Loneliness in Chinese older adults in primary care: prevalence and correlates

Roles of Loneliness, Stress, and Religiosity in Suicide Ideation Among Nigerian Older Adults

Suicidal behavior in older adults is a fundamental public health problem globally and the highest suicide rates occur in low- and middle-income countries (LMICs). However, there is limited research on suicidality among older adults, especially in sub-Saharan Africa. We sought to find out whether loneliness, stress and religiosity would be associated with suicide ideation in a sample of sub-Saharan African older adults (N = 500; aged 51-70 years, Mage = 58.97, SD = 6.16; 45.6% women). They completed the Beck Suicidal Ideation Scale, the UCLA Loneliness Scale-version 3, Perceived Stress Scale, and Religiosity Scale. Regression results showed that whereas suicidal ideation could be increased by loneliness and stress, religious older adults were less likely to report suicidal ideation. Interventions aimed at managing and protecting the mental health of older adults during their transition to late adulthood should guard them against loneliness and buffer their resilience and coping strategies with the connectedness that religiosity offers.

Mediating role of social disengagement and loneliness in the nexus between functional health and mental well-being in older individuals

Few studies have focused sufficiently on the intricate link between functional health and depression among older people aged 60 and above in India. Therefore, the current study investigates the association between functional health and depression among older Indian adults through the mediating role of social disengagement and loneliness and the moderating role of living arrangements using recent data from the Longitudinal Aging Study in India (LASI: 2017-2018). Composite International Diagnostic Interview-Short Form (CIDI-SF) for depression, the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) for functional health, and the indoor/outdoor activities, visits, and religious events for social disengagement were used. The feelings of loneliness and living arrangements were measured using single-item questions and surveys/interviews of household members. Bivariate analysis, logistic regression, and a Partial Least Squares-Structural Equation Model were adopted. The results show that older persons with functional health had 1.85 times higher odds of depression; similarly, those not engaging in social activities and experiencing loneliness were more likely to feel depressed. Living with someone was negatively linked to depression. A significant moderation by living arrangements in the functional health-depression relationship was also observed. The results also indicate significant mediating roles of social disengagement and loneliness, with 22.0% and 3.08% mediation effects, respectively. Therefore, this study recommends the provision of housing and social interaction among older people.

An exploratory study on material deprivation and loneliness among older adults in Hong Kong

BACKGROUND

Poverty, as a risk factor for loneliness, has been understudied, and there is a need to gain a better understanding of the relationship between poverty examined by material deprivation and loneliness among older adults in Hong Kong. It also aimed to explore the possible mediation and moderation effects of social support, social networks, neighborhood collective efficacy, and social engagement in the link between material deprivation and loneliness.

METHODS

1696 Chinese older adults aged 60 years and above (Mage = 74.61; SD = 8.71) participated in a two-wave study. Older adults reported their loneliness level, material deprivation, perceived level of social support, social network, neighborhood collective efficacy, social engagement, and sociodemographic information. Logistic regression was conducted to examine the effect of material deprivation on loneliness, as well as the mediation and moderation models.

RESULTS

The results indicated that material deprived older adults reported a significantly higher level of loneliness 2 years later when controlling for demographic variables, health-related factors, and loneliness at baseline. We also found that engagement in cultural activities partially mediated the effect of material deprivation and loneliness. Furthermore, neighborhood collective efficacy and engagement in cultural activities were significant moderators that buffer the relationship between material deprivation and loneliness.

CONCLUSIONS

Our results suggested the need to alleviate the negative impact of material deprivation on loneliness by developing interventions focused on promoting neighborhood collective efficacy and social engagement, which could be aimed at building meaningful bonds among Chinese older adults in Hong Kong.

Elevated levels of loneliness in migrant children compared to nonmigrant children in urban China: a systematic review and meta-analysis of comparative studies

PURPOSE OF REVIEW

About one in four children in China is a migrant child. This population has a higher risk of experiencing loneliness. However, existing studies present conflicting findings regarding the levels of loneliness among migrant children as compared to local urban children in urban China. This review performs a meta-analysis of studies comparing loneliness levels between these two groups.

RECENT FINDINGS

A literature search of major Chinese- and English-language databases revealed 27 eligible comparative studies. These studies reported the means and standardized deviations of loneliness scores for both migrant and nonmigrant children in urban China. Meta-analysis results showed that migrant children experienced significantly higher levels of loneliness than their urban nonmigrant counterparts [standardized mean difference (SMD) = 0.21, P  < 0.001]. Subgroup analysis revealed that studies enrolling migrant children from migrant children's schools had significantly higher pooled SMDs than those enrolling children from public schools (0.346 vs. 0.120, P  = 0.047).

SUMMARY

Migrant children in urban China experience higher levels of loneliness compared to their local urban peers. Efforts to create a socially inclusive, migrant-friendly environment and reduce social isolation among migrant children are crucial to help alleviate their feelings of loneliness.

Loneliness in older Chinese adults amid the COVID-19 pandemic: Prevalence and associated factors

INTRODUCTION

Data on loneliness among older adults in China during the COVID-19 pandemic are still scarce. This study aimed to examine the prevalence of loneliness and identify its associated factors among older Chinese adults during the COVID-19 pandemic.

METHODS

During the COVID-19 pandemic, 1268 older Chinese adults (aged 50+ years) were recruited through snowball sampling. The Chinese version of the validated six-item De Jong Gierveld Loneliness Scale was used to assess participants' recent feelings of loneliness, and a cut-off score of two or more was used to indicate the presence of loneliness.

RESULTS

Loneliness was experienced by 37.9% of the participants in recent days. Factors significantly associated with loneliness included male sex (vs. female, OR: 1.62, p < .001), an education level of middle school and below (vs. college and above, OR: 1.50, p = .007), residing in the COVID-19 epicenter (vs. other provinces, OR: 1.48, p = .004), concern about contracting COVID-19 (OR: 1.68, p = .001), poor knowledge of COVID-19 (OR: 2.39, p = .012), and physical health problems (OR: 1.65, p < .001).

