Factors associated with loneliness among individuals aged 80 years and over: Findings derived from the nationally representative "Old Age in Germany (D80+)" study

OBJECTIVES

To clarify the factors associated with loneliness in individuals aged 80 years and older in Germany (also stratified by sex).

METHODS

Data from the nationally representative "Old Age in Germany (D80+)" were employed. The analytic sample equaled 10,031 individuals. The D80+ study included community-dwelling and institutionalized individuals ≥ 80 years in Germany. Multiple linear regressions were used (with sociodemographic and health-related explanatory factors). The collection of data occurred between November 2020 and April 2021 (written questionnaire).

RESULTS

Higher loneliness was significantly associated with not being married (e.g., widowed compared to being married, β=0.37, p<.001), being institutionalized (β=0.33, p<.001), low education (high education compared to low education, β=-0.07, p<.01), a higher number of chronic conditions (β=0.02, p<.001), poor self-rated health (β=-0.19, p<.001) and greater functional impairment (β=0.15, p<.001). Sex-stratified regressions produced comparable results. However, low education was only associated with higher loneliness among men, but not women (with significant interaction: education x sex).

CONCLUSION

Several sociodemographic and health-related factors can contribute to loneliness among the oldest old in Germany, with sex-specific associations between education and loneliness. Overall, such knowledge can aid to address individuals with higher loneliness levels.

Living happily alone in Plato's cave? On loneliness, technology and the metaphysics of presence

In a lot of research on loneliness and technology, there is an underlying premise that actual, physical presence is more real than 'virtual' presence. This premise is rarely explicit, yet it implies a hierarchy of reality, where the 'here and now' is always on top. In this theoretical paper, we examine this latent hierarchy and the understandings of presence and mediation it implies. We point towards potential consequences of this understanding for research on the role of technology in reducing loneliness and social isolation. To do this, we draw on the philosophical analysis made by Martin Heidegger and Jacques Derrida of what they called 'the metaphysics of presence'. This is the tendency to privilege presence as the only immediate and truthful access to reality, whereas all forms of mediations constitute mere approximations, derivations and second-rate realities with dubious truth value. First, we present their diagnosis, and then we show how it pertains to research on virtual presence and loneliness by analysing some examples from this research. Finally, we discuss some potential implications of the metaphysics of presence through a case story compiled from our empirical research. Our foundational assertion is that the question of whether anyone experiences loneliness is an empirical and not a metaphysical question. If we want to properly understand loneliness and the potential for alleviating it through the use of teletechnologies, we might get off on the wrong foot if we carry with us assumptions suggesting the existence of ascending levels of reality and presence.

Can We Steer Nursing Home Residents Away from Loneliness? A Qualitative Study of Cycling without Age

BACKGROUND

Loneliness among nursing home residents is an increasing public health issue and consists of a combination of social, emotional, and existential loneliness. Cycling Without Age (CWA) involves taking nursing home residents on trishaw rides pedaled by trained volunteer 'pilots'. This study aims to explore nursing home residents' lived experiences of CWA and whether participation in CWA can mitigate experiences of loneliness.

METHODS

A qualitative phenomenological design was used. We conducted three observations and eight interviews: semi-structured interviews (n = 5) and informal interviews (n = 3) with passengers in CWA. Data were analyzed using reflexive thematic analysis.

RESULTS

Three themes were developed: 1. creating meaningful communities (related to the social mechanism connected to participating in CWA), 2. breaking the monotony of everyday life (related to how the passengers experience CWA as a meaningful activity), and 3. reconnecting to oneself (related to the meaningful experience the passengers have when they are connected to their local communities and reminiscence).

CONCLUSION

Taking part in CWA may mitigate loneliness, as passengers perceive it as being meaningful. These results strengthen the notion that participating in meaningful activities hold the potential to mitigate feelings of loneliness among nursing home residents.

The relationship between the meaning of life, psychological well-being, self-care, and social capital, with depression and death anxiety in the elderly living in nursing homes: The mediating role of loneliness

The current study aims to investigate the meaning of life, psychological well-being, self-care, and social capital, with depression and death anxiety in the elderly living in nursing homes through the mediating role of loneliness. The statistical population included all the elderly aged at least 60 years living in Tehran, Qazvin and Zanjan, Iran in 2020, among whom 489 (273 men and 216 women) were selected using convenience sampling method. Participants filled out Steger's Meaning of Life, Ryff and Singer's Psychological Well-Being Scale, Söderhamn et al.'s Self-Care Ability, Nahapiet and Ghoshal's Social capital, Beck's depression, Templer's Death Anxiety, Russell et al.'s Loneliness questionnaires. The results indicated that meaning of life, psychological well-being, self-care, and social capital are negatively associated with loneliness, which in turn, is positively associated to depression. Furthermore, meaning of life, psychological well-being, self-care, and social capital are negatively associated with loneliness, which in turn, is positively associated to death anxiety. Moreover, the results of path analysis revealed that the hypothesized model of the current study has an excellent fit in the study sample. That is, meaning of life, psychological well-being, self-care, and social capital are related to depression and death anxiety through mediating role of loneliness.

Prevalence and determinants of loneliness among the oldest old living in institutionalized settings : Study findings from a representative survey

BACKGROUND

There is very limited knowledge regarding the prevalence and determinants of loneliness in oldest old residents of nursing or old age homes.

OBJECTIVE

To examine the prevalence and determinants of loneliness among the oldest old living in institutionalized settings in Germany.

MATERIAL AND METHODS

Data were taken from the representative survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+) including individuals ≥ 80 years living in North Rhine-Westphalia. The study focused on individuals living in institutionalized settings. Sociodemographic, lifestyle-related, and health-related determinants were included in multiple linear regression models.

RESULTS

Approximately 56.6% of the individuals were not lonely, 25.7% and 17.8% of the individuals were moderately and severely lonely, respectively. Regression analyses showed that higher loneliness was associated with being married (β = 0.48, p < 0.05), high education (compared to low education, β = 0.46, p < 0.05), having a small social network size (β = -0.02, p < 0.05), having poor self-rated health (β = -0.25, p < 0.05), and more depressive symptoms (β = 0.25, p < 0.001).

CONCLUSION

A significant proportion of the institutionalized oldest old individuals reported moderate or severe loneliness, which underpins the relevance of this topic. Understanding the determinants of loneliness may help to address institutionalized adults aged 80 years and over at risk of loneliness.

Creating A child-friendly social environment for fewer conduct problems and more prosocial behaviors among children: A LASSO regression approach

BACKGROUND

Creating a child-friendly social environment is an important component of promoting child-friendly city development. This study aims to explore the key indicators of friendly family, school and community social environments from the perspective of children's conduct problems and prosocial behaviors.

METHOD

The sample included grade 3-5 students from one public elementary school in the urban areas and another public elementary school in the rural areas of a Chinese city pursuing a child-friendly philosophy. A total of 418 participants were included in this study. Data on conduct problems, prosocial behaviors and the social environment were collected. To effectively select important variables and eliminate estimation bias, this study used LASSO regression to identify key indicators predicting children's conduct problems and prosocial behavior, followed by linear regression coefficient estimation and significance testing.

RESULTS

Creating a friendly family environment (ensuring family members' assistance with academic problems) and school environment (reducing cheating, fighting, and unfriendly teacher language) was associated with reduced conduct problems in children. Creating a positive family atmosphere (enhancing children's trust in family members), school environment (increasing parents' awareness of school affairs, reinforcing students' prosocial behavior, increasing extracurricular activity programs, and encouraging student engagement in academics) and community environment (respecting all children in the community) was associated with improving children's prosocial behavior.

