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Xie Y, Sinclair C, Hamilton M, Peisah C, Temple J, Anstey KJ. Barriers Experienced by Community-Dwelling Older Adults Navigating Formal Care: Evidence From an Australian Population-Based National Survey. J Aging Health 2024:8982643241263132. [PMID: 38914050 DOI: 10.1177/08982643241263132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
OBJECTIVES This study aims to identify the relationship between psychosocial factors and unmet needs among community-dwelling older adults who have received or who expect to receive formal home-based aged care services. METHODS A subsample of the national Survey of Disability, Ageing and Carers was used to examine the prevalence of having any unmet needs among older adults navigating care. We also examined associations between older adults' psychosocial factors and their unmet needs using logistic regression. RESULTS Regression analyses highlighted that perceived social isolation (OR = 1.62, 95% CI: 1.30-2.01), high/very high psychological distress (OR = 2.11, 95% CI: 1.52-2.93), and occasional assistance from informal support (OR = 1.92, 95% CI: 1.22-3.05) were associated with increased odds of having unmet needs, after adjusting for other covariates. DISCUSSION Our study suggests that older adults facing psychosocial difficulties or lacking informal support are more likely to encounter barriers in accessing formal care. Future policy should address the psychosocial needs and support networks of older adults.
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Affiliation(s)
- Yuchen Xie
- Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
| | - Craig Sinclair
- Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
| | - Myra Hamilton
- Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
| | - Carmelle Peisah
- Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia
- Discipline of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Jeromey Temple
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Kaarin J Anstey
- Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
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Oetzel JG, Bragg C, Wilson Y, Reddy R, Simpson ML, Nock S. Cultural and co-designed principles for developing a Māori kaumātua housing village to address health and social wellbeing. BMC Public Health 2024; 24:1313. [PMID: 38750473 PMCID: PMC11094867 DOI: 10.1186/s12889-024-18771-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 05/03/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The current study is a case study of a Māori (Indigenous people of New Zealand) organisation and their developmental processes in creating a kaumātua (older people) housing village for health and social wellbeing. This study identifies how a set of established co-design and culturally-centred principles were enacted when creating and developing the village. METHOD A mixed-method concurrent design was used in creating the case with interviews (n = 4), focus groups (N = 4 with 16 total participants) and survey questionnaires (n = 56) involving kaumātua and organisation members. RESULTS Survey results illustrate that suitable and affordable housing are associated with self-rated health, loneliness, and life satisfaction. The primary purpose of the housing village was to enable kaumātua to be connected to the marae (community meeting house) as part of a larger vision of developing intergenerational housing around the marae to enhance wellbeing. Further, key themes around visioning, collaborative team and funding, leadership, fit-for-purpose design, and tenancy management were grounded in cultural elements using te ao Māori (Māori worldview). CONCLUSION This case study illustrates several co-design and culturally-centred principles from a previously developed toolkit that supported the project. This case study demonstrates how one community enacted these principles to provide the ground for developing a housing project that meets the health and social wellbeing of kaumātua.
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Affiliation(s)
| | | | | | | | | | - Sophie Nock
- University of Waikato, Hamilton, New Zealand
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3
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Oetzel JG, Simpson M, Meha P, Cameron MP, Zhang Y, Nock S, Reddy R, Adams H, Akapita N, Akariri N, Anderson J, Clark M, Ngaia K, Hokowhitu B. Tuakana-teina peer education programme to help Māori elders enhance wellbeing and social connectedness. BMC Geriatr 2024; 24:114. [PMID: 38291380 PMCID: PMC10826274 DOI: 10.1186/s12877-024-04703-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 01/11/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND There are significant inequities between Māori (Indigenous people) and non-Māori in ageing outcomes. This study used a strengths-based approach based on the key cultural concept of mana motuhake (autonomy and self-actualisation) to develop a tuakana-teina (literally older sibling-younger sibling) peer education programme to assist kaumātua (elders) in addressing health and social needs. The purpose of this study was to test the impact on those receiving the programme. Three aims identify the impact on outcomes, resources received and the cost effectiveness of the programme. METHODS Five Kaupapa Māori (research and services guided by Māori worldviews) iwi (tribe) and community providers implemented the project using a partnership approach. Tuakana (peer educators) had up to six conversations each with up to six teina (peer learners) and shared information related to social and health services. A pre- and post-test, clustered staggered design was the research design. Participants completed a baseline and post-programme assessment of health and mana motuhake measures consistent with Māori worldviews. Open-ended questions on the assessments, five focus groups, and four individual interviews were used for qualitative evaluation. FINDINGS A total of 113 kaumātua were recruited, and 86 completed the programme. The analysis revealed improvements in health-related quality of life, needing more help with daily tasks, life satisfaction, paying bills and housing problems. Qualitative results supported impacts of the programme on mana motuhake and hauora (holistic health) through providing intangible and tangible resources. Cost-effectiveness analysis showed that the intervention is cost effective, with a cost per QALY of less than the conventional threshold of three times GDP per capita. CONCLUSIONS A culturally-resonant, strengths-based programme developed through a participatory approach can significantly improve health and social outcomes in a cost-effective way. TRIAL REGISTRY Clinical trial registry: Trial registration: (ACTRN12620000316909). Prospectively registered 06/03/2020, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379302&isClinicalTrial=False .
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Grants
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
- 18566SUB1953 Ministry of Business, Innovation and Employment
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Affiliation(s)
- John G Oetzel
- University of Waikato, Private Bag 3105, 3240, Hamilton, New Zealand.
| | - Mary Simpson
- University of Waikato, Private Bag 3105, 3240, Hamilton, New Zealand
| | - Pare Meha
- Rauawaawa Kaumātua Charitable Trust, 50 Colombo St, 3204, Hamilton, New Zealand
| | - Michael P Cameron
- University of Waikato, Private Bag 3105, 3240, Hamilton, New Zealand
| | | | - Sophie Nock
- University of Waikato, Private Bag 3105, 3240, Hamilton, New Zealand
| | - Rangimahora Reddy
- Rauawaawa Kaumātua Charitable Trust, 50 Colombo St, 3204, Hamilton, New Zealand
| | - Hariata Adams
- Te Korowai Hauora o Hauraki, 210 Richmond St, 3500, Thames, New Zealand
| | - Ngapera Akapita
- Ngāti Ruanui Whānau Ora, 96 Collins Street, 4610, Hawera, New Zealand
| | - Ngareo Akariri
- Tui Ora Limited, 36 Maratahu Street, 4342, New Plymouth, New Zealand
| | - Justina Anderson
- Tui Ora Limited, 36 Maratahu Street, 4342, New Plymouth, New Zealand
| | - Marama Clark
- Poutiri Trust, 35 Commerce Lane, 3119, Te Puke, New Zealand
| | - Kawarau Ngaia
- Te Korowai o Ngāruahine Trust, 4610, Hawera, PO Box 474, New Zealand
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Morgan T, Wiles J, Morgan K, Williams L, Black S, Koh A, Fanueli E, Moeke-Maxwell T, Xu J, Goodwin H, Gott M. Older people's views on loneliness during COVID-19 lockdowns. Aging Ment Health 2024; 28:142-150. [PMID: 37178140 DOI: 10.1080/13607863.2023.2211549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/29/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND AND OBJECTIVES There have been growing concerns that social distancing and stay-at-home mandates have exacerbated loneliness for older people. Empirical evidence about older people's experiences of loneliness and COVID-19 have quantified this phenomena without considering how older people themselves define and understand loneliness. This paper explores how older New Zealanders conceptualized and experienced loneliness under 'lockdown' stay-at-home measures. METHODS This multi-methods qualitative study combines data from letters (n = 870) and interviews (n = 44) collected from 914 people aged over 60 and living in Aotearoa, New Zealand during the COVID-19 pandemic. We conducted a reflexive thematic analysis to conceptualise this data. FINDINGS We identify three interconnected ways in which older people conceptualised and experienced loneliness: (1) feeling disconnected relating to lack of emotional closeness to another often resulting from being physically separated from others and not being able to touch; (2) feeling imprisoned relating to separation from preferred identities and activities and was frequently associated with boredom and frustration; and (3) feeling neglected which often related to feeling let down by generalised and idealised forms of support, such as one's neighbourhood and health care system. DISCUSSION Older New Zealanders experienced lockdown loneliness in three interconnected ways rather than as a stable and homogenous experience. Māori, Pacific, Asian and New Zealand European older people often discussed loneliness in different ways; attesting to loneliness being a culturally-mediated concept shaped by expectations around desirable social interaction. We conclude the paper with implications for research and policy.
