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

Loneliness in Parkinson's disease: Subjective experience overshadows objective motor impairment

INTRODUCTION

Loneliness is linked to poor life quality and health, but its relevance in Parkinson's disease (PD) is incompletely understood. The current study aimed to understand rates of loneliness and its determinants in PD.

METHODS

Consecutive cross-sectional sampling resulted in 178 PD subjects (60 % men) across disease stages (86 % early-stage) with gold-standard diagnoses. Loneliness was characterized with two scales, PD was characterized by objective measures, motor ratings, and perceived functional impact, and social-emotional assessment included social connection, depression, and life space. Nonparametric bivariate and robust multivariate regression determined predictors of loneliness in PD, and social-emotional predictors of PD functional impact.

RESULTS

Most participants had concern, with 64.6 % endorsing high levels of loneliness. PD stage, but not motor impairment or other objective measures, predicted loneliness. In contrast, subjective measures of PD functional impact, social network size, social support, depression, and life space had a significant relationship with loneliness. In multivariate models, depression, PD functional impact, and social network size specifically emerged as the most important predictors of loneliness. Although social loneliness was generally more impacted by PD, men had more emotional loneliness. Similarly, loneliness was a potent, independent predictor of PD functional impact.

CONCLUSIONS

We show that loneliness is a critical issue in PD which relates more to individual response to disease than objective motor severity. Although PD most impacts general relationships' quality, men may have additional loss of intimate confidantes. Interventions targeting depression and social networks may not only improve loneliness but also improve PD functional impact.

Predictors of Loneliness in Parkinson's Disease and Craniocervical Dystonia

BACKGROUND

Loneliness is a state in which an individual feels socially isolated due to deficiencies in the quantity or quality of social relationships and interaction. To date very little is known about loneliness in Parkinson's disease (PD) and focal/segmental craniocervical dystonia (FSCD).

OBJECTIVES

To explore whether level of loneliness is disease-specific by comparing PD, FCSD and healthy controls (HCs), and to define predictors of loneliness in both PD and FSCD.

METHODS

Eighty-two people with PD, 63 people with FSCD and 50 HC were surveyed. The UCLA Loneliness Scale was used to assess loneliness. Various non-motor symptoms, psychosocial variables and measures of subjective well-being were assessed and used as potential predictors of loneliness.

RESULTS

There was no significant difference in reported levels of loneliness between people with PD and matched HCs, and between people with PD and people with FSCD, but people with FSCD reported higher levels of loneliness than HCs (p = 0.018). Perceived stigma predicted loneliness in both disease groups (p < 0.001). Additionally, non-motor symptoms (p = 0.006), lack of optimism (p = 0.015) and practical social support (p = 0.006) predicted loneliness in people with PD. Patients with PD and FSCD with higher perceived stigma levels felt lonelier (p < 0.001), as did female patients with PD (p = 0.004), younger patients with FSCD (p = 0.007) and older patients with PD (p = 0.023).

CONCLUSIONS

We identified important predictors of loneliness in PD and FSCD. The identified age- and gender-specific differences in loneliness in people with PD and FSCD contribute to our better understanding of this complex and not yet fully understood concept.

"You need to know that you are not alone": the sustainability of community-based dance programs for people living with Parkinson's disease

PURPOSE

To identify factors contributing to the long-term sustainability of community-based dance programs for people living with Parkinson's disease in order to inform the design and development of sustainable programs.

METHODS

Multi-site ethnographic fieldwork was conducted at four different preexisting dance programs for people living with Parkinson's disease. Dancer, facilitator, and community stakeholder perspectives were gathered via semi-structured interviews in order to create a deeper understanding of how existing programs navigate challenges and maintain stability. Transcripts and field notes were analyzed via reflexive thematic analysis.

RESULTS

Interviews were conducted with 18 participants (eight dancers with Parkinson's disease, seven dance facilitators, one classroom assistant, and two community stakeholders). Four key areas for supporting program sustainability were identified: (1) finding an organizational structure that works, (2) balancing funding, fundraisers, and fees, (3) prioritizing dancer experience and satisfaction, and (4) recruiting and retaining committed, high-quality facilitators.

CONCLUSION

Cultivating multiple funding sources; forging strategic connections with local Parkinson's organizations and arts institutions; building a critical mass of facilitators and administrators with diverse skillsets; offering hybrid online delivery where possible; and ensuring that the dancer experience is low-pressure, varied, and enjoyable can support the long-term sustainability of dance programs for people living with Parkinson's disease.

