Older Norwegians' understanding of loneliness

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

BACKGROUND

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

OBJECTIVE

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSION

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

Experiences of Loneliness Across the Lifespan: A Systematic Review and Thematic Synthesis of Qualitative Studies

PURPOSE

Loneliness is a fundamentally subjective experience that is common at various life stages. Studies have qualitatively explored loneliness, but a comprehensive overview is lacking. This research therefore provides a fine-grained review of studies on loneliness experiences across the lifespan.

METHODS

A systematic review and thematic synthesis were performed on studies that qualitatively investigated experiences of loneliness in people of any age from non-clinical populations. Sensitivity analysis assessed the impact of lower-quality studies and specific age groups on the findings.

RESULTS

Twenty-nine studies of 1,321 participants aged between 7 and 103 were included. Fifteen descriptive themes and three overarching analytical themes were developed: (1) Loneliness is both psychological and contextual, (2) Loneliness centres on feelings of meaningful connection and painful disconnection, and (3) Loneliness can exist in a general, pervasive sense or can relate to specific other people or relationship types. Some features were particularly pertinent to children, younger adults, and older adults, respectively.

CONCLUSIONS

Loneliness involves a primarily aversive psychological experience of perceived disconnection which is linked to physical, personal, and socio-political contexts and can be pervasive or relate to specific relationships or relationship types. An awareness of context, life stage, and personal experiences is essential to understand loneliness.

Design, implementation and evaluation of informal home care support intervention program for lonely older adults in the community: Protocol for a feasibility study

Background

Providing lonely older adults with informal home care services is important to improving their health and quality of life. The study aims to evaluate the feasibility of design, implementation and evaluation of an informal home care support intervention program (HoSIP) for community-dwelling lonely older adults in Gorgan, Iran.

Method/design

This feasibility study is a mixed-method with a concurrent nested design. Lonely older adults will be enrolled as the HoSIP intervention group and will receive 12-weeks of informal home care service by peer supporters. The purpose of this feasibility study is to determine the recruitment capability and resulting sample characteristics, data collection procedure and outcome measures, the acceptability and suitability of the intervention and study procedures, the resource and ability to manage the study and intervention, and preliminary evaluation of participant response to intervention. Primary outcomes including participant feelings of loneliness, quality of life, general health, social network, social support, and self-care ability, will be assessed at baseline and post-intervention for the intervention and control groups. Semi-structured interviews will be conducted immediately after the intervention using content qualitative approach to describe participants’ experiences with HoSIP.

Discussion

Through this study we will examine the feasibility of delivering informal home care services to community-dwelling lonely older adults in a developing country through employing a concurrent nested mixed-method design.

Trial registration

IRCT20190503043455N

Loneliness From the Adolescent Perspective: A Qualitative Analysis of Conversations About Loneliness Between Adolescents and Childline Counselors

There is limited qualitative research on the experience of loneliness in adolescence, meaning key facets of the loneliness experience that are important in adolescence may have been overlooked. The current study addresses that gap in the literature and explores how loneliness is experienced in the context of adolescence from the perspective of adolescents. About 67 online counseling conversations between Childline counselors and adolescents (ages 12–18 years; 70% females) who had contacted Childline to talk about loneliness were analyzed using Thematic Framework Analysis to establish commonalities and salient issues involved in adolescent experiences of loneliness. Young people considered loneliness to be an intense experience that negatively impacted their daily lives. Experiences of loneliness revolved around difficulties with peer relationships, but turmoil at home worsened those experiences. Young people often employed short-term coping strategies that distracted them from loneliness. Issues with trusting others and self-worth acted as barriers to seeking long-term help. Recommendations include (1) the training of teachers and parents to recognize and support young people experiencing loneliness and (2) further research to establish the coping strategies that are used by adolescents who successfully overcome loneliness.

‘The worse my hearing got, the less sociable I got’: a qualitative study of patient and professional views of the management of social isolation and hearing loss

Background

Social isolation is a major consequence of hearing loss. It includes an objective component (e.g. small social network) and a subjective component (e.g. loneliness).

