The meanings of loneliness for older persons

Being alone after late-life divorce: freedom and loneliness from an intergenerational familial/dyadic perspective

OBJECTIVES

To examine in-depth experiences of loneliness and freedom after late-life divorce from an intergenerational familial/dyadic perspective in a family-oriented society that also values self-determination. Considering the expansion of late-life divorce, it is important to understand its consequences for the family wellbeing.

METHOD

According to phenomenology tradition, data was collected through 51 semi-structured qualitative interviews, comprised from 7 family units (n = 33) including all/most family members and 9 parent-child dyads (n = 18), using thematic-analysis and dyadic interview-analysis principles. Analyzing family units enables a more complex examination of the phenomena, providing a holistic view of family life.

RESULTS

Loneliness and freedom experienced simultaneously was the most common. A gap was identified between generations regarding benefits and costs of late-life divorce. Whereas most divorcees emphasized the benefits of freedom, most of their adult-children mainly described the disadvantages of loneliness, perceiving both loneliness and freedom as negative.

CONCLUSION

Late-life divorce is a complex experience comprised of both loneliness and freedom. Each generation experiences the benefits and costs of late-life divorce differently. Unique aspects of freedom and loneliness at old age in a socio-cultural context located between self-determination and family-oriented are discussed, including strategies of coping with loneliness. Implications for families and professionals are presented.

Addressing loneliness and social isolation through the involvement of primary and secondary informal caregivers in nursing homes: a scoping review

OBJECTIVES

To clarify the mechanisms of interventions addressing loneliness and social isolation in older adults living in nursing homes through the involvement of primary and secondary informal caregivers.

METHODS

This scoping review was performed by two independent reviewers, covering the period between 2011 and 2022 and the databases MEDLINE, CINAHL, PsycINFO and Scopus. It included terms related to (A) informal caregivers, (B) nursing homes, (C) psychosocial interventions, (D) involvement and (E) social isolation or loneliness.

RESULTS

Thirty-three studies met the inclusion criteria. Although there were various definitions and assessment tools related to social isolation and loneliness, the studies referred to three dimensions of these concepts in nursing home residents: the quantity of social interactions, the perception of these encounters and biographical changes in social relationships. Most studies did not explicate the mechanisms of these interventions. The review uncovered the following aspects of intervention mechanisms: increasing opportunities for social contact, creating meaningful encounters, maintaining existing relationships with primary informal caregivers and establishing new ones with secondary informal caregivers.

CONCLUSION

Studies reporting on interventions addressing loneliness and social isolation in nursing home residents need to clarify and detail their intervention mechanisms in order to foster more targeted interventions. In addition, there is a need for further research on large-scale programs or care philosophies in this field and the development of intervention designs, which allow for tailored intervention formats in order to respond to the individual perception of social relationships.

Perceived Loneliness, Social Isolation, and Social Support Resources of Frail Older People Ageing in Place Alone in Italy

This paper presents some findings from the IN-AGE ("Inclusive ageing in place") study, which the authors carried out in 2019 in Italy. It explores the available social support resources for frail older people with functional limitations ageing in place alone, and possible links between their social isolation and perceived loneliness. The authors conducted qualitative/semi-structured interviews involving 120 participants aged 65 years and over, and used a mixed-methods analysis (quantitative/qualitative). The main results show the family as the main help resource for daily activities, but also for intimate confidences against social isolation, especially when said relatives live close. Family confidants are less present when seniors are supported by friends/neighbours or/and public services. Moreover, the family is valuable for decreasing loneliness, although not always. However, some older people feel particularly alone when they are supported by public services. Such a complex context draws attention on the need of support for frail seniors living alone and could provide insights for policymakers on adequate policies for preventing and managing loneliness and social isolation in later life. This is especially relevant when family (and other) resources are not available or scarce, also considering the opportunities offered by technology, which can help seniors remain socially connected to relatives, friends and their overall community.

