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Kim I, An H, Yun S, Park HY. Effectiveness of community-based interventions for older adults living alone: a systematic review and meta-analysis. Epidemiol Health 2024; 46:e2024013. [PMID: 38228090 DOI: 10.4178/epih.e2024013] [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: 07/28/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024] Open
Abstract
OBJECTIVES This study examined the effectiveness of community-based interventions designed for older adults living alone through a systematic review and meta-analysis. METHODS The study incorporated 4 randomized controlled trials (RCTs) and 5 non-RCTs to evaluate various interventions. The methodological quality of these studies was assessed using the Downs and Black checklist, while Q-statistic and I-square tests were performed to examine statistical heterogeneity. Additionally, visual inspection of funnel plots and the trim-and-fill method were employed to investigate potential publication bias. Of the 2,729 identified studies, 9 met the criteria for inclusion in this review. Independent variables were categorized into 5 groups (physical activity, nutrition, social relationships, social participation, and combined intervention) to examine their effects. Dependent variables were similarly classified into 5 subgroups to identify the specific effects of the interventions. RESULTS Interventions focusing on nutrition and combined approaches were the most effective, yielding effect sizes of 0.96 (95% confidence interval [CI], 0.66 to 1.25) and 0.43 (95% CI, 0.26 to 0.60), respectively. The interventions had the greatest impacts on the health behavior and mental health of the participants, with effect sizes of 0.98 (95% CI, 0.73 to 1.22) for health behavior and 0.67 (95% CI, 0.19 to 1.16) for mental health. CONCLUSIONS This study suggests a direction for the development of community-based interventions tailored to the needs of older adults living alone. Additionally, it provides evidence to inform policy decisions concerning this demographic.
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Affiliation(s)
- Inhye Kim
- Department of Occupational Therapy, Graduate School, Yonsei University, Wonju, Korea
| | - Hyunseo An
- Department of Occupational Therapy, Graduate School, Yonsei University, Wonju, Korea
| | - Sohyeon Yun
- Department of Occupational Therapy, Graduate School, Yonsei University, Wonju, Korea
| | - Hae Yean Park
- Department of Occupational Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Korea
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What is the relationship between falls, functional limitations, and depressive symptoms among Chinese older adults? The role of living alone. Maturitas 2023; 168:78-83. [PMID: 36521395 DOI: 10.1016/j.maturitas.2022.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 08/26/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Although the association between falls and depressive symptoms is well documented, the mechanisms underlying this association remain largely unexplored. We investigated the mediation role of functional limitations in the association between falls and depressive symptoms among Chinese older adults and determined whether the living arrangement (living alone or not) is a significant moderator of the above-mentioned mediation pathway. STUDY DESIGN Cross-sectional study. MAIN OUTCOME MEASURES Depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale short form (CESD-10), on which higher scores indicate higher levels of depressive symptoms. RESULTS We used the harmonized China Health and Retirement Longitudinal Study national baseline data (2011-2012 year) involving 7410 participants aged 60 years and over. After adjusting for covariates (e.g., age and sex), the effects of falls on depressive symptoms were seen to be mediated by functional limitations among Chinese older adults (β = 0.82, p < .001). The moderated mediation analysis, which assesses whether an indirect effect is conditional on values of a moderating variable, found that the mediation effect was contingent upon the living arrangement (β = -0.60, p = .029). Specifically, the levels of functional limitations and depressive symptoms were higher for people with falls who were living with others relative to those living alone. CONCLUSIONS These results suggest that functional limitations are an important intervening variable that links falls to depressive symptoms among Chinese older adults. Interventions to promote older adults' physical function and prevent falls are recommended to decrease the risk of depressive symptoms. These interventions can particularly benefit those who live with others.
