What is your life like now? Loneliness and elderly individuals residing in nursing homes

Underappreciated Benefits of Reading Own and Others' Memories

These studies investigate underappreciated benefits of reading memories, including memories of other people, for happiness, psychological well-being, and loneliness. In the studies, college students (Study 1), residents of assisted-living facilities (Study 2), and MTurk workers online (Study 3) wrote down memories. They also predicted how they would feel after reading their own and others' memories at a later date. Then, later on, participants read memories that they or another participant had written. Individuals felt happier, less lonely, and higher in well-being after reading memories, regardless of whether those memories were their own or someone else's. Participants underpredicted the affect boost that they would gain from reading memories. This affective forecasting error was related to individuals' perceptions of the “mundaneness” of the memories, and the error was especially pronounced when individuals read others' memories rather than their own. Implications of reading memories for promoting well-being and reducing loneliness are discussed.

Loneliness, Sense of Control, and Risk of Dementia in Healthy Older Adults: A Moderated Mediation Analysis

Objectives: Despite the rising prevalence of dementia, little research has been conducted to identify modifiable psychological factors that alleviate the risk of dementia in older adults and the underlying mechanisms. Given that loneliness is, in part, concomitant with a weakened sense of control, we examined whether sense of control would mediate the relation between loneliness and dementia risk. Further, considering that working -memory capacity is a critical cognitive resource that serves as a buffer against age-related cognitive decline, we examined a second-order moderated mediational model whereby working-memory capacity moderates the relation between control beliefs and dementia risk in older adults.

METHODS

We administered a series of measures to older community-dwelling adults (ages 60-93; N = 69), including the participant-rated AD8 to assess the risk of dementia. Using the PROCESS macro, we examined the moderated mediation model for the relation between loneliness, sense of control, and dementia risk.

RESULTS

We found that sense of control significantly mediated the relation between loneliness and risk of dementia. Moreover, the indirect effect of loneliness on dementia risk via lowered sense of control was significant only in individuals with poorer working-memory capacity. Notably, these findings held true when important covariates were controlled for.

CONCLUSIONS

Our findings underscore the critical role of control beliefs and working memory in protecting against dementia risk.

CLINICAL IMPLICATIONS

Our findings have implications for intervention programs that target alleviating dementia risk and promoting healthy aging in older adults by improving socioemotional health and cognitive functioning.

Associations between nurse-patient interaction and loneliness among cognitively intact nursing home residents - a questionnaire survey

Nursing home (NH) residents risk loneliness because of many losses. Nurse-patient interaction includes core aspects contributing to thriving and well-being among long-term NH residents. We performed a cross-sectional observation study of 188 residents 65 years and older from 27 NHs with ≥3 months' residence. All had informed consent competence recognized by the responsible doctor and nurse and could converse. We asked "Do you sometimes feel lonely?" and used the Nurse-Patient Interaction Scale (NPIS) in face-to-face interviews. We identified associations between nurse-patient interaction and loneliness and investigated the prevalence of loneliness. Eighty-eight (47%) respondents reported loneliness often or sometimes and 100 (53%) rarely or never. Adjusted for sex and age, 10 of the 14 NPIS items were significantly correlated with loneliness. Loneliness is common among cognitively intact NH residents. Nurse-patient interaction associates with residents' loneliness and might be important in alleviating loneliness.

The Effectiveness of Biographical Approaches in Long-Term Care: A Systematic Review

BACKGROUND AND OBJECTIVES

Older adults in long-term residential aged care experience loneliness and reduced quality of life (QoL). Biographical approaches use the recall of the past events to increase self-efficacy, promote acceptance, and improve QoL. The aim of the systematic review was to examine the effectiveness of biographical approaches in improving the QoL of older adults in long-term residential aged care.

RESEARCH DESIGN AND METHODS

This systematic review was conducted in accordance with PRISMA guidelines, using databases Medline, CINAHL, and the Cochrane Library. A 2-phase search strategy was used to identify research literature relating to the use of biographical interventions. Narrative analysis was used to synthesize results.

