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Pengpid S, Peltzer K. Loneliness and associated factors among middle-aged and older adults: cross-sectional and longitudinal survey results from the HAALSI cohort in South Africa. Aging Ment Health 2024; 28:1179-1187. [PMID: 38726552 DOI: 10.1080/13607863.2024.2345777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/15/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVES Longitudinal studies on chronic loneliness and before and during the COVID-19 pandemic are lacking in Africa. The study aimed to estimate the prevalence and associated factors of loneliness and chronic loneliness using cross-sectional and longitudinal data from middle-aged and older adults from rural South Africa. METHOD The analysis utilized data from the South African 7-year longitudinal Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) (analytic sample: n = 3,418, aged 40 years and older). Loneliness was assessed with a single and 3-item measure. RESULTS The proportion of loneliness was 19.5% in the 2021/2022 survey, the incidence of chronic loneliness (having loneliness in wave 2 and 3, and free of loneliness in wave 1) was 18.9%, and the 7-year incidence of loneliness was 41.0%. Comparing the 2019 (pre-COVID-19) to 2021/2022 (during COVID-19 pandemic) surveys participants experienced a significant reduction of loneliness. In cross-sectional and/or longitudinal analyses, we found that younger age, living alone, food insecurity, lack of social engagement, depressed mood, poor life satisfaction, poor sleep quality, impaired cognition, poor self-rated health, functional disability, underweight, obesity, and not living with HIV were associated with a higher prevalence, incidence and/or increases in loneliness. CONCLUSION One in five aging adults had acute or chronic loneliness. Several social, mental, and physical health factors were identified as associated with loneliness.
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Affiliation(s)
- Supa Pengpid
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Karl Peltzer
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
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2
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Morales M, Wilkinson-Lee AM, Ingram M, Nuño T, Guernsey De Zapien JE, Sepulveda R, Carvajal S. Risk factors associated with loneliness among mexican-origin adults in southern Arizona. BMC Public Health 2024; 24:1694. [PMID: 38918747 PMCID: PMC11197176 DOI: 10.1186/s12889-024-19199-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 06/19/2024] [Indexed: 06/27/2024] Open
Abstract
This study examines factors associated with symptoms of loneliness among a sample (n = 213) of mostly Mexican-origin adults at risk of chronic diseases in Southern Arizona's Pima, Yuma, and Santa Cruz counties. It uses baseline data from a community-based participatory research partnership and multinominal logistic regression models. Controlling for chronic diseases and sociodemographic characteristics, perceived social support and hope exhibit negative main effects on loneliness when comparing individuals who experienced loneliness for 5-7 days in the preceding week with those who did not encounter such feelings during the same period (adjusted odds ratio, AOR = 0.49 and 0.47; 95% confidence interval, CI = 0.34-0.73 and 0.29-0.75, respectively). However, when considered together, perceived social support and hope display a positive and statistically significant combined effect on loneliness (AOR = 1.03; 95% CI = 1.01-1.06). Holding all covariates constant, individuals reporting loneliness for 5-7 days exhibit a relative risk ratio of 1.24 (95% CI = 1.06-1.46) for a one-unit increase in physical problem severity compared to those who do not experience loneliness. Moreover, being 65 years old or older (AOR = 0.16, 95% CI = 0.03-0.84), and having been born in Mexico and lived in the US for less than 30 years (AOR = 0.12, 95% CI = 0.02-0.74) are associated with negative main effects on loneliness when comparing individuals who experienced loneliness 1-2, and 5-7 days in the preceding week with those who did not feel loneliness during the same timeframe, respectively. Recognizing the crucial role of loneliness in shaping health outcomes for Mexican-origin adults, our findings underscore the significance of fostering supportive environments that not only enhance well-being but also cultivate robust community bonds within the US-Mexico border region.
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Affiliation(s)
- Mario Morales
- Arizona Prevention Research Center, Health Promotion Sciences Department, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, 85724, USA.
| | - Ada M Wilkinson-Lee
- Arizona Prevention Research Center, Health Promotion Sciences Department, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, 85724, USA
- Department of Mexican American Studies, The University of Arizona, Tucson, AZ, 85721, USA
| | - Maia Ingram
- Arizona Prevention Research Center, Health Promotion Sciences Department, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, 85724, USA
| | - Thomas Nuño
- Arizona Prevention Research Center, Health Promotion Sciences Department, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, 85724, USA
| | - Jill E Guernsey De Zapien
- Arizona Prevention Research Center, Health Promotion Sciences Department, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, 85724, USA
| | - Ramses Sepulveda
- Arizona Prevention Research Center, Health Promotion Sciences Department, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, 85724, USA
| | - Scott Carvajal
- Arizona Prevention Research Center, Health Promotion Sciences Department, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, 85724, USA
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Rodrigues PMF, Silva PGS, Voss G, Martinez-Pecino R, Delerue-Matos A. Pandemic policies and sleeping problems in older adults. J Sleep Res 2024:e14268. [PMID: 38924266 DOI: 10.1111/jsr.14268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/29/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024]
Abstract
Sleep quality is fundamental to physical and mental health. Recent research shows that the COVID-19 pandemic has affected individuals' sleep quality. This study aims to investigate whether the containment and health policies (Oxford Coronavirus Government Response Tracker indexes) adopted by European countries and Israel during the pandemic are related to sleep problems in people aged 50 and over. A cross-sectional study was conducted using a logistic regression analysis based on data from the Survey of Health, Ageing and Retirement in Europe, collected in 27 European countries and Israel, in 2021. The results show that containment and health policies affect older adults' sleep, once we neutralise the influence of the sociodemographic, economic, and health characteristics of the individuals and close contact with COVID-19. In fact, the more containment and health policies, the fewer chances of sleep problems. A possible explanation for this is that these policies give people over 50 a sense of safety and security in relation to COVID-19, which may reduce sleep problems.
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Affiliation(s)
| | | | - Gina Voss
- Communication and Society Research Centre, University of Minho, Braga, Portugal
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Van Bogart K, Harrington EE, Witzel DD, Kang JE, Sliwinski MJ, Engeland CG, Graham-Engeland JE. Momentary loneliness and intrusive thoughts among older adults: the interactive roles of mild cognitive impairment and marital status. Aging Ment Health 2024:1-8. [PMID: 38907581 DOI: 10.1080/13607863.2024.2368643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 06/11/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVES Loneliness is associated with maladaptive cognitions, yet little is known about the association between loneliness and intrusive thinking during older adulthood. Links between loneliness and intrusive thoughts may be particularly strong among individuals with mild cognitive impairment (MCI), who may have greater difficulty regulating emotion and intrusive thoughts. In contrast, having close relationships (e.g. being married) may serve as a protective factor as marital status is associated with better overall well-being. METHOD Participants were 316 older adults (recruited from the Bronx, NY, as part of a larger study) without dementia at study intake (40% Black; 13% Hispanic, Mage = 77.45 years, 67% women) who completed ecological momentary assessments five times daily for 14 consecutive days (13,957 EMAs total). Multilevel modeling was used to examine the association between momentary loneliness and intrusive thoughts and whether MCI and marital status interacted to moderate this association. RESULTS There was a significant three-way interaction (β = -0.17, p < 0.05), such that lagged momentary loneliness was positively associated with intrusive thoughts (3-4 h later) for those with MCI who were not married. CONCLUSION Findings suggest that among older adults with MCI, being married may be a protective factor and being unmarried may be a risk factor for experiencing loneliness and subsequent intrusive thoughts.
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Affiliation(s)
- Karina Van Bogart
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
| | | | - Dakota D Witzel
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
| | - Jee Eun Kang
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
| | - Martin J Sliwinski
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, USA
| | - Christopher G Engeland
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Jennifer E Graham-Engeland
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
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Robinson E, Dickins M, Lad L, Beard S, McGill D, Hayes J, Fabri AM, Wade H, Meyer C, Lowthian JA. Adaptation and Implementation of a Volunteer-Delivered, Telephone-Based, Social Support Program HOW-R-U? During the COVID-19 Pandemic: A Pragmatic Study. THE GERONTOLOGIST 2024; 64:gnae034. [PMID: 38656333 DOI: 10.1093/geront/gnae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Public health concerns surrounding social isolation and loneliness heightened during the coronavirus disease 2019 (COVID-19) pandemic, as infection prevention measures led to increased feelings of loneliness and depression. Our objective was to evaluate the implementation of the HOW-R-U? program, during the pandemic (March 2020-December 2021). HOW-R-U? is a weekly volunteer-delivered telephone program designed to facilitate social connection and ease feelings of social isolation, loneliness, and depression in older people. RESEARCH DESIGN AND METHODS This pragmatic study used the Implementation Framework for Aged Care to adapt and implement HOW-R-U? in an Australian aged and community care organization and a tertiary health service in Melbourne. The evaluation involved analysis of program data, semistructured interviews, and surveys with program recipients, volunteers, and referrers. A process evaluation was conducted alongside an assessment of outcomes including pre- and post-symptoms of isolation, depression, and loneliness. RESULTS The implementation evaluation indicated that codesigned systems and processes effectively supported the ongoing implementation of HOW-R-U? with transition into business as usual across both organizations. Recipients reported that telephone calls had a positive impact on their lives, whereas volunteers reported enjoyment of supporting others. Several challenges were identified, namely in program reach and fidelity. DISCUSSION AND IMPLICATIONS HOW-R-U? was well regarded by all involved, and evaluation learnings have informed implementation into business as usual by both organizations.
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Affiliation(s)
| | - Marissa Dickins
- Bolton Clarke Research Institute, Melbourne, Victoria, Australia
- Department of Psychiatry, Southern Synergy, Monash Health, Melbourne, Victoria, Australia
| | - Lina Lad
- Bolton Clarke, Melbourne, Victoria, Australia
| | | | | | | | | | - Henni Wade
- Northern Health, Melbourne, Victoria, Australia
| | - Claudia Meyer
- Bolton Clarke Research Institute, Melbourne, Victoria, Australia
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Judy A Lowthian
- Bolton Clarke Research Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Sánchez BLP, Serrano‐Dueñas M, Panta DAM, Vásquez JAM. Abuse and other factors related to depression in older Ecuadorian adults. Aging Med (Milton) 2024; 7:328-333. [PMID: 38975313 PMCID: PMC11222729 DOI: 10.1002/agm2.12338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/30/2024] [Accepted: 06/02/2024] [Indexed: 07/09/2024] Open
Abstract
Objective To identify abuse and other risk factors associated with depression in older Ecuadorian adults using data from the 2012 Ecuador's Survey of Health, Welfare, and Aging (SABE). Methods This cross-sectional study analyzed data from the 2012 SABE survey, which included 5235 adults aged 60 and above. The study evaluated residence, education level, ethnic self-identification, self-perceived health and memory, loneliness, cognitive status, and abuse. Depression was assessed using the Yesavage Depression Scale, short version (YDS-SV). Categorical variables were analyzed with the Chi-square test, differences between groups were calculated with the Kruskal-Wallis test, and multiple linear regression analysis was performed. A p-value of ≤0.05 was considered statistically significant. Results The mean age was 71.39 ± 8.59 years and 55.10% of the sample were women. Abuse was absent in 72.1% (3.773) of the population. The Chi-square test indicated significant associations between depression and poor self-reported health (P = 0.000) and indigenous ethnicity (P = 0.000). Multiple linear regression analysis revealed that age (P < 0.001), abuse (p < 0.001), cognitive status (P = 0.002), and living alone (P = 0.034) significantly contributed to mood as assessed by the YDS-SV. No statistically significant association was found for perceived health status or place of residence (urban or rural). Conclusions Risk factors associated with depression in older Ecuadorian adults include advanced age, living alone, cognitive decline, poor self-perception of health and cognition, and abuse.
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Oken BS, Kaplan J, Klee D, Gallegos AM. Contributions of loneliness to cognitive impairment and dementia in older adults are independent of other risk factors and Alzheimer's pathology: a narrative review. Front Hum Neurosci 2024; 18:1380002. [PMID: 38873650 PMCID: PMC11169707 DOI: 10.3389/fnhum.2024.1380002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/20/2024] [Indexed: 06/15/2024] Open
Abstract
Loneliness significantly contributes to cognitive impairment and dementia in older adults. Loneliness is a distressing feeling resulting from a perceived lack of social connection (i.e., a discrepancy between desired and actual social relationships), while social isolation is a related term that can be defined by number and type of social relationships. Importantly, loneliness is distinct from social isolation in that it is associated with a distressing self-perception. The primary focus of this narrative review is the impact of chronic loneliness on cognitive impairment and dementia among older adults. Loneliness has a significant association with many factors that are related to worse cognition, and therefore we include discussion on health, mental health, as well as the physiological effects of loneliness, neuropathology, and potential treatments. Loneliness has been shown to be related to development of dementia with a hazard ratio (HR) risk comparable to having a single APOE4 gene. The relationship of dementia to loneliness appears to be at least partially independent of other known dementia risk factors that are possibly associated with loneliness, such as depression, educational status, social isolation, and physical activity. Episodic memory is not consistently impacted by loneliness, which would be more typically impaired if the mild cognitive impairment (MCI) or dementia was due to Alzheimer's disease (AD) pathology. In addition, the several longitudinal studies that included neuropathology showed no evidence for a relationship between loneliness and AD neuropathology. Loneliness may decrease resilience, or produce greater cognitive change associated with the same level of AD neuropathology. Intervention strategies to decrease loneliness in older adults have been developed but need to consider key treatment targets beyond social isolation. Loneliness needs to be assessed in all studies of cognitive decline in elders, since it significantly contributes to the variance of cognitive function. It will be useful to better define the underlying mechanism of loneliness effects on cognition to determine if it is similar to other psychological factors related to excessive stress reactivity, such as neuroticism or even depression, which are also associated with cognitive decline. It is important from a health perspective to develop better strategies to decrease loneliness in older adults.