Improved Mental Health, Social Connections and Sense of Self: A Mixed Methods Systematic Review Exploring the Impact and Experience of Community Reminiscence Programs

Older people can experience health and social challenges such as loneliness, depression, and lack of social connectedness. One initiative that has been trialed to address these challenges is reminiscence programs. These programs can include music, art, photographs, sports, and general discussion to stimulate memories. This review aimed to systematically search for literature that explored the impact and experience of reminiscence programs for older people living in the community for the purposes of informing community programming. The PICOS framework was used to develop the review parameters and search strategy. Qualitative and quantitative research focused on community-based reminiscence programs were included. Commercially produced databases and grey literature were searched. The Critical Appraisal Skills Program qualitative critical appraisal tool and McMaster quantitative critical appraisal tool were used to assess the methodological quality of the included studies. Quantitative data were descriptively synthesized, and qualitative data were thematically analyzed, with each reported separately. Twenty-seven studies were included in the review. All quantitative studies (n = 17) provided clear information regarding the purpose, sample size, and justification. The measures adopted were reliable and valid. All studies reported clear data collection/analysis information and statistically significant findings. All qualitative studies (n = 10) clearly articulated a purpose with nine clearly describing recruitment, data collection, and researcher relationship. Synthesis of quantitative data demonstrated positive findings through a reduction in depression, anxiety, and loneliness and improvements in quality of life and mastery. These findings were supported and broadened by qualitative findings with three key themes identified: program processes, program ingredients, and program benefits. Providing opportunities for older adults to come together to tell stories about their past experiences may positively contribute to social outcomes. As reminiscence programs gain popularity, their implementation in practice should be underpinned by clear and reproducible practices.

Experienced barriers in the use of ICT for social interaction in older adults ageing in place: a qualitative systematic review protocol (SYSR-D-22-00848)

BACKGROUND

Several information and communication technologies (ICT) have been developed to enhance social connectedness of older adults aging in place, although they are not accessible for all. Barriers in using ICT might for example relate to health issues, sensory loss, lack of technical skills, or reluctance to use technologies. Though knowledge on these barriers is crucial for the development and implementation of ICT for older adults, no systematic review was found on this subject. The proposed qualitative systematic review aims to explore barriers experienced by older adults aging in place in using ICT for social interaction.

METHODS

The review will be conducted in accordance with the JBI methodology. Databases for search will include MEDLINE (via PubMed), CINAHL (via EBSCO), and Web of Science (ISI), among others. Included studies focus on older adults ageing in place 60 years or older. Pairs of authors will independently, by following agreed guidelines, assess the eligibility of studies, and extract data. The testing of eligibility criteria and screening of titles, abstracts, and full texts will be performed. The findings will describe for example populations, context, culture, and the phenomena of interest. Qualitative research findings will, where possible, be pooled by using JBI SUMARI for the meta-aggregation approach.

DISCUSSION

The mapping of published studies has the potential to identify research gaps in the existing literature, which again may inform developers and stakeholders in designing more user-friendly and adaptive ICT solutions for older people ageing in place.

SYSTEMATIC REVIEW REGISTRATION

CRD42022370044.

Older Adults' Views on Social Interactions and Online Socializing Games - A Qualitative Study

Age-related difficulties and quarantine restrictions impede the possibilities to maintain contact with one's social network. Maintaining these contacts may be supported by digital games. To develop effective and feasible digital tools to foster social interaction, we aimed to explore what older adults find important in social contact and what barriers and enablers they foresee in digital gaming interventions as network support aids. Two focus groups and 20 semi-structured interviews (N = 29) with older adults (aged 55-87) were held to explore the research questions. Furthermore, a questionnaire was administered (N = 29) containing measures of loneliness, frailty, and social network size. Participants found 'reciprocity', 'in-person contact', and 'personal connection' important in contact with strong ties. Online games were not used much for socializing but may be used in the future, particularly by less mobile older adults. Future social gaming interventions should be challenging, user-friendly, and offer the possibility to communicate. Digital co-designed interventions that are feasible, challenging, intuitive, and trigger meaningful communication may strengthen social interactions in older adults. They may be a relevant social support tool in periods of interaction limitations due to functional impairment or social isolation.

