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.     

Social Isolation and Loneliness as Risk Factors for Grip Strength Decline Among Older Women and Men in China

ObjectiveThe purpose of this study was to examine the relationships of social isolation and loneliness, both individually and simultaneously, on changes in grip strength among Chinese older adults and whether these relations vary by gender.DesignA 4-year prospective observational study.Setting and ParticipantsThis study used data from the China Health and Retirement Longitudinal Study (CHARLS). Analyses were conducted with data from 2 waves (2011 and 2015) and were restricted to those respondents aged 50 and older [n = 7025, mean age (SD) = 61.46 (7.59); male, 48.4%].MethodsSocial isolation, loneliness, and grip strength were measured at baseline. Follow-up measures of grip strength were obtained 4 years later. Multiple linear regression was used to evaluate the associations among baseline isolation, loneliness, and decline of grip strength between 2 waves after adjustment for age, gender, education, body mass index, chronic diseases, smoking and drinking status, activities of daily living (ADL) and instrumental ADL disabilities, and depressive symptoms.ResultsFor women, baseline loneliness (β = 0.04, P = .035) rather than isolation (β = 0.03, P = .110) significantly predicted grip strength decline after 4 years when other confounding variables were taken into account. For men, baseline isolation (β = 0.05, P = .005) rather than loneliness (β = 0.01, P = .570) significantly predicted grip strength decline. No synergistic effect of isolation and loneliness on grip strength was found for either women or men.Conclusions and ImplicationsIn this prospective study, gender differences were found for the associations of social isolation and loneliness with grip strength decline. Our results suggest that older women and men may benefit from different social enhancement strategies for prevention of physical function decline.     

Australian homeless persons’ experiences of social connectedness,isolation and loneliness

Both loneliness and a lack of social integration are associated with serious physical and psychological health issues. One population highly susceptible to social isolation and loneliness are individuals who are homeless, who also experience high rates of mental disorder and relationship breakdown. Despite this, little research has explored how social networks, isolation and loneliness are experienced for those with a history of homelessness. In‐depth, semi‐structured interviews were used to get a nuanced understanding of how social networks and isolation are experienced and understood by individuals experiencing homelessness. Sixteen participants who were either homeless (n = 11) or previously homeless (n = 5) in Sydney, Australia, completed one‐off interviews that were audio‐recorded and transcribed. Data were analysed using thematic analysis. Participants constructed their social networks as being both constrained and enabled by marginalisation. They experienced rejection from the non‐homeless: the loss of critical network members, including rejection from family and a lack of companionship, and low quality and precarious relationships within the homeless community. These accounts were best conceptualised through loneliness theory. Participant's accounts signal that the homeless will likely continue feeling isolated if mainstream attitudes towards homelessness remain stigmatising and discriminatory.     

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.     

Do Loneliness and Perceived Social Isolation Reduce Expected Longevity and Increase the Frequency of Dealing with Death and Dying? Longitudinal Findings based on a Nationally Representative Sample

ObjectivesLoneliness and social isolation are important factors for morbidity and mortality. However, little is known about whether increases in loneliness and perceived social isolation contribute to decreased expectations of longevity and an increased frequency of dealing with death and dying. Consequently, our aim was to clarify these relationships.DesignLongitudinal data were derived from a nationally representative sample of individuals ≥40 years (analytical sample, n=7952 observations).Setting and ParticipantsCommunity-dwelling individuals aged ≥40 years.MethodsLoneliness and perceived social isolation were both measured using well-established tools. In accordance with other large cohort studies, the expectations of longevity were assessed using the question “What age do you think you will live to?” Moreover, the frequency of dealing with death and dying (from 1 = never to 5 = very often) served as outcome measure. In regression analysis, it was adjusted for several sociodemographic and health-related factors.ResultsFixed effects regressions showed that both increases in loneliness (β = –0.99, P < .001) and in perceived social isolation (β = –0.59, P < .05) were associated with decreases in expectations of longevity. Furthermore, both loneliness [incidence rate ratio (IRR) = 1.02, P < .05] and perceived social isolation (IRR = 1.02, P < .05) were associated with increases in the frequency of dealing with death and dying.Conclusions and ImplicationsBeyond the impact of various covariates, findings still point to a longitudinal association between both perceived social isolation and loneliness and lower expectations of longevity as well as an increased frequency of dealing with death and dying. Efforts in reducing loneliness and perceived social isolation can contribute to increased expected longevity and a decreased frequency of dealing with death and dying which ultimately can contribute to longevity in older age.     