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Affiliation(s)
- Barry S. Oken
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, United States
| | - Josh Kaplan
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Daniel Klee
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Autumn M. Gallegos
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
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Mouriño-Ruiz R, Serral G, Continente X, López MJ, Lapena C, Puigpinós-Riera R. Evaluation of effectiveness of an art-based museum intervention in reducing loneliness among older adults (ArtGran): a quasi-experimental study. Public Health 2024; 230:149-156. [PMID: 38552347 DOI: 10.1016/j.puhe.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES Loneliness is a public health issue among older adults. We designed an intervention offering 10 sessions with diverse artistic methods (ArtGran). This study assessed the effectiveness of ArtGran in reducing loneliness and its negative effects on health in community-dwelling older adults in 2022 in Barcelona. STUDY DESIGN Quasi-experimental study, with an intervention group (IG) and a comparison group (CG). METHODS The sample included residents aged ≥70 years from 6 selected neighbourhoods of Barcelona. In each neighbourhood, an IG and a CG was formed with participants who reported loneliness and without special mobility needs. The participants were referred from primary care centres, social services, and community health centres. We included 138 participants (IG = 63, CG = 75). We collected data on loneliness, quality of life (QoL-5D), mood, and self-perceived health before and after the intervention through validated questionnaires. To assess the effect of the intervention, we built Poisson models with robust variance and linear regression models. RESULTS At the end of the intervention, participants in the IG were more likely than those in the CG to be able to perform their usual activities without problems (adjusted prevalence ratio [aPR] = 1.22; 95% confidence interval [CI]: 1.02-1.45). Compared with the CG, participants in the IG attending more than half of the sessions had lower levels of loneliness (aPR = 1.36; 95%CI: 1.07-1.73), a better ability to perform their usual activities (aPR [95%CI] = 1.24 [1.05-1.48]), and higher happiness scores (β = 0.73; P = 0.01). CONCLUSIONS The effectiveness of the intervention was more pronounced when participants had high attendance. Our results suggest that high attendance of the ArtGran program was helpful in shielding older individuals from loneliness, fostering positive moods, and preserving their functional status.
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Affiliation(s)
- R Mouriño-Ruiz
- Evaluation and Intervention Methods Service, Public Health Agency of Barcelona, Barcelona, Catalonia
| | - G Serral
- Evaluation and Intervention Methods Service, Public Health Agency of Barcelona, Barcelona, Catalonia; Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Barcelona, Catalonia
| | - X Continente
- Evaluation and Intervention Methods Service, Public Health Agency of Barcelona, Barcelona, Catalonia; Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Barcelona, Catalonia
| | - M J López
- Evaluation and Intervention Methods Service, Public Health Agency of Barcelona, Barcelona, Catalonia; Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Barcelona, Catalonia; Department of Experimental and Health Sciences at Universitat Pompeu Fabra, Barcelona, Catalonia
| | - C Lapena
- Primary Care Center Sanllehy, Gerència Territorial de Barcelona, Catalan Health Institute (ICS), Barcelona, Catalonia; Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Catalonia
| | - R Puigpinós-Riera
- Evaluation and Intervention Methods Service, Public Health Agency of Barcelona, Barcelona, Catalonia; Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Sant Pau Institute of Biomedical Research (IIB Sant Pau), Barcelona, Catalonia.
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Carrasco PM, Crespo DP, García AIR, Ibáñez ML, Rubio BM, Montenegro-Peña M. Predictive factors and risk and protection groups for loneliness in older adults: a population-based study. BMC Psychol 2024; 12:238. [PMID: 38671496 PMCID: PMC11055238 DOI: 10.1186/s40359-024-01708-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Loneliness is considered a public health problem, particularly among older adults. Although risk factors for loneliness have been studied extensively, fewer studies have focused on the protected and risk groups that these factors configure. Our objective is to analyze the variables and latent factors that predict loneliness in older adults and that enable risk and protected groups to be configured. METHODS We employed an epidemiological, cross-sectional survey that was carried out on a random sample of 2060 people over 65 years extracted from the census. A structured telephone interview was used to assess mental and physical health, habits, quality of life, and loneliness, applying the COOP-Wonca, Goldberg General Health (GHQ-12), and Barber Questionnaires. RESULTS Predictors of loneliness were: mental health, living alone, quality of life, depressive symptoms, low educational level, and some deficiency situations such as having no one to turn to for help. The factors extracted (Factorial Analysis) were: a subjective experience of poor health, objective isolation, and psychological isolation. We established at risk and protected groups ("Decision Tree" procedure), and loneliness was referred to by 73.2% of the people living alone and with poor mental health and quality of life (risk group). By contrast, only 0.8% of people living with others, with good mental health and good quality of life felt loneliness (protected group). CONCLUSION In a well-developed city, subjective and objective factors are associated with loneliness. These factors, especially those associated with at risk or protected groups, must be considered to develop strategies that address loneliness.
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Affiliation(s)
| | - David Prada Crespo
- Department of Experimental Psychology, Faculty of Psychology, Complutense University of Madrid (UCM), Madrid, Spain
- Department of Basic Psychology I, Faculty of Psychology, National University of Distance Education of Madrid, Madrid, Spain
| | | | | | | | - Mercedes Montenegro-Peña
- Centre for the Prevention of Cognitive Impairment, Madrid Salud, Madrid, Spain.
- Department of Experimental Psychology, Faculty of Psychology, Complutense University of Madrid (UCM), Madrid, Spain.
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Khin Moe Myint, DeMaranville J, Wongpakaran T, Peisah C, Arunrasameesopa S, Wongpakaran N. Meditation Moderates the Relationship between Insecure Attachment and Loneliness: A Study of Long-Term Care Residents in Thailand. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:622. [PMID: 38674268 PMCID: PMC11051991 DOI: 10.3390/medicina60040622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Loneliness is prevalent among residents of long-term care settings, posing significant challenges to their mental wellbeing. Insecure attachment has been identified as a contributing factor to loneliness in this population. Previous research has suggested that meditation may have beneficial effects on mental health outcomes. This study aimed to examine the relationship between meditation, insecure attachment, and loneliness among residents of long-term care facilities in Thailand. Specifically, the study sought to investigate the moderating effect of meditation on the association between insecure attachment (both avoidance and anxiety) and loneliness. Materials and Methods: A cross-sectional study was conducted involving 236 residents living in long-term care homes in Thailand. Participants completed self-report measures including the 18-item Revised Experience of Close Relationship questionnaire (to assess attachment anxiety and avoidance), the Inner Strength-Based Inventory (to measure meditation practice), and the 6-item Revised Version of the University of California Los Angeles Loneliness Scale. Moderation analyses were performed to explore the role of meditation in the relationship between insecure attachment and loneliness. Results: The mean age of participants was 73.52 years, with females accounting for 57.6% of the sample. Among the participants, 58.4% reported engaging in meditation, with practice frequency ranging from often to daily. The mean meditation score was 2.92 out of 5, indicating regular but not daily practice. Meditation was found to moderate the relationship between insecure attachment (both avoidance and anxiety) and loneliness. Specifically, the moderation effect between attachment anxiety and loneliness was significant (B = 0.44, SE = 0.21, 95% CI [0.30, 0.86]), as was the interaction effect between attachment anxiety and loneliness (B = -0.34, SE = 0.17, 95% CI [-0.67, -0.02]). Conclusions: The findings suggest that the impact of meditation practice on loneliness is influenced by an individual's attachment dimension. Meditation demonstrates a moderating effect on attachment avoidance, anxiety, and loneliness, with variations observed in the direction of these effects. The clinical implications of these findings and recommendations for further research are discussed.
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Affiliation(s)
- Khin Moe Myint
- Master of Science Program (Mental Health), Multidisciplinary Interdisciplinary School, Chiang Mai University, Chiang Mai 50200, Thailand; (K.M.M.); (J.D.); (T.W.); (C.P.)
| | - Justin DeMaranville
- Master of Science Program (Mental Health), Multidisciplinary Interdisciplinary School, Chiang Mai University, Chiang Mai 50200, Thailand; (K.M.M.); (J.D.); (T.W.); (C.P.)
| | - Tinakon Wongpakaran
- Master of Science Program (Mental Health), Multidisciplinary Interdisciplinary School, Chiang Mai University, Chiang Mai 50200, Thailand; (K.M.M.); (J.D.); (T.W.); (C.P.)
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Carmelle Peisah
- Master of Science Program (Mental Health), Multidisciplinary Interdisciplinary School, Chiang Mai University, Chiang Mai 50200, Thailand; (K.M.M.); (J.D.); (T.W.); (C.P.)
- Discipline of Psychiatry and Mental, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Suthikarn Arunrasameesopa
- Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi 11120, Thailand;
| | - Nahathai Wongpakaran
- Master of Science Program (Mental Health), Multidisciplinary Interdisciplinary School, Chiang Mai University, Chiang Mai 50200, Thailand; (K.M.M.); (J.D.); (T.W.); (C.P.)
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
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Stegen H, Duppen D, Savieri P, Stas L, Pan H, Aartsen M, Callewaert H, Dierckx E, De Donder L. Loneliness prevalence of community-dwelling older adults and the impact of the mode of measurement, data collection, and country: A systematic review and meta-analysis. Int Psychogeriatr 2024:1-15. [PMID: 38525677 DOI: 10.1017/s1041610224000425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
OBJECTIVES The aim of this systematic review and meta-analysis is to assess the prevalence of loneliness in many countries worldwide which have different ways of assessing it. DESIGN Systematic review and meta-analysis. SETTING We searched seven electronic databases for English peer-reviewed studies published between 1992 and 2021. PARTICIPANTS We selected English-language peer-reviewed articles, with data from non-clinical populations of community-dwelling older adults (>60 years), and with "loneliness" or "lonely" in the title. MEASUREMENTS A multilevel random-effects meta-analysis was used to estimate the prevalence of loneliness across studies and to pool prevalence rates for different measurement instruments, data collection methods, and countries. RESULTS Our initial search identified 2,021 studies of which 45 (k = 101 prevalence rates) were included in the final meta-analysis. The estimated pooled prevalence rate was 31.6% (n = 168,473). Measurement instrument was a statistically significant moderator of the overall prevalence of loneliness. Loneliness prevalence was lowest for single-item questions and highest for the 20-item University of California-Los Angeles Loneliness Scale. Also, differences between modes of data collection were significant: the loneliness prevalence was significantly the highest for face-to-face data collection and the lowest for telephone and CATI data collection. Our moderator analysis to look at the country effect indicated that four of the six dimensions of Hofstede also caused a significant increase (Power Distance Index, Uncertainty Avoidance Index, Indulgence) or decrease (Individualism) in loneliness prevalence. CONCLUSIONS This study suggests that there is high variability in loneliness prevalence rates among community-dwelling older adults, influenced by measurement instrument used, mode of data collection, and country.
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Affiliation(s)
- Hannelore Stegen
- Society and Ageing Research Lab (SARLab), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Daan Duppen
- Society and Ageing Research Lab (SARLab), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Perseverence Savieri
- Core facility - Support for Quantitative and Qualitative Research (SQUARE), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Lara Stas
- Core facility - Support for Quantitative and Qualitative Research (SQUARE), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Honghui Pan
- Society and Ageing Research Lab (SARLab), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Brussels Interdisciplinary Research centre on Migration and Minorities (BIRMM), Brussels, Belgium
| | - Marja Aartsen
- Norwegian Social Research, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Hannelore Callewaert
- Society and Ageing Research Lab (SARLab), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Eva Dierckx
- Society and Ageing Research Lab (SARLab), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Alexianen Zorggroep Tienen, Psychiatric Clinic, Tienen, Belgium
| | - Liesbeth De Donder
- Society and Ageing Research Lab (SARLab), Vrije Universiteit Brussel (VUB), Brussels, Belgium
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12
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Seewer N, Skoko A, Käll A, Andersson G, Luhmann M, Berger T, Krieger T. Efficacy of an Internet-based self-help intervention with human guidance or automated messages to alleviate loneliness: a three-armed randomized controlled trial. Sci Rep 2024; 14:6569. [PMID: 38503870 PMCID: PMC10951227 DOI: 10.1038/s41598-024-57254-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 03/15/2024] [Indexed: 03/21/2024] Open
Abstract
Loneliness is a prevalent and stigmatized phenomenon associated with adverse (mental) health outcomes. However, evidence-based interventions to alleviate loneliness are scarce. This randomized controlled trial (ClinicalTrials.gov-ID: NCT04655196) evaluated the efficacy of an internet-based cognitive behavioral self-help intervention (ICBT) to reduce loneliness by comparing two intervention groups with guidance or automated messages against a waitlist control group. Adults (N = 243) suffering from loneliness were recruited from the general public and then randomly assigned (2:2:1) to a 10-week ICBT with human guidance (GU) or automated messages (AM) or to a waitlist control group (WL). Loneliness, assessed with the UCLA-9, was the primary outcome. Outcomes were assessed at baseline and 10 weeks (post) and analyzed using mixed-effects models. The pooled intervention conditions resulted in lower loneliness scores at post-assessment than the WL (Cohen's d = 0.57, 95% CI [0.25; 0.89]) and reduced depressive symptoms, social anxiety, social avoidance behavior, and rejection sensitivity (d = 0.32-0.52). The GU group had lower loneliness scores at post-assessment than the AM group (d = 0.42, 95% CI [0.13; 0.70]). ICBT effectively alleviated loneliness, and guidance increased the reduction in loneliness compared to automated messages. Alleviating loneliness with ICBT further seems to reduce the overall burden of psychopathological symptoms.
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Affiliation(s)
- Noëmi Seewer
- Department of Clinical Psychology and Psychotherapy, University of Bern, 3012, Bern, Switzerland.
| | - Andrej Skoko
- Department of Clinical Psychology and Psychotherapy, University of Bern, 3012, Bern, Switzerland
| | - Anton Käll
- Department of Behavioral Sciences and Learning, and Biomedical and Clinical Sciences, Linköping University, 58183, Linköping, Sweden
| | - Gerhard Andersson
- Department of Behavioral Sciences and Learning, and Biomedical and Clinical Sciences, Linköping University, 58183, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, 11763, Stockholm, Sweden
| | - Maike Luhmann
- Faculty of Psychology, Ruhr University Bochum, 44801, Bochum, Germany
- German Center for Mental Health (DZPG), 80336, Munich, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, 3012, Bern, Switzerland
| | - Tobias Krieger
- Department of Clinical Psychology and Psychotherapy, University of Bern, 3012, Bern, Switzerland
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13
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Broadbent E, Loveys K, Ilan G, Chen G, Chilukuri MM, Boardman SG, Doraiswamy PM, Skuler D. ElliQ, an AI-Driven Social Robot to Alleviate Loneliness: Progress and Lessons Learned. JAR LIFE 2024; 13:22-28. [PMID: 38449726 PMCID: PMC10917141 DOI: 10.14283/jarlife.2024.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/20/2024] [Indexed: 03/08/2024]
Abstract
Background Loneliness is a significant issue in older adults and can increase the risk of morbidity and mortality. Objective To present the development of ElliQ, a proactive, AI-driven social robot with multiple social and health coaching functions specifically designed to address loneliness and support older people. Development/Implementation ElliQ, a consumer robot with a friendly appearance, uses voice, sounds, light, and buttons through a touch screen to facilitate conversation, music, video calls, well-being assessments, stress reduction, cognitive games, and health reminders. The robot was deployed by 15 government agencies in the USA. Initial experience suggests it is not only highly engaging for older people but may be able to improve their quality of life and reduce loneliness. In addition, the development of a weekly report that patients can share with their clinicians to allow better integration into routine care is described. Conclusion This paper describes the development and real-world implementation of this product innovation and discusses challenges encountered and future directions.