Objective

To examine the perspectives of key stakeholders regarding (i) the relationship between hearing loss and social isolation and (ii) interventions to address hearing loss and social isolation.

Design

A phenomenological qualitative study.

Setting

A UK research centre with a role to engage patients and clinicians.

Participants

Hearing healthcare professionals (n = 7) and adults with hearing loss (n = 6) were recruited via maximum variation sampling.

Methods

Individual (n = 3) and group (n = 3) semi-structured interviews were conducted. Inductive thematic analysis was performed.

Results

Five themes were identified. Theme 1 (experience of isolation and hearing loss): hearing loss can cause people to feel disconnected at social events or to cease attending them. Theme 2 (complexity of isolation and hearing loss): the various causes of isolation (e.g. hearing loss, retirement, comorbidities) are difficult to disentangle. Theme 3 (downstream effects of isolation and hearing loss): hearing loss and/or isolation can lead to mental health problems, stigmatisation, fatigue and unemployment. Theme 4 (preferred components of an isolation intervention): an isolation intervention should be patient-led and patient-centred and take place in the community. Theme 5 (challenges to implementing an isolation intervention): barriers to implementing an isolation intervention include a lack of time, training and continuity.

Conclusion

This study demonstrated that social isolation arising from hearing loss is a substantial, complex problem and provided novel insights on implementing an intervention to address this issue.

Death Anxiety and Loneliness among Older Adults: Role of Parental Self-Efficacy

Death anxiety and loneliness are major issues for older people. The present study aimed to broaden the understanding of factors that are linked with increased loneliness in old age by examining the association between death anxiety and loneliness, and the role of an unexplored variable among older adults, namely, parental self-efficacy. A convenience sample of 362 Israeli parents over the age of 65 was recruited through means of social media. Participants completed self-reported questionnaires, which included background characteristics, death anxiety, parental self-efficacy, and loneliness measures. The findings showed that death anxiety was positively associated with loneliness among older adults. The findings also confirmed that parental self-efficacy moderated this association in this population. We concluded that the combination of death anxiety and low parental self-efficacy identified a group of older adults that are at higher risk of developing increased loneliness levels. Mental health professionals should consider intergenerational relationships as a fundamental component of older adults' daily lives, focusing on parental self-efficacy in old age, as this appears to be a resilience resource.

Explaining age differences in the memory-experience gap

Emotions and symptoms are often overestimated in retrospective ratings, a phenomenon referred to as the "memory-experience gap." Some research has shown that this gap is less pronounced among older compared to younger adults for self-reported negative affect, but it is not known whether these age differences are evident consistently across domains of well-being and why these age differences emerge. In this study, we examined age differences in the memory-experience gap for emotional (positive and negative affect), social (loneliness), and physical (pain, fatigue) well-being. We also tested four variables that could plausibly explain age differences in the gap: (a) episodic memory and executive functioning, (b) the age-related positivity effect, (c) variability of daily experiences, and (d) socially desirable responding. Adults (n = 477) from three age groups (21-44, 45-64, 65+ years old) participated in a 21-day diary study. Participants completed daily end-of-day ratings and retrospective ratings of the same constructs over different recall periods (3, 7, 14, and 21 days). Results showed that, relative to young and middle-aged adults, older adults had a smaller memory-experience gap for negative affect and loneliness. Lower day-to-day variability partly explained why the gap was smaller for older adults. There was no evidence that the magnitude of the memory-experience gap for positive affect, pain or fatigue depended on age. We recommend that future research considers how variability in daily experiences can impact age differences in retrospective self-reports of well-being. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

[Loneliness in nursing homes-Experience and measures for amelioration : A literature review]

BACKGROUND

Public health and health economics consider loneliness to be an important determinant of health and quality of life for all people. For older people, loneliness can be considered as possibly the most important health determinant.

OBJECTIVE

The purpose of this paper is to describe the experience of loneliness from the perspective of residents in residential long-term care and to identify interventions to reduce loneliness by caregivers.

MATERIAL AND METHODS

Systematic literature search and study evaluation.

