Older adult loneliness: myths and realities

Social Isolation, Loneliness, and All-Cause Mortality in Patients With Cardiovascular Disease: A 10-Year Follow-up Study

OBJECTIVE

Social isolation and loneliness have been associated with increased incidence of cardiovascular disease (CVD), but few studies have evaluated the impact of social isolation and loneliness on mortality in people with existing CVD, and these are limited to Western populations. We examined whether social isolation and loneliness are associated with increased risk of mortality in individuals with established CVD in Taiwan.

METHODS

The cohort was composed of 1267 patients with confirmed CVD 65 years or older followed up for up to 10 years. Cox proportional hazard regression models were used to examine the association between social isolation and loneliness at baseline and mortality at follow-up by adjusting for demographic variables, health-related behaviors, and health status.

RESULTS

There were 593 deaths during the follow-up period. Social isolation was associated with increased risk of mortality after accounting for established risk factors (hazard ratio [HR] = 1.16; 95% confidence interval [CI] = 1.06-1.26), whereas loneliness was not associated with increased risk of mortality (HR = 0.95; 95% CI = 0.82-1.09). When both social isolation and loneliness were included in the model, social isolation maintained an association with mortality (HR = 1.16; 95% CI =1.07-1.27).

CONCLUSIONS

Social isolation is associated with an increased risk of mortality in patients with CVD, and the effects are independent of loneliness. These findings expand our knowledge about the impact of social isolation on the outcomes of CVD in non-Western countries. Efforts to reduce isolation may have substantial benefits in terms of mortality in patients with CVD.

Childlessness and Health Among Older Adults: Variation Across Five Outcomes and 20 Countries

OBJECTIVES

No previous study to the best of our knowledge has examined the association between childlessness and health using a wide range of countries and health outcomes. This study improves previous literature by examining the relationship between "childlessness" (1 = childless for any reason, 0 = parent of biological, step, or adopted child) and health across 20 countries and five health outcomes.

METHODS

Drawing on cross-sectional harmonized data from the family of Health and Retirement Surveys across the United States (HRS, Wave 11), Europe (SHARE, Waves 4 and 5), Mexico (MHAS, Wave 3), and China (CHARLS, Wave 2), we use logistic regression models to estimate the association between childlessness and poor health (poor self-rated health, 1 or more ADL limitations, 1 or more IADL limitations, 1 or more chronic conditions, and depression) in a sample of adults aged 50 and older across 20 countries (N = 109,648).

RESULTS

Our results point to an absence of associations between childlessness and health, and suggest that childlessness may be associated with better (e.g., Mexico, Hungary) or worse health (e.g., Austria, Estonia, Netherlands, Poland) in certain contexts and for certain measures.

DISCUSSION

We discuss these findings in light of the meaning of childlessness, as well as cross-national economic, social, and cultural contexts to provide suggestions for aging policy and future research.

All-cause mortality and three aspects of social relationships: an eight-year follow-up of older adults from one entire Korean village

Various aspects of social relationships have been examined as risk factors for mortality. In particular, most research has focused on either loneliness or social disengagement. We aimed to extend the current research by adding a group-level segregation measure utilizing the whole social network of one entire village in South Korea. The analyses were based on the Korean Social Life, Health and Aging Project data collected over eight years across five waves. Of the 679 old adults who participated throughout the entire project (to wave 5), 63 were confirmed as deceased. All three aspects of social relationships examined, loneliness, social disengagement, and group-level segregation, were associated with mortality in the traditional Cox proportional hazard model without considering health-related time-varying covariates. However, a Cox marginal structural model, a counterfactual statistical measure that is designed to control for censoring bias due to sample attrition over the eight years and time-varying confounding variables, revealed that only group-level segregation was associated with mortality. Our results strongly suggest that more attention is needed on group-level segregation for mortality studies, as well as on well-known individual-level risk factors, including social disengagement and loneliness. All methods were carried out in accordance with relevant guidelines and regulations.

Development of the 'SNS older adults measure' (SNS-OA) to examine social network site use in older adults

OBJECTIVES

Social Networking Sites (SNSs) may ameliorate loneliness in later life but no measure of SNS use for this population exists. This study describes the development of the 'SNS Older Adults measure' (SNS-OA), to improve understanding of older adults' SNS use and its relationship to social wellbeing.

METHODS

The SNS-OA underwent initial development, including literature reviews and consultation with target population (n = 9) and experts (n = 9); piloting (n = 74), and evaluation of psychometric properties (n = 263).

RESULTS

The final measure comprised three 'motive' scales (using SNSs to maintain close ties, maintain and strengthen weaker ties and diversion), and two 'affect' scales (positive/negative). Whilst many items were weakly endorsed by participants, the measure demonstrated good reliability (Cronbach α = 0.85; ICC = 0.82) and some convergent validity, with some subscales correlating with a personality measure in hypothesised directions. No statistically significant correlations were observed between the measure and social wellbeing.

CONCLUSIONS

Despite the measure's limitations, this research has enabled a better understanding of SNS use in older adults and has important implications for research in this area. Findings also suggest a complex relationship between social wellbeing and SNS use in later life.

Loneliness in Young Adults During the First Wave of COVID-19 Lockdown: Results From the Multicentric COMET Study

The COVID-19 pandemic has affected the mental and physical health of the general population at any age, but it is expected to have a protracted and severe consequences for younger populations. The pandemic has had several consequences on mental health including anger and irritability, depressive symptoms and somatic complaints, insomnia, lack of motivation, and loneliness. In particular, loneliness and its related negative feelings are thought to be particularly pronounced during young adulthood because of the many social changes that young people deal with during this period of life. Therefore, it is essential to evaluate the type of impact of the pandemic on the mental health of young people and their levels of loneliness experienced during the first phase of the lockdown. Based on the largest Italian study on the effects of the COVID-19 pandemic on the mental health of general population, in this paper we aim to: (1) describe the levels of loneliness in a national sample of Italian young adults aged 18-34 years, during the first wave of lockdown in 2020; (2) evaluate the clinical and socio-demographic differences in young adults reporting low vs. high levels of loneliness; (3) assess the role of clinical symptomatology, coping strategies, levels of resilience, and duration of lockdown as possible predictors of loneliness. The final sample consists of 8,584 people, mainly female (72.6%), single, with a mean age of 26.4 (±4.4) years. The mean score at the UCLA was 47.5 (±13.6), with 27% (N = 2,311) of respondents exceeding the cut-off for high levels of loneliness. High levels of loneliness were predicted by the presence of avoidant coping strategies, such as self-distraction (Beta coefficient, B = 0.369, 95% Confidence Interval, CI = 0.328-0.411), venting (B = 0.245, 95% CI = 0.197-0.293), denial (B = 0.110, 95% CI = 0.061-0.159), and emotional disengagement (B = 0.133, 95% CI = 0.080-0.185). Weeks of exposure to the pandemic were significantly associated with worsening of loneliness (p < 0.000). There is currently considerable interest in trying to reduce loneliness, both within the context of COVID-19 and more generally. Our results highlight that young people are at a higher risk of developing loneliness and suggest that more interventions and practical guidelines are needed.

Effects of transient and chronic loneliness on major depression in older adults: A longitudinal study

OBJECTIVES

The number of older adults is rapidly rising globally. Loneliness is a common problem that can deteriorate health. The aims of this work were to identify different types of loneliness (transient and chronic) and to assess their association with depression over time.