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Affiliation(s)
- Tessa Morgan
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Janine Wiles
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Kathryn Morgan
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Lisa Williams
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Stella Black
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Anne Koh
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Elizabeth Fanueli
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Tess Moeke-Maxwell
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Jing Xu
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Hetty Goodwin
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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5
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Morrish N, Choudhury S, Medina-Lara A. What works in interventions targeting loneliness: a systematic review of intervention characteristics. BMC Public Health 2023; 23:2214. [PMID: 37946186 PMCID: PMC10636966 DOI: 10.1186/s12889-023-17097-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 10/29/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Loneliness has been linked to negative health and economic outcomes across the life course. Health effects span both physical and mental health outcomes, including negative health behaviours, lower well-being, and increased mortality. Loneliness is however preventable with effective intervention. This systematic review aims to identify what has worked in interventions for loneliness to guide the development of future interventions. METHODS Eight electronic databases (Medline, Embase, PsycINFO, Social Policy and Practice, Social Sciences Citation Index, Epistemonikos, CINAHL, Cochrane Library) were systematically searched from inception to February 2022 using terms for intervention and loneliness to identify relevant interventions in the general population. No restrictions on age, socio-economic status, or geographic location were imposed. Studies were to measure loneliness as the primary outcome through a validated scale or single-item question. Case studies were excluded. Additional studies were identified through citation chasing. Extracted data included study and intervention characteristics, and intervention effectiveness for cross-study comparison. Critical appraisal was conducted using the Joanna Briggs Institute and Critical Appraisal Skills Programme tools before the studies were summarised in a narrative synthesis. RESULTS Searches identified 4,734 hits, from which 22 studies were included in this review. Of these studies, 14 were effective in reducing loneliness. Additionally, five studies presented unclear findings, and three concluded no decrease in loneliness. Interventions varied between group vs. individual format, online vs. in person delivery, and regarding both intervention duration and individual session length. Furthermore, this review highlighted five key areas when considering designing an intervention for loneliness: use of between session interaction, inclusion of clear learning mechanisms, role of active participation, number of opportunities for group or facilitator interaction, and variation in teaching and learning styles. CONCLUSIONS Group sessions seem preferred to individual formats, and interaction through active participation and group or facilitator contact appear beneficial, however studies also recognised the importance of a person-tailored approach to delivery. Studies suggest there is no 'quick fix' to loneliness, but that learnt practices, behaviours, and community connection should be built into one's lifestyle to achieve sustained intervention effectiveness. Future interventions should consider longer follow-up periods, male and populations with lower educational levels.
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Affiliation(s)
- N Morrish
- Public Health Economics Group, Department of Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, South Cloisters, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK.
| | - S Choudhury
- Public Health Economics Group, Department of Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, South Cloisters, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK
| | - A Medina-Lara
- Public Health Economics Group, Department of Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, South Cloisters, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK
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Gallardo-Peralta LP, Fernández-Dávila Jara P, Tereucán Angulo J, Rodríguez Martín V. Loneliness among Chilean indigenous women: Family, community, and socio-cultural integration as protective factors. J Women Aging 2023; 35:526-541. [PMID: 36972167 DOI: 10.1080/08952841.2023.2189505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/19/2023] [Accepted: 03/05/2023] [Indexed: 03/29/2023]
Abstract
This study examined the incidence of loneliness among Chilean indigenous older adult women (106 Aymara and 180 Mapuche) and how family, community and socio-cultural integration are associated with lower levels of loneliness. A cross-sectional study involving 800 older adults living in a rural context in Chile, of whom 35.8% were indigenous women. The De Jong Gierveld Loneliness Scale (DJGLS-6) were used to assess loneliness and a questionnaire about the maintenance of certain indigenous cultural practices was created. The descriptive findings indicate more loneliness among Mapuche women. Moreover, hierarchical regression models confirmed that women who did not live alone, who participated in social groups and who maintained cultural practices reported lower levels of loneliness, with notable transmission of indigenous knowledge to their children. While, taking part in the indigenous New Year, leading or organizing a ceremony and receiving attention with a health cultural agent were associated with more loneliness. These seemingly contradictory findings are discussed and may be explained by religious changes in indigenous communities; however, this study would confirm that social integration in different dimensions is a protective factor against loneliness.
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Affiliation(s)
- Lorena P Gallardo-Peralta
- Department of Social Work and Social Service, Universidad Complutense de Madrid, Madrid, Spain
- Department of Social Work, Universidad Alberto Hurtado, Santiago, Chile
| | - Paula Fernández-Dávila Jara
- Faculty of Social Work. Department of Social Work and Social Service, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Vicenta Rodríguez Martín
- Department of Social Work and Social Services, University of Castilla-La Mancha, Ciudad Real, Spain
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Kammar-García A, Ramírez-Aldana R, Roa-Rojas P, Lozano-Juárez LR, Sánchez-García S, Tella-Vega P, García-Peña C. Association of loneliness and social isolation with all-cause mortality among older Mexican adults in the Mexican health and aging study: a retrospective observational study. BMC Geriatr 2023; 23:45. [PMID: 36698115 PMCID: PMC9876411 DOI: 10.1186/s12877-023-03750-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Plenty of evidence shows how social isolation and loneliness are associated with increased risk for numerous diseases and mortality. But findings about their interactive or combined effects on health outcomes and mortality remains inconclusive. OBJECTIVE Analyze the longitudinal association of loneliness, social isolation and their interactions, with the all-cause mortality among older adults in Mexico. METHODS A retrospective observational study was conducted. Mexican adults older than 50 years were included. Data from the Mexican Health and Aging Study (MHAS) in the 2015 and 2018 waves were used. The subjects were classified according to their level of loneliness and the presence of social isolation. Multivariate logistic regression analyzes were performed to determine the degree of association between loneliness and social isolation with all-cause mortality at a 3-year follow-up. RESULTS From the total sample of 11,713 adults aged 50 years or over, 707 (6%) did not survive, 42% presented loneliness, and 53% were classified as socially isolated. After multivariate adjustment only social isolation (OR = 1.30, 95%CI:1.03-1.64) was associated with all-cause mortality, loneliness (Mild: OR = 0.83, 95%CI:0.59-1.16; Severe: OR = 1.03, 95%CI:0.71-1.64), and the interaction between loneliness and social isolation were not associated with all-cause mortality. CONCLUSION Social isolation, but not loneliness or their interaction, was associated with all-cause mortality in Mexican adults older than 50 years. This finding may help direct possible future interventions that help improve mental health in older adults from a highly collectivistic country.
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Affiliation(s)
| | | | - Paloma Roa-Rojas
- Health Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
| | | | - Sergio Sánchez-García
- grid.419157.f0000 0001 1091 9430Epidemiological Research Unit and Health Services, Aging Area, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Pamela Tella-Vega
- Health Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
| | - Carmen García-Peña
- Health Research Director, Instituto Nacional de Geriatría, Mexico City, Mexico
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Gallardo-Peralta LP, Gálvez-Nieto JL, Fernández-Dávila P, Veloso-Besio C. Loneliness and Psychosocial Resources among Indigenous and Afro-Descendant Older People in Rural Areas of Chile. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2138. [PMID: 36767507 PMCID: PMC9915889 DOI: 10.3390/ijerph20032138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: loneliness is a problem that becomes increasingly acute in old age, with greater repercussions among socially disadvantaged groups such as indigenous and Afro-descendant older adults. The aim of this research is to analyze the psychosocial variables related to loneliness in old age. (2) Methods: a multi-ethnic sample was involved, with the participation of eight indigenous peoples and Afro-descendant tribal people (n = 1.348). Various gerontological scales previously validated among the Chilean population (De Jong Gierveld Loneliness Scale, Brief Resilient Coping Scale, Health Problems Questionnaire, and Family APGAR questionnaire) and a model are contrasted, establishing the relationship between psychosocial variables and loneliness. (3) Results: Structural equation modeling (SEM) showed the existence of indirect relationships between health problems, via family functioning and resilience, and loneliness. Resilience and family functioning were directly related to loneliness (WLSMV-χ2 (df = 345) = 875.106, p < 0.001; CFI = 0.992; TLI = 0.991; RMSEA = 0.034 [C.I. 90% = 0.031-0.037]). (4) Conclusions: loneliness has cross-culturally affected older Chilean people living in rural areas and it appears that the COVID-19 pandemic has had a negative effect on well-being. This study proves that loneliness is related to several psychosocial variables that can be intervened.
