Differences in late-life loneliness: a comparison between Turkish and native-born older adults in Germany

Systematic review of factors influencing loneliness in older-adult migrants

OBJECTIVES

Older-adult migrants constitute a proportion of the global population, and loneliness hinders their adaptation to host areas. However, review studies on risk factors for loneliness target general older-adults without focusing on older-adult migrants. Therefore, this study systematically reviews and synthesizes the factors influencing the loneliness of older-adult migrants.

METHOD

Five databases were searched and screened for quantitative studies investigating the relationship between risk factors and loneliness among older-adult migrants (over age 50). Finally, 35 articles were included.

RESULTS

Factors related to loneliness in older-adult migrants were synthesized into sociodemographic, physical health, psychological, interpersonal, and acculturation-related factors. Consistent significant relationships with loneliness were found for a few risk factors, including not having spouses, low subjective financial status, poor self-rated health, poor psychological status, few non-kin ties, low quality of kin and non-kin ties, and a weak sense of belonging to either one's ethnic group or that of the host areas.

CONCLUSION

This review discusses the unique findings on the risk factors for loneliness in older-adult migrants. Additionally, the current literature on loneliness in older-adult migrants has some research gaps, calling for longitudinal studies with a rigorous design.

Gender Differences in Social Embeddedness Determinants of Loneliness Among Moroccan and Turkish Older Migrants

OBJECTIVES

Moroccan and Turkish migrants residing in Northwestern Europe have high loneliness levels. This study examines gender differences in loneliness within this migrant population. The migrants have gender-segregated social roles at home and in public, which might lead to gender differences in what aspects of social relationships can explain variation in loneliness.

METHODS

Respondents are from the Longitudinal Aging Study Amsterdam with 446 first-generation Moroccan and Turkish migrants in the Netherlands, aged between 55 and 66 years. We use interaction effects to test for gender differences in determinants of loneliness.

RESULTS

Men and women have a similar, moderate level of loneliness. Having a spouse and receiving care from children are more strongly related with lower loneliness levels in men than in women. Coethnic ties play an equally important role for men and women. In men, frequent mosque attendance is related with greater loneliness, but not in women.

DISCUSSION

Family ties are more protective against loneliness for older men than for older women, possibly indicating that migrant women's expectations regarding family go above and beyond having a spouse, receiving intergenerational care, or having frequent contact with children. In addition, migrant older men's higher expectations regarding a public social life could make their social life in the Netherlands less fulfilling, resulting in greater loneliness.

Doing old(er) age in a translocal context: Turkish-born women's experiences of ageing, care and post-mortem care practices

This article elaborates on how Turkish-born women in Sweden do old age in relation to gender and migrancy and aims to understand the fluid process of doing over their life course. It draws upon 20 in-depth and semi-structured interviews with Turkish-born women aged 60-78 and aims to address the tensions between agency and intersecting power positions. Theoretically, the article relies on critical feminist gerontology and doing old age to address the negotiations and performances of the interviewed women. The findings show that there are several ambivalences and dilemmas in how the women do old age in a transnational setting. Intergenerational and gendered old age care comes to fore as a significant negotiation site. The women negotiate identity categories with both imagined others and the social actors in their lives (such as their children) over their life course, which implies the situated and relational aspect of doing old age.

The Migrant-Local Difference in the Relationship Between Social Support, Sleep Disturbance, and Loneliness Among Older Adults in China: Cross-Sectional Study

BACKGROUND

Driven by the accelerated aging of the population of China, the number of older adults has increased rapidly in the country. Meanwhile, following children, migrant older adults (MOA) have emerged as a vulnerable group in the process of fast urbanization. Existed studies have illustrated the association between social support and loneliness and the relationship between sleep disturbance and loneliness; however, the underlying mechanisms and the migrant-local difference in the association between social support, sleep disturbance, and loneliness have not been identified.

OBJECTIVE

This study aimed to clarify the migrant-local difference in the relationship between social support, sleep disturbance, and loneliness in older adults in China.

METHODS

Multistage cluster random sampling was used to select participants: 1205 older adults (n=613, 50.9%, MOA and n=592, 49.1%, local older adults [LOA]) were selected in Weifang City, China, in August 2021. Loneliness was assessed with the 6-item short-form University of California, Los Angeles Loneliness Scale, social support was evaluated with the Social Support Rating Scale, and sleep disturbance was measured with the Pittsburgh Sleep Quality Index. The chi-square test, t test, and structural equation modeling (SEM) were adopted to explore the migrant-local difference between social support, sleep disturbance, and loneliness among the MOA and LOA.

RESULTS

The mean score of loneliness was 8.58 (SD 3.03) for the MOA and 8.00 (SD 2.79) for the LOA. SEM analysis showed that social support exerts a direct negative effect on both sleep disturbance (standardized coefficient=-0.24 in the MOA and -0.20 in the LOA) and loneliness (standardized coefficient=-0.44 in the MOA and -0.40 in the LOA), while sleep disturbance generates a direct positive effect on loneliness (standardized coefficient=0.13 in the MOA and 0.22 in the LOA).

CONCLUSIONS

Both MOA and LOA have a low level of loneliness, but the MOA show higher loneliness than the LOA. There is a negative correlation between social support and loneliness as well as between social support and sleep disturbance among the MOA and LOA (MOA>LOA), while loneliness is positively associated with sleep disturbance in both populations (MOA Collapse

Key Words

• loneliness
• migrant-local difference
• older adults
• sleep disturbance
• social support
• structural equation modeling

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MESH Headings

• Child
• Humans
• Aged
• Cross-Sectional Studies
• Loneliness
• Transients and Migrants
• China/epidemiology
• Sleep Wake Disorders/epidemiology
• Social Support
• Sleep

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Affiliation(s)

Mingli Pang Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Jieru Wang Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Mingyue Zhao Human Resource Department, The Second Hospital of Shandong University, Jinan, China
Rui Chen Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Hui Liu Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Xixing Xu Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Shixue Li Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Fanlei Kong Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China

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Risk factors for loneliness: A literature review

RATIONALE

Increasingly, loneliness is being recognised as a serious problem with detrimental effects on health, as well as on social cohesion and community trust. To effectively tackle this complex issue, a clear understanding of the phenomenon and its main drivers is needed. Over years of scientific research on loneliness, many potential risk factors have emerged and been tested empirically.

OBJECTIVE

This narrative review of 109 studies provides a concise summary of empirical evidence on the main potential risk factors for loneliness and presents an additional section dedicated to the COVID-19 pandemic.

METHOD

Given the very large number of existing studies, emphasis is placed on recent meta-analyses and systematic literature reviews as well as longitudinal studies. Similarly, given the large number of possible risk factors for loneliness, which may differ based on the geographical and cultural context, this review focuses on studies from Europe and North America.