CONCLUSIONS

This study transforms the multidimensional, complex child-friendly social environment evaluation indicator system into concise and specific measurement indicators, which can provide theoretical and practical implications for government decision-making in child-friendly city development through empirical research.

Socially connected while apart: the use of technology to increase social connection between nursing home residents and their relatives

Introduction

This study examines whether the use of a communication technology can enhance social connectedness among nursing home residents in Norway. The concept of social connectedness suggest that positive and significant interpersonal relationships can help reduce the risk of loneliness and social isolation among older adults and can be beneficial for both their health and overall well-being. In recent years, technology has been increasingly utilized as a method to overcome physical distances and to keep families connected. Although the use of digital solutions among older people has increased in recent years, few studies have addressed the use and impact of such technologies within a nursing home context.

Methods

A total of 225 residents participated in the study, making it one of the few quantitative studies that examine the use of communication technologies in nursing homes at such a large scale. The study combines two sources of data: (1) survey data collected over a 14-month period, in three different waves, at all public nursing homes in Oslo municipality and (2) a highly detailed weekly datastream from each Komp-device, which provides an objective measure of the frequency of contact between the residents and their families. The two sources of data were combined and analyzed using multiple regression analysis.

Results

The regression analysis revealed a positive and significant relationship between Komp use and increased social satisfaction among the residents. The results indicate that Komp is a feasible communication tool to help nursing home residents maintain relations with their families.

Discussion

The positive response to Komp among the residents suggests that when designed with the user's needs in mind, technology can indeed facilitate meaningful social interactions, even for those with limited technological experience. Such interventions can thus be crucial in bridging the gap between older residents and the outside world, effectively addressing their unique challenges of social isolation and disconnection from the broader community.

Prevalence and correlates of loneliness and social isolation in the oldest old: a systematic review, meta-analysis and meta-regression

PURPOSE

Conducting a systematic review, meta-analysis and meta-regression regarding the prevalence and correlates of loneliness and social isolation amongst the community-dwelling and institutionalised oldest old (80 years and over).

METHODS

Three electronic databases (PsycINFO, CINAHL and Medline) were searched, including studies from inception to January 5, 2023. An additional hand search was conducted by checking included studies' references, and studies that cited included studies. We included observational studies describing the prevalence and (ideally) the correlates of loneliness, or social isolation, amongst individuals aged 80 years and over. Study design, operationalization of loneliness and social isolation, statistical analysis, characteristics of the sample and key findings were extracted. A random-effects meta-analysis was conducted.

RESULTS

We included 22 studies. The estimated prevalence of severe loneliness was 27.1% (95% CI: 23.7-30.4%). The estimated prevalence of moderate loneliness equalled 32.1% (95% CI: 15.8-48.4%). Moreover, the estimated prevalence of social isolation was 33.6% (95% CI: 28.9-38.2%). There was heterogeneity between the studies. Egger tests suggest the absence of potential publication bias. Meta-regressions showed that the heterogeneity could neither be attributed to the assessment of loneliness nor to the continent where the study was conducted.

CONCLUSION

Loneliness and social isolation are important problems in the oldest old. In this age group, studies are required, in particular from regions outside Europe. Additionally, longitudinal studies are required to investigate the determinants of loneliness and social isolation amongst individuals aged 80 years and over. Studies using more sophisticated tools to quantify loneliness and social isolation are required.

Marital Quality and Loneliness Among Aging Vietnam-Era Combat Veterans: The Moderating Role of PTSD Symptom Severity

OBJECTIVES

We examined links between marital quality and loneliness among aging veterans and explored whether veterans' PTSD symptom severity moderated these associations.

METHODS

Data came from 269 Vietnam-Era combat veterans who had a spouse/partner (M age = 60.50). Utilizing two waves of data spanning six years, we estimated multiple regression models that included positive and negative marital quality, PTSD symptom severity, and loneliness in 2010 as predictors of loneliness in 2016.

RESULTS

Facets of positive (but not negative) marital quality were associated with veterans' loneliness. Companionship - spousal affection and understanding - was associated with lower subsequent loneliness among veterans with low/moderate - but not high - PTSD symptom severity. Conversely, sociability - the degree to which one's marriage promotes socializing with others - was associated with lower subsequent loneliness regardless of PTSD symptom severity.

CONCLUSIONS

Companionship and sociability were each associated with veterans' subsequent loneliness. Whereas benefits of companionship were attenuated at higher levels of PTSD symptom severity, benefits of sociability were not.

CLINICAL IMPLICATIONS

For veterans with higher PTSD symptoms, recommending mental health treatment to decrease symptom severity may help them to reap the benefits of close/intimate relationships. However, bolstering veterans' social participation more broadly may provide an additional means of reducing their loneliness.

Exploring experiences of times without care and encounters in dementia: protocol for a living and adaptive evidence map

INTRODUCTION

Individuals with dementia spend most of the day without care, without encounters, and usually without activity. Although this has been proven in studies, there is a knowledge gap on how individuals with dementia experience these periods of time. Such knowledge would be highly relevant for health professionals and relatives to develop adequate strategies for dealing with these periods of time. The FreiZeit study aims to reconstruct periods of time without care and encounters from the perspective of individuals with dementia and formal and informal carers. The specific objective of this review is to provide a continuously updated overview of the topical evidence that may be used to guide data synthesis and interpretation within the FreiZeit study.

METHODS AND ANALYSIS

We conduct a living evidence map, based on a comprehensive systematic literature search in MEDLINE/PubMed, CINAHL, PsycINFO/Ovid and Web of Science Core Collection, citation-based searches and web searches. We include studies on times without care and encounters of individuals with dementia from the perspective of individuals with dementia themselves and formal or informal caregivers of any observational study design that were conducted in the institutional and domestic long-term care setting and published as journal article in English, French or German language without any restriction of the publication year. One reviewer screens titles, abstracts and full texts and extracts data. Key characteristics and results of the included studies are charted in a tabular format. The searches will be run and continuously updated throughout the duration of the overarching FreiZeit study (every 6 months for 2 years from 2023 to 2025).

ETHICS AND DISSEMINATION

Ethics approval is not required for this evidence map. We disseminate our findings via journal articles and conference proceedings as well as other formats.

REGISTRATION DETAILS

This review protocol is uploaded on Open Science Framework (OSF; DOI 10.17605/OSF.IO/GDYZ9).

Social capital and loneliness among older adults in community dwellings and nursing homes in Zhejiang Province of China

Background

Loneliness is an important problem afflicting the health of older adults, and has been proven to be associated with social capital. Previous research in China rarely investigated the differences of social capital and loneliness between older adults living in community dwellings and nursing homes. This study aims to examine the status of social capital and loneliness among older adults living in community dwellings and nursing homes, and analyze the relationship between them.

Methods

A total of 1,278 older adults were recruited for the study from the cities of Hangzhou, Huzhou, and Lishui in Zhejiang Province of China from July to October 2021 by using multi-stage stratified random sampling. Questionnaires were used to collect data on the participants' sociodemographic characteristics, social capital, and loneliness. Hierarchical multiple regression was used to examine the relationship between social capital and loneliness. The interaction of social capital and institutionalization on loneliness was also explored.