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Affiliation(s)
| | | | - Paula Fernández-Dávila
- Department of Social Work and Social Services, Universidad Complutense de Madrid, 28040 Madrid, Spain
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Wang Q, Zhang S, Wang Y, Zhao D, Zhou C. Dual Sensory Impairment as a Predictor of Loneliness and Isolation in Older Adults: National Cohort Study. JMIR Public Health Surveill 2022; 8:e39314. [PMID: 36374533 PMCID: PMC9706378 DOI: 10.2196/39314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/28/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Loneliness and social isolation are global public health challenges. Sensory impairments (SIs) are highly prevalent among older adults but are often ignored as a part of normal aging. Identifying the role of SIs in loneliness and social isolation could provide insight into strategies for improving public health among older adults. OBJECTIVE This study aims to analyze the effects of SIs on loneliness and social isolation among older adults in rural and urban China. METHODS This cohort study of 3069 older adults (aged 60+) used data from 4 waves (2011, 2013, 2015, and 2018) of the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey of adults aged 45 years or older. SIs include hearing impairment (HI), vision impairment (VI), and dual sensory impairment (DSI). DSI is defined as the co-occurrence of VI and HI. Participants with complete data on hearing, vision, social isolation, and loneliness were included in the analysis. Generalized estimating equation models adjusted for covariates were used to examine the relationships of DSI with loneliness and social isolation among older adults. RESULTS Older adults in rural areas have higher prevalence of DSI, loneliness, and social isolation than their urban counterparts. In rural areas, participants with VI only (odds ratio [OR] 1.34, 95% CI 1.12-1.62; P=.002), HI only (OR 1.32, 95% CI 1.02-1.71; P=.03), and DSI (OR 1.84, 95% CI 1.56-2.18; P<.001) were more likely to experience loneliness compared with participants without SIs. DSI showed a statistically significant association with loneliness compared with VI only (OR 1.37, 95% CI 1.22-1.54; P<.001) and HI only (OR 1.39, 95% CI 1.13-1.72; P=.002). In urban areas, participants with VI only (OR 2.44, 95% CI 1.57-3.80; P<.001), HI only (OR 2.47, 95% CI 1.41-4.32; P=.002), and DSI (OR 1.88, 95% CI 1.24-2.85; P=.003) were more likely to experience loneliness compared with participants without SIs. DSI was not associated with the increased likelihood of loneliness compared with HI only or VI only. SIs were not associated with social isolation among older adults in urban and rural areas. Until 2018, 86.97% (2669/3069) reported VI, but only 27.11% (832/3069) and 9.45% (290/3069) were treated with glasses and cataract surgery, respectively; besides, 75 individuals received both glasses and cataract surgery treatment. The prevalence of HI was 74.39% (2283/3069) in 2018, but only 0.72% (22/3069) were treated with a hearing aid. CONCLUSIONS SIs are associated with an increased risk of loneliness rather than social isolation. A compounded risk of DSI on loneliness exists in rural areas rather than in urban areas. These findings expand our knowledge about the effects of SIs on loneliness and social isolation in non-Western populations. Interventions targeting HI only and DSI might be particularly effective for mitigating loneliness of older adults in urban and rural areas, respectively. Considering the high prevalence and low treatment rate of SIs, measures should be taken to make treatment more accessible.
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Affiliation(s)
- Qiong Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission of China Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Shimin Zhang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission of China Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Yi Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission of China Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Dan Zhao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission of China Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission of China Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
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Simpson ML, Oetzel J, Wilson Y, Nock S, Johnston K, Reddy R. Codesigning a Culture-Centered Age-Friendly Community for Māori Kaumātua: Cultural Principles and Practices. J Gerontol B Psychol Sci Soc Sci 2022; 77:2265-2275. [PMID: 35796864 PMCID: PMC9799182 DOI: 10.1093/geronb/gbac092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES This study examined a Māori (Indigenous people of Aotearoa New Zealand) age-friendly housing development. Two Māori community groups worked with multiple stakeholders to codesign a culture-centered, kaumātua (older adults) urban housing community. The purpose was to identify codesign and culture-centered principles in the development. METHODS Kaupapa Māori (Māori-centered) and participatory research methodologies guided the culture-centered research design. Data collection included 27 interviews with 19 residents and 12 organizational stakeholders; three focus groups with residents' families, service providers, and nonresident kaumātua (n = 16); and project documents. Data analysis used the framework method. RESULTS Three codesign process themes emerged: (a) Kaumātua-centered vision; (b) realizing the vision; and (c) living the shared vision. DISCUSSION Accounting for cultural practices in codesigning age-friendly and culture-centered housing for and with Indigenous older adults helps meet their cultural, social, health, and economic needs. The research offers a practical pathway to developing age-friendly housing environments for Māori kaumātua, their communities, wider society, and other Indigenous people.
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Affiliation(s)
- Mary Louisa Simpson
- Address correspondence to: Mary Louisa Simpson, PhD, Waikato Management School, University of Waikato, PB 3105, Hamilton 3240, New Zealand. E-mail:
| | - John Oetzel
- Waikato Management School, University of Waikato, Hamilton, New Zealand
| | | | - Sophie Nock
- Faculty of Māori and Indigenous Studies, University of Waikato, Hamilton, New Zealand
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Stephens C, Phillips H. Older People's Neighbourhood Perceptions are Related to Social and Emotional Loneliness and Mediated by Social Network Type. THE GERONTOLOGIST 2022; 62:1336-1346. [PMID: 35719023 PMCID: PMC9579458 DOI: 10.1093/geront/gnac087] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Loneliness among older people is a public health issue, however, there is very weak support for the efficacy of individually focussed interventions. A public health model which includes the environmental influence on formation of social networks and protection from loneliness, and theoretical approaches differentiating between social and emotional loneliness, suggest the importance of neighbourhoods in preventing loneliness. This approach was used to test the influence of neighbourhood factors on loneliness and the mediating role of social networks. RESEARCH DESIGN AND METHODS A questionnaire survey of 917 people aged 60 to 100 years was conducted in one region of Aotearoa/New Zealand to assess loneliness, social network types, social participation, marital status, gender, health and four aspects of neighbourhood perceptions. RESULTS Social and Emotional Loneliness scores were regressed on predicted demographic and social variables followed by perceptions of Housing Satisfaction, Neighbourhood Accessibility, Neighbourhood Security, and Neighbourhood Social Cohesion. Neighbourhood variables added significant explanation of variance in both Social and Emotional Loneliness. Mediation tests using PROCESS showed that the effects of all neighbourhood variables were mediated by Private Restricted or Locally Integrated Network types on Social Loneliness only. DISCUSSION AND IMPLICATIONS These findings highlight the importance of neighbourhood factors in relation to feelings of loneliness and the recognition of social network types as mediators of these relationships for social loneliness. The aspects of neighbourhoods that prevent loneliness provide directions for planners and prevention programmes. Interventions to prevent social loneliness can usefully and practicably focus on the housing and neighbourhood environment.
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Affiliation(s)
- Christine Stephens
- School of Psychology, Massey University, Palmerston North, Aotearoa/New Zealand
| | - Hannah Phillips
- School of Psychology, Massey University, Palmerston North, Aotearoa/New Zealand
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Saravanakumar P, Garrett NKG, Van Wissen K, Montayre J, McBride-Henry K. Social connectedness and self-perceived health of older adults in New Zealand. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e647-e656. [PMID: 34114704 DOI: 10.1111/hsc.13400] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 02/03/2021] [Accepted: 03/08/2021] [Indexed: 06/12/2023]
Abstract
The objective of this research was to explore social connectedness and associations with self-perceived health amongst older adults in New Zealand at a population level. The data for this analysis were derived from the 2016 Health and Lifestyle Survey, a nationally representative survey administered via face-to-face interviews. The findings from this analysis of 1,374 respondents, all of whom were over the age of 55 years, highlight that being female, belonging to older age groups (above 70 years), being employed full-time or part-time, connecting online with known people, considering cultural connections to be important and not feeling isolated from others are significantly and positively associated with positive self-perceived health. The findings underscore the resilience potential of older adults and importance of social connectedness for positive health and well-being. In addition, the findings reveal target areas that would benefit by intervention and support by health professionals and policy makers.
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Affiliation(s)
- Padmapriya Saravanakumar
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Nicholas Kenneth Gerald Garrett
- Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Kim Van Wissen
- School of Nursing, Midwifery and Health Practice, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Jed Montayre
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Karen McBride-Henry
- School of Nursing, Midwifery and Health Practice, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
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13
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Morrish N, Mujica-Mota R, Medina-Lara A. Understanding the effect of loneliness on unemployment: propensity score matching. BMC Public Health 2022; 22:740. [PMID: 35477427 PMCID: PMC9045886 DOI: 10.1186/s12889-022-13107-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/24/2022] [Indexed: 01/19/2023] Open
Abstract
Background Loneliness and unemployment are each detrimental to health and well-being. Recent evidence suggests a potential bidirectional relationship between loneliness and unemployment in working age individuals. As most existing research focuses on the outcomes of unemployment, this paper seeks to understand the impact of loneliness on unemployment, potential interaction with physical health, and assess bidirectionality in the working age population. Methods This study utilised data from waves 9 (2017–19) and 10 (2018–2020) of the Understanding Society UK Household Longitudinal Study. Nearest-neighbour probit propensity score matching with at least one match was used to infer causality by mimicking randomisation. Analysis was conducted in three steps: propensity score estimation; matching; and stratification. Propensity scores were estimated controlling for age, gender, ethnicity, education, marital status, household composition, number of own children in household and region. Findings were confirmed in panel data random effect models, and heterogeneous treatment effects assessed by the matching-smoothing method. Results Experience of loneliness in at least one wave increased the probability of being unemployed in wave 10 by 17.5 [95%CI: 14.8, 20.2] percentage points. Subgroup analysis revealed a greater effect from sustained than transitory loneliness. Further exploratory analysis identified a positive average treatment effect, of smaller magnitude, for unemployment on loneliness suggesting bidirectionality in the relationship. The impact of loneliness on unemployment was further exacerbated by interaction with physical health. Conclusions This is the first study to directly consider the potentially bidirectional relationship between loneliness and unemployment through analysis of longitudinal data from a representative sample of the working age population. Findings reinforce the need for greater recognition of wider societal impacts of loneliness. Given the persisting and potentially scarring effects of both loneliness and unemployment on health and the economy, prevention of both experiences is key. Decreased loneliness could mitigate unemployment, and employment abate loneliness, which may in turn relate positively to other factors including health and quality of life. Thus, particular attention should be paid to loneliness with additional support from employers and government to improve health and well-being. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13107-x.