RESULTS

Twenty-one studies met inclusion criteria for this review, comprising both group and individual interventions. The findings were inconsistent. Subjective elements of QoL of older adults improved in a narrow majority of the studies. Of a total of 21 outcomes investigated in group interventions, 11 resulted in significant improvements in QoL. The 16 outcomes of the individual interventions resulted in 10 significant improvements. The most significant influence was observed in life satisfaction. Group reminiscence also had a particularly strong influence on self-esteem.

DISCUSSION AND IMPLICATIONS

Although benefits were observed, it remains unclear why some interventions led to improvements in subjective elements of QoL and others did not. Exploration of the participant perspective through qualitative data collection and more detailed description of interventions in future studies could lead to a better understanding of the treatment components that are related to improved outcomes for older adults.

Neuropsychology of aging

All people want to age "successfully," maintaining functional capacity and quality of life as they reach advanced age. Achieving this goal depends on preserving optimal cognitive and brain functioning. Yet, significant individual differences exist in this regard. Some older adults continue to retain most cognitive abilities throughout their lifetime. Others experience declines in cognitive and functional capacity that range from mild decrements in certain cognitive functions over time to severe dementia among those with neurodegenerative diseases. Even among relatively healthy "successful agers," certain cognitive functions are reduced from earlier levels. This is particularly true for cognitive functions that are dependent on cognitive processing speed and efficiency. Working memory and executive and attentional functions tend to be most vulnerable. Learning and memory functions are also usually reduced, although in the absence of neurodegenerative disease learning and retrieval efficiency rather than memory storage are affected. Other functions, such as visual perception, language, semantics, and knowledge, are often well preserved. Structural, functional, and physiologic/metabolic brain changes correspond with age-associated cognitive decline. Physiologic and metabolic mechanisms, such as oxidative stress and neuroinflammation, may contribute to these changes, along with the contribution of comorbidities that secondarily affect the brain of older adults. Cognitive frailty often corresponds with physical frailty, both affected by multiple exogenous and endogenous factors. Neuropsychologic assessment provides a way of measuring the cognitive and functional status of older adults, which is useful for monitoring changes that may be occurring. Neuroimaging is also useful for characterizing age-associated structural, functional, physiologic, and metabolic brain changes, including alterations in cerebral blood flow and metabolite concentrations. Some interventions that may enhance cognitive function, such as cognitive training, neuromodulation, and pharmacologic approaches, exist or are being developed. Yet, preventing, slowing, and reversing the adverse effects of cognitive aging remains a challenge.

Fulfilled preferences, perceived control, life satisfaction, and loneliness in elderly long-term care residents

OBJECTIVES

Person-centered care constructs such as fulfilled preferences, sense of control, and life satisfaction might contribute to loneliness among nursing home residents, but these relationships have not been thoroughly explored. The aim of this study was to examine the relationship between fulfilled preferences and loneliness in nursing home residents with perceived control and life satisfaction as potential mediators.

METHODS

The study utilized a cross-sectional design, examining the targeted variables with a questionnaire administered by trained research staff. A convenience sample of 65 residents (median age = 71) of eight nursing homes were interviewed. Linear regression analysis was utilized to examine the mediation hypotheses.

RESULTS

The relationships between fulfilled preferences and loneliness (β = -.377, p = .002), fulfilled preferences and perceived control (β = -.577, p < .001), and perceived control and loneliness (β = .606, p < .001) were significant, and the relationship between fulfilled preferences and loneliness (β = -.040, p = .744) became non-significant when perceived control was included in the model. The relationships between fulfilled preferences and life satisfaction (β = .420, p < .001) and life satisfaction and loneliness (β = -.598, p < .001) were significant, and the relationship between fulfilled preferences and loneliness (β = -.152, p = .174) became non-significant when life satisfaction was included in the model.

CONCLUSION

The findings suggest an important association between person-centered care, particularly fulfilling personal care and recreation preferences, and social-affective needs of long-term care residents. Fulfilling preferences may be an appropriate intervention target for loneliness.