RESULTS

Talking about their loneliness is not easy for many residents. The manifestations of loneliness vary from being alone, to boredom and to not feeling at home. Interventions range from the use of laughter yoga and animal-assisted therapy to technological measures and the use of volunteers.

CONCLUSION

Measures that focus on the spiritual level of relationship building and trust have proven to be most effective.

Experiences of loneliness among older people living alone. A qualitative study in Quebec (Canada)

In this article, we analyse experiences of loneliness among older people living alone. Current knowledge suggests that loneliness is a significant social issue that can compromise health and wellbeing, and that seniors living alone are at a higher risk of loneliness. Based on a qualitative methodological approach and semi-structured interviews conducted with 43 people aged 65 or over living alone in Montreal (Quebec, Canada), this study sought to understand how they perceive, reflect on and react to loneliness. The results show that these seniors perceive loneliness as a dynamic, and rarely static, experience, which has a very different significance, depending on whether it is chosen or circumstantially imposed. The experience of loneliness recounted by the seniors we met is characterised by its heterogeneity, and involves, to varying degrees, their relationship to themselves (solitude), to others (family (and friends) loneliness and loneliness in love) and/or to the world (existential loneliness and aloneness). Lastly, our analyses highlight how social factors, such as age, gender, marital status, social network and socio-economic conditions, shape the experience of loneliness among seniors. These factors also influence the strategies that seniors develop to prevent or alleviate loneliness, strategies that yield very mixed results.

Loneliness Among Cognitively Intact Residents of Nursing Homes With and Without Cancer: A 6-Year Longitudinal Study

Limited information exists regarding the natural development of loneliness and its determinants among cognitively intact nursing home residents. We aimed to examine loneliness among nursing home residents by following up for 6 years and to determine whether sociodemographic factors, diagnosis of cancer, sense of coherence, social support, and depression symptoms influence loneliness. The study was longitudinal and prospective and included baseline assessment and 6-year follow-up. After baseline assessment of 227 cognitively intact nursing home residents (Clinical Dementia Rating score ≤0.5), 52 respondents were interviewed a second time at the 5-year follow-up and 18 respondents a third time at the 6-year follow-up. Data from the interviews were recorded using a global question of loneliness, the Social Provisions Scale, Sense of Coherence Scale, and Geriatric Depression Scale. Scores on Groll’s index (p = .02) and the Sense of Coherence Scale (p = .04) were positively correlated with loneliness and negatively correlated with geriatric depression (p = .001). Having a diagnosis of cancer, social support, and age were not correlated with loneliness 6 years from baseline. Loneliness did not change during the 6 years of follow-up, and symptoms of depression and the sense of coherence appeared to be important components of loneliness. Finally, having a diagnosis of cancer and social support were not associated with loneliness.

Transitions in loneliness in later life: the role of social comparisons and coping strategies

This study explored the coping strategies and social comparisons used by older adults on different loneliness trajectories (decreased loneliness, stable loneliness and degenerating loneliness). The adaptive consequences of social comparison in later life are recognised as an important strategy for preserving life satisfaction regardless of age-related losses. Coping strategies are also important in managing loneliness. Narrative interviews were conducted with lonely older adults (N = 11) who had participated in Wave One of the Maintaining Function and Well-being in Later Life Study Wales (CFAS Wales). The study found key differences in the coping strategies employed by older adults on different loneliness trajectories. Differences in coping styles between those who reported decreased loneliness and those who were chronically lonely stemmed from perceptions as to whether loneliness was modifiable or not. Different types of social comparison were also found to modulate the loneliness experience. The findings indicate that higher-order strategies (problem, emotional and meaning focused) are not distinct entities but are part of a dynamic process. The management of loneliness in later life may be dependent on several factors, including older adults’ interpretations of the cause of loneliness. These interpretations will have implications for interventions aimed at alleviating chronic loneliness, where the focus may have to be on changing older adult's perceptions of unmodifiable loneliness.