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Decreasing patterns of depression in living alone across middle-aged and older men and women using a longitudinal mixed-effects model. Soc Sci Med 2023; 317:115513. [PMID: 36450172 DOI: 10.1016/j.socscimed.2022.115513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/23/2022] [Accepted: 11/03/2022] [Indexed: 11/22/2022]
Abstract
There is little evidence regarding the association between living arrangement and depression, and no studies have examined the age- and gender-specific differences in this association. The present study sought to examine the longitudinal changes in depression patterns between isolative living versus living in company among middle-aged and older men and women by obtaining data from waves 1-7 of the Korean Longitudinal Study of Aging (KloSA), which comprises a sample of persons at least 45 years of age in the Republic of Korea (2273 middle-aged and 1387 older men, 2805 middle aged and 1862 older women). Depression scores were based on the self-reported Center for Epidemiologic Studies Depression Scale (CES-D-10) short forms. Using mixed-effect linear regression models, we estimated depression patterns by living arrangement across age- and gender groups. Our findings from the mixed-effects model revealed that over a 14-year follow-up period, there were significant decreasing patterns of depression were among middle-aged men and women, and older men living alone compared to living with a spouse and living with others. However, living alone still had the highest depression compared to other living arrangement types. On the other hand, the depression of older women living alone changed to a level similar to those living with others during the follow-up period. In conclusion, these findings indicate that living alone significantly increases the risk of depression, but the risk decreases over time. Additionally, depression patterns by living arrangement proved to differ across age and gender groups.
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Ratcliffe J, Kanaan M, Galdas P. Men and loneliness in the Covid-19 pandemic: Insights from an interview study with UK-based men. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3009-e3017. [PMID: 35122333 PMCID: PMC9111711 DOI: 10.1111/hsc.13746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 12/15/2021] [Accepted: 01/20/2022] [Indexed: 06/14/2023]
Abstract
Since the onset of the Covid-19 pandemic, the UK, like many countries, has had restrictions on social contact, and injunctions of 'social distancing'. This study aimed to generate new insights into men's experiences of loneliness during the pandemic, and consider the ramifications of these for continued/future restrictions, the easing of restrictions, and the future beyond the pandemic. Twenty qualitative interviews were conducted with men between January and March 2021. A maximum variation purpose sample frame required at least three non-white men, three LGBTQ+men, three men with a university education, three without a university education, three 18-30 years old, and three aged 60+. Thematic analysis, focused on semantic themes, was employed as part of a 'grounded' epistemology whereby the stated perspectives of the interviewees drove the content of the study. Seven themes were constructed: (i) lost and new activities and routines; (ii) remote social interaction; (iii) narrowed social spheres; (iv) rethought and renewed recognition of what is important; (v) loneliness with a purpose; (vi) anxiety of social contact; and (vii) easier for themselves than others. Lost routines, fewer meaningful activities, and a reduction in face-to-face interaction, were framed as challenges to preventing loneliness. Solo-living gay men seemed particularly negatively affected. However, many men displayed new, more covid-safe routines and activities. Remote forms of interaction were often utilised, and though they were imperfect, were constructed as worth engaging with, and held capacity for improvement. A moral need to reduce transmission of SARS-COV-2, and a fear of catching it, became important features of participants lives that also affected loneliness. Men at higher risk of health complications from Covid-19 were particularly likely to highlight anxiety of social contact. Reducing restrictions alone may not return everyone to pre-pandemic levels of loneliness, particularly if the pandemic remains a significant public health issue.
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Affiliation(s)
| | - Mona Kanaan
- Department of Health SciencesUniversity of YorkYorkUK
| | - Paul Galdas
- Department of Health SciencesUniversity of YorkYorkUK
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Hirakawa Y, Aita K, Nishikawa M, Arai H, Miura H. Contemporary Issues and Practicalities in Completing Advance Care Planning for Patients With Severe COPD Living Alone: A Qualitative Study. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2022; 18:80-95. [PMID: 34605374 DOI: 10.1080/15524256.2021.1976353] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Health care professionals working with older people living alone with chronic obstructive pulmonary disease (COPD) to complete advance care planning (ACP) often encounter the double burden of social isolation and acute exacerbations in this planning. The study explored clinicians' perceptions regarding factors influencing the completion of ACP for older people with COPD living alone. Individual interviews were conducted with 18 health care professionals using the video meeting platform in 2020. A semi-structured interview guide included: (a) behavior and lifestyle related to decision-making, (b) desired place to die, and (c) facilitators and barriers to autonomy in patients with severe COPD who live alone. Five main themes were identified: information sharing among team members, patient readiness, desired place of death, economic constraints, and care at the time of and after death. Partly due to the heterogeneity and complexity of clinical courses and treatment responses of COPD, a wide range of social issues of a person's life were related to practicality in the completion of ACP for older people with COPD living alone. Social work knowledge and skills such as in-depth interviewing, outreach finance and welfare support, and holistic perspective play an essential role in completing ACP for COPD patients living alone.