RESULTS

The results show that demographic factors often correlate with loneliness, but in many cases the link becomes negligible when controlling for other factors. Often, physical and mental health problems are found to be associated with loneliness, and so are some psychological factors, such as neuroticism or extroversion. Loneliness also depends on the environment in which one lives, and possibly the broader socio-economic and socio-cultural contexts. Nevertheless, the review shows that ultimately everything comes down to the quantity and quality of social relationships. In particular, marital status, living arrangements and the characteristics of one's personal social network are quite consistently found to be among the strongest predictors of loneliness. These main findings about the risk factors for loneliness remained valid also during the COVID-19 pandemic.

POLICY IMPLICATIONS

The findings of this review have implications for policy, as understanding who the most vulnerable groups are is key for designing targeted policy solutions that tackle loneliness.

Migration-related inequalities in loneliness across age groups: a cross-national comparative study in Europe

This study aims to contribute to the growing interest in the consequences of migration for loneliness by investigating the role of generational status across various age groups in countries with differing integration policies and attitudes towards immigrants. Using data from rounds 5, 6 and 7 of the European Social Survey, I conducted logistic multilevel models on a sample of 121,835 respondents aged 18 years and older, residing in 26 countries. Loneliness was assessed based on a single-item item question from the Center for Epidemiologic Studies of Depression scale. The findings suggest that individuals with a migration background are more likely to experience loneliness than those without. Within this group, I found that first-generation immigrants who arrived after the age of 18 are more vulnerable to loneliness than those who arrived earlier, although the latter still reported more loneliness than second-generation immigrants. Furthermore, migration-related inequalities in loneliness were greater among the youngest age group (18-34 years) and in countries with a more positive public stance towards immigrants. In sum, this study highlights the persistent challenges that migration poses for loneliness across generations and age groups, and emphasizes the need to extend research in this area beyond older adults. Moreover, it suggests that promoting a welcoming culture towards immigrants may have unintended consequences for loneliness gaps, but further research is needed to explain this observation.

Factors associated with loneliness in immigrant and Canadian-born older adults in Ontario, Canada: a population-based study

BACKGROUND

While loneliness is common in older adults, some immigrant groups are at higher risk. To inform tailored interventions, we identified factors associated with loneliness among immigrant and Canadian-born older adults living in Ontario, Canada.

METHODS

We conducted a cross-sectional analysis of 2008/09 data from the Canadian Community Health Survey (Healthy Aging Cycle) and linked health administrative data for respondents 65 years and older residing in Ontario, Canada. Loneliness was measured using the Three-Item Loneliness Scale, with individuals categorized as 'lonely' if they had an overall score of 4 or greater. For immigrant and Canadian-born older adults, we developed separate multivariable logistic regression models to assess individual, relationship and community-level factors associated with loneliness.

RESULTS

In a sample of 968 immigrant and 1703 Canadian-born older adults, we found a high prevalence of loneliness (30.8% and 34.0%, respectively). Shared correlates of loneliness included low positive social interaction and wanting to participate more in social, recreational or group activities. In older immigrants, unique correlates included: widowhood, poor health (i.e., physical, mental and social well-being), less time in Canada, and lower neighborhood-level ethnic diversity and income. Among Canadian-born older adults, unique correlates were: female sex, poor mental health, weak sense of community belonging and living alone. Older immigrant females, compared to older immigrant males, had greater prevalence (39.1% vs. 21.9%) of loneliness.

CONCLUSIONS

Although both groups had shared correlates of loneliness, community-level factors were more strongly associated with loneliness in immigrants. These findings enhance our understanding of loneliness and can inform policy and practice tailored to immigrants.

Care arrangements between family and state – developing hybrid scripts of ageing in a context of migration

Due to demographic developments, the number of immigrant families with older members is growing across Western Europe. Poised between the different approaches to care in their countries of origin and destination, such families are treading new ground as they negotiate support for older family members. Based on semi-structured interviews with 26 older and younger family members from 20 Turkish immigrant families in Denmark, this article investigates the broad variation in how these families approach caring for older people. At one end of the scale, some families (re)create a traditional Turkish approach to care in which three generations live together and the daughter-in-law is the main care provider. At the other end of the scale, some families follow the Danish approach in which families rely on public care provision. In between these two poles, many families devise a variety of care solutions for their older members that often rely on considerable support by family. Utilising Cati Coe's concept of care-scription, the analysis shows how families negotiate – and sometimes struggle over – who will shoulder which tasks. In the post-migration context, daughters-in-law are often able to retreat from their traditional role of care provider, which in turn increases expectations of daughters' care provisions. In Denmark, which is a relatively gender-equal society, Turkish daughters may seek to make their brothers take on a greater role in the provision of care for their parents, and in some families, the children also turn towards public care provisions to share the burden of parental care. Resistance from older parents may, however, short-circuit this strategy. Overall, the study points both to the difficulties faced by older immigrants with limited host-country language proficiency when utilising public European care provisions and to the complex and unsettled nature of care provisions in immigrant families in Europe today.

Loneliness and time abroad in Polish migrants in the UK: Protective role of religious experience

The purpose of this study was to examine the relationship between time spent abroad, level of religious experience, and loneliness in Polish migrants in the UK. Factors differentiating the level of loneliness were migration time (up to one year, from one to five years, and over five years) and religious experience, which was postulated to have a protective function against the level of loneliness experienced. The R-UCLA test was used to verify the level of loneliness, and religious experience was measured with the Religious Experience Scale in participants (N = 200) who were Polish migrants. The results showed that the relationship between time abroad and loneliness is not linear-the highest levels of loneliness were experienced in those who had been living in the UK between one and five years, which is consistent with the observations of Homoncik et al. (2017). Furthermore, the level of religious experience was significantly related to loneliness in that those with high levels of religious experience displayed lower levels of loneliness than those with low levels of religious experience. These results may suggest the need for interventions to raise awareness of potential risks among people with high levels of loneliness.

Social networks and social support of older immigrants in Aotearoa New Zealand

Immigrants commonly report difficulties with developing social connections post-transition, which can lead to social isolation as they age. Understanding what factors promote/hinder the social integration of immigrants is an important public health objective. We tested the public health model of social integration of Berkman et al. in a sample of older immigrants. This model calls for considering both the social conditions in which social networks are embedded (upstream influences) and the levels of social support offered by different types of networks (downstream influences). First, we derived an empirical typology of social networks of older immigrants. Next, we tested associations of social networks with upstream and downstream influences. Data came from the New Zealand Health, Work and Retirement Study. The sample included 568 older adults (54% male) who immigrated as adults (mean length of stay = 28.5 years, standard deviation = 12.5). Latent profile analysis was employed on responses to the Practitioner Assessment of Network Type to identify social networks. Associations with upstream and downstream correlates were tested using logistic and multiple regression. Four network configurations emerged: ‘private-restricted’ (43.4%), ‘family-dependent’ (35.8%), ‘locally integrated’ (10.9%) and ‘wider community-based’ (9%). Having shorter length of residence and individualistic cultural background was predictive of being in a restricted network (private-restricted, family-dependent). Being in a restricted network was associated with lower levels of social support. Network type interacted with partner status: having a partner buffered the negative impact of having a restricted network on social support. Although restricted networks are common among older immigrants, they do not necessarily result in compromised social support. While we may see differences across countries regarding the impact of specific upstream and downstream influences, our findings highlight that both contextual and individual-level resources need to be considered alongside network structure to promote social integration of immigrants as they age.

