Loneliness and social support of older people living alone in a county of Shanghai,China

China has an ageing population with the number of older people living alone increasing. Living alone may increase the risk of loneliness of older people, especially for those in China where collectivism and filial piety are emphasised. Social support may fill the need for social contacts, thereby alleviating loneliness. However, little is known about loneliness and social support of older people living alone in China. This study investigated loneliness and social support of older people living alone, by conducting a cross‐sectional questionnaire survey with a stratified random cluster sample of 521 community‐dwelling older people living alone in a county of Shanghai. Data were collected from November 2011 to March 2012. The instruments used included the UCLA Loneliness Scale version 3 and the Social Support Rate Scale. The participants reported a moderate level of loneliness. Their overall social support level was low compared with the Chinese norm. Children were the major source of objective and subjective support. Of the participants, 53.9% (n = 281) and 47.6% (n = 248) asked for help and confided when they were in trouble, but 84.1% (n = 438) never or rarely attended social activities. The level of loneliness and social support differed among the participants with different sociodemographic characteristics. There were negative correlations between loneliness and overall social support and its three dimensions. The findings suggest that there is a need to provide more social support to older people living alone to decrease their feelings of loneliness. Potential interventions include encouraging more frequent contacts from children, the development of one‐to‐one ‘befriending’ and group activity programmes together with identification of vulnerable subgroups.     

Loneliness as a mediator in the relationship between social engagement and depressive symptoms: Age differences among community‐dwelling Korean adults

The purpose of this study was to examine whether loneliness mediates the relationship between social engagement and depressive symptoms and to determine how age moderates the mediation effect. Data for this study came from the survey with community‐dwelling adults aged 18 and older in South Korea, from March to April 2017. The total of 1,017 respondents were drawn from three age groups (18–44, 45–64, or 65 and older). The mediating effect of loneliness was tested between each of three social engagement‐related variables (family network, friend network, and perceived community support) and depressive symptoms. The results showed age differences in mediation: the effect was most pronounced in the relationship of family network with loneliness for the older group, whereas the size of friend network significantly predicted loneliness for younger adults. Both younger and older groups felt less lonely when they had a higher level of perceived community support; the middle age group remained uninfluenced by the mediation effects. Our findings confirm that loneliness is one of the mechanisms by which social engagement exerts its effect on depressive symptoms. As the Korean society embraces its growing proportions of older adults, the results of the study provide implications for adaptive strategies for changing social engagement need and mental health associated with ageing.     

Can videoconferencing affect older people's engagement and perception of their social support in long‐term conditions management: a social network analysis from the Telehealth Literacy Project

Social support is a key component in managing long‐term conditions. As people age in their homes, there is a greater risk of social isolation, which can be ameliorated by informal support networks. This study examined the relationship between changes in social support networks for older people living in a regional area following weekly videoconference groups delivered to the home. Between February and June 2014, we delivered 44 weekly group meetings via videoconference to participants in a regional town in Australia. The meetings provided participants with education and an opportunity to discuss health issues and connect with others in similar circumstances. An uncontrolled, pre‐post‐test methodology was employed. A social network tool was completed by 45 (87%) participants either pre‐ or post‐intervention, of which 24 (46%) participants completed the tool pre‐ and post‐intervention. In addition, 14 semi‐structured interviews and 4 focus groups were conducted. Following the intervention, participants identified increased membership of their social networks, although they did not identify individuals from the weekly videoconference groups. The most important social support networks remained the same pre‐ and post‐intervention namely, health professionals, close family and partners. However, post‐intervention participants identified friends and wider family as more important to managing their chronic condition compared to pre‐intervention. Participants derived social support, in particular, companionship, emotional and informational support as well as feeling more engaged with life, from the weekly videoconference meetings. Videoconference education groups delivered into the home can provide social support and enhance self‐management for older people with chronic conditions. They provide the opportunity to develop a virtual social support network containing new and diverse social connections.     