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Affiliation(s)
- Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Kaoruko Aita
- Graduate School of Humanities and Sociology, University of Tokyo, Tokyo, Japan
| | | | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hisayuki Miura
- National Center for Geriatrics and Gerontology, Obu, Japan
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Abstract
OBJECTIVES The aim of this study was to explore old persons' experiences of positive solitude (PS) and the gaps between their experience and professional caregivers' perceptions of older adults' experiences of PS. Moreover, we attempt to understand the basic mechanism that may explain these gaps. DESIGN A qualitative method was used. PARTICIPANTS Fourty-one older adults (aged 65-103 years) and 2 groups of professionals: 16 occupational therapists with a specialization in gerontology and 41 gerontology graduate students from other occupations. MEASUREMENT Four open-ended questions about PS were asked. The older adults described their views on PS and experiences during solitude. The two caregiver groups, who are familiar with older adults, answered the questions twice, referring once to themselves and once to older adults in general. RESULTS A. Gaps exist between old peoples' and caregivers' perceptions and experience of PS. B. The caregivers believe that older adults cannot easily enjoy PS. C. Caregivers believe that there are certain preconditions for older adults' experience of PS. D. Differences in attitude toward older adults between the caregiver groups were found. CONCLUSIONS Although old people occasionally prefer PS, culture and age bias may prevent caregivers from accepting older adults' need for PS. Practical implications include the need to raise awareness of age bias among caregiving staff, in particular regarding their acceptance of older adults' PS experiences. This may improve the staff's willingness to enable older adults to experience PS without interruption.
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Wolfe WA. Loneliness: An Overlooked Contributing Factor in Anorexia of Older Patients With End-Stage Renal Disease and Focal Point for Interventions to Enhance Nutritional Status-An Overview of Evidence and Areas of Suggested Research. J Ren Nutr 2021; 32:498-502. [PMID: 34772602 DOI: 10.1053/j.jrn.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 09/20/2021] [Accepted: 10/03/2021] [Indexed: 11/11/2022] Open
Abstract
Although research has shown that loneliness can contribute to anorexia in older non-ESRD (end-stage renal disease) populations, and the benefits of its mitigation with improving appetite, nutrient, and caloric intake, its implications for older patients with ESRD have been overlooked. This article provides an overview of evidence on the potential contributing role of loneliness in anorexia of older patients with ESRD, and loneliness as a focal point for interventions to help improve nutritional status. Areas of needed research are suggested in the course of the analysis. With a 41%-83% projected rise in the prevalence of patients in the United States with ESRD by 2030, and demographic population trends showing that an ever-increasing number will be living alone, there is a long overdue need to better understand the implications of loneliness for this nutritionally vulnerable population. KEYWORDS: Chronic kidney disease; loneliness; anorexia; malnutrition; protein energy wasting.
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Affiliation(s)
- William A Wolfe
- Women's Institute for Family Health of Philadelphia, Consultant & University of Pennsylvania, School of Social Policy & Practice, Graduate Student Mentoring.