Neighbourhood Ethnic Density, Local Language Skills, and Loneliness among Older Migrants-A Population-Based Study on Russian Speakers in Finland

So far, little attention has been paid to contextual factors shaping loneliness and their interaction with individual characteristics. Moreover, the few existing studies have not included older migrants, identified as a group who are vulnerable to loneliness. This study examined the association between neighbourhood ethnic density (the proportion of own-group residents and the proportion of other ethnic residents in an area) and loneliness among older migrants. Furthermore, we investigated whether local language skills moderated this association. A population-based representative survey (The CHARM study, n = 1082, 57% men, mean age 63.2 years) and postal code area statistics were used to study Russian-speaking migrants aged 50 or older in Finland. The study design and data are hierarchical, with individuals nested in postcode areas. We accounted for this by estimating corresponding mixed models. We used a linear outcome specification and conducted logistic and ordinal robustness checks. After controlling for covariates, we found that ethnic density variables (measured as the proportion of Russian speakers and the proportion of other foreign speakers) were not associated with loneliness. Our interaction results showed that increased own-group ethnic density was associated with a higher level of loneliness among those with good local language skills but not among those with weaker skills. Good local language skills may indicate a stronger orientation towards the mainstream destination society and living in a neighbourhood with a higher concentration of own-language speakers may feel alienating for those who wish to be more included in mainstream society.

Caregiving, volunteering, and loneliness in middle-aged and older adults: a systematic review

OBJECTIVES

Older adults contribute vast amounts of care to society, yet it remains unclear how unpaid productive activities relate to loneliness. The objective of this systematic review is to synthesise the evidence for associations between midlife and older people's unpaid productive activities (i.e., spousal and grandparental caregiving, volunteering) and loneliness.

METHODS

Peer-reviewed observational articles that investigated the association between loneliness and caregiving or volunteering in later life (>50 years) were searched on electronic databases (Ovid MEDLINE, Embase, PsychInfo and Global Health) from inception until July 2021. Studies were analysed using narrative synthesis and assessed for methodological quality applying the Newcastle Ottawa Scale.

RESULTS

A total of 28 articles from 21 countries with 191,652 participants were included (52.5% women). Results were separately discussed for the type of unpaid productive activity, namely, general caregiving (N = 10), spousal caregiving (N = 7), grandparental caregiving (N = 7), and volunteering (N = 6). Risk of bias assessments revealed a moderate to high quality of included studies. Loneliness was positively associated with spousal caregiving but negatively associated with caregiving to grandchildren and volunteering.

CONCLUSIONS

Grandparental caregiving and volunteering may be promising avenues for reducing loneliness in older age. Future studies will need to distinguish between different types of caregiving and volunteering and explore more complex longitudinal designs with diverse samples to investigate causal relationships with loneliness.

Economic gradients in loneliness, social isolation and social support: Evidence from the UK Biobank

Despite the substantial literature on how loneliness is associated with poor health and premature mortality, there is little detailed research on the extent of its economic gradients. We provide this evidence using a sample of around 400,000 respondents aged 40-70 years from the UK Biobank, who were assessed between 2006 and 2010. We focus on differences in loneliness, as well as social isolation and a lack of social support, across educational attainment, household income, local area deprivation, and recent experience of financial stress. We employ two statistical approaches, the first exploiting the large sample size and detailed geographical information about where respondents live, so we compare individuals who differ in their economic status but reside within the same postcode district. The second approach exploits the fact that for around 36,000 respondents we observe their social health and economic circumstances at two points in time (second wave of assessment conducted between 2014 and 2020), so we conduct a panel analysis that accounts for intercorrelations between the social health measures, and controls for incomplete follow-up of panel members. Across both approaches, we find a substantially higher probability of reporting loneliness, social isolation and a lack of social support, for men and women with lower economic status. Together with the existing health-loneliness literature, these findings establish a 'loneliness pathway' contributing to health inequalities, and consequently a need for effective interventions that might address loneliness and social isolation as part of a broad policy initiative on health inequalities.

Conducting Empirical Research with Older Migrants: Methodological and Ethical Issues

This special section brings together a set of four articles containing novel quantitative and qualitative research on older migrants in Europe. Detailed reporting and reflection is presented on fieldwork decisions and how certain challenges were tackled, and their implications. This introductory article aims to lay the groundwork for a better understanding and awareness of methodological and ethical challenges researchers face when designing and conducting empirical studies involving older migrants. Highlighted are the main methodological issues and ethical dilemmas we observe in studying older migrants, which can serve as a wake-up call for researchers to be more critical throughout the process. We end with a plea for more collaboration between researchers in the field of older migrants, by sharing their data despite potential methodological and ethical problems.

Women bear a burden: gender differences in health of older migrants from Turkey

Studies show that older migrants have poorer health than native populations in Western Europe. To date, little systematic research has explored the differences between men and women within older populations with migration backgrounds. This article examines gender-specific aspects and mediating mechanisms of self-reported health among older migrants from Turkey. Using a mixed method approach, data and results from a quantitative survey and a qualitative study conducted in Berlin, Germany, are analysed and integrated at the interpretive level. Standardised face-to-face interviews were carried out with the help of a network approach with 194 older migrants from Turkey (93 women, 101 men, mean age: 68). Potential mediators showing significant gender differences are included in a parallel multiple mediation analysis. The documentary method is used to analyse 11 semi-structured narrative interviews with first-generation labour migrants from Turkey. Women reported significantly worse subjective health than men (c = 0.443, bCI [0.165–0.736]), conveyed through greater functional limitations (ab = 0.183, bCI [0.056–0.321]) and emotional loneliness (ab = 0.057, bCI [0.008–0.128]). Respondents to the qualitative study perceived that women age earlier and have poorer health due to the burden of performing a greater variety of social roles. Higher levels of emotional loneliness among women could be caused by their experiences of negatively assessed partnerships. Our results show that as a group, older female migrants have an elevated health vulnerability. A broader scientific foundation regarding gender differences in the health of older migrants and their causes is needed to promote gender-sensitive prevention and care for this group.