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Affiliation(s)
- E Broadbent
- Department of Psychological Medicine, the University of Auckland, New Zealand
| | - K Loveys
- Department of Psychological Medicine, the University of Auckland, New Zealand
| | | | | | - M M Chilukuri
- Durham Family Medicine, Duke University School of Medicine, USA
| | | | - P M Doraiswamy
- Department of Psychiatry and the Center for the Study of Aging, Duke University, USA
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14
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Ekström H, Svensson M, Elmståhl S, Wranker LS. The association between loneliness, social isolation, and sleep disturbances in older adults: A follow-up study from the Swedish good aging in Skåne project. SAGE Open Med 2024; 12:20503121231222823. [PMID: 38249948 PMCID: PMC10798090 DOI: 10.1177/20503121231222823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 12/02/2023] [Indexed: 01/23/2024] Open
Abstract
Objectives The aim of this follow-up study was to investigate whether loneliness and social isolation in a sample of older adults, mean age of 67.4 years at baseline examination, were associated with sleep disturbances at re-examination at a mean age of 76.4 years. Methods The study sample consisted of 2897 participants. Data on loneliness, social isolation, and sleep disturbances were collected through questionnaires and medical examinations. Logistic regression models were constructed to identify associations between levels of loneliness and social isolation at baseline and sleep disturbances at follow-up. Sociodemographic and health-related confounding factors were controlled for in the models. Results Sleep disturbances were reported by 25.6% (95% CI: 24.0%-27.2%) at baseline and 23.7% (95% CI: 22.1%-25.3%) at re-examination. Odds ratios for sleep disturbances at re-examination in relation to not being lonely or socially isolated were as follows: single occasions of loneliness (OR: 1.37, 95% CI: 1.05-1.78), recurring periods/constant loneliness (OR: 1.92, 95% CI: 1.01-1.99), less severe social isolation (OR: 1.18, 95% CI: 0.78-1.79), and severe social isolation (OR: 1.88, 95% CI: 1.01-3.49). Discussion Sleep disturbances are common among older adults and are associated with loneliness and social isolation. Healthcare professionals should be aware of the potential effects of loneliness and social isolation when investigating sleep disturbances in older adults.
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Affiliation(s)
- Henrik Ekström
- The Department of Clinical Sciences in Malmö, Division of Geriatric Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Markus Svensson
- The Department of Clinical Sciences in Malmö, Division of Geriatric Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Sölve Elmståhl
- The Department of Clinical Sciences in Malmö, Division of Geriatric Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Lena Sandin Wranker
- The Department of Clinical Sciences in Malmö, Division of Geriatric Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
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15
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Hajek A, Petersen E, Schäfer I, Harth V, Koch-Gromus U, Härter M, Schulz H, Scherer M, König HH. Is loneliness associated with cancellation of medical appointments during the COVID-19 pandemic? Evidence from the Hamburg City Health Study (HCHS). BMC Health Serv Res 2024; 24:32. [PMID: 38178105 PMCID: PMC10768441 DOI: 10.1186/s12913-023-10490-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic engendered numerous societal and economic challenges in addition to health-related concerns. Maintenance of healthcare utilization assumed immense significance during this period. However, few studies have examined the association between loneliness and cancelled medical appointments during the COVID-19 pandemic. This study aimed to examine whether medical appointments are less likely to be cancelled with increased loneliness during a pandemic. We analyzed the association between loneliness and both patient- and provider-initiated appointment cancellations. METHODS Cross-sectional data from the Hamburg City Health Study (HCHS) were collected during April 2020-November 2021. The analytical sample included 1,840 participants with an average age of 55.1 years (standard deviation: 6.5, range 45-76 years). Medical appointments cancelled by individuals-medical appointments in general, and GP, specialist, and dentist appointments-and appointments cancelled by healthcare providers served as outcome measures. Loneliness was quantified using a single item ranging from 0 to 10. Accordingly, we created empirical loneliness tertiles. Covariates were selected based on the Andersen model. Several penalized maximum likelihood logistic regressions were utilized to examine the association between loneliness and cancellation of medical appointments during the COVID-19 pandemic. RESULTS The penalized maximum likelihood logistic regressions showed that, compared to individuals in the lowest loneliness tertiles, individuals in the other two tertiles reported a higher chance of medical appointments cancellation by individuals, particularly driven by cancelled GP appointments. Except for age and sex, none of the covariates were comparably associated with the outcomes. When appointments cancelled by healthcare providers served as outcomes, only a higher number of chronic conditions was significantly positively associated with it. CONCLUSIONS Individuals scoring higher in loneliness had a greater chance of cancelling medical (particularly GP) appointments. This may contribute to a potential cascade of loneliness and skipped medical appointments in the future, resulting in adverse health outcomes over the medium-to-long term. Future research should examine whether lonely people are more likely to lack the social motivation to visit the doctor.
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Affiliation(s)
- A Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany.
| | - E Petersen
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Population Health Research Department, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - I Schäfer
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Population Health Research Department, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - V Harth
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - U Koch-Gromus
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Schulz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H H König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany
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16
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Morgan T, Wiles J, Morgan K, Williams L, Black S, Koh A, Fanueli E, Moeke-Maxwell T, Xu J, Goodwin H, Gott M. Older people's views on loneliness during COVID-19 lockdowns. Aging Ment Health 2024; 28:142-150. [PMID: 37178140 DOI: 10.1080/13607863.2023.2211549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/29/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND AND OBJECTIVES There have been growing concerns that social distancing and stay-at-home mandates have exacerbated loneliness for older people. Empirical evidence about older people's experiences of loneliness and COVID-19 have quantified this phenomena without considering how older people themselves define and understand loneliness. This paper explores how older New Zealanders conceptualized and experienced loneliness under 'lockdown' stay-at-home measures. METHODS This multi-methods qualitative study combines data from letters (n = 870) and interviews (n = 44) collected from 914 people aged over 60 and living in Aotearoa, New Zealand during the COVID-19 pandemic. We conducted a reflexive thematic analysis to conceptualise this data. FINDINGS We identify three interconnected ways in which older people conceptualised and experienced loneliness: (1) feeling disconnected relating to lack of emotional closeness to another often resulting from being physically separated from others and not being able to touch; (2) feeling imprisoned relating to separation from preferred identities and activities and was frequently associated with boredom and frustration; and (3) feeling neglected which often related to feeling let down by generalised and idealised forms of support, such as one's neighbourhood and health care system. DISCUSSION Older New Zealanders experienced lockdown loneliness in three interconnected ways rather than as a stable and homogenous experience. Māori, Pacific, Asian and New Zealand European older people often discussed loneliness in different ways; attesting to loneliness being a culturally-mediated concept shaped by expectations around desirable social interaction. We conclude the paper with implications for research and policy.
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Affiliation(s)
- Tessa Morgan
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Janine Wiles
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Kathryn Morgan
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Lisa Williams
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Stella Black
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Anne Koh
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Elizabeth Fanueli
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Tess Moeke-Maxwell
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Jing Xu
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Hetty Goodwin
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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17
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Hajek A, Volkmar A, König HH. Prevalence and correlates of loneliness and social isolation in the oldest old: a systematic review, meta-analysis and meta-regression. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02602-0. [PMID: 38102477 DOI: 10.1007/s00127-023-02602-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 11/20/2023] [Indexed: 12/17/2023]
Abstract
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.
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Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany.
| | - Alina Volkmar
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany
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18
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Carr S. A gradual separation from the world: commentary on a qualitative exploration of existential loneliness in old age. Br J Community Nurs 2023; 28:586-590. [PMID: 38032719 DOI: 10.12968/bjcn.2023.28.12.586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
AIMS AND METHODS Loneliness is a prevalent and significant issue. It has been identified as a particularly important physical and mental health risk for older people. This article critically explores and discusses a recent study that sought to qualitatively explore the lived experiences of existential loneliness in a large sample of older people living in retirement community contexts. FINDINGS The data pointed to complex, multilayered challenges, often brought about by ageing, that give rise to unique experiences of existential loneliness for many older people. CONCLUSIONS For clinical practitioners, understanding how older people experience existential loneliness is essential if we are to develop support mechanisms that compassionately and empathically respond to them.
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Affiliation(s)
- Sam Carr
- Department of Education and Centre for Death and Society, University of Bath, UK
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19
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Bowirrat A, Elman I, Dennen CA, Gondré-Lewis MC, Cadet JL, Khalsa J, Baron D, Soni D, Gold MS, McLaughlin TJ, Bagchi D, Braverman ER, Ceccanti M, Thanos PK, Modestino EJ, Sunder K, Jafari N, Zeine F, Badgaiyan RD, Barh D, Makale M, Murphy KT, Blum K. Neurogenetics and Epigenetics of Loneliness. Psychol Res Behav Manag 2023; 16:4839-4857. [PMID: 38050640 PMCID: PMC10693768 DOI: 10.2147/prbm.s423802] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/14/2023] [Indexed: 12/06/2023] Open
Abstract
Loneliness, an established risk factor for both, mental and physical morbidity, is a mounting public health concern. However, the neurobiological mechanisms underlying loneliness-related morbidity are not yet well defined. Here we examined the role of genes and associated DNA risk polymorphic variants that are implicated in loneliness via genetic and epigenetic mechanisms and may thus point to specific therapeutic targets. Searches were conducted on PubMed, Medline, and EMBASE databases using specific Medical Subject Headings terms such as loneliness and genes, neuro- and epigenetics, addiction, affective disorders, alcohol, anti-reward, anxiety, depression, dopamine, cancer, cardiovascular, cognitive, hypodopaminergia, medical, motivation, (neuro)psychopathology, social isolation, and reward deficiency. The narrative literature review yielded recursive collections of scientific and clinical evidence, which were subsequently condensed and summarized in the following key areas: (1) Genetic Antecedents: Exploration of multiple genes mediating reward, stress, immunity and other important vital functions; (2) Genes and Mental Health: Examination of genes linked to personality traits and mental illnesses providing insights into the intricate network of interaction converging on the experience of loneliness; (3) Epigenetic Effects: Inquiry into instances of loneliness and social isolation that are driven by epigenetic methylations associated with negative childhood experiences; and (4) Neural Correlates: Analysis of loneliness-related affective states and cognitions with a focus on hypodopaminergic reward deficiency arising in the context of early life stress, eg, maternal separation, underscoring the importance of parental support early in life. Identification of the individual contributions by various (epi)genetic factors presents opportunities for the creation of innovative preventive, diagnostic, and therapeutic approaches for individuals who cope with persistent feelings of loneliness. The clinical facets and therapeutic prospects associated with the current understanding of loneliness, are discussed emphasizing the relevance of genes and DNA risk polymorphic variants in the context of loneliness-related morbidity.
