The relation between living alone and depressive symptoms in older Korean Americans: do feelings of loneliness mediate?

Objectives: As the opposite end of the continuum from social integration, social isolation may put individuals at a greater risk of poor mental health. Conceptualizing living alone as an objective and structural indicator of social isolation and loneliness as subjective perceptions of social isolation, the present study hypothesized that the relation between living alone and depressive symptoms would be mediated by the feelings of loneliness. Using older Korean Americans as the target population, the mediation model was examined in consideration of the contextual factors such as demographics (age, gender, education, perceived income, and length of stay in the USA), health (chronic conditions and functional disability), and general social integration (size of social network and community social cohesion).

Method: Date were drawn from surveys with 209 older Korean Americans in Central Texas (M_age = 69.6, SD = 7.5). Multivariate regression models of depressive symptoms were entered in the following order: (1) demographics, (2) health, (3) living alone, (4) social network/community social cohesion, and (5) loneliness. The mediation effect of loneliness in the relationship between living alone and depressive symptoms was separately examined using the bootstrapping method.

Results: Loneliness was found to mediate the relation between living alone and depressive symptoms (indirect effect = 1.03, 95% CI = .05–2.08).

Conclusion: The results suggest that subjective perceptions of loneliness may explain the mechanism through which objective social isolation presents risks for depressive symptoms in older Korean Americans.     

Loneliness and cognition in older people: the Dublin Healthy Ageing study

Introduction: While several studies have found a link between impaired cognition and social isolation, few have examined the relationship between cognition and loneliness. Loneliness has been thought to increase the risk of development of Alzheimer's dementia.

Aim: The aims of this study were to explore the relationship between loneliness and cognition and to determine whether specific cognitive domains are associated with loneliness.

Design: Cross-sectional community-based study.

Participants: This study included 466 community-dwelling subjects with mean age 75.45 (SD 6.06) years, of which 208(44%) were males.

Results: Loneliness was significantly associated with impaired global cognition independent of social networks and depression. The domains of psychomotor processing speed and delayed visual memory were specifically associated with self-reported loneliness.

Conclusion: This cross-sectional study demonstrated an association between loneliness and specific aspects of cognition independent of depression, social networks and other demographics. The mechanism for this association is unclear and warrants further investigation.     

Loneliness and the risk of dementia among older Chinese adults: gender differences

Objective: The objective of this study was to examine whether loneliness was associated with the risk of developing dementia in Chinese older adults and whether the association was moderated by gender.

Method: A 3-year cohort study was conducted using data from the 2008/2009 and 2011/2012 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Multiple logistic regression was used to analyze the relationship between loneliness and dementia. The interaction between loneliness and gender was also evaluated.

Results: At 3-year follow-up, 393 of the 7867 participants had dementia. Loneliness was associated with dementia (odds ratio (OR) = 1.31, 95% confidence interval (CI) = 1.11–1.56) after adjustment for sociodemographic characteristics, lifestyle, and baseline health status. A significant interaction between loneliness and gender was also found (OR = 0.81, 95% CI = 0.65–0.99).

Conclusion: Loneliness increased the risk of developing dementia among people aged 65 years and older in China. Moreover, the effect of loneliness on dementia risk varied by gender. Specifically, men who felt lonely were more likely to suffer from dementia than women.     

Predictors of loneliness among older women and men in Sweden: A national longitudinal study

Objectives: Longitudinal research on loneliness in old age has rarely considered loneliness separately for men and women, despite gender differences in life experiences. The objective of this study was to examine the extent to which older women and men (70+) report feelings of loneliness with a focus on: (a) changes in reported loneliness as people age, and (b) which factors predict loneliness.

Method: Data from the 2004 and 2011 waves of SWEOLD, a longitudinal national survey, was used (n = 587). The prediction of loneliness in 2011 by variables measured in 2004 and 2004–2011 variable change scores was examined in three logistic regression models: total sample, women and men. Variables in the models included: gender, age, education, mobility problems, depression, widowhood and social contacts.

