The relationship between loneliness, social support, and decline in cognitive function in the hospitalized elderly

How trained volunteers can improve the quality of hospital care for older patients. A qualitative evaluation within the Hospital Elder Life Program (HELP)

The aim of this study was to investigate, using a mixed-methods design, the added value of a trained Hospital Elder Life Program (HELP) volunteer to the quality of hospital care in the Netherlands. The trained volunteers daily stimulate older patients, at risk of a delirium, to eat, to drink, and to exercise, and they provide walking assistance and cognitive stimulation. This study showed that each group appreciated the extra attention and service from the volunteers. The positive effect on feelings of loneliness during the hospital stay was an unexpected outcome. The volunteers themselves appreciated their work. In conclusion, a HELP volunteer should be provided to every older hospital patient.

The prevalence of loneliness among U.S. Chinese older adults

OBJECTIVE

Loneliness is an important indicator of well-being. However, we have limited understanding of loneliness in minority aging populations. This study aims to identify the prevalence of loneliness among U.S. Chinese older adults.

METHOD

Data were drawn from the PINE study, a population-based study of 3,159 U.S. Chinese older adults in the Greater Chicago area.

RESULTS

Our findings indicated that the prevalence of loneliness was 26.2%. Older adults with older age, female gender, and living alone reported higher prevalence of loneliness. Older adults with worsened health status, poorer quality of life, and negative health changes over the past year were also more likely to experience loneliness.

DISCUSSION

Loneliness is common among U.S. Chinese older adults in the Greater Chicago area. Future longitudinal studies are needed to improve the understanding of risk factors and outcomes associated with loneliness in Chinese older adults.

Urban and rural variations in the characteristics associated with elder mistreatment in a community-dwelling Chinese population

This study compares the urban and rural differences in characteristics associated with elder mistreatment (EM) in a Chinese population. A cross-sectional study of 269 urban and 135 rural participants aged 60 years or greater was performed. Among those with EM, rural participants were more likely to be women, have lower levels of education and income, have lower levels of health status and quality of life, have worse change in recent health, and have lower levels of psychosocial well-being. Both higher levels of depressive symptoms and lower levels of social support were associated with increased risk of EM.

Perception and negative effect of loneliness in a Chicago Chinese population of older adults

This qualitative study aims to investigate the cultural understandings of loneliness, identify the contexts of loneliness, and to examine its effect on the health and well-being of U.S. Chinese older adults. Despite loneliness is one of the main indicators of well-being, little attention has been paid to understanding loneliness among immigrant older adults. This study utilizes both survey questionnaires and semi-structured focus group methods to investigate the feelings of loneliness among U.S. Chinese older adults. Based on interviews with 78 community-dwelling Chinese older adults in Chicago Chinatown, this community-based participatory research study (CBPR) shows loneliness is common among U.S. Chinese older adults. It was frequently identified through emotional isolation and social isolation. Social, psychological and physical health factors could contribute to the experience of loneliness. In addition, the health of older adults with loneliness may be associated with worsening overall health, elder mistreatment, health behavior changes and increased healthcare utilizations. This study has implications for healthcare professionals, social services agencies and policy makers. Our findings point to the needs for healthcare professionals to be more alert of the association of loneliness and adverse health outcomes. Communities and social services agencies should collectively take a lead in reducing social isolation, improving intergenerational relationships, and increasing social networks and companionship for this group of vulnerable older adults.

Health and aging in a Chinese population: urban and rural disparities

AIM

The objective of this study was to compare the rural and urban differences in sociodemographic, health and psychosocial factors in a Chinese aging population.

METHODS

A cross-sectional descriptive study of 135 rural and 269 urban subjects aged 60 years or greater was performed in a community-dwelling Chinese population. Variables collected included sociodemographic, health-related and psychosocial measures.

RESULTS

Rural subjects, compared with urban subjects, were significantly younger, more likely to be women, have lower education and income, and more likely to be widowed. Rural subjects also reported significant lower overall health status, lower quality of life and worse change in recent health. In addition, rural subjects had a significantly higher proportion of depressive symptomatology, feelings of loneliness and lower levels of social support measures.

CONCLUSION

In this older Chinese population, rural subjects had significantly poorer characteristics of health and well-being. These differences in characteristics were found across sociodemographic, health-related quality of life and psychosocial measures.

Loneliness in older chinese adults: a risk factor for elder mistreatment

OBJECTIVES

To examine loneliness as a risk factor for elder mistreatment in an urban, community-dwelling Chinese population.

DESIGN

Cross-sectional descriptive study.

SETTING

Major urban medical center in NanJing, China.

PARTICIPANTS

Four hundred twelve subjects aged 60 and older who presented to the general medical clinic. The mean age of the participants was 70, and 34% were female. Mean education level was 8.5 years of schooling.

MEASUREMENTS

Loneliness was assessed using validated instruments, and direct questions were asked regarding mistreatment experienced by older adults.

RESULTS

Elder mistreatment was found in 35.2% of the participants. After adjusting for confounding factors, feeling of often lacking companionship (odds ratio (OR)=4.06; 95% confidence interval (CI)=1.49-11.10) and feeling of sometimes being left out in life (OR=1.69; 95% CI=1.01-2.84) were positively associated with the risk of mistreatment. Risk of mistreatment was also correlated with higher total loneliness scores (OR=2.74; 95% CI=1.19-6.26).

CONCLUSION

Loneliness appeared to be a risk factor associated with elder mistreatment in this older Chinese population. Further prospective studies are needed to confirm this finding. An exploration of Chinese culture and tradition may yield insight into shaping a prevention framework for mistreatment of older Chinese people.