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Affiliation(s)
- Abdalla Bowirrat
- Department of Molecular Biology, Adelson School of Medicine, Ariel University, Ariel, 40700, Israel
| | - Igor Elman
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, 02139, USA
| | - Catherine A Dennen
- Department of Family Medicine, Jefferson Health Northeast, Philadelphia, PA, USA
| | - Marjorie C Gondré-Lewis
- Neuropsychopharmacology Laboratory, Department of Anatomy, Howard University College of Medicine, Washington, DC, 20059, USA
| | - Jean Lud Cadet
- Molecular Neuropsychiatry Research Branch, NIH National Institute on Drug Abuse, Bethesda, MD, 20892, USA
| | - Jag Khalsa
- Department of Microbiology, Immunology and Tropical Medicine, George Washington University, School of Medicine, Washington, DC, USA
| | - David Baron
- Division of Addiction Research & Education, Center for Sports, Exercise, and Mental Health, Western University of Health Sciences, Pomona, CA, 91766, USA
| | - Diwanshu Soni
- Western University Health Sciences School of Medicine, Pomona, CA, USA
| | - Mark S Gold
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Thomas J McLaughlin
- Division of Reward Deficiency Clinics, TranspliceGen Therapeutics, Inc, Austin, TX, USA
| | - Debasis Bagchi
- Department of Pharmaceutical Sciences, Texas Southern University College of Pharmacy, Houston, TX, USA
| | - Eric R Braverman
- Division of Clinical Neurology, The Kenneth Blum Institute of Neurogenetics & Behavior, LLC, Austin, TX, USA
| | - Mauro Ceccanti
- Alcohol Addiction Program, Latium Region Referral Center, Sapienza University of Rome, Roma, 00185, Italy
| | - Panayotis K Thanos
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, State University of New York at Buffalo, Buffalo, NY, 14203, USA
- Department of Psychology, State University of New York at Buffalo, Buffalo, NY, 14203, USA
| | | | - Keerthy Sunder
- Karma Doctors & Karma TMS, and Suder Foundation, Palm Springs, CA, USA
- Department of Medicine, University of California, Riverside School of Medicine, Riverside, CA, USA
| | - Nicole Jafari
- Department of Human Development, California State University at Long Beach, Long Beach, CA, USA
- Division of Personalized Medicine, Cross-Cultural Research and Educational Institute, San Clemente, CA, USA
| | - Foojan Zeine
- Awareness Integration Institute, San Clemente, CA, USA
- Department of Health Science, California State University at Long Beach, Long Beach, CA, USA
| | | | - Debmalya Barh
- Centre for Genomics and Applied Gene Technology, Institute of Integrative Omics and Applied Biotechnology (IIOAB), Purba Medinipur, WB, 721172, India
- Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, 31270-901, Brazil
| | - Milan Makale
- Department of Radiation Medicine and Applied Sciences, UC San Diego, La Jolla, CA, 92093-0819, USA
| | - Kevin T Murphy
- Department of Radiation Oncology, University of California San Diego, La Jolla, CA, USA
| | - Kenneth Blum
- Department of Molecular Biology, Adelson School of Medicine, Ariel University, Ariel, 40700, Israel
- Division of Addiction Research & Education, Center for Sports, Exercise, and Mental Health, Western University of Health Sciences, Pomona, CA, 91766, USA
- Division of Reward Deficiency Clinics, TranspliceGen Therapeutics, Inc, Austin, TX, USA
- Division of Clinical Neurology, The Kenneth Blum Institute of Neurogenetics & Behavior, LLC, Austin, TX, USA
- Department of Medicine, University of California, Riverside School of Medicine, Riverside, CA, USA
- Division of Personalized Medicine, Cross-Cultural Research and Educational Institute, San Clemente, CA, USA
- Centre for Genomics and Applied Gene Technology, Institute of Integrative Omics and Applied Biotechnology (IIOAB), Purba Medinipur, WB, 721172, India
- Department of Psychiatry, University of Vermont School of Medicine, Burlington, VA, USA
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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Cacciamani F, Bercu A, Bouteloup V, Grasset L, Planche V, Chêne G, Dufouil C. Understanding factors associated with the trajectory of subjective cognitive complaints in groups with similar objective cognitive trajectories. Alzheimers Res Ther 2023; 15:205. [PMID: 37993894 PMCID: PMC10666380 DOI: 10.1186/s13195-023-01348-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/05/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Cognitive complaints are often regarded as an early sign of Alzheimer's disease (AD) but may also occur in several other conditions and contexts. This study examines the correlates of cognitive complaint trajectories over a 5-year period in individuals who shared similar objective cognitive trajectories. METHODS We analyzed a subsample (n = 1748) of the MEMENTO cohort, consisting of individuals with subjective cognitive decline or mild cognitive impairment at baseline. Participants were stratified based on their latent MMSE trajectory over a 5-year period: "high and increasing," "subtle decline," and "steep decline." Within each of the three strata, we used a latent-class longitudinal approach to identify distinct trajectories of cognitive complaints. We then used multiple logistic regressions to examine the association between these complaint trajectories and several factors, including AD biomarkers (blood pTau/Aβ42 ratio, cortical thickness, APOE genotype), anxiety, depression, social relationships, a comorbidity-polypharmacy score, and demographic characteristics. RESULTS Among participants with high and increasing MMSE scores, greater baseline comorbidity-polypharmacy scores (odds ratio (OR) = 1.30, adjusted p = 0.03) were associated with higher odds of moderate and increasing cognitive complaints (as opposed to mild and decreasing complaints). Baseline depression and social relationships also showed significant associations with the complaint pattern but did not survive correction for multiple comparisons. Among participants with subtle decline in MMSE scores, greater baseline depression (OR = 1.76, adjusted p = 0.02) was associated with higher odds of moderate and increasing cognitive complaints (versus mild and decreasing). Similarly, baseline comorbidity-polypharmacy scores and pTau/Aβ42 ratio exhibited significant associations, but they did not survive correction. Among participants with a steep decline in MMSE scores, greater baseline comorbidity-polypharmacy scores increased the odds of moderate complaints (versus mild, OR = 1.38, unadjusted p = 0.03, adjusted p = 0.32), but this effect did not survive correction for multiple comparisons. CONCLUSIONS Despite similar objective cognitive trajectory, there is heterogeneity in the subjective perception of these cognitive changes. This perception was explained by both AD-related and, more robustly, non-AD-related factors. These findings deepen our understanding of the multifaceted nature of subjective cognitive complaints in individuals at risk for dementia and underscore the importance of considering a range of factors when interpreting cognitive complaints.
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Affiliation(s)
- Federica Cacciamani
- UMR 1219, Bordeaux Population Health Center, University of Bordeaux, Inserm, Bordeaux, F-33000, France.
- CIC 1401-EC, Inserm, University of Bordeaux, CHU de Bordeaux, F-33000, Bordeaux, France.
- ARAMISLab, Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, F-75013, France.
- Qairnel SAS, Paris, France.
| | - Ariane Bercu
- UMR 1219, Bordeaux Population Health Center, University of Bordeaux, Inserm, Bordeaux, F-33000, France
| | - Vincent Bouteloup
- UMR 1219, Bordeaux Population Health Center, University of Bordeaux, Inserm, Bordeaux, F-33000, France
- CIC 1401-EC, Inserm, University of Bordeaux, CHU de Bordeaux, F-33000, Bordeaux, France
- Department of Public Health, CHU de Bordeaux, 33000, Bordeaux, France
| | - Leslie Grasset
- UMR 1219, Bordeaux Population Health Center, University of Bordeaux, Inserm, Bordeaux, F-33000, France
- CIC 1401-EC, Inserm, University of Bordeaux, CHU de Bordeaux, F-33000, Bordeaux, France
| | - Vincent Planche
- CHU de Bordeaux, Pôle de Neurosciences Cliniques, Centre Mémoire de Ressources Et de Recherche, 33000, Bordeaux, France
- University of Bordeaux, CNRS UMR 5293, Institut Des Maladies Neurodégénératives, 33000, Bordeaux, France
| | - Geneviève Chêne
- UMR 1219, Bordeaux Population Health Center, University of Bordeaux, Inserm, Bordeaux, F-33000, France
- CIC 1401-EC, Inserm, University of Bordeaux, CHU de Bordeaux, F-33000, Bordeaux, France
- Department of Public Health, CHU de Bordeaux, 33000, Bordeaux, France
| | - Carole Dufouil
- UMR 1219, Bordeaux Population Health Center, University of Bordeaux, Inserm, Bordeaux, F-33000, France
- CIC 1401-EC, Inserm, University of Bordeaux, CHU de Bordeaux, F-33000, Bordeaux, France
- Department of Public Health, CHU de Bordeaux, 33000, Bordeaux, France
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21
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Pengpid S, Peltzer K, Anantanasuwong D. Longitudinal associations of loneliness with mental ill-health, physical ill-health, lifestyle factors and mortality in ageing adults in Thailand. BMC Psychiatry 2023; 23:855. [PMID: 37978470 PMCID: PMC10656829 DOI: 10.1186/s12888-023-05263-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/08/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES The aim of this study was to assess the longitudinal association between loneliness, mental and physical ill-health indicators, lifestyle factors and mortality among middle-aged and older adults in Thailand. METHODS We analyzed prospective cohort data of participants 45 years and older from three consecutive waves in 2015 (n = 5616), 2017 (n = 3600), and in 2020 (n = 2863) of the Health, Aging and Retirement in Thailand (HART) study. Loneliness was assessed with a single item. To assess the longitudinal associations between loneliness and health outcomes between 2015 (baseline), 2017 (first follow-up) and 2020 (second follow-up), we conducted Generalized Estimating Equations analysis (GEE). RESULTS The proportion of loneliness was 21.6% in 2015, 23.8% in 2017 and 21.3% in 2020. In the adjusted GEE logistic regression model, loneliness was positively associated with mental ill-health (poor self-rated mental health status, poor quality of life/happiness, depressive symptoms, and insomnia symptoms), physical ill-health (poor self-rated physical health status, hypertension, kidney disease, osteoporosis, and ADL disability), and lifestyle factors (physical inactivity, and having underweight). Furthermore, in adjusted Cox proportional hazards regression, loneliness was associated with mortality. In adjusted logistic regression, compared to without loneliness in all three study waves, having loneliness in one wave and/or two to three waves was positively associated with incident mental ill-health (incident poor self-rated mental health status, incident poor quality of life/happiness, incident depressive symptoms, and incident insomnia symptoms), incident physical ill-health (incident poor self-rated physical health status, incident diabetes, incident kidney disease, and incident ADL disability), and incident lifestyle factors (having incident underweight). CONCLUSION We found that loneliness was associated with several mental and physical ill-health indicators, lifestyle factors and mortality. Enhanced screening and treatment of loneliness may reduce mental and physical ill-health indicators in Thailand.
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Affiliation(s)
- Supa Pengpid
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand.
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
| | - Karl Peltzer
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Dararatt Anantanasuwong
- Center for Aging Society Research (CASR), National Institute of Development Administration (NIDA), Bangkapi Bangkok, Thailand
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22
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Van Bogart K, Scott SB, Harrington KD, Felt JM, Sliwinski MJ, Graham-Engeland JE. Examining the Bidirectional Nature of Loneliness and Anxiety Among Older Adults in Daily Life. J Gerontol B Psychol Sci Soc Sci 2023; 78:1676-1685. [PMID: 37527478 PMCID: PMC10561887 DOI: 10.1093/geronb/gbad105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVES Loneliness in later life increases the risk for adverse health outcomes; however, less is known about how loneliness is maintained. Anxiety may play an important role in maintaining loneliness, but little is known about how this connection plays out over time in daily life. This study thus focused on the within-person associations between momentary loneliness and anxiety among older adults. METHODS Participants were 317 diverse older adults (40% Black; 13% Hispanic, mean age = 77.45 years, 67% women) systematically recruited from the Bronx, NY, who completed ecological momentary assessments 5 times daily for 14 consecutive days. Multilevel models tested bidirectional contemporaneous, momentary cross-lagged (t - 1), day-level cross-lagged (average day to end of day), and day-to-day cross-lagged associations between loneliness and anxiety. Separate sensitivity analyses controlled for concurrent overall mood valence or depressed state. Gender and mild cognitive impairment (MCI) status were tested as moderators at all timescales. RESULTS Significant bidirectional associations between loneliness and anxiety were found at the contemporaneous and momentary cross-lagged (t - 1) timescales. Higher average daily loneliness predicted higher end-of-day anxiety, but not vice versa. Loneliness and anxiety were not significantly associated from day to day. Sensitivity analyses revealed some associations varied depending on inclusion of either concurrent mood valence or depressed state. Neither gender nor MCI status moderated associations at any timescale. DISCUSSION Findings shed light on the complex temporal ordering of loneliness and anxiety in daily life and extend contemporary theoretical notions of loneliness, including the possibility of interventions that target key moments in daily life.
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Affiliation(s)
- Karina Van Bogart
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
- Center for Healthy Aging, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Stacey B Scott
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Karra D Harrington
- Center for Healthy Aging, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - John M Felt
- Center for Healthy Aging, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Martin J Sliwinski
- Center for Healthy Aging, The Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Jennifer E Graham-Engeland
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
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23
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Bernabé E, de Oliveira C, de Oliveira Duarte YA, Bof de Andrade F, Sabbah W. Social participation and tooth loss, vision, and hearing impairments among older Brazilian adults. J Am Geriatr Soc 2023; 71:3152-3162. [PMID: 37227109 DOI: 10.1111/jgs.18423] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Vision and hearing impairments can reduce participation in social activities. Given the prominent role of the mouth in face-to-face interactions, this study evaluated the associations of tooth loss, vision, and hearing impairments with social participation among older adults. METHODS This analysis included 1947 participants, aged 60+ years, who participated in three waves (2006, 2010, and 2015) of the Health, Wellbeing and Aging Study (SABE) in Brazil. Social participation was measured by the number of formal and informal social activities (requiring face-to-face interaction) participants were regularly involved in. Teeth were counted during clinical examinations and categorized as 0, 1-19, and 20+ teeth. Reports on vision and hearing impairments were classified into three categories (good, regular, and poor). The associations of each impairment with the 9-year change in the social participation score were tested in negative binomial mixed-effects models adjusting for time-variant and time-invariant covariates. RESULTS Each impairment was associated with the baseline social participation score and the annual rate of change in the social participation score. Participants with 1-19 (incidence rate ratio: 0.96, 95% CI: 0.91-1.01) and no teeth (0.92, 95% CI: 0.87-0.97), those with regular (0.98, 95% CI: 0.95-1.01) and poor vision (0.86, 95% CI: 0.81-0.90), and those with regular (0.94, 95% CI: 0.91-0.98) and poor hearing (0.91, 95% CI: 0.87-0.95) had lower baseline social participation scores than those with 20+ teeth, good vision, and good hearing, respectively. Furthermore, participants with 1-19 (0.996, 95% CI: 0.990-1.002) and no teeth (0.994, 95% CI: 0.987-0.999), those with regular (0.996, 95% CI: 0.992-0.999) and poor vision (0.997, 95% CI: 0.991-1.003), and those with regular (0.997, 95% CI: 0.992-1.001) and poor hearing (0.995, 95% CI: 0.990-0.999) had greater annual declines in the social participation score than those with 20+ teeth, good vision and good hearing, respectively. CONCLUSION This 9-year longitudinal study shows that tooth loss, vision, and hearing impairments are associated with reduced social participation among older adults.
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Affiliation(s)
- Eduardo Bernabé
- Institute of Dentistry, Queen Mary University of London, London, UK
| | - Cesar de Oliveira
- Department of Epidemiology & Public Health, University College London, London, UK
| | | | | | - Wael Sabbah
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
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24
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Zhou X, Yang F, Gao Y. A meta-analysis of the association between loneliness and all-cause mortality in older adults. Psychiatry Res 2023; 328:115430. [PMID: 37647699 DOI: 10.1016/j.psychres.2023.115430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 08/19/2023] [Accepted: 08/20/2023] [Indexed: 09/01/2023]
Abstract
Despite the well-established association between loneliness and all-cause mortality in older adults, it remains unknown whether this association holds for older adults of different sex and whether it is influenced by different samples and study characteristics. Thus, this meta-analysis aims to examine moderators of the association between loneliness and all-cause mortality in older adults. To this end, relevant literature was retrieved from the PubMed, Embase, PsycINFO, Web of Science, Chinese National Knowledge Infrastructure, Weipu, and Wanfang databases (inception to May 2023) and was processed in the Comprehensive Meta-Analysis 3.3 software. Moreover, subgroup analysis was performed to explore the sources of heterogeneity and further explore potential moderators. Funnel plots, Begg's test, and Egger's linear regression test were used to examine the publication bias, and sensitivity analysis was used to test the robustness of the results. Thirty-six studies involving 128,927 older adults were included in this meta-analysis. In general, loneliness was related to an increase in all-cause mortality in older adults (HR = 1.09, 95% CI = 1.06-1.12, I2 = 63.31%, p < 0.001). The overall effect size for older men was 1.18 (95% CI = 1.04-1.33, p = 0.010). The association between loneliness and all-cause mortality was found to be significantly influenced by the source country of the data, follow-up length, and covariates for chronic disease as moderators. In conclusion, loneliness among older adults deserves more attention, and services are needed to improve their mental health.