Do bonding and bridging social capital affect self-rated health,depressive mood and cognitive decline in older Japanese? A prospective cohort study

Little is known regarding the longitudinal effects of bonding and bridging social capital on health. This study examined the longitudinal associations of bonding and bridging social capital with self-rated health, depressive mood, and cognitive decline in community-dwelling older Japanese. Data analyzed in this study were from the 2010 (baseline) and 2012 (follow-up) Hatoyama Cohort Study. Bonding social capital was assessed by individual perception of homogeneity of the neighborhood (the level of homogeneity among neighbors) and of networks (the amount of homogeneous personal networks) in relation to age, gender, and socioeconomic status. Bridging social capital was assessed by individual perception of heterogeneity of networks (the amount of heterogeneous personal networks) in relation to age, gender, and socioeconomic status. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to evaluate the effects of baseline social capital on poor health outcome at follow-up by logistic regression analysis. In total, 681 people completed baseline and follow-up surveys. The mean age of participants was 71.8 ± 5.1 years, and 57.9% were male. After adjusting for sociodemographics, lifestyle factors, comorbidity, functional capacity, baseline score of each outcome, and other bonding/bridging social capital, stronger perceived neighborhood homogeneity was inversely associated with poor self-rated health (OR = 0.55, 95% CI = 0.30–1.00) and depressive mood assessed by the Geriatric Depression Scale (OR = 0.58, 95% CI = 0.34–0.99). When participants who reported a depressive mood at baseline were excluded, stronger perceived heterogeneous network was inversely associated with depressive mood (OR = 0.40, 95% CI = 0.19–0.87). Neither bonding nor bridging social capital was significantly associated with cognitive decline assessed by the Mini-Mental State Examination. In conclusion, bonding and bridging social capital affect health in different ways, but they both have beneficial effects on the health of older Japanese. Our findings suggest that intervention focusing on bonding and bridging social capital may improve various health outcomes in old age.     

离退休老年人抑郁症状的影响因素分析

目的了解社区离退休老年人抑郁症状发生情况及影响因素,为改善老年人心理健康提供参考依据。方法采用老年抑郁量表简表及自编问卷,对武汉市4个社区的483名离退休老人进行问卷调查。结果共有130人存在抑郁症状,发生率为20.5%。卡方分析显示,家庭人均收入低、自理能力差、患多种疾病、有孤独感、社会支持和人际关系不好、娱乐活动欠缺的老年人有更高的抑郁症状发生率;Logistic回归分析发现,社会支持、人际关系、家庭人均收入、职业、自理能力、孤独是老年人抑郁症状发生的潜在影响因素;结构方程模型显示,社会功能、身体健康状况、孤独感对老年抑郁症状的影响具有统计学意义（P〈0.05）。结论离退休老年人存在一定程度的抑郁症状,与社会功能和身体健康状况、孤独感关系较大,可通过改善社会功能、加强身体锻炼和多参与社会活动、多与人交流等加以预防。     

Loneliness and social support of older people in China: a systematic literature review

Loneliness is a serious problem for older people, which can be alleviated by social support. The dramatic population ageing together with social and economic change in China increases the likelihood of loneliness and the availability of different sources of social support of older people. The aim of this review was to identify the prevalence of loneliness and its related factors and sources of social support of older people in China. Electronic literature searches were conducted in September 2011 using Web of Science, PsycINFO, MEDLINE, PubMed, CINAHL, China Academic Journal and VIP Database for Chinese Technical Periodicals. Twenty‐six papers were identified and reviewed. The prevalence of loneliness varied across the studies, reflecting the different measurements and samples. Marital status, gender, age, educational level, economic level, living arrangements, health status and social support were significant factors related to loneliness. The family was the most important source of social support followed by friends. The receipt of family support improved subjective well‐being and mental health, but the effects of support from friends were inconsistent. Chinese older people received relatively little support from neighbours, governmental or other social organisations. Further well‐designed studies are needed to identify additional factors related to loneliness and to understand the support from friends, neighbours, formal organisations and other sources.     