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Affiliation(s)
- N Morrish
- Health Economics Group, Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK.
| | - R Mujica-Mota
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - A Medina-Lara
- Health Economics Group, Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
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14
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Mouri N, Ohta R, Sano C. Effects of Shopping Rehabilitation on Older People's Daily Activities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010569. [PMID: 35010839 PMCID: PMC8744656 DOI: 10.3390/ijerph19010569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 02/01/2023]
Abstract
In an aged society, the deterioration of physical and cognitive functions is prevalent. To motivate the rehabilitation of older persons, an initiative known as “shopping rehabilitation” incorporates shopping as an element of a nudge. The purpose of this study was to clarify motor function changes and cognitive functions of participants during shopping rehabilitation, through a semi-experimental study. We measured changes in the Kihon Checklist score before and after rehabilitation interventions. A paired t-test was used to analyze changes in the overall score of the basic checklist before and after the rehabilitation intervention. In December 2020, 59 participants answered the Kihon Checklist after their shopping rehabilitation intervention. During the 6-month intervention period, the number of participants with a checklist score of 8 or higher was significantly reduced after the intervention (p = 0.050). In the sub-analysis, the score improved significantly for the group with families (p = 0.050). Improvement was observed in the group living alone, but the difference was not significant (p = 0.428). The shopping rehabilitation intervention improved the Kihon Checklist score. Continuous observations and research are necessary to measure the long-term effects of shopping rehabilitation and the mechanisms that foster their maintenance and effects.
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Affiliation(s)
- Naoto Mouri
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya Cho, Izumo 693-8501, Japan; (N.M.); (C.S.)
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-Cho, Unnan 699-1221, Japan
| | - Ryuichi Ohta
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-Cho, Unnan 699-1221, Japan
- Correspondence: ; Tel.: +81-9050605330
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya Cho, Izumo 693-8501, Japan; (N.M.); (C.S.)
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15
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Day A, Phelps K, Maltby J, Palmer E, Snell K, Raine D, Conroy S. A realist evaluation of loneliness interventions for older people. Age Ageing 2021; 50:2246-2253. [PMID: 34591956 DOI: 10.1093/ageing/afab188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/03/2021] [Accepted: 07/23/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION the aim of this study was to develop a programme theory to inform the design of loneliness interventions and guide any future evaluations. METHODS we undertook a mixed-method evaluation, informed by the realist approach, of different approaches to loneliness in one health and social care system in the East Midlands, UK. We used a combination of documentary analysis, interviews/focus groups with service providers and users and quantitative analysis to develop an initial programme theory. RESULTS common aims of local interventions included enhancing social connectivity, providing emotional support and advice/information; recurring interventions included social activities, emotional support, advice and information, lunch clubs, learning new skills and practical support. None were robustly evaluated.Fifty-six service user or providers were involved in interviews or focus groups, which highlighted the causes of loneliness, preferred services, access to services, thoughts about intervention configuration and desired outcomes from services.The themes emerging from the interviews/focus groups from both service provider and service user perspectives were combined with all of the previous emerging data to create an overarching programme theory. Statements were constructed to allow service providers to think about which interventions might be useful to achieve specific outcomes in different contexts. CONCLUSION the causes and consequences of loneliness vary widely between individuals, so a personalised approach is required to identify the causes and potential solutions. This study provides some high-level principles that can help commissioners and providers to tailor interventions to the individual needs of service users.
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Affiliation(s)
- Alice Day
- Department of Health Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Kay Phelps
- Department of Health Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - John Maltby
- Department of Health Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Emma Palmer
- Department of Health Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Keith Snell
- Department of Health Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Derek Raine
- Department of Health Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Simon Conroy
- Department of Health Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
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Abstract
Loneliness is a growing public health concern that is associated with a range of negative health outcomes. The extent to which loneliness may also be associated with greater use of primary health care remains unclear. The present meta-analysis aimed to address this gap by quantifying research on the association of loneliness to primary health care use. The database searches yielded 23 eligible studies with 25 effects, total N = 113,639. A random effects meta-analysis revealed a small positive average effect size (ravg = .094; 95% CI [.07, .12])between loneliness and the use of primary care that increased in magnitude as the proportion of females in the samples increased. Studies that used objective measures of primary care use yielded effects that were significantly larger than those using self-report measures. The effects were robust to differences in age and type of health-care systems, and the type of loneliness scale (single versus multi-item). The findings from this first comprehensive meta-analysis of the association of loneliness with use of primary care indicate that people who experience loneliness make a greater number of visits to primary-care practitioners. This evidence highlights the practical impact of loneliness on health-care use when viewed at the population level.
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Affiliation(s)
- Fuschia M Sirois
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Janine Owens
- Mental Health Theme, NIHR Applied Research Collaborative, Greater Manchester (NIHR ARC GM), University of Manchester, Manchester, UK
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Ohta R, Yata A, Arakawa Y, Maiguma K, Sano C. Rural Social Participation through Osekkai during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5924. [PMID: 34072993 PMCID: PMC8198868 DOI: 10.3390/ijerph18115924] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/28/2021] [Accepted: 05/29/2021] [Indexed: 12/22/2022]
Abstract
We investigated the effects of enabling Osekkai, the traditional Japanese behavior of creating a helping culture, on social participation among rural people in rebuilding social connections that can be vital during the coronavirus diseases 2019 (COVID-19) pandemic. The subjects of this cross-sectional study were people interested in the Osekkai conference (control group) and those actively involved in Osekkai activities (exposure group). The primary outcome of social participation was measured as the frequency of meeting and the number of friends or acquaintances. The demographic data of the participants and process outcomes were measured using a questionnaire provided to all 287 registered participants. The effective response rate was 64.5% (185 responses). The involvement in Osekkai conferences was statistically associated with a high frequency and number of meetings with friends or acquaintances (p < 0.001 and 0.048, respectively). A health check was significantly associated with the number of friends or acquaintances met in the previous month, while high social support was significantly associated with loneliness. Thus, we confirm that Osekkai contributes to high social participation, although we see no relationship with loneliness. Future studies should investigate this cause-and-effect relationship and promote culturally sensitive activities to improve social and health outcomes in rural Japan.
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Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan 699-1221, Shimane Prefecture, Japan
| | - Akiko Yata
- Community Nurse Company, Unnan City, 422 Satokata, Kisuki-cho, Unnan 699-1311, Shimane Prefecture, Japan;
| | - Yuki Arakawa
- Doctoral Program, Graduate School of Medicine, School of Social Medicine, The University of Tokyo, 17 Chome-3-1 Hongo, Bunkyo City, Tokyo 113-8654, Japan;
| | - Koichi Maiguma
- Department of Law and Economics, Faculty of Law and Literature, Shimane University, 1060 Nishikawatsu cho, Matsue 690-8504, Shimane Prefecture, Japan;
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya cho, Izumo 693-8501, Shimane Prefecture, Japan;
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Abstract
OBJECTIVES The number of older people choosing to relocate to retirement villages (RVs) is increasing rapidly. This choice is often a way to decrease social isolation while still living independently. Loneliness is a significant health issue and contributes to overall frailty, yet RV resident loneliness is poorly understood. Our aim is to describe the prevalence of loneliness and associated factors in a New Zealand RV population. DESIGN A resident survey was used to collect demographics, social engagement, loneliness, and function, as well as a comprehensive geriatric assessment (international Resident Assessment Instrument [interRAI]) as part of the "Older People in Retirement Villages Study." SETTING RVs, Auckland, New Zealand. PARTICIPANTS Participants included RV residents living in 33 RVs (n = 578). MEASUREMENTS Two types of recruitment: randomly sampled cohort (n = 217) and volunteer sample (n = 361). Independently associated factors for loneliness were determined through multiple logistic regression with odds ratios (ORs). RESULTS Of the participants, 420 (72.7%) were female, 353 (61.1%) lived alone, with the mean age of 81.3 years. InterRAI assessment loneliness (yes/no question) was 25.8% (n = 149), and the resident survey found that 37.4% (n = 216) feel lonely sometimes/often/always. Factors independently associated with interRAI loneliness included being widowed (adjusted OR 8.27; 95% confidence interval [CI] 4.15-16.48), being divorced/separated/never married (OR 4.76; 95% CI 2.15-10.54), poor/fair quality of life (OR 3.37; 95% CI 1.43-7.94), moving to an RV to gain more social connections (OR 1.55; 95% CI 0.99-2.43), and depression risk (medium risk: OR 2.58, 95% CI 1.53-4.35; high risk: OR 4.20, 95% CI 1.47-11.95). CONCLUSION A considerable proportion of older people living in RVs reported feelings of loneliness, particularly those who were without partners, at risk of depression and decreased quality of life and those who had moved into RVs to increase social connections. Early identification of factors for loneliness in RV residents could support interventions to improve quality of life and positively impact RV resident health and well-being.
