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Tavares J, Silva S, Ribeiro A, Matheus A, Sá-Couto P, Sousa L, Guerra S. Psychometric validation of the Portuguese ALONE scale and analysis of factors associated with severe loneliness in a sample of community-dwelling older adults. Aging Ment Health 2025:1-10. [PMID: 40215287 DOI: 10.1080/13607863.2025.2490712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Accepted: 04/03/2025] [Indexed: 04/18/2025]
Abstract
OBJECTIVES Severe loneliness poses a significant risk to older adults' health and quality of life. This study assessed the psychometric properties (reliability and validity) of the Portuguese version of the ALONE scale in community-dwelling older adults and explored the scale's associations with sociodemographic, social isolation, depression, life satisfaction, and daily functioning. METHOD A descriptive, correlational study was conducted with 285 Portuguese older adults. The questionnaire included sociodemographic and health data, the ALONE scale, Social Isolation Scale (SIS), Satisfaction with Life Scale (SWLS), Geriatric Depression Scale (GDS-15), UCLA Loneliness Scale (UCLA-16), and Lawton and Brody IADL Scale. Analyses included confirmatory factor analysis, internal consistency, group comparisons, correlations, and logistic regression. RESULTS The confirmatory factor analysis supported a unidimensional model with satisfactory fit indices and internal consistency (α = 0.743). Severe loneliness correlated positively with social isolation and depression and negatively with life satisfaction and daily functioning. Participants experiencing severe loneliness were likely older, female, living alone, socially isolated, depressed, and dependent in daily activities. Significant predictors included social isolation (OR = 0.806) and depression (OR = 1.131). CONCLUSION The ALONE scale demonstrated validity and reliability for assessing loneliness in older adults, making it a suitable, efficient tool for clinical practice.
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Affiliation(s)
- João Tavares
- School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Sofia Silva
- Coimbra School of Education, Polytechnic Institute of Coimbra, Coimbra, Portugal
| | - Ana Ribeiro
- Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | - Anna Matheus
- Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | - Pedro Sá-Couto
- Department of Mathematics, University of Aveiro, Aveiro, Portugal
| | - Liliana Sousa
- Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | - Sara Guerra
- Coimbra School of Education, Polytechnic Institute of Coimbra, Coimbra, Portugal
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Hu Z, Tang L, Zhan Y. Association between cumulative loneliness and risk of cardiovascular diseases in middle-aged and older adults: A longitudinal study. Public Health 2025; 239:156-161. [PMID: 39836996 DOI: 10.1016/j.puhe.2024.12.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 12/08/2024] [Accepted: 12/20/2024] [Indexed: 01/23/2025]
Abstract
OBJECTIVE Previous longitudinal studies have investigated the association between baseline loneliness and the risk of developing cardiovascular diseases (CVD). Nevertheless, the cumulative effect of loneliness on CVD remains uncertain. The objective of this study is to assess the relationship between the cumulative duration of loneliness and the risk of CVD in middle-aged and older adults. STUDY DESIGN Prospective cohort study. METHODS The study utilized data from a sample of 8353 adults aged 45 years and older who participated in the China Health and Retirement Longitudinal Study (CHARLS). Loneliness was assessed biennially between 2011 and 2015, and categorized into four groups: never, one time point, two time points, and three time points. The Cox Proportional Hazards Regression Model was employed to estimate hazard ratios (HRs) and corresponding 95 % confidence intervals (CIs). RESULTS Following a mean follow-up period of 4.7 years (standard deviation: 0.7 years), a total of 1314 cases of CVD were identified, including 913 cases of heart disease and 504 cases of stroke. After adjusting for potential confounding factors, individuals who experienced loneliness at one time point (HR, 1.21; 95 % CI: 1.06, 1.38), two time points (HR, 1.23; 95 % CI: 1.03, 1.45), and three time points (HR, 1.50; 95 % CI: 1.19, 1.89) had a significantly higher risk of developing CVD compared to those who never experienced loneliness. CONCLUSIONS Cumulative loneliness was associated with increased risk of CVD in middle-age and older adults. Additional research is warranted to delve into the underlying mechanisms, while it is advisable to contemplate social interventions aimed at addressing loneliness.
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Affiliation(s)
- Zhao Hu
- Department of Epidemiology, School of Public Health(shenzhen), Sun Yat-sen University, Shenzhen, China.
| | - Lu Tang
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yiqiang Zhan
- Department of Epidemiology, School of Public Health(shenzhen), Sun Yat-sen University, Shenzhen, China.
