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Loneliness in care homes: A neglected area of research?
Abstract
Approximately 5% of older people, those aged 65 years and over, in developed countries live in care homes and these represent the frailest and most vulnerable members of this population group. Levels of morbidity, especially dementia and cognitive impairment, are high, making it challenging to conduct research with these population groups. Loneliness is a debilitating condition with important negative outcomes in terms of both quality of life and wider health outcomes. The prevalence of severe loneliness among older people living in care homes is at least double that of community-dwelling populations: 22-42% for the care population compared with 10% for the community population. However, the evidence-base for the care home group is tentative as it is based upon a very limited empirical base of only five studies. This review failed to identify compelling evidence for the effectiveness of interventions to remediate loneliness in care home populations.
... Often older adults are admitted to old age homes as they get security and medical attention over there (Victor, 2012). In some cases, they go to the old age homes on their own on the other hand they are been forced to move to the old age homes due to lack of social and emotional support (Sun et al., 2021). ...
... In some cases, they go to the old age homes on their own on the other hand they are been forced to move to the old age homes due to lack of social and emotional support (Sun et al., 2021). Older adults in old age homes may experience anxiety due to the separation from their family and friends, they may often get difficulty in adjusting with the rigid schedules (Victor, 2012;& Rinnan et al., 2018). For many of them emotional support and companionship is almost absent which makes them vulnerable to the feeling of not being loved. ...
... Loneliness can be exacerbated by a lack of health, social interaction, and involvement, and reduced by remembrance and anticipation (Chew, 2021). Loneliness is a burdensome affliction that has significant negative consequences for one's quality of life and health (Victor, 2012). In contrast to a study by (Drageset, Kirkevold, & Espehaug, 2011) the study suggests that emotions of The overarching theme was evaluated as loneliness being a risk factor for mental health issues and frailty progression among older adults' living in old age homes. ...
The goal of this study was to look at loneliness, frailty, and mental health difficulties in older adults living in old age
homes, as well as to examine if loneliness is a risk factor for frailty and mental health concerns in older adults. The
study used a qualitative research design and a semi-structured interview pattern. 10 older adults participated in the
study. According to the findings, the themes and subthemes showed that loneliness was identified as a risk factor for
the progression of frailty and mental health issues in older adults living in nursing homes. The Older adults also
displayed a sense of acceptance, which allowed them to continue living their lives. The lack of a belongingness
among the older adults was revealed to be a crucial aspect in the genesis of emptiness emotions. The analysis has
clinical relevance, and more acknowledgment is needed to improve the well-being in nursing facilities.
Keywords: loneliness, frailty, older adults, mental health, old age homes
... 2,3 In fact, the prevalence of severe loneliness among LTC residents is as high as 42%, compared with the 10% in community-dwelling older adults. 4 Feelings of depression are also a symptom of loneliness, often resulting from a lack of social support for LTC residents. 5 These feelings of loneliness and depression result in multiple health implications for LTC residents, including suicidal thoughts, anxiety, and decreased cognition. ...
... In line with the JBI critical appraisal checklist, studies will be excluded if they do not meet the quality threshold (ie, if they have negative responses to 7 of the 10 critical appraisal questions). Thus, studies will need to have a "yes" response on the JBI critical appraisal checklist for qualitative research for questions related to the research methodology, ethics, participant representation, and conclusion (ie, questions [2][3][4][5][8][9][10]. This will maintain methodological quality and ensure the inclusion of participants' voices in each study. ...
Objective:
The objective of this review is to describe the experience of loneliness and/or depression due to spousal separation when one or both spouses are admitted into a long-term care facility.
Introduction:
Loneliness and depression are important concerns for the health and well-being of older adults separated from their spouses due to long-term care placement. Social relationships, specifically spousal relationships, have a significant impact on the mental health of older adults. However, there is limited research on the experience or effect of spousal separation on long-term care residents' and their spouses' experience of loneliness and/or depression.
Inclusion criteria:
This review will include long-term care residents and their spouses who are over the age of 50 and have a spouse they are separated from due to long-term care placement. Studies will be included in this review if they explore the experiences of loneliness and/or depression due to spousal separation with one or both spouses living in a long-term care facility.
Methods:
This review will be conducted in line with the JBI methodology for systematic reviews of qualitative evidence. MEDLINE was used for the initial search. A full search strategy was then developed for MEDLINE, CINAHL, Embase, and PsycINFO. The JBI approach to study selection, critical appraisal, data extraction, data synthesis, and assessment of confidence will be used. Two reviewers will pilot test the screening criteria and data extraction protocol.
Systematic review registration number:
PROSPEROCRD42022333014.
... The Canadian Longitudinal Study on Aging (CLSA), which contains data from a sample of Canadians aged 45-85, indicates the prevalence of loneliness (10.2%) and social isolation (5.1%) within this population (Latham-Mintus et al., 2019). Victor's (2012) review of the prevalence of loneliness illustrates that the severity of loneliness (as measured by quantitative scores) in long term care homes is at least twice that of community-dwelling populations: 22-42% for the long-term care home population compared to 10% for the community population (Victor, 2012). A review article of 38 studies suggests that being female, nonmarried, older, having a poor income, a lower educational level, living alone, a low quality of social relationships, poor self-reported health, and functioning are all associated with loneliness in older adults (Cohen-Mansfield et al., 2015). ...
... The Canadian Longitudinal Study on Aging (CLSA), which contains data from a sample of Canadians aged 45-85, indicates the prevalence of loneliness (10.2%) and social isolation (5.1%) within this population (Latham-Mintus et al., 2019). Victor's (2012) review of the prevalence of loneliness illustrates that the severity of loneliness (as measured by quantitative scores) in long term care homes is at least twice that of community-dwelling populations: 22-42% for the long-term care home population compared to 10% for the community population (Victor, 2012). A review article of 38 studies suggests that being female, nonmarried, older, having a poor income, a lower educational level, living alone, a low quality of social relationships, poor self-reported health, and functioning are all associated with loneliness in older adults (Cohen-Mansfield et al., 2015). ...
Older adults are at a higher risk of loneliness, compared to other demographics. The use of Internet Communication and Technologies (ICTs) among older adults is steadily increasing and given ICTs provide a means of enhancing social connectedness suggests they may have positive effects on reducing loneliness. Therefore, the aim of this scoping review was to examine the research that explores how ICTs may be implicated in mitigating loneliness and increasing social connectedness among older adults. After the examination of 54 articles, we identified three major themes within the literature: (1) ICTs were associated with a reduction in loneliness and increase in wellbeing. (2) ICTs promoted social connectedness by facilitating conversations. (3) Factors such as training, self-efficacy, self-esteem, autonomy, and the design/features, or affordances, of ICTs contribute toward the associations between ICT use and wellbeing. The heterogeneity of methodologies, statistical reporting, the small sample sizes of interventional and observational studies, and the diversity of the experimental contexts underline the challenges of quantitative research in this field and highlights the necessity of tailoring ICT interventions to the needs and contexts of the older users.
... Notwithstanding the growing number of studies examining such a major public health problem among the older adult population, little is presently known about whether the latter is associated with cognitive functioning, behavioral and psychological symptoms -BPS-and the QoL of the more vulnerable elderly, such as people with dementia [32,33]. Despite difficulties in ascertaining whether people with cognitive impairment can accurately evaluate their loneliness [33][34][35], individuals with dementia report feeling lonelier than older adults without dementia [33][34][35][36][37]. ...
... The two groups did not differ in terms of overall loneliness or its emotional facet, but mildly-impaired people with dementia reported less social loneliness than moderately-impaired ones. Such findings suggest and confirm that people with dementia generally feel lonely [32,33] and that, as dementia progresses, older adults are more likely to experience a decline in social network [36]. They also seem to indicate that, regardless of illness stage, people with dementia more likely experience emotional loneliness, rather than the social one. ...
Background
Loneliness is a major health issue among older adults. The aim of this study was to assess the relationship between loneliness, in its social and emotional facets, and the cognitive (language), and behavioral/psychological functioning as well as quality of life (QoL) in people with mild and moderate dementia, i.e., considering dementia severity as an individual characteristic.
Methods
This cross-sectional study involved 58 people with mild dementia and 55 people with moderate dementia. Participants completed the Social and Emotional Loneliness scale, along with measures assessing their language skills, the frequency and severity of their behavioral and psychological symptoms, and their QoL.
Results
Socio-demographic characteristics and depression, but not loneliness or its social and emotional facets, contributed to explain participants’ behavioral and psychological symptoms, regardless of dementia severity. Loneliness explained, though to a small extent (8% of variance), language skills in people with moderate dementia, with social loneliness only accounting for language skills (18% of variance) in this group. Loneliness also modestly accounted for dysphoria symptoms in both the mildly and moderately impaired (6% and 5% of variance, respectively) individuals with social loneliness predicting dysphoric mood in the former group only (7% of variance). Loneliness also explained, to a larger extent, QoL in both the mildly impaired and moderately impaired individuals (27% and 20% of variance, respectively), its social facet predicting QoL in the mildly impaired (30% of variance), and its emotional facet in the moderately impaired (21% of variance) group.
Conclusion
These findings suggest that loneliness and its facets have a clear impact on perceived QoL, and influence the language skills and dysphoria symptoms of people with dementia, to a degree that depends on dementia severity. The assessment of loneliness and its facets in people with dementia considering dementia severity, and the promotion of social inclusion to reduce it should be considered by professionals.
... Rights reserved. [21,31]. One study examined the prevalence of loneliness in long-term care facilities in Finland from 2011 to 2017 and found that approximately 36% of the sample was lonely, with stable prevalence rates over time [21]. ...
... A study based in Norway reported even higher rates of loneliness (56%) in nursing home residents 65 years and older who did not have a cognitive impairment [20]. For individuals living in long-term care facilities, the rates of high loneliness (22-42%) were significantly greater than for individuals living independently (10%) [31,32]. Furthermore, older individuals with the highest levels of loneliness were more likely to be admitted to a nursing home within 4 years than those who were less lonely [33]. ...
Purpose of Review
This narrative review highlights important factors contributing to loneliness in older adults prior to and during the COVID-19 pandemic and effects on brain health.
Recent Findings
We characterize risk factors for loneliness in older adulthood and the impact of COVID-19. Furthermore, we discuss the implications of loneliness for older adults’ brain health.
Summary
Understanding the multifactorial causes of loneliness in different subpopulations of older adults both before and during the COVID-19 pandemic will provide insights for the development of interventions targeted to reduce loneliness in older adults based on their specific risk factors.
... 27. See Victor (2012). ...
Offers a comprehensive account of ethically-based guidelines in dementia care.
... A lack of meaningful activity leads to older adults' inactivity, resulting in mental and physical impairment, as well as an increased risk of mortality [5][6][7][8]. Furthermore, several studies show that older adults in nursing homes experience more loneliness compared to those living in the community, even though they are often surrounded by other residents and caregivers [9,10]. Addressing these issues requires innovative solutions [8,11,12]. ...
Background
Virtual reality (VR) group activities can act as interventions against inactivity and lack of meaningful activities in nursing homes. The acceptance of VR among older adults has been explored from different perspectives. However, research on the impact of older adults’ individual characteristics on the acceptance of VR group activities in nursing homes is necessary.
Objective
This study investigates the impact of individual characteristics (eg, psychosocial capacities) on VR acceptance among older adults in nursing homes, as well as this group’s perceptions of VR after participating in a VR intervention.
Methods
In this pre-post study conducted in nursing homes, we applied a VR group intervention with 113 older adult participants. These participants were categorized into two groups based on their naturalistic choice to join the intervention: a higher VR acceptance group (n=90) and a lower VR acceptance group (n=23). We compared the two groups with respect to their sociodemographic characteristics, psychosocial capacities, and attitudes toward new technologies. Additionally, we examined the participants’ perceptions of VR.
Results
The results show that those with lower acceptance of VR initially reported higher capacities in organizing daily activities and stronger interpersonal relationships compared to older adults with higher VR acceptance. The VR group activity might hold limited significance for the latter group, but it offers the chance to activate older adults with lower proactivity. Openness to new technology was associated with a favorable perception of VR. After the VR intervention, the acceptance of VR remained high.
Conclusions
This study investigates the acceptance of VR group events as meaningful activities for older adults in nursing homes under naturalistic conditions. The results indicate that the VR group intervention effectively addressed low proactivity and interpersonal relationship issues among older adults in nursing homes. Older adults should be encouraged to experience VR if the opportunity to participate is offered, potentially facilitated by caregivers or trusted individuals.
... Information about loneliness among residents in long-term care settings is scarce. It was found that the loneliness of older adults in LTC settings was generally two times higher than those living in the community (22-42% vs. 12%) [18,19]. A meta-analysis reported that 61% of the residents in long-term care (LTC) homes experienced moderate loneliness, while approximately 35% experienced severe loneliness [20]. ...