Results

Compared with community-dwelling older adults, institutionalized older adults had higher levels of loneliness and lower degrees of social support, social connection, trust, cohesion, and reciprocity. A further analysis of the social capital showed that low levels of social support, trust, and cohesion were related to high levels of loneliness among adults in both community dwellings and nursing homes. Social connection was negatively correlated with loneliness among older adults living in community dwellings. Institutionalization itself demonstrated a strong effect on loneliness.

Conclusion

Health-related policies should help older adults gain more social support, trust and cohesion to alleviate their loneliness. This is particularly crucial for older adults living in nursing homes, as they have higher levels of loneliness and lower levels of social capital than noninstitutionalized older adults.

Effect of online and offline social network group clusters on life satisfaction across age groups

Background

Positive social relationships are critical for better subjective well-being across ages. Future research will benefit from examining how to improve life satisfaction by utilizing social groups in new, ever-changing social and technological contexts. This study aimed to evaluate the effect of online and offline social network group clusters on life satisfaction across different age groups.

Methods

Data were derived from the Chinese Social Survey (CSS) (2019), which is a nationally representative survey. We adopted a K-mode cluster analysis algorithm to categorize participants into four clusters according to their online and offline social network groups. ANOVA and chi-square analysis were used to understand the associations among age groups, social network group clusters, and life satisfaction. Multiple linear regression was applied to identify the association between social network group clusters and life satisfaction across age groups.

Results

Younger and older adults had higher life satisfaction than middle-aged adults. Individuals who joined diverse social network groups had the highest life satisfaction, followed by those who joined personal and working social groups, while those who joined restricted social groups had the lowest life satisfaction (F = 81.19, p < 0.001). According to the results of multiple linear regression, individuals who belonged to diverse social groups had higher life satisfaction than those who belonged to restricted social groups among adults aged 18-59 years, except students (p < 0.05). Individuals who joined personal and working social groups had higher life satisfaction than those who joined restricted social groups among adults aged 18-29 and 45-59 years (β = 2.15, p < 0.01; β = 1.45, p < 0.01).

Conclusions

Interventions to promote participation in diverse social network groups among adults aged 18-59 years, except for students, are highly recommended to improve life satisfaction. Health practitioners could provide interventions to encourage young and middle-aged adults to join both personal and working social groups.

Patients’ Trust in Health Care Providers Among Hospitalized Patients, Jimma, South West Ethiopia

Introduction

Trust is a fundamental aspect of the patient–health care provider (HCP) relationship associated with adherence to medical treatment and continuity of follow-up. Despite its importance there is a paucity of information in Ethiopia.

Objectives

This study aimed to assess patient trust in HCPs at the Jimma medical center (JMC), Ethiopia.

Methods

An institution based cross-sectional study was conducted among 404 participants from April 16 to June 29, 2020. Study participants were selected using a systematic sampling technique. Data were collected on socio-demographic characteristics, health related and clinical characteristics, and patient trust in the patient–HCP. The collected data were entered into Epi-Data version 3.1 then exported to SPSS version 23.0 for analysis. Variables with a p-value <.25 on bivariate analysis were considered as candidates for multivariate analyses. Statistical significance on multivariable analysis was declared with p-value < .05 and 95% confidence intervals (CI).

Results

In our study, 38% of patients had low trust. Among the 397 study participants, 46.6% were female. One-third (33.2%) of respondents had no formal education. Patients who live alone [(AOR) 4.30(1.98–9.33), p = .00], and self-reported as a poor current health status [(AOR) 2.32(1.39–3.88), p = .002] were positively associated to patient trust in patient–HCP. On the other hand, duration of disease more than one year after diagnosis [(AOR) 0.48 (0.25–0.92), p = .028], comorbid disease [(AOR) 0.39(0.22−0.67), p = .001], and impaired physical mobility [(AOR) 0.27(0.16−0.45), p = .001] were negatively associated with patient trust in HCP.

Conclusion

This study pinpoints that 38 out of 100 patients had low trust. Living alone and having poor self-reported current health status increased low trust. This calls for HCPs to rebuild trust and give due attention to patients living alone and with poor health status.

A conversational, small-story approach to narrative care for people with dementia living in care institutions: Strategies and challenges

The aim of the paper was to define what narrative care is and identify and discuss everyday conversational narrative care strategies regarding people living with dementia in long-term care institutional settings. To do so, we differentiate between two approaches to narrative care: a big-story approach (reflecting on life stories) and a small-story approach (enacting stories in everyday conservations). The paper is focused on the second approach, which appears to be particularly fit to be used with people living with dementia. We identify three main strategies to implement this approach in everyday care: (1) prompting and sustaining narratives; (2) valuing non-verbal and embodied cues; and (3) constructing narrative environments. Finally, we discuss some training, institutional and cultural barriers and challenges for providing conversational, small story-based narrative care for people living with dementia in long-term care institutions.

Perceptions of neighborhood environment and loneliness among older Chinese adults: the mediator role of cognitive and structural social capital

OBJECTIVE

This study aimed to examine the mediating role of social capital in the association between perceived physical neighborhood environment and loneliness among older adults in urban China.

METHOD

Data were derived from face-to-face interviews with people (n = 472) aged 60 or older in urban communities of Shanghai, China, in 2020. Loneliness was measured by the 6-item De Jong Gierveld Scale. A multiple mediator model was adopted to examine the research hypotheses.

RESULTS

Cognitive social capital played a full mediation role in the association between perceived community health care (β = -.061, p < .05), safety (β = -.168, p < .001), recreational services (β = -.058, p < .05), and loneliness. Structural social capital was associated with loneliness (β = -.102, p < .05), whereas its mediator effect was not significant. Perceived transportation convenience had neither a direct nor an indirect effect on loneliness among older adults.

CONCLUSION

Findings indicate that older adults' perceptions of healthcare services, safety, and recreational resources could help alleviate their loneliness via fostering cognitive social capital. Interventions improving older adults' perceptions of community health care, safety, and recreation, and their social capital level could help reduce the prevalence of loneliness.

Barriers and Enablers for the Use of Digital Interactive Television in Nursing Home Settings: An Interview Case Study with Older Adults and Professionals

Increasingly, public health programs are recommending the use of information and communication technologies to address the psychosocial needs of Older Adults (OAs). Recently, several applications that allow access to communication and stimulation functionalities using digital interactive television (DiTV) have been developed. The use of the television interface to access digital services seems to help meet several accessibility and usability needs of OAs. However, its use entails other challenges related to different dimensions (organizational, technological, ethical, etc.). This study aims to identify the factors that enable or hinder the use of DiTV by OAs living in geriatric institutions. A qualitative interview case study was conducted in three French geriatric facilities. A total of 25 semi-structured interviews were carried out with residents and care professionals, between February and April 2022, to identify enablers and barriers to DiTV use. Data were processed using a thematic deductive analysis inspired by a multidimensional Health Technology Assessment model. The analysis showed that DiTV use may be limited by organizational (e.g., workload), technological (e.g., ergonomic issues), human (e.g., health issues), ethical (e.g., privacy), and safety factors (e.g., frustration due to technical problems). A summary of these factors and five recommendations for DiTV implementation in geriatric settings are presented in this paper.

Communication and engagement as potentiality in everyday life between persons with young onset dementia living in a nursing home and caregivers

Objectives

To explore communication and engagement in everyday situations between persons with young-onset dementia (YOD) living in a nursing home (NH) and the caregivers.

Methods

The study draws on ethnographic methods aligned with participatory design. Three residents with YOD living in a NH and eight staff members were recruited. A narrative approach was used for data collection and analysis.