METHODS

A nationally representative sample from the Spanish population comprising 1190 individuals aged 50+ years was interviewed on three evaluations over a 7-year period. The UCLA Loneliness Scale was used to measure loneliness. While chronic loneliness was defined as the presence of loneliness across all three waves, transient loneliness expressed the presence of loneliness in one wave only. A 12-month major depressive episode was assessed at each interview. After confirming the cross-sectional relationship, a multilevel mixed-effects model was used to examine the association between loneliness and depression.

RESULTS

Almost a quarter of individuals felt lonely and one out of 10 presented depression at baseline. Of the sample, 22.78% showed transient loneliness, while 6.72% presented the chronic type. People experiencing chronic loneliness were at a higher risk of presenting major depression (OR = 6.11; 95% CI = 2.62, 14.22) than those presenting transient loneliness (OR = 2.22; 95% CI = 1.19, 4.14). This association varied over time and was stronger at the first follow-up than at the second one.

CONCLUSIONS

Focusing on loneliness prevention could reduce the risk of depression. Chronic loneliness is a public health problem that should be addressed through the full participation of the political, social, and medical sectors.

Connection Through Calls: The Impact of a Seniors Center Without Walls on Older Adults' Social Isolation and Loneliness

The Edmonton Seniors Centre Without Walls program provides free health, psychosocial, and educational telephone programming for older adults who experience multiple barriers to traditional in-person programming. The aim of this program evaluation was to assess outcomes of participation using validated scales of loneliness and psychosocial and health quality of life. Telephone interviews were conducted pre (n = 160) and post (n = 99) with participants. Given the variation in average attendance, results were assessed by level of participation: Low, Moderate, and High Users. There was statistically significant improvement in all participants' attitudes towards their self-realization and towards energy levels, and EQ-5D-5L anxiety/depression scale after participation, along with a significant reduction in feelings of social isolation. The highest rates of improvement were seen within High Users. These findings suggest that telephone-based programs could be a useful intervention to improve the wellbeing and socially connectedness of older adults.

The Role of Self-Esteem in the Relationship Between Loneliness and Life Satisfaction in Late Adulthood: Evidence from Poland

Background

The life satisfaction of elderly persons has been extensively investigated and discussed. However, a literature review shows that relatively few studies have focused on the effect of loneliness on the life satisfaction of older adults. Some researchers have acknowledged that the character of the relationship between loneliness and life satisfaction is still unclear, and this association is much more complex that it appears to be. Therefore, the main purpose of the current study was to understand how loneliness is associated with satisfaction, and whether self-esteem and educational involvement in the University of the Third Age (U3A) courses can affect this relationship among elderly people.

Methods

The research was conducted on a group of 179 elderly adults (65% women). We measured loneliness, satisfaction, and self-esteem. The data were collected via the paper-and-pencil format through convenience sampling, just before the COVID-19 pandemic began.

Results

The results obtained show that loneliness correlated negatively with self-esteem and life satisfaction. Self-esteem was associated positively with life satisfaction. Self-esteem acted as a suppressor between loneliness and life satisfaction. The participation of older adults in U3A moderated the strength of the relationship between loneliness and life satisfaction (direct effect) and between loneliness and life satisfaction mediated by self-esteem (indirect effect).

Conclusion

The mediatory role of self-esteem and the moderating role of educational activities in the relationship between loneliness and life satisfaction in late adulthood have important developmental and social implications. It appears that although feelings of loneliness and social isolation have a negative association on the life satisfaction of older adults, this relationship may be altered by empowering seniors’ self-esteem through their involvement in lifelong learning. Such a solution supports the functioning of older people also at the social level.

Young Adults' Migration to Cities in Sweden: Do Siblings Pave the Way?

Young adult internal migration forms a large share of the influx of people into large cities in the developed world. We investigate the role of the residential locations of siblings for young adults’ migration to large cities, using the case of Sweden and its four largest cities: Stockholm, Gothenburg, Malmö/Lund, and Uppsala. We use register data for the full Swedish-born population of young adults aged 18–28 living in Sweden in the years 2007–2013 and multinomial logistic regression analyses of migrating to each of the four cities or migrating elsewhere versus not migrating. Our point of departure is the paving-the-way hypothesis, which posits that young adults who have a sibling living at a migration destination are particularly likely to move to that destination, more so than to other destinations. Additional hypotheses are related to having more than one sibling in the city and to the gender of siblings living at the destination. We find support for the paving-the-way hypothesis and an additional effect for having more than one sibling in the city. Having a sibling of the same gender in a city matters more for moving there than having a sibling of the opposite gender.

Longitudinal analysis of the impact of loneliness on cognitive function over a 20-year follow-up

Background: Loneliness and cognitive impairment are both commonly experienced by older old people, but evidence for the association between these has been inconsistent. Moreover, most evidence has been cross-sectional in nature and largely based on studies with relatively young later life age groups rather than 'the oldest old'. We aimed to test the potential impact of loneliness amongst older old people on their cognitive function over a 20-year period.Method: Data were drawn from wave 3 to wave 10 of the Cambridge City over-75s Cohort (CC75C) study. The impact of loneliness on transition between normal and impaired cognitive states was examined by multi-state modelling. The associations between loneliness changes and cognitive function decline were tested by using generalized estimating equation (GEE) with an independent working correlation structure. Missing data were imputed by using multiple imputation chained equations.Results: At wave 3, 713 participants were interviewed, of whom 657 (92%) had Mini-Mental State Examination (MMSE) assessments. Of individuals who had an MMSE score, approximately one quarter reported feeling lonely, and another 16% felt slightly lonely. The prevalence of feeling lonely or slightly lonely varied between waves. Results from multi-state modelling indicated that loneliness was not related to cognitive function transitions, and results from the GEE model showed that loneliness was not significantly associated with cognitive function decline after adjusting for cohort effects, follow-up time, sex, education, and interaction terms for sex, education and time.Conclusions: Loneliness did not exert long-term harmful effects on cognitive function in the oldest old.

Impact of the COVID-19 Pandemic on Loneliness Among Older Adults

The COVID-19 pandemic has created a pattern of everyday physical distancing worldwide, particularly for adults aged 65+. Such distancing can evoke subjective feelings of loneliness among older adults, but how this pandemic has influenced that loneliness is not yet known. This study, therefore, explored the association between subjective loneliness and different time phases of the COVID-19 pandemic to explain the pandemic's impact on loneliness among older adults. The analysis employed a sample of 1,990 community-dwelling older adults aged 65-95 (mean age = 72.74 years; 43% female) in Switzerland. Data collection occurred both before and after Switzerland's first confirmed COVID-19 case. Regression models allowed the researchers to determine the binary and multivariate effects of different pandemic time phases on loneliness. The descriptive analysis revealed that loneliness increased after the Swiss government recommended physical distancing and slightly decreased after the Federal Council decided to ease these measures. According to the multivariate analysis, women, lower-income individuals, individuals living alone, individuals with no children, individuals unsatisfied with their contact with neighbors, and individuals interviewed after the physical distancing recommendations were more likely to report greater loneliness. The results suggest the pandemic has affected older adults' subjective evaluations of their subjective loneliness, and these findings help illustrate the pandemic's outcomes.