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Jeon SH, Hong GRS, Jang HY. Life Experiences of Older Men Living Alone With Depression. J Psychosoc Nurs Ment Health Serv 2021; 60:33-40. [PMID: 34432587 DOI: 10.3928/02793695-20210819-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
As the percentage of older adults living alone increases, social interest has been drawn to this physically, financially, and socially vulnerable group. The purpose of the current study was to gain a deeper understanding of the life experiences of older men with depression who live alone. Eight community-dwelling men aged ≥65 years who lived alone in Korea and had depression were enrolled in this study. Data were collected via individual in-depth interviews and analyzed using thematic analysis. Four themes emerged from analysis: Life Trapped in the Traditional Masculine Ideology, Weakening Mind and Body, Lost and Helpless, and Beginning of Communication With the World. Results of this study will be helpful in developing more effective depression intervention programs for older men living alone by increasing community health care professionals' understanding and sensitivity. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].
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Ost Mor S, Palgi Y, Segel-Karpas D. The Definition and Categories of Positive Solitude: Older and Younger Adults’ Perspectives on Spending Time by Themselves. Int J Aging Hum Dev 2020; 93:943-962. [DOI: 10.1177/0091415020957379] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper attempts to develop a better understanding of the positive solitude (PS) phenomenon and its meaning among age groups, as well as formulate a unanimous definition for PS. A qualitative study ( N = 124) was conducted. Participants were gerontology professionals and laypeople. Interviews were conducted and content was analyzed in order to understand the essence of PS, themes, and subthemes. Two major categories were found: the essence and the components of the PS experience. Seven PS content categories and three meta-themes were raised: (1) PS is a matter of choice; (2) PS is satisfying and enjoyable; and (3) PS is meaningful. Differences in PS categories between younger and older adults were found. The meta-themes served as the foundation of a new definition. PS has different attributes in old age. A unified definition of PS may help distinguishing between PS and other forms of being alone. Recognizing and facilitating the PS experience among older adults might be beneficial and contribute to their quality of life.
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Affiliation(s)
- Sharon Ost Mor
- Gerontology, University of Haifa Faculty of Social Science, Haifa, Israel
| | - Yuval Palgi
- Gerontology, University of Haifa Faculty of Social Science, Haifa, Israel
| | - Dikla Segel-Karpas
- Gerontology, University of Haifa Faculty of Social Science, Haifa, Israel
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Loneliness, social dislocation and invisibility experienced by older men who are single or living alone: accounting for differences across sexual identity and social context. AGEING & SOCIETY 2020. [DOI: 10.1017/s0144686x20000914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractAcross literature on loneliness and ageing, little attention is given to the intersection of ageing, sexuality and masculinities, and how this shapes the social connections of older men. We report findings from a qualitative study of older men's experiences of loneliness and social participation, focusing on perspectives from two groups who are single and/or living alone: men identifying as (a) heterosexual and (b) gay (not bisexual). We present findings generated from semi-structured interviews with 72 men residing in England (65–95 years). We discuss three prominent themes: (a) loneliness, loss and social dislocation; (b) diverging life-events that trigger loneliness; and (c) variations in visibility and exclusion across social settings. Embedded within men's descriptions of loneliness is a running theme of social dislocation that speaks to a wider sense of social separation and estrangement. Unique to gay men's accounts are the ways in which experiences of loneliness and social isolation are compounded by living in heteronormative social environments and their encounters with ageism in gay social settings. Older men's accounts convey anxieties about visibility and anticipated exclusion across social settings shared with other men that vary according to sexual identity and context. We discuss how sexuality and being single and/or living alone impact on older men's social participation as we seek to move beyond a heterocentric understanding of loneliness.