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Tkatch MT, Towers AJ, Keller HH, Wham CA. Nutrition risk prevalence and associated health and social risk factors in Māori and non-Māori: Results from the New Zealand Health, Work and Retirement Study. Australas J Ageing 2021; 41:59-69. [PMID: 33871906 DOI: 10.1111/ajag.12952] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/07/2021] [Accepted: 03/23/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To determine the nutrition risk prevalence and associated health and social risk factors amongst community-living Māori and non-Māori older adults in New Zealand. METHODS As part of the 2014 Health, Work and Retirement postal survey, 2914 community-living older adults (749 Māori) aged 49-87 years completed the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN II-AB) to determine nutrition risk status and sociodemographic and health measures. RESULTS Half (50.2%) of Māori and 32.7% of non-Māori were at nutrition risk. Independent risk factors were as follows: for Māori, being unpartnered and rating general health as fair, and for non-Māori, being unpartnered and rating general health as fair or poor, lower life satisfaction, higher number of health conditions and emotional loneliness. CONCLUSIONS Findings highlight the need for culturally appropriate intervention strategies, which provide opportunity for older adults to eat with others, especially for those who are unpartnered and lonely.
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Affiliation(s)
- Melaney T Tkatch
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Andy J Towers
- School of Health Sciences, Massey University, Palmerston North, New Zealand
| | - Heather H Keller
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON, Canada
| | - Carol A Wham
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
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20
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Yu K, Wu S, Jang Y, Chou CP, Wilber KH, Aranda MP, Chi I. Longitudinal Assessment of the Relationships Between Geriatric Conditions and Loneliness. J Am Med Dir Assoc 2020; 22:1107-1113.e1. [PMID: 33071157 DOI: 10.1016/j.jamda.2020.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES In response to the lack of longitudinal evidence, this study aims to disentangle time sequence and directionality between the severity of geriatric conditions (GCs) and loneliness. DESIGN Longitudinal panel study. SETTING AND PARTICIPANTS The working sample had 4680 participants of 2006, 2010, and 2014 waves of the Health and Retirement Study (HRS). All participants were at least 65 years old at baseline. Proxy responded cases and individuals who suffered from moderate to severe cognitive impairment were excluded from the analysis. METHODS Loneliness was measured with the 3-item UCLA loneliness scale. Five GCs were included: falls, incontinence, vision impairment, hearing impairment, and pain. Severity indicators were the number of times fallen in the past 2 years, number of days experiencing loss of bladder control in the past month, self-rated eyesight, self-rated hearing, and participants' perceived level of pain. RESULTS Random-intercept cross-lagged panel models were run to analyze the relationship between the severity of each individual GC and loneliness. All models were controlled for baseline demographics, social isolation, self-rated health, physical function, comorbidities, and hospitalization. The longitudinal association between loneliness and fall was bidirectional: a higher loneliness score predicted an increased number of falls and vice versa. Incontinence, vision impairment, hearing impairment, and pain were not significantly associated with loneliness longitudinally. The association between the random intercept of loneliness and some GCs (vision and pain) were significant, indicating the severity of these GCs were related to loneliness at the between-person level at baseline. CONCLUSION AND IMPLICATIONS Findings of the longitudinal analysis suggest a reciprocal relationship between fall and loneliness. Fall prevention programs could be integrated with social service for addressing loneliness, and alleviating loneliness might be beneficial for preventing falls. Results of this study highlight the importance of integrating clinical management of falls with social services addressing loneliness in long term care.
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Affiliation(s)
- Kexin Yu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA; Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA.
| | - Shinyi Wu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA; Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA; Viterbi School of Engineering, Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA
| | - Yuri Jang
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA; Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA
| | - Chih-Ping Chou
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA; Department of Bio-Industry Communication & Development, National Taiwan University, Taipei, Taiwan
| | - Kathleen H Wilber
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA
| | - María P Aranda
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA; Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA
| | - Iris Chi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA; Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA
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Morgan T, Wiles J, Moeke-Maxwell T, Black S, Park HJ, Dewes O, Williams LA, Gott M. 'People haven't got that close connection': meanings of loneliness and social isolation to culturally diverse older people. Aging Ment Health 2020; 24:1627-1635. [PMID: 31256631 DOI: 10.1080/13607863.2019.1633619] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- Tessa Morgan
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Janine Wiles
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Tess Moeke-Maxwell
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Stella Black
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Hong-Jae Park
- School of Social Sciences and Psychology, Western Sydney University, Penrith, Australia
| | - Ofa Dewes
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Lisa Ann Williams
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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The experiences and needs of Asian older adults who are socially isolated and lonely: A qualitative systematic review. Arch Gerontol Geriatr 2020; 92:104254. [PMID: 32957019 DOI: 10.1016/j.archger.2020.104254] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 09/02/2020] [Accepted: 09/07/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE To examine the experiences and needs of Asian older adults who are socially isolated and lonely living in Asian and western countries. MATERIALS AND METHODS Six databases were searched for qualitative studies from each database's inception to December 2019. Qualitative data were meta-summarized and then meta-synthesized. RESULTS Fourteen studies were included in this review. Five themes emerged: (1) association with older adults' well-being, (2) loss of social support, (3) dealing with social isolation and loneliness (4) unique experiences of Asian older adults in western countries, and (5) wish list of older adults. The older adults felt psychologically down and experienced a lack of social support from their family members. They coped using strategies such as religious reliance and social engagement with peers. Asian older adults in western countries faced cultural barriers and tried to form ethnic communities. The older adults wished for more community resources and care. CONCLUSION There were multiple associations of social isolation and loneliness on the Asian older adults' well-being and social support. Coping mechanisms such as acceptance and social engagement were adopted. They expressed support needs such as social programs and healthcare services. More geographically distributed studies are needed to gather a more comprehensive and causality-related perspectives of socially isolated and lonely older adults. Lay-led programs, technology, and active coping strategies are proposed and can be incorporated in healthcare services and social programs to assist these older adults.
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Salway S, Such E, Preston L, Booth A, Zubair M, Victor C, Raghavan R. Reducing loneliness among migrant and ethnic minority people: a participatory evidence synthesis. PUBLIC HEALTH RESEARCH 2020. [DOI: 10.3310/phr08100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background
To date, there has been little research into the causes of, and solutions to, loneliness among migrant and ethnic minority people.
Objectives
The objectives were to synthesise available evidence and produce new insights relating to initiatives that aim to address loneliness among these populations, plus the logic, functioning and effects of such initiatives.
Data sources
Electronic database searches (MEDLINE, Applied Social Sciences Index and Abstracts and Social Science Citation Index via Web of Science – no date restrictions were applied), grey literature searches, and citation and reference searching were conducted. Data were generated via nine workshops with three consultation panels involving 34 public contributors, and one practitioner workshop involving 50 participants.
Review methods
Guided by ‘systems thinking’, a theory-driven synthesis was combined with an effectiveness review to integrate evidence on the nature and causes of loneliness, interventional types and programme theory, and intervention implementation and effectiveness.
Results
The theory review indicated that common conceptualisations of ‘loneliness’ can be usefully extended to recognise four proximate determinants when focusing on migrant and ethnic minority populations: positive social ties and interactions, negative social ties and interactions, self-worth, and appraisal of existing ties. A total of 170 interventions were included. A typology of eight interventions was developed. Detailed logic models were developed for three common types of intervention: befriending, shared-identity social support groups and intercultural encounters. The models for the first two types were generally well supported by empirical data; the third was more tentative. Evaluation of intervention processes and outcomes was limited by study content and quality. Evidence from 19 qualitative and six quantitative studies suggested that social support groups have a positive impact on dimensions of loneliness for participants. Evidence from nine qualitative and three quantitative studies suggested that befriending can have positive impacts on loneliness. However, inconsistent achievements of the befriending model meant that some initiatives were ineffective. Few studies on intercultural encounters reported relevant outcomes, although four provided some qualitative evidence and three provided quantitative evidence of improvement. Looking across intervention types, evidence suggests that initiatives targeting the proximate determinants – particularly boosting self-worth – are more effective than those that do not. No evidence was available on the long-term effects of any initiatives. UK intervention (n = 41) and non-intervention (n = 65) studies, together with consultation panel workshop data, contributed to a narrative synthesis of system processes. Interlocking factors operating at individual, family, community, organisational and wider societal levels increase risk of loneliness, and undermine access to, and the impact of, interventions. Racism operates in various ways throughout the system to increase risk of loneliness.
Limitations
There was a lack of high-quality quantitative studies, and there were no studies with longer-term follow-up. UK evidence was very limited. Studies addressing upstream determinants operating at the community and societal levels did not link through to individual outcome measures. Some elements of the search approach may mean that relevant literature was overlooked.
Conclusions
Theory regarding the causes of loneliness, and functioning of interventions, among migrant and ethnic minority populations was usefully developed. Evidence of positive impact on loneliness was strongest for shared-identity social support groups. Quantitative evidence was inadequate. The UK evidence base was extremely limited.
Future work
UK research in this area is desperately needed. Co-production of interventional approaches with migrant and ethnic minority people and evaluation of existing community-based initiatives are priorities.