Are Filial Piety and Ethnic Community Engagement Associated With Psychological Wellbeing Among Older Chinese American Immigrants? A Cultural Resource Perspective

This research examined whether perceived receipt of filial piety from adult children and ethnic community engagement—two major ethnocultural resources—were associated with psychological wellbeing of older Chinese American immigrants. Analyses used data from the PINE study, a sample of older Chinese adults in Chicago. Tobit regression revealed that elders who received more filial piety and visited community centers experienced less loneliness and depression than their counterparts did. Tests of interactions showed that community center visits moderated the negative relationship between perceived filial piety and depression. Results suggest the importance of community engagement for diminishing depressive symptoms in older Chinese American immigrants, particularly those with culturally weak intergenerational ties. Discussion centers on how visiting community centers in ethnically dense neighborhoods compensates for unfulfilled filial piety expectations by protecting the mental health of minority elders within a rapidly growing and acculturating immigrant population.

"You Never Get Used to Loneliness" - Older Adults' Experiences of Loneliness When Applying for Going on a Senior Summer Camp

The aim of the present study was explore why the informants were feeling lonely and considered themselves to be in need of attending a senior summer camp, and how the informants were experiencing loneliness before they went to the senior summer camp. Interviews was made with nineteen older adult people (15 women and 4 men). A phenomenological inspired approach was used for the analysis of the interviews. Eight themes resulted: Hard to make new friends, Other circumstances making it hard to be social, Feel very lonely even if they lead rich social lives, Loss of loved ones, Do not want to do things alone, Friends make a difference, Do not feel lonely but need a change and Loneliness occurs at certain times. Through this analysis, we have gain insights to better understand loneliness as a multifaceted phenomenon that is associated with both personal circumstances and social situations. Many of the informants experienced being very lonely, even if they lead rich social lives. The experience of loneliness was connected to not having anyone they can turn to in confidence or to share experiences with and the need to belong to something or the need of a change in everyday life.

"I´m the one who has written this": reciprocity in writing courses for older adults in Norway

Purpose: The aim of this article is to explore, theoretically and empirically, the reciprocity of care afforded by writing courses as community interventions for older adults.

Methods: We narratively analyzed 209 excerpts of the anthology “I´m the one who has written this” written by teachers and participants of courses organized by the Church City Mission in Norway.

Results: The reciprocity that appeared in the writing courses is grounded in the sense of vulnerability that both teachers and participants embraced, and that is experienced in three main relational movements that these writing courses convey: self-exploration, otherness and togetherness. In addition, the data suggests that these courses promote affective processing and existential meaning-making, motivation, as well as improvements of memory and attention. However, more research is needed to confirm these preliminary findings, and their possible effects in older adults with and without symptoms of dementia.

Conclusion: Even though these writing courses for older adults are not explicitly therapeutic, they can have therapeutic effects, given the reciprocity afforded in these cultural community interventions. A theoretical exploration upon reciprocity in eldercare is hereby provided. These findings could shape improvements in aging and health care policies that are person-centered and focus on reciprocity.

Defining loneliness in older adults: protocol for a systematic review

BACKGROUND

Socialization is an important part of the healthy aging process, but natural changes in the lifestyle and health of older people increased risk of loneliness. However, loneliness is not well defined and might differ in different cultures and settings. The main objective of this systematic review is to summarize literature on the topic and propose a definition that might help aging research and practice in the future.

METHODS

Eight databases including PubMed, Scopus, CINAHL, Web of Science, EMBASE, PsycINFO, Proquest, and Age Line bibliographic will be run individually to retrieve relevant literature on loneliness among elderly population using subject headings and appropriate MeSH terms. Inclusion and exclusion criteria will be developed and refined by the research team. Two reviewers will participate in each search stage including abstract/title and full text screening, data extraction, and appraisal. We will restrict our search to articles published in the English language biomedical journal between 2000 and 2017. The protocol adheres to the standards recommended by the PRISMA-P.

DISCUSSION

The results of this systematic review can present a more accurate definition of loneliness for researchers who aim at conducting new primary and secondary studies on this subject.

SYSTEMATIC REVIEW REGISTRATION

CRD42017058729.