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Hirakawa Y, Chiang C, Yasuda K, Iwaki Y, Andoh H, Aoyama A. Spirituality in older men living alone near the end-of-life. NAGOYA JOURNAL OF MEDICAL SCIENCE 2020; 81:557-570. [PMID: 31849374 PMCID: PMC6892679 DOI: 10.18999/nagjms.81.4.557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Older people living alone has been reported to be socially isolated and suffering from loneliness. Although spiritual care is a core element of end-of-life care for older people, a clear-cut definition of spirituality has not been established yet. It remains unclear how spirituality is perceived by heath care professionals and how spiritual care is delivered in the end of life. Also, most of the previous studies on perspective of older people living alone targeted women, while very few researches shed light on the experience of older men. The aim of the present study was to investigate the spirituality of older men living alone near the end-of-life. We conducted group interviews targeting 30 care managers and individual in-depth interviews to 15 older men living alone. Qualitative content analysis was used. Five main themes emerged: worthlessness and hopelessness, autonomy and independence, comfort and gratitude, past experiences, and well-being indicator. Our findings provide important additional information that can help clinicians, nurses and care managers achieve better patient-centered care for older men living alone and enhance their dignity. Our investigation found that Japanese older men living alone were enjoying their autonomous status and freedom, despite wide spread negative views of them. Their spiritual health was found to be enhanced through gratitude to everyone with whom they had crossed paths in their life, yearning for the presence of a female companion, and confirming their health measurements were comparative or better than those of others in the same age group.
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Affiliation(s)
- Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Chifa Chiang
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuki Yasuda
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinobu Iwaki
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideaki Andoh
- Department of Clinical Nursing, Akita University Graduate School of Health Science, Akita, Japan
| | - Atsuko Aoyama
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Koskinen C, Nyman G, Nyholm L. Life has given me suffering and desire – A study of older men’s lives after the loss of their life partners. Scand J Caring Sci 2020; 35:163-169. [DOI: 10.1111/scs.12831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/28/2020] [Accepted: 02/04/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Camilla Koskinen
- Faculty of Health Sciences Department of Caring and Ethics University of Stavanger Stavanger Norway
- Faculty of Education and Welfare Studies Department of Caring Science Åbo Akademi University Vaasa Finland
| | - Gun‐Britt Nyman
- Faculty of Education and Welfare Studies Department of Caring Science Åbo Akademi University Vaasa Finland
| | - Linda Nyholm
- Faculty of Education and Welfare Studies Department of Caring Science Åbo Akademi University Vaasa Finland
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Roos V, Keating N, Kahl C. Loneliness of older black South African women subjected to forcible relocation. Glob Health Action 2020; 12:1672329. [PMID: 31594491 PMCID: PMC6792040 DOI: 10.1080/16549716.2019.1672329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: A cohort of older black South African women, forcibly relocated during apartheid, has grown old in these places. Even after 50 years, residents in a rural township expressed no connection to place and ruptured intergenerational relations. Their sense of community was based almost exclusively on their links with others who shared their history of relocation. Objective: This article seeks to understand loneliness of a group of older women who have been rendered vulnerable by longstanding exclusion from community, services and material resources. We use loneliness as a metric for exclusion from social relations. Methods: Sixteen Setswana-speaking women in Ikageng, a township in North West Province of South Africa (age 61–73), participated in the Mmogo-method® and open-ended interviews. Textual data were analyzed using thematic analysis, visual data analysis of elements and symbolic representations of loneliness. Results: Loneliness is a powerfully unpleasant experience of not being able to interact with other people in general, or more specifically as a result of the loss of particular people (including spouses, parents and children) and isolation provoked by the impact of relational interactions and group dynamics. Loneliness was mitigated by socializing and gathering for traditional activities, performing spiritual rituals, and keeping busy individually or with others, thus reinforcing a core theme that any social interaction alleviates loneliness. Conclusions: Even though loneliness is powerfully unpleasant, it is an expression of the importance of social interactions formed in a particular context. In the face of longstanding societal exclusion and disconnection from community, social connections are central to identity and to survival.