A Tale of Two Solitudes: Loneliness and Anxiety of Family Caregivers Caring in Community Homes and Congregate Care

We surveyed 604 family caregivers residing in the province of Alberta to better understand the impact of the COVID-19 pandemic on anxiety, loneliness, and care work. We assessed anxiety with the Six-Item State Anxiety Scale and loneliness with the DeJong-Gierveld Loneliness Scale. The COVID-19 pandemic created two contexts giving rise to feelings of solitude for family caregivers. Family caregivers of Albertans living in private community homes were overwhelmed with caregiving needs while those caring for Albertans living in congregate settings were restricted from caregiving. The results indicated that before the COVID-19 pandemic, 31.7% of family caregivers were anxious and 53.5% were lonely. The proportions of those who were anxious rose to 78.8% and lonely to 85.9% during the pandemic. The qualitative responses of family caregivers connected being overwhelmed with care work either in community homes or as the designated essential caregiver in congregate living settings, as well as being unable to care in congregate care settings, with anxiety and loneliness. The caregivers reporting improvements in their health and relationships with care-receivers credited spending time with the receiver doing pleasant activities together, rather than purely performing onerous care tasks. Policymakers need to consider organizing health and community services to ensure family caregivers are not overwhelmed with care tasks or excluded from caring in congregate care.

Perceived loneliness and the role of cultural and intergenerational belonging: the case of Portuguese first-generation immigrants in Luxembourg

The risk of loneliness for migrants, particularly in older age, has been documented across multiple studies. Migration is a life-changing transition. While often retaining links to their country of origin, an important developmental task for migrants is the establishment of bonds in the receiving country. Drawing on recent studies, I will explore the role of cultural and intergenerational belonging in order to identify both protective and risk factors regarding loneliness in middle and older age in a sample of first-generation immigrants from Portugal living in Luxembourg. The sample comprises N = 131 participants (51.9% female) between the ages of 41 and 80 (M = 56.08; SD = 7.80) who have on average spent M = 31.71 years (SD = 8.81) in Luxembourg and raised children in Luxembourg. They took part in the IRMA project ('Intergenerational Relations in the Light of Migration and Ageing') which was funded by the Fonds National de la Recherche Luxembourg. A standardised questionnaire assessed socio-demographic data, aspects of cultural belonging (i.e. cultural attachment to both countries, bicultural identity orientation, acculturative stress), intergenerational belonging (i.e. family cohesion, family conflict, perceived intergenerational value consensus) and perceived loneliness. Results showed that while cultural and intergenerational belonging were protective factors, the strongest predictors for participants' perceived loneliness were cultural identity conflict and, even more so, intergenerational conflict. Our findings suggest that establishing roots and bonds in the host country is a protective factor against loneliness, whereas the feeling of not fitting in is a strong risk factor.

What protects older Romanians in Switzerland from loneliness? A life-course perspective

The topic of loneliness among older migrants has recently gained scholarly interest. There is a particular focus on why older migrants are generally lonelier than their non-migrant peers from the destination. These studies neglect variations both within and between older migrant groups. Our qualitative study is innovative for three reasons. First, it focuses on Romanian migrants aged 65+ who fled communism and aged in place in Switzerland-an understudied population of former political refugees that experiences little or no loneliness in later years. Second, it takes a life-course approach to explore experiences of loneliness during communist Romania, in the context of migration and later in life. Third, it focuses on protective and coping factors rather than risk factors. Having been through hard times in communist Romania-marked by fear and distrust among people and estrangement from society-older Romanian migrants built strength to withstand difficult times, learned to embrace solitude, and/or to relativise current hardships, if any. Upon arrival many founded or joined an association or church, which offers the opportunity to establish a sustainable social network consisting of a large pool of Romanian non-kin with a shared past and experience of migration and integration, to counteract social losses in later life. When moments of loneliness cannot be prevented (e.g. due to death of a spouse), they try to be active to distract from loneliness or 'simply' accept the situation. These aspects need to be taken into account in future research and when developing loneliness interventions.

Stronger feelings of loneliness among Moroccan and Turkish older adults in the Netherlands: in search for an explanation

The prevalence of loneliness among Turkish-Dutch and Moroccan-Dutch older adults is higher than among Dutch older adults of non-migrant origin. Three explanations may account for this difference: (1) differential item functioning might result in scores that vary in intensity and in meaning across categories; (2) the position of migrants is much more vulnerable than that of non-migrants; (3) the lack of protective factors has more severe consequences for older migrants. The Longitudinal Aging Study Amsterdam interviewed 176 persons born in Morocco and 235 born in Turkey, aged 55-66 and living in urban areas. They are compared with a matched sample of 292 Dutch persons. The psychometric properties of the loneliness scale are satisfying, although there is some differential item functioning. Older migrants have more frequent social contacts but are at a disadvantage in other domains. Taking into account differences in social participation, satisfaction with income, mastery and depressive symptoms, the difference between older migrants' and non-migrants' loneliness is reduced by more than half. Protective factors are equally important for older migrants and non-migrants. Exceptions are marriage (less protective for Moroccans), frequent contact with children/children-in-law (mostly for Turks), a higher educational level (protects Moroccans and Turks) and better physical functioning (less for Turks). Being an older migrant and belonging to a minority might further contribute to feelings of loneliness. Interventions can be directed at stimulating social contact, but also at aspects like enhancing the appreciation of their social status and avoiding negative interpretations of a situation.

Reducing loneliness in older adults: looking at locals and migrants in a Swiss case study

Older adults are at a high risk for loneliness, and community-based interventions can help reduce loneliness for all older adults in a community, regardless of their migration status. However, little research has investigated how older adults, including locals and migrants (in this case, internal newcomers and international expats) participate in these interventions. The "Neighbourhoods in Solidarity" (NS) are a series of community-based interventions that aim to increase social connectedness and reduce loneliness in older adults (55+) in the canton of Vaud, Switzerland. This longitudinal embedded mixed-methods study aimed to understand whether older adults (distinguishing between locals, newcomers, and expats) were aware of and participated in the NS, to assess whether participation was associated with changes in loneliness, and to identify relevant processes that could explain a reduction in loneliness. We combined a longitudinal pre/post survey (235 respondents) with ethnographic observations and informal interviews. Quantitative findings showed that individuals who participated in the NS did not have significant changes in loneliness. Qualitative findings showed that perceived migration played an important role in who participated, and that the community distinguished between two types of migrants: newcomers who spoke French fluently, and expats who did not. Individuals were only 'local' if they had ancestors from the town. Some newcomers and some locals used the NS as a platform to build a new sense of community within the NS, whereas expats rarely participated. This was due to linguistic and cultural determinants, institutional constraints, interpersonal relationships, and personal preferences.