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Tierney WM, McNamee C, Harris SS, Strakowski SM. Community-Based Mental Health Improvement Initiatives: A Narrative Review and Indiana Case Study. Popul Health Manag 2025; 28:31-36. [PMID: 39506568 DOI: 10.1089/pop.2024.0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2024] Open
Abstract
There is a global mental health crisis: mental illness is underrecognized, underdiagnosed, and undertreated with adverse effects on mental, physical, and social health. In the United States, there is an insufficient number of traditional psychiatric and psychological resources to provide the mental health care needed to solve this crisis. Community-based interventions could be an important adjunct to traditional mental health care. An evaluation of peer-reviewed articles was performed describing community-based interventions and identified 3 approaches with some evidence of effectiveness: (1) interventions that enhance community mental health literacy to improve recognition of early signs of mental illness for early engagement and provide community, family, and peer support; (2) community clinics providing social, medical, and mental health care and support to transition-age youth (15-25 years); and (3) social networking activities to enhance interactions among elders suffering from social isolation and loneliness. Multisector, multidisciplinary, and multicomponent interventions involving health care providers and community-based organizations had the best evidence of effectiveness and should target transition-age youth and elders.
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Affiliation(s)
- William M Tierney
- Department of Community and Global Health, Richard M. Fairbanks School of Public Health, Indiana University Indianapolis, Indianapolis, Indiana, USA
- Regenstrief Institute, Inc, Indianapolis, Indiana, USA
| | - Cassidy McNamee
- Department of Community and Global Health, Richard M. Fairbanks School of Public Health, Indiana University Indianapolis, Indianapolis, Indiana, USA
| | - Sydney S Harris
- Department Psychiatry and Behavioral Health Sciences, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Stephen M Strakowski
- Department of Community and Global Health, Richard M. Fairbanks School of Public Health, Indiana University Indianapolis, Indianapolis, Indiana, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Indiana University Health, Inc, Indianapolis, Indiana, USA
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König HH, Hajek A. Disutility associated with social isolation and loneliness in Germany: results of a population survey using the EQ-5D-5L instrument. Health Qual Life Outcomes 2024; 22:110. [PMID: 39707414 DOI: 10.1186/s12955-024-02329-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 12/13/2024] [Indexed: 12/23/2024] Open
Abstract
BACKGROUND Social isolation and loneliness are highly prevalent and may have a negative impact on health-related quality of life (HRQL). The EQ-5D-5L is a widely used questionnaire from which an index value for HRQL based on societal preferences (utility) can be derived. The purpose of this study was to estimate the loss in utility (i.e. disutility) associated with loneliness and social isolation in the German adult population. METHODS Data came from a quota sample of individuals aged 18-74 years residing in Germany (n = 5,000) and representing the adult population in terms of age groups, gender and geographic locations. Data collection was conducted online in August and September 2023 by a certified market research firm. The EQ-5D-5L index score based on the German value set was used as outcome. Moreover, the established Lubben Social Network Scale was used to measure social isolation. The De Jong Gierveld tool was used to quantify loneliness. Groups affected by social isolation or loneliness were compared to non-affected groups, respectively. Differences in covariates between affected and non-affected groups were balanced using entropy balancing. Linear regressions were conducted afterwards (using the weights derived from the entropy balancing). Subgroup analyses by sex and age groups as well as various robustness checks were conducted. RESULTS The EQ-5D-5L index score was lower among individuals with social isolation compared to individuals without social isolation (β=-0.04, p < 0.001). Moreover, the EQ-5D-5L index score was lower among individuals with loneliness compared to individuals without loneliness (β=-0.07, p < 0.001). Several robustness checks produced similar results. The findings were almost the same for both women and men and varied only slightly between age groups. CONCLUSIONS We found a statistically significant and relevant disutility associated with social isolation and, even more pronounced, with loneliness. The magnitude of disutilities is similar to those reported for various chronic diseases. Taking into account the high prevalence of social isolation and, in particular, loneliness, the associated burden in terms of quality-adjusted life years (QALY) lost is likely to be tremendous. The results underline the need to take action against the high prevalence of loneliness and social isolation.