Quantifying Social Connectedness in Parkinson's Disease: Reliability and Validity of a Clinical Assessment Toolkit

BACKGROUND

Loneliness and isolation impact health detrimentally but are understudied in Parkinson's disease (PD). Outcome measurement properties for social connection remain unexplored in PD.

OBJECTIVE

To evaluate the measurement properties of six social connection outcomes in PD.

METHODS

We evaluated internal consistency, structural validity, and construct validity for measures of loneliness (brief UCLA Loneliness Scale [ULS3], short and long de Jong Gierveld Loneliness Scale [dJGLS], social isolation [Cohen Social Network Index-SNI total people, SNI high contact networks], and social support brief Perceived Social Support Scale [PSS]).

RESULTS

We administered measures to 178 PD participants (Mage = 67.9; 81.5% at Hoehn & Yahr stage 2). There was strong internal consistency, content validity across outcomes, and a 1-factor structure (PSS, ULS3) and a 2-factor structure (dJGLS) for two measures each.

CONCLUSIONS

We provide a toolbox for clinicians and researchers studying social connection in PD.

Experiences of people living with Parkinson's disease and key stakeholders in dance-based programs: a systematic review and meta-ethnography

PURPOSE

To identify and synthesize qualitative literature on the experiences of participants and key stakeholders in dance programs for people living with Parkinson's disease. Synthesizing the available literature can generate new insights into participant experience to inform current and future programs.

MATERIALS AND METHODS

Qualitative and mixed methods studies were identified via a systematic search of six databases: CINAHL, Web of Science, Scopus, SPORTDiscus, PsycInfo, and MEDLINE. Articles were synthesized using the meta-ethnographic method developed by Noblit and Hare (1988). Key concepts across studies were related via reciprocal translation, ultimately forming a line-of-argument synthesis.

RESULTS

26 articles met the inclusion criteria. Four interrelated, overarching themes were developed: (1) dance communities provide peer support and insight into living with Parkinson's, (2) feeling safe, accepted, and included in the dance experience, (3) overcoming dance-based challenges contributes to sense of achievement, confidence, and connectedness, and (4) dance participation is an opportunity to re-imagine oneself.

CONCLUSION

Participant experience is shaped by the instructor-participant relationship, the social environment of classes, and class difficulty level. In order to support participant experience, classes should be safe, supportive, and have an appropriate challenge-skill balance. These qualities facilitate creative immersion and the potential for personal and collective change.

Loneliness and Risk of Parkinson Disease

Importance

Loneliness is associated with morbidity and mortality, including higher risk of neurodegenerative diseases. To our knowledge, no study has examined whether the association between loneliness and detrimental outcomes extends to Parkinson disease (PD).

Objective

To assess whether loneliness is associated with risk of incident PD and whether the association is independent of other risk factors or modified by age, sex, and genetic vulnerability.

Design, Setting, and Participants

This prospective cohort study included a population-based sample of UK Biobank participants aged 38 to 73 years with loneliness data and without a diagnosis of PD at baseline who were first assessed from March 13, 2006, to October 1, 2010, and followed up to October 9, 2021.

Exposure

Feeling lonely and covariates that are known risk factors for or prodromal features of PD.

Main Outcome and Measure

Incident PD was ascertained through UK National Health Service health records.

Results

Of 491 603 participants (mean [SD] age, 56.54 [8.09] years; 54.4% female), 2822 developed PD during the 15-year follow-up. Individuals who reported being lonely had a higher risk of PD (hazard ratio [HR], 1.37; 95% CI, 1.25-1.51), an association that remained after accounting for demographic factors, socioeconomic status, social isolation, PD polygenetic risk score, smoking, physical activity, body mass index, diabetes, hypertension, stroke, myocardial infarction, depression, and ever seeing a psychiatrist (fully adjusted model: HR 1.25; 95% CI, 1.12-1.39). The association between loneliness and incident PD was not moderated by sex (HR for interaction, 0.98; 95% CI, 95% CI, 0.81-1.18), age (HR for interaction, 0.99; 95% CI, 0.98-1.01), or polygenic risk score (HR for interaction, 0.93; 95% CI, 0.85-1.02). Contrary to expectations for a prodromal syndrome, when stratified by time, loneliness was not associated with risk for incident PD during the first 5 years (HR, 1.15; 95% CI, 0.91-1.45) but was associated with PD risk during the subsequent 10 years (HR, 1.32; 95% CI, 1.19-1.46).

Conclusions and Relevance

This large cohort study found that loneliness was associated with risk of incident PD across demographic groups and independent of depression and other prominent risk factors and genetic risk. The findings add to the evidence that loneliness is a substantial psychosocial determinant of health.