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Affiliation(s)
- Xiang Zhou
- Department of Social Work, School of Sociology and Political Science, Shanghai University, Nanchen Road, Baoshan District, Shanghai, 200444, China
| | - Fang Yang
- Department of Social Work, School of Sociology and Political Science, Shanghai University, Nanchen Road, Baoshan District, Shanghai, 200444, China.
| | - Yourong Gao
- Department of Social Work, School of Sociology and Political Science, Shanghai University, Nanchen Road, Baoshan District, Shanghai, 200444, China
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25
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Aunsmo RH, Langballe EM, Hansen T, Selbæk G, Strand BH. Time trends in loneliness from 1984 to 2019 among 27,032 older adults in Norway: A HUNT study. Prev Med 2023; 175:107659. [PMID: 37567367 DOI: 10.1016/j.ypmed.2023.107659] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/13/2023]
Abstract
The aging population and increasing evidence of the detrimental health impacts of loneliness emphasize the importance of studying and predicting changes in loneliness prevalence among older adults. To understand and project changes in loneliness over time, we examined 35-year trends in adults aged 70 and older, considering factors such as sex, age, and living situation. Cross-sectional data from 27,032 home-dwelling adults aged 70 years and older who participated in at least one of the four Norwegian HUNT surveys from 1984 to 2019, and Norwegian population data from Statistics Norway were used for the analyses. Loneliness was self-reported, and the prevalence of loneliness was standardized to the Norwegian population at the survey year by age and sex. The results showed that the prevalence of loneliness significantly decreased between each survey. The higher categories of loneliness (a good amount, very much) decreased, from 11.4% (1995-97), 6.7% (2006-08), and 5.8% (2017-19). Across surveys, loneliness was significantly more common among women, the oldest, and those living alone. The prevalence of loneliness among the oldest adults living alone increased from 2006 to 2019. The gradual decline in loneliness observed from 1995 to 2019 coincided with notable societal changes in Norway. We estimated that the number of older adults experiencing loneliness in Norway could rise from 184,000 in 2020 to 286,000 in 2035, and potentially reach 380,000 in 2050.
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Affiliation(s)
- Ragnhild Holmberg Aunsmo
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Verdal municipality, Norway.
| | - Ellen Melbye Langballe
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
| | - Thomas Hansen
- Norwegian Institute of Public Health, Oslo, Norway; Oslo Metropolitan University, Oslo, Norway; Promenta Research Center, University of Oslo, Oslo, Norway.
| | - Geir Selbæk
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Bjørn Heine Strand
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway; Norwegian Institute of Public Health, Oslo, Norway.
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26
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Werneck AO, Cunha PM, Silva DR. The mediation role of social network size and perception in the association between physical activity and depressive symptoms: a prospective analysis from the SHARE study. Aging Ment Health 2023; 27:1738-1743. [PMID: 36803247 DOI: 10.1080/13607863.2023.2177831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 02/03/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVES To investigate the mediating role of social network size and perceived quality in the associations of physical activity with quality of life and depressive symptoms in middle-aged and older adults. METHOD We analyzed information of 10,569 middle-aged and older adults from waves 2 (2006-2007), 4 (2011-2012), and 6 (2015) of the Survey of Health, Ageing, and Retirement in Europe study (SHARE). Data on physical activity (moderate and vigorous intensities), social network (size and quality), depressive symptoms (EURO-D scale), and quality of life (CASP) were self-reported. Sex, age, country of residency, schooling, occupational status, mobility, and baseline values of the outcome were used as covariates. We created mediation models to test the mediating effect of social network size and quality in the association between physical activity and depressive symptoms. RESULTS Social network size partly mediated the association between vigorous physical activity and depressive symptoms (7.1%; 95%CI: 1.7-12.6) as well as the association between moderate (9.9%; 1.6-19.7) and vigorous (8.1%; 0.7-15.4) physical activity and quality of life. Social network quality did not mediate any of the associations tested. CONCLUSION We conclude that social network's size, but not satisfaction, mediates part of the association of physical activity with depressive symptoms and quality of life in middle-aged and older adults. Future physical activity interventions among middle-aged and older adults should consider increasing social interactions to facilitate benefits for mental health-related outcomes.
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Affiliation(s)
- André O Werneck
- Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, Universidade de São Paulo (USP), São Paulo, Brazil
| | - Paolo M Cunha
- Metabolism, Nutrition, and Exercise Laboratory, Physical Education and Sport Center, Londrina State University, Londrina, Brazil
- Albert Einstein Israelite Hospital, São Paulo 05652-900, Brazil
| | - Danilo R Silva
- Albert Einstein Israelite Hospital, São Paulo 05652-900, Brazil
- Department of Physical Education, Federal University of Sergipe - UFS, São Cristóvão, Brazil
- Faculty of Health Sciences, Universidad Autónoma de Chile, Providencia, Chile
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27
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Nissanholtz-Gannot R, Peretz-Dayan H. Equal Opportunities in Aging: Income Level Moderates the Relationship Between Infrequent Participation in Formal Social Activities and Loneliness Among Older Adults. J Appl Gerontol 2023; 42:1982-1992. [PMID: 37231706 PMCID: PMC10467004 DOI: 10.1177/07334648231175429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 04/03/2023] [Accepted: 04/09/2023] [Indexed: 05/27/2023] Open
Abstract
Infrequent participation in formal social activities among older adults increases the risk of loneliness. We examined whether a higher income level moderates the relationship between infrequent participation and loneliness. Utilizing data from wave #6 of the European Health, Aging, and Retirement Survey, we included participants aged 65+ (i.e., older adults), non-participants in the labor force (N = 24 819). Loneliness was measured by the R-UCLA loneliness questionnaire, formal social activity by participation frequency in volunteer/charity activities, educational course/training, sports/social/other clubs, and political/community organizations. Hierarchical multiple regression models examined relationships between variables, controlled by country. Infrequent participation in formal social activity associated with higher risk of loneliness. However, income moderated the association between participation and loneliness; infrequently participating older adults with low-to-moderate income were more vulnerable to loneliness than higher income older adults, for whom infrequent participation did not increase loneliness. This reinforces the need to encourage formal social activity with subsidy for low-to-moderate income older adults.
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Affiliation(s)
| | - Hagar Peretz-Dayan
- Department of Health System Management, Ariel University, Kiryat Hamada 3 Ariel, Israel 40700
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28
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Ae-Ri J, Kowoon L, Eun-A P. Development and evaluation of the information and communication technology-based Loneliness Alleviation Program for community-dwelling older adults: A pilot study and randomized controlled trial. Geriatr Nurs 2023; 53:204-211. [PMID: 37544264 DOI: 10.1016/j.gerinurse.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 08/08/2023]
Abstract
This study aimed to develop an information and communication technology (ICT)-based Loneliness Alleviation Program (LAP) for community-dwelling older adults, which was developed according to the ADDIE model. The LAP is a complex non-face-to-face program for physical, psychological, and interpersonal loneliness alleviation. We conducted a randomized controlled trial to verify the effects of the program on loneliness, depression, and laughter index in older adults. Program sessions were conducted twice a week for 6 weeks (12 sessions). Data on 40 older adults aged 65 years and above were collected from January 2, 2023 to February 17, 2023 at a public health center in South Korea. The experimental group showed statistically significant effects of the program on loneliness, depression, and laughter index scores. The older adults were alleviated their loneliness by utilizing non-face-to-face programs, and the program is expected to increase continuity and inclusiveness of care.
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Affiliation(s)
- Jung Ae-Ri
- Assistant Professor, College of Nursing, Eulji University, Uijeongbu, South Korea
| | - Lee Kowoon
- Assistant Professor, Department of Nursing, Suwon Women's University, Suwon, South Korea.
| | - Park Eun-A
- Assistant Professor, Department of Nursing, Hwasung Medi-Science University, Hwaseong, South Korea
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29
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Akkuş K. Fear of Positive Evaluation and Loneliness: Mediating Role of Social Anxiety and Suppression. Psychol Rep 2023:332941231197154. [PMID: 37612839 DOI: 10.1177/00332941231197154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Loneliness is a commonly observed problem that is associated with several mental and physical health outcomes. Although research shows that fear of negative evaluation is related to loneliness, no study has examined the role of fear of positive evaluation (FPE) on loneliness. This study investigated the mediator role of social anxiety and suppression in the relationship between FPE and loneliness using an undergraduate sample (N = 467). The results show that FPE is positively associated with loneliness and that this relationship is mediated by social anxiety and suppression. This study highlights the importance of the FPE in understanding loneliness and can guide intervention programs for loneliness.
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Affiliation(s)
- Koray Akkuş
- Department of Psychology, Afyon Kocatepe University, Afyon, Turkey
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30
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Pollak C, Verghese J, Blumen H. Loneliness and Functional Decline in Aging: A Systematic Review. Res Gerontol Nurs 2023; 16:202-212. [PMID: 37159388 PMCID: PMC10926714 DOI: 10.3928/19404921-20230503-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Loneliness is prevalent in adults aged ≥65 years in the United States and is associated with functional decline. The purpose of the current review was to synthesize evidence on the relationship between loneliness and functional decline using Roy's Adaptation Model as a theoretical framework. A comprehensive review of PubMed, Medline, and Embase databases was performed. Inclusion criteria were samples including adults primarily aged >60 years, peer-reviewed, published in the English language, and included a measure for loneliness and function. A total of 47 studies were analyzed. Most studies examined correlates, risk factors, and predictors of loneliness, rather than the relationship between loneliness and function. Evidence suggests there is bidirectionality in the relationship between loneliness and functional decline. Loneliness is associated with functional decline in aging via multiple possible pathways. Further studies are needed to determine causality and biological mechanisms underlying the relationship. [Research in Gerontological Nursing, 16(4), 202-212.].
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31
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Cho J, Xiang X. The Relationship Between Volunteering and the Occurrence of Loneliness Among Older Adults: A Longitudinal Study with 12 Years of Follow-Up. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:680-693. [PMID: 36330601 DOI: 10.1080/01634372.2022.2139322] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
Informed by the social model of health promotion, this study examined the association between formal volunteering and the occurrence of loneliness among older adults over 12 years of follow-up and whether the association differs by gender. Data came from the Health and Retirement Study (2006-2018). The study sample included 5,000 individuals aged 60 and over who did not experience loneliness in 2006. Self-reported participation in formal volunteer work was classified into three levels: (0) no volunteering, (1) less than 100 hours of volunteering per year, and (2) more than 100 hours of volunteering per year. Cox regression was used to examine the relationship between volunteering level and the onset of loneliness during the 12 years of follow-up. Volunteering more than 100 hours per year was associated with a lower risk of loneliness compared to non-volunteers (HR = 0.55, p = .008). This protective effect was not observed for those who volunteered less than 100 hours per year (HR = 0.84, p = .246). The benefits of volunteering in mitigating loneliness did not differ by gender. Engagement in moderate to high levels of volunteering can protect against loneliness. More volunteering programs can be offered to older adults to reduce loneliness in later life.
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Affiliation(s)
- Joonyoung Cho
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Xiaoling Xiang
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
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Rees J, Liu W, Ourselin S, Shi Y, Probst F, Antonelli M, Tinker A, Matcham F. Understanding the psychological experiences of loneliness in later life: qualitative protocol to inform technology development. BMJ Open 2023; 13:e072420. [PMID: 37336536 DOI: 10.1136/bmjopen-2023-072420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVES Loneliness is a public health issue impacting the health and well-being of older adults. This protocol focuses on understanding the psychological experiences of loneliness in later life to inform technology development as part of the 'Design for health ageing: a smart system to detect loneliness in older people' (DELONELINESS) study. METHODS AND ANALYSIS Data will be collected from semi-structured interviews with up to 60 people over the age of 65 on their experiences of loneliness and preferences for sensor-based technologies. The interviews will be audio-recorded, transcribed and analysed using a thematic codebook approach on NVivo software. ETHICS AND DISSEMINATION This study has received ethical approval by Research Ethics Committee's at King's College London (reference number: LRS/DP-21/22-33376) and the University of Sussex (reference number: ER/JH878/1). All participants will be required to provide informed consent. Results will be used to inform technology development within the DELONELINESS study and will be disseminated in peer-reviewed publications and conferences.
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Affiliation(s)
- Jessica Rees
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Wei Liu
- Department of Engineering, King's College London, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Yu Shi
- School of Design, University of Leeds, Leeds, UK
| | - Freya Probst
- Department of Engineering, King's College London, London, UK
| | - Michela Antonelli
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Anthea Tinker
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Faith Matcham
- School of Psychology, University of Sussex, Falmer, UK
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Pilleron S, Sun V, Ayala AP, Haase KR, Arthur EK, Kenis C, Roggendorf S, Krok-Schoen JL, Trevino K, Schmidt H, Hannan M, Nikita N, Monginot S, Navarrete E, Puts M. Loneliness in older adults living with cancer: A scoping review of the quantitative and qualitative evidence on behalf of the International Society of Geriatric Oncology Nursing and Allied Health Interest Group. J Geriatr Oncol 2023; 14:101519. [PMID: 37179207 PMCID: PMC10641442 DOI: 10.1016/j.jgo.2023.101519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/31/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Loneliness is common in older adults. Cancer and its treatments can heighten loneliness and result in poor outcomes. However, little is known about loneliness in older adults with cancer. Our objective was to provide an overview of the prevalence of loneliness, contributing factors, evolution during the cancer trajectory, impact on treatment, and interventions to reduce loneliness. MATERIALS AND METHODS We conducted a scoping review including studies on loneliness in adults with cancer aged ≥65. Original, published studies of any designs (excluding case reports) were included. A two-step screening process was performed. RESULTS Out of 8,720 references, 19 studies (11 quantitative, 6 qualitative, 2 mixed-methods), mostly from the United States, Netherlands, and/or Belgium, and most published from 2010, were included. Loneliness was assessed by the De Jong Gierveld Loneliness Scale, and the UCLA loneliness scale. Up to 50% of older adults felt lonely. Depression and anxiety were often correlated with loneliness. Loneliness may increase over the first 6-12 months during treatment. One study assessed the feasibility of an intervention aiming at reducing primarily depression and anxiety and secondarily, loneliness in patients with cancer aged ≥70 after five 45-min sessions with a mental health professional. No studies investigated the impact of loneliness on cancer care and health outcomes. DISCUSSION This review documents the scarcity of literature on loneliness in older adults with cancer. The negative impacts of loneliness on health in the general population are well known; a better understanding of the magnitude and impact of loneliness in older adults with cancer is urgently warranted.