Results: Older people moved into and out of frequent loneliness over time, although there was a general increase in loneliness with age. Loneliness at baseline, depression increment and recent widowhood were significant predictors of loneliness in all three multivariable models. Widowhood, depression, mobility problems and mobility reduction predicted loneliness uniquely in the model for women; while low level of social contacts and social contact reduction predicted loneliness uniquely in the model for men.

Conclusion: This study challenges the notion that feelings of loneliness in old age are stable. It also identifies important gender differences in prevalence and predictors of loneliness. Knowledge about such differences is crucial for the development of effective policy and interventions to combat loneliness in later life.     

Do caregiving burden and satisfaction predict loneliness in older care recipients?

Objectives: The goal of this study was to assess the extent to which caregiving burden and satisfaction of primary family caregivers in Israel predict loneliness among their older care recipients.

Method: The study included a convenience sample of 325 dyads of respondents. The short version of Zarit Caregiving Burden Interview and Lawton Caregiving Appraisal measures were used to assess caregiving burden and satisfaction; the de Jong Gierveld Loneliness Scale was used to assess care recipient's loneliness.

Results: The results showed that greater caregiving burden was significantly correlated with increased loneliness, whereas greater caregiving satisfaction was significantly correlated with lower levels of loneliness.

Conclusion: The literature has broadly addressed the association between caregiving burden and satisfaction and the caregivers’ well-being, whereas this association with regard to care recipients’ well-being has been barely examined. The multivariate analyses showed that caregiving burden was insignificant in explaining loneliness, whereas greater caregiving satisfaction was found significant in explaining lower levels of loneliness. The results and implications for further research and practice are discussed.     

What prevents old people living alone from feeling lonely? Findings from the KORA-Age-study

Objectives: Living alone in later life is an important risk factor of loneliness for elderly people unless they have resources to compensate for that. The aim of this investigation was to identify these resources.

Method: Data were drawn from the population-based KORA-Age-study (KOoperativen Gesundheitsforschung in der Region Augsburg) conducted in the Region of Augsburg, Germany in 2008/2009 with 1079 elderly men and women (64–94 years). Loneliness was measured by the short version of the UCLA-Loneliness-Scale in a face-to-face interview. Multiple logistic regression analyses were conducted to identify associations between loneliness and potential protecting resources.

Results: A total of 346 (32%) subjects reported to be living alone, among them 70% (n = 241) expressed no feelings of loneliness. Participants with a stable social network had a fourfold higher chance (OR 4.08, 95% CI 1.20–13.88, p = 0.025) and with the absence of depression a threefold higher chance (OR 3.04, 95% CI 1.59–5.78, p-value < 0.001) of not feeling lonely. Physical or mental resources were not correlated with lower levels of loneliness.

Conclusion: Absence of depression and a functioning social network are the most important protecting resources against loneliness for elderly people living alone, while income, level of education and age-related limitations have no impact. These findings should be considered when supporting the elderly in successful aging.     

Is loneliness in later life a self-fulfilling prophecy?

Objectives: There are many stereotypes about ageing and later life. We looked at the association between expectations and stereotyping of loneliness in old age and actual self-reported loneliness status 8 years later in English Longitudinal Study of Ageing (ELSA).

Method: Data from 4465 ELSA core members aged over 50 who responded to Waves 2 (2004) did not report loneliness in Wave 2, and responded to loneliness questions at least once between Waves 3 and 6 (2006–2012) were used in multivariable repeated measures logit regression analysis to estimate relationship between perceived stereotypes and expectation of loneliness in older age and actual loneliness reported within 8 years of follow-up.

