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Gao Q, Mak HW, Fancourt D. Longitudinal associations between loneliness, social isolation, and healthcare utilisation trajectories: a latent growth curve analysis. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1839-1848. [PMID: 38429539 PMCID: PMC11464645 DOI: 10.1007/s00127-024-02639-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 02/12/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE To explore the longitudinal associations between eight-year trajectories of loneliness, social isolation and healthcare utilisation (i.e. inpatient, outpatient, and nursing home care) in US older adults. METHODS The study used data from the Health and Retirement Study in 2006-2018, which included a nationally representative sample of American adults aged 50 and above (N = 6,832). We conducted latent growth curve models to assess the associations between trajectories of loneliness and isolation and healthcare utilisation over 8 years. RESULTS Independent of sociodemographic and health-related confounders, social deficits were associated with a lower likelihood of baseline physician visits (loneliness β= -0.15, SE = 0.08; social isolation β= -0.19, SE = 0.08), but there was a positive association between loneliness and number of physician visits (β = 0.06, SE = 0.03), while social isolation was associated with extended hospital (β = 0.07, SE = 0.04) and nursing home stays (β = 0.05, SE = 0.02). Longer nursing home stays also predicted better trajectories of loneliness and isolation over time. CONCLUSION Loneliness and social isolation are cross-sectionally related to complex patterns of different types of healthcare. There was no clear evidence that social deficits led to specific trajectories of healthcare utilisation, but nursing home stays may over time help provide social contact, supporting trajectories of isolation and potentially loneliness. Non-clinical services such as social prescribing could have the potential to address unmet social needs and further promote patients' health-seeking profiles for improving healthcare equity.
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Affiliation(s)
- Qian Gao
- Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- School of Public Health, Imperial College London, London, UK
| | - Hei Wan Mak
- Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
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Xie X, Lyu Y, Li X, Zhuang Z, Xu A. Exploring the association between social isolation and utilization of primary health services by older adults: evidence from China. Front Public Health 2024; 12:1341304. [PMID: 38562256 PMCID: PMC10982333 DOI: 10.3389/fpubh.2024.1341304] [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: 11/20/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Objective This study aims to investigate the impact of social isolation on the utilization of primary health services among older adults in China. Methods Data from the China Longitudinal Aging Social Survey (CLASS) conducted in 2018 were utilized. A binary logistic regression model was established, and propensity score matching (PSM) was employed for analysis. Results The results of the binary logistic regression showed that family isolation within social isolation had a significant negative impact on the utilization of primary health services for older adults. In contrast, there was no significant association between friend isolation, community isolation, and the utilization of primary health services. Furthermore, the PSM results, using three matching methods (nearest neighbor matching, radius matching, and kernel matching), confirmed that family isolation significantly reduced older adults' utilization of primary health services, consistent with the baseline regression findings. Conclusion Reducing the occurrence of family isolation among older adults may be a cost-effective intervention measure. Efforts should be directed toward improving family support for older adults, promoting the utilization of primary health services, and strengthening disease prevention.
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Affiliation(s)
- Xinlong Xie
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yanxia Lyu
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Research Center for Major Health Risk Management and TCM Control Policy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xinyu Li
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhiruo Zhuang
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Aijun Xu
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Research Center for Major Health Risk Management and TCM Control Policy, Nanjing University of Chinese Medicine, Nanjing, China
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Chokkanathan S. Family Environment, Loneliness, Hope, and Subjective Well-Being of Asian Older Adults. Int J Aging Hum Dev 2024; 98:208-220. [PMID: 37122151 DOI: 10.1177/00914150231171839] [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] [Indexed: 05/02/2023]
Abstract
The current study examined the interactions between family environment, hope, and loneliness, and their subsequent influence on the subjective well-being (SWB) of 345 noninstitutionalized older adults (aged 60 years and above) in Singapore. Door-to-door surveys information was collected on family environment (cohesiveness, relationship closeness, and support), hope, loneliness, and SWB (life satisfaction, happiness, and absence of negative affect). Structural equation modelling was conducted to test competing hypotheses derived from life stress and integrated resource theories. The results revealed that family environment influenced SWB both directly and indirectly. Family environment decreased loneliness and increased SWB. Additionally, family environment influenced SWB by offering increased hope. Family environment sets the context for the SWB of older adults in Singapore. Families should therefore be targeted for interventions to reduce loneliness, increase psychological resources, and raise SWB during old age.
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Affiliation(s)
- Srinivasan Chokkanathan
- Department of Social Work, AS3 Arts Link, National University of Singapore, Singapore, Singapore
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Martínez-Angulo P, Muñoz-Mora M, Rich-Ruiz M, Ventura-Puertos PE, Cantón-Habas V, López-Quero S. "With your age, what do you expect?": Ageism and healthcare of older adults in Spain. Geriatr Nurs 2023; 51:84-94. [PMID: 36921397 DOI: 10.1016/j.gerinurse.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/17/2023]
Abstract
INTRODUCTION Ageism could influence the relationship between older patients' meeting needs and healthcare professionals' answers. AIMS To highlight the experience of older adults with healthcare systems, how they perceive ageism from their healthcare providers, and to explore the relationship between perceived ageism and self-perception of aging (SPA). METHODS We conducted an exploratory qualitative study. The participants were 14 women over 65 who lived alone in their homes. RESULTS Professional responses ignored the expression of preferences of the older patients and excluded them from decision-making processes. These answers influenced older patients' use of health services. Moreover, the negative aspects predominated in a SPA influenced by the internalization of stereotypes and a relationship weighed down by ageist behaviors on the part of health professionals. CONCLUSION Explicit situations of ageism influence an imbalance in power relations between older patients and healthcare professionals, a misuse of health services, and a negative SPA.