Older people living alone in Shanghai: A questionnaire survey of their life experience

Globally the number of older people living alone is increasing. Little is known about the life experience of older people living alone in Mainland China. This study aimed to explore older people's experience regarding different components of their lives. A cross‐sectional survey of 387 older people aged 60 years and above and living alone in two communities in Shanghai was conducted from April to July 2015. A structured questionnaire including 15‐item Geriatric Depression Scale, Activity of Daily Living Scale, UCLA Loneliness Scale version 3, Social Support Rate Scale and Older People's Quality of Life Questionnaire was used to assess the health status, loneliness, social support, quality of life and demographic information. A total of 15.7% of the participants rated their health as poor with 56.8% reporting chronic diseases and 26.9% reporting being depressed. A total of 71.1% of the participants reported a high level of functional ability. However, 54.3% and 21.7% of the participants reported a moderately and moderately high level of loneliness respectively. The median of SSRS was 30 and the mean of Older People's Quality of Life Questionnaire was 120.2, indicating a lower level of social support and quality of life. There were statistically significant differences in health, loneliness, social support and quality of life across the participants with different characteristics. Interventions to improve the health status, reduce loneliness, increase social support and maintain or improve quality of life of older people living alone in Shanghai could be developed and implemented. Potential interventions include providing frequent home care services, early detection of depression, encouraging more contacts from children and other family members, and providing support from other sources.     

Empowering elderly Iranians through a social group work intervention: A trial study to assess the effect of the intervention on participants' quality of life

We designed and ran an empowerment‐oriented social group work intervention to assess whether the intervention could improve the quality of life of older Iranians. The intervention consisted of nine group sessions that focused on capacity building and increasing individual competences, environmental resources and opportunities. Using a randomised controlled trial (RCT), 60 elderly people (30 men and 30 women in the intervention and control groups) from Social Services Centres in Tehran Municipality participated in this study. The WHOQOL‐BREF instrument was used to measure quality of life, comparing before, after and follow‐up measures between the groups and within each group. ANOVA and GEE tests were applied to analyse the data. The results showed significant progress in overall quality of life of the participants, particularly in the domains of physical health, psychological health, social relationships and environmental health. In pretest, there were no significant differences between the groups in terms of quality of life and its domains, but there were significant differences in the post‐ and follow‐up tests. This study provides support for the empowerment‐oriented social group work intervention with Iranian elderly people. This kind of intervention can be a useful model for empowering older people, especially in countries where social support and health services for seniors are not yet freely available.     

“The people make it fun,the activities we do just make sure we turn up on time.” Factors influencing older adults’ participation in community‐based group programmes in Perth,Western Australia

Rapid ageing in western societies is placing increasing strain on health and social care services. In response, governments and health agencies have sought to promote healthy ageing through a range of interventions, many of which aim to enhance social engagement and participation among older people. Such interventions are based on evidence that being socially engaged through participation in various activities leads to better physical, mental and psychosocial health outcomes. The research reported here employed focus groups and individual interviews to address research aims: (a) identify enablers and barriers to participation in community‐based group activities among a sample of older people (n = 35, median age 71 years) living in a local government area in the northern suburbs of Perth, Western Australia, and (b) examine how these factors differ between those who regularly participate and those who do not. Our research highlighted four themes: Friendship and Function; Availability and Accessibility; Competing Responsibilities and Priorities; and Changing of the Guard. In particular, this research highlighted the importance of group activities in offering social support as a platform to develop friendships. The findings also indicated that opportunities for social interaction should be embedded in the structure of the group, beyond that which may occur incidentally during activities. This is important, given that while interest may motivate older people to join a group, a sense of belonging and connectedness generated through the group is more likely to maintain their attendance. Barriers included limited availability of local programmes, limited accessibility related to programme scheduling, and lack of programmes relevant to those who do not find traditional seniors’ centres appealing. Recommendations include incorporating social engagement as an outcome measure when evaluating the efficacy of programmes targeting older people, and encouraging local governments to work with seniors’ centres in developing activities attractive to a broader cohort of older people.     