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.
... Health-related factors include chronic illness and communication di culties [40], as well as cognitive decline impairing the ability to recall recent conversations or appointments [41]. Environmental factors contributing to loneliness include a lack of friends, moving to a nursing home, the bereavement of a loved one, and excessive time spent alone, all of which increase feelings of isolation from others [42,43]. Lonely people are at high risk for reduced life satisfaction, depression, low self-esteem, negative emotions, and impaired functioning in activities of daily living, all of which can impair health and well-being [44,45]. ...
Background
Older adults often face loneliness due to chronic illness or loss of close ones, a situation worsened by COVID-19. Increased loneliness heightens the risk of diseases, especially dementia, necessitating urgent action. This study aims to assess the impact of a virtual reality (VR)-based open-air bath program on depression and loneliness in elderly individuals with Subjective Cognitive Decline/Mild Cognitive Impairment (SCD/MCI) attending our Dementia Medical Centre and evaluate the feasibility (participant recruitment and adherence) and measuring program enjoyment and satisfaction.
Methods
The study design is a crossover trial with a 1:1 ratio wherein 12 participants will be randomly assigned to Groups 1 and 2, with Group 2 serving as a waitlist control, and the VR program will be conducted six times (monthly). Group 1 will participate from the program's commencement and continue for 6 months, followed by an observation period from months 7 to 12. Group 2 will participate from months 7 to 12, with an observation period from months 1 to 6. Cognitive tests, psychiatric assessments, and the UCLA loneliness scale will be conducted before the study, at 6 months, and at 12 months. Results will be analyzed using repeated measures ANOVA. Head MRI and SPECT scans will be performed pre- and post-VR program to evaluate changes and effects on brain regions. Recruitment began in September 2023, and data collection is expected to be completed by March 2025. Complete study results will be published by September 2025.
Discussion
The study examines the preliminary effects of VR on loneliness in predementia seniors through open-air bath simulations. Virtual reality experiences could benefit this population, particularly those with limited outdoor activities. Quantifying VR's impact will aid in determining the size for a larger clinical trial. Qualitative results will inform participation mechanisms and guide the implementation and design of future trials.
Trial registration
: The protocol and informed consent were approved by the Ethical Review Board of Kyoto Prefectural University of Medicine on October 31, 2023 (ERB-C-2978). The study has been registered in the University Hospital Medical Information Network (UMIN) on November 1, 2023 (Trial Registration Number: 000052667).
... In Canada, older adults also report elevated rates of loneliness and social isolation [24]. Moving to LTCHs can increase older adults' likelihood of being lonely or socially isolated with reported rates of loneliness in older adults living in LTCHs varying from 22% to 75% [20,25,26]. ...
Background
The COVID-19 pandemic and resultant restrictions on social gatherings significantly impacted many peoples’ sense of social connectedness, defined as an individual’s subjective sense of having close relationships with others. Older adults living in long-term care homes (LTCHs) experienced extreme restrictions on social gatherings, which negatively impacted their physical and mental health as well as the health and well-being of their family caregivers. Their experiences highlighted the need to reconceptualize social connectedness. In particular, the pandemic highlighted the need to explore novel ways to attain fulfilling relationships with others in the absence of physical gatherings such as through the use of a hybridized system of web-based and in-person presence.
Objective
Given the potential benefits and challenges of web-based presence technology within LTCHs, the proposed research objectives are to (1) explore experiences regarding the use of web-based presence technology (WPT) in support of social connectedness between older adults in LTCHs and their family members, and (2) identify the contextual factors that must be addressed for successful WPT implementation within LTCHs.
Methods
This study will take place in south western Ontario, Canada, and be guided by a qualitative multimethod research design conducted in three stages: (1) qualitive description with in-depth qualitative interviews guided by the Technology Acceptance Model (TAM) and analyzed using content analysis; (2) qualitative description and document analysis methodologies, informed by content and thematic analysis methods; and (3) explicit between-methods triangulation of study findings from stages 1 and 2, interpretation of findings and development of a guiding framework for technology implementation within LTCHs. Using a purposeful, maximum variation sampling approach, stage 1 will involve recruiting approximately 45 participants comprising a range of older adults, family members (30 participants) and staff (15 participants) within several LTCH settings. In stage 2, theoretical sampling will be used to recruit key LTCH stakeholders (directors, administrators, and IT support). In stage 3, the findings from stages 1 and 2 will be triangulated and interpreted to develop a working framework for WPT usage within LTCHs.
Results
Data collection will begin in fall 2023. The findings emerging from this study will provide insights and understanding about how the factors, barriers, and facilitators to embedding and spreading WPT in LTCHs may benefit or negatively impact older adults in LTCHs, family caregivers, and staff and administrators of LTCHs.
Conclusions
The results of this research study will provide a greater understanding of potential approaches that could be used to successfully integrate WPTs in LTCHs. Additionally, benefits as well as challenges for older adults in LTCHs, family caregivers, and staff and administrators of LTCHs will be identified. These findings will help increase knowledge and understanding of how WPT may be used to support social connectedness between older adults in LTCHs and their family members.
International Registered Report Identifier (IRRID)
PRR1-10.2196/50137
... The opposite of loneliness is social connectedness, a subjective construct indicated by feelings of intimacy, caring and belonging (O'Rourke & Sidani, 2017). For decades, research has highlighted high rates of loneliness among older adults living in care homes (i.e., long-term care) (Victor, 2012), and with dementia (Alzheimer's Society, 2013). Yet, few interventions have been developed for use with people living with dementia in care homes (Hung et al., 2021;O'Rourke et al., 2018;Quan et al., 2019). ...
Objectives:
Social isolation and loneliness affect the quality of life of people living with dementia, yet few interventions have been developed for this population. The purpose of this study was to assess the feasibility and acceptability of 'Connecting Today', a remote visiting program designed for use with care home residents living with dementia.
Methods:
This was a feasibility study to assess whether Connecting Today can be delivered in care homes, and was acceptable to family and friends and people living with dementia. We used a single-group before/after design and included residents ≥ 65 years old with a dementia diagnosis from two care homes in Alberta, Canada. Connecting Today involved up to 60 min per week of facilitated remote visits for 6 weeks. To understand feasibility, we assessed rates and reasons for non-enrollment, withdrawal and missing data. We assessed acceptability with the Observed Emotion Rating Scale (residents) and a Treatment Perception and Preferences Questionnaire (family and friends). Data were analyzed with descriptive statistics.
Results:
Of 122 eligible residents, 19.7% (n = 24) enrolled (mean age = 87.9 years, 70.8% females). Three residents withdrew from the study before the first week of calls. Among 21 remaining residents, 62%-90% completed at least 1 call each week. All the calls were completed by videoconference, rather than by phone. Alertness and pleasure were observed for ≥92% of residents during calls. The 24 contacts rated Connecting Today as logical, effective and low risk.
Conclusions:
Facilitated, remote visits are feasible and highly acceptable to residents and their family and friend contacts. Connecting Today shows promise to address social isolation and loneliness for people living with moderate to severe dementia because it can promote positive engagement in meaningful interactions with their family and friends while they are living in a care home. Future studies will test effectiveness of Connecting Today in a large sample.
... Several studies have investigated the links between social support, participation and activities with health outcomes for older adults. Similar to the results in our study, residents' involvement in activities is found to foster social relationships, higher levels of connectedness and lower levels of loneliness (Drageset et al., 2011;Paque et al., 2018;Victor, 2012). ...
During the outbreak of the COVID-19 pandemic, Norwegian health authorities introduced social distancing measures in nursing homes. The aim was to protect vulnerable residents from contracting the potentially deadly infection. Drawing on individual interviews with nursing home managers and physicians, and focus groups with nursing staff, we explore and describe consequences the social distancing measures had on nursing home residents’ health and wellbeing. The analysis indicates that most residents became socially deprived, while some became calmer during the nursing home lockdown. Nursing home staff, physicians and managers witnessed that residents’ health and functional capacity declined when services to maintain health, such as physiotherapy, were put on hold. In conclusion, we argue that although Norwegian health authorities managed to keep the infection rates low in nursing homes, this came at a high price for the residents however, as the social distancing measures also negatively impacted their health and wellbeing.
... Even though self-rated loneliness slightly decreased during the first year after relocation to senior housing, almost 40% of the participants reported suffering from a certain extent of loneliness. This agrees with what has been reported in other studies (Victor, 2012;Jansson et al., 2021aJansson et al., , 2021b. Notably, previous research has revealed that some older adults may experience negative social relationships with co-residents, which can lead to a loss of privacy and unwanted social interactions (Jungers, 2010), while others may distrust or dislike the care provider (Wu & Rong, 2020). ...
... 28 Although empirical research into loneliness in LTC 'is remarkably slim,' the issue is gaining more recognition. 29 Considering social groups at risk of social deprivation, including those in LTC and other segregating institutions, Kimberley Brownlee has advocated for a human right against social deprivation, that is, 'a right to have minimally adequate access to decent human contact and connection'. 30 However, this article analyses how the CRPD specifically can contribute towards protecting the right to social participation in the particular niche of LTC. ...
The COVID-19 pandemic has drawn public attention to the long-standing issues of social isolation and loneliness of older persons living in residential long-term care (LTC) and has increased awareness of the importance of social participation. This article aims to contribute towards a shift in the understanding of how the United Nations Convention on the Rights of Persons with Disabilities (CRPD) may be applied in aged-care. It argues that the CRPD, in particular Article 19 (Living independently and being included in the community), has considerable potential to protect the right to social participation. It is also argued that changes in LTC settings and support may assist in protecting this right. Furthermore, the participation of older persons in this process and cultural change within LTC provider organizations and the general community is crucial. However, applying the Convention in the aged-care context raises challenges that require further consideration by human rights mechanisms.
... Insgesamt sind wir der Meinung, dass das Potenzial von AIBO, das Wohlbefinden zu steigern, vor allem in seiner Wirkung auf die von den Nutzer*innen wahrgenommene Einsamkeit liegt, die einige als Folge der sozial isolierenden Umgebung des Heims sehen, zumindest im Bereich von Pflegeheimen (Aung et al., 2017;Victor, 2012). AIBO kann zwar die zwischenmenschliche Kommunikation anregen, indem er als Gesprächsöffner fungiert, ein gemeinsames Thema schafft, als Sozialpartner fungiert und den Menschen eine positive Ablenkung und Gelegenheit zum Reden bietet, er kann jedoch keine echte persönliche Interaktion mit anderen Menschen außerhalb des Heims ersetzen. ...
In this chapter, the authors discuss the history and context of support services for people with disabilities in the European Union (EU) and the U.S., review approaches to evaluation and measurement of the impact of services of peoples’ experiences and outcomes, and make recommendations in the field for both federations. Evaluation of services and outcomes for people with disabilities in the EU and in the U.S. are framed by the historical context, values, policies and approaches which have been shaping services for people with disabilities in the EU and in the U.S. over the last more than a half of century. The authors identify similarities and differences in policy, practice and research around quality services and formulate lessons that the EU and the U.S. learn from each other. Collaborations between the member states to learn from each other’s strengths and challenges in evaluating services, working with individuals with disabilities at a local level, and learning from their life course trajectory by collecting different types of data is regarded as an important element for operationalization of the objective indicators and definitions of what good (and poor) services would look like.
... The pandemic has also highlighted certain pre-existing problems in the older institutionalised population, such as loneliness [52][53][54]. In many cases, the compulsory physical and social distancing led to situations of total isolation [17,33,55,56], with the consequences that this entails both for physical health [57], including mortality [58], and for psychosocial capacities [59]. ...
Nursing homes for the elderly in Spain have experienced high rates of infection and mortality from COVID-19, although rates have varied from one region to another. Madrid is the region where most institutionalized older adults have died from the coronavirus. However, there is little known about the psychosocial and environmental factors involved in the high incidence of COVID-19 among the institutionalised population in this region. This article describes the protocol of a study on nursing homes during the SARS-CoV-2 pandemic in the Autonomous Community of Madrid (hereafter: Region of Madrid or Madrid Region) and provides information on the study design, measures used, and characteristics of the population studied. A questionnaire about life in nursing homes during the COVID-19 pandemic was designed and a total of 447 persons over 60 years of age without cognitive impairment—220 in private nursing homes and 227 in public nursing homes—participated by answering questions about different topics: personal situations during the pandemic, feelings and methods of coping, residential environment, health, quality of life, ageism, and self-perception of ageing. The institutionalised person profile discussed in this study was an old woman, widowed, without children, with a low level of education, with multimorbidity, and who perceived her health and quality of life positively. Most of the participants were very concerned about COVID-19 and its effects. In fact, 38% had been diagnosed with COVID-19, of whom 20% were admitted to hospital and 20% had suffered negative impacts, such as pain and neurological problems. In addition, 70% of the residents remained confined to their rooms, which increased their perceptions of loneliness and social isolation. The worst-rated aspects of the nursing home resulted from the restrictive measures imposed on nursing homes during the pandemic. This research offers useful material for understanding the pandemic and its consequences from the perspective of the older institutionalised population, which could provide insights for designing public policies.