Comparing loneliness in England and the United States, 2014-2016: Differential item functioning and risk factor prevalence and impact

The purpose of this study is to compare mean levels of loneliness, and correlates of loneliness, among older adults in the U.S. and England. Comparisons are conducted after attending to comparability of the loneliness measure between countries based on tests for discriminatory capacity and differential item functioning of the 3-item UCLA Loneliness Scale. Cross-sectional data from the 2015–16 wave of the National Social Life, Health and Aging Project (NSHAP) and the 2014–2015 wave of the English Longitudinal Study on Ageing (ELSA) were analyzed using graded item response models and multiple indicators and multiple causes (MIMIC) models. Risk factors included demographic variables, health characteristics, and social characteristics that were harmonized across surveys. Because of differences in the racial-ethnic composition of the U.S. and England, analyses were limited to white respondents (N = 2624 in NSHAP; N = 6639 in ELSA). Only respondents born 1925–1965 were included in analyses. Discriminatory capacity was evident in each item being able to distinguish a lonely from a nonlonely individual. Differential item functioning (DIF) was evident in country differences in the likelihood of endorsing the “lack companionship” item at a given level of trait loneliness, and in DIF among marital status, education, and gender subgroups that were comparable across countries. Overall loneliness levels are equivalent in England and the U.S. Risk factor impact did not differ between countries, but differences in risk factor prevalence between countries combined to produce a net result of slightly lower mean levels of loneliness in older adults in England than in the U.S. after risk factor adjustment. The fact that the impact of risk factors were similar across countries suggests that evidence of successful interventions in one country could be leveraged to accelerate development of effective interventions in the other.

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Scale items differed in ability to distinguish between loneliness levels.

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Items functioned differentially by country and by individual characteristics.

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Overall loneliness among white older adults does not differ between countries.

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Risk factor impact on loneliness did not differ between countries.

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Loneliness levels are lower in England despite greater risk factor prevalence.

'People haven't got that close connection': meanings of loneliness and social isolation to culturally diverse older people

Objectives: Social isolation and loneliness among older people are known to have negative effects on health and wellbeing. Few studies, however, have enabled older people to define these concepts in their own terms. This paper based on research in Aotearoa, New Zealand is the first to comparatively outline the meanings of loneliness and social isolation from the perspective of four ethnically diverse groups of older adults (Māori, Pacific, Asian, and NZ European).Method: We interviewed 44 older people and conducted three focus groups with 32 older people. We used thematic and narrative analyses.Results: Loneliness and social isolation were conceptualized as interconnected concepts described as a 'look and feel', a 'state of mind' and as a 'lack of desired companionship'. Participants conveyed sophisticated understandings of the structural underpinnings of both loneliness and social isolation as multi-dimensional, complex, and situated.Conclusions: Older people describe complex and culturally- nuanced understanding and experience of social isolation and loneliness. More culturally appropriate services, greater mental-health support and more service provision on weekends and evenings are needed.

Qualitative evaluation of a community-based intervention to reduce social isolation among older people in disadvantaged urban areas of Barcelona

This study analyses participants' and coordinators' perceptions of the implementation process and perceived benefits of a community-based intervention to reduce social isolation among older adults. The 'School of Health for Older People' is a weekly community intervention that promotes resources among individuals and communities in order to enhance their ability to identify problems and activate solutions, encouraging participation in the community. A qualitative approach was employed, based on semi-structured interviews and focus groups (FGs). This study was carried out in Barcelona. Two coordinators (community nurses) and 26 community-dwelling people aged 65 and over who attended the School of Health for Older People in the neighbourhoods of Besòs and Guineueta, participated in in-depth interviews and FGs between January and February 2016. Views and experiences about the intervention were explored. The main perceived effects of the intervention were expanding knowledge of health issues and of community activities, encouraging participants to go out, giving them a feeling of being heard, and peer relationships, increasing participants' contacts and knowledge while the main negative features were related to repetition of certain contents. The benefits identified included learning something about health and their own neighbourhood and breaking the habit of staying at home. Social isolation might be prevented by increasing the number of contacts with peers and sharing a common interest, since it could help to give them a sense of belonging to a community.

Intolerance of Uncertainty and Loneliness in Older Adults During the COVID-19 Pandemic

OBJECTIVE

The COVID-19 pandemic imposed a psychological burden on people worldwide, including fear and anxiety. Older adults are considered more vulnerable during public health emergency crises. Therefore, the aim of the present study was to investigate the psychological response of older adults during the acute phase of the pandemic in Greece.

METHOD

This cross-sectional study was part of a larger three-day online survey. A total of 103 participants over the age of 60 fulfilled inclusion criteria. The survey included sociodemographic questions and six psychometric scales: the Fear of COVID-19 Scale (FCV-19S), the Brief Patient Health Questionnaire (PHQ-9) depression scale, the Generalized Anxiety Disorder scale (GAD-7), the Athens Insomnia Scale (AIS), the Intolerance of Uncertainty Scale (IUS-12), and the De Jong Gierveld Loneliness Scale (JGLS).

RESULTS

A significant proportion of the participants reported moderate to severe depressive symptoms (81.6%), moderate to severe anxiety symptoms (84.5%), as well as disrupted sleep (37.9%). Women reported significantly higher levels of COVID-19-related fear, more severe depressive symptoms and sleep disturbances, as well as higher levels of intolerance of uncertainty. Participants living alone showed higher levels of loneliness. Intolerance of uncertainty was shown to modulate levels of loneliness.

CONCLUSIONS

During the quarantine, attention was promptly drawn upon the risks related with older people's loneliness. Studies identifying factors that may contribute to loneliness during a public health emergency facilitate the implementation of supportive interventions. Preparedness to address and manage older people's loneliness may limit this deleterious emotional response during the pandemic, as well as at the post-COVID-19 phase.

Social Withdrawal and Loneliness Among Older Adult Athletes: A Case for Playing Alone

Some older adults may not receive social connection due to social withdrawal, potentially resulting in loneliness. The purpose of this study was to examine relationships between social withdrawal and loneliness, in the context of sports participation. The authors hypothesized that individuals who are more shy and avoidant would be more lonely than those who are less shy and avoidant, and that those who are unsocial would not necessarily be more lonely. The authors also hypothesized individual sport participation would further exacerbate loneliness over group sport participation. Results from participants in the Huntsman Senior Games (n = 374) indicated that as shyness, avoidance, and unsociability increased, loneliness increased as well. Furthermore, shy athletes in group sports reported higher levels of loneliness than those in individual sports. Although the authors seek to prevent individuals from being lonely in later life, there may be instances where removing oneself from a group is beneficial for mental health.

Loneliness and disability as predictors of oral diseases among 2 groups of older adults in central India

BACKGROUND

In this study, the authors aimed to assess the association of loneliness and disability with oral health in 2 groups older adults (≥ 60 years) in central India.

METHODS

A total of 421 older adults participated in the study; 316 (75.1%) attended outpatient services at the Department of Dentistry, All India Institute of Medical Sciences, Bhopal, India, and 105 (24.9%) were from old age homes. The authors used the Patients Reported Outcomes Measurement Information System's social isolation 8a short form to assess loneliness. Disability was assessed using the 12-item version of the self-administered World Health Organization Disability Assessment Scale. The authors conducted regression analyses to establish the association of loneliness and disability with the decayed, missing, and filled tooth index; periodontal disease; and edentulousness.

RESULTS

Poor oral health findings were noted in both groups. Eighty-eight (20.9%) participants had never visited a dentist, and 201 (88.5%) had unmet dental prosthetic needs. Loneliness and disability were associated with decayed, missing, and filled tooth index scores; periodontal disease; and edentulousness, with odds ratios of 1.86, 1.29, 2.37 and 4.63, 3.85, 3.63 respectively (P < .001). Age, sex, socioeconomic status, type of residence, tobacco use, and use of oral health care were also independent variables associated with oral health (P < .001).