Does unemployment lead to greater levels of loneliness? A systematic review

There is evidence that loneliness and unemployment each have a negative impact on public health. Both are experienced across the life course and are of increasing concern in light of the COVID-19 pandemic. This review seeks to examine the strength and direction of the relationship between loneliness and unemployment in working age individuals, and in particular the potential for a self-reinforcing cycle with combined healthcare outcomes. A systematic search was undertaken in Medline, PubMed, PsycINFO, Embase and EconLit from inception to December 2020. PRISMA reporting guidelines were followed throughout this review, study quality was assessed using the Joanna Briggs Institute checklist and results were summarised in a narrative synthesis. English language studies evaluating the relationship between loneliness and unemployment in higher income western countries were included. Thirty-seven studies were identified; 30 cross-sectional and 7 longitudinal. Loneliness was measured by a direct question or loneliness scale while unemployment was self-reported or retrieved from a national register. A positive association between unemployment and increased loneliness was observed across all studies. Thus, across the life-course a clear yet complex relationship exists between unemployment and greater experience of loneliness. The magnitude of this relationship increases with the severity of loneliness and appears to peak at age 30–34 and 50–59. Logistic regression provided the greatest consistency at statistical significance revealing at least a 40% increase in the likelihood of reporting loneliness when unemployed. Recent longitudinal studies identified in this review found higher levels of loneliness following job loss, but also that loneliness was predictive of unemployment suggesting potential bi-directionality in the relationship. This bi-directionality may create a multiplier effect between loneliness and unemployment to form a self-reinforcing relationship and greater health concerns for those most at risk. Thus, review findings suggest the need for cross-sector awareness and intervention to tackle both loneliness and unemployment.

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Unemployment is related to feeling lonely.

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Stronger association of unemployment with severe experience of loneliness.

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Greatest connection between loneliness and unemployment at age 30–34 and 50-59.

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Potential for a bi-directional relationship between loneliness and unemployment.

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Greater understanding is needed in the face of COVID-19 recovery.

Older Chinese migrants in coronavirus pandemic: exploring risk and protective factors to increased loneliness

Older migrants may be one of the most vulnerable populations during the coronavirus pandemic, yet the degree of impact remains largely unknown. This study explores (1) the consequences of the coronavirus pandemic for older Chinese migrants in Belgium and the Netherlands in terms of increased loneliness and its risk factors (reduced in-person contact, decreased social participation, feelings of existential threat) and protective factors (increased non-in-person contact, more individual activities), and (2) which risk and protective factors have contributed to the incidence and prevention of higher loneliness levels. Using quantitative data of a survey among 98 Chinese migrants aged 50 years and older in Belgium (n = 84) and the Netherlands (n = 14), the findings first indicate that the coronavirus pandemic has a significant impact on older Chinese migrants' lives. One in five experienced more loneliness. Second, reduced social participation (measured as less frequent participation in outdoor group activities) and financial insecurity (measured as experiencing financial difficulties) lead to higher than pre-pandemic loneliness levels. Problem-focused coping strategies (measured as increased non-in-person contact, via telephone or social media) and emotion-focused coping (measured as finding distraction through increased participation in individual activities) were not found to protect against increased loneliness in the pandemic. Two practical implications for loneliness interventions for older Chinese migrants are put forward. Organizing COVID-19-safe social participation activities and paying more attention to older Chinese migrants' financial situation can be beneficial when addressing higher levels of loneliness due to the coronavirus pandemic.

Effects of Living Conditions, Subjective Integration, and Social Networks on Health-Related Quality of Life among the Migrant Elderly Following Children in Jinan, China

With accelerated urbanization in China, an increasing number of the migrant elderly following children (MEFC) have appeared. This study aims to explore the effects of living conditions, subjective integration, and social networks on the health-related quality of life (HRQOL) of MEFC in Jinan, China. HRQOL was assessed by the 12-item Short-Form Health Survey, which included the mental component summary (MCS) and the physical component summary (PCS). Univariate analyses and binary logistic regression were used to investigate the association between the above indicators and HRQOL. A total of 656 MEFC were selected by multi-stage cluster random sampling, 25.2% and 25.0% of whom were defined as poor MCS and poor PCS, respectively. Those who understood the local dialect, could trust others, and connected with friends were more likely to have good MCS; those with a nanny, faulty elevator, and no support from their spouse were the reverse. MEFC who were trans-city, had no elevator or a faulty elevator, and went to the hospital alone were more likely to have poor PCS; those who approved of living conditions in their hometowns were the reverse. Results indicated that better living conditions, stronger subjective integration, and wider social networks led to higher HRQOL of MEFC. Implications of the government, communities, and families of MEFC were given to improve their HRQOL.

Economic Aspects of Loneliness in Australia

We highlight the problem of loneliness, and argue that it is not only a public health issue but also an economic problem. We provide a brief review of findings from the key literature on the associations between loneliness, mental and physical health, and healthcare costs; and then present some evidence on its trends, the extent of socioeconomic inequalities and its links with health and healthcare usage, in Australia. We hope to encourage further economics research on loneliness, and related issues of social isolation and poor social support, to aid the design of policies and interventions to reduce loneliness.

Loneliness in mid-life and older adults from ethnic minority communities in England and Wales: measure validation and prevalence estimates

We investigated the prevalence of loneliness among 1206 adults aged 40 + from six minority communities in England and Wales: Black Caribbean, Black African, Indian, Pakistani, Bangladeshi and Chinese. Replicating the approach from the previous studies, we demonstrate robust acceptability, reliability and validity for both the six-item De Jong Gierveld (DJG) and single-item loneliness scales in our six ethnic groups. The prevalence of loneliness using a single-item question (loneliness reported as often/always) ranges from 5% (Indian) to 14% (Chinese) compared with approximately 5% for the general population aged 40 + in Britain. Levels of loneliness are very much higher using the DJG scale. Using a loneliness threshold score of 5 +, the percentage ranged from 13% (Indian) to 36% (Chinese). We explored the importance of six established loneliness vulnerability factors for our sample using regression modelling. Three factors were not associated with loneliness-number of children, gender and health rating, and three factors were protective: younger age, being married and low financial strain. The addition of ethnicity did not change these relationships or enhance statistical power of our models. Being a member of the African Caribbean group was protective against loneliness but not for the other groups included in our study. We suggest that exposure to loneliness vulnerability factors rather than ethnicity per se or measurement artefact underpins differences in loneliness across ethnic groups.

Evaluating the Relationship Between Olfactory Function and Loneliness in Community-Dwelling Individuals: A Cross-sectional Study

BACKGROUND

Olfactory dysfunction (OD) has been reported to impact social interactions. However, the relationship between OD and loneliness has received little attention. The purpose of this study was to determine the association between OD and loneliness, controlling for patient factors.

METHODS

Subjects without otolaryngic complaints were enrolled and olfactory function was assessed using: Sniffin' Sticks test to measure threshold, discrimination and identification (TDI), Questionnaire of Olfactory Disorders Negative Statements (QOD-NS) and 9 - item Olfactory-Visual Analogue Scale (VAS). Loneliness was assessed using the De Jong Gierveld (DJG) and University of California Los Angeles (UCLA) loneliness scales. Bivariate analysis was performed followed by regression analysis, controlling for confounders.