Video Communication With Cognitively Intact Nursing Home Residents: A Scoping Review

Limited research exists examining video communication among cognitively intact nursing home residents to connect with family. This scoping review evaluated existing literature for video communication usage with nursing home residents, family, and nursing homes. A comprehensive search was completed using PubMed and EBSCOhost (including AgeLine, CINAHL, and PsycINFO) between 1972 and 2016 to locate English-language articles. The analysis identified five eligible studies (four involved an intervention, one assessed family views) meeting inclusion criteria. Findings included, seeing family members separated by distance, seeing other parts of their life, and visually monitoring resident's health. Participants described frustration with technology limitations, such as video or audio lag. Current literature does not show a comprehensive assessment of video communication usage for residents, family, and nursing homes. Future studies should address the complexity of the intersection of the person, nursing home, and families in terms of potential benefits and capability of video communication use with residents.

Aging and place in long-term care settings: influences on social relationships

OBJECTIVE

This article presents results of a qualitative research study that examined how living in a long-term care (LTC) home influences the quality of residents' relationships with peers, family members, and outside friends.

METHOD

Semistructured interviews using a phenomenological approach were conducted with 23 residents of a LTC home. Thematic analysis was employed to illuminate residents' perspectives on the nature of social relationships in this setting.

RESULTS

Four key themes were identified that highlight the role of place in social relationships. Residing in a LTC home influences the context of social interactions, impacts their quality and process, clusters individuals with health and functional declines that hinder socialization, and poses structural and cultural barriers that impede social interactions. Health and functional limitations posed the greatest challenge to socialization relative to characteristics of the facility itself.

DISCUSSION

Residents' insights emphasize how personal characteristics influence community culture and the experience of place.

Loneliness in older adults: an embodied experience

Loneliness is of significant concern in the older adult population. Loneliness has been associated with old age because of multiple losses that may occur. These include loss of health, social status, friends, and/or spouse. There is a gap in the literature with regard to understanding the meaning of loneliness in older adults. Interpretive phenomenology was used for this study, involving multiple interviews with older adults to explore the meaning of loneliness. Findings revealed that many participants experienced loneliness as a result of disrupted meaningful engagement with others due to different age-related changes. Loneliness was embodied as it was expressed through the participants' bodies in several ways, including fatigue, tension, withdrawal, and emptiness. Conclusions from this study reveal the need for nurses to become more aware of loneliness in older adults as a significant health issue.

Changes in depressive symptoms, social support, and loneliness over 1 year after a minimum 3-month videoconference program for older nursing home residents

Background

A 3-month videoconference interaction program with family members has been shown to decrease depression and loneliness in nursing home residents. However, little is known about the long-term effects on residents’ depressive symptoms, social support, and loneliness.

Objective

The purpose of this longitudinal quasi-experimental study was to evaluate the long-term effectiveness of a videoconference intervention in improving nursing home residents’ social support, loneliness, and depressive status over 1 year.

Methods

We purposively sampled 16 nursing homes in various areas of Taiwan. Elderly residents (N = 90) of these nursing homes meeting our inclusion criteria were divided into an experimental (n = 40) and a comparison (n = 50) group. The experimental group received at least 5 minutes/week for 3 months of videoconference interaction with their family members in addition to usual family visits, and the comparison group received regular family visits only. Data were collected in face-to face interviews on social support, loneliness, and depressive status using the Social Support Behaviors Scale, University of California Los Angeles Loneliness Scale, and Geriatric Depression Scale, respectively, at four times (baseline, 3 months, 6 months, and 12 months after baseline). Data were analyzed using the generalized estimating equation approach.

Results

After the videoconferencing program, participants in the experimental group had significantly lower mean change in instrumental social support scores at 6 months (–0.42, P = .03) and 12 months (–0.41, P = .03), and higher mean change in emotional social support at 3 (0.74, P < .001) and 12 months (0.61, P = .02), and in appraisal support at 3 months (0.74, P = .001) after adjusting for confounding variables. Participants in the experimental group also had significantly lower mean loneliness and depressive status scores at 3 months (–5.40, P < .001; –2.64, P < .001, respectively), 6 months (–6.47, P < .001; –4.33, P < .001), and 12 months (–6.27, P = .001; –4.40, P < .001) compared with baseline than those in the comparison group.