Impact of social prescribing to address loneliness: A mixed methods evaluation of a national social prescribing programme

Loneliness is considered a global public health issue because of its detrimental impact on physical and mental health but little is known about which interventions can reduce loneliness. One potential intervention is social prescribing, where a link worker helps service-users to access appropriate support such as community activities and social groups. Some qualitative studies have identified that social prescribing may help to reduce service-users’ loneliness. Given this, the British Red Cross (a third sector organisation) developed and delivered a national social prescribing service in the United Kingdom to support people who were experiencing, or at risk of, loneliness. Service-users could receive up to 12 weeks of support from a link worker. A mixed methods study was conducted to understand the impact of the support on loneliness, and to identify the facilitators and barriers to service delivery. The study included: (a) analysis of quantitative data collected routinely between May 2017 and December 2019 (n = 10,643) including pre-post analysis of UCLA data (n = 2,250) and matched comparator work to measure changes in loneliness; (b) semi-structured interviews with service-users, link workers and volunteers (n = 60) and (c) a Social Return on Investment Analysis. The majority of the service-users (72.6%, n = 1634/2250) felt less lonely after receiving support. The mean change in UCLA score was −1.84 (95% CI −1.91 to −1.77) of a maximum change of 6.00 (decrease indicates an improvement). Additional benefits included improved wellbeing, increased confidence and life having more purpose. The base case analysis estimated a social return on investment of £3.42 per £1 invested in the service. Having skilled link workers and support tailored to individual needs appeared key. However, challenges included utilising volunteers, meeting some service-users’ needs in relation to signposting and sustaining improvements in loneliness. Nonetheless, the service appeared successful in supporting service-users experiencing loneliness.     

Patterns and causes of health inequalities in later life: a Bourdieusian approach

This study explores the relationship between social class and health change in older people in a path analysis, using data from the English Longitudinal Study of Ageing (n = 6241) in a Bourdieusian theoretical framework. Bourdieu drew a distinction between the occupational characteristics by which people are classified and the secondary properties of class that relate to lifestyle (economic, cultural and social capitals). Our path model includes both occupational and secondary characteristics of objective social class as well as a measure of subjective social class. We investigate the effects of the predictors on change in three health outcomes (self‐rated health, number of symptoms of depression and number of difficulties with the activities of daily living). The analysis adds to Bourdieusian research by showing how the effects of objective social class on health are partially mediated by perceived social status. It also adds to substantive research on the relationship between class and health by suggesting that class‐related health inequalities do persist for older people, even for those who are not in paid employment. It suggests that a large amount of the effect of occupation on the health of older people is not direct but indirect; through their personal wealth and lifestyle.     

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.     

The healthcare experiences of Koreans living in North Carolina: a mixed methods study