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Affiliation(s)
- Vera Roos
- Optentia Research Focus Area, North-West University , Vanderbijlpark , South Africa
| | - Norah Keating
- Optentia Research Focus Area, North-West University , Vanderbijlpark , South Africa.,Centre for Innovative Ageing, Swansea University , Swansea , UK
| | - Carlien Kahl
- Optentia Research Focus Area, North-West University , Vanderbijlpark , South Africa
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Joe A, Dickins M, Enticott J, Ogrin R, Lowthian J. Community-Dwelling Older Women: The Association Between Living Alone and Use of a Home Nursing Service. J Am Med Dir Assoc 2020; 21:1273-1281.e2. [PMID: 31889634 DOI: 10.1016/j.jamda.2019.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 11/10/2019] [Accepted: 11/12/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the use of home nursing by community-dwelling older women to determine the nature of services required by those living alone. DESIGN A retrospective cohort study using routinely collected data. SETTING AND PARTICIPANTS Women aged 55 years and older living in metropolitan Melbourne who received an episode of nursing care from a large community home-based nursing service provider between January 1, 2006 and December 31, 2015. METHODS Descriptive and inferential statistical analyses were used to examine the relationship between client- and service-related factors and use of community nursing services. The primary outcome of interest was the hours of service received in a care episode. RESULTS A total of 134,396 episodes of care were analyzed, in which 51,606 (38.4%) episodes involved a woman who lived alone. The median hours of care per episode to women who lived alone was almost 70% more than that for women who lived with others. Multivariable regression identified factors influencing the amount of service use: living alone status, cognitive health status, and number of required home nursing activities. After adjusting for confounding and interactions, living alone was associated with at least 13% more hours of care than is provided to those not living alone. Compared with women who lived with others, women living alone required almost double the amount of assistance with medication management and were 30% more likely to experience a deterioration in their condition or be discharged from home nursing care into an acute hospital. From 2006 to 2015, for all women there was a trend toward fewer hours of nursing service provided per episode. CONCLUSIONS AND IMPLICATIONS Community-dwelling older women who live alone have greater service needs and higher rates of discharge to hospital. This knowledge will help guide provision of services and strategies to prevent clinical deterioration for this population.
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Affiliation(s)
- Angela Joe
- Bolton Clarke Research Institute, Bolton Clarke, Bentleigh, Victoria, Australia.
| | - Marissa Dickins
- Bolton Clarke Research Institute, Bolton Clarke, Bentleigh, Victoria, Australia; Southern Synergy, Department of Psychiatry at Monash Health, Southern Clinical School, Monash University, Dandenong, Victoria, Australia
| | - Joanne Enticott
- Southern Synergy, Department of Psychiatry at Monash Health, Southern Clinical School, Monash University, Dandenong, Victoria, Australia; Department of General Practice, School of Primary and Allied Health Care, Monash University, Notting Hill, Victoria, Australia
| | - Rajna Ogrin
- Bolton Clarke Research Institute, Bolton Clarke, Bentleigh, Victoria, Australia; Department of International Business and Asian Studies, Griffith University, Gold Coast, Queensland, Australia; Biosignals for Affordable Healthcare, Royal Melbourne Institute of Technology University, Melbourne, Victoria, Australia; Austin Health Department of Medicine, University of Melbourne, Heidelberg, Victoria, Australia
| | - Judy Lowthian
- Bolton Clarke Research Institute, Bolton Clarke, Bentleigh, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia; Institute of Future Environments, Queensland University of Technology, Brisbane, Queensland, Australia
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15
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Hirakawa Y, He Y, Chiang C, Aoyama A. Gender differences in wishes and feelings regarding end-of-life care among Japanese elderly people living at home. J Rural Med 2019; 14:148-151. [PMID: 31191781 PMCID: PMC6545423 DOI: 10.2185/jrm.2992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/24/2019] [Indexed: 11/27/2022] Open
Abstract
Objective: This study aimed to explore the gender differences in wishes and
feelings regarding end-of-life care among Japanese elderly people requiring home care
services. Patient/Materials and Methods: This study was a secondary analysis of the
qualitative data previously compiled from a total of 102 elderly people living at home.
The data was retrospectively collected from the participants’ nursing records, which
included a designated advance care planning (ACP) form completed between January and July
2015. Out of the 102 participants, 86 men and women who were either living alone or with a
spouse were selected for the present analysis. We reviewed the participants’ ACP forms
based on which of the sentiments on the following checklist were expressed: anxiety about
the future, abandonment of control, clinging to current daily life, inadequate support
from spouse, and a tendency to delegate decision-making. Results: The most commonly expressed feeling was abandonment of control,
among both men and women. Among elderly people living alone, women were more likely to
want to be surrounded by good, caring people when approaching the end of their lives.