Conclusion

Our videoconference program had a long-term effect in alleviating depressive symptoms and loneliness for elderly residents in nursing homes. This intervention also improved long-term emotional social support and short-term appraisal support, and decreased residents’ instrumental social support. However, this intervention had no effect on informational social support.

Living alone, loneliness, and psychological well-being of older persons in singapore

Studies of the psychological well-being of elderly living alone have yielded inconsistent results. Few investigators have distinguished living alone from loneliness in the same study. Thus, the present study examined the independent and interactive effects of living alone and loneliness on depressive symptoms (GDS score) and quality of life (SF-12 MCS score) in a prospective 2-year follow-up cohort study of 2808 community-dwelling older adults (aged ≥55 years) in Singapore, controlling for baseline covariates. In cross-sectional analysis, loneliness was a more robust predictor of GDS score than living arrangements; living alone, when controlled for loneliness, was not associated with GDS score. GDS score associated with living alone was worse for those who felt lonely than for those who did not feel lonely. Similar patterns of association were found in longitudinal analyses and for SF-12 MCS score, although not all were significant. Thus, though living alone predicted lower psychological well-being, its predictive ability was reduced when loneliness was taken into account and loneliness, a stronger predictor, worsened the psychological effects of living alone.

The management of loneliness in aged care residents: an important therapeutic target for gerontological nursing

Social engagement and meaningful relationships are critical determinants of the quality of life of older people. Human beings have an intrinsic need for social connections and an engagement with the social environment. Deficits in the quality of these social relationships lead to feelings of isolation and loneliness in older people. Loneliness can have serious physiological and health implications. It is well established that loneliness is a risk factor for poor physical and mental health, comparable in size to obesity, a sedentary lifestyle and possibly even smoking. The aim of this article is to present an argument for the management of loneliness in aged care residents as an important therapeutic target in gerontological nursing. To date little is known about the effectiveness of intervention strategies designed to alleviate loneliness in aged care residents. Nurses can address this deficit in our understanding by evaluating the impact of loneliness intervention strategies.

The meaningfulness of Canine-Assisted Interventions (CAIs) on the health and social care of older people residing in long term care: a systematic review

BACKGROUND

Preliminary evidence suggests that canine-assisted interventions (any therapeutic process that intentionally involves dogs as part of the process ) may produce some short term beneficial effects on the health and social care of older people residing in long term care facilities; however there has been no formal qualitative synthesis on how these activities are experienced by those involved. Determining peoples' opinions and feelings towards this activity is crucial to its success.

OBJECTIVE

The aim of this systematic review was to synthesise the best available evidence on the meaningfulness of canine-assisted intervention on older people who reside in long term care.

DATA SOURCES

A comprehensive search was undertaken of 32 electronic databases and two reputable websites from their inception to 2009. The search was restricted to English language and both published and unpublished studies were considered.

REVIEW METHODS

Studies that examined the experience of older people residing in long term care that were involved in canine-assisted interventions were considered. Critical appraisal of study quality was undertaken using Joanna Briggs Institute critical appraisal instruments. Data extraction was via the Joanna Briggs Institute standard data extraction form for evidence of meaningfulness.

RESULTS

Two studies met inclusion criteria and methodological quality requirements. Studies had some differences: one explored residents' experiences while the other focused on staff experiences, one was conducted in a 'Westernised' country and one included residents who had been involved in this activity for two years prior to the study being conducted. There were 41 findings extracted from both studies that were organised into 12 categories. A meta-synthesis was undertaken and two synthesised findings were developed; the first suggesting that providing residents of long term care facilities the opportunity to participate in canine-assisted interventions (more specifically canine-assisted activities) can provide a range of mental, emotional, physiological and social benefits and the other suggesting that undertaking a program in such a facility has both practical and safety considerations for staff, residents and animals.

CONCLUSIONS

The current evidence base for the meaningfulness of canine-assisted activities in long term care facilities is limited and methodologically weak. A qualitative meta-synthesis using the Joanna Briggs Institute Qualitative Assessment and Review Instrument software suggests that the experience of a resident being involved in a canine-assisted activity can be positive on an emotional, mental, physiological and social level but there are some practical issues to consider such as the personal preference of the resident and staff training. Caution is advised when interpreting these results due to the small number of studies included and their methodological limitations.