This study examined the healthcare experiences of Korean immigrants aged 40–64 living in the North Carolina Triangle area of the Southeastern United States. Using a mixed methods design, we collected quantitative data via a questionnaire from 125 participants and conducted a focus group with 10 interviewees from December 2010 to February 2011. The quantitative data were analysed using t‐tests and chi‐square tests, and a thematic analysis was used for the focus group study. Questionnaire findings showed that only 27.2% had sufficient English skills to communicate adequately. Participants with insurance were significantly more likely to be employed (P < 0.001), had higher incomes (P = 0.011) and higher education (P < 0.001), and had greater English‐speaking ability (P = 0.011) than those without insurance. Participants who did not use healthcare services showed significantly less knowledge (P < 0.001) of and less satisfaction (P = 0.034) with the healthcare system than those using healthcare services. Sixty‐two participants (49.6%) reported having no health insurance for one or more of the following reasons: high costs (75.8%), medical tourism (22.6%) and lack of information or knowledge (6.5%). The following themes emerged from the data collected during the focus group: (i) barriers to utilisation of healthcare services; (ii) facilitators of utilisation of healthcare services; and (iii) social support seeking for health management. Our mixed methods study findings indicate that healthcare disparities exist among Korean immigrants and that a number of factors, including health literacy, may contribute to their poor health outcomes. Continued collaboration among community members, healthcare professionals and academicians is needed to discuss the community's health concerns and to develop sustainable programmes that will ensure meaningful access to care for those with limited English proficiency and medically underserved populations.     

“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.     

Care and support for older adults in The Netherlands living independently

The growth in the numbers of older adults needing long‐term care has resulted in rising costs which have forced the Dutch government to change its long‐term care system. Now, the local authorities have greater responsibility for supporting older adults and in prolonging independent living with increased support provided by the social network. However, it is unclear whether these older adults have such a network to rely upon. The objective of this study was to gain insight into the providers of formal and informal care to older adults, and to assess possible differences between older adults who are frail and those who are not. In addition, we investigated their care and support needs. We used data from a quantitative survey using a cross‐sectional design in different regions of the Netherlands from July until September 2014 (n = 181). Frailty was measured using the Tilburg Frailty indicator. To analyse the data chi‐square tests, crosstabs and odds ratios were used for dichotomous data and the Mann–Whitney U‐Test for nominal data. The number of formal care providers involved was significantly higher (median = 2) for those deemed frail than for those not deemed frail (median = 1), U = 2,130, p < .005. However, more than one‐third of the respondents deemed frail did not get the care or support they needed (33.7%). There was a significant positive association between being frail and having an informal care provider (χ² = 18.78, df = 1, p < .005). However, more than one‐third of those deemed frail did not have an informal care provider (36.8%). One‐third of older adults deemed to be frail did not have their needs sufficiently addressed by their care network. For a substantial part of this group of older adults, the informal network seems to be unable to support them sufficiently. Additional attention for their needs and wishes is required to implement the policy reforms successfully.     

Rising to the Occasion: A National Nursing Home Study Documenting Attempts to Address Social Isolation During the COVID-19 Pandemic

ObjectivesCOVID-19–related policies introduced extraordinary social disruption in nursing homes. In response, nursing facilities implemented strategies to alleviate their residents’ loneliness. This study sought to describe interventions nursing homes used, document the perceived effectiveness of efforts, and determine barriers to implementing strategies to mitigate social isolation and loneliness.DesignNational survey of nursing homes sampled in strata defined by facility size (beds: 30-99, 100+) and quality ratings (1, 2-4, 5).Settings and ParticipantsUS Nursing Home Directors of Nursing/Administrators (n = 1676).MethodsThe survey was conducted between February and May 2022 (response rate: 30%; n = 504, weighted n = 14,506). Weighted analyses provided nationally representative results.ResultsOne-third were extremely concerned about their home's ability to meet residents' medical and social needs during COVID-19 before vaccines were available and 13% after vaccines. Nearly all reported trying to mitigate residents' social isolation during the pandemic. Efforts tried, and perceived as most useful, included using technology (tablets, phones, emails), assigning staff as a family contact, and more staff time with residents. Most frequently cited barriers to implementation were related to staffing issues.Conclusions and ImplicationsDespite multiple challenges, nearly all nursing homes tried to implement many different approaches to address residents’ social needs, with some (eg, having an assigned family contact, use of tablets and phones) perceived as more useful than others. Staffing issues presented barriers for addressing the social needs of nursing home residents. Many strategies for addressing social isolation placed more demands on a workforce already stretched to the limit. While concerns about resident social isolation reduced after vaccine availability, administrators remained extremely concerned about staff burnout and mental health.     