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Affiliation(s)
- Sophie Pilleron
- Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK; Ageing, Cancer, and Disparities Research Unit, Department of Precision Health, Luxembourg Institute of Health, 1A-B, rue Thomas Edison, 1445 Strassen, Luxembourg.
| | - Virginia Sun
- Department of Population Sciences and Department of Surgery, City of Hope, Duarte, California, USA
| | - Ana Patricia Ayala
- Gerstein Science Information Centre, University of Toronto, Toronto, Canada
| | - Kristen R Haase
- School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, Canada
| | | | - Cindy Kenis
- Department of General Medical Oncology and Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium
| | - Sigrid Roggendorf
- Institute of Health and Nursing Science, Medical Faculty of Martin Luther University Halle-, Wittenberg, Germany
| | - Jessica L Krok-Schoen
- Division of Health Sciences, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Kelly Trevino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heike Schmidt
- Department for Radiation Medicine and Institute of Health and Nursing Science, Medical Faculty of Martin Luther University Halle-Wittenberg, Wittenberg, Germany
| | - Michelle Hannan
- Department of Medical Oncology, University Hospital Waterford, Waterford, Ireland
| | - Nikita Nikita
- Division of Population Science, Department of Medical Oncology, Philadelphia, PA, USA
| | - Susie Monginot
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Erna Navarrete
- Department of Occupational Therapy and Occupational Science, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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Park JH, Park S, Jung JH, Bae S, Yun S, Khan A, Hong I, Park JH. The Mediating Role of Social Participation in Motoric Cognitive Risk and its Relation to Depression and Loneliness in Older Adults. Ann Geriatr Med Res 2023; 27:134-140. [PMID: 37403316 DOI: 10.4235/agmr.23.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 06/12/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Motoric cognitive risk syndrome (MCR) reduces the quality of life, independence, and social interaction in older adults. Social participation is a potentially modifiable factor that benefits cognitive and mental health. This study explored the mediating roles of social participation between MCR and depression and between MCR and loneliness. METHODS We performed a secondary analysis of data from the 2015-2016 National Social Life, Health, and Aging Project. Slow gait speed and cognitive decline were used to assess MCR. Mediation analysis was applied to two models, both of which used MCR as an exposure and social participation as a mediator. The outcomes were depression and loneliness for each model, respectively. RESULTS Among 1,697 older adults, 196 (11.6%) had MCR. The mediating role of social participation was statistically significant in both models. The indirect effect (β=0.267, p=0.001) of MCR on depression through social participation comprised 11.97% of the total effect (β=2.231, p<0.001). The indirect effect (β=0.098, p=0.001) of MCR on loneliness through social participation was 19.48% of the total effect (β=0.503, p<0.001). CONCLUSION Interventions to increase social participation may reduce depression and loneliness of older adults with MCR.
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Affiliation(s)
- Ji Hyeun Park
- Department of Occupational Therapy, Graduate School, Yonsei University, Wonju, Korea
| | - Sangmi Park
- Department of Occupational Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Korea
| | - Jae Hyu Jung
- Department of Rehabilitation, Gyeonggi Provincial Medical Center, Anseong, Korea
| | - Suyeong Bae
- Department of Occupational Therapy, Graduate School, Yonsei University, Wonju, Korea
| | - Sohyeon Yun
- Department of Occupational Therapy, Graduate School, Yonsei University, Wonju, Korea
| | - Anastassiya Khan
- Department of Occupational Therapy, Graduate School, Yonsei University, Wonju, Korea
| | - Ickpyo Hong
- Department of Occupational Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Korea
| | - Ji-Hyuk Park
- Department of Occupational Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Korea
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Thompson A, Pollet TV. An exploratory psychometric network analysis of loneliness scales in a sample of older adults. CURRENT PSYCHOLOGY 2023:1-15. [PMID: 37359673 PMCID: PMC10182353 DOI: 10.1007/s12144-023-04697-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 06/28/2023]
Abstract
To examine the relationships within and between commonly used measures of loneliness to determine the suitability of the measures in older adults. Further, to determine whether certain items in these measures are more psychometrically robust in terms of capturing different types of loneliness across this population. Data were obtained from 350 older adults via completion of an online survey. Four measures of loneliness were completed. These were the University of California Los Angeles Loneliness Scale 4 (Version 3), the de Jong Gierveld Loneliness Scale, the Social and Emotional Loneliness Scale for Adults (Short Version) and a direct measure of loneliness. Analysis via a regularized partial correlation network and via clique percolation revealed that only the SELSA-S encompassed loneliness relating to deficits in social, family and romantic relationships. The remaining measures tapped mostly into social loneliness alone. The direct measure of loneliness had the strongest connection to the UCLA item-4 and the de Jong Gierveld item-1 exhibited the strongest bridge centrality, being a member of the most clusters. The results indicate that should researchers be interested in assessing loneliness resulting from specific relationships, then the SELSA-S would be the most suitable measure. Whereas the other measures are suitable for assessing loneliness more generally. The results further suggest that the de Jong Gierveld item-1 may be a more suitable direct measure of loneliness than that currently employed as it taps into a greater number of relationships.
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Affiliation(s)
- Alexandra Thompson
- Department of Psychology, Northumbria University, Newcastle Upon Tyne, UK
| | - Thomas V. Pollet
- Department of Psychology, Northumbria University, Newcastle Upon Tyne, UK
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Kirkland SA, Griffith LE, Oz UE, Thompson M, Wister A, Kadowaki L, Basta NE, McMillan J, Wolfson C, Raina P. Increased prevalence of loneliness and associated risk factors during the COVID-19 pandemic: findings from the Canadian Longitudinal Study on Aging (CLSA). BMC Public Health 2023; 23:872. [PMID: 37170234 PMCID: PMC10175060 DOI: 10.1186/s12889-023-15807-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 05/04/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Older adults have been disproportionately impacted by COVID-19 and related preventative measures undertaken during the pandemic. Given clear evidence of the relationship between loneliness and health outcomes, it is imperative to better understand if, and how, loneliness has changed for older adults during the COVID-19 pandemic, and whom it has impacted most. METHOD We used "pre-pandemic" data collected between 2015-2018 (n = 44,817) and "during pandemic" data collected between Sept 29-Dec 29, 2020 (n = 24,114) from community-living older adults participating in the Canadian Longitudinal Study on Aging. Loneliness was measured using the 3-item UCLA Loneliness Scale. Weighted generalized estimating equations estimated the prevalence of loneliness pre-pandemic and during the pandemic. Lagged logistic regression models examined individual-level factors associated with loneliness during the pandemic. RESULTS We found the adjusted prevalence of loneliness increased to 50.5% (95% CI: 48.0%-53.1%) during the pandemic compared to 30.75% (95% CI: 28.72%-32.85%) pre-pandemic. Loneliness increased more for women (22.3% vs. 17.0%), those in urban areas (20.8% vs. 14.6%), and less for those 75 years and older (16.1% vs. 19.8% or more in all other age groups). Loneliness during the pandemic was strongly associated with pre-pandemic loneliness (aOR 4.87; 95% CI 4.49-5.28) and individual level sociodemographic factors [age < 55 vs. 75 + (aOR 1.41; CI 1.23-1.63), women (aOR 1.34; CI 1.25-1.43), and no post-secondary education vs. post-secondary education (aOR 0.73; CI 0.61-0.86)], living conditions [living alone (aOR 1.39; CI 1.27-1.52) and urban living (aOR 1.18; CI 1.07-1.30)], health status [depression (aOR 2.08; CI 1.88-2.30) and having two, or ≥ three chronic conditions (aOR 1.16; CI 1.03-1.31 and aOR 1.34; CI 1.20-1.50)], health behaviours [regular drinker vs. non-drinker (aOR 1.15; CI 1.04-1.28)], and pandemic-related factors [essential worker (aOR 0.77; CI 0.69-0.87), and spending less time alone than usual on weekdays (aOR 1.32; CI 1.19-1.46) and weekends (aOR 1.27; CI 1.14-1.41) compared to spending the same amount of time alone]. CONCLUSIONS As has been noted for various other outcomes, the pandemic did not impact all subgroups of the population in the same way with respect to loneliness. Our results suggest that public health measures aimed at reducing loneliness during a pandemic should incorporate multifactor interventions fostering positive health behaviours and consider targeting those at high risk for loneliness.
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Affiliation(s)
- Susan A Kirkland
- Departments of Community Health & Epidemiology and Medicine, Dalhousie University, Halifax, NS, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W. MIP-309A, Hamilton, ON, L8S 4K1, Canada.
- Labarge Centre for Mobility in Aging, McMaster University, Hamilton, ON, Canada.
- McMaster Institute for Research On Aging, McMaster University, Hamilton, ON, Canada.
| | - Urun Erbas Oz
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W. MIP-309A, Hamilton, ON, L8S 4K1, Canada
| | - Mary Thompson
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - Andrew Wister
- Gerontology Research Centre, Simon Fraser University, British Columbia, Canada
| | - Laura Kadowaki
- Gerontology Research Centre, Simon Fraser University, British Columbia, Canada
| | - Nicole E Basta
- Department of Epidemiology, and Occupational Health, McGill University, BiostatisticsMontreal, QC, Canada
| | - Jacqueline McMillan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christina Wolfson
- Department of Epidemiology, and Occupational Health, McGill University, BiostatisticsMontreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W. MIP-309A, Hamilton, ON, L8S 4K1, Canada
- Labarge Centre for Mobility in Aging, McMaster University, Hamilton, ON, Canada
- McMaster Institute for Research On Aging, McMaster University, Hamilton, ON, Canada
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Pengpid S, Peltzer K. Prevalence and associated factors of incident and persistent loneliness among middle-aged and older adults in Thailand. BMC Psychol 2023; 11:70. [PMID: 36918991 PMCID: PMC10015912 DOI: 10.1186/s40359-023-01115-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/06/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND The aim of the study was to assess the prevalence and associated factors of incident and persistent loneliness in a prospective cohort study among middle-aged and older adults (≥ 45 years) in Thailand. METHODS Longitudinal data from the Health, Aging, and Retirement in Thailand (HART) study in 2015 and 2017 were analysed. Loneliness was assessed with one item from the Center for Epidemiological Studies Depression scale. Logistic regression was used to calculate predictors of incident and persistent loneliness. RESULTS In total, at baseline 21.7% had loneliness, 633 of 3696 participants without loneliness in 2015 had incident loneliness in 2017 (22.2%), and 239 of 790 adults had persistent loneliness (in both 2015 and 2017) (30.3%). In adjusted logistic regression analysis, low income (aOR: 1.27, 95% CI: 1.03 to 1.57), poor self-rated physical health status (aOR: 1.64, 95% CI: 1.27 to 2.12), hypertension (aOR: 1.34, 95% CI: 1.09 to 1.65), depressive symptoms (aOR: 1.97, 95% CI: 1.11 to 3.49), and having three or chronic conditions (aOR: 1.76, 95% CI: 1.19 to 2.60) were positively associated and a higher education (aOR: 0.74, 95% CI: 0.55 to 0.98) and living in the southern region of Thailand (aOR: 0.43, 95% CI: 0.30 to 0.61) were inversely associated with incident loneliness. Poor self-rated physical health status (aOR: 1.91, 95% CI: 1.26 to 2.88), and having three or more chronic diseases (aOR: 1.78, 95% CI: 1.07 to 2.98), were positively associated, and living in the southern region (aOR: 0.40, 95% CI: 0.25 to 0.65) was inversely associated with persistent loneliness. CONCLUSION More than one in five ageing adults had incident loneliness in 2 years of follow-up. The prevalence of incident and/or persistent loneliness was higher in people with a lower socioeconomic status, residing in the central region, poor self-rated physical health status, depressive symptoms, hypertension, and a higher number of chronic diseases.
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Affiliation(s)
- Supa Pengpid
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand.,Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Karl Peltzer
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand. .,Department of Psychology, University of the Free State, PO Box 339 (40), 9300, Bloemfontein, South Africa. .,Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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Zhang Y, Kuang J, Xin Z, Fang J, Song R, Yang Y, Song P, Wang Y, Wang J. Loneliness, social isolation, depression and anxiety among the elderly in Shanghai: Findings from a longitudinal study. Arch Gerontol Geriatr 2023; 110:104980. [PMID: 36863166 DOI: 10.1016/j.archger.2023.104980] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVES To investigate the longitudinal associations between loneliness, social isolation, depression and anxiety in the elderly. METHODS A longitudinal cohort study was conducted among 634 older adults from three districts of Shanghai. Data were collected at baseline and 6-month follow-up. Loneliness and social isolation were measured using the De Jong Gierveld Loneliness Scale and the Lubben Social Network Scale respectively. Depressive and anxiety symptoms were assessed using the subscales of Depression Anxiety Stress Scales. Logistic regression and negative binomial regression models were used to examine the associations. RESULTS We found that moderate to severe loneliness at baseline predicted higher depression scores 6 months later (incidence rate ratio (IRR)=1.99, 95% confidence interval (CI) [1.12, 3.53], p=0.019), while higher depression scores at baseline predicted social isolation at follow-up (odds ratio (OR)=1.14, 95% CI [1.03, 1.27], p=0.012). We also observed that higher anxiety scores predicted lower risk of social isolation (OR=0.87, 95% CI [0.77, 0.98], p=0.021). Additionally, persistent loneliness at both timepoints was significantly associated with higher depression scores at follow-up, and persistent social isolation was associated with a greater likelihood of having moderate to severe loneliness and higher depression scores at follow-up. CONCLUSIONS Loneliness was found to be a robust predictor of changes in depressive symptoms. Both persistent loneliness and social isolation were closely associated with depression. We should develop effective and feasible interventions for older adults who have depressive symptoms or who are at risk of long-term social relationship problems to avoid the vicious circle among depression, social isolation and loneliness.
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Affiliation(s)
- Yuwen Zhang
- Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Jiawen Kuang
- School of Public Health; NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Zhaohua Xin
- Lingqiao Community Health Center, Pudong New Area, Shanghai, China
| | - Jialie Fang
- Jing'an District Center for Disease Control and Prevention, Shanghai, China
| | - Rui Song
- Xiaodongmen Subdistrict Community Health Center, Huangpu District, Shanghai, China
| | - Yuting Yang
- School of Public Health; NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Peige Song
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310058, China.
| | - Ying Wang
- School of Public Health; NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China.
| | - Jingyi Wang
- School of Public Health; NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China.