CONCLUSIONS

Loneliness and disability were found to be significantly associated with oral health. The study results found poor oral health, low use of oral health care, and high unmet need for dental prosthetics in the 2 groups of older adults.

PRACTICAL IMPLICATIONS

Practicing dentists need to understand the significance of loneliness and social isolation on oral health. Interventions to reduce isolation and disability can be beneficial in improving the oral health of older adults.

A Systematic Review on Technology-Supported Interventions to Improve Old-Age Social Wellbeing: Loneliness, Social Isolation, and Connectedness

Background

This review studies technology-supported interventions to help older adults, living in situations of reduced mobility, overcome loneliness, and social isolation. The focus is on long-distance interactions, investigating the (i) challenges addressed and strategies applied; (ii) technology used in interventions; and (iii) social interactions enabled.

Methods

We conducted a search on Elsevier's Scopus database for related work published until January 2020, focusing on (i) intervention studies supported mainly by technology-mediated communication, (ii) aiming at supported virtual social interactions between people, and (iii) evaluating the impact of loneliness or social isolation.

Results

Of the 1178 papers screened, 25 met the inclusion criteria. Computer and Internet training was the dominant strategy, allowing access to communication technologies, while in recent years, we see more studies aiming to provide simple, easy-to-use technology. The technology used was mostly off-the-shelf, with fewer solutions tailored to older adults. Social interactions targeted mainly friends and family, and most interventions focused on more than one group of people. Discussion. All interventions reported positive results, suggesting feasibility. However, more research is needed on the topic (especially randomized controlled trials), as evidenced by the low number of interventions found. We recommend more rigorous methods, addressing human factors and reporting technology usage in future research.

Coping with being cooped up: Social distancing during COVID-19 among 60+ in the United States

Objectives.

This study examined the impact of sheltering in place and social distancing among adults aged 60 and older during the 2020 outbreak of COVID-19 in the United States.

Methods.

Using convenience sampling respondents were asked to complete a web-administered survey to explore impact of social distancing on loneliness, stress, and behavioral changes. The analytic sample consisted of 833 responses of persons aged 60 and older.

Results.

A large portion reported being stressed (36%), and/or being lonely (42.5%). Nearly 1/3 stated that their sense of loneliness increased during the time of social distancing. Respondents reported engaging in more solitary activity (and fewer in-person activities), using email and text messages more than usual, and spending more time on computers/tablet than usual. Approximately 2/3 reported using more social media than usual. These differed significantly by younger (age 60-70) and older (71+) respondents. Additionally, changes in physical activity, drinking, recreational drug use and sleeping pattern changes differed by age.

Conclusions.

Social distancing has significant consequences on loneliness and health behaviors among adults in the United States, many of which differ by age group. Results have implications for continued shelter in place practices, but also for any older adult that may be homebound for other reasons.

Trends in the Mortality Risk of Living Alone during Old Age in Sweden, 1992-2011

Objectives: This study investigates the association between living alone and mortality over a recent 19-year period (1992-2011). Method: Data from a repeated cross-sectional, nationally representative (Sweden) study of adults ages 77 and older are analyzed in relation to 3-year mortality. Results: Findings suggest that the mortality risk associated with living alone during old age increased between 1992 and 2011 (p = .076). A small increase in the mean age of those living alone is partly responsible for the strengthening over time of this association. Throughout this time period, older adults living alone consistently reported poorer mobility and psychological health, less financial security, fewer social contacts, and more loneliness than older adults living with others. Discussion: Older adults living alone are more vulnerable than those living with others, and their mortality risk has increased. They may have unique service needs that should be considered in policies aiming to support aging in place.

Is Living Alone "Aging Alone"? Solitary Living, Network Types, and Well-Being

Objectives

When identifying older adults who may be at risk of being without necessary supports, policy makers and scholars tend to focus on those living alone, neglecting differences within that group. We examine how their social networks contribute to subjective well-being, why some of them fare better and compare their well-being to older adults coresiding with others.

Method

Data are from the fourth wave of the Survey of Health and Retirement in Europe (N = 53,383). A network typology for older people living alone (N = 10,047) is constructed using a latent class analysis. Using ordinary least squares (OLS) regressions, we examined differences in subjective well-being (life satisfaction, satisfaction with social network, depression) by network type, adding adults coresiding with others (N = 43,336) as comparison group.

Results

We find four social network types among older adults living alone. The likelihood of having “restricted” and “child-based” networks is greater in Eastern and Southern European countries, whereas the likelihood of having “friend-oriented” networks is greater in Western and Northern European countries. Across countries, only those with “restricted” networks tend to have the poorest well-being. Those with “diverse” networks have even better well-being than coresiding older adults.

Discussion

Our study shows the importance of drawing distinctions within the group of older adults living alone. Most (two thirds) are not vulnerable and at risk, but fare just as well or even better than peers who coreside with others. Country-level factors shape the opportunities to build satisfactory networks, but subjective well-being depends more strongly on individual resources, including social networks, than country-level factors.

"Left Like Stones in the Middle of the Road": Narratives of Aging Alone and Coping Strategies in Rural Albania and Bulgaria

OBJECTIVES

We explore and compare older adults' lived experiences and coping strategies in two postcommunist countries-Albania and Bulgaria. Wholesale youth outmigration and economic and institutional regional decline have led to decaying rural areas where older adults become "abandoned." Aging alone, as couples or widowed, they are socially marginalized and in constant search for coping mechanisms which enable them to survive.

METHODS

We adopt a social-psychology theoretical framework which distinguishes between problem-focused and emotion-focused coping. Data include 28 in-depth interviews with older residents and participant observation in selected rural areas of the two countries.

RESULTS

In both countries, rural social isolation is expressed as a lack of close family ties-mainly due to the removal through outmigration of children and grandchildren-and detachment from society at large. The most prevalent coping mechanism consists of practical and emotional support from non-kin ties, especially neighbors. Remittances help to resolve material needs, especially in Albania, where most rural young people migrate abroad. In both settings, a range of emotion-focused coping strategies were identified, including perceptions of decreased needs, lowered expectations about relationships, and satisfaction at the achievements of the younger generations.

DISCUSSION

Similarities between research findings in Albania and Bulgaria reflect their shared political and institutional history. Although few, differences relate to a combination of contrasting migration and cultural patterns. In both settings problem- and emotion-focused adaptive strategies are overlapping, and successful aging efforts seem to be of a communal rather than an individualistic nature.

Alternatives to Aging Alone?: "Kinlessness" and the Importance of Friends Across European Contexts

OBJECTIVES

Increasing numbers of older adults cross-nationally are without children or partners in later life and therefore likely have greater reliance on nonkin (e.g., friends). This pattern may be particularly pronounced in country contexts that emphasize friendship. This article hypothesizes that those who lack kin (e.g., children, partners) and/or who live in countries with a stronger emphasis on friendship have more friends in their networks. Although these hypothesized patterns are consistent with interdisciplinary literatures, they have not been tested empirically and therefore remain overlooked in current "aging alone" narratives.

METHOD

This study combines individual-level data from the Survey of Health, Ageing, and Retirement in Europe (Wave 6) with nation-level data from the European Values Survey to estimate multilevel negative binomial models exploring number of friends among those aged more than 50 years who lack kin across 17 countries.

RESULTS

Older adults who lack kin or whose kin are unavailable report more friends in their networks, particularly in countries with a higher percentage of people who believe that friends are "very important" in life.