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

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

Who often feels lonely? A cross-sectional study about loneliness and its related factors among older home-dwelling people

AIM AND OBJECTIVES

To investigate the prevalence of individuals who often feel lonely among a sample of Norwegian older home-dwelling people aged ≥65 years old, as well as to identify any possible factors explaining their loneliness.

BACKGROUND

Loneliness is known to be common among older people. To identify those older adults who are lonely, and to acquire knowledge about the complexity of their loneliness, is important to provide them with adequate help and support.

DESIGN

This study employed a cross-sectional design.

METHOD

A questionnaire was mailed to a randomised sample of 6,033 older home-dwelling persons aged ≥65 years. A total of 2,052 persons returned the questionnaire and were included in the study. The questionnaire consisted of questions asking whether the subjects often felt lonely or not, as well as health-related and background questions and instruments to measure the participants' sense of coherence, mental problems, nutritional screening and self-care ability. The data were analysed using univariate and multivariate statistical methods.

RESULTS

A total of 11.6% of the participants reported often feeling lonely. Six factors emerged to be independently associated with often feeling lonely among the respondents: Living alone, not being satisfied with life, having mental problems, a weak sense of coherence, not having contact with neighbours and being at risk for undernutrition.

CONCLUSIONS

The study shows that often feeling lonely among older home-dwelling persons is a health-related problem that includes social, psychological and physical aspects. Moreover, these persons have limited resources to overcome feelings of loneliness.

IMPLICATIONS FOR PRACTICE

Lasting loneliness among older home-dwelling persons requires an overall, person-centred and time-consuming approach by nurses. Nurses with advanced knowledge on geriatric nursing may be required to offer appropriate care and support. Healthcare leaders and politicians should offer possibilities for adequate assessment, support and help.

Identity Processes Among Older Norwegians Living in Urban and Rural Areas

Guided by the Identity Process Theory, we examined whether 424 Norwegians 60+ years of age would attribute their physical and mental functioning to their health (identity assimilation), to aging itself (identity accommodation), or to both (identity balance). We were also interested in the effect of these attribution styles upon depressive symptoms. Secondary data from the 2004 World Health Organization Quality of Life OLD Group Norwegian Field Study were analyzed using General Linear Model Regression and subsequent Path Analyses. Attributing physical functioning to health as opposed to aging had a negligible effect on depressive symptoms among both study groups. Attributing mental functioning to aging worsened depressive symptoms among rural participants. Attributing mental functioning to health was associated with more positive perceptions of psychosocial loss among urban participants. Positivity toward psychosocial loss lessened depressive symptoms and factors affecting those perceptions differed among rural versus urban participants. Adapting to functional changes in older age is a complex process affecting depressive symptoms.

Association of loneliness and healthcare utilization among older adults in Singapore

AIM

To assess the association between loneliness and physician visits among community-dwelling older adults in Singapore.

METHODS

We obtained data from two consecutive waves (2009 and 2011) of a nationally representative longitudinal survey of community-dwelling Singaporeans aged 60 years and older. Out of 3103 responses, we excluded proxy interviews (n = 365; 11.8 %), resulting in a final analysis cohort of 2738 respondents. Using the frequency of physician visits in the past 30 days as the dependent variable, we carried out negative binomial hurdle regression controlling for predisposing characteristics, enabling factors, needs, social capital and change in loneliness status between the two waves of the survey.

RESULTS

Approximately 23% of respondents suffered from chronic loneliness; a further 19% developed loneliness, whereas 33% recovered from loneliness by wave 2. Chronic (OR 0.76 ± 0.11) and recently-developed loneliness (OR 0.70 ± 0.10) were significantly associated with lower odds of physician visits, compared with being never lonely. Meanwhile, those who recovered from loneliness had the same odds of physician visits, but were associated with lower number of visits (-0.71 ± 0.27) if they did utilize their physicians.