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Affiliation(s)
- Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - André Hajek
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Periyakoil VS, Bangoy M, Rodriguez D, Fuller J, Neri E, Kraemer H. Loneliness in Seriously Ill Nursing Home Residents During the COVID-19 Pandemic. J Palliat Med 2024; 27:1467-1474. [PMID: 39162413 DOI: 10.1089/jpm.2024.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024] Open
Abstract
Background: Loneliness and social isolation coexist, making it difficult to study each separately. The COVID-19 lockdown provided an unprecedented and ethically viable opportunity to study loneliness in seriously ill nursing home residents under uniformly imposed social isolation conditions. Objective: To understand the phenomenon of loneliness of the seriously ill nursing home patients under a uniform social isolation condition imposed by the COVID-19 pandemic lockdown. Design: Cross-sectional, semi-structured interviews were tape-recorded, transcribed verbatim, and analyzed qualitatively using an inductive thematic analysis. The University of California, Los Angeles (UCLA) Three-Item Loneliness Scale was used to measure loneliness and any relationships between self-reported loneliness and isolation were elucidated. Setting/Participants: Thirty seriously ill nursing home residents living in complete social isolation imposed by the COVID-19 pandemic lockdown. Results: Thematic analysis identified four key themes: (1) Diverse perceptions about the impact of the COVID-19 lockdown, (2) regret over the missed opportunities for spending time with friends and family, (3) using electronic communication to maintain connections with loved ones, and (4) the impact of nursing home staff. In total, 50% of the participants reported feeling socially isolated, 60% patients reported loneliness, and 70% reported being adversely impacted by the lockdown. Patients who felt socially isolated also reported experiencing loneliness (Kendall's Tau = 0.61, 95% confidence interval [CI] = 0.30, 0.89, p < 0.01, large effect size). Persons from communities of color had higher median loneliness scores compared to Non-Hispanic Whites. Participants in the last year of life also reported higher levels of loneliness. Conclusion: A study of loneliness under uniform social isolation conditions in seriously ill nursing home patients showed a high prevalence of loneliness and a strong correlation between self-reported loneliness and social isolation, especially in persons from minority communities and those in the last year of life. In-person support provided by nursing home staff and virtual support from family was helpful to patients.
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Affiliation(s)
- Vyjeyanthi S Periyakoil
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Palo Alto, California, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Margery Bangoy
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Dulce Rodriguez
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Jon Fuller
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Eric Neri
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Helena Kraemer
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Palo Alto, California, USA
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Kivelä LMM, Fried EI, van der Does W, Antypa N. Examining contemporaneous and temporal associations of real-time suicidal ideation using network analysis. Psychol Med 2024; 54:1-9. [PMID: 39245794 PMCID: PMC11496231 DOI: 10.1017/s003329172400151x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 05/14/2024] [Accepted: 05/20/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Suicidal ideation arises from a complex interplay of multiple interacting risk factors over time. Recently, ecological momentary assessment (EMA) has increased our understanding of factors associated with real-time suicidal ideation, as well as those predicting ideation at the level of hours and days. Here we used statistical network methods to investigate which cognitive-affective risk and protective factors are associated with the temporal dynamics of suicidal ideation. METHODS The SAFE study is a longitudinal cohort study of 82 participants with current suicidal ideation who completed 4×/day EMA over 21 days. We modeled contemporaneous (t) and temporal (t + 1) associations of three suicidal ideation components (passive ideation, active ideation, and acquired capability) and their predictors (positive and negative affect, anxiety, hopelessness, loneliness, burdensomeness, and optimism) using multilevel vector auto-regression models. RESULTS Contemporaneously, passive suicidal ideation was positively associated with sadness, hopelessness, loneliness, and burdensomeness, and negatively with happiness, calmness, and optimism; active suicidal ideation was positively associated with passive suicidal ideation, sadness, and shame; and acquired capability only with passive and active suicidal ideation. Acquired capability and hopelessness positively predicted passive ideation at t + 1, which in turn predicted active ideation; acquired capability was positively predicted at t + 1 by shame, and negatively by burdensomeness. CONCLUSIONS Our findings show that systematic real-time associations exist between suicidal ideation and its predictors, and that different factors may uniquely influence distinct components of ideation. These factors may represent important targets for safety planning and risk detection.
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Affiliation(s)
- Liia M. M. Kivelä
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Eiko I. Fried
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Willem van der Does
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
- Leiden University Treatment and Expertise Center (LUBEC), Leiden, The Netherlands
| | - Niki Antypa
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
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Torres Z, Oliver A, Tomás JM. Understanding the Effect of Loneliness on Quality of Life in Older Adults from Longitudinal Approaches. PSYCHOSOCIAL INTERVENTION 2024; 33:171-178. [PMID: 39234356 PMCID: PMC11370129 DOI: 10.5093/pi2024a11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/12/2024] [Indexed: 09/06/2024]
Abstract
Aim: To study the longitudinal relationship between loneliness and quality of life (QoL) in adults to identify key mechanisms to better design future psychosocial interventions. Method: 13,222 participants from three consecutive waves of the Survey of Health, Ageing, and Retirement in Europe (SHARE), aged 65 or older, 56.3% women. They were analyzed using cross-lagged panel model (CLPM), random intercept cross-lagged panel model (RI-CLPM), and multi-group models disaggregated by gender. Results: The RI-CLPM provided a better fit than the CLPM. Both models showed the stability of QoL and loneliness. All autoregressive paths were significant, and a negative association between concurrent QoL and loneliness was observed across all waves. The CLPM supported a reciprocal relationship, while the RI-CLPM only confirmed the effects of loneliness on QoL. Women reported higher levels of loneliness and poorer QoL, but no gender differences were identified in the longitudinal association. Conclusions: Addressing loneliness in early stages could be a better preventive measure to promote quality of life in both genders.