DISCUSSION

This article challenges dominating assumptions about "aging alone" that rely heavily on lack of family as an indicator of "alone." Future studies of "kinlessness" should consider the extent to which friendship is correlated with lack of kin, particularly in more socioeconomically developed countries. Previous research on "aging alone" may have overestimated risk in more privileged countries that already emphasize friendship, but underestimated risk in family-centered countries where "kinlessness" and alternative sources of support are less common.

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

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

Relationships of self-management abilities to loneliness among older people: a cross-sectional study

BACKGROUND

We investigated relationships of broader self-management abilities (self-efficacy, positive frame of mind, investment behavior, taking initiatives, multifunctionality of resources, variety of resources) to social and emotional loneliness among community-dwelling older people while controlling for background characteristics.

METHODS

This cross-sectional study employed a representative sample of 41,327 community-dwelling people aged ≥55 years in Limburg, the Netherlands, identified using the population register (weighted per district, complex sampling design). In total, 20,327 (50%) people responded to the questionnaire.

RESULTS

All self-management abilities were associated negatively with emotional loneliness. Taking initiatives, multifunctionality, self-efficacy, and a positive frame of mind were associated negatively with social loneliness. Self-efficacy had the strongest relationships with social and emotional loneliness.

CONCLUSIONS

In combatting loneliness among older people, investment in their ability to self-manage their social lives and activities, such as increasing opportunities for positive social interaction and social support and reducing maladaptive cognition, seems to be crucial.

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

OBJECTIVES

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSION

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

Prevalence of loneliness and association with depressive and anxiety symptoms among retirees in Northcentral Nigeria: a cross-sectional study

BACKGROUND

Retirees face numerous challenges, including disassociation from persons in their social networks in Nigeria. Perceived social isolation or loneliness could impair the quality of life in old age, and lead to mental disorders. However, it is uncertain whether perceived loneliness has an independent association with depressive and anxiety symptoms and comorbid conditions in Nigerian retirees. Therefore, we aimed at examining the association between perceived loneliness, depressive and anxiety symptoms, including comorbid conditions among retirees in Northcentral Nigeria.

METHODS

This community-based cross-sectional study enrolled retirees aged 60 years and above in different pension zones from February 2019 to August 2019. A two-stage sampling procedure was used to select the study participants. Data on perceived loneliness, depressive, and anxiety symptoms were collected using the 8-item University of California, Los Angeles Loneliness Scale (ULS-8), and the DASS 21-depression and anxiety subscales, respectively. We collected information on the demographic characteristics using a well-validated structured questionnaire. Descriptive statistics, binary and multivariable logistic regression were used to examine the independent associations between loneliness, depression, anxiety, and anxious depression. P-values below 0.05 were considered statistically significant.

RESULTS

The mean age of participants was 71.3 (± 6.01) years, and 54.4% were men. The prevalence of loneliness, depression, anxiety, and anxious depression was 21.8, 52.0, 27.7, and 20.5%, respectively. Retirees with depression or anxiety symptoms perceived that they were lonelier than those without depression or anxiety. The multivariable logistic regression model showed that female gender (AOR 1.49; 95% CI (1.09, 2.00), having secondary education (AOR 2.24, 95% CI (1.40, 3.57) and having higher education (AOR 3.82, 95%CI (2.37, 6.16) were significantly associated with depression. Also, lonely retirees are 1.19 times (AOR 1.19; 95% CI (0.84, 1.69) more likely to be depressed compared to retirees that are not lonely, and the anxious depressed retirees are 314.58 times (AOR 314.58; 95% CI (508.05, 1941.70) more likely to be depressed than those without anxious depression.

CONCLUSION

The prevalence of loneliness, depression, anxiety, and anxious depression were relatively high among the older retirees. Female gender and advanced age were significantly associated with perceived loneliness, depression and anxiety.

Examining social isolation and loneliness in combination in relation to social support and psychological distress using Canadian Longitudinal Study of Aging (CLSA) data

BACKGROUND

Although a large body of research has focused on social isolation and loneliness, few studies have examined social isolation and loneliness together. The objectives of this study were to examine: 1) the relationship between four groups derived from combining social isolation and loneliness (socially isolated and lonely; only socially isolated; only lonely; neither socially isolated nor lonely) and the desire for more social participation, and social support; and 2) the relationship between the four groups and psychological distress.

METHODS

The study was based on the Comprehensive Cohort of the Canadian Longitudinal Study on Aging. Using CLSA baseline data (unweighted N = 30,079), ordinary and logistic regression analysis was used to examine the cross-sectional relationship between the four social isolation/loneliness groups and desire for more social participation and four types of social support (tangible, positive interaction, affection, and emotional support). Prospective logistic regression analysis was possible for psychological distress, which was derived from the Maintaining Contact Questionnaire administered about 18 months after the baseline questionnaire (unweighted N = 28,789).

RESULTS

Findings indicate that being socially isolated and lonely was associated with the most social support gaps; this group also had an increased likelihood of psychological distress, relative to those who were neither socially isolated nor lonely. Participants who were only socially isolated, and those only lonely also perceived some social support gaps. In addition, the only lonely group was more likely to be psychologically distressed than the only socially isolated group and the neither isolated nor lonely group.

CONCLUSION

Examining the four social isolation/loneliness was useful, as it provided more nuanced risk profiles than would have been possible had we examined social isolation and loneliness separately. Findings may suggest avenues for interventions tailored to the unique needs of at-risk individuals.

Development and validation of a 6-item Revised UCLA Loneliness Scale (RULS-6) using Rasch analysis

OBJECTIVE

The UCLA Loneliness Scale, containing 20 items, is one of the commonly used loneliness scales. Some shorter versions have been developed using factor analysis. The study aimed to shorten the UCLA Loneliness Scale using Rasch and factor analysis methods and test the psychometric properties of the new scale.

METHODS

The full sample of the study included 719 respondents, divided into three subsamples (205, 324, and 190 for samples 1-3, respectively). The original, 20-item Revised UCLA Loneliness Scale (R-ULS) was shortened using 205 students (sample 1); the shortened scale was then validated for construct and concurrent validity with 324 students (sample 2) and 190 clinical participants (sample 3). Confirmatory factor analysis and Rasch analysis were used for construct validity. Convergent, discriminant, and concurrent validity were assessed by exploring the correlation with other psychological measurements.

RESULTS

In sample 1, the R-ULS was shortened to a 6-item scale (RULS-6) that fits the Rasch model. The RULS-6 met the criteria of unidimensionality and local independence without differential item functioning due to age and sex, and good targeting the clinical sample. Person Separation Index (PSI) reflected that reliability from the Rasch perspective was acceptable. However, collapsing categories 2 (sometime) and 3 (rarely) may be required in a clinical sample. When tested in samples 2 and 3, the RULS-6 fits the Rasch measurement model. Convergent and discriminant validity were demonstrated with interpersonal problems and attachment scales. As expected, a positive correlation was found between RULS-6 and anxiety, depression subscale, interpersonal difficulties, and somatization subscales denoting concurrent validity. Cronbach's alpha of the RULS-6 was good (.83).

CONCLUSION

Using Rasch analysis, the proposed RULS-6 constituted a 70% reduction of the number of original items, yet preserved the psychometric properties in independent samples of students and psychiatric outpatients. Statement of contribution What is already known on this subject? The UCLA Loneliness Scale is a common instrument used to gauge loneliness levels. The 20-item revised scale (R-ULS) has acceptable psychometric properties but its construct varies. Due to the length of the questionnaire, administration of R-ULS is not always practical. Short versions vary in items and were developed with classic test theory (e.g., factor analysis). Rasch analysis - providing more accuracy based on measurement theory - could be used instead. What does this study add? Using a Rasch analysis approach, a 6-item scale of loneliness (RULS-6) was created. The RULS-6 was tested in student and clinical samples, meeting Rasch measurement model criteria. The RULS-6 showed promising psychometrics to be used in both non-clinical and clinical samples.