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Affiliation(s)
- Pablo Martínez-Angulo
- Department of Nursing, Pharmacology, and Physiotherapy, Faculty of Medicine and Nursing, University of Córdoba (UCO), Córdoba 14004, Spain; Interdisciplinary Research Group in Discourse Analysis (HUM380), University of Córdoba (UCO), Córdoba 14071, Spain
| | - Margarita Muñoz-Mora
- Department of Nursing, Pharmacology, and Physiotherapy, Faculty of Medicine and Nursing, University of Córdoba (UCO), Córdoba 14004, Spain; Hospital Universitario Reina Sofía (HURS), Córdoba 14004, Spain
| | - Manuel Rich-Ruiz
- Department of Nursing, Pharmacology, and Physiotherapy, Faculty of Medicine and Nursing, University of Córdoba (UCO), Córdoba 14004, Spain; Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba 14004, Spain; Ciber Fragility and Healthy Aging (CIBERFES), Madrid 28029, Spain; Nursing and Healthcare Research Unit (Investén-isciii), Instituto de Salud Carlos III, Madrid 28029, Spain.
| | - Pedro E Ventura-Puertos
- Department of Nursing, Pharmacology, and Physiotherapy, Faculty of Medicine and Nursing, University of Córdoba (UCO), Córdoba 14004, Spain; Interdisciplinary Research Group in Discourse Analysis (HUM380), University of Córdoba (UCO), Córdoba 14071, Spain
| | - Vanesa Cantón-Habas
- Department of Nursing, Pharmacology, and Physiotherapy, Faculty of Medicine and Nursing, University of Córdoba (UCO), Córdoba 14004, Spain; Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba 14004, Spain
| | - Salvador López-Quero
- Interdisciplinary Research Group in Discourse Analysis (HUM380), University of Córdoba (UCO), Córdoba 14071, Spain; Department of Language Sciences, Faculty of Philosophy and Letters, University of Córdoba (UCO), Córdoba, Andalucía 14003, Spain
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Smith KJ, Victor C. The Association of Loneliness With Health and Social Care Utilization in Older Adults in the General Population: A Systematic Review. THE GERONTOLOGIST 2022; 62:e578-e596. [PMID: 34875042 DOI: 10.1093/geront/gnab177] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Loneliness is proposed to be linked with increased service use. This review examined the association of loneliness and health and social care utilization (HSCU) in older adults from the general population. RESEARCH DESIGN AND METHODS Four databases were screened for studies that examined the association of loneliness (predictor) with HSCU (outcome) in older adults (defined as the majority of sample 60 or older). Study quality was assessed with the National Institutes for Health scale for observational cohorts and cross-sectional studies. RESULTS We identified 32 studies, of which 9 prospective studies were evaluated as being good or good-fair quality. Two good-fair quality studies found that loneliness at baseline was associated with subsequent admission to a residential care home. There was emerging evidence that loneliness was associated with emergency department use (n = 1) and cardiovascular disease-specific hospitalization (n = 1). Once adjusted for confounders, the highest quality studies found no association of baseline loneliness with physician utilization, outpatient service utilization, skilled nursing facility use, and planned or unplanned hospital admissions. The remaining studies were cross-sectional, or of fair to poor quality, and inadequate to reliably determine whether loneliness was associated with a subsequent change in HSCU. DISCUSSION AND IMPLICATIONS There was heterogeneity in study design, measurement, and study quality. This generated an inconsistent evidence base where we cannot determine clear inferences about the relationship between loneliness and HSCU. Only one consistent finding was observed between 2 good-fair quality studies regarding care home admission. To determine clinical implications and make reliable inferences, additional good quality longitudinal research is needed.
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Affiliation(s)
- Kimberley J Smith
- School of Psychology, Faculty of Health and Medicine, University of Surrey, Guildford, UK
| | - Christina Victor
- Department of Health Sciences, Brunel University London, Uxbridge, UK
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Liu TY, Qiu DC, Chen T. Effects of Social Participation by Middle-Aged and Elderly Residents on the Utilization of Medical Services: Evidence From China. Front Public Health 2022; 10:824514. [PMID: 35875043 PMCID: PMC9301239 DOI: 10.3389/fpubh.2022.824514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesAim to evaluate the effect of social participation on utilization of medical services among middle-aged and elderly residents in China.MethodsWe used data from the 2018 wave of the China Health and Retirement Longitudinal Study. Social participation is classified into three types. Furthermore, to control for confounding factors, our study computed propensity score matching (PSM) to evaluate the effect of social participation on the utilization of medical services.ResultThe result of PSM indicates that social participation significantly positively affects the utilization of outpatient services, the average treatment effect on the treated (ATT = 0.038***) and the utilization of inpatient services (ATT = 0.015**) by middle-aged and elderly residents. Furthermore, the utilization of outpatient health care services was significantly positively associated with leisure activities (ATT = 0.035***), social activities to help others (ATT = 0.031***), and learning activities to gain new knowledge (ATT = 0.034***) among middle-aged and elderly residents. The utilization of inpatient health care was significantly positively associated with leisure activities (ATT = 0.015***) but had no significant association with social deeds that help others and increased new knowledge among middle-aged and elderly residents.ConclusionThus, social participation significantly positively affects healthcare utilization by middle-aged and elderly residents. Hence, the government and society should provide more conveniences and promote social participation among middle-aged and elderly residents.
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Affiliation(s)
- Tai-Yi Liu
- School of Public Health, Hubei Provincial Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, China
| | - De-Chao Qiu
- Jintang First People's Hospital, West China Hospital Sichuan University, Jingtang, China
| | - Ting Chen
- School of Public Health, Hubei Provincial Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, China
- *Correspondence: Ting Chen
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Ge L, Yap CW, Heng BH. Associations of social isolation, social participation, and loneliness with frailty in older adults in Singapore: a panel data analysis. BMC Geriatr 2022; 22:26. [PMID: 34991493 PMCID: PMC8734362 DOI: 10.1186/s12877-021-02745-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/23/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is a shortage of research evidence about how social isolation, social participation, and loneliness were longitudinally associated with frailty. This study was to 1) examine the associations of social isolation, social participation, and loneliness with level of frailty among community-dwelling older adults using panel data, and 2) explore the moderating effect of gender on the association of social isolation, social participation and loneliness with frailty. METHODS The study included 606 participants aged 60 years and above from the longitudinal Population Health Index Survey conducted in Singapore. At each timepoint, level of frailty was determined using the Clinical Frailty Scale. Social isolation was assessed by the Lubben Social Network Scale-6, and loneliness was assessed using the three-item UCLA Loneliness Scale. Fixed-effects ordinal logistic regressions were conducted with level of frailty as the dependent variable and social isolation and loneliness as the independent variables, adjusting for time-varying socio-demographic, lifestyle, and health-related factors. RESULTS Increase in social participation was associated with lower level of frailty (odds ratio: 0.96, 95% confidence interval: 0.93-0.99) and feeling lonely was associated with higher level of frailty (odds ratio: 2.90, 95% confidence interval: 1.44-5.84). Social isolation was not associated with frailty. Gender did not have moderating effect on these associations. CONCLUSIONS This study observed that social isolation and loneliness had differential longitudinal association with level of frailty among community-dwelling older adults and suggested that loneliness and frailty should be measured and addressed concurrently among community-dwelling older adults.