Results: Twenty-four per cent of respondents from the analytical sample agreed at Wave 2 that old age is time of loneliness and 33% expected to be lonely in old age. Loneliness was reported by 11.5% of respondents at Waves 3–6. Both stereotypes and expectation were significantly associated with later reported loneliness (OR 2.65 (95% CI 2.05–3.42) for stereotypes and 2.98 (95% CI 2.33–3.75) for expectations in age-sex adjusted analysis). Both variables significantly predicted future loneliness even when socio-demographic circumstances were taken into account and both variables were mutually adjusted although the effect was reduced (OR's 1.53 (95% CI 1.16–2.01) for stereotypes and 2.38 (95% CI 1.84–3.07) for expectations).

Conclusions: Stereotypes and expectations related to loneliness in the old age were significantly associated with reported loneliness 8 years later. Interventions aimed at changing age-related stereotypes in population may have more impact on reducing loneliness than individually based services.     

Social networks and links to isolation and loneliness among elderly HCBS clients

Objectives: The purpose of this study was to explore the network types of HCBS clients based on the structural characteristics of their social networks. We also examined how the network types were associated with social isolation, relationship quality and loneliness.

Method: Forty personal interviews were carried out with HCBS clients to assess the structure of their social networks as indicated by frequency of contact with children, friends, family and participation in religious and community organizations. Hierarchical cluster analysis was conducted to identify network types.

Results: Four network types were found including: family (n = 16), diverse (n = 8), restricted (n = 8) and religious (n = 7). Family members comprised almost half of participants’ social networks, and friends comprised less than one-third. Clients embedded in family, diverse and religious networks had significantly more positive relationships than clients embedded in restricted networks. Clients embedded in restricted networks had significantly higher social isolation scores and were lonelier than clients in diverse and family networks.

Discussion: The findings suggest that HCBS clients’ isolation and loneliness are linked to the types of social networks in which they are embedded. The findings also suggest that clients embedded in restricted networks are at high risk for negative outcomes.     

Stressors social support and elder mistreatment

Objectives: This study sought to examine the pathways through which interpersonal relationship strain and loneliness (stressors) influence elder mistreatment. In addition, the study tested the buffer effects of social support within the stressor-mistreatment relationship.

Method: Face-to-face interviews were conducted with 897 randomly selected older adults in rural Tamil Nadu, India. Mediation and moderation models were tested using the process module.

Results: Results showed that, in addition to the direct effects, interpersonal problems also influenced mistreatment via loneliness (partially mediating model). In the moderation model, social support buffered the influence of interpersonal strain on mistreatment (unconditional direct effect) and also buffered the influence of interpersonal strain on mistreatment through loneliness (conditional indirect effects).

Discussion: Intervention on mistreatment should involve elimination of risk factors and strengthening of social resources.     

Effect of a social intervention of choice vs. control on depressive symptoms,melancholy, feeling of loneliness,and perceived togetherness in older Finnish people: a randomized controlled trial

Objectives: This study examined effects of a social intervention on depressive symptoms, melancholy, loneliness, and perceived togetherness in community-dwelling Finnish older people.

Method: Promotion of mental well-being in older people (GoodMood; ISRCTN78426775) was a single-blinded randomized control trial lasting 1.5 years. Two hundred and twenty-three persons aged 75–79 years reporting symptoms of loneliness or melancholy were randomized into intervention and control groups. The intervention group was allowed to choose among supervised exercise, social activity, or personal counseling. Follow-up measurements were conducted at the end of 6-month intervention, and at 3, 6, and 12 months post intervention.

Results: Number of depressive symptoms remained unchanged, while loneliness and melancholy decreased in both the intervention and control groups during the study (p < 0.001). Social integration increased in the intervention group but not in controls (p = 0.041). Attachment and guidance increased in both groups (p < 0.001).

Conclusion: The intervention did not alleviate depressed mood. Positive changes over time were observed in loneliness, feelings of melancholy, attachment, and guidance but these occurred independently of the intervention. Our secondary analysis suggests that the intervention increased perceived social integration. In sum, the effects of the intervention were moderate only and did not expedite further overcoming depressive mood or loneliness.     