... As is clear in the cases of Teresa, Mario and Grazyna, communication technology solutions for maintaining social interactions are crucial for those who are geographically distanced from family, community or language groups. Moving to residential aged care, especially for those born overseas, further limits social connectivity and the ability to maintain meaningful relationships, which is linked to poor physical and mental health outcomes (Bath & Deeg, 2005;Gerst-Emerson & Jayawardhana, 2015;Santini et al., 2020;Victor, 2012). Service providers, particularly in residential care, struggle to meet the social support needs of older adults and research shows that residents in care facilities tend to be lonelier than community-dwelling older people, even though they are surrounded by other residents and carers (Brownie & Horstmanshof, 2011;Royal Commission into Aged Care Quality and Safety, 2019;Pinquart & Sorensen, 2001). ...
A large influx of refugees in several European countries has created challenges at all levels of society, starting with the actors in charge of their integration. During this crisis, social media platforms seem to have played a major role in the refugees’ journey and inclusion in their host countries. Based on in-depth interviews with 28 Syrian refugees who settled in Belgium after 2015, this chapter looks at the ways they use social media in the hope of integrating in the host country and overcoming cultural challenges. Social media use has helped them alleviate their social isolation, access information in their native language, and find out about the rights and responsibilities of citizenship in their new country.
... 100 The deaths of loved ones and friends with associated declines in social interactions and displacement to group homes result in lower life satisfaction, self-esteem, and sensations of belonging. 101 These changes can be especially challenging for older adults when other capacities such as cognition and function are diminished. ...
Older adults with cardiovascular disease (CVD) contend with deficits across multiple domains of health due to age-related physiological changes and the impact of CVD. Multimorbidity, polypharmacy, cognitive changes, and diminished functional capacity, along with changes in the social environment, result in complexity that makes provision of CVD care to older adults challenging. In this review, we first describe the history of geriatric cardiology, an orientation that acknowledges the unique needs of older adults with CVD. Then, we introduce 5 essential principles for meeting the needs of older adults with CVD: 1) recognize and consider the potential impact of multicomplexity; 2) evaluate and integrate constructs of cognition into decision-making; 3) evaluate and integrate physical function into decision-making; 4) incorporate social environmental factors into management decisions; and 5) elicit patient priorities and health goals and align with care plan. Finally, we review future steps to maximize care provision to this growing population.
... Brownie et al. (2014) and Prieto-Flores et al. (2011) reported that the transition from home to residential care led to increased loneliness in older adults due to a loss of identity, independence and autonomy. It is also reasonable to suppose that the risk of loneliness is higher among older adults in residential care than those in the community due to multiple losses and disrupted meaningful engagement with friends, family and the community (Smith, 2012;Victor, 2012). ...
OBJECTIVE: Older adults may experience loneliness and boredom in residential care. The purpose of this study is to extend understanding of the experiences of older adults in residential care and identify factors that residents themselves believe contribute to loneliness and boredom. In addition, I aim to identify the strategies used to cope with these experiences and provide recommendations to enhance the quality of life in residential care.
METHODS: A phenomenological qualitative study was conducted through participant observation, in-depth interviews with 24 residents and key informant interviews with 10 staff members.
RESULTS: The findings emphasise the pervasiveness of loneliness and boredom in residential care despite facilities’ efforts to provide activities and support. Staff and family support helped to alleviate loneliness and boredom and participants employed individual coping strategies.
DISCUSSION: Health professionals and social workers should recognise loneliness and boredom as issues and prioritise residents’ individual needs and preferences to minimise the risk of loneliness and boredom.
KEYWORDS: Boredom; loneliness; older adults; phenomenology; residential care
... Furthermore, most of the persons socialise only with primary contacts (Level 6 of social integration limitations SI). Indeed, the prevalence of the isolated elderly individuals living in nursing homes is at least twice as high as that of the community-dwelling population (Victor, 2012). ...
The financing of long-term care and the planning of care capacity are of increasing interest due to demographic changes and the ageing population in many countries. Since many care-intensive conditions begin to manifest at higher ages, a better understanding and assessment of the expected costs, required infrastructure, and number of qualified personnel are essential. To evaluate the overall burden of institutional care, we derive a model based on the duration of stay in dependence and the intensity of help provided to elderly individuals. This article aims to model both aspects using novel longitudinal data from nursing homes in the canton of Geneva in Switzerland. Our data contain comprehensive health and care information, including medical diagnoses, levels of dependence, and physical and psychological impairments on 21,758 individuals. We build an accelerated failure time model to study the influence of selected factors on the duration of care and a beta regression model to describe the intensity of care. We show that apart from age and gender, the duration of stay before death is mainly affected by the underlying diseases and the number of different diagnoses. Simultaneously, care intensity is driven by the individual level of dependence and specific limitations. Using both evaluations, we approximate the overall care severity for individual profiles. Our study sheds light on the relevant medical, physical, and psychological health indicators that need to be accounted for, not only by care providers but also by policy-makers and insurers.
... Loneliness in LTC has been identified as a particularly acute problem; the prevalence of 'severe loneliness' reported by care home residents (22-42%) is more than twice that of older people in the wider community (10%) (Victor, 2012). Furthermore, a 2011 survey study suggests that institutionalized older adults are more likely to feel lonely due to reduced social opportunities compared to older adults living in the community (Prieto-Flores et al., 2011). ...
Context: Despite being widely used with older adults in the community, there is limited literature on using the de Jong Gierveld Loneliness Scale with older adults living in long-term care (LTC).Objective: The purpose of this article is to discuss the considerations of using this scale with older adults in LTC.Method: Our team consisted of older person and family partners, a clinician, and academic researchers working together in all stages of research using the Loneliness scale to conduct individual interviews with 20 older adults in LTC in Vancouver, Canada, as part of a study exploring the experience of loneliness during the COVID-19 pandemic. Team reflection was embedded in the research process, with reflection data consisting of data transcripts, field notes, and regular team meeting notes. Thematic analysis was employed to identify lessons learned and implications.Findings: Participants had various challenges responding to the scale. Our analysis identified five themes: a) diverse meanings of loneliness, b) multi-faceted factors of loneliness, c) technical challenges, d) social desirability, and e) situational experience. We also offer five recommendations to consider when using this scale with older adults in LTC.Limitations: We used this scale with a small sample of older adults in LTC, which is a more time and labour-intensive population. Data on marital status and educational background was not collected but might help in understanding considerations for using the scale with older adults in LTC.Implications: We offer practical recommendations for using the scale with older adults in LTC, especially how qualitative open-ended questions can complement the scale by providing useful insights into context and complex experiences.
... However, once older persons start residing in long-term care facilities, feelings of social isolation and loneliness are compounded due to the loss of lifelong social environments and related memories. In the pre-pandemic context, the prevalence of loneliness among older persons in residential care settings was found to be at least double that of community-dwelling populations, ranging from 22% to 42%, and sometimes even reaching 50%, compared with 10% for older persons dwelling in the community (Victor 2012). More recently, a study used the UCLA loneliness scale in Malaysian nursing homes and found that most residents felt lonely, 25% moderately and 75% severely (Aung et al. 2020). ...
Research conducted during the course of the COVID-19 pandemic
has showcased an increase in the levels of loneliness and social isolation
in later life. Lockdown and social distance measures certainly put
many things to rest and battered many a socio-economic realm. However,
their most devastating impact was certainly on older persons.
COVID-19 brought a ‘social connectivity paradox’ as a common set
of actions simultaneously protected and harmed older adults. While
on one hand as the level of an older adult’s physical interactions with
others increases, it can protect against social isolation and disconnectedness,
although it can increase the risk of COVID-19 exposure,
on the other hand as the level of an older adult’s physical interactions
with others decreases, it can increase risk for social isolation and disconnectedness,
although it can protect against risk of COVID-19 exposure.
Some groups of older persons are affected more negatively
than others. Two such groups include persons living with dementia
and residents in care homes. The online and virtual world was hailed
as a key ‘saving grace’ to mitigate against the perils of social isolation
and loneliness. Nevertheless, all is not well in that interface between
information and communication technology and later life due to the
age-based digital divide. Rather than seeking to mitigate against the
increasing levels of social isolation and loneliness of older persons as
the result of the pandemic by augmenting the range of online and virtual
services, the most crucial step is to address the barriers and obstacles
that they face in taking up and using technology.
... It is also beneficial for residents, helping them find conversational points that can ease them into social connections with others, helping counteract feelings of isolation and loneliness, which are a problem in care homes. 44 As Anne shared, "Having dementia makes you withdraw, in how you relate to other people, but when someone invites you to a conversation, you get an opportunity to reach out and engage in a dialogue that matters." ...
Reminiscence therapy is beneficial for improving the quality of life for older adults living with dementia. However, it is difficult for caregivers in care homes to make this part of their daily practice because remembering a resident’s individual stories is difficult. Proximity-aware technologies can make rapid connections between residents, their histories, and nearby artefacts. Through a user-centred iterative design approach, we designed Memento, a prototype technology system that makes it easy and convenient for caregivers to connect residents with real stories from their past and engage them in meaningful conversations. Memento displays connections between a resident’s stories and their surroundings on a caregiver smartphone. Caregivers can then subtly use this information to start spontaneous reminiscences with residents, as they go about their everyday activities. Remembering their histories was highly enjoyable for residents, giving them a renewed sense of self-confidence and well-being.
... Similarly, the prevalence of loneliness in care homes is also high, affecting well over half of people living in these settings (Nyqvist, Cattan, Conradsson, Näsman, & Gustafsson, 2017). For example, in Europe the reported rates range from 37 to 56 per cent (Victor, 2012), and in some studies these rates range from 56 to 95.5 per cent (Elias, 2018). Loneliness has a negative impact on health and is linked to depression, heart disease, dementia, decreased physical function, and increased mortality (Donovan & Blazer, 2020). ...
Social isolation and loneliness in long-term care settings are a growing concern. Drawing on concepts of social citizenship, we developed a peer mentoring program in which resident mentors and volunteers formed a team, met weekly for training, and paired up to visit isolated residents. In this article, we explore the experiences of the resident mentors. As part of a larger mixed-methods study conducted in 10 sites in Canada, we interviewed mentors ( n = 48) and analysed data using inductive thematic analysis. We identified three inter-related themes: Helping others, helping ourselves described the personal benefits experienced through adopting a helping role; Building a bigger social world encapsulated new connections with those visited, and; Facing challenges, learning together described how mentors dealt with challenges as a team. Our findings suggest that a structured approach to mentoring benefits residents and helps them feel confident taking on a role supporting their isolated peers.
... This pandemic shed even more light on the insidious cycle of depression and loneliness among nursing home residents. The prevalence of severe loneliness among older people living in care homes is at least double that of community-dwelling populations 1 . Compared to depression overall in older adults, depression in nursing home residents is even more prevalent 2 . ...
... These findings are interesting, because we know that up to 42% of residents, regardless of COVID-19, feel lonely (Victor, 2012). ...
The objective of this study was to assess burdens placed on and consequences of the COVID‐19 pandemic on nursing home staff.
Design
We conducted a qualitative descriptive interview study.
Methods
We interviewed 18 nurses, nursing aides and care aides from five different nursing homes by using a semi‐structured interview guideline between June and September 2020. Data were analysed with a qualitative content analysis method by combining an inductive and deductive coding frame.
Results
Results show that the qualitative work load and work organization were major concerns. Regarding the qualitative work load, participants stated that they were required to perform additional tasks to care for residents, because the pandemic interventions placed the residents under stress and dealing with relatives presented significant challenges. Nursing home staff reported that psychological consequences such as uncertainty, fear and stress represented major effects of the COVID‐19 situation.
Conclusion
We could show that qualitative workloads were assessed and perceived differently. Most nursing home care staff members experienced the changes in working conditions as both physically and psychologically challenging.
Impact
We highly recommend that nursing home staff receive support in such pandemics by being allowed, for example personal protective equipment breaks. Individually tailored programs need to be established to enhance wellbeing and decrease psychological stress and fear in such challenging times.
... Before COVID-19, the prevalence of severe loneliness among older persons in LTC was already twice that of community-dwelling populations (22%-42% versus 10%) (Victor, 2012), and the situation was only made worse by the pandemic (Dichter et al., 2020). However, caution should be exercised as discrepancies exist about the extent of the increase in perceived loneliness. ...