Supporting African refugees in Canada: insights from a support intervention

Although evidence suggests the importance of social support for refugees, this knowledge has not been invoked to systematically develop culturally congruent support interventions that help refugees adapt to life in receiving countries. The objective of this study was to design and pilot test a culturally congruent intervention that meets the support needs and preferences of two ethno‐culturally distinct refugee groups. Support was delivered to Somali and Sudanese refugees (n = 58), by trained peer and professional facilitators. Face‐to‐face groups comprised of refugees, matched by gender and ethnicity, were created to enhance the depleted social networks of Somali and Sudanese refugees. Each peer support group met bi‐weekly for a face‐to‐face session for 12 weeks. Peer facilitators delivered supplementary one‐to‐one support via the telephone. The ingredients of the support intervention included: (i) peer facilitators and professionals; (ii) provision of information, affirmation and emotional support; and (iii) accessibility (e.g. childcare, transportation). The study employed a qualitative participatory research design. Data collected for the study included (i) in‐depth pre‐intervention interviews with potential support group participants in 2008–2009 to assess intervention preferences; (ii) fieldnotes by peer and professional facilitators during the intervention in 2009–10; (iii) post‐intervention group interviews with support group participants in 2010; and (iv) in‐depth interviews with peer and professional helpers in 2010. A major perceived benefit of the support programme was connecting with people from African refugee participants’ cultural communities. Participants appreciated the gender and culture‐specific groups. Following the social support intervention, refugees reported increased social integration, decreased loneliness and expanded coping repertoire.     

Social participation among older adults (55+): Results of a survey in the region of South Limburg in the Netherlands

Social participation may improve the health and well‐being of older adults, and may increase the social and human capacity of their communities. This study investigates the level and forms of social participation among older adults (aged 55 years or older) in the region of South Limburg, the Netherlands, and their association with socio‐demographic and health‐related characteristics. The study provides evidence that can be used by policy makers to enhance social participation in the region. We use cross‐sectional data collected in a survey in 2012 among a sample of older adults (aged 55 years or older) representative for the region of South Limburg. The results indicate that 56% (N = 16,291/weighted sample N = 213,332) of the older adults in the region participate in social activities. Specifically, 25.5% perform paid labour, 20% give informal care and 25% participate in volunteer work. Older adults with a higher education (OR = 2.49 for the highest education group) or higher income (OR = 1.70 for the highest income group) are significantly more likely to participate in social activities compared with the respective reference categories. Increased age (OR = 0.23 for the oldest age group), female gender (OR = 0.83), loneliness (OR = 0.75 for severe loneliness) and restrictions (OR = 0.78 for restrictions on the OECD scale, OR = 0.68 for restrictions on the HDL scale, OR = 0.52 for transportation restrictions) significantly hinder social participation. The lower social participation rate among older adults that we observe compared with the national statistics can be explained by the relatively higher proportion of people with low or average socioeconomic status in South Limburg. And as South Limburg is the unhealthiest region of the Netherlands, this also contributes to the low social participation. Prevention of poor physical and mental health, and provision of care services are important to encourage social participation among the older adults in South Limburg.     

Health outcomes associated with participating in community care centres for older people in Taiwan

Community care centres (CCCs) are widespread across Taiwan and have provided health promotion and social activities for older people in communities since 1995. The purpose of this study was to describe the status of the delivery and management of CCCs for older people, and to explore the effects of individual factors and the organisational factors on the health‐related outcome of older people's participation in CCCs. The sample was taken from participants at CCCs in Taichung, Taiwan. Twenty‐five CCCs participated in the study. The managers and the elderly participants of CCCs underwent face‐to‐face interviews. In total, 417 elderly participants and 25 chiefs completed the face‐to‐face interviews. The participants reported that self‐reported health, sleep quality, memory, family relationships, care for health, and health literacy improved after they participated in the programme. There were no consistent organisational factors related to the outcomes. However, management style was related to sleep quality improvement and staffing getting paid was related to family relationship improvement. Policy recommendations are provided.     