IMPLICATIONS FOR PRACTICE

Canine-assisted activities may provide a positive experience for residents however the following should be considered: IMPLICATIONS FOR RESEARCH: Due to the limited number of qualitative studies attempting to determine the experiences of older people involved in canine-assisted interventions within a long term care environment, further high quality studies should be undertaken. Studies should focus on the experiences of the different people involved (staff, family, animal handlers), and compare residents with different medical or psychological conditions to determine if involvement is experienced differently across populations.

Factors Associated With Loneliness of Noninstitutionalized and Institutionalized Older Adults

Objectives: First, to seek if sociodemographic and health factors contribute differentially to the explanation of loneliness in institutionalized and noninstitutionalized older adults; and second, to analyze the influence of institutionalization on loneliness. Method: This work was based on two surveys of older adults aged 60 years or more in Spain. A group of 234 community-dwelling people and 234 nursing homes residents were selected ( n = 468). Logistic regression models were applied using the six-item De Jong Gierveld Loneliness Scale as dependent variable. Results: Depression was associated with loneliness in both populations. Sex and marital status contributed to explain loneliness among those living at home, whereas gathering with family, friends, and neighbors showed a significant effect in the institutionalized group. Institutionalization per se showed a strong effect on loneliness. Discussion: Findings have potential implications for targeting older adults at risk for loneliness.

Nursing home staffing and training recommendations for promoting older adults' quality of care and life: Part 1. Deficits in the quality of care due to understaffing and undertraining

Caught between the inability or unwillingness of nursing home corporations and owners to redistribute revenue and the reluctance of federal and state agencies to increase payments to nursing homes, the nation's most vulnerable older adults are not receiving the care they deserve. Widespread recognition of substandard care and quality of life of older adults in nursing homes has existed for decades. In addition, there is substantial evidence that poor quality of care is related to inadequate numbers and training of nursing staff. Still, policy makers and nursing home owners have failed to take needed action. In the first article of this two-part series, major deficits in the care of older adult nursing home residents are reviewed, and research documenting the relationship between nursing home staffing and the quality of care and life of residents is summarized.

Addressing loneliness in later life

OBJECTIVES

Social and solitary pastimes with the potential to ameliorate the experience of loneliness among older individuals were investigated for the purpose of informing future interventions designed to reduce the negative consequences of social isolation.

METHOD

Nineteen individual interviews with Australians aged 65 years and older.

RESULTS

Several pastimes were described by interviewees as instrumental in determining whether the increasing social isolation they experience in older age results in feelings of emotional isolation and thus of loneliness.

CONCLUSION

The specific behaviours that were found to ameliorate loneliness included utilizing friends and family as an emotional resource, engaging in eating and drinking rituals as a means of maintaining social contacts, and spending time constructively by reading and gardening. Specific recommendations are provided for interventions designed to prevent and treat loneliness among older people.

Physical activity and executive functions in the elderly with mild cognitive impairment

The primary goal of the present study was to examine whether in the elderly with mild cognitive impairment (MCI), the effect of physical activity measured directly following treatment, was reflected in an improvement in cognitive functioning in general or in executive functions (EF) in particular. Secondly, this study aimed to compare the effectiveness of two types of intervention, with varying intensities: walking and hand/face exercises. Forty-three frail, advanced elderly subjects (mean age: 86) with MCI were randomly divided into three groups, namely, a walking group (n=15), a group performing hand and face exercises (n=13), and a control group (n=15). All subjects received individual treatment for 30 minutes a day, three times a week, for a period of six weeks. A neuropsychological test battery, administered directly after cessation of treatment, assessed cognitive functioning. The results show that although a (nearly) significant improvement in tasks appealing to EF was observed in both the walking group and the hand/face group compared to the control group, the results should be interpreted with caution. Firm conclusions about the effectiveness of mild physical activity on EF in the oldest old can only be drawn after studies with larger number of subjects.