Study registration
This study is registered as PROSPERO CRD42017077378.
Funding
This project was funded by the National Institute for Health Research Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 10. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sarah Salway
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - Elizabeth Such
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Louise Preston
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Maria Zubair
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Christina Victor
- College of Health and Life Sciences, Brunel University London, London, UK
| | - Raghu Raghavan
- School of Nursing and Midwifery, De Montfort University, Leicester, UK
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Oetzel JG, Cameron MP, Simpson ML, Reddy R, Nock S, Greensill H, Meha P, Johnston K, Harding T, Shelford P, Smith LT, Hokowhitu B. Kaumātua Mana Motuhake: peer education intervention to help Māori elders during later-stage life transitions. BMC Geriatr 2020; 20:186. [PMID: 32471351 PMCID: PMC7260849 DOI: 10.1186/s12877-020-01590-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aotearoa/New Zealand has a population that is ageing and there are challenges to health and social outcomes related to related to key life transitions (e.g., retirement, change in health conditions, loss of spouse). Further, there are significant inequities between Māori (Indigenous people) and non-Māori in ageing outcomes. The purpose of this study was to test the impacts and cost effectiveness of a tuakana/teina (peer education) intervention on kaumātua (elders) receiving the intervention. This study was framed by a strengths-based approach based on the key cultural concept of mana motuhake (autonomy and self-actualisation). METHODS This study was grounded in principles of Kaupapa Māori and community-based participatory research to bring together a diverse group of stakeholders to co-develop and co-evaluate the intervention. The intervention had tuakana (peer educators) having conversations with up to six teina (recipients) and providing information related to health and social services. The research design was a pre- and post-test, clustered staggered design. Participants completed a baseline assessment of health and mana motuhake measures consistent with Māori worldviews along with two follow-up assessments (one after the first intervention group completed its activities and a second after the second intervention group completed its activities). Additionally, five focus groups and open-ended questions on the assessments were used to provide qualitative evaluation. FINDINGS A total of 180 kaumātua were recruited to the intervention with 121 completing it. The analysis revealed improvements over time in the expected direction on most of the variables. However, only three of the variables had statistically significant intervention effects: received support, tribal identity, and trouble paying bills. Qualitative results supported impacts of the intervention on mana motuhake, social connectedness, and tangible/information support related to services. Cost-effectiveness analysis showed that the intervention is cost effective, with a cost per QALY of less than the conventional threshold of three times gross domestic product per capita. CONCLUSIONS The findings support the relevancy and importance of kaumātua knowledge to create a strengths-based approach to improve health and social outcomes. This study demonstrates that a contextually based and culturally safe age-friendly environments can facilitate engagement and participation by kaumātua for kaumātua. TRIAL REGISTRY Australia New Zealand Clinical Trial Registry (ACTRN12617001396314); Date Registered: 3 October 2017 (retrospectively registered); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373733&isClinicalTrial=False.
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Affiliation(s)
- John G Oetzel
- University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand.
| | - Michael P Cameron
- University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | - Mary L Simpson
- University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | - Rangimahora Reddy
- Rauawaawa Kaumātua Charitable Trust, 50 Colombo St., Hamilton, 3204, New Zealand
| | - Sophie Nock
- University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | | | - Pare Meha
- Rauawaawa Kaumātua Charitable Trust, 50 Colombo St., Hamilton, 3204, New Zealand
| | - Kirsten Johnston
- Rauawaawa Kaumātua Charitable Trust, 50 Colombo St., Hamilton, 3204, New Zealand
| | - Truely Harding
- University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | - Pita Shelford
- University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
| | | | - Brendan Hokowhitu
- University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
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Abstract
Objectives: We identify and describe the meanings of loneliness among older persons, the kinds of relationships they are seeking in order to alleviate it, and the barriers they face in developing these connections.Method: Study participants were 35 older persons between the ages of 66 and 92 years from Tel Aviv, Israel, who participated in an intervention which involved group activities and individual meetings. The transcriptions of the individual meetings in which participants described their loneliness and explored potential solutions formed the data for thematic analysis.Results: Participants experienced loneliness in highly individualized ways. They were more likely to experience it when alone in the evening and on weekends, and when distracting activities were not available. While most sought companionship, many focused on a specific type of relationship, ranging from instrumental companionships to intimate and spousal relationships. Participants often had particular preferences about the demographic and socioeconomic characteristics they desired in a companion. Barriers to alleviating loneliness included cognitive sets, social skills deficits, rejection of others, technological illiteracy, and physical, sensory, and cognitive limitations. External factors included economic hardship and community programming which failed to promote socialization.Conclusion: New approaches are needed to counter and prevent loneliness among older persons by addressing the types of particular desires raised in our findings, as well as the psychological barriers to realizing them. Public policy and societal initiatives should tackle external barriers through programming which promotes social engagement and the development of other innovative strategies.
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Affiliation(s)
- Jiska Cohen-Mansfield
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Minerva Center for the Interdisciplinary Study of End of Life, Tel-Aviv University, Tel Aviv, Israel.,The Herczeg Institute on Aging, Tel-Aviv University, Tel Aviv, Israel
| | - Rotem Eisner
- Minerva Center for the Interdisciplinary Study of End of Life, Tel-Aviv University, Tel Aviv, Israel
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Sims J, Cornell V. Is an Australian's home their castle? The challenges of ageing in place. Australas J Ageing 2020; 39:5-8. [PMID: 32153109 DOI: 10.1111/ajag.12786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 02/09/2020] [Accepted: 02/10/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Jane Sims
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Melbourne, Vic., Australia.,General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Vic., Australia
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Freedman A, Nicolle J. Isolement social et solitude : les nouveaux géants gériatriques. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:e78-e85. [PMID: 32165477 PMCID: PMC8302349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Objectif Examiner les problèmes de l’isolement social, de la solitude et de la vulnérabilité sociale chez les adultes plus âgés, de même que les risques qui leur sont associés, et aider les professionnels des soins primaires à identifier les patients à risque et à recommander des interventions efficaces. Sources de l’information Une recherche documentaire a été effectuée dans PubMed et PsycINFO en se servant des expressions aged, social isolation, loneliness, screening et interventions, de même que des mots clés associés pour trouver des articles pertinents en anglais. Les références des articles cernés ont aussi fait l’objet d’une recherche manuelle. Une recension distincte dans la littérature grise à l’aide de Google a aussi été faite pour trouver des documents de politiques et du matériel de transfert des connaissances provenant d’organisations appropriées. La recherche portait sur les articles publiés durant les 10 années précédant juin 2019. Message principal L’isolement social, la solitude et la vulnérabilité sociale sont très fréquents chez les adultes plus âgés; ils sont liés à une morbidité et à une mortalité considérables, et sont comparables à des facteurs de risque établis comme le tabagisme, la consommation d’alcool, l’obésité et la fragilité. De nombreuses interventions pour lutter contre la solitude et l’isolement social ont fait l’objet d’études : la facilitation sociale (y compris avec la technologie), l’exercice, les psychothérapies, les services sociaux et de santé, la zoothérapie, les programmes d’amitié, les loisirs et le perfectionnement des compétences. Par ailleurs, les données scientifiques actuelles sur leur efficacité sont limitées. Les besoins des populations mal desservies et marginalisées, y compris les nouveaux immigrants, les adultes plus âgés s’identifiant comme LGBTQ+ (lesbienne, gai, bisexuel, transgenre, queer ou en questionnement, et les communautés connexes), les personnes âgées autochtones et les aînés qui vivent dans la pauvreté, de même que les besoins des bénéficiaires de soins de longue durée et des aidants plus âgés, doivent être évalués de manière plus approfondie. Conclusion L’isolement social, la solitude et la vulnérabilité sociale sont des problèmes fréquents chez les adultes plus âgés, et ils ont des répercussions importantes sur la santé. Les médecins de famille sont bien placés pour identifier les aînés esseulés ou socialement isolés et enclencher l’amorce des services voulus.
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Affiliation(s)
- Amy Freedman
- Médecin de famille à l'Hôpital St Michael's et au Baycrest Centre à Toronto (Ontario), et professeure adjointe et directrice du programme des compétences avancées en soins aux aînés au Département de médecine familiale et communautaire de l'Université de Toronto.
| | - Jennifer Nicolle
- Médecin remplaçante au Département de médecine familiale et communautaire de l'Hôpital St Michael's, et médecin hospitalière au Centre for Addiction and Mental Health et pour les Inner City Health Associates à Toronto
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Freedman A, Nicolle J. Social isolation and loneliness: the new geriatric giants: Approach for primary care. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:176-182. [PMID: 32165464 PMCID: PMC8302356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To review the problems of social isolation, loneliness, and social vulnerability in older adults and the associated risks, and to help primary care providers identify patients at risk and recommend effective interventions. SOURCES OF INFORMATION PubMed and PsycINFO searches were conducted using the terms aged, social isolation, loneliness, screening, and interventions and associated key words for relevant English-language articles. References of identified articles were also hand searched. A separate search of the gray literature using Google was conducted to find policy documents and knowledge translation materials from relevant organizations. The search covered relevant articles from the 10 years before June 2019. MAIN MESSAGE Social isolation, loneliness, and social vulnerability are very common in older adults and are associated with considerable morbidity and mortality, comparable to established risk factors such as smoking, alcohol consumption, obesity, and frailty. Numerous interventions addressing loneliness and social isolation have been studied: social facilitation (including technology), exercise, psychological therapies, health and social services, animal therapy, befriending, and leisure and skill development. However, current evidence of effectiveness is limited. A patient-centred approach is essential to the selection of interventions. The needs of underserviced and marginalized populations, including new immigrants, older adults identifying as LGBTQ+ (lesbian, gay, bisexual, transgender, queer or questioning, and related communities), Indigenous seniors, and seniors living in poverty, as well as the needs of long-term care residents and older caregivers, require further evaluation. CONCLUSION Social isolation, loneliness, and social vulnerability are common problems in older adults and have important health consequences. Family physicians are uniquely positioned to identify lonely and socially isolated older adults and to initiate services.