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Affiliation(s)
- Zaira Torres
- University of ValenciaValenciaSpainUniversity of Valencia, Spain
| | - Amparo Oliver
- University of ValenciaValenciaSpainUniversity of Valencia, Spain
| | - José M. Tomás
- University of ValenciaValenciaSpainUniversity of Valencia, Spain
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Lebuf E, Van Dyck D, Van de Velde L, Beeckman M, Van Cauwenberg J, Compernolle S. Sedentary patterns and health outcomes in the oldest-old: a latent profile analysis. PeerJ 2024; 12:e17505. [PMID: 38938606 PMCID: PMC11210487 DOI: 10.7717/peerj.17505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 05/13/2024] [Indexed: 06/29/2024] Open
Abstract
Background Sedentary behavior is most prevalent among those aged 80 years and above, referred to as the oldest-old. Current literature emphasizes the significance of sedentary behavior patterns, but further evidence is required to understand how these patterns relate to specific health outcomes and to identify at-risk profiles for tailored interventions in the oldest-old. Therefore, the aim of this study was to identify profiles of adults aged 80+ years based on their sedentary patterns and health outcomes, and to examine associations between profiles and socio-demographics. Methods A cross-sectional study was conducted in Flanders (Belgium) from February 2021 to December 2022 recruiting 90 older adults (80+) through convenience sampling, employing word of mouth, social media and local service centers. Latent profile analysis identified device-based sedentary patterns and assessed their associations with physical and cognitive functioning, mental health-related quality of life (QoL), and social isolation. Associations of these profiles with socio-demographic factors were analyzed. Results Three distinct profiles were identified: (1) the 'cognitively and physically frail' profile, (2) the 'healthy' profile and (3) the 'lower mental health-related QoL' profile. Those in the 'cognitively and physically frail' profile exhibited the least favorable sedentary pattern, and had a higher likelihood of residing in a nursing home. No significant differences were found for the other socio-demographic variables, being age, sex, educational degree and family situation. Conclusions Three distinct profiles in the oldest-old population, based on cognitive and physical functioning, mental health-related QoL, and sedentary behavior patterns, were identified. Lower physical and cognitive functioning was associated with unhealthy sedentary patterns. Further research with larger samples is crucial to uncover potential links between socio-demographics and at-risk subgroups, enhancing our understanding of sedentary behavior and geriatric health outcomes in this population.
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Affiliation(s)
- Elien Lebuf
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Delfien Van Dyck
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Laura Van de Velde
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Melanie Beeckman
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | | | - Sofie Compernolle
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
- Research Foundation Flanders, Brussels, Belgium
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Bally ELS, Korenhof SA, Ye L, van Grieken A, Tan SS, Mattace-Raso F, Procaccini E, Alhambra-Borrás T, Raat H. Factors associated with health-related quality of life among community-dwelling older adults: the APPCARE study. Sci Rep 2024; 14:14351. [PMID: 38906882 PMCID: PMC11192871 DOI: 10.1038/s41598-024-64539-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 06/10/2024] [Indexed: 06/23/2024] Open
Abstract
This study aimed to identify the factors associated with health-related quality of life (HRQOL) among community-dwelling older adults. Physical and mental HRQOL were measured by the 12-item Short Form Health Survey (SF-12) at baseline and follow-up. Linear regression models were used to evaluate associations between socio-demographic, health, and lifestyle factors and HRQOL. The sample included 661 participants (mean age = 77.4 years). Frailty was negatively associated with physical HRQOL (B = - 5.56; P < 0.001) and mental HRQOL (B = - 6.65; P < 0.001). Participants with a higher score on activities of daily living (ADL) limitations had lower physical HRQOL (B = - 0.63; P < 0.001) and mental HRQOL (B = - 0.18; P = 0.001). Female sex (B = - 2.38; P < 0.001), multi-morbidity (B = - 2.59; P = 0.001), and a high risk of medication-related problems (B = - 2.84; P < 0.001) were associated with lower physical HRQOL, and loneliness (B = - 3.64; P < 0.001) with lower mental HRQOL. In contrast, higher age (B = 2.07; P = 0.011) and living alone (B = 3.43; P < 0.001) were associated with better mental HRQOL in the multivariate models. Future interventions could be tailored to subpopulations with relatively poor self-reported HRQOL, such as frail or lonely older adults to improve their HRQOL.