Mortality risk of loneliness in the oldest old over a 10-year follow-up

Objective: To investigate the impact of loneliness on all-cause mortality in the oldest old population over a 10-year follow-up.Method: Participants were from the third wave of the Cambridge City over-75s Cohort (CC75C) study, a population-based longitudinal study of older people aged 75 or over. Loneliness was measured two further times. At each wave, participants were asked how often they felt lonely and the answers were divided into three levels: not lonely, slightly lonely and lonely. The relationship between loneliness and all-cause mortality was examined using Cox regression with loneliness as a time-varying predictor. The association was adjusted for socio-demographic factors, number of chronic diseases, functional ability and depression.Results: Seven hundred thirteen participants were seen at wave 3 (out of 2166 at baseline), of whom 665 had data on loneliness. The prevalence of feeling slightly lonely and lonely was 16% and 25%, respectively. Vital status was followed for a further 10 years. A total of 562 participants died during the follow-up. After adjusting for age, sex and other socio-demographic factors, loneliness was associated with a 20% increased risk of mortality (HR: 1.2, 95% CI: 1.0-1.6). The association was disappeared after further adjusting for health conditions and depression (HR: 1.0, 95% CI: 0.8-1.4). Individuals who reported being slightly lonely were not at risk of mortality.Conclusions: The association between loneliness and mortality was fully explained by health conditions, suggesting that in the very old age, health problem is the proximal risk factor for mortality.

Are U.S. older adults getting lonelier? Age, period, and cohort differences

Media portrayals of a loneliness "epidemic" are premised on an increase in the proportion of people living alone and decreases in rates of civic engagement and religious affiliation over recent decades. However, loneliness is a subjective perception that does not correspond perfectly with objective social circumstances. In this study, we examined whether perceived loneliness is greater among the Baby Boomers-individuals born 1948-1965-relative to those born 1920-1947 and whether older adults have become lonelier over the past decade (2005-2016). We used data from the National Social Life, Health and Aging Project and from the Health and Retirement Study collected during 2005-2016 to estimate differences in loneliness associated with age, birth year, and survey time point. Overall, loneliness decreased with age through the early 70s, after which it increased. We found no evidence that loneliness is substantially higher among the Baby Boomers or that it has increased over the past decade. Loneliness is, however, associated with poor health, living alone or without a spouse-partner, and having fewer close family and friends, which together accounted for the overall increase in loneliness after age 75. Although these data do not support the idea that older adults are becoming lonelier, the actual number of lonely individuals may increase as the Baby Boomers age into their 80s and beyond. Our results suggest that attention to social factors and improving health may help to mitigate this. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Influence of Outdoor Living Environment on Elders’ Quality of Life in Old Residential Communities

The population is getting older in Mainland China, which presents a huge challenge of how to support these increasing elders to enjoy a high quality of life (QoL). Due to the limited nursing institutions and Chinese traditional culture, aging in place is the most common choice for elders. Up to now, most elders in cities are living in old residential communities (ORCs) rather than new ones. Poor quality of outdoor living environment (OLE) in these ORCs cannot well support the daily life of the elders, especially for those with physical problems. A questionnaire study was conducted to explore the influence of OLE on the QoL of elders living in ORCs. A total of 107 questionnaires were completed by both elderly residents in ORCs (45.79% were male and 54.21% were female). The data was analyzed by a mix of reliability analysis, correlation analysis, and regression analysis. The results showed that physical health of elders was influenced by distance, safety, greenery, seat, recreational facilities; psychological health was predicted by width, height, and greenery; social relationship was affected by distance, safety, and recreational facilities. Based on the research results, recommendations were proposed to property management service providers and local governments, including providing more seats at a reasonable height, setting handrails alongside the long ramp, installing folding seats along building stairs, and so on.

Typology of Social Network Structures and Late-Life Depression in Low- and Middle-Income Countries

Background:

Rapid social changes and youth migration ensures a continuous drain on the social networks of the elderly in Low- and Middle-Income Countries (LMICs).

Objective:

We reviewed available literature on the relationship between social network structures and depression among community dwelling older persons in LMICs with a view to identifying patterns that might provide information for designing preventive psychosocial interventions.

Methods:

We searched the MEDLINE database through Pubmed, extracted information on the typologies of social network structures in LMICs and identified dimensions with the strongest systematic association with late-life depression, by weight, using the inverse of variance method. All analyses were conducted using the Cochrane review manager version 5.3.

Results:

Fourteen community-based surveys drawn from 16 LMIC contexts met criteria for syntheses. They included a total of 37,917 mostly female (58.8%) participants with an average age of 73.2 years. Social network size, contact with network, diversity of network, co-residency with own child, having more friends than family in the network, and prestigious standing of persons in the social network were protective structures against late-life depression. Conversely, low network diversity contributed 44.2% of the weight of all social network structures that are predictive of late-life depression.

Conclusion:

Recommendations are made for the design of new measures of social network structures in LMICs that captures the key dimensions identified. Epidemiological studies using such tools will provide more precise information for planning and prioritization of scarce resources for the prevention of late-life depression in LMICs.

On the Suitability and Potential of Nursing Care Discussion Forums as a Health Promotion Measure for Long-Distance Caregiving Relatives: Evidence from Upper Austria

Background: The number of persons who have to overcome extensive geographical distances for caring for their older parent(s), hereinafter referred to as long-distance caregiving relatives (LDCs), is rising. However, in the non-English-speaking Global North, little is known about the LDCs’ health literacy and the design of tailor-made health promotion measures for this target-group. Using the example of nursing care discussion forums (NCDF), this paper reflects the requirements and (future) potential of professionally-lead support groups for LDCs on the case-study example of Upper Austria. Methods: In order to approach this unexplored topic considering spatial-related aspects, a qualitative-explorative study design was chosen, focusing on the providers’ perspective. A written survey among all NCDF-group leaders was carried out. Results: LDCs do not make use of NCDFs at present. It is considered that this is above all for time constraints, lack of information and location-based problems of fit. This applies for urban as well as rural contexts. Conclusions: LDCs need more attention in public health. Suitable NCDFs have to be located in the LCDs’ residential municipalities and have to fulfill different requirements from those of local caregiving relatives, particularly with regard to purpose and scope.

‘A lonely old man’: empirical investigations of older men and loneliness, and the ramifications for policy and practice

Loneliness has become an issue of significant academic, public and policy focus. There has been much research on experiences of loneliness in later life and many accompanying interventions targeting lonely older people. However, there has been a dearth of research on the impact that loneliness can have on older men and the resulting implications for policy and practice. This paper aims to redress this by developing a theoretical framework to improve understanding of older men's constructions and experiences of loneliness. It draws on two qualitative empirical studies: the first explores older men's perceptions of masculinity and loneliness; and the second looks at the effectiveness of a service for older men which was designed to alleviate loneliness among older people more generally. The paper outlines the way in which older men often construct masculinity as an oppressive (hegemonic) requirement, but which can be reformed into ‘positive’ traits of ‘strength of mind’, ‘responsibility’, ‘caring’, ‘helping out’, ‘doing a favour’ and ‘giving something back’, with a consistent yet implicit assumption that enactment of these denotes a ‘proud’ masculine identity. Loneliness, on the other hand, is represented as a subordinate social role, both non-masculine and related to marginalising stereotypes of age. This results in the identification of two important implications for the way in which services can assist in the alleviation of loneliness in older men: that men are more likely to engage with a service that can facilitate the construction of a ‘proud’ masculine identity; and that services which deconstruct hegemonic masculinities, particularly by providing a space where men feel comfortable being emotionally tactile, are likely to be most effective at both alleviating loneliness and promoting overall wellbeing.