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Affiliation(s)
- Lixia Ge
- Health Services & Outcomes Research, National Healthcare Group, Singapore, Singapore.
| | - Chun Wei Yap
- Health Services & Outcomes Research, National Healthcare Group, Singapore, Singapore
| | - Bee Hoon Heng
- Health Services & Outcomes Research, National Healthcare Group, Singapore, Singapore
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8
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Ong M, Pek K, Tan CN, Chew J, Lim JP, Yew S, Yeo A, Lim WS. Social Frailty and Executive Function: Association with Geriatric Syndromes, Life Space and Quality of Life in Healthy Community-Dwelling Older Adults. J Frailty Aging 2022; 11:206-213. [PMID: 35441199 PMCID: PMC8542364 DOI: 10.14283/jfa.2021.43] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/21/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Despite emerging evidence about the association between social frailty and cognitive impairment, little is known about the role of executive function in this interplay, and whether the co-existence of social frailty and cognitive impairment predisposes to adverse health outcomes in healthy community-dwelling older adults. OBJECTIVES We aim to examine independent associations between social frailty with the MMSE and FAB, and to determine if having both social frailty and cognitive impairment is associated with worse health outcomes than either or neither condition. METHODS We studied 229 cognitively intact and functionally independent community-dwelling older adults (mean age= 67.2±7.43). Outcome measures comprise physical activity; physical performance and frailty; geriatric syndromes; life space and quality of life. We compared Chinese Mini Mental State Examination (CMMSE) and Chinese Frontal Assessment Battery (FAB) scores across the socially non-frail, socially pre-frail and socially frail. Participants were further recategorized into three subgroups (neither, either or both) based on presence of social frailty and cognitive impairment. Cognitive impairment was defined as a score below the educational adjusted cut-offs in either CMMSE or FAB. We performed logistic regression adjusted for significant covariates and mood to examine association with outcomes across the three subgroups. RESULTS Compared with CMMSE, Chinese FAB scores significantly decreased across the social frailty spectrum (p<0.001), suggesting strong association between executive function with social frailty. We derived three subgroups relative to relationship with socially frailty and executive dysfunction: (i) Neither, N=140(61.1%), (ii) Either, N=79(34.5%), and (iii) Both, N=10(4.4%). Compared with neither or either subgroups, having both social frailty and executive dysfunction was associated with anorexia (OR=4.79, 95% CI= 1.04-22.02), near falls and falls (OR= 5.23, 95% CI= 1.10-24.90), lower life-space mobility (odds ratio, OR=9.80, 95% CI=2.07-46.31) and poorer quality of life (OR= 13.2, 95% CI= 2.38-73.4). CONCLUSION Our results explicated the association of executive dysfunction with social frailty, and their synergistic relationship independent of mood with geriatric syndromes, decreased life space and poorer quality of life. In light of the current COVID-19 pandemic, the association between social frailty and executive dysfunction merits further study as a possible target for early intervention in relatively healthy older adults.
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Affiliation(s)
- M Ong
- Ms. Melissa Ong, TTSH Annex 2, Level 3, 11 Jalan Tan Tock Seng, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Telephone: +65 6359 6327,
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9
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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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10
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Kuru Alici N, Kalanlar B. Attitudes toward aging and loneliness among older adults: A mixed methods study. Perspect Psychiatr Care 2021; 57:1838-1845. [PMID: 33651388 DOI: 10.1111/ppc.12757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 01/20/2021] [Accepted: 02/06/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The purpose of this study was to comprehensively investigate attitudes toward aging and loneliness in Turkish older adults living at a nursing home (n = 110). DESIGN AND METHODS A convergent mixed methods design was used. Data were collected using Europe-attitudes to aging questionnaire (AAQ) and De Jong Gierveld loneliness scale (DJGLS); and through semi structured interviews. FINDINGS The participants obtained mean scores of 19.98 ± 3.0 on the DJGLS and 71.84 ± 7.7 on the AAQ. PRACTICE IMPLICATIONS Healthcare professionals should improve their awareness about nursing home-dwelling older adults' attitudes toward aging and their experiences of loneliness so that they are better informed to address these issues and develop appropriate interventions that foster adaptive coping strategies.
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Affiliation(s)
- Nilgün Kuru Alici
- Department of Public Health Nursing, Hacettepe University Faculty of Nursing, Ankara, Turkey
| | - Bilge Kalanlar
- Department of Public Health Nursing, Hacettepe University Faculty of Nursing, Ankara, Turkey
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11
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Ho AHY, Ma SHX, Tan MKB, Bajpai RC. A Randomized Waitlist-Controlled Trial of an Intergenerational Arts and Heritage-Based Intervention in Singapore: Project ARTISAN. Front Psychol 2021; 12:730709. [PMID: 34552538 PMCID: PMC8450511 DOI: 10.3389/fpsyg.2021.730709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/03/2021] [Indexed: 11/21/2022] Open
Abstract
Loneliness has become a global major public health concern, with detrimental effects to the young and old. ARTISAN (Aspiration and Resilience Through Intergenerational Storytelling and Art-based Narratives) is a 5-week, 15-h participatory art and group-based intervention that focuses on resilience building and loneliness alleviation among the young and old through a structured multimodal framework held at a museum space. Developed with a Participatory Action Research (PAR) approach, this intervention is evaluated using an open-label waitlist randomized controlled trial design (RCT) comprised of community-dwelling youth and older adults randomized into an intervention group (n = 35) or a waitlist-control group (n = 33). Participants were assessed on standardized self-reported psychometric measures including loneliness, resilience, quality of life, social support, life satisfaction and national identity at three time points. Qualitative data generated during each intervention session as well as acceptability focus groups were recorded and transcribed. Linear mixed modeling analyses revealed that participants in the intervention group experienced improvements in life satisfaction compared to participants in the waitlist-control group (95% CI: 0.22 to 0.77, p < 0.001, Cohen's d = 0.53) immediately after the completion of ARTISAN. Subgroup analyses for youth participants indicated improvements in quality of life (95% CI: 0.16 to 0.52, p < 0.001, d = 1.31) and national identity (95% CI: 0.18 to 0.80, p = 0.002, d = 0.43) in comparison to the waitlist-control group. At 5-weeks follow-up, the intervention group participants continued to experience high levels of life satisfaction (95% CI: 0.04 to 0.42, p = 0.017, d = 0.47), enhancements in resilience (95% CI: 0.07 to 0.55, p = 0.011, d = 0.46), as well as a significant reduction in loneliness (95% CI: −0.34 to −0.08, p = 0.001, d = 0.61) compared to baseline, reflecting the effectiveness and positive residual effects of the ARTISAN intervention. Similarly, the qualitative findings provided support for the intervention and additional insights to the quantitative findings. This holistic intervention framework that integrates stories, arts and heritage for bridging and empowering lives fills a critical gap in knowledge and practice between the arts, health and citizenship, paving the way for further research in creating a more caring and inclusive society with the arts. Clinical Trials Registration:www.ClinicalTrials.gov, identifier: NCT03048708.