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Pan H, Qualter P, Barreto M, Stegen H, Dury S. Loneliness in Older Migrants: Exploring the Role of Cultural Differences in Their Loneliness Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2785. [PMID: 36833479 PMCID: PMC9957511 DOI: 10.3390/ijerph20042785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/18/2023] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION AND BACKGROUND The scientific literature suggests the necessity of studying loneliness from a broader social perspective. This article aims to broaden the research on loneliness in older migrants by exploring the role of cultural differences through the lens of the social environment (as measured in social capital, discrimination, and ageism) and social situation (as measured in relational mobility, childness, and marital status). Based on Hofstede's Individualism Index, older migrants involved in the BBC Loneliness Experiment (N = 2164) were classified into three groups: cultural migrants (i.e., from a collectivist to individualist culture) (N = 239), migrants with a similar culture (i.e., within an individualist culture) (N = 841), and ageing non-migrants (N = 1084). OBJECTIVES The two main objectives were (1) to compare the levels of loneliness among these three groups, and (2) to unravel how different influencing factors, such as the social environment, social situation, coping strategies, and personal characteristics, are related to loneliness. METHODS Bivariate analyses were performed to determine the differences in the loneliness, social environment, social situation, and personal characteristic variables between the groups, with adjusted p-values according to the Bonferroni correction to limit the potential for type I errors (α = 0.005). Multiple linear regressions were performed to unravel the relationships between loneliness and the different influencing factors, namely the social environment, social situation, coping strategies, and personal characteristics. RESULTS The bivariate analyses show no significant difference in loneliness across the three groups. The multiple linear regressions demonstrate that the social environment (i.e., social capital, discrimination, and ageism) is significantly associated with loneliness. Social capital acts as a protective factor for cultural migrants (β = -0.27, p < 0.005, 95% CI [-0.48, -0.05]), similar-culture migrants (β = -0.13, p < 0.005, 95% CI [-0.25, -0.03]), and non-migrants (β = -0.21, p < 0.001, 95% CI [-0.28, -0.12]). Discrimination and ageism are both risk factors for loneliness across the three groups. Social situation, as measured in married/cohabitation status and relational mobility, shows a significant association with loneliness in the non-migrants and similar-culture migrants but not the cultural migrants. In terms of individual resources for coping strategies, engagement in active coping is protective for all three groups. Non-coping, the unawareness of any coping strategies, is a risk factor, while passive coping shows no significant association. DISCUSSION The results show that the structural factor of the social environment in which older migrants' find themselves, rather than their culture of origin, is more important for older migrants' feelings of loneliness in later life. A favorable social environment with high social capital and low levels of discrimination and ageism protects against loneliness in the ageing population across cultures. Practical implications for loneliness interventions for older migrants are put forward.
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Affiliation(s)
- Honghui Pan
- Faculty of Psychology and Educational Sciences, Adult Educational Sciences, Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium
- Brussels Interdisciplinary Research Centre on Migration and Minorities (BIRMM), Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium
- Society and Ageing Research Lab, Vrije Universiteit Brussel (VUB), Pleinlaan 2, 1050 Brussels, Belgium
| | - Pamela Qualter
- Manchester Institute of Education, University of Manchester, Manchester M13 9PL, UK
| | - Manuela Barreto
- Department of Psychology, University of Exeter, Exeter EX4 4QG, UK
| | - Hannelore Stegen
- Faculty of Psychology and Educational Sciences, Adult Educational Sciences, Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium
- Society and Ageing Research Lab, Vrije Universiteit Brussel (VUB), Pleinlaan 2, 1050 Brussels, Belgium
- Research Foundation Flanders (FWO), 1000 Brussels, Belgium
| | - Sarah Dury
- Faculty of Psychology and Educational Sciences, Adult Educational Sciences, Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium
- Society and Ageing Research Lab, Vrije Universiteit Brussel (VUB), Pleinlaan 2, 1050 Brussels, Belgium
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Ho KHM, Hung MSY, Zhang Y, Bai X, Cheung DSK, Chow MCM, Lee PH, Chien WT. The perceived relationship quality with migrant domestic workers is correlated with a lower level of loneliness among community-dwelling older adults: A cross-sectional study. Arch Gerontol Geriatr 2023; 109:104952. [PMID: 36753937 DOI: 10.1016/j.archger.2023.104952] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
PURPOSE To explore older adults' perceived relationship quality with migrant domestic workers (MDWs) and examine the correlation between older adult/MDW (O-M) relationship quality and loneliness of community-dwelling older adults. MATERIALS AND METHODS In this cross-sectional study, older adults living with MDWs were conveniently recruited from neighbourhood elderly centers in Hong Kong. Loneliness and O-M relationship quality were assessed by the 6-item De Jong Gierveld Loneliness Scale and the mutuality scale, respectively. Older adults' demographic and functional characteristics, and MDW's nationality, spoken language and years of service in the dyad were also collected. Hierarchical multiple regression analyses were conducted to examine the contributions of 1) demographic variables and functional status, 2) MDW characteristics, 3) perceived social network and 4) perceived O-M relationship quality on loneliness. RESULTS The 178 participants [mean age 83.44 (SD 7.05 years); 155 (87.1%) women and 23 men (22.9%)] were socially lonely (1.07 ± 1.15) and close to being lonely overall (1.90 ± 1.68), and emotionally (0.84 ± 0.97). The mean O-M relationship quality was poor (1.42 ± 0.79), which was significantly correlated with overall (β= -0.33, 95% CI: -0.65 to -0.01, P value = 0.045), and social (β= -0.24, 95% CI: -0.46 to -0.01, P value = 0.04) loneliness, but not significantly correlated to emotional loneliness. CONCLUSION Better perceived O-M relationship quality is correlated with a lower level of loneliness among older adults. Strategies to improve O-M relationship quality may alleviate loneliness among older adults.
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Affiliation(s)
- Ken H M Ho
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
| | - Maria S Y Hung
- School of Health Sciences, Caritas Institute of Higher Education, Tseung Kwan O, New Territories, Hong Kong
| | - Youjuan Zhang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Xue Bai
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Daphne S K Cheung
- School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Meyrick C M Chow
- School of Health Sciences, Caritas Institute of Higher Education, Tseung Kwan O, New Territories, Hong Kong
| | - Paul H Lee
- Southampton Clinical Trials Unit, University of Southampton, United Kingdoms
| | - Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
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41
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Ribeiro-Gonçalves JA, Costa PA, Leal I. Loneliness, ageism, and mental health: The buffering role of resilience in seniors. Int J Clin Health Psychol 2023; 23:100339. [PMID: 36168598 PMCID: PMC9485034 DOI: 10.1016/j.ijchp.2022.100339] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/19/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Ageism and loneliness are two relevant public health phenomena because of their negative impact on the senior's mental health. With the increase in average life expectancy, these tend to co-occur, which may increase the psychological distress (PD) of seniors. Resilience has been shown to be an important protective factor of seniors mental health, although its potential buffering role of public health risk factors with cumulative impact on mental health, such as loneliness and ageism, needs to be more studied. Aim To assess the potential mediator role of resilience between the effects of ageism and loneliness on PD in seniors. Methods A sample of 349 Portuguese seniors aged 60 years and over was collected through an online survey and during the COVID-19 pandemic period. Seniors completed the Kessler Psychological Distress Scale (K6), the Short-Form of UCLA Loneliness Scale (USL-6), the Ambivalent Ageism Scale (AAS) and the Connor-Davidson Resilience Scale (CD-RISC-10). A mediation analysis model was developed with resilience as a mediating variable. Results There were moderate to high levels of PD and moderate levels of ageism, loneliness and resilience. Resilience fully mediated the effect of ageism on PD and partially mediated the effect of loneliness on PD. Conclusions Resilience was an important protective factor of mental health against the effects of ageism, and partially protected mental health from the effects of loneliness among seniors. It is suggested that resilience be considered as a factor to be integrated in future intervention programs for mental health. The practical applicability of this study is discussed.
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Affiliation(s)
- José Alberto Ribeiro-Gonçalves
- Corresponding author at: William James Center for Research, ISPA - University Institute, Rua Jardim do Tabaco, n° 34, 1149-041 Lisboa, Portugal.
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Axén A, Taube E, Sanmartin Berglund J, Skär L. Loneliness in Relation to Social Factors and Self-Reported Health Among Older Adults: A Cross-Sectional Study. J Prim Care Community Health 2023; 14:21501319231198644. [PMID: 37698121 PMCID: PMC10498702 DOI: 10.1177/21501319231198644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Loneliness is described as a public health problem and can be both a consequence of aging and a cause of ill health. Lonely older adults tend to have difficulties making new social connections, essential in reducing loneliness. Loneliness often varies over time, but established loneliness tends to persist. Maintaining good health is fundamental throughout the life course. Social connections change with aging, which can contribute to loneliness. AIM This study aimed to investigate loneliness in relation to social factors and self-reported health among older adults. METHOD A cross-sectional research design was used based on data from the Swedish National Study on Aging and Care, Blekinge (SNAC-B), from February 2019 to April 2021. Statistical analysis consisted of descriptive and inferential analysis. RESULTS Of n = 394 participants, 31.7% (n = 125) stated loneliness. Close emotional connections were necessary for less loneliness. Loneliness was more common among those who did not live with their spouse or partner and met more rarely. Furthermore, seeing grandchildren and neighbors less often increased loneliness, and a more extensive social network decreased loneliness. CONCLUSION This study underlined the importance of social connections and having someone to share a close, emotional connection with to reduce loneliness.
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Affiliation(s)
- Anna Axén
- Blekinge Institute of Technology, Karlskrona, Sweden
- Malmö University, Malmö, Sweden
| | | | | | - Lisa Skär
- Blekinge Institute of Technology, Karlskrona, Sweden
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Harrington KD, Vasan S, Kang JE, Sliwinski MJ, Lim MH. Loneliness and Cognitive Function in Older Adults Without Dementia: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2023; 91:1243-1259. [PMID: 36617781 PMCID: PMC9983432 DOI: 10.3233/jad-220832] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Loneliness has been highlighted as a risk factor for dementia. However, the nature of the relationship between loneliness and cognitive function prior to onset of dementia is unclear. OBJECTIVE The aim of this systematic review and meta-analysis was to examine the relationship between loneliness and cognitive function in samples screened for dementia at study commencement. METHODS Five electronic databases (PubMed, PsycNET, Web of Science, EBSCOhost, Scopus) were searched from inception to August 31, 2021. A narrative review and random-effects meta-analysis were conducted on studies meeting search criteria. PROSPERO registration number: CRD42020155539. RESULTS The sixteen studies that met inclusion criteria involved 30,267 individuals, with mean age ranging from 63.0 to 84.9 years. Studies varied in dementia screening criteria, measurement of loneliness and cognitive function, and statistical modeling approach. The narrative review indicated that loneliness was associated with poorer global cognition, episodic memory, working memory, visuospatial function, processing speed, and semantic verbal fluency. Results of the meta-analysis indicated that loneliness was negatively associated with global cognitive function (overall r = -0.08; 95% CI = -0.14, -0.02; n = 6). Due to lack of sufficient data and heterogeneity between studies, we were unable to explore associations with other cognitive domains or longitudinal associations. CONCLUSION Loneliness is associated with subtle impairment across multiple cognitive domains in older adults who were screened for dementia. Better characterization of this relationship will provide important information about how loneliness contributes to the clinical and pathological sequalae of AD and be informative for risk reduction and early detection strategies.
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Affiliation(s)
- Karra D Harrington
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC, Australia,Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
| | - Shradha Vasan
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Jee eun Kang
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA,Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Martin J Sliwinski
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA,Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Michelle H Lim
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC, Australia,Prevention Research Collaboration, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Tapia-Muñoz T, Staudinger UM, Allel K, Steptoe A, Miranda-Castillo C, Medina JT, Calvo E. Income inequality and its relationship with loneliness prevalence: A cross-sectional study among older adults in the US and 16 European countries. PLoS One 2022; 17:e0274518. [PMID: 36472996 PMCID: PMC9725142 DOI: 10.1371/journal.pone.0274518] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/27/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUNDS The prevalence of loneliness increases among older adults, varies across countries, and is related to within-country socioeconomic, psychosocial, and health factors. The 2000-2019 pooled prevalence of loneliness among adults 60 years and older went from 5.2% in Northern Europe to 24% in Eastern Europe, while in the US was 56% in 2012. The relationship between country-level factors and loneliness, however, has been underexplored. Because income inequality shapes material conditions and relative social deprivation and has been related to loneliness in 11 European countries, we expected a relationship between income inequality and loneliness in the US and 16 European countries. METHODS We used secondary cross-sectional data for 75,891 adults age 50+ from HRS (US 2014), ELSA (England, 2014), and SHARE (15 European countries, 2013). Loneliness was measured using the R-UCLA three-item scale. We employed hierarchical logistic regressions to analyse whether income inequality (GINI coefficient) was associated with loneliness prevalence. RESULTS The prevalence of loneliness was 25.32% in the US (HRS), 17.55% in England (ELSA) and ranged from 5.12% to 20.15% in European countries (SHARE). Older adults living in countries with higher income inequality were more likely to report loneliness, even after adjusting for the sociodemographic composition of the countries and their Gross Domestic Products per capita (OR: 1.52; 95% CI: 1.17-1.97). DISCUSSION Greater country-level income inequality was associated with higher prevalence of loneliness over and above individual-level sociodemographics. The present study is the first attempt to explore income inequality as a predictor of loneliness prevalence among older adults in the US and 16 European countries. Addressing income distribution and the underlying experience of relative deprivation might be an opportunity to improve older adults' life expectancy and wellbeing by reducing loneliness prevalence.