COVID-19 pandemic has raised serious concerns about the mental well-being of the older residents of long-term care facilities. The authors discuss the developing mental health crisis in this population, focusing on the major psychiatric manifestations of the COVID-19 and their underlying pathophysiology. Despite early reports of resilience among older persons against the impact of chronic lockdown, current literature suggests an overall negative impact on the mental health in this population.
... It is associated with adverse health outcomes (Drageset et al., 2013;Jansson et al., 2017) and poor satisfaction with care (Kajonius and Kazemi, 2016). Recent studies have explored older people's experiences of loneliness in LTCF (Victor, 2012;Paque et al., 2018;Barbosa Neves et al., 2019;Jansson et al., 2021a) and how to alleviate them (Quan et al., 2020). ...
Loneliness has proved to be common in long-term care facilities (LTCF) and is associated with adverse health outcomes. Although older residents have expressed their experiences of loneliness in previous studies in various ways, researchers have rarely distinguished or explored the three dimensions of loneliness: social, emotional and existential. Furthermore, descriptions of existential loneliness in LTCF is still a neglected area of research. The aim of this study was to explore how the experiences of loneliness of older people in LTCF are manifested and divided into these dimensions. We used an ethnographic multi-method approach. The analysis leaned on abductive reasoning. In terms of social loneliness, the respondents missed company and lacked peer support, but also felt lonely in a crowd. Emotional loneliness felt miserable and could not be shared with anyone. It was related to a feeling of meaninglessness of life and a lack of meaningful others. Existential loneliness was characterised by waiting and a feeling of emptiness. It reflected the fundamental issues of humanity. The present study is one of the first to explore the dimensions of the experiences of loneliness among frail and cognitively impaired older people in LTCF. According to the voices of the lonely respondents, loneliness has many social, emotional and existential aspects. These features of loneliness should be recognised in studies, care practices and interventions.
... There are negatively worded items, in which the neutral and positive responses (plus or minus and yes) and the "no" response with 0; and in the positively worded items, the neutral and negative responses (plus or minus and no) are scored with 1 and the yes response with a 0. This gives a total score range of 0 to 6, which can be interpreted from the lowest to the highest levels as "less alone or more alone". However, in the present study, to define the presence of loneliness levels, scores between 0 and 2 were considered normal, and scores above 2 were considered as a cut-off point, in line with authors of previous studies on older adults living in NHs (29)(30)(31). ...
1) Background: Loneliness, little studied in Nursing Homes (NHs), can affect physical and mental health. We aimed to verify the prevalence of loneliness in 5 NHs and its associated factors. (2) Methods: Cross-sectional study. Older adults aged 65 or over with preserved cognitive status were included. The De Jong Gierveld Loneliness Scale was used to assess overall, social, and emotional loneliness; sociodemographic and health-related variables were collected. The chi-square (or Fisher's) test and logistic regression were used for bivariate and multivariate analysis respectively. (3) Results: The final sample consisted of 65 participants (81.5% female) with a mean age of 84±7.13. Prevalence of overall loneliness was 70.7% (95%CI:58.2-81.4), social loneliness 44.6% (95% CI: 33.1-56.6) and emotional loneliness 46.2% (95% CI: 34.5-58.1). Overall loneliness was associated with lower perceived quality of life (Odds Ratio-OR= 5.52, 95% CI:1.25-24.38) and NH with state subsidized places (OR=0.19, 95% CI: 0.05-0.74); social loneliness with having 0-1 children (OR=0.25, 95% CI: 0.08-0.77), and emotional loneliness with depression (OR=4.54, 95% CI: 1.28-16.08) and uri-nary incontinence (UI) (OR=4.65, 95% CI: 1.23-17.52). (4) Conclusions: Loneliness was present in almost 71% of residents and was associated with the type of NH and poorer quality of life, emotional loneliness with depression and UI and social loneliness with having less than 2 children.
Background
Older adults often face loneliness due to chronic illness or loss of close ones, a situation worsened by the COVID-19 pandemic. Increased loneliness heightens the risk of diseases, especially dementia, necessitating urgent action.
Objective
This study aims to assess the impact of a virtual reality (VR)–based open-air bath program on depression and loneliness in older individuals with subjective cognitive decline/mild cognitive impairment attending the Dementia Medical Center in Kyoto, Japan. We further aim to evaluate the feasibility of the program (participant recruitment and adherence) and to measure program enjoyment and satisfaction.
Methods
The study design is a crossover trial with a 1:1 ratio, wherein 12 participants will be randomly assigned to groups 1 and 2, with group 2 serving as a waitlist control and group 1 receiving the VR program from the onset for 6 months; the VR program will be conducted 6 times (monthly). Program completion for group 1 will be followed by an observation period from months 7 to 12. Group 2 will participate in the VR program from months 7 to 12, with an observation period from months 1 to 6. Cognitive tests, psychiatric assessments, and the University of California, Los Angeles Loneliness Scale will be conducted before the study, at 6 months, and at 12 months. Results will be analyzed using repeated-measures ANOVA. Head magnetic resonance imaging and single-photon emission computed tomography scans will be performed before and after the VR program to evaluate changes and effects on brain regions.
Results
Recruitment began in September 2023 and data collection is expected to be completed by March 2025. Complete study results will be published by September 2025.
Conclusions
This study examines the preliminary effects of VR on loneliness in older adults with predementia through open-air bath simulations. VR experiences could benefit this population, particularly those with limited outdoor activities. Quantifying VR’s impact will aid in determining the size for a larger clinical trial. Qualitative results will inform participation mechanisms and guide the implementation and design of future trials.
Trial Registration
University hospital Medical Information Network UMIN000052667; https://tinyurl.com/3yaccay5
International Registered Report Identifier (IRRID)
DERR1-10.2196/57101
According to the UK Government, people with a disability or long-term health condition are more likely to experience chronic loneliness than the general population. However, government figures do not disaggregate data on loneliness among different types of health conditions or disabilities, and it remains unclear how this affects people with visual impairment (VI). This review examines experiences of loneliness and isolation among people with VI. Six databases (CINAHL, PubMed, Scopus, Sage, APA Psycharticles, and Psychology and Behavioural Sciences Collection) were searched using a Population, Interest and Outcome (PIO) framework, yielding a total of 2476 articles. A total of 29 articles were selected and appraised for quality using JBI appraisal tools. These articles represented studies from 14 countries. Relevant Government and voluntary sector organisation websites were also considered. Findings showed widespread experiences of isolation and exclusion among people with VI, but subjective experiences of loneliness did not necessarily align with this. Further research is needed to gain a better understanding of the relationship between VI and loneliness and experiences of loneliness for people with VI within both LGBTQ+ communities and within Black, Asian, and Ethnically Minoritised communities, where research remains notably scant. Studies about the impact of the COVID-19 pandemic showed its heightened effect on isolation and loneliness among the VI community. Further research is needed to understand the long-term effects of this. While technology holds promise in mitigating loneliness and isolation among individuals with VI, accessibility issues persist. Future research is needed to understand how technology-based interventions might address loneliness and isolation for individuals with VI and the accessibility barriers associated with the implementation of these. For loneliness and isolation to be minimised, recognising the diversity within the VI population is imperative for tailoring interventions and initiatives effectively.
Objective
The objectives of this review were to determine the effectiveness of socially assistive technologies for improving depression, loneliness, and social interaction among residents of long-term care (LTC) homes, and to explore the experiences of residents of LTC homes with socially assistive technologies.
Introduction
Globally, the number of older adults (≥ 65 years) and the demand for LTC services are expected to increase over the next 30 years. Individuals within this population are at increased risk of experiencing depression, loneliness, and social isolation. The exploration of the extent to which socially assistive technologies may aid in improving loneliness and depression while supporting social interactions is essential to supporting a sustainable LTC sector.
Inclusion criteria
This mixed methods systematic review included studies on the experiences of older adults in LTC homes using socially assistive technologies, as well as studies on the effectiveness of these technologies for improving depression, loneliness, and social interaction. Older adults were defined as people 65 years of age and older. We considered studies examining socially assistive technologies, such as computers, smart phones, tablets, and associated applications.
Methods
A JBI mixed methods convergent, segregated approach was used. CINAHL (EBSCOhost), MEDLINE (Ovid), Embase, APA PsycINFO (EBSCOhost), and Scopus databases were searched on January 18, 2022, to identify published studies. The search for unpublished studies and gray literature included ProQuest Dissertations and Theses Global, Open Access Theses and Dissertations, Google, and the websites of professional organizations associated with LTC. No language or geographical restrictions were placed on the search. Titles, abstracts, and full texts of included studies were screened by 2 reviewers independently. Included studies underwent quality appraisal and data extraction. Quantitative and qualitative data findings were analyzed separately and then integrated. Where possible, quantitative data were synthesized using comparative meta-analyses with a fixed-effects model.
Results
From 12,536 records identified through the search, 14 studies were included. Quantitative (n = 8), mixed methods (n = 3), and qualitative (n = 3) approaches were used in the included studies, with half (n = 7) using quasi-experimental designs. All studies received moderate to high-quality appraisal scores. Comparative meta-analyses for depression and loneliness scores did not find any significant differences, and narrative findings were mixed. Qualitative meta-aggregation identified 1 synthesized finding (Matching technology functionality to user for enhanced well-being) derived from 2 categories (Enhanced sense of well-being, and Mismatch between technology and resident ability).
Conclusions
Residents’ experiences with socially assistive technologies, such as videoconferencing, encourage a sense of well-being, although quantitative findings related to depression and loneliness reported mixed impact. Residents experienced physical and cognitive challenges in learning to use the technology and required assistance. Future work should consider the unique needs of older adults and LTC home residents in the design and use of socially assistive technologies.
Review registration
PROSPERO CRD42021279015
Objectives:
Good social connection is associated with better physical and mental health but care home residents experience barriers to social connection. Activities present a potential avenue for improving social connection in care homes but residents often experience loneliness despite access to activity programmes. We therefore aimed to identify what aspects of activities facilitate social connection in care home residents.
Method:
Qualitative study using semi-structured interviews that were analysed using Thematic Analysis. A purposive sample of 35 participants, including 12 residents, 10 family caregivers, nine care home staff and four clinicians, recruited from UK care homes.
Results:
We found four main themes describing features of activities important for facilitating social connection: (1) personalisation with respect to residents' interests, social preferences, and cognitive ability; (2) activities which foster a sense of community; (3) finding and emphasising things in common that residents share; and (4) facilitating a sense of involvement with others.
Conclusion:
We identified the key aspects of activities which facilitate social connection in care homes. These findings can be applied to a range of existing and newly designed activities in care homes and inform the development and testing of psychosocial interventions aiming to improve social connection.
Objective
The objective of this review was to describe the experiences of loneliness and/or depression for residents and their spouses who are separated by long-term care placement.
Introduction
Loneliness and depression have a pernicious influence on the overall health and well-being of older adults. Older adults’ mental health is significantly affected by social relationships, including those between spouses. However, research pertaining to the experience or effect of spousal separation on long-term care residents and community-dwelling spouses’ feelings of loneliness and/or depression is limited.
Inclusion criteria
This systematic review included studies that recruited community-dwelling spouses and long-term care residents over 50 years of age with living spouses from whom they are separated due to long-term care placement. Studies on the experiences of loneliness and/or depression due to spousal separation with one or both spouses living in long-term care were included in this review.
Methods
Ovid MEDLINE(R) was used for the initial search. A full search strategy was developed for Ovid MEDLINE(R), CINAHL (EBSCOhost), Embase (Ovid), and PsycINFO (Ovid). The review was conducted using the JBI approach, with 2 independent reviewers performing study selection, critical appraisal, data extraction, assessment of confidence, and data synthesis.
Results
Eleven papers were included in this systematic review. Four synthesized findings were extracted from 10 categories and 42 findings: i) Loneliness and depression result from a lack of physical and social connection for separated long-term care residents and community-dwelling spouses; ii) Community-dwelling spouses feel unprepared and upset with spousal separation due to a lack of psychological support; iii) Behavioral strategies can prevent community-dwelling spouses and long-term care residents from developing loneliness and/or depression; and 4) Community-dwelling spouses have differing abilities to adapt and cope with feelings of loneliness and/or depression.
Conclusion
This review provides a comprehensive synthesis of the feelings of loneliness and/or depression spouses who are separated due to long-term care admission experience. This review has demonstrated that there is a lack of literature inclusive of the voices and perspectives of all spouses affected by spousal separation in long-term care. The limitations of this review include the small number of included studies and the range of quality of included studies. Recommendations include additional research on the lived experience of spousal separation from the perspectives of long-term care residents and their community-dwelling spouses. Further, additional psychological support is needed for separated spouses guided by the suggestions and experiences of long-term care residents and their community-dwelling spouses.