CONCLUSIONS

The present study found a significant association between loneliness and lower odds of physician visits regardless of whether the loneliness was recently developed or chronic. In addition, respondents who had loneliness in the past also had a significantly lower number of visits to physicians compared with those who were never lonely. Further studies on the underlying behavior and the health consequences are warranted. Geriatr Gerontol Int 2017; 17: 1789-1798.

Loneliness, loss, and social support among cognitively intact older people with cancer, living in nursing homes--a mixed-methods study

BACKGROUND

Loneliness is a significant psychosocial effect following a cancer diagnosis and may prevent people from engaging in social activities, thus creating difficulties in interpersonal relationships. This study investigated loneliness and social support among cognitively intact nursing home residents with cancer by using a quantitatively driven mixed-methods design with sequential supplementary qualitative components.

METHODS

The quantitative component consisted of face-to-face interviews of 60 nursing home residents (≥65 years) using the one-item Loneliness Scale and the Social Provisions Scale. The supplementary psychosocial component consisted of qualitative research interviews about experiences related to loneliness with nine respondents.

RESULTS

The quantitative results indicated that reassurance of worth was associated with loneliness. The experience of loneliness was identified by the following: loneliness that was dominated by a feeling of inner pain, feeling of loss, and feeling small. Loneliness was alleviated by the following: being engaged in activities, being in contact with other people, and occupying oneself.

CONCLUSION

Enhancing the lives of nursing home residents with cancer requires attending to the residents' experience of loneliness and social relationships in a targeted and individualized manner. This might require screening all nursing home residents for early detection of loneliness. Revealing factors that may contribute to or reduce loneliness improves the ability to enhance people's lives.

Being stuck in a vice: The process of coping with severe depression in late life

Articles describing older persons’ experiences of coping with severe depression are, to our knowledge, lacking. This article is methodologically grounded in phenomenological hermeneutics, inspired by Paul Ricoeur, and applies a descriptive design with in-depth interviews for producing the data. We included 18 older persons, 13 women and 5 men, with a mean age of 77.9 years, depressed to a severe or moderate degree, 1–2 weeks after admission to a hospital for treatment of depression. We found the metaphor “being in a vice” to capture the essence of meaning from the participants’ stories, and can be understood as being stuck in an immensely painful existence entirely dominated by depression in late life. This is the first article where coping in older men and women experiencing the most severe phase of depression is explored.

Losing connections and receiving support to reconnect: experiences of frail older people within care programmes implemented in primary care settings

AIMS AND OBJECTIVES

The objective of this study was to evaluate whether care provided in the care programmes matched the needs of older people.

BACKGROUND

Care programmes were implemented in primary-care settings in the Netherlands to identify frail older people and to prevent further deterioration of health.

DESIGN AND METHODS

In total, 23 older people participated in in-depth interviews. Within this study, three older people participated as co-researchers; they gathered and analysed the data together with the academic researchers. Content analysis was used to analyse the data.

RESULTS

Two categories emerged from the data: 'Losing connections' and 'Receiving support to reconnect.' 'Losing connections' reflects the needs of older people and 'Receiving support to reconnect' reflects their experience and the appreciated aspects of the provided care. A relationship of trust with the practice nurse (PN) appeared to be an important aspect of care, as it fostered the sharing of feelings and issues other than physical or medical problems that could not be shared with the general practitioner. The PNs are experienced as connectors, who help to restore feelings of connectedness and older peoples' access to resources in the community.

CONCLUSIONS

The relationship with the PN was experienced as valuable because of the feelings of 'connectedness' it created. Through this connectedness, older people could discuss feelings of loneliness, depression and frustration in receiving and acquiring the appropriate resources and services with the PNs. Furthermore, the relationship with the PN helped the older people to gain access to other health professionals and services.

IMPLICATIONS FOR PRACTICE

The results imply that care for frail older people should include an awareness of the importance of the trusting relationship. Nurses can play a vital role in creating a trusting relationship and are able to bridge the gap between older people and other professionals and services.