DISCUSSION

Loneliness is common among older Chinese adults amid the COVID-19 pandemic. Targeted intervention programs may be more effective in reducing loneliness among older adults who are worried about contracting COVID-19, have poor COVID-19 knowledge, and experience physical health problems.

Longitudinal Association Between Perceived Availability of Home- and Community-Based Services and All-Cause Mortality Among Chinese Older Adults: A National Cohort Study

Home- and community-based services (HCBS) may contribute to lowering mortality and enhancing quality of life among older adults. Limited research, however, has examined this relationship in the Chinese context. This study explored the longitudinal association between perceived availability of HCBS and all-cause mortality among Chinese older adults. This cohort study included 8,102 individuals aged 65 years and older from the 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. HCBS included daily life assistance, medical care services, emotional support and social services, and reconciliation and legal aid services. The association between perceived availability of HCBS and all-cause mortality was investigated using Cox proportional hazards models. Emotional support and social services were negatively associated with all-cause mortality (HR = 0.86, 95% CI: 0.78 ~ 0.95, P = .004). Daily life assistance, medical care services, and reconciliation and legal aid services were not significantly associated with all-cause mortality. Providing community-level emotional support and social services may reduce the risk of death. Focusing on the mental health and social well-being of older adults is just as important as caring for their physical health.

The Psychological Network of Loneliness Symptoms Among Chinese Residents During the COVID-19 Outbreak

Purpose

Social distancing measures implemented during the COVID-19 pandemic have contributed to increased levels of loneliness, but the specific interactions between loneliness symptoms in the context of the pandemic remain unknown. This study characterized the psychological network of loneliness symptoms in residents during the initial wave of COVID-19 outbreak in China.

Patients and Methods

The study recruited 8472 Chinese residents (61.5% women, aged 33.0±10.6 years) through online snowball sampling. The Six-item De Jong Gierveld Loneliness Scale (DJGLS) was used to measure loneliness symptoms. Central symptoms of and bridge symptoms between emotional and social loneliness subscales were identified based on centrality and bridge centrality indices, respectively. Network stability was examined using the case-dropping procedures.

Results

The nodes in the loneliness network were separated into two groups, corresponding to the social and emotional loneliness domains of the DJGLS. The strongest direction association was between "no reliable people" and "no trustworthy people" (edge weight=0.546). "No trustworthy people" has the highest node strength (1.047) in the loneliness network, followed by "emptiness sense" (0.767) and "no reliable people" (0.749). "Feeling of rejection" (1.672) and "no close people" (0.403) showed the first and second highest bridge strengths, respectively. Both the stability and accuracy tests supported robustness of the whole network.

Conclusion

Interventions targeting central symptoms "no trustworthy people" and "emptiness sense" and central bridge symptom "feeling of rejection" may be effective for alleviating the overall level of loneliness in pandemic-affected Chinese residents.

Association between age and loneliness in different residential type and gender groups: evidence from China

BACKGROUND

Age has been identified as a prominent predictor of loneliness, although the findings about the relationship between age and loneliness are inconclusive. This study examines the relationship between age and loneliness in the context of China, with a focus on residential and gender differences.

METHODS

Data were from the Chinese General Social Survey (CGSS) of 2017. A total of 3899 respondents were included. Loneliness was measured using a three-item Short Loneliness Scale. Age, squared terms of age, residential type, gender, and other socio-demographic characteristics were included in the study. Regression analyses were conducted among the total sample and subgroups of different gender and residential type subgroups, to investigate the association between age and loneliness.

RESULTS

There is a reverse U-shaped tendency between age and loneliness that peaks at the age of 47. This tendency is true of the male subgroup, that peaks at the age of 55, while the female respondents do not share that tendency. The inverted U-shaped distribution holds true for urban but not for rural residents. The female respondents reported a higher level of loneliness than the male. The rural respondents reported higher loneliness than their counterparts.

CONCLUSIONS

This study demonstrates that an inverted U-shaped tendency between age and loneliness existed for the entire group, and the male and urban subgroups. Implications for service and practice are proposed based on the empirical findings.

Influencing factors of loneliness among older adults in China: a systematic review and meta-analysis

China has a large and rapidly growing older population. Loneliness is associated with a range of negative health outcomes in older adults. However, to date, there is still a lack of comprehensive and systematic evidence on the factors influencing loneliness among older adults in China. Nine Chinese and English databases were searched by computer from inception to March 2022: China Knowledge Network, WanFang Data, Chinese Scientific Journal Database, SinoMed, PubMed, Embase, Web of Science, PsycINFO, and Cochrane Library. Studies on factors influencing loneliness among older adults in China were included. Two reviewers independently completed the literature screening, quality evaluation, and data extraction, and statistical analyses were performed using Review Manager 5.4 software. A total of 15 studies were included in the review, with 47 066 participants in total. Fifty-nine influencing factors of loneliness in older Chinese were involved. Twenty factors with a total of 30 subfactors that were involved in two or more studies and with extractable data were included in the data synthesis. Eleven subfactors were not statistically significantly associated with loneliness, namely, male, female, lower age, higher education level, health status-fair, health status-poor, social support-none/low, no health insurance, smoking, alcohol consumption, and body mass index-overweight and above (all P > 0.05), while the remaining 19 subfactors (concerning 15 factors) were significantly associated with loneliness in older adults in China (all P < 0.05). This study suggested that age, education level, marital status, living arrangement, having (no) children, receiving family support, relationship with family members, being with or without chronic diseases, health status, activities of daily living, social support, social activities, financial status, satisfaction with housing conditions, and the decision-making right for major household expenditures were the main influencing factors of loneliness among older adults in China.