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Affiliation(s)
- Amy Freedman
- Family physician at St Michael's Hospital and Baycrest in Toronto, Ont, and Assistant Professor and Program Director of the Care of the Elderly Enhanced Skills Program in the Department of Family and Community Medicine at the University of Toronto.
| | - Jennifer Nicolle
- Locum physician in the Department of Family and Community Medicine at St Michael's Hospital and a hospitalist at the Centre for Addiction and Mental Health and for Inner City Health Associates in Toronto
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Financial difficulty and biopsychosocial predictors of loneliness: A cross-sectional study of community dwelling older adults. Arch Gerontol Geriatr 2019; 85:103935. [DOI: 10.1016/j.archger.2019.103935] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/22/2019] [Accepted: 08/06/2019] [Indexed: 11/22/2022]
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Johnson S, Bacsu J, McIntosh T, Jeffery B, Novik N. Social isolation and loneliness among immigrant and refugee seniors in Canada: a scoping review. INTERNATIONAL JOURNAL OF MIGRATION HEALTH AND SOCIAL CARE 2019. [DOI: 10.1108/ijmhsc-10-2018-0067] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Social isolation and loneliness are global issues experienced by many seniors, especially immigrant and refugee seniors. Guided by the five-stage methodological framework proposed by Arksey and O’Malley and more recently Levac, Colquhoun and O’Brien, the purpose of this paper is to explore the existing literature on social isolation and loneliness among immigrant and refugee seniors in Canada.
Design/methodology/approach
The authors conducted a literature search of several databases including: PubMed; MEDLINE; CINAHL; Web of Science; HealthStar Ovid; PschyInfo Ovid; Social Services Abstracts; AgeLine; Public Health Database, Google Scholar and Cochrane Library. In total, 17 articles met the inclusion criteria.
Findings
Based on the current literature five themes related to social isolation and loneliness emerged: loss; living arrangements; dependency; barriers and challenges; and family conflict.
Research limitations/implications
Given the increasing demographic of aging immigrants in Canada, it is useful to highlight existing knowledge on social isolation and loneliness to facilitate research, policy and programs to support this growing population.
Practical implications
The population is aging around the world and it is also becoming increasingly diverse particularly in the high-income country context. Understanding and addressing social isolation is important for immigrant and refugee seniors, given the sociocultural and other differences.
Social implications
Social isolation is a waste of human resource and value created by seniors in the communities.
Originality/value
The paper makes a unique contribution by focusing on immigrant and refugee seniors.
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Oetzel JG, Hokowhitu B, Simpson M, Reddy R, Cameron MP, Meha P, Johnston K, Nock S, Greensill H, Harding T, Shelford P, Smith LT. Correlates of Health-Related Quality of Life for Māori Elders Involved in a Peer Education Intervention. JOURNAL OF HEALTH COMMUNICATION 2019; 24:559-569. [PMID: 31274386 DOI: 10.1080/10810730.2019.1637483] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The purpose of this study was to identify social determinant and communication correlates of health-related quality of life for kaumātua (Māori elders) in New Zealand. A total of 209 kaumātua completed a self-report survey of self-rated health, physical/mental quality of life, spirituality, and a series of questions about social determinants (e.g., factors related to income) and communication variables (e.g., loneliness, social support, cultural identity, and perceived burden/benefit). The survey was baseline data for a peer education intervention to help kaumātua work through life transitions in older age. The main findings of this study were that social determinants, particularly difficulty paying bills, accounted for a small amount of variance in physical/mental quality of life and self-rated health. Further, the communication correlates of loneliness, perceived burden, and desired support accounted for about three times as much variance in these two outcomes all with negative associations. Strength of tribal identity, importance of whānau (extended family), and knowledge of tikanga (customs and protocols) accounted for a moderate amount variance in spirituality with positive associations. These findings have important theoretical and practical implications for positive aging.
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Affiliation(s)
- John G Oetzel
- a Waikato Management School, University of Waikato , Hamilton , New Zealand
| | - Brendan Hokowhitu
- b Faculty of Māori and Indigenous Studies, University of Waikato , Hamilton , New Zealand
| | - Mary Simpson
- a Waikato Management School, University of Waikato , Hamilton , New Zealand
| | | | - Michael P Cameron
- a Waikato Management School, University of Waikato , Hamilton , New Zealand
| | - Pare Meha
- c Rauawaawa Kaumātua Charitable Trust , Hamilton , New Zealand
| | | | - Sophie Nock
- b Faculty of Māori and Indigenous Studies, University of Waikato , Hamilton , New Zealand
| | - Hineitimoana Greensill
- b Faculty of Māori and Indigenous Studies, University of Waikato , Hamilton , New Zealand
| | - Truely Harding
- a Waikato Management School, University of Waikato , Hamilton , New Zealand
| | - Pita Shelford
- a Waikato Management School, University of Waikato , Hamilton , New Zealand
| | - Linda Tuhiwai Smith
- b Faculty of Māori and Indigenous Studies, University of Waikato , Hamilton , New Zealand
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Jamieson H, Abey-Nesbit R, Bergler U, Keeling S, Schluter PJ, Scrase R, Lacey C. Evaluating the Influence of Social Factors on Aged Residential Care Admission in a National Home Care Assessment Database of Older Adults. J Am Med Dir Assoc 2019; 20:1419-1424. [PMID: 30926408 DOI: 10.1016/j.jamda.2019.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/31/2019] [Accepted: 02/03/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Evaluate the influence of social factors on admission to aged residential care (ARC) facilities using a national comprehensive geriatric assessment database in New Zealand. DESIGN Time-to-event analysis of a continuously recruited national cohort. PARTICIPANTS AND SETTING An anonymized data extract from a large national database for home care assessments (June 2012-December 2015) was matched with data on mortality and admissions into ARC. METHODS Four key components of psychosocial risk in relation to ARC admission were used for analysis: living alone, negative social interactions, perceived loneliness, and carer stress. Exploratory data analysis was conducted for each of the variables of interest and demographics. Unadjusted and adjusted competing risk regressions were then performed with admission into ARC being the primary outcome, death the competing risk, and remaining at home the survival case. RESULTS After data cleaning, matching, and applying exclusions, the study population consisted of 54,345 eligible participants. Mean age of participants was 81.9 years (standard deviation 7.4), 62.1% were female, and 88.7% identified as European ethnicity. In the adjusted model, all 4 social factors remained significantly associated with ARC admission, namely: living alone [subhazard ratio (SHR) = 1.43 95% confidence interval (CI) 1.37-1.50]; negative social interactions (SHR = 1.22, 95% CI 1.15-1.30); perceived loneliness (SHR = 1.18, 95% CI 1.13-1.24); and carer stress (SHR = 1.28, 95% CI 1.23-1.34). CONCLUSIONS AND IMPLICATIONS Interventions targeted at social factors in the context of delaying ARC admission merit further development and evaluation.
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Affiliation(s)
- Hamish Jamieson
- Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand.
| | - Rebecca Abey-Nesbit
- Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand
| | - Ulrich Bergler
- Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand
| | - Sally Keeling
- Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand
| | - Philip J Schluter
- University of Canterbury-Te Whare Wānanga o Waitaha, School of Health Sciences, Christchurch, Canterbury, New Zealand; The University of Queensland, School of Clinical Medicine, Primary Care Clinical Unit, Brisbane, Queensland, Australia
| | - Richard Scrase
- Department of Nursing, Canterbury District Health Board, Canterbury, Christchurch, New Zealand
| | - Cameron Lacey
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Hemberg J, Nyqvist F, Näsman M. "Homeless in life" - loneliness experienced as existential suffering by older adults living at home: a caring science perspective. Scand J Caring Sci 2018; 33:446-456. [PMID: 30566252 DOI: 10.1111/scs.12642] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 11/26/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Due to physical impairments and functional limitations, older adults receiving home care can be considered especially vulnerable to loneliness. To understand how society can provide support that enhances vulnerable individuals' quality of life, it is important to explore loneliness and its underlying causes in older adults. AIMS To contribute to a deeper understanding of caring science theory, the aim of this study was to use a caring science perspective to explore and understand experiences of suffering from loneliness in older adults receiving home care. The research questions are as follows: What phenomena are associated with the experience of suffering from loneliness in older adults receiving home care? How can this experience be understood? METHODOLOGY A hermeneutical approach was used. The material was collected through interviews with 17 older adults about their quality of life, including their experiences of loneliness. The texts were interpreted through latent content analysis. FINDINGS The findings resulted in one main category and three subcategories. The main category was as follows: Being homeless in life-loneliness expressed and primarily stemming from existential suffering. The subcategories were as follows: Loss of communion with one's partner or other loved ones, Loss of meaningful social activities due to isolation and Loss of health due to frailty and vulnerability. All categories were described and implications for practice discussed. CONCLUSION This study contributes to an understanding of experiences of suffering from loneliness in older adults receiving home care, with relevance for the healthcare context as well as for what a community or society should focus on when addressing these important issues.