Findings

Three narrative vignettes were developed representing everyday situations in which communication and engagement was enacted among residents and caregiver staff: (a) waiting for something to happen, (b) tensions about everyday communication, and (c) negotiating a combined living + working environment. The findings stress a paradoxical tension rooted in the NH as residence and workplace as well as place of calm and place of boredom. The everyday situations are interpreted differently from the perspective of the residents and staff.

Conclusion

The identified paradox of planned and spontaneous situations influences communication and engagement in everyday life, and the potentiality for active engagement embedded in contexts of units for residents with YOD. The degree to which everyday activities and encounters are redefined and renegotiated is an important part of caregiving practices in NH settings for residents with YOD.

The effects of social isolation stress and discrimination on mental health

Social isolation and discrimination are growing public health concerns associated with poor physical and mental health. They are risk factors for increased morbidity and mortality and reduced quality of life. Despite their detrimental effects on health, there is a lack of knowledge regarding translation across the domains of experimental research, clinical studies, and real-life applications. Here, we review and synthesize evidence from basic research in animals and humans to clinical translation and interventions. Animal models indicate that social separation stress, particularly in early life, activates the hypothalamic-pituitary-adrenal axis and interacts with monoaminergic, glutamatergic, and GABAergic neurotransmitter systems, inducing long-lasting reductions in serotonin turnover and alterations in dopamine receptor sensitivity. These findings are of particular importance for human social isolation stress, as effects of social isolation stress on the same neurotransmitter systems have been implicated in addictive, psychotic, and affective disorders. Children may be particularly vulnerable due to lasting effects of social isolation and discrimination stress on the developing brain. The effects of social isolation and loneliness are pronounced in the context of social exclusion due to discrimination and racism, during widespread infectious disease related containment strategies such as quarantine, and in older persons due to sociodemographic changes. This highlights the importance of new strategies for social inclusion and outreach, including gender, culture, and socially sensitive telemedicine and digital interventions for mental health care.

Loneliness among very old people with and without dementia: prevalence and associated factors in a representative sample

Loneliness and dementia are common among very old (aged ≥ 80 years) people, but whether the prevalence of loneliness differs between very old people with and without dementia is unknown and few studies have investigated associated factors. The aims of the present study were to compare the prevalence of loneliness between people with and without dementia in a representative sample of very old people, and to investigate factors associated with loneliness in the two groups separately. This population-based study was conducted with data on 1176 people aged 85, 90, and ≥ 95 years (mean age 89.0 ± 4.47 years) from the Umeå 85 + /Gerontological Regional Database study conducted in northern Sweden, during year 2000-2017. Structured interviews and assessments were conducted during home visits. Loneliness was assessed using the question "Do you ever feel lonely?." Multivariable logistic regression analysis was conducted to identify factors associated with loneliness in participants with and without dementia. The prevalence of loneliness did not differ between people with and without dementia (50.9% and 46.0%, respectively; p =  0.13). Seven and 24 of 35 variables were univariately associated with the experience of loneliness in participants with and without dementia, respectively. In the final models, living alone and having depressive symptoms were associated with the experience of loneliness in both study groups. In participants without dementia, living in a nursing home was associated with the experience of less loneliness. These findings contribute with important knowledge when developing strategies to reduce loneliness in this growing age group.

The Impact of Engagement with the PARO Therapeutic Robot on the Psychological Benefits of Older Adults with Dementia

OBJECTIVES

This study aimed to examine the effect of 8-weeks of a 60-minute PARO intervention to reduce depressive symptoms and loneliness in older adults with dementia and investigated changes in their emotional or behavioral expressions and level of engagement with the PARO robot.

METHODS

This was a quasi-experimental study with a repeated measures design. The outcome measures were evaluated at four time-points: before the intervention, week 4, immediately after the intervention, and one month after the PARO intervention.

RESULTS

Fifty-two participants were recruited. The age of the participants ranged from 65 to 96 years, with a mean age of 81.81 years (SD = 8.54) in the PARO group and 79.08 years (SD = 7.71) in the control group. Using a mixed between-within subjects' analysis of variance, the results showed that there were significant interaction effects between the groups and time-periods for depression (p < .000), loneliness (p < .000), and engagement (p < .000).

CONCLUSIONS

The PARO intervention alleviated depression and loneliness for older adults. Furthermore, the process of engagement with PARO may play an important role in the PARO effects.

CLINICAL IMPLICATIONS

A tailored PARO intervention of at least 4 weeks could engender positive psychological benefits for older adults.

Social Isolation and Loneliness among Near-Centenarians and Centenarians: Results from the Fordham Centenarian Study

Social isolation and loneliness have been recognized as problems older people face due to their adverse effects on health and mortality, but very few researchers have analyzed their co-occurrence, which might be particularly prevalent and critical among the very old. In this study, we investigated the prevalence of combinations of social isolation and loneliness among near-centenarians and centenarians. We used data collected from 94 individuals aged 95–107 from the Fordham Centenarian Study. We built a four-group typology and explored associations with individual characteristics in various domains (demographic, socioeconomics, social, health, care, and psychological) with multinomial logistic regression models. Considering their combinations, the most prevalent groups were “isolated and lonely” and “neither isolated nor lonely” (29.8% and 28.7%, respectively). The “lonely but not isolated” (20.2%) and “isolated but not lonely” (21.3%) groups were also notably large. The likelihood of belonging to each group varied according to various individual characteristics, such as education, health, and personality. Social isolation and loneliness are distinct phenomena among centenarians. The consideration of their varied combination can help better assess life conditions at very old ages. Taking into account the differences between groups can facilitate the design of tailored interventions to improve the lives of near-centenarians and centenarians.

The relationship among aging in place, loneliness, and life satisfaction in the elderly in Turkey

PURPOSE

This study was conducted to determine the relationship between aging in place, loneliness, and life satisfaction in older people.

DESIGN AND METHODS

The descriptive and cross-sectional study has used the Aging in Place Scale (APS), the Life Satisfaction Scale (LSS), and the Loneliness Scale for the Elderly (LSFE). The study was examined the correlation among APS, LSS, and LSFE.

FINDING

In our study, when we examined the subscales of the APS scale, we found that the perceived social support, physical competence, and achievable social support of the elderly were at a high level. These high levels led to increased life satisfaction and decreased loneliness.

PRACTICE IMPLICATIONS

The results obtained in this study are particularly important for highlighting the importance of aging in place in reducing loneliness, which has a negative impact on the mental health of the elderly, and in shedding light on increasing life satisfaction in the later stages of life.

Social capital and self-rated health among Chinese rural empty nesters: A multiple mediation model through sleep quality and psychological distress

BACKGROUND

many studies explore the relationship between social capital and self-rated health. However, few studies clarified the mechanisms underlying the relationship between social capital and self-rated health among Chinese rural empty nesters. This study aimed to explore the multiple mediating roles of sleep quality and psychological distress between this relationship.

METHODS

A total of 2,254 rural empty-nest older adults were included in the analysis. A descriptive analysis was conducted to describe the sample characteristics. Logistic regressions were performed to assess the relationships between social capital and self-rated health. The multiple mediating roles of sleep quality and psychological distress was analyzed using Mplus 8.3.