How sweet is your love? Disentangling the role of marital status and quality on average glycemic levels among adults 50 years and older in the English Longitudinal Study of Ageing

INTRODUCTION

The health benefits of marriage have been widely documented and, to a lesser extent, the effects of marital quality. Marital relationships may be particularly relevant to the health of older adults. This study explores the associations of marital status and marital quality with average glycemic levels in older adults using longitudinal data.

RESEARCH DESIGN AND METHODS

Our sample consisted of adults aged 50-89 years without previously diagnosed diabetes from the English Longitudinal Study of Ageing (n=3335). We used biomarker data from waves 2 (2004/2005), 4 (2008/2009) and 6 (2012/2013) to analyze changes in hemoglobin A1c (HbA1c) levels within individuals in relation to their marital indicators (marital status, social support from spouse, and social strain from spouse) over time using linear fixed effect models.

RESULTS

We found that being married was associated with lower HbA1c values (β: -0.21%; 95% CI -0.31% to -0.10%) among adults without pre-existing diabetes. Spousal support and spousal strain were generally not associated with HbA1c values.

CONCLUSIONS

It seems that marital relationships, regardless of the quality of the relationship, are associated with lower HbA1c values for male and female adults aged over 50 years.

The micro-macro interplay of economic factors in late-life loneliness: Evidence from Europe and China

Individual socioeconomic status has a significant impact on whether older adults can initiate and maintain social relationships and participate in society, hence it affects loneliness. At the macro level, income inequality is expected to increase the risk of loneliness by eroding social cohesion and trust, while welfare generosity might protect people from loneliness. The aim of the study is to explore whether income inequality and welfare generosity at the country level moderate the effect of socioeconomic status at the individual level on late-life loneliness. Data were obtained from the HRS family of surveys - the Survey of Health, Aging and Retirement in Europe (SHARE) (wave 5, 2011/12) and China Health and Retirement Longitudinal Study (CHARLS) (wave 2, 2012/13). Respondents aged 50 years and older from twelve European countries and China were included in the study. Logistic country fixed effect models were used in the analysis. The findings show a stronger effect of individual socioeconomic status on late-life loneliness in more income-unequal societies and a weaker effect in more welfare-generous societies. There is a need to consider the impact of income distribution and welfare spending on the risk of loneliness among those older adults with low socioeconomic status when tailoring preventive programs and interventions to reduce loneliness among this vulnerable group.

Financial hardship and mental health conditions in people with underlying health conditions during the COVID-19 pandemic in Bangladesh

Background

Financial hardship is a major concern for patients who are suffering from long-term underlying health conditions. It is likely that emergencies such as the COVID-19 pandemic would impose increased financial distress and lead to the development or exacerbation of mental health conditions.

Objective

The present study aimed to explore the relationship between financial hardship and mental health conditions (loneliness, anxiety, and depression) among patients with underlying health conditions in Bangladesh.

Methods

An e-survey based cross-sectional study was conducted among purposively selected 971 patients (50.1% male; mean age = 42.29 [SD = 15.86]) with underlying health conditions between November 2020 and January 2021. Depression, anxiety, and loneliness were measured using the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), and UCLA loneliness scale, respectively. Multiple logistic regression analyses were performed to determine any associations between financial hardship and mental health conditions (loneliness, anxiety, and depression).

Results

46.2% of participants reported experiencing financial difficulties, and a number of respondents (12.3%) had lost their jobs during the COVID-19 pandemic. The prevalence of anxiety, depression and loneliness were 35.2%, 38.9%, and 47.68%, respectively. In the multiple logistic regression analysis, age, gender, occupation, marital status, monthly income, self-reported health status and financial hardship were significantly associated with mental health conditions.

Conclusions

Mental health problems were prevalent among people with underlying health conditions and were also associated with financial difficulties. The findings suggest that care facilities should be strengthened by including psychosocial support components delivered with lower costs, particularly for patients with underlying health conditions.