RESULTS

In total, 221 subjects were included with a mean age of 50.5 years (range 20 to 93), 133 (60.2%) females and 161 (72.9%) white. Mean TDI score was 29.3 (7.0) and 49.5% of the cohort was dysosmic. Using DJG, 36.4% of the cohort were classified as lonely, whereas 35.0% were lonely using UCLA. Olfactory measures were significantly associated with DJG, including TDI (β = -0.03, p = 0.050), olfactory discrimination (β = -0.111, p = 0.005), QOD-NS (β = 0.058, p < 0.001) and olfactory-VAS (β = 0.032, p < 0.001). UCLA scores were significantly associated with QOD-NS (PR 1.061 [CI 1.018-1.107], p = 0.005) and olfactory-VAS scores (PR 1.027, [CI 1.007-1.049], p = 0.009). After controlling for confounders, the association between DJG and olfactory discrimination, as well as DJG and olfactory-VAS remained significant.

CONCLUSIONS

In this community-based sample of older adults, both OD and loneliness were common. Those subjects with worse olfactory function were more likely to report loneliness. Further research is necessary to establish causality, as well as explore the role of depression.

A Closer Look at Loneliness: Why Do First-Generation Migrants Feel More Lonely Than Their Native Dutch Counterparts?

Background and Objectives

Along with the current aging demographics in the Netherlands, the number of older first-generation migrants is also increasing. Despite studies suggesting a higher quantity of social contacts of migrants, loneliness is more common among migrants as compared to native Dutch. We theorize that migrants experience more emotional and social loneliness due to a lower satisfaction with social relationships and lower participation in social activities, respectively, compared to their native counterparts.

Research Design and Methods

We use data from Statistics Netherlands (N = 7,920) with first-generation migrants aged 40 years and older and their Dutch counterparts. Contact frequency, household composition, satisfaction with social relationships, relationship quality with the partner, and social activities, are used as main predictors and separate regression models for social and emotional loneliness are analyzed.

Results

Compared to the native Dutch, first-generation migrants are both socially and emotionally more lonely. Migrants have a similar contact frequency as the native Dutch, but are less satisfied with their social relationships, which contributes to their higher emotional, social, and overall loneliness. Migrants engage less in social activities but this does not put them at additional risk of loneliness.

Discussion and Implications

Migrants experience more social and emotional loneliness and are less satisfied with their social relationships compared to their native counterparts. Interventions should focus on reducing both social and emotional loneliness among older migrants. Specific attention should be paid to fostering satisfying social interactions. Additionally, encouraging migrants to broaden their social network may reduce social loneliness.

Understanding loneliness in the twenty-first century: an update on correlates, risk factors, and potential solutions

PURPOSE

Loneliness is increasingly recognised as the next critical public health issue. A plausible reason for this concern may be related to emerging societal trends affecting the way we relate, communicate, and function in our social environment. In 2006, a prominent review of the clinical significance of loneliness was published. However, there has not been a comprehensive update on known and emerging risk factors and correlates of loneliness since then. Furthermore, there is no conceptual model that has been developed to better account for the complexity of loneliness and to inform the development of evidence-based solutions as we challenge the issues of the twenty-first century.

METHODS

We reviewed the current literature to identify either known or emerging risk factors and correlates of loneliness since 2006. This includes new or known evidence on: (1) demography; (2) health, including physical health; mental health; cognitive health; brain, biology, and genetics; and (3) socio-environmental factors including digital communication and the workplace.

RESULTS

We synthesized the literature according to a new proposed conceptual model of loneliness which showed the interplay between known and emerging correlates and risk factors from demography, health, to socio-environmental factors. In the conceptual model of loneliness, we illustrated how solutions can be delivered and tailored to an individual based on their life circumstances and preferences.

CONCLUSION

We concluded by making specific recommendations in advancing our scientific understanding of loneliness. Our knowledge can only be deepened if we increase scientific rigour via accounting for confounding variables and using longitudinal, multi-disciplinary, and multiple methodologies in research. We also call for the rigorous evaluation of programs targeting loneliness.

Loneliness and self-rated physical health among gay, bisexual and other men who have sex with men in Vancouver, Canada

BACKGROUND

Due to stigma and discrimination, gay, bisexual and other men who have sex with men (gbMSM) potentially carry a heightened burden of loneliness. This analysis investigates loneliness among gbMSM and its relationship with self-rated physical health, along with the mediating effect of depression.

METHODS

Participants were recruited using respondent-driven sampling into the Momentum Health Study (February 2012-February 2015) with follow-up visits occurring every 6 months till February 2018. Using computer-assisted self-interviews, measures of loneliness were assessed using a 6-item Loneliness Scale for Emotional and Social Loneliness (lonely vs not lonely). Current physical health was self-assessed (poor, fair, good, very good or excellent). A multivariable generalised linear-mixed model with a logit link function was used to examine the relationship between loneliness and self-rated physical health. We further investigated the mediating effect of depressive symptomatology on this relationship via the Hospital Anxiety and Depression Scale.

RESULTS

Of the 770 participants included, we found that 61% (n=471) experienced loneliness at baseline. Of the 674 (88%) who reported good/very good/excellent physical health, 59% (n=391) reported loneliness, compared with 87% (n=80) of those in poor/fair self-rated physical health who reported feeling lonely. After adjustment for confounding, loneliness was associated with poor self-rated physical health (adjusted OR 1.71; 95% CI 1.13 to 2.60). Depressive symptomatology was found to partially mediate this relationship.

CONCLUSION

There may be a need for the integration of social, mental and physical health programming, targeted towards gbMSM, to alleviate the degree of loneliness experienced and its co-occurrence with poor self-rated physical health.

Understanding the friendship networks of older Black and Minority Ethnic people living in the United Kingdom

Older Black and Minority Ethnic (BME) people living in the United Kingdom (UK) are vulnerable to the experiences of social isolation and loneliness. Despite this, it is widely assumed that they adhere to traditional family practices and living arrangements that protect them from social isolation and loneliness. Such assumptions are problematic and can reify family networks as the main area of research for older BME people to the detriment of friendship networks which are also crucial. However, few researchers have explored this area. With the older BME population increasing at a faster rate than the older white population, further research is needed. Utilising data from Wave 6 of Understanding Society (N = 7,499, 4.3% of whom self-identified as BME), this study explores the ways in which the friendship networks of older BME people differ compared to older white people using logistic regression analyses. After controlling for potential confounding socio-demographic characteristics, older BME people were more likely to report having fewer close friends and fewer friends who live locally, suggesting that their friendship networks may be restricted in quantity and accessibility. Not only do these findings raise important questions about the varying needs of older minority ethnic people who have been largely overlooked in recent government policy, but they also highlight the continuing challenges of using large-scale surveys to research older BME people in the UK.

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).

Resettling amidst a mood of loneliness: later-life Chinese, Indian and Korean immigrants in New Zealand

This project was a secondary hermeneutic analysis of text expressing loneliness or social isolation, gathered in an original study exploring how Chinese, Indian and Korean late-life immigrants participated in New Zealand society. It utilised the 24 interview recordings, initially transcribed in participants’ first languages from nine focus group and 15 individual interviews, and translated into English for analysis. Hermeneutic methods were used to extract and analyse quotes indicative of loneliness or social isolation. The data cohered into three notions: being unsettled, feeling sidelined and being oriented towards social connectedness. Being unsettled names the experiences of disconcerting loneliness or social isolation when previously familiar things, people and places were not there in the host society context. Feeling sidelined names the feelings of being put aside by others or feeling opaque with local communities. Being oriented towards social connectedness expresses these late-life immigrants’ longing to communicate with and to join with others in the community through culturally familiar engagements. A mood of loneliness coloured these late-life immigrants’ resettlement experiences in New Zealand. Yet they turned away from loneliness and sought out encounters with other older immigrants within co-ethnic communities.