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Affiliation(s)
- Andy Hau Yan Ho
- Action Research for Community Health Laboratory, Psychology Programme, School of Social Sciences, Nanyang Technological University, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
| | - Stephanie Hilary Xinyi Ma
- Action Research for Community Health Laboratory, Psychology Programme, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Michael Koon Boon Tan
- Lab4Living, Culture and Creativity Research Institute, Sheffield Hallam University, Sheffield, United Kingdom
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Lee JML, Ang S, Chan A. Fear of crime is associated with loneliness among older adults in Singapore: Gender and ethnic differences. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1339-1348. [PMID: 32959506 DOI: 10.1111/hsc.13174] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 08/07/2020] [Accepted: 08/26/2020] [Indexed: 06/11/2023]
Abstract
Fear of crime is a complex perception and has underlying psychological, social and health repercussions. The influence of fear of crime on psychosocial outcomes, however, may be moderated by various social factors. This study examined how fear of crime influences loneliness among low-income older adults attending a Senior Activity Centre (SAC) in multiethnic Singapore. In addition, we tested whether these associations were moderated by gender and ethnicity. We analysed cross-sectional data (N = 1,266) from The SAC Study, a survey conducted with older adults who were attending a SAC between March 2015 and August 2015. Multilevel models were used to test whether fear of crime was associated with loneliness; and whether the association was moderated by gender and ethnicity. We found that fear of crime was positively associated with loneliness, and that this association was stronger among men than women, but ethnicity did not moderate this relationship. Findings from our study suggest that fear of crime may have a stronger negative effect on men's psychological well-being, even though they report lower fear of crime. This highlights the importance of sociocultural context when examining the psychosocial implications of fear of crime in the population.
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Affiliation(s)
- June May-Ling Lee
- Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore
| | - Shannon Ang
- School of Social Sciences, Nanyang Technological University, Singapore
| | - Angelique Chan
- Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore
- Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore
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Chawla K, Kunonga TP, Stow D, Barker R, Craig D, Hanratty B. Prevalence of loneliness amongst older people in high-income countries: A systematic review and meta-analysis. PLoS One 2021; 16:e0255088. [PMID: 34310643 PMCID: PMC8312979 DOI: 10.1371/journal.pone.0255088] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/09/2021] [Indexed: 11/18/2022] Open
Abstract
Background and objective Loneliness is associated with increased rates of morbidity and mortality, and is a growing public health concern in later life. This study aimed to produce an evidence-based estimate of the prevalence of loneliness amongst older people (aged 60 years and above). Study design and setting Systematic review and random-effects meta-analysis of observational studies from high income countries 2008 to 2020, identified from searches of five electronic databases (Medline, EMBASE, PsychINFO, CINAHL, Proquest Social Sciences Premium Collection). Studies were included if they measured loneliness in an unselected population. Results Thirty-nine studies reported data on 120,000 older people from 29 countries. Thirty-one studies were suitable for meta-analysis. The pooled prevalence estimate of loneliness was 28.5% (95%CI: 23.9% - 33.2%). In twenty-nine studies reporting loneliness severity, the pooled prevalence was 25.9% (95%CI: 21.6% - 30.3%) for moderate loneliness and 7.9% (95%CI: 4.8% - 11.6%) for severe loneliness (z = -6.1, p < 0.001). Similar pooled prevalence estimates were observed for people aged 65–75 years (27.6%, 95%CI: 22.6% - 33.0%) and over 75 years (31.3%, 95%CI: 21.0% - 42.7%, z = 0.64, p = 0.52). Lower levels of loneliness were reported in studies from Northern Europe compared to South and Eastern Europe. Conclusions Loneliness is common amongst older adults affecting approximately one in four in high income countries. There is no evidence of an increase in the prevalence of loneliness with age in the older population. The burden of loneliness is an important public health and social problem, despite severe loneliness being uncommon. PROSPERO registration CRD42017060472.
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Affiliation(s)
- Kavita Chawla
- Population and Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Tafadzwa Patience Kunonga
- Population and Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
| | - Daniel Stow
- Population and Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Robert Barker
- Population and Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Dawn Craig
- Population and Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Barbara Hanratty
- Population and Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Burns A, Leavey G, O'Sullivan R. Loneliness and Healthcare Use in Older Adults: Evidence From a Nationally Representative Cohort in Northern Ireland-A Cross-Sectional Replication Study. Front Public Health 2021; 9:620264. [PMID: 34026705 PMCID: PMC8131653 DOI: 10.3389/fpubh.2021.620264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Few have explored associations between loneliness and healthcare use independent of health and health behaviors. Recent indication of gender effects also requires validation across health service and cultural settings. We investigated the associations among loneliness, health and healthcare use (HCU) in older adults including stratification to investigate whether associations differed by gender. Methods: Secondary analysis of a nationally representative sample of 8,309 community-dwelling adults aged 50 and over from the Northern Ireland Cohort for the Longitudinal Study of Aging. Primary outcomes were: self-reported General Practice (GP) and emergency department (ED) visits in past year. Negative binomial and logistic regression analysis were used to investigate associations between loneliness and HCU, later adjusting for potential confounders (health and health behaviors). Results: Loneliness was consistently positively associated with both GP and ED visits (with IRRs ranging from 1.10 to 1.49 for GP visits, 1.16 to 1.98 for ED visits and ORs ranging from 1.13 to 1.51 for reporting at least one ED visit). With addition of health and health behaviors, all associations between loneliness and HCU became non-significant, excepting a small independent association between UCLA score and GP visits [IRR 1.03 (95% CI 1.01-1.05)]. Stratification of models revealed no gender effects. Conclusion: All but one association between loneliness and HCU became non-significant when health and health behaviors were included. The remaining association was small but implications remain for health service resources at population level. No gender effects were present in contrast to recent findings in the Republic of Ireland. Further studies on gender, loneliness and healthcare use needed.