High prevalence and adverse health effects of loneliness in community-dwelling adults across the lifespan: role of wisdom as a protective factor

OBJECTIVES

This study of loneliness across adult lifespan examined its associations with sociodemographics, mental health (positive and negative psychological states and traits), subjective cognitive complaints, and physical functioning.

DESIGN

Analysis of cross-sectional data.

PARTICIPANTS

340 community-dwelling adults in San Diego, California, mean age 62 (SD = 18) years, range 27-101 years, who participated in three community-based studies.

MEASUREMENTS

Loneliness measures included UCLA Loneliness Scale Version 3 (UCLA-3), 4-item Patient-Reported Outcomes Measurement Information System (PROMIS) Social Isolation Scale, and a single-item measure from the Center for Epidemiologic Studies Depression (CESD) scale. Other measures included the San Diego Wisdom Scale (SD-WISE) and Medical Outcomes Survey- Short form 36.

RESULTS

Seventy-six percent of subjects had moderate-high levels of loneliness on UCLA-3, using standardized cut-points. Loneliness was correlated with worse mental health and inversely with positive psychological states/traits. Even moderate severity of loneliness was associated with worse mental and physical functioning. Loneliness severity and age had a complex relationship, with increased loneliness in the late-20s, mid-50s, and late-80s. There were no sex differences in loneliness prevalence, severity, and age relationships. The best-fit multiple regression model accounted for 45% of the variance in UCLA-3 scores, and three factors emerged with small-medium effect sizes: wisdom, living alone and mental well-being.

CONCLUSIONS

The alarmingly high prevalence of loneliness and its association with worse health-related measures underscore major challenges for society. The non-linear age-loneliness severity relationship deserves further study. The strong negative association of wisdom with loneliness highlights the potentially critical role of wisdom as a target for psychosocial/behavioral interventions to reduce loneliness. Building a wiser society may help us develop a more connected, less lonely, and happier society.

Social networking sites and the experience of older adult users: a systematic review

This study aimed to systematically review the use of social networking sites (SNSs) from an older adult perspective (all papers had an average sample age of 65+ and samples ranged in age from 50 to 98). Characteristics of older adult SNS users, incentives and disincentives for use, and the relationship between SNS use, wellbeing and cognitive function were explored. From a systematic search, 21 papers met inclusion criteria and were subjected to a quality review. Paper quality was often low or medium, as rated by a standard quality assessment framework. Results indicated that older adult SNS users were more likely to have particular characteristics, including being female and younger. The main incentive for use was to maintain contact with family and friends. Disincentives included privacy concerns and lack of perceived usefulness. The relationship between SNS use, wellbeing and cognitive function was inconclusive. SNS use is a multi-dimensional phenomenon that needs to be understood in the context of broader communication practices, individuals’ social relationships, and individual preferences and characteristics.

Comparisons of the discrepancy between loneliness and social isolation across Ireland and Sweden: findings from TILDA and SNAC-K

PURPOSE

Loneliness may have different cultural meanings in different countries. This may manifest as differing levels of Social Asymmetry-the discrepancy between loneliness and social isolation. Since loneliness is thought to be low in Sweden relative to more southerly countries, we hypothesised that more number of individuals would also fall into the "discordant robust" category of Social Asymmetry, i.e. that more individuals in Sweden would have lower loneliness levels relative to social isolation than in Ireland. We also explored the clinical relevance of Social Asymmetry in both countries, by examining its association with cognitive functioning.

METHODS

We derived Social Asymmetry metrics in two representative cohort studies: the Irish Longitudinal Study on Ageing (TILDA) and the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Data pertaining to a dementia-free sample of 4565 Irish participants and 3042 Swedish participants, all aged over 60 years, were analysed using a multilevel modelling approach, with country as a higher-order variable.

RESULTS

Contrary to the expected, more individuals in Ireland were "discordant robust" than in Sweden. We also found evidence for superior performance in global cognitive functioning among those in the "discordant robust" category relative to those in the discordant susceptible (i.e. those with higher levels of loneliness than social isolation) category, β = 0.61, p < .001, across both countries.

CONCLUSIONS

Irish older adults may be more robust to the impact of social isolation on loneliness than those in the Swedish cohort. Social Asymmetry was related to cognitive functioning in both countries, suggesting that Social Asymmetry is a clinically relevant construct.

Differential impact of transient and chronic loneliness on health status. A longitudinal study

Objective: Loneliness is associated with worse health status outcomes. Yet, the present study is one of the first to identify how patterns of loneliness (transient and chronic) are associated with health over time. Design: A total of 2,390 individuals were interviewed in 2011-2012 and 2014-2015 in a follow-up study conducted over a nationally representative sample of Spain. After confirming a longitudinal relationship between loneliness and health status, a growth curve mixture modeling was used to examine health trajectories. Main outcome measures: The three-item UCLA Loneliness Scale was used to assess loneliness. Health status was measured with self-reported questions regarding ten domains (vision, mobility, and self-care, among others), and seven measured tests (including grip strength, walking speed and immediate and delayed verbal recall). Results: A quarter of participants were lonely at baseline. Both the group of transient and chronic loneliness showed a negative significant relationship with health status at follow-up, (β = -0.063 and β = -0.075 respectively, p < 0.001). Nevertheless, the health status did not change across time in any group. Conclusion: People experiencing chronic loneliness had the worst health status. Different patterns of loneliness could benefit from the appropriate interventions.

Loneliness and social support: Differential predictive power on depression and satisfaction in senior citizens

The lack of social support and the feelings of loneliness among older adults are associated with physical and mental health negative outcomes. This study attempts to test for their differential predictive power on depression and satisfaction in seniors. Data were drawn from a sample of 335 older adults ranging from 55 to 80 years old, with a mean age of 63.97 years (standard deviation = 5.56) attending a learning program at the University of Valencia during the academic year 2014-2015. In addition to health and wellbeing outcomes, we used the Functional Social Support Questionnaire DUKE-UNC, and two scales of loneliness, the de Jong Gierveld Loneliness Scale and the University of California Loneliness Scale version 3. Using structural equations models with Mplus, two models were proposed to assess the predictive power of social support and loneliness on wellbeing outcomes, specifically life satisfaction and depression, while controlling for health. Results confirm the negative association between loneliness and satisfaction with life and the positive one with depression.

Is loneliness associated with increased health and social care utilisation in the oldest old? Findings from a population-based longitudinal study

OBJECTIVES

The present study aimed to examine the impact of loneliness on health and social care service use in the oldest old over a 7-year follow-up.

DESIGN

Prospective study.

SETTING

UK population-based cohort.

PARTICIPANTS

713 people aged 80 years or older were interviewed at wave 3 of the Cambridge City over-75s Cohort Study. Of these, 665 provided data on loneliness. During 7 years' follow-up, 480 participants left the study, of which 389 due to death. 162 still in the study answered the loneliness question.

MAIN OUTCOME MEASURE

Use of health and social care services, assessed at each wave from wave 3 to wave 5.