Review registration
PROSPERO CRD42022333014
Background
In addition to illness, inactivity is a risk factor for high mortality in nursing homes. Using innovative technology, such as virtual reality (VR), for meaningful group activities could provide new opportunities for solving this problem. VR interventions have already been approved as a promising method for enhancing the health of older adults.
Objective
In this study, we examined whether VR-based group activities can have a positive impact on activity level and group interaction among older adults living in nursing homes.
Methods
We conducted a longitudinal study and provided VR interventions as a group activity once a week for 4 consecutive weeks in nursing homes. Participants were recruited based on the experience of the nursing staff members and the natural decisions of the older adults. Within a virtual cottage, designed according to the needs of the target group, older adults were able to perform daily tasks that they were no longer able to do in real life, such as gardening and making pizza. Overall, 2 psychologists measured the psychosocial capacities, activities of daily life, and well-being before and after the interventions using standardized instruments.
Results
The results focus on a total of 84 older adults from 14 nursing homes who completed at least 3 VR interventions. The results indicate that several psychosocial capacities among the older adults improved, including adherence to regulations (P<.001; η²=0.122), flexibility (P<.001; η²=0.109), and group integration (P<.001; η²=0.141). Problems related to competence also showed a slight decrease (P=.04; η²=0.039). In addition, the VR intervention promoted their proactivity (P<.001; η²=0.104) and mobility (P=.04; η²=0.039). During the VR group intervention, older adults’ well-being could be maintained at a high level. The results highlight the beneficial effects of VR intervention as a meaningful activity in nursing homes, showcasing the potential of VR applications in this setting.
Conclusions
This study provides a novel and naturalistic perspective, offering new insights into the use of VR in nursing homes. The VR intervention was well accepted and fulfilled the aim of enhancing capacity and well-being. It could be a meaningful group activity in nursing homes to improve social group interaction. To provide stronger evidence, randomized controlled trials are necessary.
Background
There is growing interest in understanding the care needs of lonely people but studies are limited and examine healthcare settings separately. We estimated and compared healthcare trajectories in lonely and not lonely older female and male respondents to a national health survey.
Methods
We conducted a retrospective cohort study of community‐dwelling, Ontario respondents (65+ years) to the 2008/2009 Canadian Community Health Survey—Healthy Aging. Respondents were classified at baseline as not lonely, moderately lonely, or severely lonely using the Three‐Item Loneliness Scale and then linked with health administrative data to assess healthcare transitions over a 12 ‐year observation period. Annual risks of moving from the community to inpatient, long‐stay home care, long‐term care settings—and death—were estimated across loneliness levels using sex‐stratified multistate models.
Results
Of 2684 respondents (58.8% female sex; mean age 77 years [standard deviation: 8]), 635 (23.7%) experienced moderate loneliness and 420 (15.6%) severe loneliness. Fewer lonely respondents remained in the community with no transitions (not lonely, 20.3%; moderately lonely, 17.5%; and severely lonely, 12.6%). Annual transition risks from the community to home care and long‐term care were higher in female respondents and increased with loneliness severity for both sexes (e.g., 2‐year home care risk: 6.1% [95% CI 5.5–6.6], 8.4% [95% CI 7.4–9.5] and 9.4% [95% CI 8.2–10.9] in female respondents, and 3.5% [95% CI 3.1–3.9], 5.0% [95% CI 4.0–6.0], and 5.4% [95% CI 4.0–6.8] in male respondents; 5‐year long‐term care risk: 9.2% [95% CI 8.0–10.8], 11.1% [95% CI 9.3–13.6] and 12.2% [95% CI 9.9–15.3] [female], and 5.3% [95% CI 4.2–6.7], 9.1% [95% CI 6.8–12.5], and 10.9% [95% CI 7.9–16.3] [male]).
Conclusions
Lonely older female and male respondents were more likely to need home care and long‐term care, with severely lonely female respondents having the highest probability of moving to these settings.
The COVID-19 pandemic hit long-term care (LTC) facilities hard, and leaders relied on ingenuity and creative problem solving to support operations and resident care. The objective of this study was to identify innovative ideas within LTC, accelerated by the pandemic, that may continue to improve operations and resident care moving forward. Nursing home administrators and directors of nursing, food/nutrition, social services, and therapeutic recreation at 40 skilled nursing facilities were asked about beneficial, novel ideas that emerged throughout the pandemic that they believe should continue going forward. A qualitative analysis yielded 10 categories of innovative ideas (infection control, resident care, family communication, resident engagement and satisfaction, staff communication and education, sprit of the team, operations, staffing, employee wellness, and public relations). These novel ideas can be employed to improve both operations and resident care, benefiting providers, staff, residents, and families.
Background:
Older people in the nursing home environment are much less mobile and capable of taking care of themselves as they age, and most of them face the plight of loneliness, which seriously affects the quality of life of older people in their later years.
Aims:
A systematic review and synthesis of older people's experiences of loneliness in nursing homes.
Design:
Following ENTREQ, do a systematic evaluation and synthesis of qualitative investigations.
Methods:
A search of PubMed, Cochrane Library, Web of Science, Embase, the Chinese biomedical literature service system, the China National Knowledge Infrastructure, the Wanfang Database and the Wipu Database for qualitative studies of older people's experiences of loneliness in nursing homes was conducted with a search time frame of March 2023. Evaluation of the quality of the literature using the Joanna Briggs Institute's Australian Centre for Evidence-Based Health Care Quality Assessment Criteria for Qualitative Research, And the data were synthesised using Thomas and Harden's method of thematic and content analysis.
Results:
A total of 13 papers were included, and 36 research findings were distilled and integrated into three themes: causes of loneliness; feelings of loneliness; coping with loneliness; and seven sub-themes: aging and loss; environmental transformation; loneliness is a pain; loneliness is a choice; participation; strengthening social ties; and diverting attention.
Conclusions:
Older people in nursing homes face varying degrees of loneliness, which is a subjective feeling influenced by the interplay between personal awareness and the external environment, so future care interventions should be developed in a comprehensive manner, taking into account the characteristics of the older people themselves and their external environment.
No patient or public contribution:
This study is a meta-synthesis and does not require relevant contributions from patients or the public.
This mixed-methods complementarity study explored family members', friends', and health care providers' perspectives of acceptability of group leisure activities as an intervention for loneliness experienced by older adults living with dementia. A sample of 25 family members, friends, and health care providers of people living with dementia in ON rated the acceptability of group leisure activities (adapted Treatment Perception and Preference questionnaire) and discussed their ratings in an interview. Quantitative (descriptive statistics) and qualitative (conventional content analysis) results were integrated to understand acceptability. Participants viewed group leisure activities as effective, logical, and suitable for use with people living with dementia. Participants described the need for flexible programs, careful facilitation, and attention to activity selection. Group leisure activities were seen as low risk, but stigmas related to dementia could prevent participation. The findings inform the design of acceptable group leisure activities, promoting their use to address loneliness in people living with dementia.
Objectives:
Despite social engagement being a robust predictor of wellbeing for older adults living in residential care, social programming ceased during the COVID-19 pandemic to abide by social distancing guidelines. Consequently, a tablet-based program called the Java Music Club-Digital (JMC-D) was developed. The JMC-D enables residents to engage with peers through discussion and singing from the safety of their own rooms. This study investigated the likability and usability of the JMC-D for older adults living in residential care and recreation staff.
Methods:
Data was collected through semi-structured interviews and focus groups with seven residents and three recreation coordinators. Interviews were analyzed using thematic analysis.
Results:
Three themes emerged: 1) Addressing a need, 2) Factors that affect virtual social connection, and 3) Usability. Interest in future participation in the JMC-D program varied depending on certain personal characteristics including comfort with computers, openness to new experiences, and existing social network.
Conclusion:
Findings suggest that the JMC-D is likeable and usable for residents and recreation coordinators.
Clinical implications:
Study findings can be applied by researchers and residential care staff who wish to increase the use of virtual social programs to improve the psychosocial health of residents. Constructive feedback was incorporated into the platform.
Objective:
The objective of this review is to explore the experiences of residents in long-term-care homes using socially assistive technologies and the effectiveness of these technologies in relation to depression, loneliness, and social interaction.
Introduction:
Research related to the experiences of residents in long-term-care homes with socially assistive technologies, and their effectiveness, is limited. This population of older adults is projected to steeply increase in the future, as will the need for services, such as long-term care. Older adults (≥65) in long-term care are at increased risk of depression, loneliness, and social isolation. Therefore, there is a need to explore the experiences of long-term-care residents in the use of socially assistive technologies and to determine the effectiveness of these technologies in relation to depression, loneliness, and social interaction.
Inclusion criteria:
This review will include studies about the experiences of older adults in long-term care using socially assistive technologies, and the effectiveness of these technologies. Older adults are defined as people 65 years of age and above. We will consider human-to-human socially assistive technologies, such as computers, smart phones, tablets, and associated applications. We will review quantitative, qualitative, and mixed methods studies from the inception of databases to present.
Methods:
A JBI mixed methods convergent segregated approach will be used. Select databases and gray literature will be searched for published and unpublished studies. Titles, abstracts, and full texts of included studies will be screened by at least two reviewers, and undergo quality appraisal, data extraction, and synthesis of quantitative and qualitative data followed by integration of the two types of evidence.
Systematic review registration number:
PROSPERO CRD42021279015.
The digital citizenship of older migrants in Australia is a complex picture. As older adults, they are part of one of the least digitally included groups; yet, as migrants, they also represent one of the most digitally included groups. Drawing on ethnographic research documenting the experiences of older migrants, we argue that digital citizenship is vital to their wellbeing, evident in the practices and processes of ‘digital kinning’ that support their transnational care networks (Baldassar and Wilding, ‘Migration, aging, and digital kinning: The role of distant care support networks in experiences of aging well’. The Gerontologist, 60(2): 313–321, 2020). Access to digital technologies is also a significant equity issue, given the increasing shift of critical health and aged care service delivery from face-to-face to online platforms, including in response to the COVID-19 pandemic. We examine the uneven nature of access to both digital infrastructure and digital literacy initiatives, including in residential aged care settings. In conclusion, we call for a comprehensive policy framework to safeguard their digital inclusion.
Cities and countries the world over are at the cusp of epochal global trends whose impacts are likely to be more intense and more far-reaching than those of similar trends in the past. The simultaneity of the demographic transition, deepening urbanization, a technological revolution, frequent shocks brought on by health and climate emergencies, mean that one will need to plan for an older and more urban future. This report is intended as a policy document that helps articulate the idea of age-readiness while building on the idea of age-friendliness. It highlights the varied trajectories of aging and urbanization and draws on the experiences of older and more urban countries to show how others can become age-ready. It is intended for cities and towns as they prepare for an older urban age, offering examples and options to help younger cities visualize age-readiness while focusing primarily on the built urban environment. Its main audience is intended to be policymakers, city leaders, and implementing agencies, but it is also expected be useful to researchers, nongovernmental organizations, the private sector, and communities.
Background and Aims
Social connection is associated with better physical and mental health and is an important aspect of the quality of care for nursing home residents. The primary objective of this scoping review was to answer the question: what nursing home and community characteristics have been tested as predictors of social connection in nursing home residents? The secondary objective was to describe the measures of social connection used in these studies.
Methods
We searched MEDLINE(R) ALL (Ovid), CINAHL (EBSCO), APA PsycINFO (Ovid), Scopus, Sociological Abstracts (ProQuest), Embase and Embase Classic (Ovid), Emcare Nursing (Ovid), and AgeLine (EBSCO) for research that quantified associations between nursing home and/or community characteristics and resident social connection. Searches were limited to English‐language articles published from database inception to search date (July 2019) and update (January 2021).
Results
We found 45 studies that examined small‐scale home‐like settings (17 studies), facility characteristics (14 studies), staffing characteristics (11 studies), care philosophy (nine studies), and community characteristics (five studies). Eight studies assessed multiple home or community‐level exposures. The most frequent measures of social connection were study‐specific assessments of social engagement (11 studies), the Index of Social Engagement (eight studies) and Qualidem social relations (six studies), and/or social isolation (five studies) subscales. Ten studies assessed multiple social connection outcomes.
Conclusion
Research has assessed small‐scale home‐like settings, facility characteristics, staffing characteristics, care philosophy, and community characteristics as predictors of social connection in nursing home residents. In these studies, there was no broad consensus on best approach(es) to the measurement of social connection. Further research is needed to build an evidence‐base on how modifiable built environment, staffing and care philosophy characteristics—and the interactions between these factors—impact residents' social connection.
Background
Engagement and social connection are key elements of a meaningful life however the current aged care system does not universally foster community connectedness. Limited research has explored community engagement from the perspective of older people in aged care.