RESULTS

we found that social capital has a significant directly affect self-rated health (β=0.127, 68.65% CI=0.082-0.171), and through three significantly mediation pathways: (1) the path through sleep quality (β=0.013, 95% CI=0.005-0.021), which accounted for 7.03% of the total effect; (2) the path through psychological distress (β=0.037, 95% CI=0.024-0.049), which accounted for 20.00% of the total effect; (3) the path through sleep quality and psychological distress (β=0.008, 95% CI=0.004-0.013), which accounted for 4.32% of the total effect. The total mediating effect was 31.35%.

CONCLUSIONS

sleep quality and psychological distress mediate the relationship between social capital and self-rated health. Attention should be paid to mental health and sleep quality of empty nester through primary health, strengthen the attention to social resources, provide intervention and treatment for the empty nesters with sleep problem and psychological distress.

Video Calls for Older Adults: A Narrative Review of Experiments Involving Older Adults in Elderly Care Institutions

Social isolation in geriatric institutions is a real threat to older adults' (OAs) well-being. Visits from family members, when they are not impacted by geographical distance or illness, sometimes fail to provide sufficient opportunities for social connectedness and interaction to prevent and/or combat OAs' loneliness and social isolation. Information and Communication Technologies (ICTs) offer promising solutions to this problem. Video calls provide a quick and convenient way for remote communication between OAs and their families, and a complement to face-to-face visits in geriatric settings. Over the last months, during the several confinements imposed to stop the transmission of COVID-19 over the world, several care homes and long-care facilities have equipped themselves with laptops, tablets and video call applications to help OAs remain in contact with their relatives. However, numerous technical and human-related factors may hinder the use of video calls in these settings. The complexity of technological devices, as well as OAs limited digital skills, low confidence and experience in the use of technology are some examples. Furthermore, the specific context of use and the required implication of multiple actors (care professionals, family members) should also be considered when examining the use and implementation of video calls in geriatric institutions. We conducted a narrative review of literature describing the use of video calls in geriatric institutions between 2000 and 2021, especially because of the little information related to OAs' use of video calls in geriatric settings. One thousand one hundred ninety-seven references were screened and 15 studies focusing on the usability, acceptability and effectiveness of video calls were included. A qualitative, deductive thematic analysis inspired by a Health Technology Assessment (HTA) multidimensional model was used to identify barriers, enablers and solutions to video calls implementation in geriatric institutions. The results from the HTA-based analysis provide encouraging evidence for the feasibility of video call use in geriatric settings, and its efficacy on reducing social isolation among residents. However, numerous technical, human-related, ethical and organizational barriers persist and should be addressed in future works. The present analysis has also allowed the identification of potential solutions to overcome these barriers, which are discussed in this publication.

Mental health and factors related to life satisfaction in nursing home and community-dwelling older adults during COVID-19 pandemic in Turkey

BACKGROUND

The geriatric population is supposed to be at high risk for psychological distress as well as adverse outcomes and mortality during the COVID-19 pandemic. This study aimed to investigate the levels of depression, anxiety, death anxiety and life satisfaction levels and factors related to life satisfaction in individuals aged 65 years and older during the pandemic and to compare these variables between nursing home (NH) and community-dwelling older adults.

METHOD

This study has a cross-sectional and descriptive design, and a total of 133 nursing NH and community-dwelling older adults were enrolled in the study. Turkish death anxiety scale (TDAS), life satisfaction scale (SLS) and depression anxiety stress scale-21 (DASS-21) were used for the assessment.

RESULTS

The majority of the older adults had no or mild depression, anxiety and stress symptoms in spite of the prolonged confinements, and were slightly satisfied with their lives. However, depression, anxiety, stress and TDAS levels were higher in participants aged 80 years and older. Residents of NHs had higher TDAS, depression and anxiety levels and lower SLS levels than community-dwelling older adults. Participants who were meeting their children and/or grandchildren less than 2 h a week, were found to have significantly lower SLS and higher depression scores. The increase in depression and TDAS scores predicted a decrease in SLS scores in older adults.

CONCLUSIONS

As NH resident older adults have higher psychological distress and decreased life satisfaction due to the social isolation caused by the prolonged confinements, NH staff should be regularly informed on both preventive measures and mental health consequences of the pandemic, and should be trained for basic therapeutic interventions. Older adults should be supported to use telecommunication technologies to contact their families and friends, and participate in safe and accessible person-centred activity programs.

A pilot study implementing the JAVA Music Club in residential care: impact on cognition and psychosocial health

BACKGROUND

Ninety percent of long-term care (LTC) residents experience some form of cognitive impairment. Social support may benefit cognition by decreasing depressive symptoms and loneliness, which are commonly reported among LTC residents.

OBJECTIVE

To investigate the effects of the Java Music Club (JMC), a manualized social support program, on cognition and psychosocial health among LTC residents using a pre-post mixed-methods approach.

METHODS

The JMC was implemented once a week for twelve weeks. Participants (n = 24, 91.7% female) completed cognitive tasks and psychosocial questionnaires before (T1), after (T2), and twelve weeks following (T3) participation in the JMC. Qualitative interviews were conducted at T2 with participants and recreation coordinators.

RESULTS

Analyses showed decreased loneliness from T1 to T2 (t = 3.31, p = .003) and reductions in depressive symptoms (F = 3.459, p = .043) and subjective memory complaints (F = 3.837, p = .048) from T2 to T3. Participants' qualitative interviews (N = 19) illustrate that the JMC was a positive experience that promoted social engagement. Important group elements included the group facilitator and group composition. Possible process elements included social engagement, the opportunity for reminiscence, and the ability of both social interaction and singing to benefit the residents and lift their 'spirits'. Recreation coordinators (N = 3) reported that the group was unlike currently available group programs and increased socialization between residents.

CONCLUSIONS

Participation in the JMC may be a promising approach to counter loneliness, depressive symptoms and subjective memory complaints in LTC residents.

Protocol for 'virtual presence': a qualitative study of the cultural dialectic between loneliness and technology

INTRODUCTION

Most research on loneliness comes from the health sciences, statistically seeking to measure the health-related effects of feeling alone or isolated. There is a need to expand on this understanding and explore loneliness as a more complex social phenomenon. In this article, we present a qualitative design for studying the intersection between loneliness, technology and culture. Conceptualising this as the cultural dialectic between loneliness and technology, we aim to unpack the reciprocal ways by which understandings of loneliness shape technology, while technologies also affect society's understandings of loneliness. In elucidating this dialectic, we aim to develop new knowledge and a novel theoretical framework for understanding loneliness and its technological solutions, which, in turn, can enable better solutions to contemporary problems of loneliness.

METHODS AND ANALYSIS

We will adopt a qualitative approach that combines interviews, participant observation and textual analysis to explore loneliness and its technological solutions from the perspectives of policy-makers, producers, professionals and users in Norway and the UK. The data will be analysed through an analytical framework combining insights from discourse theory and philosophical debates on presence, which will allow us to capture and rethink fundamental assumptions about loneliness and technology. Outcomes will be revised understandings of loneliness, relevant to researchers, entrepreneurs, policy-makers, clinicians, educators and the broader public.

ETHICS AND DISSEMINATION

The project has been evaluated and approved by the data protection officer at Oslo Metropolitan University and by the Norwegian Social Science Data Services. Additional ethical approval for data collection in the UK has been provided by the University of Oxford Interdivisional Research Ethics Committee. Informed consent will be obtained from all participants. Findings will be disseminated through peer-reviewed publications, international conference presentations and lay media.