A Systematic Literature Review of Loneliness in Community Dwelling Older Adults

Research on loneliness is extensive. This paper presents a systematic review of intervention studies, outlining the antecedents to, and consequences of loneliness in community-dwelling older people. Using PRISMA methodology, a systematic literature review was conducted between January and August 2021 resulting in 49 useable articles. Papers were included if they: (a) investigated older people (+50); (b) were living in community dwellings; (c) had been published in English; (d) had titles or abstracts available and, (e) were published between 2016 and 2021. This study found the antecedents and consequences of social, emotional and existential loneliness differ, however, the vast majority of research has not examined the unique types of loneliness and instead kept loneliness as a generic term, despite the acceptance that various types of loneliness exist. In addition, the findings of intervention studies identified through this review have yielded mixed results. Those interventions focused on improving personal and psycho-social resources for older people fared better outcomes than those focused on technological and social connections alone. This paper reports important implications for the future of research conducted on loneliness and interventions accordingly.

The Association of Loneliness With Health and Social Care Utilization in Older Adults in the General Population: A Systematic Review

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.

Clinical insomnia among elderly primary care attenders in Wuhan, China: A multicenter cross-sectional epidemiological study

Background and objectives

Integrating sleep health into primary care is a promising approach to narrow the treatment gap for insomnia in older adults but data regarding the epidemiological characteristics of insomnia among elderly primary care attenders (EPCAs) are very limited. This study examined the prevalence and correlates of clinical insomnia among Chinese EPCAs.

Methods

By using two-stage consecutive sampling method, a total of 757 EPCAs were recruited from seven urban and six rural primary care centers in Wuhan, China. The Insomnia Severity Index (ISI) and the Geriatric Depression Scale (15 item version) were administered to assess insomnia severity and depressive symptoms, respectively.

Results

The two-week prevalence of clinical insomnia (ISI score ≥ 15) was 28.9%. Significant correlates of clinical insomnia were: female sex (vs. male, OR = 2.13, P < 0.001), fair and poor family relationship (vs. good, OR = 1.59, P = 0.028), hypertension (OR = 1.67, P = 0.004), heart disease (OR = 1.73, P = 0.048), arthritis (OR = 2.72, P = 0.001), and depressive symptoms (OR = 4.53, P < 0.001).

Conclusion

The high prevalence of clinical insomnia among Chinese EPCAs suggests a high level of sleep health need in older patients in China's primary care settings. Considering the many negative outcomes associated with insomnia, it is necessary to integrate sleep health into primary care in China.

Depressive disorders in older Chinese adults with essential hypertension: A classification tree analysis

Background

Although there has been accumulating evidence on the elevated risk of depression in hypertensive patients, data regarding depressive disorders in older adults with hypertension and the interplay between factors associated with depression in this population are very limited. Disentangling the mutual influences between factors may help illuminate the pathways involved in the pathogenesis of the comorbidity of depression in hypertension. This study investigated the prevalence of depressive disorders in older Chinese adults with hypertension and examined major correlates of depressive disorders and the interactions between correlates by using classification tree analysis (CTA).

Methods

In total, 374 older adults with essential hypertension were enrolled from seven urban and six rural primary care centers in Wuhan, China, and interviewed with the Chinese Mini-international Neuropsychiatric Interview 5.0. Family relationship and feelings of loneliness were assessed with standardized questions. A checklist was used to assess the presence of six major medical conditions: diabetes mellitus, heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, chronic gastric ulcer, and arthritis.

Results

The 1-month prevalence rate of depressive disorders was 25.7%. The CTA model identified four major correlates of depressive disorders: loneliness was the most salient, followed by arthritis, family relationship, and heart disease. There were statistically significant interactions between loneliness and arthritis, loneliness and family relationship, and arthritis and heart disease.

Conclusion

Over one out of every four older Chinese adults with hypertension suffer from depressive disorders. Collaborative multidisciplinary management services are needed to reduce the burden of depression in hypertensive older adults, which may include social work outreach services to promote family relationship, mental health services to relive loneliness, and primary care services to manage arthritis and heart disease.

Prevalence and correlates of suspected dementia in older adults receiving primary healthcare in Wuhan, China: A multicenter cross-sectional survey

Background

Integrating the management of dementia into primary healthcare is a cost-effective way to reduce the burden of dementia but the clinical epidemiology of dementia in primary healthcare settings remains unclear. This study investigated the prevalence and correlates of suspected dementia in Chinese older adults receiving primary healthcare.

Methods

In this multicenter cross-sectional survey, a total of 773 older adults (≥65 years) were consecutively recruited from seven urban and six rural primary care clinics in Wuhan, China, and interviewed with the validated Chinese version of the Brief Community Screening Instrument for Dementia (BCSI-D). Participants with suspected dementia were those who were screened positive on the BCSI-D.

Results

The prevalence of suspected dementia in older primary healthcare adults was 26.8%. Factors significantly associated with suspected dementia were female sex (OR = 1.95, P < 0.001), age-group of 75+ (OR = 1.68, P = 0.004), poor financial status (OR = 4.79, P < 0.001), rural residence (OR = 1.47, P = 0.032), no regular physical exercise (OR = 1.74, P = 0.002), and stroke and other cerebrovascular diseases (OR = 1.97, P = 0.015).

Conclusions

Chinese older adults receiving primary healthcare are at high risk of suspected dementia. Screening and intervention efforts for dementia in primary healthcare settings may be more useful to target older adults who are women, are 75 years and above, have poor economic status, are rural residents, have no exercise habit, and suffer from cerebrovascular diseases.

Anxiety symptoms in older Chinese adults in primary care settings: Prevalence and correlates

Background

Integrating mental health services into primary care is a potentially cost-effective way to decrease the treatment gap for anxiety in older adults but data on the epidemiology of anxiety symptoms in older Chinese adults in primary care settings have been very limited. This study investigated the prevalence and correlates of anxiety symptoms in Chinese older primary care patients.