Aim
To explore older people's perceptions of community engagement in aged care.
Methods
A qualitative exploratory descriptive approach involving individual interviews and focus groups
Setting
A large not-for-profit aged care provider in Victoria and Tasmania, Australia.
Participants
Twenty-eight older adults living in residential aged care (n = 23) and independent living units (n = 5).
Findings
Four themes were identified: (i) a new home; (ii) opportunities to engage in aged care; (iii) connecting with the wider community, and; (iv) social connection to community.
Discussion
Participants perceived community as being characterised by the notion of home, that is, the place where they lived. Being socially connected to a community was important and benefits included being with people to avoid being alone, reconnecting with the wider community and having positive social connections. Opportunities for engagement were either created for, or by them. In residential aged care, staff facilitated engagement opportunities using a one-size-fits-all approach. This approach was deemed to be unsuitable. People from independent living units, although not completely removed from the wider community, desired to maintain their independence and be part of the wider community.
Conclusions
Understanding older people's perceptions of community engagement in aged care can support development of appropriate, applicable and meaningful strategies to promote engagement and socialisation within aged care and the wider community.
(ENG):The possible use of Biological Warfare Agents (BWAs) causes fear and anxiety among people and disrupts the functioning of the Economy, Society, and Administration. Biological Warfare is the deliberate use of pathogenic strains of microorganisms such as bacteria, viruses, or their toxins to spread life-threatening diseases on a large scale. Early detection of BWAs is highly important for the timely management of any biological attack, whether intentional or natural. The symptoms of biological infection in the population can occur in hours, days, or even weeks. It is very difficult to distinguish these symptoms from infections from more benign and common biological factors.
Biological defense includes the methods, plans, and procedures involved in defining and executing defensive measures (detection, protection, disinfection, and medical management) against biological attack. Many countries are making efforts to develop systems and new technologies for the early detection of BWAs. To date, there is no single system that can detect all the bio-threats agents. Despite the availability of many biology techniques and tools, there is no complete proof system for detecting/identifying all BWAs. In the present review, we describe the currently available techniques and systems for locating and identifying these biological warfare agents. The basic identification techniques are presented which include organic culture, immunological methods, nucleic acid-based detection, cellular fatty acid profile, flow cytometry detection, and Matrix-Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrometry (MALDI-TOF/MS). Detection of BWAs with biosensors, biological detectors, surface plasmon resonance, and stand-off detection (standoff detection can detect a biological warfare agent remotely without sampling) is also summarized.
(EL):Η απειλή από Βιολογικούς Παράγοντες Πολέμου (Biological Warfare Agents: BWAs) έχει αναδειχθεί ως μία υψηλής πιθανότητας πρόκληση εθνικής και παγκόσμιας ασφάλειας λόγω της απλής και φθηνής παραγωγής τους, της εύκολης διασποράς, της περίπλοκης ανίχνευσης, της ακριβής προστασίας και του ψυχολογικού, οικονομικού και κοινωνικού αντικτύπου. Η έγκαιρη ανίχνευση και ταυτοποίηση των BWAs κατά τη διάρκεια Χημικών-Βιολογικών-Ραδιολογικών-Πυρηνικών συμβάντων είναι απαραίτητη για την έναρξη διορθωτικών ενεργειών έκτακτης ανάγκης για τη διαχείριση τέτοιων συμβάντων. Καταβάλλονται προσπάθειες σε όλο τον κόσμο για την ανάπτυξη προηγμένων τεχνολογιών και συστημάτων για την ανίχνευση και αναγνώριση των BWAs. Ωστόσο, μέχρι σήμερα δεν υπάρχει ενιαίο σύστημα που να μπορεί να ανιχνεύσει όλους τους παράγοντες βιο-απειλής. Σε αυτή την ανασκόπηση, περιγράφονται οι τρέχουσες διαθέσιμες τεχνικές και συστήματα για τον εντοπισμό και την ταυτοποίηση αυτών των παραγόντων. Παρουσιάζονται οι βασικές τεχνικές ταυτοποίησης που περιλαμβάνουν βιολογική καλλιέργεια, ανοσολογικές μεθόδους, ανίχνευση με βάση νουκλεϊκό οξύ, μήτρα υποβοήθησης λέιζερ εκρόφησης/ιονισμού με φασματομετρίας μάζας χρόνου πτήσης (MALDI-TOF MS), προφίλ κυτταρικού λιπαρού οξέος και ανίχνευση με βάση την κυτταρομετρία ροής. Συνοψίζεται επίσης η ανίχνευση BWAs με βιοαισθητήρες, συντονισμό επιφανειακού πλασμονίου, βιολογικοί ανιχνευτές και συστήματα ανίχνευσης stand-off. Ωστόσο, παρά τη διαθεσιμότητα πολλών τεχνικών και εργαλείων, δεν υπάρχει πλήρες σύστημα απόδειξης για ανίχνευση / αναγνώριση όλων των BWA.
Positive peer interaction in nursing homes has been consistently recognized as essential to residents’ life quality. However, low rates of resident-to-resident interaction were found to be pervasive. Our research explores the potential of applying public display systems to promote residents’ unplanned co-located interaction. This article describes the design and assessment of “Reading-to-Sharing” (R2S): a tabletop display system intended to improve nursing home residents’ social interaction by enhancing their public reading experience. R2S was assessed via supervised field trials, in which the participants were invited to experience R2S in real-life settings with necessary assistance. The objectives were mainly to investigate the participants’ engagement with R2S, user experience and the potential impact on residents’ social behaviors and feelings. The result showed that R2S was capable of engaging the participants in content viewing and sharing. It was effective in catalyzing and facilitating their social interaction. The participants’ perceived user experience was primarily favorable. Although R2S was anticipated to increase the participants’ mutual closeness, no statistically significant change was seen. The key implications were highlighted to guide the design of public display systems in this context.
In this study, the authors tested the relation between loneliness and subsequent admission to a nursing home over a 4-year time period in a sample of approximately 3,000 rural older Iowans. Higher levels of loneliness were found to increase the likelihood of nursing home admission and to decrease the time until nursing home admission. The influence of extremely high loneliness on nursing home admission remained statistically significant after controlling for other variables, such as age, education: income, mental status. physical health, morale, and social contact, that were also predictive of nursing horne admission, Several mechanisms are proposed to explain the link between extreme loneliness and nursing home admission. These include loneliness as a precipitant of declines in mental and physical health and nursing home placement as a strategy to gain social contact with others. Implications for preventative interventions are discussed.
Key messages • Older people are particularly vulnerable to social isolation or loneliness owing to loss of friends and family, mobility or income. • Social isolation and loneliness impact upon individuals' quality of life and wellbeing, adversely affecting health and increasing their use of health and social care services. • The interventions to tackle social isolation or loneliness include: befriending, mentoring, Community Navigators, social group schemes. • People who use befriending or Community Navigator services reported that they were less lonely and socially isolated following the intervention. • The outcomes from mentoring services are less clear; one study reported improvements in mental and physical health, another that no difference was found. • Where longitudinal studies recorded survival rates, older people who were part of a social group intervention had a greater chance of survival than those who had not received such a service. • Users report high satisfaction with services, benefiting from such interventions by increasing their social interaction and community involvement, taking up or going back to hobbies and participating in wider community activities. • Users argued for flexibility and adaptation of services. One-to-one services could be more flexible, while enjoyment of group activities would be greater if these could be tailored to users' preferences. • When planning services to reduce social isolation or loneliness, strong partnership arrangements need to be in place between organisations to ensure developed services can be sustained. • We need to invest in proven projects. Community Navigator interventions have been shown to be effective in identifying those individuals who are socially isolated. Befriending services can be effective in reducing depression and cost-effective. • Research needs to be carried out on interventions that include different genders, populations and localities. • There is an urgent need for more longitudinal, randomised controlled trials that incorporate standardised quality-of-life and cost measures.
Social relationships benefit not only mental health but also physical health. This review addresses the following questions: (1) What is the overall magnitude of the effect of social relationships on risk for premature death? (2) How generalized is the effect and are there factors known to influence this association? (3) What are the likely pathways by which social relationships influence longevity? The article concludes by discussing the implications of these findings for potential interventions aimed at reducing risk for mortality.
This study examines loneliness and its correlates-health, residential care, partner status, and network size-over a seven-year period among adults born between 1908 and 1937. The four waves of data are from the Dutch "Living Arrangements and Social Networks of Older Adults" and the "Longitudinal Aging Study of Amsterdam" programs. Data from at least two waves are available for 2,925 respondents. Results show that older adults generally become lonelier as time passes. The increase is greater for the oldest, the partnered, and those with a better functional capacity at baseline. Older adults who lose their partner by death show the greatest increase in loneliness. Not all older adults become more lonely: Improvement in functional capacity and network expansion lead to less loneliness. Entry into residential care does not affect loneliness. The longitudinal design provides new insights into factors that protect against loneliness compared to cross-sectional studies
Loneliness concerns the subjective evaluation that the number of relationships is smaller than the individual considers desirable or that the intimacy that the individual wishes for has not been realized. The aim of this study was to assess variations in levels of late-life loneliness and its determinants across Europe. Data came from the SHARE surveys, Wave 2 (Borsch-Supan et al., 2008), encompassing adults aged 50 years and over in Austria, Belgium, the Czech Republic, Denmark, France, Germany, Greece, Ireland, Italy, the Netherlands, Poland, Spain, Sweden, and Switzerland (N = 12,248). Loneliness was measured by a single item derived from the CES-D (depression) scale. Using logistic models, the present authors tested several types of explanations for country differences: differences in demographic characteristics, wealth and health, and social networks. Older adults in the southern and central European countries were generally lonelier than their peers in the northern and western European countries. In the southern and central European countries, loneliness was largely attributable to not being married, economic deprivation, and poor health. Frequent contacts with parents and adult children, social participation, and providing support to family members were important in preventing and alleviating loneliness in almost all countries. To combat loneliness among older adults, the findings suggest both (a) generic approaches aimed at improving social embeddedness and (b) country-tailored approaches aimed at improving health and wealth.
A 3-month videoconference interaction program with family members has been shown to decrease depression and loneliness in nursing home residents. However, little is known about the long-term effects on residents' depressive symptoms, social support, and loneliness.
The purpose of this longitudinal quasi-experimental study was to evaluate the long-term effectiveness of a videoconference intervention in improving nursing home residents' social support, loneliness, and depressive status over 1 year.
We purposively sampled 16 nursing homes in various areas of Taiwan. Elderly residents (N = 90) of these nursing homes meeting our inclusion criteria were divided into an experimental (n = 40) and a comparison (n = 50) group. The experimental group received at least 5 minutes/week for 3 months of videoconference interaction with their family members in addition to usual family visits, and the comparison group received regular family visits only. Data were collected in face-to face interviews on social support, loneliness, and depressive status using the Social Support Behaviors Scale, University of California Los Angeles Loneliness Scale, and Geriatric Depression Scale, respectively, at four times (baseline, 3 months, 6 months, and 12 months after baseline). Data were analyzed using the generalized estimating equation approach.
After the videoconferencing program, participants in the experimental group had significantly lower mean change in instrumental social support scores at 6 months (-0.42, P = .03) and 12 months (-0.41, P = .03), and higher mean change in emotional social support at 3 (0.74, P < .001) and 12 months (0.61, P = .02), and in appraisal support at 3 months (0.74, P = .001) after adjusting for confounding variables. Participants in the experimental group also had significantly lower mean loneliness and depressive status scores at 3 months (-5.40, P < .001; -2.64, P < .001, respectively), 6 months (-6.47, P < .001; -4.33, P < .001), and 12 months (-6.27, P = .001; -4.40, P < .001) compared with baseline than those in the comparison group.
Our videoconference program had a long-term effect in alleviating depressive symptoms and loneliness for elderly residents in nursing homes. This intervention also improved long-term emotional social support and short-term appraisal support, and decreased residents' instrumental social support. However, this intervention had no effect on informational social support.
Targeting social isolation in older people is a growing public health concern. The proportion of older people in society has increased in recent decades, and it is estimated that approximately 25% of the population will be aged 60 or above within the next 20 to 40 years. Social isolation is prevalent amongst older people and evidence indicates the detrimental effect that it can have on health and wellbeing. The aim of this review was to assess the effectiveness of interventions designed to alleviate social isolation and loneliness in older people.
Relevant electronic databases (MEDLINE, EMBASE, ASSIA, IBSS, PsycINFO, PubMed, DARE, Social Care Online, the Cochrane Library and CINAHL) were systematically searched using an extensive search strategy, for randomised controlled trials and quasi-experimental studies published in English before May 2009. Additional articles were identified through citation tracking. Studies were included if they related to older people, if the intervention aimed to alleviate social isolation and loneliness, if intervention participants were compared against inactive controls and, if treatment effects were reported. Two independent reviewers extracted data using a standardised form. Narrative synthesis and vote-counting methods were used to summarise and interpret study data.