Longitudinal association between home and community-based services provision and cognitive function in Chinese older adults: Evidence from the Chinese Longitudinal Healthy Longevity Survey

Few studies have assessed the impact of home and community-based services (HCBSs) provision on cognitive function among older adults over time. This study examined the longitudinal association between HCBSs provision and cognitive function in Chinese older adults. The study included 5,134 participants aged 65 years and older in the Chinese Longitudinal Healthy Longevity Survey from 2008 to 2014. The Mini-Mental State Examination (MMSE) was used to evaluate cognitive function over the same time period. Participants were asked what kind of HCBSs were provided in his or her community. However, they were not asked whether services were utilised. The study used the number of HCBSs provided each wave to represent the strength of HCBSs, and used the MMSE score of each wave to represent the older adults’ cognitive function status. A latent growth model was used to explore the relationship between HCBSs provision and cognitive function of older adults. The number of HCBSs provided was positively associated with older adults’ cognitive function (2008: β = 0.03, p = 0.031; 2011: β = 0.06, p < 0.001; 2014: β = 0.06, p < 0.001) after controlling for gender, age, residence, education, income, medical insurance, activities of daily living disability, instrumental activities of daily living disability, serious illness, living arrangement and marital status. Results provided longitudinal evidence that an increase in HCBSs provision at a national level can result in better cognitive function in Chinese older adults.     

Factors related to preference for participation and degree of commitment in community activities among older adults in Japanese depopulated areas

To address the rapid increase in the ageing population, Japan implemented the Long‐Term Care Insurance System (LTCS) in 2000. Additionally, a community‐based integrated community care system was released in 2012. The purpose of these policies was to help older people who need care or support to continue to live their preferred lifestyles in their own communities. According to this paradigm, older residents are themselves considered members of the community caregiving team and expected to participate in volunteer activities to help the neighbourhood. One such activity is social participation including community activities. Many factors influencing social participation have been found in previous literature. However, knowledge of specific factors about community activities is limited, even though these kinds of activities have attracted policy attention. Our study examined factors related to thoughts about community activities among people aged >40 years. We conducted random sampling in two depopulated areas in Japan and used an anonymous mail survey method. Our survey consisted of three parts: social demographics, health and life, and medical/long‐term care. A total of 2,466 individuals participated in the study (response rate 52.2%), whose average age was 64.2 (SD = 10.3) and 46.5% (n = 1,146) were female. Items including talking with neighbours frequently (social demographics), higher self‐rated health (health and life), the need for health consultations and the desire to take care of family members when they need help (medical/long‐term care) were significantly related to both preference for participation and degree of commitment in community activities. To encourage participation in community activities among older citizens, we recommend interventions related to health literacy and family ties.     

Exploring the potential for social prescribing in pre-hospital emergency and urgent care: A qualitative study

There is a sustained increase in demand for emergency and urgent care services in England. The NHS Long Term Plan aims to reduce the burden on emergency hospital services through changing how pre-hospital care operates, including increased delivery of urgent care. Given the recognised potential of social prescribing to address wider determinants of health and reduce costs in other settings, this study aimed to understand the role that social prescribing can play in pre-hospital emergency and urgent care from the perspectives of staff. Semi-structured interviews (n = 15) and a focus group (n = 3) were conducted with clinical staff (n = 14) and non-clinical health advisors (n = 4) from an English Ambulance Service covering emergency (999) and non-emergency (111) calls. Data were analysed using a pre-defined framework: awareness of social prescribing; potential cohorts suitable for social prescribing; and determinants of social prescribing. Awareness and knowledge of social prescribing was limited, though when social prescribing was explained to participants they almost universally recognised its benefits for their role. Social prescribing was considered to be most beneficial to those calling for reasons relating to mental health, loneliness or social isolation, in particular older people and frequent users of 999 and 111 services. Determinants of social prescribing were identified across the micro (patient and staff acceptability of social prescribing), meso (triage and referral pathways) and macro (commissioning and funding) levels of analysis. This is the first empirical study to explore social prescribing in pre-hospital emergency and urgent care services, which suggests that it has potential to improve quality of care at the point of people accessing these services. There is a pressing need to address the micro, macro and meso level determinants identified within this study, in order to support staff within pre-hospital emergency and urgent care services to socially prescribe.     