Methods

A total of 753 older primary care patients (≥65 years) were consecutively recruited from 13 primary care clinics in Wuhan, China, and interviewed with the validated Chinese version of the short form of the Geriatric Anxiety Inventory (GAI-SF).

Results

The prevalence of anxiety symptoms (GAI-SF ≥ 3) in older primary care patients was 21.1%. Statistically significant correlates of anxiety symptoms were female sex (vs. male, OR = 1.85, P = 0.002), poor economic status (vs. good, OR = 2.31, P = 0.013), fair and poor family relationship (vs. good, OR = 1.85, P = 0.006), hypertension (OR = 2.01, P < 0.001), chronic gastric ulcer (OR = 6.82, P < 0.001), and Parkinson's disease (OR = 7.83, P = 0.031).

Conclusions

Anxiety symptoms are prevalent among older adults attending primary care clinics. Efforts for preventing or reducing anxiety symptoms in older primary care patients may be more useful to target those who are women, have poor financial status, don't have a good family relationship, suffer from hypertension, have chronic gastric ulcer, and suffer from Parkinson's disease.

Vulnerable populations during COVID-19 response: Health-related quality of life among Chinese population and its influence due to socio-demographic factors and loneliness

Background

Infection control policy affected people's wellbeing during the COVID-19 pandemic, especially those vulnerable populations. This study aimed to compare the health-related quality of life (HRQoL) of the Hong Kong (HK) Chinese population under the pandemic with the normative profiles and explore its influencing factors, including socio-demographic characteristics, loneliness, and the interaction between them.

Methods

A cross-sectional questionnaire survey (301 online and 202 in-person) was conducted between June and December 2020 among the adult Chinese population during the 2nd wave of COVID-19 in HK. HRQoL was measured by a Hong Kong validated EQ-5D-5L instrument (EQ-5D-5L HK). Loneliness was measured by a single-item question regarding the frequency of the participants reporting feeling lonely and their subjective social status was measured by the MacArthur Scale of Subjective Social Status. A series of Tobit regressions was conducted. The interaction terms between socio-demographics and loneliness were also examined to decide their association with HRQoL.

Results

A total of 503 responses were collected. The level of HRQoL of the respondents was significantly lower than the referred norms profile among the local general population. The findings identified that younger age, single, a higher subjective social status, and a lower level of loneliness were significantly associated with better HRQoL. Moreover, age and marital status were significant moderators in the relationship between loneliness and HRQoL.

Conclusion

The present study found that some population groups face additional vulnerabilities during the pandemic in terms of declined HRQoL. In addition, reducing loneliness can protect the HRQoL during the pandemic, especially among older people. This article provides useful information for policy-makers to design and promote effective services or provide education to improve the connection of people and recover from the global pandemic.

Predictors of Depression Level among Community-Dwelling Elderly Persons

Elderly people in the community have difficulty taking care of themselves because of their inability to care for themselves in daily life as well as their poor social support system, which leads to loneliness, resulting in depression. The primary objective was to investigate the level of depression and related factors among community-dwelling elderly persons (CDEP). This was a cross-sectional study, and 150 participants were interviewed. The questionnaires included demographics, the Functional Independence Measure, the Interpersonal Support Evaluation List, the UCLA Loneliness Scale, and the Geriatric Depression Scale Short Form. It was found that participants with different levels of depression accounted for 26%, and education level, living status, chronic disease, daily life function, social support, and loneliness were all significant factors influencing the depression level among the CDEP that could significantly predict 63.4% of the variation in depression level. Nursing staff must understand the level of depression and its influencing factors, encourage the elderly in the community to increase social networks, and integrate leisure into their lives, thereby enhancing the sense of value and meaning of life and reducing feelings of loneliness and depression.

Caste and COVID-19: Psychosocial disparities amongst rural Indian women during the coronavirus pandemic

The COVID-19 pandemic has exacerbated preexisting mental health disparities. In India, marginalization based on caste membership, gender, and rural residence are critical determinants of inequity across the lifespan. Guided by the theoretical frameworks of minority stress and intersectionality, this study examined caste-based disparities in fear of coronavirus (FOC), mental health symptoms, and perceived loneliness amongst rural women in north India during the COVID-19 pandemic. Participants (N = 316) completed self-report measures and were classified into three groups based on their responses: General caste (GC, n = 124), other backward castes (OBC, n = 122), and scheduled caste or tribe (SC/ST, n = 71). Using a three-way ANOVA and Tukey t-tests, women in SC/ST and OBC groups reported greater FOC (OBC d = .37; SC/ST d = .40) and greater mental health symptoms (OBC d = .58; SC/ST d = .43) relative to the GC group. OBC, but not SC/ST, group also reported higher perceived loneliness (d = .32). The results were consistent after adjusting for demographic variables such as wealth and highlight caste as an important social determinant for well-being during the COVID-19 pandemic amongst rural Indian women.

Mediating Role of Psychological Capital in the Relationship Between Social Support and Self-Neglect Among Chinese Community-Dwelling Older Adults

Objectives

Self-neglect in older adults has become an important public health issue and is associated with negative health outcomes and increased morbidity and mortality. Social support has been recognized as a prominent predictor of self-neglect, but the underlying mechanism is unclear. This study aims to investigate and illustrate the associations among social support, psychological capital, and self-neglect.

Methods

This study used a cross-sectional convenience sampling design. A total of 511 older adults were recruited in Chinese communities. Spearman’s correlation coefficient and hierarchical multiple regression analysis were performed to assess the influencing factors of self-neglect. A structural equation model was applied to test the hypothesized mediation model.

Results

Social support and psychological capital were found to be negatively related to self-neglect. Social support and psychological capital explained 5.1 and 11.9% of the incremental variances of older adults’ self-neglect, respectively. Psychological capital acts as a mediator between social support and self-neglect.