Thirty two studies were included in the review. There was evidence of substantial heterogeneity in the interventions delivered and the overall quality of included studies indicated a medium to high risk of bias. Across the three domains of social, mental and physical health, 79% of group-based interventions and 55% of one-to-one interventions reported at least one improved participant outcome. Over 80% of participatory interventions produced beneficial effects across the same domains, compared with 44% of those categorised as non-participatory. Of interventions categorised as having a theoretical basis, 87% reported beneficial effects across the three domains compared with 59% of interventions with no evident theoretical foundation. Regarding intervention type, 86% of those providing activities and 80% of those providing support resulted in improved participant outcomes, compared with 60% of home visiting and 25% of internet training interventions. Fifty eight percent of interventions that explicitly targeted socially isolated or lonely older people reported positive outcomes, compared with 80% of studies with no explicit targeting.
More, well-conducted studies of the effectiveness of social interventions for alleviating social isolation are needed to improve the evidence base. However, it appeared that common characteristics of effective interventions were those developed within the context of a theoretical basis, and those offering social activity and/or support within a group format. Interventions in which older people are active participants also appeared more likely to be effective. Future interventions incorporating all of these characteristics may therefore be more successful in targeting social isolation in older people.
The goal of this research is to test whether often observed correlates of loneliness in older age are related to onset of loneliness longitudinally. Despite the increasing number of longitudinal studies, the investigation of factors that are related to onset of loneliness is still limited. Analyses are based on data of the TamELSA study, which is a population-based prospective study in Tampere, Finland and started in 1979. For the present study 469 older adults aged between 60 and 86 years at baseline, who were not lonely at baseline, were selected and followed-up in 1989, 1999 and 2006. During the 28 years of follow-up approximately one third (N = 178) of the study population developed feelings of loneliness. Logistic regression analyses indicated that losing a partner, reduced social activities, increased physical disabilities, increased feelings of low mood, uselessness and nervousness, rather than baseline characteristics, are related to enhanced feelings of loneliness at follow-up. The higher incidence of loneliness among women can be fully explained by the unequal distribution of risk factors among men and women (e.g., women more often become widowed). Our results are in line with the cognitive approach that conceptualizes loneliness as an unpleasant feeling due to a perceived discrepancy between the desired and the achieved level of social and personal resources.
Care home placements constitute the majority (57%) of net council spending in England on social care for older people. Information about the expected length of stay for people admitted to a care home is important for predicting lifetime costs and for understanding the implications of reforming funding arrangements for social care. To date there has been very little research able to give us an accurate picture of how long people live in care homes before they die. In this study, we draw on anonymised information about all the residents (11,565 residents in total) that died in Bupa care homes in the period Nov 2008 to May 2010. The availability of this Bupa data has given the opportunity to produce some needed and timely research on the question of length of stay. The results of this study will help to fill some of the gaps in our knowledge on this subject. Residents of the 305 Bupa homes are largely representative of the England average in relation to age, sex and funding source. Bupa have more people in nursing beds with a higher level of frailty than the average in England, but we are able to re-weight the results to estimate average lengths of stay that more closely reflect the England situation. In the Bupa sample, the average length of stay was 801 days, but with a considerable tail of long-stayers. Half of residents had died by 462 days. Around 27% of people lived for more than three years, with the longest stayer living for over 20 years. People had a 55% chance of living for the first year after admission, which increased to nearly 70% for the second year before falling back over subsequent years. Lengths of stay for the Bupa sample and those estimated for England are given in Table One (below). Adjusted figures show a bigger difference between nursing beds and residential beds than the unadjusted figures as they account for people that might have changed from a residential to a nursing bed during their stay in the home. Length of stay information can be combined with information about the unit (e.g. weekly) costs of a care home placement to calculate expected costs of care for people newly admitted to care homes (see Table One). At £550 per week (before inflation), an 832-day expected stay would cost £65,400. The total cost for around a quarter of people would exceed £94,700 at this weekly rate, and for 10% it would be more than £166,000.
Objectives: First, to seek if sociodemographic and health factors contribute differentially to the explanation of loneliness in institutionalized and noninstitutionalized older adults; and second, to analyze the influence of institutionalization on loneliness. Method: This work was based on two surveys of older adults aged 60 years or more in Spain. A group of 234 community-dwelling people and 234 nursing homes residents were selected (n = 468). Logistic regression models were applied using the six-item De Jong Gierveld Loneliness Scale as dependent variable. Results: Depression was associated with loneliness in both populations. Sex and marital status contributed to explain loneliness among those living at home, whereas gathering with family, friends, and neighbors showed a significant effect in the institutionalized group. Institutionalization per se showed a strong effect on loneliness. Discussion: Findings have potential implications for targeting older adults at risk for loneliness.
Social and demographic trends are placing an increasing number of adults at risk for loneliness, an established risk factor for physical and mental illness. The growing costs of loneliness have led to a number of loneliness reduction interventions. Qualitative reviews have identified four primary intervention strategies: (a) improving social skills, (b) enhancing social support, (c) increasing opportunities for social contact, and (d) addressing maladaptive social cognition. An integrative meta-analysis of loneliness reduction interventions was conducted to quantify the effects of each strategy and to examine the potential role of moderator variables. Results revealed that single-group pre-post and nonrandomized comparison studies yielded larger mean effect sizes relative to randomized comparison studies. Among studies that used the latter design, the most successful interventions addressed maladaptive social cognition. This is consistent with current theories regarding loneliness and its etiology. Theoretical and methodological issues associated with designing new loneliness reduction interventions are discussed.
The quality and quantity of individuals' social relationships has been linked not only to mental health but also to both morbidity and mortality.
This meta-analytic review was conducted to determine the extent to which social relationships influence risk for mortality, which aspects of social relationships are most highly predictive, and which factors may moderate the risk.
Data were extracted on several participant characteristics, including cause of mortality, initial health status, and pre-existing health conditions, as well as on study characteristics, including length of follow-up and type of assessment of social relationships.
Across 148 studies (308,849 participants), the random effects weighted average effect size was OR = 1.50 (95% CI 1.42 to 1.59), indicating a 50% increased likelihood of survival for participants with stronger social relationships. This finding remained consistent across age, sex, initial health status, cause of death, and follow-up period. Significant differences were found across the type of social measurement evaluated (p<0.001); the association was strongest for complex measures of social integration (OR = 1.91; 95% CI 1.63 to 2.23) and lowest for binary indicators of residential status (living alone versus with others) (OR = 1.19; 95% CI 0.99 to 1.44).
The influence of social relationships on risk for mortality is comparable with well-established risk factors for mortality. Please see later in the article for the Editors' Summary.
As a social species, humans rely on a safe, secure social surround to survive and thrive. Perceptions of social isolation, or loneliness, increase vigilance for threat and heighten feelings of vulnerability while also raising the desire to reconnect. Implicit hypervigilance for social threat alters psychological processes that influence physiological functioning, diminish sleep quality, and increase morbidity and mortality. The purpose of this paper is to review the features and consequences of loneliness within a comprehensive theoretical framework that informs interventions to reduce loneliness. We review physical and mental health consequences of loneliness, mechanisms for its effects, and effectiveness of extant interventions. Features of a loneliness regulatory loop are employed to explain cognitive, behavioral, and physiological consequences of loneliness and to discuss interventions to reduce loneliness. Loneliness is not simply being alone. Interventions to reduce loneliness and its health consequences may need to take into account its attentional, confirmatory, and memorial biases as well as its social and behavioral effects.
We present evidence from a 5-year longitudinal study for the prospective associations between loneliness and depressive symptoms in a population-based, ethnically diverse sample of 229 men and women who were 50-68 years old at study onset. Cross-lagged panel models were used in which the criterion variables were loneliness and depressive symptoms, considered simultaneously. We used variations on this model to evaluate the possible effects of gender, ethnicity, education, physical functioning, medications, social network size, neuroticism, stressful life events, perceived stress, and social support on the observed associations between loneliness and depressive symptoms. Cross-lagged analyses indicated that loneliness predicted subsequent changes in depressive symptomatology, but not vice versa, and that this temporal association was not attributable to demographic variables, objective social isolation, dispositional negativity, stress, or social support. The importance of distinguishing between loneliness and depressive symptoms and the implications for loneliness and depressive symptomatology in older adults are discussed.
Loneliness is a prevalent social problem with serious physiological and health implications. However, much of the research to date is based on cross-sectional data, including our own earlier finding that loneliness was associated with elevated blood pressure (Hawkley, Masi, Berry & Cacioppo, 2006). In this study, we tested the hypothesis that the effect of loneliness accumulates to produce greater increases in systolic blood pressure (SBP) over a 4-year period than are observed in less lonely individuals. A population-based sample of 229 50- to 68-year-old White, Black, and Hispanic men and women in the Chicago Health, Aging, and Social Relations Study was tested annually for each of 5 consecutive years. Cross-lagged panel analyses revealed that loneliness at study onset predicted increases in SBP 2, 3, and 4 years later (B = 0.152, SE = 0.091, p < .05, one-tailed). These increases were cumulative such that higher initial levels of loneliness were associated with greater increases in SBP over a 4-year period. The effect of loneliness on SBP was independent of age, gender, race or ethnicity, cardiovascular risk factors, medications, health conditions, and the effects of depressive symptoms, social support, perceived stress, and hostility.
This study examines the prevalence of loneliness amongst older people in Great Britain, and makes comparisons with the findings of studies undertaken during the last five decades. In addition, the risk factors for loneliness are examined using a conceptual model of vulnerability and protective factors derived from a model of depression. Loneliness was measured using a self-rating scale, and measures of socio-demographic status and health/social resources were included. Interviews were undertaken with 999 people aged 65 or more years living in their own homes, and the sample was broadly representative of the population in 2001. Among them the prevalence of ‘severe loneliness’ was seven per cent, indicating little change over five decades. Six independent vulnerability factors for loneliness were identified: marital status, increases in loneliness over the previous decade, increases in time alone over the previous decade; elevated mental morbidity; poor current health; and poorer health in old age than expected. Advanced age and possession of post-basic education were independently protective of loneliness. From this evidence we propose that there are three loneliness pathways in later life: continuation of a long-established attribute, late-onset loneliness, and decreasing loneliness. Confirmation of the different trajectories suggests that policies and interventions should reflect the variability of loneliness in later life, for undifferentiated responses may be neither appropriate nor effective.
The purpose of this study was to examine sociodemographic and health-related risks for loneliness among older adults using Health and Retirement Study Data. Overall prevalence of loneliness was 19.3%. Marital status, self-report of health, number of chronic illnesses, gross motor impairment, fine motor impairment, and living alone were predictors of loneliness. Age, female gender, use of home care, and frequency of healthcare visits were not predictive. Loneliness is a prevalent problem for older adults in the United States with its own health-related risks. Future research of interventions targeting identified risks would enhance the evidence base for nursing and the problem of loneliness.
The focus in this paper is on the social domain of quality of life, and more particularly loneliness. The empirical literature on older adult loneliness is reviewed, thereby challenging three often-held assumptions that figure prominently in public debates on loneliness. The first assumption that loneliness is a problem specifically for older people finds only partial support. Loneliness is common only among the very old. The second assumption is that people in individualistic societies are most lonely. Contrary to this belief, findings show that older adults in northern European countries tend to be less lonely than those in the more familialistic southern European countries. The scarce data on Central and Eastern Europe suggest a high prevalence of older adult loneliness in those countries. The third assumption that loneliness has increased over the past decades finds no support. Loneliness levels have decreased, albeit slightly. The review notes the persistence of ageist attitudes, and underscores the importance of considering people's frame of reference and normative orientation in analyses of loneliness.
To determine cross-sectional and prospective associations between loneliness and physical activity, and to evaluate the roles of social control and emotion regulation as mediators of these associations.
A population-based sample of 229 White, Black, and Hispanic men and women, age 50 to 68 years at study onset, were tested annually for each of 3 years.
Physical activity probability, and changes in physical activity probability over a 3-year period.
Replicating and extending prior cross-sectional research, loneliness was associated with a significantly reduced odds of physical activity (OR = 0.65 per SD of loneliness) net of sociodemographic variables (age, gender, ethnicity, education, income), psychosocial variables (depressive symptoms, perceived stress, hostility, social support), and self-rated health. This association was mediated by hedonic emotion regulation, but not by social control as indexed by measures of social network size, marital status, contact with close ties, group membership, or religious group affiliation. Longitudinal analyses revealed that loneliness predicted diminished odds of physical activity in the next two years (OR = 0.61), and greater likelihood of transitioning from physical activity to inactivity (OR = 1.58).