Loneliness Among Older Lesbian,Gay, and Bisexual Adults: The Role of Minority Stress

Past research has consistently found that aging lesbians, gay men, and bisexuals (LGBs) are more apt to suffer from loneliness than their heterosexual counterparts. Data from the 2002 Gay Autumn survey (N = 122) were used to find out whether minority stress relates to higher levels of loneliness among older LGB adults in the Netherlands. We examined five minority stress factors: external objective stressful events, expectations of those events, internalized homonegativity, hiding and concealment of one’s LGB identity, and ameliorating processes. The results showed that greater insight into loneliness among older LGB adults was obtained when minority stress factors were considered. Older LGB adults who had experienced negative reactions, as well as aging LGBs who expected those reactions, had the highest levels of loneliness. Having an LGB social network buffered against the impact of minority stress. These minority stress processes added to the variance already explained by general factors that influenced levels of loneliness (partner relationships, general social network, physical health, and self-esteem). Interventions aimed at decreasing feelings of loneliness among older LGBs should be focused on decreasing societal homonegativity (to decrease the amount of negative and prejudiced reactions) and on the enhancement of social activities for LGB elderly.     

A randomised controlled study to explore the effect of life story review on depression in older Chinese in Singapore

There is little evidence to support the efficacy of the life storybook creation process, which incorporates the use of narratives, in mediating depression levels. The study aimed to examine the effects of the life storybook creation process on depressive symptoms among older community‐dwelling Chinese adults in Singapore. A randomised controlled trial was conducted from January 2011 to March 2012. Twenty‐six Chinese aged over 60 years, who were able to communicate in Chinese and/or English, and with mild to severe depression were randomly allocated to either the life storybook (intervention) group (n = 14) or the non‐life storybook (control) group (n = 12). Subjects in the intervention group were interviewed on a one to one basis on five sessions over 8 weeks. Depressive symptoms were measured using the Geriatric Depression Scale. Generalised estimating equations were used to examine the effects of the intervention on the elderly peoples’ depression level. Significant reductions in depression scores were found in the intervention group from baseline (mean 7.9 [SD 3.0]) to week 8 (2.5 [1.7], χ² = 15.25, P < 0.001). At week 8, the intervention group showed a lower level of depression than the control (χ² = 4.33, P = 0.037). This study supports the life storybook creation process as an effective intervention for depressed older Chinese adults living in the community. The findings suggest that this intervention may enhance the quality of care provided by healthcare providers as the therapeutic relationship between provider and client is being established.     

Reaching people with disabilities to learn about their experiences of social connection and loneliness

BackgroundPeople with disabilities experience higher rates of social isolation and loneliness than people without disabilities, but there is limited information about how these conditions are manifested in people with specific types of disabilities.ObjectivesUsing data collected as part of the second administration of the National Survey on Health and Disability (n = 2,132), our objectives were to determine if disability type and recruitment method added explanatory power to observed levels of social connectedness, after controlling for socio-demographic and environmental indicators.MethodsWe used hierarchical regression to evaluate how socio-demographic, disability, environmental, and recruitment type explained four outcome variables for different dimensions of social connectedness, including satisfaction with social activity, quantity of social connections, quality of social connections, and loneliness.ResultsAcross all models, employment status (not employed), having mental illness/psychiatric disability, lack of transportation for social needs, and recruitment type (MTurk) significantly predicted lower levels of social connectedness.ConclusionsThe study provides evidence that using alternative methods, such as MTurk, to complement conventional recruitment strategies can improve understanding of social isolation and feelings of loneliness among people with disabilities, particularly those with mental illnesses and/or psychiatric disorders who are less likely to be accessed through group affiliations, but who are at greater risk for experiencing social isolation and feelings of loneliness.