Conclusion

Self-neglect among older adults is a rising problem in China. Social support and higher psychological capital could decrease the risk of self-neglect in older adults. It is crucial to improve social networks and facilitate psychological interventions to reduce such self-neglect.

Prevalence of Loneliness and Associated Factors among Community-Dwelling Older Adults in Indonesia: A Cross-Sectional Study

Loneliness has become one of the most common psychological problems experienced by older adults. Previous studies have indicated that loneliness is correlated with poor physical and psychological health outcomes; therefore, it is important to pay attention to people experiencing loneliness. However, there is a lack of information regarding the prevalence of loneliness, and its associated factors, among community-dwelling older adults in Indonesia, which this study aimed to understand. This study used a cross-sectional, descriptive, and correlational research design. Stratified random sampling was applied to 1360 participants, aged ≥ 60 years, in 15 community health centers in Kendari City, Indonesia. The following questionnaires were used to collect data, including demographic and characteristic information, Short Portable Mental Status Questionnaire, Multidimensional Scale of Perceived Social Support, Geriatric Depression Scale Short Form, and a single-item loneliness question. The prevalence of loneliness among older adults was 64.0%. The multivariate logistic regression showed that older adults who were female, lived with family, had fewer children, had a poor health status, had a poor oral status, had more chronic diseases, had no hearing problems, had poor cognitive function, and had depression had a higher chance of feeling lonely. Loneliness is a serious health issue among the older population in Indonesia. The government, social workers, and healthcare professionals should pay immediate attention to this psychological problem. The study also suggests that appropriate strategies for the prevention of loneliness should be developed in the near future.

Psychosocial aspects and support networks associated with disability in two longevous populations in Brazil: a cross-sectional study

BACKGROUND

Among the oldest old, aged 80 years and over, the prevalence of disability is higher than in other age groups and can be considered a predictor of mortality.

OBJECTIVE

To evaluate how psychosocial aspects and support networks influence the disability of these oldest-old individuals, performing a comparison between two longevous populations, one living in one of the poorest regions of Brazil, in the backlands of Paraíba, and another living in one of the largest urban centres in Latin America.

METHOD

A cross-sectional study in which 417 oldest-old persons aged 80 years and older were interviewed, with data collected through the "Health, Welfare and Ageing" survey conducted in two Brazilian cities. Disability was assessed by reporting the need for assistance in Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Bivariate and multiple analyses were performed using R statistical software.

RESULTS

Food insufficiency in the first years of life had negative repercussions on the disability of oldest old people living in the northeast. On the other hand, in this region, older people have a higher rate of support and live longer with their peers, which may contribute to reducing feelings of loneliness, depressive symptoms, and worse self-perception of health. In the Southeast, financial constraints, subjective poverty, and unmet needs may favour the development of functional limitations between long-lived people.

CONCLUSION

Our findings indicate that regional differences in Brazil may influence the disability of older people aged 80 and older. In northeast Brazil, having no partner may contribute to disability for ADLs and IADLs; while, in the longevous population of São Paulo, having a worse self-rated health may contribute to disability for IADLs.

Prevalence and correlates of suicidal ideation among older adults attending primary care clinics in Wuhan, China: A multicenter cross-sectional study

BACKGROUND

Primary care represents an ideal setting for screening for and managing suicidal older adults but the clinical epidemiology of suicidal ideation in Chinese older primary care patients remains unclear. This study investigated the prevalence and correlates of suicidal ideation in older Chinese adults receiving primary care.

METHODS

This multicenter cross-sectional survey included a total of 769 older adults (≥65 years) from seven urban and six rural primary care clinics in Wuhan, China. The presence of depressive symptoms and suicidal ideation was assessed with the Geriatric Depression Scale and a single-item question "In the past 12 months, did you think about ending your life?," respectively.

RESULTS

The 12-month prevalence of suicidal ideation in older primary care patients was 16.6%. Significant correlates of suicidal ideation were poor economic status (vs. good, OR = 2.80, P = 0.008), heart disease (OR = 2.48, P = 0.005), chronic gastric ulcer (OR = 3.55, P = 0.012), arthritis (OR = 2.10, P = 0.042), and depressive symptoms (OR = 11.29, P < 0.001).

CONCLUSIONS

Suicidal ideation is common among older adults attending Chinese primary care clinics. It is necessary to integrate psychological crisis intervention into primary care to prevent late-life suicide.

Prevalence of Insomnia Symptoms in Older Chinese Adults During the COVID-19 Pandemic: A Meta-Analysis

Background: The ongoing COVID-19 pandemic has disproportionately affected the sleep health of older adults, but the limited number of studies on insomnia symptoms of older Chinese adults differed in terms of screener of insomnia, sample size, and prevalence, making mental health planning for this population difficult. This meta-analysis estimated the prevalence of insomnia symptoms in older Chinese adults during the COVID-19 pandemic.

Methods: Both Chinese (CNKI, Wanfang, VIP) and English (PubMed, EmBase, PsycInfo) databases were systematically searched to identify cross-sectional studies containing data on the prevalence of insomnia symptoms in older Chinese adults during the pandemic. Risk of bias (RoB) of included studies was assessed with the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data.

Results: Nine studies with a total of 27,207 older Chinese adults were included. RoB scores of these studies ranged between zero and six. The pooled prevalence rates of insomnia symptoms and moderate and severe insomnia symptoms were 24.6% [95% confidence interval (CI): 19.5–30.5%] and 11.1% (95% CI: 7.2–16.9%), respectively. In subgroup analysis, significantly higher prevalence rates were observed in studies defining insomnia symptoms as “Insomnia Severity Index (ISI) ≥ 8” than in those defining them as “ISI ≥ 15” (32.6 vs. 15.6%, P < 0.001) and in older adults living in the COVID-19 epicenter than in those living in other places (35.2 vs. 23.3%, P = 0.006).