Is it normal to be depressed in old age? Needs assessors' conceptions of older people's mental illness

The article contributes to the research on older people's mental illness through its focus on how needs assessors conceive mental illness amongst older people and their strategies for dealing with mental illness within existing organisational frameworks. The contribution is based on an empirical study of the needs assessment in eldercare in Sweden. The article aims to explore needs assessors' conceptions of mental illness amongst older people in relation to intertwining processes of normalisation and organisational and legal constraints. The normalisation principle (NP) proposes that individuals with a disability should have access to the same living conditions as 'others'. The NP can be described as a strategy that highlights equal rights for individuals regardless of their life situation. The main findings are that mental illness is defined by needs assessors on a spectrum of diagnoses from schizophrenia and borderline personality disorder to anxiety and depression. The successful normalisation of mental illness is linked to structural context, attitudes to older people's mental illnesses and ageing, the practise established on a unit and whether needs assessors reproduce ageism or challenge it through the NP by attempting to secure the rights of older people.

Effects of traditional Cantonese opera songs on Cantonese-speaking, community-dwelling older adults' cognitive and psychological function, well-being, and health

Objectives: Experiencing multi-sensory cognitive stimulation through the enjoyment of Cantonese opera songs, with their lively rhythms, familiar folk tales, meaningful lyrics and pleasant scenarios, has the potential to increase neuroplasticity and prevent cognitive decline.Methods: This prospective pre- and post-test quasi-experimental randomised controlled trial design study aimed to explore the social benefits of older adults' active participation in practising Cantonese opera songs as compared with passive participation (as an audience) and a non-interventional control group on cognitive function psychological function, functional independence, well-being and health.Results: By recruiting a group of older adults who were receiving day activities social service in Hong Kong. Thirty participants were randomly allocated to active participation in Cantonese opera (ACO). They participated in practising Cantonese opera songs. Thirty-four participants were assigned to passive participation in Cantonese opera (PCO). They received passive intervention by listening to and appreciating the opera songs as a social event. Thirty-one participants were used as a control group and received no similar training. (Results) ACO caused a positive change in cognitive function as compared to PCO and to no intervention, which implies that active learning and practise of opera songs benefits global cognitive function. The psychological function of the participants in the PCO group showed an elevated positive affect and a reduced negative affect. A statistically significant difference was noted in the time effect among the physical domains of health status, functional independence and well-being of participants who underwent Cantonese opera intervention.

Effects of Developmental Bibliotherapy on Subjective Well-Being of Older Adults Living in Nursing Homes: A Quasi-Experimental Study

The current study sought to create a developmental bibliotherapy material database (DBMD) and examine the effectiveness of developmental bibliotherapy on subjective well-being of older adults living in nursing homes. Based on the reading needs of older adults, we developed a DBMD, which included 327 materials with five themes: Health Care, Current Affairs and Politics, Historical Biographies, Geriatric Culture, and Psychological Adjustment. Fifty-four single materials were randomly selected from the DBMD to perform the intervention. This study used a quasi-experimental, single-group pre-/post-survey approach. Sixty-four older adults participated in the study for 6 weeks. Immediately before and after the intervention, older adults completed the Optimism-Pessimism Scale and Memorial University of Newfoundland Scale of Happiness. There were significant improvements in older adults' optimistic tendency and subjective well-being (p < 0.05). Reading materials in the DBMD promoted older adults' optimistic attitude toward life, reduced negative emotions, and improved subjective well-being. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