‘Help me! I’m old!’ How negative aging stereotypes create dependency among older adults

Objectives: This study examined the effects of negative aging stereotypes on self-reported loneliness, risk-taking, subjective health, and help-seeking behavior in a French sample of older adults. The aim of this study was to show the detrimental effects of negative aging stereotypes on older adults’ self-evaluations and behaviors, therefore contributing to the explanations of the iatrogenic effect of social environments that increase dependency (e.g., health care institutions).

Method: In the first experiment conducted on 57 older adults, we explored the effects of positive, neutral, or negative stereotype activation on the feeling of loneliness and risk taking decision. The second experiment (n = 60) examined the impact of stereotype activation on subjective health, self-reported extraversion as well as on a genuine help-seeking behavior, by allowing participants to ask for the experimenter's help while completing a task.

Results: As predicted, negative stereotype activation resulted in lower levels of risk taking, subjective health and extraversion, and in higher feelings of loneliness and a more frequent help-seeking behavior.

Conclusion: These findings suggest that the mere activation of negative stereotypes can have broad and deleterious effects on older individuals’ self-evaluation and functioning, which in turn may contribute to the often observed dependency among older people.     

Loneliness and depressive symptoms: the moderating role of the transition into retirement

Objectives: The transition to retirement implies significant changes in daily routine and in the social environment. More specifically, it requires more self-directed efforts in order to stay socially engaged. Hence, for those who suffer from loneliness, the transition to retirement could result in increased depressive symptoms due to the lack of structured daily routine.

Methods: We used two waves of the Health and Retirement Study, and tested whether the transition to retirement between the two waves moderates the effects of loneliness on depressive symptoms.

Results: The transition to retirement moderated the effect of loneliness in wave 1 on depressive symptoms in wave 2, such that for those who retired, the effect was stronger in comparison to those who stayed employed.

Conclusions: Although many manage to easily transition into retirement, lonely older workers are at increased risk for maladjustment and the experience of depressive symptoms following retirement. This group could perhaps benefit from interventions aimed at increasing daily social interactions and establishing a socially satisfying routine.     

Loneliness among men and women – a five-year follow-up study

Objectives: The purpose of the study was to explore whether and how loneliness in adults was influenced by life events and experiences in early and later stages in life. Applying a life-course and gender perspective, the current study investigates statuses and transitions that influence self-reported loneliness among men and women in middle age (age 40–59) and when older (age 60–80).

Method: The panel data are from two waves of the Norwegian study of the life course, ageing and generations. Our sample consists of 3750 people aged 40–80 at baseline who were surveyed in 2002–2003 (T1) and 2007–2008 (T2). Multivariate analyses were used to investigate personal characteristics and life events associated with loneliness at baseline and life events predicting the incidence of loneliness during the five-year period.

Results: Adverse childhood events were associated with loneliness by both men and women. In the older group, men's loneliness was related to having been bullied, and conflicts between parents. Women's loneliness was related to economic problems in their childhood family. Regarding the incidence of loneliness – becoming lonely between T1 and T2 – among those aged 40–59, divorce predicted women becoming lonely, but not men. Among those aged 60–80, the partner's death was a stronger predictor of the incidence of loneliness among men than among women.

Conclusion: The results demonstrate that loneliness is influenced by events and experiences from early childhood to later life, and that some events and experiences influence loneliness in men and women differently.     

Neurocognitive and functional correlates of mobile phone use in middle-aged and older patients with schizophrenia

Objectives: Our objective was to examine the association of mobile phone use and ownership with psychopathology, cognitive functioning, and functional outcome in 196 outpatients aged 40 years and older who were diagnosed with schizophrenia.

Method: Participants reported their past and current mobile phone use on a standardized self-report scale and they were administered tests of global cognition, functional capacity, and informant-rated functional outcome.