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Affiliation(s)
- Esmée L S Bally
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sophie A Korenhof
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Lizhen Ye
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Amy van Grieken
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Siok Swan Tan
- Research Group City Dynamics, InHolland University of Applied Sciences, Rotterdam, The Netherlands
| | - Francesco Mattace-Raso
- Division of Geriatric Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Elena Procaccini
- Funded Project Office, Local Health Authority n.2 Treviso, Treviso, Italy
| | | | - Hein Raat
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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Park NS, Jang Y, Chung S, Chiriboga DA, Haley WE. Relationship of Living and Eating Arrangements to Mental Distress Among Older Korean Immigrants: Gender Difference in the Mediating Role of Loneliness. Res Aging 2024; 46:153-166. [PMID: 37820385 DOI: 10.1177/01640275231206482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
This study examined how different living/eating arrangements were associated with loneliness and depressive symptoms among older Korean immigrants. We examined gender differences considering: (1) patterns of living/eating arrangements and their relations with loneliness and mental distress and (2) indirect effect of living/eating arrangements on mental distress through feeling lonely. Data were drawn from the Study of Older Korean Americans that surveyed older; Korean immigrants during 2017-2018 (N = 2150). Living/eating arrangements were classified in the combination of four categores. Using the PROCESS macro, we tested gender differences in the mediation effect of loneliness on the relationship between living/eating arrangements and mental distress while controlling for background/health characteristics and social connectedness-related variables. The mediating role of loneliness was manifested differentially between men and women. By administering simple measures of living/eating arrangements, practitioners could potentially identify key targets to improve social and mental well-being, particularly among older immigrants with limited resources.
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Affiliation(s)
- Nan Sook Park
- School of Social Work, University of South Florida, Tampa, FL, USA
| | - Yuri Jang
- Edward R. Roybal Institute on Aging, Suzanne Dworak-Peck School of Social Work, University of Southern California, California, CA, USA
- Department of Social Welfare, Ewha Womans University, Seoul, South Korea
| | - Soondool Chung
- Department of Social Welfare, Ewha Womans University, Seoul, South Korea
| | - David A Chiriboga
- Department of Child and Family Studies, University of South Florida, Tampa, FL, USA
| | - William E Haley
- School of Aging Studies, University of South Florida, Tampa, FL, USA
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Quach LT, Ritchie CS, Reynolds Z, Paul R, Seeley J, Tong Y, Hoeppner S, Okello S, Nakasujja N, Olivieri-Mui B, Saylor D, Greene M, Asiimwe S, Tindimwebwa E, Atwiine F, Sentongo R, Siedner MJ, Tsai AC. HIV, Social Networks, and Loneliness among Older Adults in Uganda. AIDS Behav 2024; 28:695-704. [PMID: 38281251 PMCID: PMC10947585 DOI: 10.1007/s10461-023-04258-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 01/30/2024]
Abstract
Loneliness among older adults has been identified as a major public health problem. Yet little is known about loneliness, or the potential role of social networks in explaining loneliness, among older people with HIV (PWH) in sub-Saharan Africa, where 70% of PWH reside. To explore this issue, we analyzed data from 599 participants enrolled in the Quality of Life and Ageing with HIV in Rural Uganda study, including older adults with HIV in ambulatory care and a comparator group of people without HIV of similar age and gender. The 3-item UCLA Loneliness Scale was used to measure loneliness, and HIV status was the primary explanatory variable. The study found no statistically significant correlation between loneliness and HIV status. However, individuals with HIV had smaller households, less physical and financial support, and were less socially integrated compared to those without HIV. In multivariable logistic regressions, loneliness was more likely among individuals who lived alone (aOR:3.38, 95% CI:1.47-7.76) and less likely among those who were married (aOR:0.34, 95% CI:0.22-0.53) and had a higher level of social integration (aOR:0.86, 95% CI: 0.79-0.92). Despite having smaller social networks and less support, older adults with HIV had similar levels of loneliness as those without HIV, which may be attributed to resiliency and access to HIV-related health services among individuals with HIV. Nonetheless, further research is necessary to better understand the mechanisms involved.
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Affiliation(s)
- Lien T Quach
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Centre for Aging and Serious Illness, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA.
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, USA.