Formal support, mental disorders and personal characteristics: a 25-year follow-up study of a total cohort of older people

The present study was designed to describe the pattern of long-term formal support received by people with mental disorders, and to investigate the relationship between the medical, psychological and social characteristics of the participants and types of formal support. This study is based on a cohort (n = 192) of people born in 1902 and 1903 in a community in Southern Sweden. The research participants were assessed using interviews, psychological tests and medical examinations. Information was collected about the use of primary healthcare and social services. The first assessment took place when the cohort was aged 67 years, and then on eight further occasions until they were 92. The participation rate ranged from 72% to 100%. During the observation period of 25 years, 53% of people with dementia eventually received both home help and institutional care compared to 34% of people with other psychiatric diagnoses and 12% of people with good mental health. The last group had all physical health problems and/or problems with activities of daily living. However, 35% of the dementia group, 46% with other psychiatric diagnoses and 52% of people with good mental health did not receive any formal support. Males and self-employed people were significantly less likely to use formal support. The institutionalised group reported loneliness significantly more often than the other two groups. In a logistic regression analysis, loneliness, low social class, high blood pressure and low problem-solving ability were predictors of formal support use. People with a mental disorder, including dementia, were significantly more likely to use formal support compared to people with good mental health. Social factors were the main factors predicting formal support.     

A pilot programme evaluation of social farming horticultural and occupational activities for older people in Italy

The aim of this study was to evaluate a 1‐year social farming programme conducted between 2014 and 2015, including horticultural and occupational activities on six agricultural farms for older people in good general health. Social farming is a practice that uses agricultural resources to provide health, social or educational services to vulnerable groups of people. Activity participation, social relationships, physical activity, and the quality of life of the participants were assessed using a pretest, posttest design. A total of 112 subjects were interviewed at baseline, though only 73 participants were retained through the end of the follow‐up, resulting in a dropout rate of 34%. Data analysis revealed significant improvements in both social relationships and overall occupational engagement at the end of the programme, with significant increases in the frequency of contact with friends or relatives as well as the number of activities performed by the participants. This work adds to the literature on the effects of social farming and indicates that farming may provide opportunities for older people to engage in activities that stimulate social behaviours.     

Social disorganization/social fragmentation and risk of depression among older people in Japan: Multilevel investigation of indices of social distance

Previous studies reported that social disorganization/fragmentation could predict mental well-being of residents in a community. The aim of this study is to examine how area and individual level of social distance could predict likelihood of mental health among older people in Japan. We empirically derived an index of “social distance” by taking averaged differences in sociodemographic characteristics that are income, education, hometown of origin, the duration of residency, and life stage, between the study participants and their neighbors. We used the study participants (n = 9147) from the Aichi Gerontological Evaluation Study, which targeted residents with aged 65 years or over in a central part in Japan. Depressive symptoms of the study participants were assessed using the short version of the Geriatric Depression Scale (GDS-15). We also tested if area-level social capital would moderate the association between social distance and depressive symptoms. Using multilevel analyses, we found that higher social distance from neighbors was associated with increased depressive symptoms, independently of respondents' own values of income and educational attainment. At the individual level, each standard deviation in income-based and education-based social distance was associated with an odds ratio for depressive symptoms of 1.15 (95% CI: 1.01–1.30) and 1.17 (95% CI: 1.03–1.32), respectively. However, the area-aggregated indices of social distance were not associated with depressive symptoms. Additionally, area-level social capital indicating higher levels of trust between neighbors and social participation, buffered the adverse effect of social distance on depressive risk. In an instance of the “dark side” of social capital, we also found that stronger social cohesion increased depressive symptoms for residents whose hometown of origin differed from the communities where they currently resided.     