Results: The great majority of subjects had used a mobile phone (78%) but few currently owned one (27%). After adjusting for age (mean age 51), any past mobile phone use was associated with less severe negative symptoms, and higher global cognitive performance, functional capacity, and functional outcome. A total of 60% of participants reported being comfortable with mobile phones, but comfort was not associated with any cognitive or functional outcomes.

Conclusion: Most of the older patients with schizophrenia have used mobile phones and lifetime mobile phone use is a positive indicator of cognitive and functional status.     

Long-term predictors of loneliness in old age: results of a 20-year national study

Objectives: The understanding of social phenomena is enhanced if individuals can be studied over longer periods. Regarding loneliness in old age, there is a general lack of longitudinal research. The aim of this study was to examine whether there is an association between loneliness in old age and social engagement 20 years earlier, as stated by life course theory and the convoy model.

Method: Data from the nationally representative Swedish Panel Study of Living Conditions of the Oldest Old (2002 and 2011 data collection waves) and the Swedish Level of Living Survey (1981 and 1991 data collection waves) were used. The sample included 823 individuals with an average age of 62.2 years at baseline and 82.4 years at follow-up.

Results: Each form of social engagement in old age was significantly associated with the same form of social engagement 20 years earlier. Close forms of social engagement were associated with loneliness in old age; as were more distant forms of social engagement, but only when they were considered solely in old age.

Conclusion: Patterns of social engagement in old age were established at least 20 years earlier and close forms of social engagement are long-term predictors of loneliness, although current social engagement tended to be more influential on loneliness. The study underlines the importance of interventions targeted at close relationships that can provide social support in old age.     

The impacts of community social capital on the life satisfaction of older adults in Hong Kong: the moderator role of intergenerational family capital

Objective: This study examined the moderator role of intergenerational family capital on the relationship between community social capital and life satisfaction of older Chinese adults.

Method: The data were derived from a quota sampling of 372 older adults aged 60 and above, who were interviewed at four districts in Hong Kong in 2011. Multiple group analysis was employed to examine the proposed model.

Results: For the low family capital group, community social capital was found to be a significant predictor of life satisfaction, even when the well-known covariates were controlled. However, the association between community social capital and life satisfaction was statistically non-significant among the high family capital group.

Discussion: The findings highlighted the interplay between community social capital and intergenerational family capital, which supported community social capital replacement theory in understanding the mechanism linking social capital to life satisfaction in older age in a Chinese context. Community social capital can play a compensatory role in maintaining the mental health of older people. It is particularly important for older adults who lack family support and/or suffer from social isolation and loneliness in local communities.     

Death ideation in older adults: psychological symptoms of depression,thwarted belongingness,and perceived burdensomeness

Death ideation is commonly reported by older adults in the United States; however, the factors contributing to death ideation in older adults are not fully understood. Depressive symptoms, as well as components of the interpersonal theory of suicide, perceived burden, and thwarted belonging may contribute to death ideation.

Objectives: The purpose of this study was to investigate the moderating relationship of the psychological symptoms of depression on the relation between perceived burdensomeness and death ideation, and thwarted belongingness and death ideation.

Method: A sample of 151 older adults completed questionnaires assessing numerous covariates, as well as perceived burdensomeness, thwarted belongingness, death ideation, and the psychological symptoms of depression.

Results: The results of this study indicated that the proposed moderating relationship was supported for the relationship between perceived burdensomeness and death ideation, but was not supported for the relationship between thwarted belongingness and death ideation when covariates (loneliness and hopelessness) were controlled.

Conclusion: This suggests that the psychological symptoms of depression are significantly associated with death ideation in older adults experiencing feelings of perceived burdensomeness. Additionally, the findings suggest that loneliness and hopelessness are also important factors to consider when assessing death ideation in older adults.     