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- The Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, USA.
| | - Christine S Ritchie
- Centre for Aging and Serious Illness, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Zahra Reynolds
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Robert Paul
- Department of Psychological Sciences, University of Missouri at St. Louis, St. Louis, USA
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Yao Tong
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Susanne Hoeppner
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Samson Okello
- Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Noeline Nakasujja
- Department of Psychiatry, College of Health Sciences, Makerere University School of Medicine, Kampala, Uganda
| | - Brianne Olivieri-Mui
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Deanna Saylor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Meredith Greene
- Department of Medicine, Indiana University School of Medicine and Indiana University Center for Aging Research, Regenstreif Institute, Inc., Indianapolis, IN, USA
| | - Stephen Asiimwe
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
- Kabwohe Clinical Research Center, Kabwohe, Uganda
| | | | - Flavia Atwiine
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ruth Sentongo
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark J Siedner
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alexander C Tsai
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
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12
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Larnyo E, Tettegah S, Griffin B, Nutakor JA, Preece N, Addai-Dansoh S, Dubon N, Liu S. Effect of social capital, social support and social network formation on the quality of life of American adults during COVID-19. Sci Rep 2024; 14:2647. [PMID: 38302613 PMCID: PMC10834438 DOI: 10.1038/s41598-024-52820-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 01/24/2024] [Indexed: 02/03/2024] Open
Abstract
This study aims to evaluate the effect of social capital (SC), social support (SS), and social network formation (SNF) on the quality of life of American adults during COVID-19. Using a probability sample of American adults aged 49+, 2370 respondents were selected from the National Social Life Health and Aging Project (NSHAP) dataset for analysis using an integrated partial least squares based on structural equation modeling (PLS-SEM)-K-fold cross-validation approach. The analysis showed that social capital assessed using civic engagement, social cohesion, socioeconomic status (SES), social support, and social network formation were significantly and positively associated with American adults' quality of life during the COVID-19 pandemic. Furthermore, the results showed that using the PLS-SEM and K-fold cross-validation approach produced a medium predictive power of the overall model, confirming the importance of SC, SS, and SNF in predicting quality of life-outcomes. These findings suggest that efforts to promote the well-being of American adults, especially older adults, during the pandemic should focus on strengthening social capital, social support and social network formation.
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Affiliation(s)
- Ebenezer Larnyo
- Center for Black Studies Research, University of California, Santa Barbara, Santa Barbara, CA, 93106, USA.
| | - Sharon Tettegah
- Center for Black Studies Research, University of California, Santa Barbara, Santa Barbara, CA, 93106, USA
| | - Brianna Griffin
- University of California, Santa Barbara, Santa Barbara, CA, 93106, USA
| | - Jonathan Aseye Nutakor
- Department of Health Policy and Management, School of Management, Jiangsu University, 301 Xuefu Road, Zhenjiang, Jiangsu Province, China
| | - Natasha Preece
- University of California, Santa Barbara, Santa Barbara, CA, 93106, USA
| | - Stephen Addai-Dansoh
- Department of Health Policy and Management, School of Management, Jiangsu University, 301 Xuefu Road, Zhenjiang, Jiangsu Province, China
| | - Natalia Dubon
- University of California, Santa Barbara, Santa Barbara, CA, 93106, USA
| | - Senyuan Liu
- University of California, Santa Barbara, Santa Barbara, CA, 93106, USA
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13
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Geigl C, Loss J, Leitzmann M, Janssen C. Social factors of health-related quality of life in older adults: a multivariable analysis. Qual Life Res 2023; 32:3257-3268. [PMID: 37458960 PMCID: PMC10522508 DOI: 10.1007/s11136-023-03472-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE The objective of the analysis was to examine the relationships between sociodemographic, socioeconomic, psychosocial, and behavioural factors and both physical and mental health-related quality of life (HRQOL) in older adults. METHODS The analysis was based on recent cross-sectional data of 1687 community residents from a whole population postal survey of German adults aged 65 years and older (33% response rate, 52% female, mean age 76 years). HRQOL was assessed using the 36-Item Short Form Survey (SF-36v2). For a differentiated analysis, hierarchical multiple linear regressions were performed. RESULTS An internal health locus of control, physical activity, social support, and income were positively associated with physical HRQOL (Adj. R2 = 0.34; p < 0.001) and mental HRQOL (Adj. R2 = 0.18; p < 0.001), whereas an external health locus of control and age were negatively associated with both. Alcohol use and educational level were positively associated only with physical HRQOL, whilst female gender was negatively associated only with mental HRQOL. CONCLUSION Sociodemographic, socioeconomic, psychosocial, and behavioural factors were associated with physical and mental HRQOL. These results highlight the importance of social factors in HRQOL and provide approaches for policy and practice to develop and implement tailored health interventions for older adults. Our findings may be transferable to municipalities in metropolitan areas of high-income European countries. CLINICAL TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Christoph Geigl
- Department of Applied Social Sciences, Munich University of Applied Sciences, 81243, Munich, Germany.