Conclusion: Nearly one out of every four older Chinese adults suffered from insomnia symptoms during the pandemic. Mental health services for this population during the pandemic should include supportive activities aimed at improving mental well-being, periodic assessment of insomnia symptoms, and psychiatric assessment and treatment when necessary.

Leisure activity and cognitive function among Chinese old adults: The multiple mediation effect of anxiety and loneliness

BACKGROUND

Most countries in the world, including China, are experiencing serious aging problems. The decline of cognitive function seriously affects the quality of life of the elderly in their later years and brings an inevitable heavy burden to the family and society. Therefore, in order to achieve successful aging, the purpose of this study is to test the serial multiple mediation effect of anxiety and loneliness between leisure activity and cognitive function in Chinese elderly population.

METHODS

Using 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS) dataset, we finally selected 6,525 Chinese elderly people over 65 years old after screening. Firstly, we described the basic social demographic information of the sample population. Secondly, Spearman correlation analysis was used to determine whether there is a correlation between leisure activity, anxiety, loneliness and cognitive function in Chinese elderly. Finally, the serial multiple mediation analysis was completed using the SPSS macro PROCESS program.

RESULTS

Leisure activity, anxiety, loneliness and cognitive function were significantly correlated (p<0.01). Leisure activity can not only have a direct positive impact on the cognitive function of the elderly (effect=0.2231; SE=0.0122; 95%CI: LL=0.1992, UL=0.2470), but also have an indirect impact on the cognitive function through three paths: the independent mediating role of anxiety (effect=0.0028; SE=0.0015; 95%CI: LL=0.0001, UL=0.0059), the independent mediating role of loneliness (effect=0.0032; SE=0.0016; 95%CI: LL=0.0002, UL=0.0065), and the chain mediating role of anxiety and loneliness (effect=0.0008; SE=0.0004; 95%CI: LL=0.0001, UL=0.0017).

LIMITATIONS

All items were self-reported and some results may have biased. In the future, it may be more instructive to explore the impact of specific leisure activity on the cognitive function of the elderly.

CONCLUSIONS

The study suggests that leisure activity can improve cognitive function through decreasing anxiety and loneliness among the Chinese elderly. Diversified interventions aimed at increasing leisure activity participation in older adults would be beneficial for their mental health and cognitive function.

Feelings of loneliness and mental health needs and services utilization among Chinese residents during the COVID-19 epidemic

BACKGROUND

Due to the implementation of social distancing and quarantine measures, loneliness has been a major public health concern during the COVID-19 pandemic. However, few studies have examined loneliness in Chinese residents during the COVID-19 epidemic, as well as its associations with mental health needs and services utilization.

METHODS

The present study was a cross-sectional survey during the COVID-19 outbreak in China. A total of 7741 adults were invited and completed an online self-administered questionnaire. The Chinese 12-item General Health Questionnaire was used to screen for common mental health problems, loneliness was measured with a single-item self-report question ("How often do you feel lonely in recent days?"), and two standardized questions were used to assess perceived needs for and use of mental health services.

RESULTS

In total, 24.2 % of the participants felt lonely in recent days. Age of 16-29 years (OR = 1.36, P = 0.020), marital status of never-married (OR = 1.47, P < 0.001), marital status of "others" (re-married, co-habiting, separated, divorced, and widowed) (OR = 1.72, P < 0.001), having infected family members or close relatives (OR = 1.64, P = 0.026), and having infected colleagues, friends, or classmates (OR = 1.62, P < 0.001) were significant correlates of loneliness. Rates of mental health needs (17.4 % vs. 4.9 %, P < 0.001) and services utilization (2.7 % vs. 1.0 %, P < 0.001) were significantly higher in lonely than not lonely participants. After adjusting for socio-demographic and epidemic characteristics and common mental health problems, loneliness was still significantly associated with mental health needs (OR = 2.50, P < 0.001) and services utilization (OR = 1.62, P = 0.020).

CONCLUSIONS

Feelings of loneliness are prevalent among Chinese residents affected by the COVID-19 epidemic and the presence of loneliness is associated with high levels of mental health needs and greater services utilization. Effective measures aiming at preventing or reducing loneliness are potentially beneficial for the mental wellbeing of COVID-19-affected population and reducing the use of the limited mental health service resources during the COVID-19 pandemic.

Predictors of loneliness incidence in Chinese older adults from a life course perspective: a national longitudinal study

Objectives: We aim to examine what factors are predictive of loneliness incidence from a life course perspective and whether predictors differ between women and men based on a nationally representative longitudinal dataset in China. Method: A total of 5,043 older adults aged 65 or above from the Chinese Longitudinal Healthy Longevity Survey who were not lonely in the 2008 wave were included in the analysis. Logistic regression models were applied to examine what factors in the 2008 wave predicted loneliness incidence in the 2011 wave. Analyses were also stratified by gender to examine gender differences.Results: Older ages and self-rated poor health increased the odds, whereas receiving one or more years of schooling, rural-urban migration, living with family members, having a white-collar job, having a good family economic status, being currently married, having a higher resilience and social support decreased the odds of loneliness incidence. We also found gender differences: socioeconomic factors were significant only for older men, whereas self-rated health, resilience, and social support were significant only for older women.Conclusion: This study offers insights into disentangling the complexity of factors associated with loneliness incidence in Chinese older adults from a life course perspective and from a gendered perspective.

The association between smoking and loneliness among Chinese university freshmen

Background

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

Methods

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

Results

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

Conclusions

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

Loneliness, hopelessness and suicide in later life: a case-control psychological autopsy study in rural China

AIMS

Loneliness is increasingly recognised as a serious public health issue worldwide. However, there is scarce research addressing the association between loneliness and suicide in older adults in rural China. We set out to examine loneliness and other psychosocial factors in elderly suicide cases and explore their interaction effects.

METHODS

Using a 1 : 1 matched case-control design, data were collected from 242 elderly suicide cases and 242 living community controls by psychological autopsy method in rural China, including demographic characteristics, loneliness, depression, hopelessness and social support. The chi-square automatic interaction detection (CHAID) tree model and multivariable logistic regression analysis were used to explore the relationships of these factors and suicide.