Associations between nurse-patient interaction and loneliness among cognitively intact nursing home residents - a questionnaire survey

Nursing home (NH) residents risk loneliness because of many losses. Nurse-patient interaction includes core aspects contributing to thriving and well-being among long-term NH residents. We performed a cross-sectional observation study of 188 residents 65 years and older from 27 NHs with ≥3 months' residence. All had informed consent competence recognized by the responsible doctor and nurse and could converse. We asked "Do you sometimes feel lonely?" and used the Nurse-Patient Interaction Scale (NPIS) in face-to-face interviews. We identified associations between nurse-patient interaction and loneliness and investigated the prevalence of loneliness. Eighty-eight (47%) respondents reported loneliness often or sometimes and 100 (53%) rarely or never. Adjusted for sex and age, 10 of the 14 NPIS items were significantly correlated with loneliness. Loneliness is common among cognitively intact NH residents. Nurse-patient interaction associates with residents' loneliness and might be important in alleviating loneliness.

[Psychosocial effects of the pandemic on staff and residents of nursing homes as well as their relatives-A systematic review]

Hintergrund

Die COVID-19-Pandemie stellt Bewohner von Altenpflegeeinrichtungen, deren Angehörige bzw. Besucher ebenso wie Mitarbeitende vor große Herausforderungen. Viruseindämmende Maßnahmen wirken sich stark auf das Wohlbefinden der betroffenen Personengruppen aus.

Material und Methode

Systematische Literatursuche nach Studien zu psychosozialen Folgen der Pandemie für Bewohner, deren Angehörige bzw. Besucher sowie Mitarbeitende und Zusammenführung der Ergebnisse mittels narrativer Synthese.

Ergebnisse

Es wurden 756 Studien gesichtet, davon 15 Arbeiten eingeschlossen. Die Daten wurden zwischen Februar und Juni 2020 mit Teilnehmenden aus 14 Ländern erhoben. Es wurden v. a. Einsamkeit, Trauer und Depressivität, aber auch Angst, als häufige Reaktionen der Bewohner auf die Kontakt- und Besuchsrestriktionen berichtet. Bewohner mit kognitiven Einschränkungen litten stärker unter den Auswirkungen, auch wenn es gegenteilige Hinweise gibt. Angehörige bzw. Besucher berichteten ebenfalls von einer Zunahme ihrer Einsamkeit und einer reduzierten Lebensqualität. In den Befragungen der Mitarbeitenden schildern diese Angst vor einer Infektion sowohl bei sich als auch bei den Bewohnern. Infizierte Mitarbeitende in den USA äußerten Wut darüber, nicht ausreichend geschützt worden zu sein. Darüber hinaus berichteten Mitarbeitende von einer erheblichen Mehrbelastung.

Schlussfolgerung

Infolge der Pandemie und der ergriffenen Maßnahmen wurden negative psychosozialen Folgen bei Bewohnern, deren Angehörigen bzw. Besuchern und den Mitarbeitenden berichtet. Die abzuleitenden Unterstützungsbedarfe der 3 Personengruppen sind unterschiedlich und sollten bei zukünftigen Maßnahmen hinsichtlich der Pandemie stärker mitevaluiert werden.

Zusatzmaterial online

Die Online-Version dieses Beitrags (10.1007/s00391-021-01859-x) enthält eine Übersicht über die Suchstrategie und eine Übersicht über die Auswahlkriterien und eine Auflistung der eingeschlossenen Studien. Beitrag und Zusatzmaterial stehen Ihnen im elektronischen Volltextarchiv auf https://www.springermedizin.de/zeitschrift-fuer-gerontologie-und-geriatrie/7952776 zur Verfügung. Sie finden das Zusatzmaterial am Beitragsende unter „Supplementary Material“.

Association between social capital and loneliness among older adults: a cross-sectional study in Anhui Province, China

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.

How Elderly Residents in Nursing Homes Handle Loneliness-From the Nurses' Perspective

Introduction

Elderly people who leave their home environment and move to a nursing home enter a phase in life with diminishing contact with family and friends. This situation often results in a feeling of loneliness with a concomitant deterioration in physical and mental health. By exploring the topic through the lens of the nurses, this study takes a novel approach to address an under-researched area in the nursing field.

Objective

The objective of the study was to identify, based on the nurses’ experience, how elderly residents handle loneliness in the nursing home.

Methods

This study used a qualitative explorative approach with data collected through two focus group interviews with nine nurses at two elderly care facilities in Norway. The resulting transcripts were examined using an approach based on inductive content analysis.

Results

Three main categories emerged as crucial to help lonely nursing home residents cope with day-to-day life: (i) maintaining ties to one’s earlier life; (ii) engaging in recreational pursuits; and (iii) building new networks.

Conclusion

Analysing the findings based on sense of coherence (SOC) and person-centred care (PCC) theories illustrates the importance of maintaining a connection with both family and friends. To that point, having access to familiar objects from their earlier life seemingly provides meaning to the residents by bridging the past and the present. Recreational activities, ideally adapted to each person’s needs and ability, have a positive impact by providing structure and meaning that help overtake feelings of loneliness. Building a new network with fellow residents and staff imparts a sense of meaningful community belonging and projects both dignity and self-worth.

A systematic review of interventions for loneliness among older adults living in long-term care facilities

OBJECTIVES

This study aimed to review loneliness interventions for older adults living in long-term care (LTC) facilities over the past 10 years, to categorize interventions by type, and to compare effectiveness of loneliness interventions in these settings.

METHODS

Systematic review followed PRISMA guidelines. Articles matching search criteria were collected from PubMed, PsycINFO, and Web of Science from 2009 to 2019. The inclusion criteria were as follows: 1) English language, 2) intervention studies with a quantitative measure that compares pre-trial to post-trial changes, 3) loneliness as a primary or secondary outcome 4) subjects age >65, and 5) subjects living in a LTC facility, such as a nursing home, assisted-living, or hospice.

RESULTS

A total of 15 intervention studies qualified for systematic review. Most of these interventions were psychological therapies and leisure/skill development interventions. Approximately, 87% of studies reported significant decreases in loneliness following intervention. Laughter therapy, horticultural therapy, and reminiscence therapy were associated with the greatest decreases in loneliness.

DISCUSSION

Results suggest that, although less common than interventions in the community, there are several effective interventions to reduce loneliness among older adults living in LTC facilities. Lack of standardized measures and high-quality studies limits comparisons between intervention types and generalizability to different populations.

Association between Personal Social Capital and Loneliness among Widowed Older People

To explore the association between the personal social capital and loneliness among the widowed older adults in China. Data from 1497 widowed older adults were extracted from China’s Health-Related Quality of Life Survey for Older Adults 2018. The Chinese version of the Personal Social Capital Scale (PSCS-16) was used to evaluate the participants’ status of bonding and bridging social capital (BOC and BRC). Loneliness was assessed by the short-form UCLA Loneliness Scale (ULS-8). Multiple linear regression models were established to examine the relationship between social capital and loneliness. The BOC and BRC of rural widowed older people were significantly lower than those of widowed older people in urban areas, while loneliness of rural widowed older people was higher than that of widowed older people in urban areas. The result of the final model showed that loneliness of rural participants was significantly associated with both BOC (B = 0.141, p = 0.001) and BRC (B = −0.116, p = 0.003). The loneliness of the urban widowed sample had no association with both BOC and BRC (p > 0.05). These findings suggested that more social support and compassionate care should be provided to enrich the personal social capital and thus to reduce loneliness of widowed older adults, especially those in rural areas.

A social robot intervention on depression, loneliness, and quality of life for Taiwanese older adults in long-term care

OBJECTIVES

To investigate the effect of a social robot intervention on depression, loneliness, and quality of life of older adults in long-term care (LTC) and to explore participants' experiences and perceptions after the intervention.