Loneliness among middle and older age adults is an independent risk factor for physical inactivity and increases the likelihood that physical activity will be discontinued over time.
There are many reasons why people frequently consult their general practitioner (GP). Although loneliness is increasingly recognized as a problem affecting well-being for elderly people, it has rarely been addressed as a predictor of frequency of consultation.
To examine whether loneliness is associated with rates of GP consultations (home and surgery visits).
Analysis of data collected in face-to-face interviews at the second wave of a longitudinal health survey of two adult age cohorts living in four socially contrasting urban localities in Glasgow City. There were a total of 691 subjects: 142 males and 176 females aged 40 years at interview; and 167 males and 206 females aged 60 years at interview. Frequency of reported GP consultations in the past 12 months at home or in the surgery was examined.
After controlling for sociodemographic and socioeconomic variables and health, loneliness was significantly associated with frequency of consultation at the surgery but not with the frequency of home visits.
Loneliness may still be underestimated as a factor related independently to frequency of consultations with a GP at the surgery.
In this study, Weiss's (1973) theorizing about the sources of emotional and social loneliness is elaborated--with notions about the asymmetric gratifications derived from marriage, about the conflicting loyalties that result from remarriage, and about selection into marriage--in order to reach an understanding of gender differences in loneliness, both in and outside of marriage. First and subsequent marriages are considered, as well as marital disruptions and never marrying. The data (N = 3737) are from the 1992 Dutch survey on older adults' living arrangements and social networks (NESTOR-LSN). Marital-history differences emerge, not only for emotional loneliness, but also (and contrary to Weiss's theoretical conceptualizations) for social loneliness. The marital-history differences in emotional and social loneliness are greater among men than women. For men, the marriage bond appears not only to be more central to emotional well-being than is the case for women but also to play a pivotal role in their involvement with others. Marital history offers the best explanation for differences in emotional loneliness among men, but social embeddedness characteristics also account for differences in emotional loneliness among women. Apparently, whereas men are more likely to find an intimate attachment in marriage, women also find protection from emotional loneliness in other close ties. The marital-history differences in social loneliness are largely mediated by social embeddedness characteristics, partly in different ways for men and women. Involvement in activities outside the home serves as the context for sociability for men, whereas parenthood plays a more important role in women's social engagements.
The extent to which loneliness is a unique risk factor for depressive symptoms was determined in 2 population-based studies of middle-aged to older adults, and the possible causal influences between loneliness and depressive symptoms were examined longitudinally in the 2nd study. In Study 1, a nationally representative sample of persons aged 54 and older completed a telephone interview as part of a study of health and aging. Higher levels of loneliness were associated with more depressive symptoms, net of the effects of age, gender, ethnicity, education, income, marital status, social support, and perceived stress. In Study 2, detailed measures of loneliness, social support, perceived stress, hostility, and demographic characteristics were collected over a 3-year period from a population-based sample of adults ages 50-67 years from Cook County, Illinois. Loneliness was again associated with more depressive symptoms, net of demographic covariates, marital status, social support, hostility, and perceived stress. Latent variable growth models revealed reciprocal influences over time between loneliness and depressive symptomatology. These data suggest that loneliness and depressive symptomatology can act in a synergistic effect to diminish well-being in middle-aged and older adults.
Social isolation in old age has been associated with risk of developing dementia, but the risk associated with perceived isolation, or loneliness, is not well understood.
To test the hypothesis that loneliness is associated with increased risk of Alzheimer disease (AD).
Longitudinal clinicopathologic cohort study with up to 4 years of annual in-home follow-up.
A total of 823 older persons free of dementia at enrollment were recruited from senior citizen facilities in and around Chicago, Ill. Loneliness was assessed with a 5-item scale at baseline (mean +/- SD, 2.3 +/- 0.6) and annually thereafter. At death, a uniform postmortem examination of the brain was conducted to quantify AD pathology in multiple brain regions and the presence of cerebral infarctions.
Clinical diagnosis of AD and change in previously established composite measures of global cognition and specific cognitive functions.
During follow-up, 76 subjects developed clinical AD. Risk of AD was more than doubled in lonely persons (score 3.2, 90th percentile) compared with persons who were not lonely (score 1.4, 10th percentile), and controlling for indicators of social isolation did not affect the finding. Loneliness was associated with lower level of cognition at baseline and with more rapid cognitive decline during follow-up. There was no significant change in loneliness, and mean degree of loneliness during the study was robustly associated with cognitive decline and development of AD. In 90 participants who died and in whom autopsy of the brain was performed, loneliness was unrelated to summary measures of AD pathology or to cerebral infarction.
Loneliness is associated with an increased risk of late-life dementia but not with its leading causes.
Nearly all older adults experience social losses, which can disrupt their social support networks and impair their quality of life. Events such as retirement, an inability to drive, death of a spouse and/or close life-long friends, or moving to an elder care facility may negatively affect the quality of older adults' social support networks. Low levels of perceived social support are associated with increased depression, impaired immune functioning and reduced life expectancy. Moreover, social interactions can be cognitively stimulating and may help older adults preserve their cognitive abilities. In the present study, institutionalized older adults were exposed to either a cognitive enhancement programme designed to enhance social networks or a control group. Measures of perceived social support and loneliness were administered before and after a 3-month, group-based intervention. There was a significant interaction between group and time. Those who did not participate in the intervention experienced a decrease in perceived social support and an increase in perceived loneliness. Participants in the intervention group stayed the same on the above measures. Helping older adults increase or maintain the quality of their social networks may lead to enhanced cognitive functioning, decreased depression and improved quality of life. Recommendations to help assisted living facilities, nursing homes, retirement communities and senior centres develop social and cognitive interventions are provided.
A widely held stereotype associates old age with social isolation and loneliness. However, only 5% to 15% percent of older adults report frequent loneliness. In this study, we report a meta-analysis of the correlates of loneliness in late adulthood. A U-shaped association between age and loneliness is identified. Quality of social network is correlated more strongly with loneliness, compared to quantity; contacts with friends and neighbors show stronger associations with loneliness, compared to contacts with family members. Being a woman, having low socioeconomic status and low competence, and living in nursing homes were also associated with higher loneliness. Age differences in the association of social contacts and competence with loneliness are investigated as well.
The relationship between age and loneliness is intriguing. While loneliness has been widely perceived as a problem of old age, there is evidence suggesting that adolescence is the peak age for experiencing loneliness and there are demonstrable variations between nations in reported rates of loneliness. However, comparative data for examining both the prevalence of loneliness across age groups and across nations are sparse. As the first phase of a larger project, we explore the prevalence of loneliness across different age groups in 25 European nations, with a focus on people of an advanced age. After discussing issues of comparability, we present our empirical findings employing data collected in the third round (2006–07) of the European Social Survey (total sample size 47,099, age range 15–101) which included a ‘self-rating’ loneliness scale. Our results suggest that the prevalence of loneliness does increase with age for the combined sample. However, the nation in which one lives shows a greater impact than age on reported levels of loneliness, with Russia and Eastern European nations having the highest proportions of lonely people (about 10–34% for different age groups) and Northern European nations the lowest (mostly below 6%). Possible explanatory factors are identified and discussed, which provides the groundwork of a subsequent and formal study.
If we are to develop better methods of integrating elderly people into society then above all we need a better sociology of the ageing and the aged. In this paper I wish to put forward the thesis that the dependency of the elderly in the twentieth century is being manufactured socially and that its severity is unnecessary. The process can therefore be revised or at least modified. Certain major influences, which will be discussed below, are steadily deepening, or widening that dependency. There is the imposition, and acceptance, of earlier retirement; the legitimation of low income; the denial of rights to self-determination in institutions; and the construction of community services for recipients assumed to be predominantly passive.
Aims and objectives:
Hypothesised that sociodemographic factors and illness variables would be associated with mortality and that emotional and social loneliness measured using the Social Provisions Scale would influence mortality among nursing homes residents with cancer.
Background:
Studies are lacking on how emotional and social loneliness influence mortality among cognitively intact older people in nursing homes with and without a diagnosis of cancer.
Design:
A cross-sectional design was used at baseline with a five-year follow-up of mortality. Methods. A cohort of 227 cognitively intact (Clinical Dementia Rating scale score ≤0·5) older residents (60 with cancer and 167 without) from 30 nursing homes were followed from 2004-2005 to 2010. Data were collected by face-to-face interview. Sociodemographic variables and medical diagnoses were obtained from the records.
Results:
Survival did not differ significantly between residents with and without cancer. After adjustment for sociodemographic and illness variables, increasing age, higher education and comorbidity were associated with mortality. In the final model from a backward selection procedure, attachment (emotional loneliness) was associated with mortality.
Conclusions:
Independent of a cancer diagnosis or not, emotional loneliness, age, education and comorbidity influenced mortality among nursing homes residents without cognitive impairment.
Relevance to clinical practice:
Nurses should pay attention to emotional loneliness among nursing homes residents independent of cancer and especially give attention to the importance to have a close confidant who provides emotional support.
Objectives: To determine the prevalence and demographic correlates of loneliness in a sample of older people in Perth, Western Australia.
Methods: People aged 65 years and over living in private dwellings were recruited randomly, stratified by socioeconomic area, sex and 5-year age groups to 85 years. A total of 353 people with mean age of 77.5 years responded to a mailed questionnaire comprising demographic questions and three measures of loneliness.
Results: Severe loneliness was reported by 7.0% of the sample and feeling lonely sometimes by 31.5%. Higher levels of loneliness were reported by single participants, those who lived alone and those with worse self-rated health. The protective value against loneliness of social networks appears to be, in order of importance: friends, relatives, neighbours and children.
Conclusions: Although loneliness is not universally reported by older Perth residents, its prevalence is still considerable and worthy of attention from mental health practitioners and policy-makers.
Preventing and alleviating social isolation and loneliness among older people is an important area for policy and practice, but the effectiveness of many interventions has been questioned because of the lack of evidence. A systematic review was conducted to determine the effectiveness of health promotion interventions that target social isolation and loneliness among older people. Quantitative outcome studies between 1970 and 2002 in any language were included. Articles were identified by searching electronic databases, journals and abstracts, and contact-ing key informants. Information was extracted and synthesised using a standard form. Thirty studies were identified and categorised as 'group ' (n=17) ; ' one-to-one ' (n=10) ; 'service provision' (n=3) ; and ' community development ' (n=1). Most were conducted in the USA and Canada, and their design, methods, quality and transferability varied considerably. Nine of the 10 effective interventions were group activities with an educational or support input. Six of the eight ineffective interventions provided one-to-one social support, advice and information, or health-needs assessment. The review suggests that educational and social activity group interventions that target specific groups can alleviate social isolation and loneliness among older people. The effectiveness of home visiting and befriending schemes remains unclear.
More than two decades of research has consistently indicated that feelings of loneliness among older people are more common
in southern Europe than in its northern parts, with the lowest rates in Denmark and Sweden. Our analyses based on analysis
of 2004–2006 data from 8,787 individuals aged 65years or older in the SHARE project replicate, update, and extend these findings.
We found, similar to previous studies, that the prevalence of feelings of loneliness was more common in the Mediterranean
countries than in Northern Europe. Living together with a spouse/partner was consistently associated with the lower prevalence
of loneliness across countries. The combination of living alone and having bad health was associated with 10times higher
odds of feeling lonely as compared with living together with someone and having good health. With regard to gender and health,
we found signs of differences between countries in how these factors were related to loneliness. Our results indicate the
importance of both contextual features and cultural expectations in interpreting reported loneliness, that is, loneliness
across Europe has both nomothetic and idiographic features.
Longitudinal studies of loneliness among older people are comparatively rare. At 8 years after the initial survey in 1999-2000, we followed up on the 999 people aged 65+ years who were living in the community in the United Kingdom. We found that 583 participants were still alive, and 287 (58%) participated in the follow-up survey. The overall prevalence of loneliness at both time points was very similar, with 9% reporting severe loneliness; 30% reporting that they were sometimes lonely, and 61% reporting that they were never lonely. We developed a 12-category typology to describe changes in loneliness across the follow-up period and report that 60% of participants had a stable loneliness rating, with 40-50% rating themselves as never lonely, and 20-25% rating themselves as persistently lonely; 25% demonstrated decreased loneliness, and approximately 15% demonstrated worse loneliness. Changes in loneliness were linked with changes in marital status, living arrangements, social networks, and physical health. Importantly improvements in physical health and improved social relationships were linked to reduced levels of loneliness. This result suggests that strategies to combat loneliness are not confined to the arena of social interventions such as befriending services, which aim to build and support social embeddedness, but may also result from the treatment of chronic and long-term health conditions.