- Department of Epidemiology and Preventive Medicine, University of Regensburg, 93053, Regensburg, Germany.
| | - Julika Loss
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, 13353, Berlin, Germany
| | - Michael Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, 93053, Regensburg, Germany
| | - Christian Janssen
- Department of Applied Social Sciences, Munich University of Applied Sciences, 81243, Munich, Germany
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14
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Boehlen FH, Heider D, Schellberg D, Hohls JK, Schöttker B, Brenner H, Friederich HC, König HH, Wild B. Gender-specific association of loneliness and health care use in community-dwelling older adults. BMC Geriatr 2023; 23:502. [PMID: 37605106 PMCID: PMC10441715 DOI: 10.1186/s12877-023-04201-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 07/28/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Loneliness in older adults is common, particularly in women. In this article, gender differences in the association of loneliness and health care use are investigated in a large sample of community-dwelling older adults. METHODS Data of 2525 persons (ages 55-85 years)-participants of the fourth follow- up (2011-2014) of the ESTHER study- were analyzed. Loneliness and health care use were assessed by study doctors in the course of a home visit. Gender-specific regression models with Gamma-distribution were performed using loneliness as independent variable to predict outpatient health care use, adjusted for demographic variables. RESULTS In older women, lonely persons were shown to have significantly more visits to general practitioners and mental health care providers in a three-month period compared to less lonely persons (p = .005). The survey found that outpatient health care use was positively associated with loneliness, multimorbidity, and mental illness in older women but not in older men. Older men had significantly more contact with inpatient care in comparison to women (p = .02). CONCLUSIONS It is important to consider gender when analyzing inpatient and outpatient health care use in older persons. In older women loneliness is associated with increased use of outpatient services.
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Affiliation(s)
- Friederike Hildegard Boehlen
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany
| | - Dieter Schellberg
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Johanna Katharina Hohls
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, 69120, Heidelberg, Germany
- Network Aging Research, Heidelberg University, 69115, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, 69120, Heidelberg, Germany
- Network Aging Research, Heidelberg University, 69115, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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15
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Prell T, Schönenberg A, Heimrich KG. The impact of loneliness on quality of life in people with Parkinson's disease: results from the Survey of Health, Ageing and Retirement in Europe. Front Med (Lausanne) 2023; 10:1183289. [PMID: 37425329 PMCID: PMC10326722 DOI: 10.3389/fmed.2023.1183289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Background Loneliness is a growing issue for public health in an aging society. However, there is a lack of research on loneliness in people with Parkinson's disease (PwPD). Methods We analyzed cross-sectional and longitudinal data from wave 5 (N = 559 PwPD) and 6 (N = 442 PwPD) from the Survey of Health, Ageing and Retirement in Europe (SHARE). Loneliness was assessed using the three-item version of the Revised UCLA Loneliness Scale. Descriptive statistics, group comparisons, multiple linear regressions, and generalized estimating equation analysis were performed to explore loneliness prevalence, its relationship with other factors, and its impact on Quality of Life (QoL) in PwPD. Results Depending on the used cut-off, the prevalence of loneliness in PwPD ranged from 24.1 to 53.8%. These prevalences were higher compared to people without PD. Loneliness was mainly linked to decreased functional abilities, weaker grip strength, more symptoms of depression, and country of residence. Loneliness was also associated with current QoL and predicts future QoL in PwPD, highlighting its impact on well-being. Conclusion Addressing loneliness could potentially improve QoL for PwPD, making it a modifiable risk factor that clinicians and policy-makers should consider.
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Affiliation(s)
- Tino Prell
- Department of Geriatrics, Halle University Hospital, Halle, Germany
- Department of Neurology, Jena University Hospital, Jena, Germany
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Min J, Chang JS, Kong ID. Domain-specific physical activity, sedentary behavior, subjective health, and health-related quality of life among older adults. Health Qual Life Outcomes 2023; 21:52. [PMID: 37248513 DOI: 10.1186/s12955-023-02136-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 05/22/2023] [Indexed: 05/31/2023] Open
Abstract
PURPOSE This study aims to investigate the association between domain-specific physical activity (PA), sedentary behavior, subjective health perception, and health-related quality of life (HR-QoL) in Korean adults aged ≥ 65 years. METHODS This cross-sectional study analyzed 6,004 older adults from the Korean National Health and Nutrition Examination Survey 2017-2020. PA and sedentary behavior were measured using a global PA questionnaire, and HR-QoL was assessed using the EuroQol-5 Dimension (EQ-5D, three-level version). Multiple logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) after adjusting for confounding parameters. RESULTS Older adults who were physically active at work showed a negative association with subjectively good health and HR-QoL, whereas those physically active in transport or leisure time showed a positive association with subjectively good health and HR-QoL. Older adults highly engaged in sedentary behavior showed a worse perception of health and HR-QoL. Compared to high sedentary behavior and physical activity during leisure time or transport, the EQ-5D index was higher than that of their counterparts. CONCLUSION Both domain-specific PA and sedentary behavior were significantly associated with older adults' perception of health and HR-QoL. Interventions are needed to improve HR-QoL by reducing sedentary behavior and encouraging physical activity in transportation or leisure time among adults aged 65 years and above.