A Conceptual Review of Loneliness in Adults: Qualitative Evidence Synthesis

The paper reports an evidence synthesis of how loneliness is conceptualised in qualitative studies in adults. Using PRISMA guidelines, our review evaluated exposure to or experiences of loneliness by adults (aged 16+) in any setting as outcomes, processes, or both. Our initial review included any qualitative or mixed-methods study, published or unpublished, in English, from 1945 to 2018, if it employed an identified theory or concept for understanding loneliness. The review was updated to include publications up to November 2020. We used a PEEST (Participants, Exposure, Evaluation, Study Design, Theory) inclusion criteria. Data extraction and quality assessment (CASP) were completed and cross-checked by a second reviewer. The Evidence of Reviews of Qualitative Research (CERQual) was used to evaluate confidence in the findings. We undertook a thematic synthesis using inductive methods for peer-reviewed papers. The evidence identified three types of distinct but overlapping conceptualisations of loneliness: social, emotional, and existential. We have high confidence in the evidence conceptualising social loneliness and moderate confidence in the evidence on emotional and existential loneliness. Our findings provide a more nuanced understanding of these diverse conceptualisations to inform more effective decision-making and intervention development to address the negative wellbeing impacts of loneliness.

A Psychometric Analysis of the 20-item Revised University of California Los Angeles Loneliness Scale Among Korean Older Adults Living Alone

The current study aimed to explore the factor structure of the Korean version of the Revised University of California Los Angeles loneliness scale for the Korean older adult population. Analyses were based on a cross-sectional cohort of 1,041 community-dwelling older adults (age ≥65 years) living alone in one Korean city. Exploratory factor analysis (EFA) was conducted to determine the underlying structure of the scale, and confirmatory factor analysis (CFA) was used to ascertain the validity of the outcomes. For reliability, Cronbach's alpha was computed. Based on EFA and CFA results, a two-factor structure was found. The first factor reflected "intimate loneliness" and the second "relational loneliness." Derived factors demonstrated satisfactory reliability (>0.8). The two factors of loneliness identified in this study could be considered when attempting to treat loneliness among older adults. Nevertheless, future studies should confirm the findings of this study and evaluate aspects of validity beyond factorial validity to further support the conceptual separation of the two identified factors. [Research in Gerontological Nursing, 14(6), 305-316.].

‘The care circle consists of me.’ Loneliness and social isolation for older male spousal care-givers. A qualitative study

Whilst loneliness and social isolation amongst older care-givers are becoming increasingly recognised, little is known about how these concepts impact on specific sub-groups of care-givers, such as older males. In the current study, we aimed to gain a better understanding of the experiences of loneliness and social isolation amongst older spousal male care-givers. Semi-structured interviews were undertaken with 24 participants, caring for a spouse/partner with a long-term chronic condition. After thematic analysis of the data, three themes were identified: dwindling social interactions, loneliness in the spousal relationship, and living with loneliness and social isolation. Study findings suggest that opportunities for social interactions gradually ‘dwindled’ due to a reluctance by older male care-givers to leave their spouse/partner at home alone, to accept offers of help or respite, or to attend social events without their spouse/partner. Consequently, social isolation increased. Feelings of physical and emotional loneliness were evident, and the loss of spousal companionship (such as loss of conversation and shared interests) increased loneliness. Individualised coping strategies were adopted including focusing on moments of positivity, talking to others and using prescribed medication. Findings provide insight into the experience of loneliness and social isolation for many older male spousal care-givers. This may facilitate a better understanding of older male care-givers’ support needs in addressing loneliness and social isolation, and should help to inform the development of targeted support services for this population.

"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.

'People haven't got that close connection': meanings of loneliness and social isolation to culturally diverse older people

Objectives: Social isolation and loneliness among older people are known to have negative effects on health and wellbeing. Few studies, however, have enabled older people to define these concepts in their own terms. This paper based on research in Aotearoa, New Zealand is the first to comparatively outline the meanings of loneliness and social isolation from the perspective of four ethnically diverse groups of older adults (Māori, Pacific, Asian, and NZ European).Method: We interviewed 44 older people and conducted three focus groups with 32 older people. We used thematic and narrative analyses.Results: Loneliness and social isolation were conceptualized as interconnected concepts described as a 'look and feel', a 'state of mind' and as a 'lack of desired companionship'. Participants conveyed sophisticated understandings of the structural underpinnings of both loneliness and social isolation as multi-dimensional, complex, and situated.Conclusions: Older people describe complex and culturally- nuanced understanding and experience of social isolation and loneliness. More culturally appropriate services, greater mental-health support and more service provision on weekends and evenings are needed.