RESULTS

The CHAID tree model showed that loneliness, hopelessness and depressive symptoms were closely associated with completed suicide and that loneliness and hopelessness interacted with each other. The result of multivariable logistic regression showed that individuals who were unemployed [odds ratio (OR) = 2.344; 95% confidence interval (CI): 1.233-4.457], living alone (OR = 2.176; 95% CI: 1.113-4.254), had lower levels of subjective social support (OR = 2.185; 95% CI: 1.243-3.843), experienced depressive symptoms (OR = 6.700; 95% CI: 3.405-13.182), showed higher levels of hopelessness (OR = 7.253; 95% CI: 3.764-13.974) and felt higher levels of hopelessness × higher levels of loneliness (OR = 2.446; 95% CI: 1.089-5.492) were significantly associated with an elevated suicide risk in older people in rural China.

CONCLUSIONS

Regular evaluation of loneliness, hopelessness and depression can help detect older adults who are at risk of committing suicide. Interventions should target social support systems, particularly among people living alone, to alleviate feelings of loneliness and hopelessness. Treating depression is also key to preventing suicide among elderly people in rural China.

Factors associated with social isolation in community-dwelling older adults: a cross-sectional study

PURPOSE

Social isolation in older adults is a major public health problem and associated with increased morbidity and mortality. There are limited data on the association between social isolation and physical function including gait speed. Hence, this study is to determine the prevalence of social isolation and its association with gait speed, frailty, cognition, depression and comorbidities amongst community-dwelling older adults.

METHODS

Social isolation, depression, frailty and perceived general health were assessed using 6-item Lubben Social Network Scale (LSNS-6), Geriatric Depression Scale (GDS), FRAIL scale and EuroQol EQ-5D-5L questionnaire which includes EQ Visual Analogue Scale (EQ-VAS), respectively. Cognition was assessed using the Chinese Mini Mental State Examination (cMMSE), while physical performance test included gait speed and short physical performance battery test. Binary logistic regression was performed to determine the influence of socio-demographic, medical, functional and cognitive variables on social isolation.

RESULTS

Out of 202 participants, 27.7% were robust, 66.8% of participants were pre-frail, and 5.4% of participants were frail. Almost half (45.5%, n = 92) of the participants were found to be at risk of social isolation. A poor social network was negatively associated with mean gait speed (OR = 0.674, CI 0.464-0.979, p = 0.039), EQ-VAS (OR = 0.561, CI 0.390-0.806, p < 0.01) and cMMSE (OR = 0.630, 95% CI 0.413-0.960, p = 0.032).

CONCLUSION

Almost half of older adults in the community are at risk of social isolation with a very significant association with gait speed, cMMSE and EQ-VAS scores.

Prevalence and recognition of depressive disorders among Chinese older adults receiving primary care: A multi-center cross-sectional study

BACKGROUND

In recent years, there have been increasing calls for integrating late-life mental health services into primary care in China, but data on the epidemiology of depressive disorders in older adults receiving primary care are very limited. This study examined prevalence, correlates and recognition of depressive disorders among Chinese older adults receiving primary care.

METHODS

A total of 752 older patients (65+ years) were consecutively recruited from 13 primary care clinics in Wuhan, China, and interviewed with the Chinese Mini-international Neuropsychiatric Interview 5.0.

RESULTS

One-fifth (20.3%) of the older adults met DSM-IV criteria for depressive disorders during the month prior to the interview: 10.2% had major depression, 4.8% had dysthymia, and 5.3% had minor depressive disorder. The recognition rate of older patients with depressive disorders was 1.3% only. In multiple logistic regression analysis, factors significantly associated with depressive disorders included female gender (OR = 1.61), an education of primary school and below (OR = 1.69), poor financial status (OR = 2.44), poor or fair family relationship (OR = 1.66), loneliness (OR = 1.77), hypertension (OR = 1.91), heart disease (OR = 2.02), chronic gastric ulcer (OR = 6.01), and arthritis (OR = 3.55).

LIMITATIONS

Older adults from primary care clinics of economically underdeveloped regions of China were not included.

CONCLUSIONS

Depressive disorders are prevalent but poorly recognized in Chinese older adults receiving treatment in primary care clinics. In order to improve the emotional well-being and health of older adults, it is time to integrate the management of common mental disorders into primary healthcare in China.

Depressive Symptoms in Elderly Chinese Primary Care Patients: Prevalence and Sociodemographic and Clinical Correlates

OBJECTIVE

To estimate the prevalence of depressive symptoms (depression thereafter) and to identify the sociodemographic and clinical correlates of depression in a sample of elderly patients treated in the primary care setting in Wuhan, China.

BACKGROUND

Primary care is an opportune setting for the management of late-life depression in China, but there have been no representative studies on the clinical epidemiology of depression in elderly Chinese primary care patients.

METHODS

In total, 752 elderly patients (≥ 65 years) were consecutively recruited from 13 primary care centers in Wuhan, China, and interviewed with a standardized questionnaire. Depression was assessed with the 15-item Geriatric Depression Scale (GDS-15).

RESULTS

Of the elderly Chinese primary care patients, 30.6% had depression (GDS-15 ≥ 5). Correlates of depression were an education level of primary school or less (odds ratio [OR]: 1.94, 95% confidence interval [CI]: 1.36-2.77, P < .001), poor financial status (OR: 2.19, 95% CI: 1.16-4.15, P = .016), lack of an exercise habit (OR: 1.40, 95% CI: 1.06-1.74, P = .023), 2 or more chronic medical conditions (OR: 1.90, 95% CI: 1.34-2.69, P < .001), and loneliness (OR: 3.53, 95% CI: 2.46-5.08, P < .001).