RESULTS

At wave 3, of 665 participants who had data on loneliness, about 60% did not feel lonely, 16% felt slightly lonely and 25% felt lonely. Being slightly lonely at wave 3 was associated with a shorter time since last seeing a general practitioner (β=-0.5, 95% CI: -0.8 to -0.2); when examining the association between time-varying loneliness and health and social care usage, being lonely was associated with three times greater likelihood of having contact with community nurses and using meals on wheels services (community nurse contact: incidence rate ratio (IRR)=3.4, 95% CI: 1.4 to 8.7; meals on wheels service use: IRR=2.5, 95% CI: 1.1 to 5.6). No associations between loneliness and other health and social care services use were found.

CONCLUSION

Loneliness was a significant risk factor for certain types of health and social care utilisations, independently of participants' health conditions, in the oldest old. Study findings have several implications, including the need for awareness-raising and prevention of loneliness to be priorities for public health policy and practice.

Precarity and the assumption of rising insecurity in later life: a critique

In recent years, several authors have drawn attention to signs of growing inequalities in the ageing populations of the developed economies. Such formulations have employed the concept of precariousness to suggest that a ‘new’ precarity has emerged in old age. Questioning this position and drawing on data reported over the last two decades on income and health inequalities between and within retired and working-age households, the present paper argues that evidence of this ‘precarity’ is speculative at most and relates more to imagined futures than to empirically observed trends in the present. The ageing of ageing societies – that is the growing agedness of the older population – might imply an increase in precarity or vulnerability at older ages, but this is not a result of changes in the underlying economic and social relations of society. Instead, we would contend that it is the corporeal consequences of living longer. By conflating the various meanings of ‘precarity’ there is a corresponding danger that the very real changes brought about by population ageing will be underplayed, which may be to the detriment of the most vulnerable. The idea of a new precarity in later life may thus not serve the ends to which it is intended.

Needs of the Aging LGBT Community in Israel

Since the late 1980s, there have been changes in attitudes toward the LGBT (lesbian, gay, bisexual, and transgender) community in Israel. Nevertheless, the service system for the elderly is largely characterized by heteronormativity and relies on family members to help their elderly relatives. Goal: To examine the difficulties experienced by old LGBT people, particularly in receiving health and social services. Method: A total of 104 LGBT people aged 55+ years responded to a structured online questionnaire. Findings: Compared with the general elderly population, elderly LGBT people have fewer support networks, they tend to live alone, and suffer from tremendous loneliness. They are afraid of coming out to health and social service providers and of functional dependency, particularly due to their fear of disclosing their sexual orientation or gender identity, the barriers to receiving help, and the absence of family support to assist them.

Loneliness correlates and associations with health variables in the general population in Indonesia

Background

Loneliness has been commonly reported in high-income countries, while less is known about loneliness in Association of the Southeast Asian Nations (ASEAN) member states, in particular in Indonesia.

Objective

The aim of the study was to estimate the prevalence of loneliness, its correlates and associations with health variables in a national survey in the general population in Indonesia.

Methods

In the Indonesia Family Life Survey (IFLS-5) in 2014–2015, 31,447 participants 15 years and older (median age 35.0 years, interquartile range = 22.0) were interviewed and examined in a national population-based cross-sectional study. The self-reported prevalence of loneliness, blood pressure, body height and weight, physical and mental health, health behaviour and psychosocial variables were measured. Multinomial logistic regression analyses were used to estimate determinants of loneliness and logistic and linear regression analyses were applied to estimate the associations of loneliness with physical, mental and health risk behaviour variables.

Results

The self-reported prevalence of loneliness (occasionally or all of the time or 3–7 days per week) was 10.6% (11.0% for females and 10.1% for males), and 8.0% reported sometimes (1–2 days/week) to be lonely. Loneliness was distributed in a slight U-shaped form, with adolescents and the oldest old having the highest prevalence of loneliness. In adjusted multinomial logistic regression analysis, lower education, lower economic status, adverse childhood experiences, having one or more chronic conditions, functional disability and low neighbourhood trust were associated with loneliness. Loneliness was significantly associated with most health variables, including self-reported unhealthy health status (AOR 1.70, CI 1.57, 1.84), cognitive functioning (Beta: − 0.72, CI − 0.90 to − 0.54), having one or more chronic medical conditions (AOR 1.25, CI 1.16, 1.35), having had a stroke (AOR 1.58, CI 1.08, 2.29), depression symptoms (Beta: 5.19, CI 4.98–5.39), sleep disturbance (Beta: 0.34, CI 0.31–0.37), sleep related impairment (Beta: 0.69, CI 0.64–0.73), low life satisfaction (AOR 1.78, CI 1.64, 1.93), out-patient health care utilization in the past 4 weeks (AOR 1.11, CI 1.01, 1.21), current tobacco use (AOR 1.42, CI 1.28, 1.58), and one or more days in the past week soft drink consumption (AOR 1.20, CI 1.10, 1.31).

Conclusion

Loneliness was found to be prevalent across the life span and was associated with a number of poorer health variables. Several factors associated with loneliness were identified, which warrant further research in Indonesia.

Swimming Against the Stream: Non-normative Family Transitions and Loneliness in Later Life Across 12 Nations

Background and Objectives

Relatively little research investigated whether experiences during young adulthood have long-lasting consequences for older age loneliness. This article examines whether deviations from culturally based scripts regarding family transitions represent risk factors for later-life loneliness. Moreover, it analyzes whether and in which conditions long-term associations between family transitions and loneliness differ across nations.

Research Design and Methods

The analyses use micro-level data from the Generations and Gender Survey Wave 1 for 12 European countries. The sample comprises 61,082 individuals aged 50–85. The research questions are addressed using a step-wise approach based on linear regression analyses, meta-analyses, and meta-regressions.

Results

Results show that never having lived with a partner and childlessness are most strongly related to later-life loneliness. Whereas early transitions are unrelated to later-life loneliness, the postponement of partnership, and parenthood are associated with higher levels of loneliness compared to having experienced these transitions “on-time”. Childlessness is more strongly associated with later-life loneliness in more traditionalist countries than in less traditionalist ones.

Discussion and Implications

This study reveals that individuals with non-normative family transitions are more exposed to loneliness in old age, and that this exposure is related to societal context. In traditionalist contexts, where people rely on families for support, older adults who have experienced non-normative family behavior, and childlessness in particular, may be particularly at risk of loneliness.

Social relationship adversities throughout the lifecourse and risk of loneliness in later life

Understanding how social experiences throughout life shape later loneliness levels may help to identify how to alleviate loneliness at later lifestages. This study investigates the association between social relationship adversities throughout the lifecourse and loneliness in later life. Using prospective data from the Medical Research Council National Survey of Health and Development (N = 2,453), we conducted multivariable analyses to investigate independent, cumulative and moderated effects between the number of social relationship adversities experienced in childhood, mid-adulthood and later adulthood and the feeling of loneliness at age 68. We examined interactions between social relationship adversities and current quantity and quality aspects of social relationships. We found evidence of a step-dose response where greater exposure to social relationship adversities experienced at three earlier lifestages predicted higher loneliness levels in later life with more recent social relationship adversities more strongly related to loneliness. The results also demonstrated support for exacerbation and amelioration of earlier adverse social relationship experiences by current social isolation and relationship quality, respectively. This study suggests that social relationship adversities experienced throughout the lifecourse continue to influence loneliness levels much later in life. A key finding is that adverse social relationship experiences in earlier life may explain why otherwise socially similar individuals differ in their levels of loneliness. Implications for policy and research are discussed.

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

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