DESIGN

A mixed-methods approach consisting of a single group, before and after quasi-experimental design, and individual interview.

PARTICIPANTS

Twenty older adults with depression from four LTC facilities in Taiwan were recruited.

INTERVENTION

Each participant participated in 8 weeks of observation and 8 weeks of intervention. In the observation stage, participants received usual care or activities without any research intervention. In the intervention stage, each participant was given a Paro (Personal Assistive RobOt) to keep for 24 hours, 7 days a week.

MEASUREMENTS

The Geriatric Depression Scale, the UCLA Loneliness Scale Version 3, and the World Health Organization Quality of Life Questionnaire for older adults were administered at four time points. Individual qualitative interviews with thematic analysis followed.

RESULTS

A repeated multivariate analysis of variance and Friedman's test showed no significant changes during the observation stage between T1 and T2 for depression and quality of life (p >.5). For the intervention stage, statistically significant changes in decreasing depression and loneliness and improving quality of life over time were identified. Three themes emerged from the interviews: (i) humanizing Paro through referring to personal experiences and engagement; (ii) increased social interaction with other people; and (iii) companionship resulting in improved mental well-being.

CONCLUSIONS

There were significant improvements in mental well-being in using Paro. Further research may help us to understand the advantages of using a Paro intervention as depression therapy.

Relationships and material culture in a residential home for older people

Residents of older people's homes furnish their rooms with belongings that are associated with meaningful relationships. Previous research shows how material culture symbolises residents’ past and existing relationships, helping residents to remain embedded within familial and social networks. Less attention has been paid to how relationships are actively (re)constituted through socio-material interactions, and to the potential for objects to facilitate new relationships. This article presents findings from an ethnographic study into the everyday experiences of residents of an older people's home in northern England. Using observations of daily life and in-depth interviews with residents, it demonstrates how residents used material culture in gift-giving, divestment practices and in mundane social interactions. In this way, residents used objects to not only maintain relationships with family members outside the home, but form new relationships inside the home with other residents and members of staff. Combining theories of materiality, relationality and social practice, I argue that residents’ interactions with material culture helped to facilitate new social interaction and meaningful relationships. This is important in a social context where loneliness has been identified as a significant threat to residents’ mental and physical health. Residential homes for older people can develop guidance on practical activities and strategies that can use material culture to increase social interaction and enhance quality of life for residents.

Changes in prevalence of loneliness over time in institutional settings, and associated factors

OBJECTIVES

The aim of this study was to examine changes in the prevalence of loneliness over time from 2011 to 2017 in long-term care facilities; and its related factors.

MATERIAL AND METHODS

Repeated cross-sectional studies exploring loneliness and its associated factors among residents in long-term care facilities were conducted in Helsinki, Finland in 2011 (N = 4966) and 2017 (N = 3767). Residents in temporary respite care or with severe cognitive impairment, and those unable or refusing to respond to the loneliness item were excluded. The total number of participants in this analysis was 1563 in 2011, and 1367 in 2017. In both samples, we used the same loneliness measurement by asking "Do you suffer from loneliness?" (never/sometimes/often or always). When comparing the samples in order to reduce the effect of confounding between them, we used propensity score matching. A multivariable logistic regression model explored the relationship between various characteristics and loneliness.

RESULTS

Loneliness showed no change in prevalence over time: propensity score-adjusted loneliness was 36 % in 2011 and 2017. In the multivariate logistic regression model, feeling depressed was the only independent characteristic associated with loneliness. Of the respondents who did not feel depressed, 24 % suffered from loneliness at least sometimes. Among the respondents who felt depressed, the respective figure was 55 %.

CONCLUSION

Loneliness is common in institutional settings. It remained stable, and not decreased over time. Because loneliness impairs the well-being, quality of life and health of residents, it needs to be addressed. Screening loneliness and developing interventions to alleviate it, is essential.

Social Capital: A Concept Analysis

The concept of social capital appears in the literature of multiple disciplines as a social determinant of health, an important aspect of human interaction, and a means to support population health capacity. Little is known about the use of social capital within the context of nursing. This article's aim provides insight into the concept of social capital and nursing. Avant and Walker methodology was used to analyze a sample of 78 articles. Along with a variety of articles and content themes, findings from this concept analysis include critical attributes, an operational definition, and reflections regarding future use.

Time- and place-dependent experiences of loneliness in assisted living facilities

The purpose of the study is to explore feelings of loneliness among residents in assisted living facilities in terms of how loneliness is experienced and articulated, and what specific factors are related to the experiences. The study used a mixed-method approach. We individually interviewed 13 residents twice over six months. We conducted two focus group interviews and noted our observations each time we met the respondents. Data analysis leaned on abductive reasoning. The respondents described loneliness in versatile, rich ways. It proved to be time and place dependent. It was dependent on the time of day, days of the week and seasons. Lonely time was meaningless and filled with a feeling of waiting. Loneliness was also intertwined with place. None of the respondents called their apartment home; instead they called it a hospital, even a prison. They had to spend long periods of time in their apartments against their will, and their desire to interact with other residents was not met. The respondents felt invisible. Residents’ experiences of loneliness in assisted living facilities are unique and distinctive. Time- and place-dependent experiences of loneliness act as important signals for reflection on how care practices in these facilities could be more satisfying. Loneliness should therefore be a key topic and the target of prevention and interventions.

Social Capital and Self-Rated Health among Older Adults Living in Urban China: A Mediation Model

Social capital and healthy aging are both crucial for social sustainability in China. The present study tested the role of structural social capital in self-rated health among older urban Chinese adults and the influence of cognitive social capital on this relationship. A sample of 456 older adults aged 60 or older in Suzhou, China, were recruited and completed the survey in 2015. Structural equation modeling was used to test the proposed model. Cognitive social capital had larger effects on self-rated health than structural social capital. The relationship between structural social capital and self-rated health was fully mediated by cognitive social capital, when sociodemographic characteristics, socioeconomic status, physical health conditions, and living arrangements were controlled. The culturally sensitive latent construct of community-based social capital proved to be a valid instrument in urban Chinese contexts. Structural social capital likely indirectly affects self-rated health through cognitive social capital. Policy and intervention implications are discussed.

Experienced Loneliness in Home-Based Rehabilitation: Perspectives of Older Adults With Disabilities and Their Health Care Professionals

This study aimed to describe and interpret perspectives of older adults with disabilities and their health care professionals (HCPs) on experienced loneliness during home-based rehabilitation. The interpretive description methodology guided the study. Data included semistructured individual interviews with seven older adults and a focus group interview with three HCPs. The analysis revealed four main findings that symbolized experienced loneliness. “Unspoken pain” and “gatekeeping emotions” concerning experienced loneliness as a taboo and stigma during rehabilitation were closely connected. “Resignation” and “awaiting company” signified the consequences of experienced loneliness when not addressed. Unspoken pain, gatekeeping emotions, resignation, and awaiting company were dominating experiences in the lives of the older adults during a home-based rehabilitation program following disability. This had restrained them from verbalizing and coping with loneliness during rehabilitation and life in general. The HCPs’ attempt to provide support for the older adults in coping with loneliness appeared to be characterized by gatekeeping emotions and keeping hidden agendas.