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Affiliation(s)
- Thamara Tapia-Muñoz
- Department of Behavioural Science and Health, University College London, London, United Kingdom
- Society and Health Research Center, School of Public Health, Universidad Mayor, Santiago, Chile
- Laboratory on Aging and Social Epidemiology, Facultad de Ciencias Sociales y Artes, Universidad Mayor, Santiago, Chile
- Millennium Institute for Caregiving Research, Santiago, Chile
- Millennium Nucleus on Sociomedicine, Santiago, Chile
| | - Ursula M. Staudinger
- Mailman School of Public Health, Columbia University, New York, NY, United States of America
- Technische Universität Dresden, Dresden, Germany
| | - Kasim Allel
- Millennium Nucleus on Sociomedicine, Santiago, Chile
- Institute for Global Health, University College London, London, United Kingdom
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Claudia Miranda-Castillo
- Millennium Institute for Caregiving Research, Santiago, Chile
- Faculty of Nursing, Universidad Andres Bello, Santiago, Chile
- Millennium Institute for Research in Depression and Personality, Santiago, Chile
| | - José T. Medina
- Society and Health Research Center, School of Public Health, Universidad Mayor, Santiago, Chile
- Laboratory on Aging and Social Epidemiology, Facultad de Ciencias Sociales y Artes, Universidad Mayor, Santiago, Chile
- Millennium Nucleus on Sociomedicine, Santiago, Chile
| | - Esteban Calvo
- Society and Health Research Center, School of Public Health, Universidad Mayor, Santiago, Chile
- Laboratory on Aging and Social Epidemiology, Facultad de Ciencias Sociales y Artes, Universidad Mayor, Santiago, Chile
- Millennium Nucleus on Sociomedicine, Santiago, Chile
- Mailman School of Public Health, Columbia University, New York, NY, United States of America
- * E-mail:
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45
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Gustafsson PE, Fonseca-Rodríguez O, Nilsson I, San Sebastián M. Intersectional inequalities in loneliness among older adults before and during the early phase of the COVID-19 pandemic: A total population survey in the Swedish eldercare setting. Soc Sci Med 2022; 314:115447. [PMID: 36288648 PMCID: PMC9556960 DOI: 10.1016/j.socscimed.2022.115447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/04/2022] [Accepted: 10/08/2022] [Indexed: 01/26/2023]
Abstract
Loneliness among older adults is a public health problem that has received particular attention since the emergence of the COVID-19 pandemic. Studies to date have however found a rather modest psychosocial impact of the pandemic on older adults, and scarce research has analyzed this impact using a comprehensive equity lens. The present study used an intersectional approach to examine social inequalities in loneliness before and during the early phase of the pandemic among older adults receiving eldercare in Sweden. The study population (analytical N = 205,529) came from two waves (2019 and 2020) of a total population survey to all older adult (>65 years of age) home care recipients and nursing home residents in Sweden. Loneliness was self-reported by a single-item measure, and survey data were linked to population register data on age, gender, residential setting, income, and country of birth. Additive binomial regression models were used to estimate prevalence differences and discriminatory accuracy according to an analysis of individual heterogeneity and discriminatory accuracy (AIHDA) approach. Results showed inequalities in loneliness arising particularly in the intersection of country of birth, income, and residential setting. The inequalities widened slightly but ubiquitously following the emergence of the pandemic in 2020, with particularly nursing home residents emerging as a risk group. The discriminatory accuracy of inequalities was consistently low to moderate throughout the analyses but increased marginally during the pandemic in 2020. The study illustrates how social inequalities engenders heterogeneity in the psychosocial risk of older adults before and during the pandemic. These findings should stimulate more nuanced and equity-oriented depictions, research and policies about loneliness among older adults in the peri-pandemic era.
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Affiliation(s)
- Per E. Gustafsson
- Department of Epidemiology and Global Health, Umeå University, 901 87, Sweden,Corresponding author
| | | | - Ingeborg Nilsson
- Department of Community Medicine and Rehabilitation, Unit of Occupational Therapy, Umeå University, 901 87, Sweden
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De Luca V, Femminella GD, Patalano R, Formosa V, Lorusso G, Rivetta C, Di Lullo F, Mercurio L, Rea T, Salvatore E, Korkmaz Yaylagul N, Apostolo J, Silva RC, Dantas C, van Staalduinen WH, Liotta G, Iaccarino G, Triassi M, Illario M. Assessment Tools of Biopsychosocial Frailty Dimensions in Community-Dwelling Older Adults: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16050. [PMID: 36498125 PMCID: PMC9739796 DOI: 10.3390/ijerph192316050] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/21/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Frailty is a complex interplay between several factors, including physiological changes in ageing, multimorbidities, malnutrition, living environment, genetics, and lifestyle. Early screening for frailty risk factors in community-dwelling older people allows for preventive interventions on the clinical and social determinants of frailty, which allows adverse events to be avoided. By conducting a narrative review of the literature employing the International Narrative Systematic Assessment tool, the authors aimed to develop an updated framework for the main measurement tools to assess frailty risks in older adults, paying attention to use in the community and primary care settings. This search focused on the biopsychosocial domains of frailty that are covered in the SUNFRAIL tool. The study selected 178 reviews (polypharmacy: 20; nutrition: 13; physical activity: 74; medical visits: 0; falls: 39; cognitive decline: 12; loneliness: 15; social support: 5; economic constraints: 0) published between January 2010 and December 2021. Within the selected reviews, 123 assessment tools were identified (polypharmacy: 15; nutrition: 15; physical activity: 25; medical visits: 0; falls: 26; cognitive decline: 18; loneliness: 9; social support: 15; economic constraints: 0). The narrative review allowed us to evaluate assessment tools of frailty domains to be adopted for multidimensional health promotion and prevention interventions in community and primary care.
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Affiliation(s)
- Vincenzo De Luca
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Grazia Daniela Femminella
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Roberta Patalano
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Valeria Formosa
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Grazia Lorusso
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Cristiano Rivetta
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Federica Di Lullo
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Lorenzo Mercurio
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Teresa Rea
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Elena Salvatore
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | | | - Joao Apostolo
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
| | - Rosa Carla Silva
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
| | | | | | - Giuseppe Liotta
- Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Guido Iaccarino
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Maria Triassi
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Maddalena Illario
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
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Manera KE, Stamatakis E, Huang BH, Owen K, Phongsavan P, Smith BJ. Joint associations of social health and movement behaviours with mortality and cardiovascular disease: an analysis of 497,544 UK biobank participants. Int J Behav Nutr Phys Act 2022; 19:137. [PMID: 36384558 PMCID: PMC9670497 DOI: 10.1186/s12966-022-01372-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background Poor physical activity and excessive sedentary behaviour are well-established risk factors for morbidity and mortality. In the presence of emerging social problems, including loneliness and social isolation, these risks may be even greater. We aimed to investigate the joint effects of social health and movement behaviours on mortality and cardiovascular disease (CVD). Methods 497,544 UK Biobank participants were followed for an average of 11 years. Loneliness and social isolation were measured via self-report. Physical activity was categorised around current World Health Organisation (WHO) guidelines as low (< 600 metabolic equivalent of task [MET]-mins/week), moderate (600 < 1200) and high (≥ 1200). Sedentary behaviour was classified as low (≤ 3.5 h/day), moderate (3.5 ≤ 5) and high (> 5.5). We derived 24 social health–movement behaviour combinations, accordingly. Mortality and hospitalisations were ascertained to May 2020 for all-cause and CVD mortality, and non-fatal cardiovascular events. Results Social isolation amplified the risk of both all-cause and CVD death across all physical activity and sedentary levels (hazard ratio, 95% confidence interval [HR, 95% CIs] for all-cause mortality; 1.58 [1.49 to 1.68] for low active-isolated vs. 1.26 [1.22 to 1.30] for low active-not isolated). Loneliness was only found to amplify the risk of death from cardiovascular disease among the high active and low sedentary participants. Loneliness and social isolation did not add to the risk of non-fatal cardiovascular events across most activity levels. Conclusion The detrimental associations of poor physical activity and sedentary behaviour with mortality were consistently amplified by social isolation. Our study supports the need to target the socially isolated as a priority group in preventive public health strategies. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-022-01372-3.
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48
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Astell-Burt T, Hartig T, Putra IGNE, Walsan R, Dendup T, Feng X. Green space and loneliness: A systematic review with theoretical and methodological guidance for future research. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 847:157521. [PMID: 35878853 DOI: 10.1016/j.scitotenv.2022.157521] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/08/2022] [Accepted: 07/16/2022] [Indexed: 06/15/2023]
Abstract
Persistent loneliness troubles people across the life span, with prevalence as high as 61 % in some groups. Urban greening may help to reduce the population health impacts of loneliness and its concomitants, such as hopelessness and despair. However, the literature lacks both a critical appraisal of extant evidence and a conceptual model to explain how green space would work as a structural intervention. Both are needed to guide decision making and further research. We conducted a systematic review of quantitative studies testing associations between green space and loneliness, searching seven databases. Twenty two studies were identified by 25/01/2022. Most of the studies were conducted in high-income countries and fifteen (68 %) had cross-sectional designs. Green space was measured inconsistently using either objective or subjective indicators. Few studies examined specific green space types or qualities. The majority of studies measured general loneliness (e.g. using the UCLA loneliness scale). Different types of loneliness (social, emotional, existential) were not analysed. Of 132 associations, 88 (66.6 %) indicated potential protection from green space against loneliness, with 44 (33.3 %) reaching statistical significance (p < 0.05). We integrated these findings with evidence from qualitative studies to elaborate and extend the existing pathway domain model linking green space and health. These elaborations and extensions acknowledge the following: (a) different types of green space have implications for different types of loneliness; (b) multilevel circumstances influence the likelihood a person will benefit or suffer harm from green space; (c) personal, relational, and collective processes operate within different domains of pathways linking green space with loneliness and its concomitants; (d) loneliness and its concomitants are explicitly positioned as mediators within the broader causal system that links green space with health and wellbeing. This review and model provide guidance for decision making and further epidemiological research on green space and loneliness.
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Affiliation(s)
- Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), NSW, Australia; School of Health and Society, Faculty of Arts, Social Sciences, and Humanities, University of Wollongong, Wollongong, Australia.
| | - Terry Hartig
- Institute for Housing and Urban Research, Uppsala University, Sweden; Department of Psychology, Uppsala University, Sweden
| | - I Gusti Ngurah Edi Putra
- Population Wellbeing and Environment Research Lab (PowerLab), NSW, Australia; Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Ramya Walsan
- Centre of Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Tashi Dendup
- Population Wellbeing and Environment Research Lab (PowerLab), NSW, Australia; Save the Children, Bhutan Office, Thimphu, Bhutan
| | - Xiaoqi Feng
- Population Wellbeing and Environment Research Lab (PowerLab), NSW, Australia; School of Health and Society, Faculty of Arts, Social Sciences, and Humanities, University of Wollongong, Wollongong, Australia; School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
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49
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Schutter N, Holwerda TJ, Kuipers H, Van RHL, Stek ML, Comijs HC, Peen J, Dekker JJM. The Association Between Loneliness and Psychiatric Symptomatology in Older Psychiatric Outpatients. J Geriatr Psychiatry Neurol 2022; 35:778-788. [PMID: 34937438 DOI: 10.1177/08919887211060022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Loneliness in adults increases with age. Although loneliness has been found to be associated with psychiatric disorders and dementia, no information is available on prevalence of loneliness in older psychiatric patients. The aims of this study were to examine prevalence of loneliness in older psychiatric outpatients, including gender differences and associations with psychiatric disorders and social isolation. METHODS Cross-sectional study in an outpatient clinic for geriatric psychiatry between September 2013 and February 2018. Interviews were done in 181 patients. RESULTS 80% of participants were lonely. Loneliness was associated with having contacts in less social network domains, in women but not in men. There were no associations with DSM-IV-TR-classifications. However, loneliness was associated with higher scores on questionnaires for depression and cognitive function. Intensity of treatment did not differ significantly between lonely and non-lonely participants. CONCLUSION Loneliness is highly prevalent in older psychiatric outpatients, with men and women equally affected. Loneliness should be assessed in all older psychiatric patients, especially when they show high scores on symptom checklists or have a restricted social network.
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Affiliation(s)
- Natasja Schutter
- Department of Geriatric Psychiatry, 120662Arkin Mental Health Care, Amsterdam, Netherlands
| | - Tjalling J Holwerda
- Department of Psychiatry, 120662Arkin Mental Health Care, Amsterdam, Netherlands
| | - Hanna Kuipers
- Department of Psychiatry, Amici Zorgt, Heerhugowaard, Netherlands
| | - Rien H L Van
- Department of General Psychiatry Residency Training/Netherlands Psychoanalytical Institute, 120662Arkin Mental Health Care, Amsterdam, Netherlands
| | - Max L Stek
- GGZ InGeest/Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Hannie C Comijs
- GGZ InGeest/Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Jaap Peen
- Department of Clinical Research, 120662Arkin Mental Health Care, Amsterdam, Netherlands
| | - Jack J M Dekker
- Department of Clinical Research, 120662Arkin Mental Health Care, Amsterdam, Netherlands.,Department of Psychology, VU University, Amsterdam, Netherlands
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50
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Kojima G, Taniguchi Y, Aoyama R, Tanabe M. Associations between loneliness and physical frailty in community-dwelling older adults: A systematic review and meta-analysis. Ageing Res Rev 2022; 81:101705. [PMID: 35932978 DOI: 10.1016/j.arr.2022.101705] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 07/10/2022] [Accepted: 08/01/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Older adults may be at increased risk of loneliness. Frailty is also common in older adults, however, associations between loneliness and frailty have been understudied. This systematic review and meta-analysis aimed to explore evidence on how loneliness and frailty are correlated. METHODS A systematic search of the literature was conducted using 4 electronic databases in February 2022 for any studies published in 2000 or later that provided cross-sectional or longitudinal associations between loneliness and physical frailty in community-dwelling older adults. A meta-analysis was attempted to combine data when possible. RESULTS From 1386 studies identified by the initial search, 16 studies were included for this review. Standardized mean difference (SMD) meta-analysis based on mean loneliness score across 3 frailty groups provided by 6 cross-sectional studies showed that worse frailty status was significantly associated with a higher degree of loneliness (SMD between frail and robust, frail and prefrail, and prefrail and robust were 0.77 (95% confidence interval (CI)= 0.57-0.96), 0.37 (95%CI=0.25-0.50), and 0.30 (95%CI=0.20-0.40), respectively.) Meta-analyses combining cross-sectional data from 6 studies revealed that frailty was significantly associated with a higher risk of loneliness compared with robustness (3 studies: pooled OR=3.51, 95%CI=2.70-4.56 for frailty, pooled OR=1.88, 95%CI=1.57-2.25 for prefrailty) and compared with non-frailty (4 studies: pooled OR=2.05, 95%CI=1.76-2.39). A meta-analysis involving two longitudinal studies showed that baseline loneliness was associated with a significantly higher risk of worsening frailty (2 studies: pooled OR=1.41, 95%CI=1.16-1.72). CONCLUSIONS This systematic review and meta-analysis was the first, to our knowledge, to quantitatively demonstrate significant cross-sectional and longitudinal associations between loneliness and frailty in community-dwelling older adults.
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Affiliation(s)
- Gotaro Kojima
- Department of Research, Dr. AGA Clinic, Tokyo, Japan.
| | - Yu Taniguchi
- Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan
| | - Reijiro Aoyama
- Department of Japanese Studies, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Marianne Tanabe
- Veterans Affairs Pacific Islands Health Care System, Honolulu, HI, USA
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