Changes in Self-Rated Health Right After Immigration: A Panel Study of Economic, Social, Cultural, and Emotional Explanations of Self-Rated Health Among Immigrants in the Netherlands

Immigrants are often found to rate their health better than the native population does. It is, however, suggested that this healthy immigrant effect declines with an enduring length of stay. With Dutch panel data, we investigate which patterns in self-rated health can be found among immigrants shortly after their migration. We test to what extent economic, social, cultural and emotional explanations affect the changes that immigrants report in self-rated health. Based on a four-wave panel, our results support the immigrants' health decline hypothesis, since the self-rated health decreases in the first years after immigration to the Netherlands. The major change occurs between immigrants rating their health no longer as "very good," but as "good." Shortly after immigration, self-rated health is associated with being employed and a higher income. Hazardous work and physically heavy work decrease self-rated health. Notwithstanding these effects, social, cultural, and emotional explanations turn out to be stronger. A lack of Dutch friends, perceptions of discrimination, perceived cultural distance, and feelings of homesickness strongly affect self-rated health. Furthermore, in understanding changes in self-rated health, the effects of making contact with Dutch people and changes in the perception of discrimination are definitive. However, contact with Dutch people did not decrease and discrimination did not increase over time, making them ineligible as an explanation for overall health decrease. Only the small effect that first-borns have may count as a reason for decreased self-rated health, since many of the recent immigrants we followed started families in the first years after immigration. Our findings leave room for the coined "acculturation to an unhealthier lifestyle thesis," and we see promise in a stronger focus on the role of unmet expectations in the first years after immigration.

Mobilities of Older Chinese Rural-Urban Migrants: A Case Study in Beijing

Along with the rapid urbanization process in Beijing, China, the number of older rural-urban migrants is increasing. This study aims to understand how Chinese rural-urban migration in older age is influenced by, and impacts on the migrants’ mobilities. This study draws on a new conceptual framework of mobile vulnerability, influenced by physical, economic, institutional, social and cultural mobility, to understand older people’ experiences of migration from rural to urban areas. Forty-five structured in-depth interviews with older rural-urban migrants aged 55 and over were undertaken in four study sites in Beijing, using the constant comparative method. Results demonstrate that rural household registration (hukou) is an important factor that restricts rural older migrants’ institutional mobility. As older migrants’ physical mobility declines, their mobile vulnerability increases. Economic mobility is the key factor that influences their intention to stay in Beijing. Older migrants also described coping strategies to improve their socio-cultural mobility post-migration. These findings will inform service planning for older rural-urban migrants aimed at maintaining their health and wellbeing.

[Stronger feelings of loneliness among Moroccan and Turkish older adults in the Netherlands: A search for an explanation]

The prevalence of loneliness among Turkish- and Moroccan-Dutch older adults is higher than among Dutch older adults of non-migrant origin. Two explanations may account for this difference. (1) The meaning of the concept may differ, or there is differential item functioning. This might result in scores that not only differ in intensity but also in meaning across groups. (2) The position of older migrants is much more vulnerable than of non-migrant older people. Data from the Longitudinal Aging Study Amsterdam were used to examine support for both explanations. Feelings of loneliness are explored among 176 people born in Morocco and 235 people born in Turkey, aged 55-66 years, and living in urban areas. They migrated on average 35 years ago to the Netherlands. They are compared with a matched sample of 292 older people of Dutch origin. The psychometric properties of the loneliness scale are satisfying, although there is some differential item functioning. Older migrants have more frequent social contacts, but are at a disadvantage in other domains. Taking into account differences in social participation, satisfaction with their income, mastery and depressive symptoms, the difference between older migrants' and non-migrants' loneliness is reduced to more than half. Being an older migrant and belonging to a minority might further contribute to feelings of loneliness. Interventions should not be directed at stimulating social contact, but rather, for example, at enhancing the appreciation of their social status and at avoiding negative interpretations of the situation.

On the move in search of health and care: Circular migration and family conflict amongst older Turkish immigrants in Germany

This study focuses on circular migration amongst older Turkish immigrants to investigate two main questions: (1) How do perceived health and available healthcare systems in Turkey and Germany determine the structure of circular migration? (2) How is eldercare shaped by intergenerational conflict and exchange relations amongst older immigrants, their adult children in Germany, and their extended families in Turkey? Through the analysis of 40 in-depth interviews, this study finds that while Turkey offers healthier physical, psychological, and religious options, older circular migrants are more drawn to Germany because they perceive its healthcare system to be superior. Furthermore, contrary to conventional accounts, eldercare has mostly been navigated through intergenerational conflict and exchange relations, instead of family solidarity or traditional filial roles, and these conflicts and exchange principles around eldercare regulate family living arrangements across the two countries. In short, older Turkish immigrants encounter unique challenges in both their home and host countries, which promulgates their circular migration.

How do older people achieve well-being? Validation of the Social Production Function Instrument for the level of well-being-short (SPF-ILs)

In a time of aging populations and an enormous increase in frailty within them, examination of these populations' ability to achieve well-being has become increasingly important. This study aims to validate a theory-driven instrument for the measurement of well-being in three community-dwelling older populations: (i) a general population, (ii) a frail population, and (iii) Turkish migrants. The short (15-item) version of the Social Production Function Instrument for the Level of Well-being (SPF-ILs) measures whether a person's needs for stimulation, comfort, behavioral confirmation, affection, and status are met. This instrument has been validated only in adult (aged 18-65 years) populations. Three datasets were used to validate the SPF-ILs in samples of the general older population (945 respondents aged ≥ 70 years), frail older people (414 respondents aged ≥ 70 years), and older Turkish migrants (680 respondents aged ≥ 65 years) residing in Rotterdam, the Netherlands. Psychometric results showed that the SPF-ILs is a valid and reliable instrument for the assessment of well-being and need-related goals to achieve well-being among (frail) native and migrant older populations. Worldwide, countries face the challenge of maintaining community-dwelling older people's well-being. This study clearly showed that older people differ in their realization of well-being which increased our understanding of the ability of community-dwelling older people in various populations to achieve well-being.

Interventions to improve social determinants of health among elderly ethnic minority groups: a review

Background

Like the European general population, ethnic minorities are aging. In this group, important social determinants of health (social participation, social isolation and loneliness) that lead to negative health outcomes frequently occur. Interventions targeting these determinants may decrease negative health outcomes. The goal of this article was to identify effective interventions that improve social participation, and minimise social isolation and loneliness in community dwelling elderly ethnic minorities.