Effects on leisure activities and social participation of a case management intervention for frail older people living at home: a randomised controlled trial

Frailty causes disability and restrictions on older people's ability to engage in leisure activities and for social participation. The objective of this study was to evaluate the effects of a 1‐year case management intervention for frail older people living at home in Sweden in terms of social participation and leisure activities. The study was a randomised controlled trial with repeated follow‐ups. The sample (n = 153) was consecutively and randomly assigned to intervention (n = 80) or control groups (n = 73). The intervention group received monthly home visits over the course of a year by nurses and physiotherapists working as case managers, using a multifactorial preventive approach. Data collections on social participation, leisure activities and rating of important leisure activities were performed at baseline, 3, 6, 9 and 12 months, with recruitment between October 2006 and April 2011. The results did not show any differences in favour of the intervention on social participation. However, the intervention group performed leisure activities in general, and important physical leisure activities, to a greater extent than the control group at the 3‐month follow‐up (median 13 vs. 11, P = 0.034 and median 3 vs. 3, P = 0.031 respectively). A statistically significantly greater proportion of participants from the intervention group had an increased or unchanged number of important social leisure activities that they performed for the periods from baseline to 3 months (93.2% vs. 75.4%, OR = 4.48, 95% CI: 1.37–14.58). Even though statistically significant findings in favour of the intervention were found, more research on activity‐focused case management interventions is needed to achieve clear effects on social participation and leisure activities.     

“Growing Old is not for the Weak of Heart”: Social isolation and loneliness in Muslim immigrant older adults in Canada

The increase in global migration means more immigrants are ageing in host countries with unique experiences and needs. Muslim immigrants in Canada are from diverse ethnocultural communities and experience unmet health and social needs in older age. A community‐based participatory research project was conducted in Alberta, Canada, in 2017–2018 to understand the experiences and needs of healthy ageing in this population. A community advisory committee participated in all phases of the research project including initial framing of the research focus, recruitment, data collection and data analysis. In total, 67 older adults and stakeholders from South Asian, Arab and African Muslim communities participated in one of 23 individual interviews or seven focus group discussions over a 1‐year period. Participants were asked about their experiences of growing old in Canada, unmet health and social needs, and community perspectives on healthy ageing. All data were audio‐taped and transcribed verbatim. Interpreters were used for non‐English speaking participants. Data were thematically analysed with a focus on social isolation and loneliness. Using an exclusion lens two major themes were identified: (a) intersections of exclusion: ageism, sexism, racism, and; (b) strategies for inclusion: local, national, transnational. Findings highlight both the vulnerability of Muslim immigrant older adults and their capacity for agency. The study findings point to the intersecting influences of exclusionary practices on social isolation and loneliness in immigrant older adults and the need to incorporate an exclusion lens in developing social policies and programs for healthy ageing.     

Enhancing social networks: a qualitative study of health and social care practice in UK mental health services

People with severe mental health problems such as psychosis have access to less social capital, defined as resources within social networks, than members of the general population. However, a lack of theoretically and empirically informed models hampers the development of social interventions which seek to enhance an individual's social networks. This paper reports the findings of a qualitative study, which used ethnographic field methods in six sites in England to investigate how workers helped people recovering from psychosis to enhance their social networks. This study drew upon practice wisdom and lived experience to provide data for intervention modelling. Data were collected from 73 practitioners and 51 people who used their services in two phases. Data were selected and coded using a grounded theory approach to depict the key themes that appeared to underpin the generation of social capital within networks. Findings are presented in four over‐arching themes – worker skills, attitudes and roles; connecting people processes; role of the agency; and barriers to network development. The sub‐themes which were identified included worker attitudes; person‐centred approach; equality of worker–individual relationship; goal setting; creating new networks and relationships; engagement through activities; practical support; existing relationships; the individual taking responsibility; identifying and overcoming barriers; and moving on. Themes were consistent with recovery models used within mental health services and will provide the basis for the development of an intervention model to enhance individuals’ access to social capital within networks.