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Affiliation(s)
- Jessica Hemberg
- Department of Caring Sciences and Health Sciences, Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland
| | - Fredrica Nyqvist
- Faculty of Education and Welfare Studies, Social Policy Unit, Åbo Akademi University, Vaasa, Finland
| | - Marina Näsman
- Faculty of Education and Welfare Studies, Social Policy Unit, Åbo Akademi University, Vaasa, Finland
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Promoting Age-Friendly Communities: an Integrative Review of Inclusion for Older Immigrants. J Cross Cult Gerontol 2018; 33:427-440. [DOI: 10.1007/s10823-018-9359-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Leitch S, Glue P, Gray AR, Greco P, Barak Y. Comparison of Psychosocial Variables Associated With Loneliness in Centenarian vs Elderly Populations in New Zealand. JAMA Netw Open 2018; 1:e183880. [PMID: 30646265 PMCID: PMC6324443 DOI: 10.1001/jamanetworkopen.2018.3880] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
IMPORTANCE Loneliness is associated with reduced health-related quality of life and increased morbidity and mortality and typically worsens with aging. OBJECTIVES To evaluate associations between demographic and psychosocial variables and loneliness, examine any age-specific associations, and compare centenarians (aged ≥100 years) with elderly people (aged 65-99 years). DESIGN, SETTING, AND PARTICIPANTS In this retrospective, observational, cross-sectional study, previously collected data from all New Zealanders 65 years and older who completed their first international Resident Assessment Instrument-Home Care (interRAI-HC) assessment during the study period (January 1, 2013, to November 27, 2017) were reviewed. Participants were people living independently in the community who were requesting or referred for assessment with a potential need for support services. MAIN OUTCOMES AND MEASURES The interRAI-HC is a 236-item, electronically recorded assessment that encompasses a comprehensive range of aspects of an older person's life, including physical, psychological, and cognitive domains. Eight main items from the interRAI-HC data set were analyzed to describe the population and evaluate the core psychosocial components of aging, namely, age, sex, race/ethnicity, marital status, living arrangements, family support, depression, and loneliness. Loneliness was evaluated by the participants' response to the assessment statement, "Says or indicates that he/she feels lonely." RESULTS A total of 73 286 New Zealanders (mean age, 81.4 years; age range, 65-109 years; 41 641 [56.9%] female) participated in the study. The assessments of 191 centenarians (mean [SD] age, 100.9 [1.2] years) and 73 095 elderly people (mean [SD] age, 81.4 [7.6] years) were analyzed. Centenarians vs elderly people were more likely to be female (136 [71.2%] vs 41 488 [56.8%]; P < .001), and the populations differed by marital status (widowed: 170 [89.0%] vs 31 554 [43.2%]; overall P < .001) and depression status (70.2% vs 59.5% free of depression; overall P = .008). Centenarians were less likely to be lonely compared with elderly people, with a 22% lower risk of loneliness for a typical centenarian (aged 100.9 years) compared with a typical elderly person (aged 81.4 years) in unadjusted analyses (relative risk, 0.78; 95% CI, 0.67-0.92; P = .002). In the fully adjusted model, there was a 32% reduction in loneliness for a centenarian compared with an elderly person (relative risk, 0.68; 95% CI, 0.58-0.79; P < .001). Living with others, having family support, and lacking depression were associated with lower risk of loneliness. CONCLUSIONS AND RELEVANCE Centenarians are a unique group to study as a model of successful aging. The sample of centenarians in this study appeared to be less lonely than other groups studied internationally. The study identified multiple psychosocial variables that were associated with the risk of loneliness, including living arrangements, family support, and depression. Knowing these variables may help our society address risk factors for loneliness in older people.
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Affiliation(s)
- Sharon Leitch
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Paul Glue
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Andrew R. Gray
- Biostatistics Unit, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Yoram Barak
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Kotian DB, Mathews M, Parsekar SS, Nair S, Binu VS, Subba SH. Factors Associated With Social Isolation Among the Older People in India. J Geriatr Psychiatry Neurol 2018; 31:271-278. [PMID: 30149767 DOI: 10.1177/0891988718796338] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To explore the factors associated with social isolation among older people using the data from Building Knowledge Base on Population Ageing in India (BKPAI) survey. METHODS Multiple logistic regression and classification and regression tree (CART) analysis were used to identify the factors associated with social isolation using data from BKPAI survey. An individual was regarded as socially isolated if the response was "never" to all 4 activities in the last 12 months: (1) attending public meeting, (2) attending any group/club/organizational meeting, (3) attending any religious program, and (4) visiting friends or relatives. RESULTS Among 9836 older people, 19.7% were observed to be socially isolated. From multiple logistic regression, age (odds ratio [OR] = 1.85 for age 80 to 89 years and OR = 2.67 for age ≥90), religion (OR = 0.54 for Christians compared to Hindus), duration of stay in current home (OR = 0.64 for 6-10 years compared to >10 years of stay), number of activities of daily living (ADLs) for which the assistance was needed (OR = 2.09 for 1 or 2, OR = 3.14 for 3 or 4, and OR = 12.05 for 5 or 6), and Alzheimer's disease (OR = 1.65) were identified as factors associated with social isolation. Number of ADL for which the assistance was needed and self-reported health status were the factors identified through CART analysis. DISCUSSION Requiring help in performing ADL, advancing age, and Alzheimer's disease were the likely factors for socially isolation among elderly patients in this surveyed population.
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Affiliation(s)
- Devaki B Kotian
- 1 Department of Statistics, Prasanna School of Public Health (PSPH), Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Maria Mathews
- 1 Department of Statistics, Prasanna School of Public Health (PSPH), Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Shradha S Parsekar
- 1 Department of Statistics, Prasanna School of Public Health (PSPH), Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Suma Nair
- 2 Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - V S Binu
- 3 Department of Biostatistics, National Institute of Mental Health and Neuro Sciences, Dr M. V. Govindasamy Centre, Bengaluru, Karnataka, India
| | - Sonu Hangma Subba
- 4 Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
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Kitzmüller G, Clancy A, Vaismoradi M, Wegener C, Bondas T. "Trapped in an Empty Waiting Room"-The Existential Human Core of Loneliness in Old Age: A Meta-Synthesis. QUALITATIVE HEALTH RESEARCH 2018; 28:213-230. [PMID: 29235943 DOI: 10.1177/1049732317735079] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Loneliness in old age has a negative influence on quality of life, health, and survival. To understand the phenomenon of loneliness in old age, the voices of lonely older adults should be heard. Therefore, the purpose of this meta-synthesis was to synthesize scientific studies of older adults' experiences of loneliness. Eleven qualitative articles that met the inclusion criteria were analyzed and synthesized according to Noblit and Hare's meta-ethnographic approach. The analysis revealed the overriding meaning of the existential human core of loneliness in old age expressed through the metaphor "trapped in an empty waiting room." Four interwoven themes were found: (a) the negative emotions of loneliness, (b) the loss of meaningful interpersonal relationships, (c) the influence of loneliness on self-perception, and (d) the older adults' endeavors to deal with loneliness. The joint contribution of family members, health care providers, and volunteers is necessary to break the vicious circle of loneliness.
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Affiliation(s)
| | - Anne Clancy
- 2 UiT, The Arctic University of Norway, Harstad, Norway
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Jamieson HA, Gibson HM, Abey-Nesbit R, Ahuriri-Driscoll A, Keeling S, Schluter PJ. Profile of ethnicity, living arrangements and loneliness amongst older adults in Aotearoa New Zealand: A national cross-sectional study. Australas J Ageing 2017; 37:68-73. [DOI: 10.1111/ajag.12496] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Hamish A Jamieson
- Department of Medicine; University of Otago; Christchurch New Zealand
| | - Helen M Gibson
- Department of Medicine; University of Otago; Christchurch New Zealand
| | | | | | - Sally Keeling
- Department of Medicine; University of Otago; Christchurch New Zealand
| | - Philip J Schluter
- School of Health Sciences; University of Canterbury; Christchurch New Zealand
- School of Nursing, Midwifery and Social Work; University of Queensland; Brisbane Queensland Australia
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Breheny M, Severinsen C. Is social isolation a public health issue? A media analysis in Aotearoa/New Zealand. CRITICAL PUBLIC HEALTH 2017. [DOI: 10.1080/09581596.2017.1400162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mary Breheny
- School of Public Health, Massey University , Palmerston North, New Zealand
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