"Homeless in life" - loneliness experienced as existential suffering by older adults living at home: a caring science perspective

BACKGROUND

Due to physical impairments and functional limitations, older adults receiving home care can be considered especially vulnerable to loneliness. To understand how society can provide support that enhances vulnerable individuals' quality of life, it is important to explore loneliness and its underlying causes in older adults.

AIMS

To contribute to a deeper understanding of caring science theory, the aim of this study was to use a caring science perspective to explore and understand experiences of suffering from loneliness in older adults receiving home care. The research questions are as follows: What phenomena are associated with the experience of suffering from loneliness in older adults receiving home care? How can this experience be understood?

METHODOLOGY

A hermeneutical approach was used. The material was collected through interviews with 17 older adults about their quality of life, including their experiences of loneliness. The texts were interpreted through latent content analysis.

FINDINGS

The findings resulted in one main category and three subcategories. The main category was as follows: Being homeless in life-loneliness expressed and primarily stemming from existential suffering. The subcategories were as follows: Loss of communion with one's partner or other loved ones, Loss of meaningful social activities due to isolation and Loss of health due to frailty and vulnerability. All categories were described and implications for practice discussed.

CONCLUSION

This study contributes to an understanding of experiences of suffering from loneliness in older adults receiving home care, with relevance for the healthcare context as well as for what a community or society should focus on when addressing these important issues.

Perpetuating harms from isolation among older adults with cognitive impairment: observed discrepancies in homecare service documentation, assessment and approval practices

Background

Older persons with cognitive impairment (CI) risk social isolation. Strong evidence shows that perceived loneliness, or inadequate social networks, triggers and increases health problems. How homecare systems address social participation remains unknown; anecdotal data suggests there are significant gaps. This study’s objective was to identify and describe how the assessors of homecare needs document social participation among persons with CI and how their documentation corresponds with the services actually provided to meet social needs. The research questions were: How and what kinds of social participation needs are documented on need assessment forms? What types of homecare services (with a social focus) are documented and approved? How are specified needs in social participation profiles addressed by a homecare service?

Methods

Descriptive data from need assessment forms and their attached care plans for all applicants aged 65+ were collected during a 2 month period from a large homecare agency serving a municipality in Sweden. Persons with documented CI (n = 43) in the group were identified. Qualitative data analysis was conducted to examine the research questions.

Results

Social participation factors were not documented consistently. The relationship between recognition of limitations to social participation and approval of service eligibility was not consistent. Social participation was designated by references to social status, sometimes by social network size, and occasionally by limitations to social participation. The range of approved homecare services (with social focus) covered services such as day care center visits or companionship. Three profiles of social participation were identified: clients with, (a) no participation limitations; (b) potential limitations; and (c) marked limitations.

Conclusion

Given the known health harms from social isolation and the high risk of isolation among older persons with CI, this novel study’s documentation of inadequate and inconsistent information in homecare social need assessments and services is sobering. The findings suggest a pressing need for initiatives to formulate best practices and standards to ensure alignment of care service systems to the health needs of the growing group of aging individuals with CI.

Social and emotional loneliness in Korsakoff's syndrome

INTRODUCTION

Loneliness is the subjective negative evaluation of social participation and isolation. Emotional loneliness reflects the absence of close relationships, and social loneliness the absence of a social network. Although loneliness is a growing problem in modern society, studies about loneliness in patients with Korsakoff's syndrome (KS) in need of chronic care are currently missing.

METHODS

Sixty-three KS patients in long-term care and their primary caregivers reported loneliness of the patients on the De Jong Gierveld Loneliness Scale.

RESULTS

A majority of KS patients reliably reported to feel lonely on both a social and emotional level of loneliness. The caregiving professionals rated loneliness of the patients even higher. Patients that had stayed in the clinic for a longer time tended to report less social loneliness, while caregivers reported less emotional loneliness in those patients. The KS-specific neuropsychiatric symptom of confabulations and a lack of social visits had a negative impact on social loneliness as perceived by the caregivers.

CONCLUSION

Loneliness is a large problem in patients with KS that live in a long term care facility. Social loneliness can be positively influenced by creating possibilities to interact with other people, although the severity of the neuropsychiatric aspects of KS could compromise the presence of those interactions.

Fulfilled preferences, perceived control, life satisfaction, and loneliness in elderly long-term care residents

OBJECTIVES

Person-centered care constructs such as fulfilled preferences, sense of control, and life satisfaction might contribute to loneliness among nursing home residents, but these relationships have not been thoroughly explored. The aim of this study was to examine the relationship between fulfilled preferences and loneliness in nursing home residents with perceived control and life satisfaction as potential mediators.

METHODS

The study utilized a cross-sectional design, examining the targeted variables with a questionnaire administered by trained research staff. A convenience sample of 65 residents (median age = 71) of eight nursing homes were interviewed. Linear regression analysis was utilized to examine the mediation hypotheses.

RESULTS

The relationships between fulfilled preferences and loneliness (β = -.377, p = .002), fulfilled preferences and perceived control (β = -.577, p < .001), and perceived control and loneliness (β = .606, p < .001) were significant, and the relationship between fulfilled preferences and loneliness (β = -.040, p = .744) became non-significant when perceived control was included in the model. The relationships between fulfilled preferences and life satisfaction (β = .420, p < .001) and life satisfaction and loneliness (β = -.598, p < .001) were significant, and the relationship between fulfilled preferences and loneliness (β = -.152, p = .174) became non-significant when life satisfaction was included in the model.

CONCLUSION

The findings suggest an important association between person-centered care, particularly fulfilling personal care and recreation preferences, and social-affective needs of long-term care residents. Fulfilling preferences may be an appropriate intervention target for loneliness.

"Trapped in an Empty Waiting Room"-The Existential Human Core of Loneliness in Old Age: A Meta-Synthesis

Loneliness in old age has a negative influence on quality of life, health, and survival. To understand the phenomenon of loneliness in old age, the voices of lonely older adults should be heard. Therefore, the purpose of this meta-synthesis was to synthesize scientific studies of older adults' experiences of loneliness. Eleven qualitative articles that met the inclusion criteria were analyzed and synthesized according to Noblit and Hare's meta-ethnographic approach. The analysis revealed the overriding meaning of the existential human core of loneliness in old age expressed through the metaphor "trapped in an empty waiting room." Four interwoven themes were found: (a) the negative emotions of loneliness, (b) the loss of meaningful interpersonal relationships, (c) the influence of loneliness on self-perception, and (d) the older adults' endeavors to deal with loneliness. The joint contribution of family members, health care providers, and volunteers is necessary to break the vicious circle of loneliness.

Older People, Loss, and Loneliness: The Troublesome Nature of Increased Contact With Adult Children

Older people may experience considerable loss when they endure emotional or social loneliness. Emotional loneliness is related to the loss or absence of a confidant while social loneliness describes the discrepancy between the nature of one’s desired and actual social network. In this article, both concepts are examined in relation to new attendees at time-limited day center reablement programs in Northern Ireland. Using group work activities, reablement programs aim to motivate participants to continue to live independently, often in the face of later life losses. Out of a total of 91 initial respondents (range, 61–94), 13 lived with adult children (10 of whom were lone parents). Those living with, or who had daily contact with, adult children had significantly higher levels of emotional loneliness at the start of their program, but not at the end. For this sample, reductions in emotional loneliness in certain cohorts of older adults who attend these programs have been identified. In conclusion, it is proposed that fourth age losses mediate older people’s living arrangement and may create greater vulnerability to emotional loneliness in those living with adult children. In addition, social groups may be effective in helping reduce emotional loneliness.