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Affiliation(s)
- Annette Burns
- Ageing Research and Development Division, The Institute of Public Health in Ireland, Dublin, Ireland
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Coleraine, Ireland
| | - Gerard Leavey
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Coleraine, Ireland
| | - Roger O'Sullivan
- Ageing Research and Development Division, The Institute of Public Health in Ireland, Dublin, Ireland
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Coleraine, Ireland
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Hajek A, Bertram F, Heinrich F, van Rüth V, Ondruschka B, Kretzler B, Schüler C, Püschel K, König HH. Determinants of health care use among homeless individuals: evidence from the Hamburg survey of homeless individuals. BMC Health Serv Res 2021; 21:317. [PMID: 33827570 PMCID: PMC8026095 DOI: 10.1186/s12913-021-06314-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/22/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND To identify the determinants of health care use among homeless individuals. METHODS Data were taken from the Hamburg survey of homeless individuals (n = 100 individuals in the here used model, mean age 44.8 years, SD 12.5) focusing on homeless individuals in Hamburg, Germany. The number of physician visits in the past 3 months and hospitalization in the preceding 12 months were used as outcome measures. Drawing on the Andersen model of health care use as a conceptual framework, predisposing characteristics, enabling resources and need factors as well as psychosocial variables were included as correlates. RESULTS Negative binomial regressions showed that increased physician visits were associated with being female (IRR: 4.02 [95% CI: 1.60-10.11]), absence of chronic alcohol consume (IRR: 0.26 [95% CI: 0.12-0.57]) and lower health-related quality of life (IRR: 0.97 [95% CI: 0.96-0.98]). Furthermore, logistic regressions showed that the likelihood of hospitalization was positively associated with lower age (OR: 0.93 [95% CI: 0.89-0.98]), having health insurance (OR: 8.11 [2.11-30.80]) and lower health-related quality of life (OR: 0.97 [95% CI: 0.94-0.99]). CONCLUSIONS Our study showed that predisposing characteristics (both age and sex), enabling resources (i.e., health insurance) and need factors in terms of health-related quality of life are main drivers of health care use among homeless individuals. This knowledge may assist in managing health care use.
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Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Franziska Bertram
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Heinrich
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victoria van Rüth
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benedikt Kretzler
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Schüler
- Deutsches Rotes Kreuz Kreisverband Hamburg Altona und Mitte e.V, Hamburg, Germany
| | - Klaus Püschel
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Bolcato M, Trabucco Aurilio M, Di Mizio G, Piccioni A, Feola A, Bonsignore A, Tettamanti C, Ciliberti R, Rodriguez D, Aprile A. The Difficult Balance between Ensuring the Right of Nursing Home Residents to Communication and Their Safety. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052484. [PMID: 33802378 PMCID: PMC7967622 DOI: 10.3390/ijerph18052484] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/10/2021] [Accepted: 02/26/2021] [Indexed: 12/22/2022]
Abstract
The COVID-19 epidemic has had a profound impact on healthcare systems worldwide. The number of infections in nursing homes for the elderly particularly is significantly high, with a high mortality rate as a result. In order to contain infection risks for both residents and employees of such facilities, the Italian government passed emergency legislation during the initial stages of the pandemic to restrict outside visitor access. On 30 November 2020, the Italian President of the Council of Ministers issued a new decree recognizing the social and emotional value of visits to patients from family and friends. In addition, it indicated prevention measures for the purposes of containing the infection risk within nursing homes for the elderly. This article comments on these new legislative provisions from the medicolegal perspective, providing indications that can be used in clinical practice.
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Affiliation(s)
- Matteo Bolcato
- Legal Medicine, Department of Molecular Medicine, University of Padua, via G. Falloppio 50, 35121 Padua, Italy; (D.R.); (A.A.)
- Correspondence: (M.B.); (M.T.A.); Tel.: +39-0499941096 (M.B.); +39-081-778-316 (M.T.A.)
| | - Marco Trabucco Aurilio
- Department of Medicine and Health Sciences “V. Tiberio,” University of Molise, 86100 Campobasso, Italy
- Correspondence: (M.B.); (M.T.A.); Tel.: +39-0499941096 (M.B.); +39-081-778-316 (M.T.A.)
| | - Giulio Di Mizio
- Forensic Medicine, Department of Law, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy;
| | - Andrea Piccioni
- Department of Emergency Medicine, Gemelli, IRCCS (Scientific Institute for Hospitalization and Treatment), Catholic University of Rome-Teaching Hospital Foundation A, 00168 Rome, Italy;
| | - Alessandro Feola
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, via Luciano Armanni 5, 80138 Naples, Italy;
| | - Alessandro Bonsignore
- Department of Health Sciences, Section of Legal and Forensic Medicine, University of Genova, 16126 Genova, Italy; (A.B.); (C.T.)
| | - Camilla Tettamanti
- Department of Health Sciences, Section of Legal and Forensic Medicine, University of Genova, 16126 Genova, Italy; (A.B.); (C.T.)
| | - Rosagemma Ciliberti
- Department of Health Sciences, Section of History of Medicine and Bioethics, University of Genova, 16126 Genova, Italy;
| | - Daniele Rodriguez
- Legal Medicine, Department of Molecular Medicine, University of Padua, via G. Falloppio 50, 35121 Padua, Italy; (D.R.); (A.A.)
| | - Anna Aprile
- Legal Medicine, Department of Molecular Medicine, University of Padua, via G. Falloppio 50, 35121 Padua, Italy; (D.R.); (A.A.)