CONCLUSIONS

Depression is prevalent among elderly Chinese primary care patients, indicating that elderly patients treated in primary care have a high level of need for mental health services in China. There is an urgent need to integrate mental health services into primary health care.

Prevalence and correlates of suicide attempt among Chinese individuals receiving methadone maintenance treatment for heroin dependence

To date, there have been very limited studies regarding the clinical epidemiology of attempted suicide in Chinese individuals with heroin-dependence. The objective of this study was to examine the prevalence and correlates of suicide attempt in Chinese individuals receiving methadone maintenance treatment for heroin dependence. Demographic, clinical, and psychosocial data of 603 methadone-maintained patients with heroin dependence were collected with a standardized self-administered questionnaire. The presence of suicide attempt and antisocial personality disorder was assessed by using a single question and the Mini-International Neuropsychiatric Interview 5.0. The one-month and lifetime prevalence rates of suicide attempt were 9.5% and 34.2%, respectively. In multivariable logistic regression, lifetime suicide attempt was significantly associated with female gender (OR = 2.81), being 20–39 years old (OR = 2.73), an education level of primary school or lower (OR = 2.07), poor economic status (OR = 3.06), injecting heroin before methadone maintenance treatment (OR = 2.92), depressive symptoms (OR = 3.46), anxiety symptoms (OR = 1.88), and antisocial personality disorder (OR = 2.85). Suicide attempt is very prevalent among Chinese individuals receiving methadone maintenance treatment for heroin dependence. Services for patients with heroin dependence in methadone maintenance treatment clinics in China should include psychosocial supports, periodic screening for suicide attempt and other suicidal behaviors and, when needed, psychiatric treatment and crisis intervention.

Factor Structures of General Health Questionnaire-12 Within the Number of Kins Among the Rural Residents in China

The 12-item general health questionnaire (GHQ-12) has been extensively used with Chinese population. Yet, it has not been used from a national representative survey in rural China. The aim of this study was to examine how number of kins associated with the factor structures of the CHQ-12 among the rural residents in China. Data were obtained from the 2009 rural-to-urban migrants survey (RUMiC). Exploratory factor analysis (EFA) (principal component analysis with varimax rotation) was performed to identify factor structures of GHQ-12 regarding number of siblings, age ranking, and number of children. To investigate the reliability of the questionnaire, Cronbach’s alpha was used. Internal consistency was assessed by confirmatory factor analysis (CFA). In all, 32171 rural residents in China from 2009 RUMiC participated in the study. The mean age of the respondents was 37.03 (SD = 19.21) years. The psychometric properties and factor structures of the GHQ-12 used were described. All of the fit indices in CFA models were satisfactory. The two-factor and three-factor structures gathered the satisfactory fit indexes in the part of 2009 subsamples. The rural version of the GHQ-12 was reliable measures of psychological distress among the rural residents in China with respect to number of kins. The two-and three-factor structures derived from the present sample, with good model fit in the CFA analysis, which suggested that two-and three-factor solution could be used to assess mental health of rural residents in rural China.

Quality of life of older Chinese adults receiving primary care in Wuhan, China: a multi-center study

Background

Quality of life (QOL) is an important primary care outcome, but the QOL of older adults treated in primary care is understudied in China. This study examined QOL and its associated factors in older adults treated in Chinese primary care.

Methods

A total of 752 older patients (65+ years) were consecutively recruited from 13 primary care centers in Wuhan, China, and interviewed with a standardized questionnaire, concerning socio-demographics, major medical conditions, loneliness, and depression. QOL and depression were measured with the Chinese six-item QOL questionnaire and the shortened Geriatric Depression Scale, respectively. Multiple linear regression was used to identify factors associated with poor QOL.

Results

The average QOL score of primary care older adults was (20.7 ± 2.5), significantly lower than that of the Chinese general population. Factors significantly associated with poor QOL of Chinese primary care older adults included engaging in manual labor before older adulthood (unstandardized coefficient [β]: −0.702, P < 0.001), no living adult children (β: −1.720, P = 0.001), physical inactivity (β: −0.696, P < 0.001), having ≥ four major medical conditions (β: −1.813, P < 0.001), hearing problem (β: −1.004, P = 0.017), depression (β: −1.153, P < 0.001), and loneliness (β: −1.396, P < 0.001).

Conclusions

Older adults treated in Chinese primary care have poorer QOL than the general population. Addressing psychosocial problems at Chinese primary care settings could be helpful in improving QOL in Chinese older adults.

Loneliness in Primary Care Patients: A Prevalence Study

PURPOSE

Loneliness has important health consequences. Little is known, however, about loneliness in primary care patient populations. This study describes the prevalence of loneliness in patients presenting for primary care and associations with self-reported demographic factors, health care utilization, and health-related quality of life.

METHODS

We conducted cross-sectional surveys of adults presenting for routine care to outpatient primary care practices in 2 diverse practice-based research networks. The 3-item University of California, Los Angeles Loneliness Scale was utilized to determine loneliness.

RESULTS

The prevalence of loneliness was 20% (246/1,235). Loneliness prevalence was inversely associated with age (P <.01) and less likely in those who were married (P <.01) or employed (P <.01). Loneliness was more common in those with lower health status (P <.01), including when adjusting for employment and relationship status (odds ratio [OR] = 1.05; 95% CI, 1.03-1.07). Primary care visits (OR = 1.07; 95% CI, 1.03-1.10), urgent care/emergency department visits (OR = 1.24; 95% CI, 1.12-1.38), and hospitalizations (OR = 1.15; 95% CI, 1.01-1.31) were associated with loneliness status. There was no significant difference in rates of loneliness between sexes (P = .08), racial categories (P = .57), or rural and urban respondents (P = .42).

CONCLUSIONS

Our findings demonstrate that loneliness is common in primary care patients and is associated with adverse health consequences including poorer health status and greater health care utilization. Further work is needed to understand the value of screening for and using interventions to treat loneliness in primary care.