Cultural Frames, Qualities of Life, and the Aging Self

We used the Self-Concept Enhancement Tactician (SCENT) model to explore whether older Norwegians and Canadians would tactically self-enhance on qualities considered significant within their cultures in their self-perceptions of aging. Qualities were measured using the WHOQOL-BREF and WHOQOL-OLD. Self-perceptions of aging were measured by the Attitudes to Aging Questionnaire. The study is a secondary analysis of data collected in a larger study; 393 older Norwegians and 202 older Canadians were included. The Norwegian and Canadian group self-enhanced their perceptions of psychosocial loss based on harmonious social relationships and being part of a larger social group. For self-perceptions of physical change, both groups self-enhanced on being self-sufficient and being part of a larger social group. Our findings suggest that Norwegians and Canadians are not highly individualistic people and also provide evidence of a bicultural self-perception of aging. Nurses should consider how cultural and individual perspectives affect the care priorities of older people.

Variations in older persons' descriptions of the burden of loneliness

Research indicates that approximately one-third of older people over the age of 65 years report loneliness, with even higher rates among those aged over 85. Loneliness is associated with a variety of health issues, such as depression, anxiety, physical impairment and social isolation. The purpose of this paper is to describe the characteristics of the burden of loneliness, and investigate the variability in how it is described by older. In-depth interviews were conducted with 12 older people in autumn 2006 and spring 2007 in Norway. Participants aged from 70 to 97 years were recruited from a variety of backgrounds, and varied in health status and social status. The findings reported in this paper are based on hermeneutic analyses of the interviews. Our findings indicate that some of the participants experienced loneliness that they felt able to manage. They experienced a fluctuating loneliness that was linked to feeling valuable and having power and energy. However, another group described experiences of agonising loneliness. They felt a present and extensive loneliness, together with feeling less valuable and lacking in power and initiative. They seemed trapped in their loneliness, and unable to overcome their situation themselves. Our findings indicate that the burden of loneliness is experienced differently. For some older persons, the experience of loneliness is so severe that they urgently need help to manage their situation.

Perception and negative effect of loneliness in a Chicago Chinese population of older adults

This qualitative study aims to investigate the cultural understandings of loneliness, identify the contexts of loneliness, and to examine its effect on the health and well-being of U.S. Chinese older adults. Despite loneliness is one of the main indicators of well-being, little attention has been paid to understanding loneliness among immigrant older adults. This study utilizes both survey questionnaires and semi-structured focus group methods to investigate the feelings of loneliness among U.S. Chinese older adults. Based on interviews with 78 community-dwelling Chinese older adults in Chicago Chinatown, this community-based participatory research study (CBPR) shows loneliness is common among U.S. Chinese older adults. It was frequently identified through emotional isolation and social isolation. Social, psychological and physical health factors could contribute to the experience of loneliness. In addition, the health of older adults with loneliness may be associated with worsening overall health, elder mistreatment, health behavior changes and increased healthcare utilizations. This study has implications for healthcare professionals, social services agencies and policy makers. Our findings point to the needs for healthcare professionals to be more alert of the association of loneliness and adverse health outcomes. Communities and social services agencies should collectively take a lead in reducing social isolation, improving intergenerational relationships, and increasing social networks and companionship for this group of vulnerable older adults.

Social inclusion through ageing-in-place with care?

The onset of ill-health and frailty in later life, within the context of the policy of ageing-in-place, is increasingly being responded to through the provision of home care. In the philosophy of ageing-in-place, the home provides for continuity of living environment, maintenance of independence in the community and social inclusion. The provision of assistance to remain at home assumes continuity in the living environment and independence in the organisation of daily life and social contact. This paper explores the changes that occur as a result of becoming a care recipient within the home and concludes that the transition into receiving care is characterised by discontinuity and upheaval which tends to reinforce social exclusion. We draw on the rites of passage framework, which highlights social processes ofseparation, liminality and reconnection, in analysing this transition to enhance understanding of the experience and gain insights to improve the policy and practice of home care. Separation from independent living leads to a state of liminality. The final stage in the rites of passage framework draws attention to reconnections, but reconnection is not inevitable. Reconnection is, however, an appropriate goal for the care sector when supporting frail or disabled older people through the transition into becoming a home-care recipient.