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Affiliation(s)
- Jihee Min
- Department of Convergence Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Yonsei Institute of Sports Science and Exercise Medicine, Wonju, Republic of Korea
- National Cancer Survivorship Center, National Cancer Control Institute, National Cancer Center, Goyang-si, Republic of Korea
| | - Jae Seung Chang
- Department of Sports Science, Hannam University, Daejeon, Republic of Korea
| | - In Deok Kong
- Department of Convergence Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
- Yonsei Institute of Sports Science and Exercise Medicine, Wonju, Republic of Korea.
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17
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Wong ELY, Li J, Yuen S, Lai AHY, Cheung AWL, Yau PSY, Yeoh EK. Vulnerable populations during COVID-19 response: Health-related quality of life among Chinese population and its influence due to socio-demographic factors and loneliness. Front Public Health 2022; 10:857033. [PMID: 36081475 PMCID: PMC9446419 DOI: 10.3389/fpubh.2022.857033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 07/06/2022] [Indexed: 01/21/2023] Open
Abstract
Background Infection control policy affected people's wellbeing during the COVID-19 pandemic, especially those vulnerable populations. This study aimed to compare the health-related quality of life (HRQoL) of the Hong Kong (HK) Chinese population under the pandemic with the normative profiles and explore its influencing factors, including socio-demographic characteristics, loneliness, and the interaction between them. Methods A cross-sectional questionnaire survey (301 online and 202 in-person) was conducted between June and December 2020 among the adult Chinese population during the 2nd wave of COVID-19 in HK. HRQoL was measured by a Hong Kong validated EQ-5D-5L instrument (EQ-5D-5L HK). Loneliness was measured by a single-item question regarding the frequency of the participants reporting feeling lonely and their subjective social status was measured by the MacArthur Scale of Subjective Social Status. A series of Tobit regressions was conducted. The interaction terms between socio-demographics and loneliness were also examined to decide their association with HRQoL. Results A total of 503 responses were collected. The level of HRQoL of the respondents was significantly lower than the referred norms profile among the local general population. The findings identified that younger age, single, a higher subjective social status, and a lower level of loneliness were significantly associated with better HRQoL. Moreover, age and marital status were significant moderators in the relationship between loneliness and HRQoL. Conclusion The present study found that some population groups face additional vulnerabilities during the pandemic in terms of declined HRQoL. In addition, reducing loneliness can protect the HRQoL during the pandemic, especially among older people. This article provides useful information for policy-makers to design and promote effective services or provide education to improve the connection of people and recover from the global pandemic.
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Affiliation(s)
- Eliza Lai-Yi Wong
- Centre for Health Systems and Policy Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China,*Correspondence: Eliza Lai-Yi Wong
| | - Jia Li
- Centre for Health Systems and Policy Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Shannon Yuen
- Faculty of Social Sciences, Developmental and Educational Psychology, Leiden University, Leiden, Netherlands
| | - Angel Hor-Yan Lai
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Annie Wai-Ling Cheung
- Centre for Health Systems and Policy Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Peter Sen-Yung Yau
- Centre for Health Systems and Policy Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Eng-Kiong Yeoh
- Centre for Health Systems and Policy Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Gender Differences in Correlates of Loneliness among Community-Dwelling Older Koreans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127334. [PMID: 35742581 PMCID: PMC9224515 DOI: 10.3390/ijerph19127334] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022]
Abstract
Background: Despite a relatively large number of studies exploring late-life loneliness, few studies have compared gender differences in the correlates of loneliness of older adults. Thus, we examined the gender differences in correlates of loneliness among community-dwelling older adults. Methods: This study was a secondary analysis of data from a parent study conducted among community-dwelling Koreans 65 years of age or older. Loneliness was measured by the 20-item Revised University of California Los Angeles Loneliness Scale. As potential correlates, demographic, health-related, and social variables were included. Multivariate hierarchical regression analyses were performed separately by gender. Results: Men were more likely to be lonely than women, after controlling for demographic, health-related, and social variables. A social network of family ties and being married were found to be inversely correlated with loneliness in men but not in women. A social network of friendship ties and participation in a variety of community activities were inversely correlated with loneliness in both men and women. Conclusions: A social network of family ties and being married may help reduce late-life loneliness, particularly among men. This study highlights the importance of considering gender differences in the design of strategies for preventing and alleviating late-life loneliness.
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