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Bai Z, Wang Z, Shao T, Qin X, Hu Z. Association between social capital and loneliness among older adults: a cross-sectional study in Anhui Province, China. BMC Geriatr 2021; 21:26. [PMID: 33413141 PMCID: PMC7791664 DOI: 10.1186/s12877-020-01973-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/17/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We aimed to examine the association between social capital and loneliness in Anhui Province, China. METHODS Data were collected from a cross-sectional study using a multi-stage stratified cluster sampling strategy. Data on demographic characteristics, socioeconomic factors, social capital, and loneliness in 1810 older adults (aged 60 years and older) were used for analysis. Binary logistic regression models and a classification and regression tree model were performed to assess the association of social capital and loneliness. RESULTS Our results indicated that social capital in terms of lower level of social participation (AOR = 1.38; 95% CI: 1.10-1.74), social connection (AOR = 1.51; 95% CI: 1.18-1.93), and reciprocity (AOR = 1.47; 95% CI: 1.13-1.90) were associated with higher odds of developing loneliness. We noted the interactive effect of different social capital dimensions on loneliness, suggesting that the risk for suffering loneliness was greatest in older people limited in functional ability, with less trust, less social connection, and less social participation. CONCLUSIONS Our findings show that social capital is associated with loneliness in older adults. This implies that social capital, especially in terms of trust, social connection, and social participation may be significant for alleviating loneliness in later life.
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Affiliation(s)
- Zhongliang Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China.,Department of Health Services Management, School of Health Services Management, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Zijing Wang
- Department of Health Services Management, School of Health Services Management, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Tiantai Shao
- Department of Health Services Management, School of Health Services Management, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Xia Qin
- Department of Health Services Management, School of Health Services Management, Anhui Medical University, Hefei, 230032, Anhui, China.
| | - Zhi Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China. .,Department of Health Services Management, School of Health Services Management, Anhui Medical University, Hefei, 230032, Anhui, China.
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18
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Burns A, Leavey G, Ward M, O’Sullivan R. The impact of loneliness on healthcare use in older people: evidence from a nationally representative cohort. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-020-01338-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Abstract
Aim
Concerns around loneliness leading to increased healthcare use persist in spite of a mixed evidence base and lack of adjustment for key potential confounders. We investigated the associations among loneliness, health and healthcare use in older adults including stratification to investigate whether these associations differ by gender.
Subject and methods
Secondary analysis of a nationally representative sample of 8175 community-dwelling adults aged 50 years and over from The Irish Longitudinal Study on Ageing (TILDA). Primary outcomes were self-reported general practitioner (GP) and emergency department (ED) visits in the past 12 months. Negative binomial and logistic regression analysis was used to investigate associations between loneliness and healthcare use, later adjusting for potential mediators (health and health behaviours).
Results
Loneliness was consistently positively associated with number of GP visits according to both cross-sectional and longitudinal analyses, with incidence rate ratios (IRRs) ranging from 1.08 to 1.33 in the sample overall. Associations with ED visits were less consistent. After adjusting for health and health behaviours, male loneliness does not appear to influence ED or GP visits. However, women who reported loneliness had an elevated risk of an ED visit at wave 1 (W1; odds ratio (OR) 1.08 [1.01–1.16]), as well as increased GP visits at both waves (IRRs ranging from 1.05 [1.02–1.07] to 1.16 [1.07–1.26]).
Conclusion
Older women experiencing loneliness visit their GP more often irrespective of health, health behaviours or social isolation. While effect sizes were small, there are implications for health service resources at a population level. Importantly, however, this may also be a useful opportunity to redirect towards appropriate services and tailored resources.
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Wee LE, Low LL, Thumboo J, Chan A, Lee KH. Factors associated with emergency room visits and hospitalisation amongst low-income public rental flat dwellers in Singapore. BMC Public Health 2019; 19:713. [PMID: 31174499 PMCID: PMC6556005 DOI: 10.1186/s12889-019-7009-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 05/20/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In Singapore, a densely urbanised Asian society, more than 80% of the population stays in public housing estates and the majority (90%) own their own homes. For the needy who cannot afford home ownership, public rental flats are available. Staying in a public rental flat is associated with higher hospital readmission rates and poorer access to health services. We sought to examine sociodemographic factors associated with hospital admissions and emergency room visits amongst public rental flat residents. METHODS We surveyed all residents aged ≥60 years in a public rental housing precinct in central Singapore in 2016. Residents self-reported their number of emergency room visits, as well as hospitalisations, in the past 6 months. We obtained information on residents' sociodemographic characteristics, medical, functional and social status via standardised questionnaires. We used chi-square to identify associations between emergency room visits/hospitalisations and sociodemographic characteristics, on univariate analysis; and logistic regression for multivariate analysis. RESULTS Of 1324 contactable residents, 928 participated in the survey, with a response rate of 70.1%. A total of 928 residents participated in our study, of which 59.5% were male (553/928) and 51.2% (476/928) were ≥ 70 years old. Around 9% (83/928) of residents had visited the emergency room in the last 6 months; while 10.5% (100/928) had been admitted to hospital in the past 6 months. On multivariable analysis, being religious (aOR = 0.43, 95%CI = 0.24-0.76) and having seen a primary care practitioner in the last 6 months (aOR = 0.46, 95%CI = 0.27-0.80) were independently associated with lower odds of emergency room visits, whereas loneliness (aOR = 1.96, 95%CI = 1.13-3.43), poorer coping (aOR = 1.72, 95%CI = 1.01-3.03) and better adherence (aOR = 2.23, 95%CI = 1.29-3.83) were independently associated with higher odds of emergency room visits. For hospitalisations, similarly poorer coping (aOR = 1.85, 95%CI = 1.12-3.07), better adherence (aOR = 1.69, 95%CI = 1.04-2.75) and poorer functional status (aOR = 1.85, 95%CI = 1.15-2.98) were all independently associated with higher odds of hospitalisations, whereas those who were religious (aOR = 0.62, 95%CI = 0.37-0.99) and those who were currently employed (aOR = 0.46, 95%CI = 0.37-0.99) had lower odds of being hospitalised. CONCLUSION In this public rental flat population, functional status, coping and adherence, and having a religion were independently associated with emergency room visits and hospitalisation. Residents who had seen a primary care practitioner in the last 6 months had lower odds of visiting the emergency room.