Beyond the basics. Effects of the Eden Alternative model on quality of life issues

In Life Worth Living, Thomas (1996) proposed that in long-term care facilities for elderly individuals, loneliness, helplessness, and boredom are out of control and are steadily decaying the residents' spirits, adversely affecting quality of life. While Thomas' contention appeals to common sense, no empirical evidence is offered in its support. The purpose of this quasi-experimental study was to assess the impact of implementation of the Eden Alternative model on levels of loneliness, boredom, and helplessness of older residents of a long-term care facility. The model was introduced into the experimental facility on May 1, 1998. The final sample for the experimental group included 21 cognitively intact older adults from a state veterans home (13 men, 8 women, mean age = 76.1). The final control group was composed of 13 residents in a private long-term care facility (11 women, 2 men, mean age = 85.7). A Background Data Sheet, the Geriatric Depression Scale (includes yes or no questions related to helplessness and boredom), and the UCLA Loneliness Scale (Version 3) were administered by an interviewer at baseline and 1-year post-implementation of the Eden Alternative model. Data analysis from the post-implementation phase revealed significant differences between the groups on levels of boredom (z = -2.6, p = .01) and helplessness (z = -2.2, p = .03). Lower levels of distress were found in the experimental group on both boredom and helplessness, but not loneliness. Findings suggest health care professionals and researchers have an opportunity to take a leading role in impacting services related to quality-of-life issues for this important, but often overlooked, population.

LIVING ALONE, SOCIAL SUPPORT, AND FEELING LONELY AMONG THE ELDERLY

This study aimed to describe the characteristics of the elderly population living alone, and to examine how living alone relates to feeling lonely. Interviews were conducted with a stratified random sample of 4,859 elderly individuals living in Kaohsiung, Taiwan. Variables collected included demographic information, living alone or not, activities of daily living (ADL), instrumental activities of daily living (IADL), Short Portable Mental Status Questionnaire (SPMSQ), chronic conditions, perceived social support, and a subjective measure of feeling lonely. Using logistic regression, it was found that factors associated with living alone included gender, marital status, occupation, source of income, religion, and IADL. Living alone was, in turn, related to decreased levels of both perceived social support and feeling lonely after adjustment for potential confounders. Managing retired life is important for adult elders, particularly for men. Lack of social support is common among the elderly community who live alone, which could well be a main reason for this group to feel lonely. As loneliness is linked to physical and mental health problems, increasing social support and facilitating friendship should be factored into life-style management for communities of elderly.

Masterworks of art and chronic illness experiences in the elderly

AIM

This article presents findings of a qualitative study, conducted between 1997 and 2000, to investigate the plausibility of integrating masterworks of art with care of the chronically ill elderly, and to analyse perceptions about chronic illness among three groups: registered nurses, nursing students, and the elderly.

BACKGROUND AND SIGNIFICANCE

Statistically the incidence of chronic illness increases in the elderly. Although pathophysiology of chronic illness is increasingly understood, few studies explore the experience of living with chronicity from the perspective of the elderly. Understanding and intervening appropriately for the elderly with chronic illness may contribute significantly to improving quality of life for this growing population.

ETHICAL ISSUES AND APPROVAL

The study was approved through an Institutional Review Board. Facility permission and participant informed consent were obtained. Anonymity and confidentiality were protected.

DESIGN

Using hermeneutic phenomenology and masterworks of art as a centre point for dialogue, the investigators explored the perceptions of nurses, students, and the elderly about living with a chronic illness. A purposive sample of 65 participants made up seven focus groups with which group interviews were conducted. Themes were explicated and analysed from audiotaped interviews until data saturation was reached.

FINDINGS

Content analysis of focus group interviews revealed themes of social isolation, inevitable role change, and inertia-movement. Only the elderly acknowledged hope and a steadfast refusal to give up, while nurses and students viewed chronicity more negatively. Themes of social isolation and role change are consistent with other studies of the elderly. A paradox of inertia-movement in the chronically ill elderly has not been reported in the nursing literature.

CONCLUSIONS

Paradoxical tension of inertia-movement in the chronically ill elderly appears to be linked to the broader concept of energy in nursing science, and to Parse's theory of human becoming. Masterworks of art can generate energy exchange between the elderly and caregivers, providing a plausible catalyst for meaningful interventions that transcend age and practice settings.