Methods

An electronic database (PubMed) was systematically searched using an extensive search strategy, for intervention studies in English, French, Dutch of German, without time limit. Additional articles were found using references. Articles were included if they studied an intervention aimed to improve social participation or minimise social isolation or loneliness and were focusing on community dwelling elderly ethnic minorities. Data regarding studies characteristics and results were extracted.

Results

Six studies (three randomized controlled trials, three non-controlled intervention studies) were included in the review. All studies were group-based interventions and had a theoretical basis. Five out of six studies showed improvement on a social participation, -isolation or loneliness outcome. Type of intervention included volunteering-, educational- and physical activities. In three studies active participation of the participant was required, these interventions were not more effective than other interventions.

Conclusion

Some interventions improved the included social determinants of health in community dwelling elderly ethnic minorities. Investment in further development and implementation of these interventions may help to improve social determinants of health in these populations. It is necessary to evaluate these interventions in the European setting.

Sources and directions of social support and life satisfaction among solitary Chinese older adults in Hong Kong: the mediating role of sense of loneliness

Based on survey data collected from 151 community-dwelling solitary Chinese older adults in Hong Kong, the present study used path analysis to examine the mediating role of sense of loneliness in the relationship between different sources and directions of social support and life satisfaction. The results showed that sense of loneliness mediated the effects of support from families, friends, and support for others on life satisfaction. In addition, a formal source of social support was not associated with life satisfaction among solitary older adults, although those with a more secure financial status had greater overall life satisfaction. These findings highlight the importance of enhancing awareness among social and health care service providers about the negative effects of insufficient social support on older adults' sense of loneliness and life satisfaction. Family and friendship networks should be expanded for solitary older adults.

The Missing Link in the Chain

As the migrant workers of the 1960s and 1970s age in place, many countries are facing caring for increasing numbers of older migrants, many of whom have complex health and social care needs. By applying a qualitative case study approach, of a grassroots disability resource center that works with older migrants, this article critically explores the social policy debates that are focused on older migrants in the Black and Minority Ethnic community. A number of themes have emerged, including the impact of changing family structure, difficulties with accessing services, and increased isolation. In addition, there are also examples of older migrants activtly engaged in building communities and supporting others, defying the stereotypes of vulnerable older migrants being a burden on the state. This article argues for politicians and social policy makers to refocus on the new challenges that are emerging in the older migrants of the Black and Minority Ethnic community.

National and transnational belonging among Turkish and Moroccan older migrants in the Netherlands: protective against loneliness?

This research investigates how a sense of belonging functions as protective mechanism against loneliness. Inspired by the work of Berry (1980) on acculturation strategies (i.e. integration, assimilation, separation and marginalization), we distinguish migrants who feel a relatively strong or weak sense of belonging to larger society and those who feel a strong or weak belonging to the "own group." We expect that more national belonging contributes to less loneliness. We add a transnational perspective by arguing that feelings of belonging to the own group can take place in the country of settlement, but can also be transnational, i.e. a feeling of belonging to the country of origin. Transnational belonging can protect against loneliness, as it acknowledges the importance of place attachment. Using data from the Longitudinal Aging Study Amsterdam on older migrants aged 55-66, we employ latent class analysis and find five national belonging clusters, interpretable in terms of Berry's acculturation strategies. Further analyses reveal mixed evidence: some aspects of transnational belonging vary with belonging to the own group, but other aspects point to a third dimension of belonging. Regression analysis shows that those marginalized are loneliest and that a transnational sense of belonging contributes to more loneliness. We conclude that Berry's (1980) typology is useful for interpreting older migrants' national belonging and that a transnational sense of belonging is apparent among older migrants, but needs to be explored further.

Validation of the Aging Perceptions Questionnaire Short on a sample of community-dwelling Turkish elderly migrants

Background

Aging perceptions have been found to be major contributors to health in old age. To quantitatively explore aging perceptions among elderly Turkish migrants, valid and reliable Turkish-language instruments are needed. The objective of the current study was to examine the construct validity and reliability of the Turkish-language version of the seven-dimension Aging Perceptions Questionnaire Short version (APQ-S) in a sample of community-dwelling elderly Turkish migrants in the Netherlands.

Methods

A questionnaire including the Turkish-language APQ-S was administered to 438 community-dwelling Turkish migrants aged 65–99 years who resided in Rotterdam, the Netherlands. The APQ-S includes 21 items in seven dimensions (timeline chronic and cyclical, consequence positive and negative, control positive and negative, and emotional representations). The questionnaire also contained items measuring well-being, physical and mental health-related quality of life, and number of chronic conditions.

Results

The latent factor model of the Turkish APQ-S was found to have an acceptable fit (root mean square error of approximation = .06; standardized root mean square residual = .07; comparative fit index = .90). Each indicator loaded significantly on its corresponding latent factor, and standardized factor loadings > .40 supported the convergent validity of the Turkish APQ-S dimensions. The APQ-S was also found to have acceptable construct validity in terms of its inter-factor structure and its expected associations with various health measures and age, gender, educational level, and marital status. Contrary to expectations, income level was not associated with any APQ-S dimension. With the exception of timeline cyclical (α = .56), each APQ-S dimension had acceptable reliability, with Cronbach’s alpha values ranging from .75 (timeline chronic) to .88 (control positive). Most APQ-S dimension scores differed significantly between elderly Turkish migrants and a general population of elderly Rotterdam residents, with Turkish elders having more negative and less positive aging perceptions.

Conclusion

The Turkish-language version of the APQ-S is a psychometrically valid and reliable instrument for the assessment of aging perceptions among elderly Turkish migrants. Further research is needed to gain insight into aging perceptions and their health and sociodemographic correlates in this population.

Electronic supplementary material

The online version of this article (doi:10.1186/s12955-017-0619-7) contains supplementary material, which is available to authorized users.

Social ties and embeddedness in old age: older Turkish labour migrants in Vienna

This paper focuses on older Turkish labour migrants and their spouses, who mostly came to Vienna as young adults in the 1960s and thereafter. They are now entering retirement age and constitute a significant part of Vienna's older population. I analyse their understandings of transnational ageing, their social ties and feelings of social embeddedness. For those still mobile, active participation in one of Vienna's Turkish cultural/religious/political associations is identified as a particular source of social embeddedness. I argue that these voluntary associations provide an important place for older migrants to strengthen social ties and are relatively easy to access, including in old age. Nevertheless, I demonstrate that older Turkish labour migrants are exposed to several forms of discrimination, some of which are felt especially strongly in old age, including a lack of adequate institutionalised late life care. In the discussion of the paper, I critically revisit the debate on ethnicity as a resource versus ethnicity as a vulnerability factor in old age. I argue that this debate is misleading since it camouflages other central social categories and relations. I conclude by suggesting closer attention be paid to the specific but multiple generational experiences of older labour migrants and their spouses.