayores de España y México: un análisis comparativo

Se ha encontrado evidencia de que la soledad incrementa la probabilidad de presentar problemas de ansiedad y depresión en personas mayores, razón por la cual se hace importante el estudio de las consecuencias negativas de este fenómeno sobre la salud mental y física de estas personas. El objetivo de este trabajo fue analizar la influencia de la soledad en la vejez y en la forma de convivencia de los adultos mayores, así como determinar si existen diferencias en función del grupo cultural analizado (España y México). Para esto, se utilizó un diseño cuantitativo con alcances comparativos, en el que participaron 691 adultos mayores (hombres = 40.2 %, mujeres = 59.8 %) de 60 o más años (M = 71.49, DE = 7.41), residentes de España (42.7 %) o México (57.3 %), seleccionados por medio de un muestreo por conveniencia. Para el análisis, por medio de la aplicación de un apartado sobre datos sociodemográficos y la escala ESTE de soledad ¾que mide los déficits existentes en el soporte del sujeto a nivel familiar, conyugal y social, así como los sentimientos resultantes de tales déficits¾, se procesaron pruebas de hipótesis con el coeficiente c2, el coeficiente de contingencia y la prueba t para muestras independi- entes ¾con un nivel de p ≤ .050¾. Los resultados demostraron que las diferencias culturales según el país de pertenencia tienen peso sobre la prevalencia de situaciones de soledad en el adulto mayor; que en ambas submuestras las características demográficas hacen diferencia en la caracterización de la soledad; y que hay evidencia de una relación entre los factores so- ciodemográficos de las personas mayores y la aparición de la soledad. El estudio subraya la importancia del entorno cultural y de las características demográficas sobre la soledad, elementos que se deben tener en cuenta como factores de riesgo para el desarrollo de soledad en las personas mayores.

Loneliness and Neighborhood Characteristics: A Multi-Informant, Nationally Representative Study of Young Adults

In this study, we investigated associations between the characteristics of the neighborhoods in which young adults live and their feelings of loneliness, using data from different sources. Participants were drawn from the Environmental Risk Longitudinal Twin Study. Loneliness was measured via self-reports at ages 12 and 18 years and also by interviewer ratings at age 18. Neighborhood characteristics were assessed between the ages of 12 and 18 via government data, systematic social observations, a resident survey, and participants' self-reports. Greater loneliness was associated with perceptions of lower collective efficacy and greater neighborhood disorder but not with more objective measures of neighborhood characteristics. Lonelier individuals perceived the collective efficacy of their neighborhoods to be lower than did their less lonely siblings who lived at the same address. These findings suggest that feelings of loneliness are associated with negatively biased perceptions of neighborhood characteristics, which may have implications for lonely individuals' likelihood of escaping loneliness.

Project eARTh: participatory arts and mental health recovery, a qualitative study

AIMS

To identify the potential mental health benefits of a rural-based participatory arts programme in the United Kingdom.

METHODS

Fourteen narrative interviews were conducted among participants of the Project eARTh programme. The data were subjected to a thematic analysis process.

RESULTS

Three overarching themes were identified: identity and self-expression; connectedness through occupation; wellbeing and personal growth. The importance of meaningful relationships was highlighted as preventing social isolation, particularly in rural locations. Engagement in artistic group activities enable participants to connect with their communities.

CONCLUSIONS

Artistic activities help people to develop friendships and to engage with local communities in rural locations. Connectedness to people and places were valued by participants as part of their personal growth. The groups empower people to experience increased confidence and identities beyond illness narratives. Artistic group activities can benefit the mental health of participants in rural locations.