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Affiliation(s)
- Liang En Wee
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Lian Leng Low
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
| | - Julian Thumboo
- Department of Rheumatology, Singapore General Hospital, Singapore, Singapore
| | - Angelique Chan
- Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Kheng Hock Lee
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
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Peltzer K, Pengpid S. Loneliness correlates and associations with health variables in the general population in Indonesia. Int J Ment Health Syst 2019; 13:24. [PMID: 31007711 PMCID: PMC6456978 DOI: 10.1186/s13033-019-0281-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 04/01/2019] [Indexed: 12/31/2022] Open
Abstract
Background Loneliness has been commonly reported in high-income countries, while less is known about loneliness in Association of the Southeast Asian Nations (ASEAN) member states, in particular in Indonesia. Objective The aim of the study was to estimate the prevalence of loneliness, its correlates and associations with health variables in a national survey in the general population in Indonesia. Methods In the Indonesia Family Life Survey (IFLS-5) in 2014–2015, 31,447 participants 15 years and older (median age 35.0 years, interquartile range = 22.0) were interviewed and examined in a national population-based cross-sectional study. The self-reported prevalence of loneliness, blood pressure, body height and weight, physical and mental health, health behaviour and psychosocial variables were measured. Multinomial logistic regression analyses were used to estimate determinants of loneliness and logistic and linear regression analyses were applied to estimate the associations of loneliness with physical, mental and health risk behaviour variables. Results The self-reported prevalence of loneliness (occasionally or all of the time or 3–7 days per week) was 10.6% (11.0% for females and 10.1% for males), and 8.0% reported sometimes (1–2 days/week) to be lonely. Loneliness was distributed in a slight U-shaped form, with adolescents and the oldest old having the highest prevalence of loneliness. In adjusted multinomial logistic regression analysis, lower education, lower economic status, adverse childhood experiences, having one or more chronic conditions, functional disability and low neighbourhood trust were associated with loneliness. Loneliness was significantly associated with most health variables, including self-reported unhealthy health status (AOR 1.70, CI 1.57, 1.84), cognitive functioning (Beta: − 0.72, CI − 0.90 to − 0.54), having one or more chronic medical conditions (AOR 1.25, CI 1.16, 1.35), having had a stroke (AOR 1.58, CI 1.08, 2.29), depression symptoms (Beta: 5.19, CI 4.98–5.39), sleep disturbance (Beta: 0.34, CI 0.31–0.37), sleep related impairment (Beta: 0.69, CI 0.64–0.73), low life satisfaction (AOR 1.78, CI 1.64, 1.93), out-patient health care utilization in the past 4 weeks (AOR 1.11, CI 1.01, 1.21), current tobacco use (AOR 1.42, CI 1.28, 1.58), and one or more days in the past week soft drink consumption (AOR 1.20, CI 1.10, 1.31). Conclusion Loneliness was found to be prevalent across the life span and was associated with a number of poorer health variables. Several factors associated with loneliness were identified, which warrant further research in Indonesia.
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Affiliation(s)
- Karl Peltzer
- 1North West University, Potchefstroom, South Africa
| | - Supa Pengpid
- 1North West University, Potchefstroom, South Africa.,2ASEAN Institute for Health Development, Mahidol University, 25/25 Phutthamonthon Road 4, Salaya, Phutthamonton, Nakhon Pathom, 73170 Thailand
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Wee LE, Tsang TYY, Yi H, Toh SA, Lee GL, Yee J, Lee S, Oen K, Koh GCH. Loneliness amongst Low-Socioeconomic Status Elderly Singaporeans and its Association with Perceptions of the Neighbourhood Environment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16060967. [PMID: 30889851 PMCID: PMC6466029 DOI: 10.3390/ijerph16060967] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 01/08/2023]
Abstract
In Singapore, a densely urbanised Asian city state, more than 80% of the population stays in public housing estates and the majority (90%) own their own homes. For the needy who cannot afford home ownership, public rental flats are available. We were interested in exploring social-environmental factors that are associated with loneliness among elderly residents of public rental housing in Singapore. We surveyed residents aged ≥60 in two Singapore public housing precincts in 2016. Loneliness was measured using a three-item scale. Sociodemographic information was obtained via standardised questionnaires. We used chi-square to identify associations between loneliness and sociodemographic characteristics, as well as neighbourhood perceptions (safety, convenience and the physical environment), on univariate analysis; and logistic regression for multivariate analysis. The response rate was 62.1% (528/800). On multivariate analysis, staying in a rental flat block was independently associated with loneliness (adjusted odds ratio, aOR = 2.10, 95% confidence interval (CI) = 1.32⁻3.36), as was staying in a poorer physical environment (aOR = 1.92, 95% CI = 1.15⁻3.22). Although needy Singapore residents share the same built environment as more well-to-do neighbours, differences in the impact of loneliness do exist.
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Affiliation(s)
- Liang En Wee
- Department of Infectious Diseases, Singapore General Hospital, Singapore 169608, Singapore.
- Duke-NUS Graduate Medical School, Singapore 169857, Singapore.
| | | | - Huso Yi
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore 119228, Singapore.
| | - Sue Anne Toh
- Regional Health System Planning and Development, National University Health System, National University of Singapore, Singapore 119228, Singapore.
| | - Geok Ling Lee
- Department of Social Work, Faculty of Arts and Social Sciences, National University of Singapore, Singapore 119077, Singapore.
| | - Jaime Yee
- Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, Singapore 119228, Singapore.
| | - Shannon Lee
- Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, Singapore 119228, Singapore.
| | - Kellynn Oen
- Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, Singapore 119228, Singapore.
| | - Gerald Choon Huat Koh
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore 119228, Singapore.
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Gené-Badia J, Comice P, Belchín A, Erdozain MÁ, Cáliz L, Torres S, Rodríguez R. [Profiles of loneliness and social isolation in urban population]. Aten Primaria 2019; 52:224-232. [PMID: 30770152 PMCID: PMC7118570 DOI: 10.1016/j.aprim.2018.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/20/2018] [Accepted: 09/18/2018] [Indexed: 12/27/2022] Open
Abstract
Objetivo Determinar la prevalencia de soledad y aislamiento social en la población mayor de 65 años cubierta por un equipo de atención primaria urbano e identificar sus principales características. Diseño Encuesta telefónica. Emplazamiento Área básica de Barcelona. Participantes Muestra aleatoria de población asignada de edad igual o superior a 65 años. Mediciones principales Encuesta de soledad de UCLA, escala de red social de Lubben. Resultados Se entrevistó a 278 personas (respuesta 61,36%), 172 mujeres y 106 hombres, con una edad media de 76,7 ± 7,9 años. Existía una mayor proporción de factores de riesgo de soledad en los que no respondieron. La soledad se correlaciona estrechamente con el aislamiento social r = 0,736. La soledad moderada, con una prevalencia del 16,54%, se asocia a presentar dificultades a la marcha (OR 3,09, IC del 95%, 1,03-9,29), deterioro cognitivo (OR 3,97, IC del 95%, 1,19-13,27) y a barreras arquitectónicas (OR 5,29, IC del 95%, 2,12-13,23), mientras que la soledad severa, con una prevalencia de 18,71%, solo se asocia a convivir con menos personas (OR 0,61, IC del 95%, 0,40-0,93). El riesgo de aislamiento social, con una prevalencia del 38,85%, se asocia a la edad (OR 1,06, IC del 95%, 1,02-1,10) y a problemas de salud (OR 4,35, IC del 95%, 1,11-16,99). Conclusiones La soledad y el aislamiento social son muy prevalentes. Existen 2 perfiles de soledad, una moderada relacionada con las dificultades a la sociabilidad que aparecen con el envejecimiento y otra severa que no está asociada a la salud o las barreras. Las intervenciones deberían adecuarse a cada uno de estos perfiles.