Association between depressive symptoms and age,sex, loneliness and treatment among older people in Sweden

Objectives: The objective of this study was to examine the prevalence of and the association between depressive symptoms and loneliness in relation to age and sex among older people (65–80 years) and to investigate to what extent those who report depressive symptoms had visited a health care professional and/or used antidepressant medication.

Method: A cross-sectional study was conducted in a Swedish sample randomized from the total population in the age group 65–80 years (n = 6659). Chi square tests and logistic regression analyses were conducted.

Results: The data showed that 9.8% (n = 653) reported depressive symptoms and 27.5% reported feelings of loneliness. More men than women reported depressive symptoms, and the largest proportion was found among men in the age group 75–80 years. An association between the odds to have a depressive disorder and loneliness was found which, however, decreased with increasing age. Of those with depressive symptoms a low proportion had visited a psychologist (2.9%) or a welfare officer (4.2%), and one in four reported that they use antidepressant medication. Of those who reported depressive symptoms, 29% considered that they had needed medical care during the last three months but had refrained from seeking, and the most common reason for that was negative experience from previous visits.

Conclusion: Contrary to findings in most of the studies, depressive symptoms were not more prevalent among women. The result highlights the importance of detecting depressive symptoms and loneliness in older people and to offer adequate treatment in order to increase their well-being.     

Risk factors and mediating pathways of loneliness and social support in community-dwelling older adults

Objectives: To develop biopsychosocial models of loneliness and social support thereby identifying their key risk factors in an Irish sample of community-dwelling older adults. Additionally, to investigate indirect effects of social support on loneliness through mediating risk factors.

Methods: A total of 579 participants (400 females; 179 males) were given a battery of biopsychosocial assessments with the primary measures being the De Jong Gierveld Loneliness Scale and the Lubben Social Network Scale along with a broad range of secondary measures.

Analysis: Bivariate correlation analyses identified items to be included in separate psychosocial, cognitive, biological and demographic multiple regression analyses. The resulting model items were then entered into further multiple regression analyses to obtain overall models. Following this, bootstrapping mediation analyses was conducted to examine indirect effects of social support on the subtypes (emotional and social) of loneliness.

Results: The overall model for (1) emotional loneliness included depression, neuroticism, perceived stress, living alone and accommodation type, (2) social loneliness included neuroticism, perceived stress, animal naming and number of grandchildren and (3) social support included extraversion, executive functioning (Trail Making Test B-time), history of falls, age and whether the participant drives or not. Social support influenced emotional loneliness predominantly through indirect means, while its effect on social loneliness was more direct.

Conclusions: These results characterise the biopsychosocial risk factors of emotional loneliness, social loneliness and social support and identify key pathways by which social support influences emotional and social loneliness. These findings highlight issues with the potential for consideration in the development of targeted interventions.     

Executive functioning independently predicts self-rated health and improvement in self-rated health over time among community-dwelling older adults

Objectives: Self-rated health, as distinct from objective measures of health, is a clinically informative metric among older adults. The purpose of our study was to examine the cognitive and psychosocial factors associated with self-rated health.

Methods: 624 participants over the age of 60 were assessed at baseline, and of these, 510 were contacted for a follow-up two years later. Measures of executive function and self-rated health were assessed at baseline, and self-rated health was assessed at follow-up. We employed multiple linear regression analyses to investigate the relationship between executive functioning and self-rated health, while controlling for demographic, psychosocial and biological variables.

Results: Controlling for other relevant variables, executive functioning independently and solely predicted self-rated health, both at a cross-sectional level, and also over time. Loneliness was also found to cross-sectionally predict self-rated health, although this relationship was not present at a longitudinal level.

Conclusion: Older adults' self-rated health may be related to their executive functioning and to their loneliness. Self-rated health appeared to improve over time, and the extent of this improvement was also related to executive functioning at baseline. Self-rated health may be a judgement made of one's functioning, especially executive functioning, which changes with age and therefore may be particularly salient in the reflections of older adults.