Indoor gardening older adults: effects on socialization, activities of daily living, and loneliness

This study examined the effects of indoor gardening on socialization, activities of daily living (ADLs), and perceptions of loneliness in elderly nursing home residents. A total of 66 residents from two nursing homes participated in this two-phase study. In phase one, experimental group 1 participated once a week for 5 weeks in gardening activities while a control group received a 20-minute visit. While no significant differences were found between groups in socialization or perceptions of loneliness, there were significant pretest-posttest differences within groups on loneliness and guidance, reassurance of worth, social integration, and reliable alliance. The results also demonstrated gardening interventions had a significant effect on three ADLs (transfer, eating, and toileting). Phase two examined differences in the effects of a 5-week versus a 2-week intervention program. Although no significant within-group differences were noted in socialization, loneliness, or ADLs, the 5-week program was more effective in increasing socialization and physical functioning.

Social isolation and loneliness: differences between older rural and urban Manitobans

The purpose of this paper was to identify predictors of social isolation and loneliness for very old rural and urban adults. With data from the 1996 Aging in Manitoba Study (N = 1,868; age range 72-104), separate multiple regression models were constructed for rural and urban sub-samples, using the life space index (LSI) to measure social isolation as one outcome, and a loneliness index created by the authors from a combination of items to measure loneliness as a second outcome. Different factors were found to predict the outcomes for the two sub-samples. The models with isolation as the outcome produced five predictors for the rural sub-sample and three for the urban sub-sample. Only living alone was the same for both groups. The models with loneliness as the outcome produced five predictors for the rural sub-sample and two for the urban sub-sample, again with only one factor in common--four or more chronic illnesses. We conclude that health and social factors are important predictors of social isolation and loneliness, and sensitivity to these factors may improve the experience of older adults.

Patterns of loneliness in an immigrant population

Loneliness has been recognized as a public health problem that requires the attention of clinicians and researchers both as a condition in itself and in its relation to other conditions. This study sought to examine the relationship between self-reported loneliness, psychological distress, and social support among immigrants. A community survey of 386 recent immigrants to Israel from the former Soviet Union was conducted using the Revised UCLA Loneliness Scale (R-UCLA-LS), Talbieh Brief Distress Inventory (TBDI), and Multidimensional Scale of Perceived Social Support (MSPSS). A cross-sectional design, and correlation and factor analyses were used to study the relationship between the studied variables. The distress-related and distress-free patterns of loneliness were distinguished as independent constructs, each with a specific sphere of influence. Distress-related loneliness accounted for 56.3% and distress-free for 18.2% of the total variance in individual loneliness scores. Distress-related loneliness is a generalized negative experience embedded in an array of distress symptoms, while distress-free loneliness appears to be a normal psychological reaction to dissatisfaction with current friend support. An important implication of this study in mental health practice is the sensitivity to these differences when treating recent immigrants.

Family members' experiences of the quality of geriatric care

The quality of institutional geriatric care is a topical issue in Finland. The study to be described here is part of a Finnish project on the quality assessment and development of long-term geriatric care provided by the City of Helsinki. The health care division of the City of Helsinki authorized an outside survey of long-term geriatric care in the hospitals providing such care in 1998. Based on the results, recommendations concerning the development of geriatric care were issued. In the years 1999-2000, a further education programme was arranged for ward nurses, chief nurses and heads of profit centres concerning leadership in long-term geriatric nursing. A re-survey was conducted in 2001, using the same criteria of quality assessment. The purpose of this paper is to report on the quality of institutional geriatric nursing as evaluated by family members in 2001 and to compare the responses to those obtained in 1998. The results are presented as frequency and percentage distributions, means and medians and cross-tabulations. The responding family members were generally content with the care of their elderly relatives: 92% said they were very satisfied or satisfied with the care, and the average of the marks given for geriatric care was 8.3 (range 4-10). Family members were more content now than in 1998, when the corresponding figures were 86% and 7.3 (range 4-10). Nevertheless, the results still highlight certain aspects that should be improved and developed.

Promoting positive outcomes for elderly persons in the hospital: prevention and risk factor modification

The hospitalized elderly are at an increased risk for poor outcomes such as increased length of stay, readmissions, functional decline, and iatrogenic complications, as compared with other age groups. Research related to the hospitalized elderly has identified factors associated with poor outcomes. Nurses and other healthcare team members may be able to identify elderly patients at risk for poor outcomes and target modifiable factors to minimize their negative impact. Clinical experience and research validate the conclusion that multidimensional, preventive risk factor modification balanced with acute illness treatment can result in positive outcomes for elderly patients.

Confusion and aggression in restrained elderly persons undergoing hip repair surgery

The purpose of this pilot study was to observe and describe the behaviors of confusion and aggression in physically restrained elderly hospitalized persons following hip repair surgery. Five elderly persons who were 75-95 years of age and physically restrained following hip repair surgery comprised the sample of this descriptive study. Descriptive data including age, sex, medical diagnosis, current medications, serum electrolyte and arterial blood gas results, date/time of hip fracture, subsequent surgical repair, and restraint application were obtained from the medical record. Observations of behaviors associated with confusion and aggression were conducted at six separate observation times lasting approximately 20 to 30 minutes each. The observation periods were divided into two mornings, two afternoons, and two evening sessions. These behaviors were assessed by utilizing a combined observational tool developed by the researcher, and was created from the Clinical Assessment of Confusion--A, by Vermeersch, and Ryden Aggression Scale. After data analysis, three patterns of confusion emerged. These were the major pattern of confusion, the minor pattern of confusion, and pattern of confusion relative to time. All patients experienced low serum sodium levels immediately prior to the application of physical restraints. Based on the results of the pilot study, further investigation is needed.