Among elderly people living with a spouse, women were more likely to want to delegate
decision-making to others. Conclusion: Our results pointed to a gender difference in the attitudes of
elderly people toward interactions with the people surrounding them during the end-of-life
decision-making process. In order to provide better overall care, health care
professionals must come to realize the importance of this gender difference, as it has an
impact on the ACP choices made by elderly people living in the community.
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Affiliation(s)
- Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Japan
| | - Yupeng He
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Japan
| | - Chifa Chiang
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Japan
| | - Atsuko Aoyama
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Japan
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Hemberg J, Nyqvist F, Näsman M. "Homeless in life" - loneliness experienced as existential suffering by older adults living at home: a caring science perspective. Scand J Caring Sci 2018; 33:446-456. [PMID: 30566252 DOI: 10.1111/scs.12642] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 11/26/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Due to physical impairments and functional limitations, older adults receiving home care can be considered especially vulnerable to loneliness. To understand how society can provide support that enhances vulnerable individuals' quality of life, it is important to explore loneliness and its underlying causes in older adults. AIMS To contribute to a deeper understanding of caring science theory, the aim of this study was to use a caring science perspective to explore and understand experiences of suffering from loneliness in older adults receiving home care. The research questions are as follows: What phenomena are associated with the experience of suffering from loneliness in older adults receiving home care? How can this experience be understood? METHODOLOGY A hermeneutical approach was used. The material was collected through interviews with 17 older adults about their quality of life, including their experiences of loneliness. The texts were interpreted through latent content analysis. FINDINGS The findings resulted in one main category and three subcategories. The main category was as follows: Being homeless in life-loneliness expressed and primarily stemming from existential suffering. The subcategories were as follows: Loss of communion with one's partner or other loved ones, Loss of meaningful social activities due to isolation and Loss of health due to frailty and vulnerability. All categories were described and implications for practice discussed. CONCLUSION This study contributes to an understanding of experiences of suffering from loneliness in older adults receiving home care, with relevance for the healthcare context as well as for what a community or society should focus on when addressing these important issues.
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Affiliation(s)
- Jessica Hemberg
- Department of Caring Sciences and Health Sciences, Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland
| | - Fredrica Nyqvist
- Faculty of Education and Welfare Studies, Social Policy Unit, Åbo Akademi University, Vaasa, Finland
| | - Marina Näsman
- Faculty of Education and Welfare Studies, Social Policy Unit, Åbo Akademi University, Vaasa, Finland
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Kitzmüller G, Clancy A, Vaismoradi M, Wegener C, Bondas T. "Trapped in an Empty Waiting Room"-The Existential Human Core of Loneliness in Old Age: A Meta-Synthesis. QUALITATIVE HEALTH RESEARCH 2018; 28:213-230. [PMID: 29235943 DOI: 10.1177/1049732317735079] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Loneliness in old age has a negative influence on quality of life, health, and survival. To understand the phenomenon of loneliness in old age, the voices of lonely older adults should be heard. Therefore, the purpose of this meta-synthesis was to synthesize scientific studies of older adults' experiences of loneliness. Eleven qualitative articles that met the inclusion criteria were analyzed and synthesized according to Noblit and Hare's meta-ethnographic approach. The analysis revealed the overriding meaning of the existential human core of loneliness in old age expressed through the metaphor "trapped in an empty waiting room." Four interwoven themes were found: (a) the negative emotions of loneliness, (b) the loss of meaningful interpersonal relationships, (c) the influence of loneliness on self-perception, and (d) the older adults' endeavors to deal with loneliness. The joint contribution of family members, health care providers, and volunteers is necessary to break the vicious circle of loneliness.
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Affiliation(s)
| | - Anne Clancy
- 2 UiT, The Arctic University of Norway, Harstad, Norway
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