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Affiliation(s)
- Joan Gené-Badia
- Institut Català de la Salut, Barcelona, España; CAPSBE, Barcelona, España; Universitat de Barcelona, Barcelona, España.
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Zhang J, Xu L, Li J, Sun L, Ding G, Qin W, Wang Q, Zhu J, Yu Z, Xie S. Loneliness and Health Service Utilization among the Rural Elderly in Shandong, China: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071468. [PMID: 29997379 PMCID: PMC6068910 DOI: 10.3390/ijerph15071468] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 06/21/2018] [Accepted: 07/10/2018] [Indexed: 12/15/2022]
Abstract
Objectives: To examine the prevalence of loneliness and to explore the association between loneliness and health service utilization among the rural elderly in Shandong Province, China. Methods: A total of 5514 rural people aged 60 and above from Shandong Province, China, were enrolled in this study. Loneliness was used as a binary variable based on a single-item question. Health service utilization was measured by recent two-week physician visits and annual hospitalizations rates. Multiple logistic regression analysis was performed to examine the association between loneliness and health service utilization. Results: The prevalence of loneliness among the rural elderly in Shandong, China, was 25.0%. Loneliness was associated with higher rates of recent two-week physician visits (OR = 1.260, p < 0.01) and annual hospitalizations (OR = 1.183, p < 0.05). The regression results also showed that self-rated health status and chronic conditions were significant and positively associated with both physician visits and hospitalizations rates. Conclusions: Loneliness had a significant association with higher odds of health service utilization among the elderly. The independent contribution of loneliness on health service utilization was smaller than self-rated health status and chronic conditions. Thus, healthcare policies need to shift from an emphasis on controlling health utilization and cost to a greater focus on enabling lonely older people to get more social support.
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Affiliation(s)
- Jiao Zhang
- School of Public Health, Shandong University, Jinan 250012, China.
| | - Lingzhong Xu
- School of Public Health, Shandong University, Jinan 250012, China.
- Collaborative Innovation Center of Social Risks Governance in Health, School of Public health, Fudan University, Shanghai 200032, China.
- Key Laboratory of Health Economics and Policy Research, School of Public Health, Shandong University, Jinan 250012, China.
| | - Jiajia Li
- School of Public Health, Shandong University, Jinan 250012, China.
- Collaborative Innovation Center of Social Risks Governance in Health, School of Public health, Fudan University, Shanghai 200032, China.
| | - Long Sun
- School of Public Health, Shandong University, Jinan 250012, China.
- Collaborative Innovation Center of Social Risks Governance in Health, School of Public health, Fudan University, Shanghai 200032, China.
| | - Gan Ding
- School of Public Health, Shandong University, Jinan 250012, China.
| | - Wenzhe Qin
- School of Public Health, Shandong University, Jinan 250012, China.
| | - Qian Wang
- School of Public Health, Shandong University, Jinan 250012, China.
| | - Jing Zhu
- School of Public Health, Shandong University, Jinan 250012, China.
| | - Zihang Yu
- School of Public Health, Shandong University, Jinan 250012, China.
| | - Su Xie
- School of Public Health, Shandong University, Jinan 250012, China.
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Low LL, Maulod A, Lee KH. Evaluating a novel Integrated Community of Care (ICoC) for patients from an urbanised low-income community in Singapore using the participatory action research (PAR) methodology: a study protocol. BMJ Open 2017; 7:e017839. [PMID: 28993391 PMCID: PMC5640049 DOI: 10.1136/bmjopen-2017-017839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Poorer health outcomes and disproportionate healthcare use in socioeconomically disadvantaged patients is well established. However, there is sparse literature on effective integrated care interventions that specifically target these high-risk individuals. The Integrated Community of Care (ICoC) is a novel care model that integrates hospital-based transitional care with health and social care in the community for high-risk individuals living in socially deprived communities. This study aims to evaluate the effectiveness of the ICoC in reducing acute hospital use and investigate the implementation process and its effects on clinical outcomes using a mixed-methods participatory action research (PAR) approach. METHODS AND ANALYSIS This is a single-centre prospective, controlled, observational study performed in the SingHealth Regional Health System. A total of 250 eligible patients from an urbanised low-income community in Singapore will be enrolled during their index hospitalisation. Our PAR model combines two research components: quantitative and qualitative, at different phases of the intervention. Outcomes of acute hospital use and health-related quality of life are compared with controls, at 30 days and 1 year. The qualitative study aims at developing a more context-specific social ecological model of health behaviour. This model will identify how influences within one's social environment: individual, interpersonal, organisational, community and policy factors affect people's experiences and behaviours during care transitions from hospital to home. Knowledge on the operational aspects of ICoC will enrich our evidence-based strategies to understand the impact of the ICoC. The blending of qualitative and quantitative mixed methods recognises the dynamic implementation processes as well as the complex and evolving needs of community stakeholders in shaping outcomes. ETHICS AND DISSEMINATION Ethics approval was granted by the SingHealth Centralised Institutional Review Board (CIRB 2015/2277). The findings from this study will be disseminated by publications in peer-reviewed journals, scientific meetings and presentations to government policy-makers. TRIAL REGISTRATION NUMBER NCT02678273.
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Affiliation(s)
- Lian Leng Low
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore
- Department of Family Medicine, Duke-NUS Medical School, Singapore
| | - Adlina Maulod
- Centre for Aging Research and Education, Duke-NUS Medical School, Singapore
| | - Kheng Hock Lee
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore
- Department of Family Medicine, Duke-NUS Medical School, Singapore
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